INS-CONFIDENTIAL BENEFIT FORMS

Illinois General Assembly - Full Text of HB5481

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB5481

Introduced 2/13/2026, by Rep. Barbara Hernandez

SYNOPSIS AS INTRODUCED:

5 ILCS 375/6.11
55 ILCS 5/5-1069.3
65 ILCS 5/10-4-2.3
105 ILCS 5/10-22.3f
215 ILCS 5/356z.88 new
215 ILCS 125/5-3

from Ch. 111 1/2, par. 1411.2
215 ILCS 130/4003

from Ch. 73, par. 1504-3
215 ILCS 165/10

from Ch. 32, par. 604
305 ILCS 5/5-16.8

Prohibits health insurance issuers from specifying or describing
personal sensitive health care information in any explanation of benefits,
summary of payments, claims history, or any other communication or record
relating to payment or coverage of services or procedures involving
sensitive health care information for an insured member other than the
insured subscriber, unless the insured member receiving the service or
procedure clearly makes a request orally or in writing to not suppress
information relating to sensitive health care. Grants the Department of
Insurance rulemaking authority. Provides that the Department of Insurance,
in collaboration with the Department of Public Health, shall develop and
implement a plan to educate health care providers and consumers regarding
the rights of insured members and the responsibilities of health insurance
issuers to promote compliance with the stated requirements. Amends the
State Employees Group Insurance Act of 1971, the Counties Code, the
Illinois Municipal Code, the School Code, the Health Maintenance
Organization Act, the Limited Health Service Organization Act, the
Voluntary Health Services Plans Act, and the Illinois Public Aid Code to
establish the same requirements in the provisions of those Acts. Effective
one year after becoming law.
LRB104 19193 BAB 32638 b

A BILL FOR

HB5481
LRB104 19193 BAB 32638 b
1

AN ACT concerning regulation.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 5.
The State Employees Group Insurance Act of 1971
5
is amended by changing Section 6.11 as follows:

6

(5 ILCS 375/6.11)
7

(Text of Section before amendment by P.A. 104-1
)
8

Sec. 6.11.
Required health benefits; Illinois Insurance
9
Code requirements.
The program of health benefits shall
10
provide the post-mastectomy care benefits required to be
11
covered by a policy of accident and health insurance under
12
Section 356t of the Illinois Insurance Code. The program of
13
health benefits shall provide the coverage required under
14
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10,
15
356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
16
356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
17
356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
18
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
19
356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
20
356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70,
21
356z.71, 356z.74, 356z.76,
and
356z.77,
and
356z.80
, 356z.81,
22
356z.82, 356z.83, 356z.84, and 356z.85
of the Illinois
23
Insurance Code. The program of health benefits must comply

HB5481
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LRB104 19193 BAB 32638 b
1
with Sections 155.22a, 155.37, 355b, 356z.19,
356z.88,
370c,
2
and 370c.1 and Article XXXIIB of the Illinois Insurance Code.
3
The program of health benefits shall provide the coverage
4
required under Section 356m of the Illinois Insurance Code
5
and, for the employees of the State Employee Group Insurance
6
Program only, the coverage as also provided in Section 6.11B
7
of this Act. The Department of Insurance shall enforce the
8
requirements of this Section with respect to Sections 370c and
9
370c.1 and Article XXXIIB of the Illinois Insurance Code; all
10
other requirements of this Section shall be enforced by the
11
Department of Central Management Services.
12

Rulemaking authority to implement Public Act 95-1045, if
13
any, is conditioned on the rules being adopted in accordance
14
with all provisions of the Illinois Administrative Procedure
15
Act and all rules and procedures of the Joint Committee on
16
Administrative Rules; any purported rule not so adopted, for
17
whatever reason, is unauthorized.
18
(Source: P.A. 103-8, eff. 1-1-24; 103-84, eff. 1-1-24; 103-91,
19
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
20
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
21
7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-870,
22
eff. 1-1-25; 103-914, eff. 1-1-25; 103-918, eff. 1-1-25;
23
103-951, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-27, eff.
24
1-1-26, 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
25
1-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,
26
eff. 1-1-26; 104-417, eff. 8-15-25; revised 11-19-25.)

HB5481
- 3 -
LRB104 19193 BAB 32638 b
1

(Text of Section after amendment by P.A. 104-1
)
2

Sec. 6.11.
Required health benefits; Illinois Insurance
3
Code requirements.
The program of health benefits shall
4
provide the post-mastectomy care benefits required to be
5
covered by a policy of accident and health insurance under
6
Section 356t of the Illinois Insurance Code. The program of
7
health benefits shall provide the coverage required under
8
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10,
9
356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
10
356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
11
356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
12
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
13
356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
14
356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70,
15
356z.71, 356z.74, 356z.76,
and
356z.77,
356z.79,

and
356z.80
,
16
356z.81, 356z.82, 356z.83, 356z.84, and 356z.85
of the
17
Illinois Insurance Code. The program of health benefits must
18
comply with Sections 155.22a, 155.37, 355b, 356z.19,
356z.88,

19
370c, and 370c.1 and Article XXXIIB of the Illinois Insurance
20
Code. The program of health benefits shall provide the
21
coverage required under Section 356m of the Illinois Insurance
22
Code and, for the employees of the State Employee Group
23
Insurance Program only, the coverage as also provided in
24
Section 6.11B of this Act. The Department of Insurance shall
25
enforce the requirements of this Section with respect to

HB5481
- 4 -
LRB104 19193 BAB 32638 b
1
Sections 370c and 370c.1 and Article XXXIIB of the Illinois
2
Insurance Code; all other requirements of this Section shall
3
be enforced by the Department of Central Management Services.
4

Rulemaking authority to implement Public Act 95-1045, if
5
any, is conditioned on the rules being adopted in accordance
6
with all provisions of the Illinois Administrative Procedure
7
Act and all rules and procedures of the Joint Committee on
8
Administrative Rules; any purported rule not so adopted, for
9
whatever reason, is unauthorized.
10
(Source: P.A. 103-8, eff. 1-1-24; 103-84, eff. 1-1-24; 103-91,
11
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
12
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
13
7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-870,
14
eff. 1-1-25; 103-914, eff. 1-1-25; 103-918, eff. 1-1-25;
15
103-951, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
16
7-1-27; 104-27, eff. 1-1-26, 104-42, eff. 8-1-25; 104-68, eff.
17
1-1-26; 104-73, eff. 1-1-26; 104-289, eff. 1-1-26; 104-324,
18
eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25;
19
revised 11-19-25.)

20

Section 10.
The Counties Code is amended by changing
21
Section 5-1069.3 as follows:

22

(55 ILCS 5/5-1069.3)
23

(Text of Section before amendment by P.A. 104-446
)
24

Sec. 5-1069.3.
Required health benefits.
If a county,

HB5481
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LRB104 19193 BAB 32638 b
1
including a home rule county, is a self-insurer for purposes
2
of providing health insurance coverage for its employees, the
3
coverage shall include coverage for the post-mastectomy care
4
benefits required to be covered by a policy of accident and
5
health insurance under Section 356t and the coverage required
6
under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
7
356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
8
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
9
356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36,
10
356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
11
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
12
356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71, 356z.74,
13
and
356z.77,
356z.79,

and
356z.80
, 356z.81, 356z.82, 356z.83,
14
356z.84, and 356z.85
of the Illinois Insurance Code. The
15
coverage shall comply with Sections 155.22a, 355b, 356z.19,
16
356z.88,
and 370c of the Illinois Insurance Code. The
17
Department of Insurance shall enforce the requirements of this
18
Section. The requirement that health benefits be covered as
19
provided in this Section is an exclusive power and function of
20
the State and is a denial and limitation under Article VII,
21
Section 6, subsection (h) of the Illinois Constitution. A home
22
rule county to which this Section applies must comply with
23
every provision of this Section.
24

Rulemaking authority to implement Public Act 95-1045, if
25
any, is conditioned on the rules being adopted in accordance
26
with all provisions of the Illinois Administrative Procedure

HB5481
- 6 -
LRB104 19193 BAB 32638 b
1
Act and all rules and procedures of the Joint Committee on
2
Administrative Rules; any purported rule not so adopted, for
3
whatever reason, is unauthorized.
4
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
5
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
6
8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
7
eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
8
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
9
6-9-25; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
10
1-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,
11
eff. 1-1-26; 104-417, eff. 8-15-25; revised 1-7-26.)

12

(Text of Section after amendment by P.A. 104-446
)
13

Sec. 5-1069.3.
Required health benefits.
If a county,
14
including a home rule county, is a self-insurer for purposes
15
of providing health insurance coverage for its employees, the
16
coverage shall include coverage for the post-mastectomy care
17
benefits required to be covered by a policy of accident and
18
health insurance under Section 356t and the coverage required
19
under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
20
356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
21
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
22
356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36,
23
356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
24
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
25
356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71, 356z.74,

HB5481
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LRB104 19193 BAB 32638 b
1
and
356z.77,
356z.79,

and
356z.80
, 356z.81, 356z.82, 356z.83,
2
356z.84, and 356z.85
of the Illinois Insurance Code. The
3
coverage shall comply with Sections 155.22a, 355b, 356z.19,
4
356z.88,
370c, and 370c.4 of the Illinois Insurance Code. The
5
Department of Insurance shall enforce the requirements of this
6
Section. The requirement that health benefits be covered as
7
provided in this Section is an exclusive power and function of
8
the State and is a denial and limitation under Article VII,
9
Section 6, subsection (h) of the Illinois Constitution. A home
10
rule county to which this Section applies must comply with
11
every provision of this Section.
12

Rulemaking authority to implement Public Act 95-1045, if
13
any, is conditioned on the rules being adopted in accordance
14
with all provisions of the Illinois Administrative Procedure
15
Act and all rules and procedures of the Joint Committee on
16
Administrative Rules; any purported rule not so adopted, for
17
whatever reason, is unauthorized.
18
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
19
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
20
8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
21
eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
22
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
23
6-9-25; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
24
1-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,
25
eff. 1-1-26; 104-417, eff. 8-15-25; 104-446, eff. 6-1-26;
26
revised 1-7-26.)

HB5481
- 8 -
LRB104 19193 BAB 32638 b
1

Section 15.
The Illinois Municipal Code is amended by
2
changing Section 10-4-2.3 as follows:

3

(65 ILCS 5/10-4-2.3)
4

(Text of Section before amendment by P.A. 104-446
)
5

Sec. 10-4-2.3.
Required health benefits.
If a
6
municipality, including a home rule municipality, is a
7
self-insurer for purposes of providing health insurance
8
coverage for its employees, the coverage shall include
9
coverage for the post-mastectomy care benefits required to be
10
covered by a policy of accident and health insurance under
11
Section 356t and the coverage required under Sections 356g,
12
356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
13
356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
14
356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
15
356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
16
356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
17
356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
18
356z.67, 356z.68, 356z.70, 356z.71, 356z.74,
and
356z.77,
19
356z.79,

and
356z.80
, 356z.81, 356z.82, 356z.83, 356z.84, and
20
356z.85
of the Illinois Insurance Code. The coverage shall
21
comply with Sections 155.22a, 355b, 356z.19,
356z.88,
and 370c
22
of the Illinois Insurance Code. The Department of Insurance
23
shall enforce the requirements of this Section. The
24
requirement that health benefits be covered as provided in

HB5481
- 9 -
LRB104 19193 BAB 32638 b
1
this
Section
is an exclusive power and function of the State
2
and is a denial and limitation under Article VII, Section 6,
3
subsection (h) of the Illinois Constitution. A home rule
4
municipality to which this Section applies must comply with
5
every provision of this Section.
6

Rulemaking authority to implement Public Act 95-1045, if
7
any, is conditioned on the rules being adopted in accordance
8
with all provisions of the Illinois Administrative Procedure
9
Act and all rules and procedures of the Joint Committee on
10
Administrative Rules; any purported rule not so adopted, for
11
whatever reason, is unauthorized.
12
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
13
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
14
8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
15
eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
16
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
17
6-9-25; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
18
1-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,
19
eff. 1-1-26; 104-417, eff. 8-15-25; revised 1-8-26.)

20

(Text of Section after amendment by P.A. 104-446
)
21

Sec. 10-4-2.3.
Required health benefits.
If a
22
municipality, including a home rule municipality, is a
23
self-insurer for purposes of providing health insurance
24
coverage for its employees, the coverage shall include
25
coverage for the post-mastectomy care benefits required to be

HB5481
- 10 -
LRB104 19193 BAB 32638 b
1
covered by a policy of accident and health insurance under
2
Section 356t and the coverage required under Sections 356g,
3
356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
4
356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
5
356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
6
356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
7
356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
8
356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
9
356z.67, 356z.68, 356z.70, 356z.71, 356z.74,
and
356z.77,
10
356z.79,

and
356z.80
, 356z.81, 356z.82, 356z.83, 356z.84, and
11
356z.85
of the Illinois Insurance Code. The coverage shall
12
comply with Sections 155.22a, 355b, 356z.19,
356z.88,
370c,
13
and 370c.4 of the Illinois Insurance Code. The Department of
14
Insurance shall enforce the requirements of this Section. The
15
requirement that health benefits be covered as provided in
16
this
Section
is an exclusive power and function of the State
17
and is a denial and limitation under Article VII, Section 6,
18
subsection (h) of the Illinois Constitution. A home rule
19
municipality to which this Section applies must comply with
20
every provision of this Section.
21

Rulemaking authority to implement Public Act 95-1045, if
22
any, is conditioned on the rules being adopted in accordance
23
with all provisions of the Illinois Administrative Procedure
24
Act and all rules and procedures of the Joint Committee on
25
Administrative Rules; any purported rule not so adopted, for
26
whatever reason, is unauthorized.

HB5481
- 11 -
LRB104 19193 BAB 32638 b
1
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
2
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
3
8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
4
eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
5
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
6
6-9-25; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
7
1-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,
8
eff. 1-1-26; 104-417, eff. 8-15-25; 104-446, eff. 6-1-26;
9
revised 1-8-26.)

10

Section 20.
The School Code is amended by changing Section
11
10-22.3f as follows:

12

(105 ILCS 5/10-22.3f)
13

(Text of Section before amendment by P.A. 104-446
)
14

Sec. 10-22.3f.
Required health benefits.
Insurance
15
protection and benefits for employees shall provide the
16
post-mastectomy care benefits required to be covered by a
17
policy of accident and health insurance under Section 356t and
18
the coverage required under Sections 356g, 356g.5, 356g.5-1,
19
356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a,
20
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14,
21
356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
22
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
23
356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
24
356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71,

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LRB104 19193 BAB 32638 b
1
356z.74,
and
356z.77,
356z.79,

and
356z.80
, 356z.81, 356z.82,
2
356z.83, 356z.84, and 356z.85
of the Illinois Insurance Code.
3
Insurance policies shall comply with
Sections

Section
356z.19
4
and 356z.88
of the Illinois Insurance Code. The coverage shall
5
comply with Sections 155.22a, 355b, and 370c and Article
6
XXXIIB of the Illinois Insurance Code. The Department of
7
Insurance shall enforce the requirements of this Section.
8

Rulemaking authority to implement Public Act 95-1045, if
9
any, is conditioned on the rules being adopted in accordance
10
with all provisions of the Illinois Administrative Procedure
11
Act and all rules and procedures of the Joint Committee on
12
Administrative Rules; any purported rule not so adopted, for
13
whatever reason, is unauthorized.
14
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
15
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
16
8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
17
eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
18
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
19
6-9-25; 104-27, eff. 1-1-26; 104-42, eff. 8-1-25; 104-68, eff.
20
1-1-26; 104-73, eff. 1-1-26; 104-289, eff. 1-1-26; 104-324,
21
eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25;
22
revised 1-8-26.)

23

(Text of Section after amendment by P.A. 104-446
)
24

Sec. 10-22.3f.
Required health benefits.
Insurance
25
protection and benefits for employees shall provide the

HB5481
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LRB104 19193 BAB 32638 b
1
post-mastectomy care benefits required to be covered by a
2
policy of accident and health insurance under Section 356t and
3
the coverage required under Sections 356g, 356g.5, 356g.5-1,
4
356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a,
5
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14,
6
356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
7
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
8
356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
9
356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71,
10
356z.74,
and
356z.77,
356z.79,

and
356z.80
, 356z.81, 356z.82,
11
356z.83, 356z.84, and 356z.85
of the Illinois Insurance Code.
12
Insurance policies shall comply with
Sections

Section
356z.19
13
and 356z.88
of the Illinois Insurance Code. The coverage shall
14
comply with Sections 155.22a, 355b, 370c, and 370c.4 and
15
Article XXXIIB of the Illinois Insurance Code. The Department
16
of Insurance shall enforce the requirements of this Section.
17

Rulemaking authority to implement Public Act 95-1045, if
18
any, is conditioned on the rules being adopted in accordance
19
with all provisions of the Illinois Administrative Procedure
20
Act and all rules and procedures of the Joint Committee on
21
Administrative Rules; any purported rule not so adopted, for
22
whatever reason, is unauthorized.
23
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
24
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
25
8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
26
eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;

HB5481
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LRB104 19193 BAB 32638 b
1
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
2
6-9-25; 104-27, eff. 1-1-26; 104-42, eff. 8-1-25; 104-68, eff.
3
1-1-26; 104-73, eff. 1-1-26; 104-289, eff. 1-1-26; 104-324,
4
eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25;
5
104-446, eff. 6-1-26; revised 1-8-26.)

6

Section 25.
The Illinois Insurance Code is amended by
7
adding Section 356z.88 as follows:

8

(215 ILCS 5/356z.88 new)
9

Sec. 356z.88.
Confidentiality on explanation of benefit
10
forms.
11

(a) Health insurance issuers shall not specify or describe
12
personal sensitive health care information in any explanation
13
of benefits, summary of payments, claims history, or any other
14
communication or record relating to payment or coverage of
15
services or procedures involving sensitive health care
16
information for an insured member other than the insured
17
subscriber, unless the insured member receiving the service or
18
procedure clearly makes a request orally or in writing to not
19
suppress information relating to sensitive health care.
20

(b) The Department shall define sensitive health care
21
services and information for the purposes of this Section. In
22
determining that definition, the Department shall consider the
23
recommendations of the National Committee on Vital and Health
24
Statistics and similar regulations in other states and shall

HB5481
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1
consult with experts in fields, including, but not limited to,
2
infectious disease, reproductive and sexual health, domestic
3
violence and sexual assault, and mental health and substance
4
use disorders.
5

(c) The Department shall adopt rules necessary to
6
implement and enforce this Section, which shall include
7
requirements for reasonable reporting by health insurance
8
issuers to the division regarding compliance and the number
9
and type of complaints received regarding noncompliance with
10
this Section.
11

(d) The Department of Insurance, in collaboration with the
12
Department of Public Health, shall develop and implement a
13
plan to educate health care providers and consumers regarding
14
the rights of insured members and the responsibilities of
15
health insurance issuers to promote compliance with this
16
Section. The plan shall include, but not be limited to, staff
17
training and other education for hospitals, community health
18
centers, school-based health centers, physicians, nurses,
19
other licensed health care professionals, and administrative
20
staff, including, but not limited to: (i) all staff involved
21
in patient registration and confidentiality education and (ii)
22
billing staff involved in processing insurance claims. The
23
plan shall be developed in consultation with groups
24
representing health care insurers, providers, and consumers,
25
including consumer organizations concerned with the provision
26
of sensitive health care services.

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LRB104 19193 BAB 32638 b
1

(e) Nothing in this Section shall supersede any general or
2
special law related to the informed consent of minors.

3

Section 30.
The Health Maintenance Organization Act is
4
amended by changing Section 5-3 as follows:

5

(215 ILCS 125/5-3)

(from Ch. 111 1/2, par. 1411.2)
6

Sec. 5-3.
Illinois Insurance Code provisions.
7

(a) Health Maintenance Organizations shall be subject to
8
the provisions of Sections 133, 134, 136, 137, 139, 140,
9
141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
10
152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
11
155.49, 352c, 355.2, 355.3, 355.6, 355.7, 355b, 355c, 356f,
12
356g, 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
13
356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
14
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
15
356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
16
356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
17
356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
18
356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,
19
356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
20
356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
21
356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
22
356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,
23
356z.76, 356z.77, 356z.78,
356z.79,
356z.80,
356z.81, 356z.82,
24
356z.83, 356z.84, 356z.85, 356z.88,
364, 364.01, 364.3, 367.2,

HB5481
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1
367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370a, 370c,
2
370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444,
3
and 444.1, paragraph (c) of subsection (2) of Section 367, and
4
Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
5
XXVI, and XXXIIB of the Illinois Insurance Code.
6

(b) For purposes of the Illinois Insurance Code, except
7
for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
8
Health Maintenance Organizations in the following categories
9
are deemed to be "domestic companies":
10

(1) a corporation authorized under the Dental Service
11

Plan Act or the Voluntary Health Services Plans Act;
12

(2) a corporation organized under the laws of this
13

State; or
14

(3) a corporation organized under the laws of another
15

state, 30% or more of the enrollees of which are residents
16

of this State, except a corporation subject to
17

substantially the same requirements in its state of
18

organization as is a "domestic company" under Article VIII
19

1/2 of the Illinois Insurance Code.
20

(c) In considering the merger, consolidation, or other
21
acquisition of control of a Health Maintenance Organization
22
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
23

(1) the Director shall give primary consideration to
24

the continuation of benefits to enrollees and the
25

financial conditions of the acquired Health Maintenance
26

Organization after the merger, consolidation, or other

HB5481
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LRB104 19193 BAB 32638 b
1

acquisition of control takes effect;
2

(2)(i) the criteria specified in subsection (1)(b) of
3

Section 131.8 of the Illinois Insurance Code shall not
4

apply and (ii) the Director, in making his determination
5

with respect to the merger, consolidation, or other
6

acquisition of control, need not take into account the
7

effect on competition of the merger, consolidation, or
8

other acquisition of control;
9

(3) the Director shall have the power to require the
10

following information:
11

(A) certification by an independent actuary of the
12

adequacy of the reserves of the Health Maintenance
13

Organization sought to be acquired;
14

(B) pro forma financial statements reflecting the
15

combined balance sheets of the acquiring company and
16

the Health Maintenance Organization sought to be
17

acquired as of the end of the preceding year and as of
18

a date 90 days prior to the acquisition, as well as pro
19

forma financial statements reflecting projected
20

combined operation for a period of 2 years;
21

(C) a pro forma business plan detailing an
22

acquiring party's plans with respect to the operation
23

of the Health Maintenance Organization sought to be
24

acquired for a period of not less than 3 years; and
25

(D) such other information as the Director shall
26

require.

HB5481
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LRB104 19193 BAB 32638 b
1

(d) The provisions of Article VIII 1/2 of the Illinois
2
Insurance Code and this Section 5-3 shall apply to the sale by
3
any health maintenance organization of greater than 10% of its
4
enrollee population (including, without limitation, the health
5
maintenance organization's right, title, and interest in and
6
to its health care certificates).
7

(e) In considering any management contract or service
8
agreement subject to Section 141.1 of the Illinois Insurance
9
Code, the Director (i) shall, in addition to the criteria
10
specified in Section 141.2 of the Illinois Insurance Code,
11
take into account the effect of the management contract or
12
service agreement on the continuation of benefits to enrollees
13
and the financial condition of the health maintenance
14
organization to be managed or serviced, and (ii) need not take
15
into account the effect of the management contract or service
16
agreement on competition.
17

(f) Except for small employer groups as defined in the
18
Small Employer Rating, Renewability and Portability Health
19
Insurance Act and except for medicare supplement policies as
20
defined in Section 363 of the Illinois Insurance Code, a
21
Health Maintenance Organization may by contract agree with a
22
group or other enrollment unit to effect refunds or charge
23
additional premiums under the following terms and conditions:
24

(i) the amount of, and other terms and conditions with
25

respect to, the refund or additional premium are set forth
26

in the group or enrollment unit contract agreed in advance

HB5481
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LRB104 19193 BAB 32638 b
1

of the period for which a refund is to be paid or
2

additional premium is to be charged (which period shall
3

not be less than one year); and
4

(ii) the amount of the refund or additional premium
5

shall not exceed 20% of the Health Maintenance
6

Organization's profitable or unprofitable experience with
7

respect to the group or other enrollment unit for the
8

period (and, for purposes of a refund or additional
9

premium, the profitable or unprofitable experience shall
10

be calculated taking into account a pro rata share of the
11

Health Maintenance Organization's administrative and
12

marketing expenses, but shall not include any refund to be
13

made or additional premium to be paid pursuant to this
14

subsection (f)). The Health Maintenance Organization and
15

the group or enrollment unit may agree that the profitable
16

or unprofitable experience may be calculated taking into
17

account the refund period and the immediately preceding 2
18

plan years.
19

The Health Maintenance Organization shall include a
20
statement in the evidence of coverage issued to each enrollee
21
describing the possibility of a refund or additional premium,
22
and upon request of any group or enrollment unit, provide to
23
the group or enrollment unit a description of the method used
24
to calculate (1) the Health Maintenance Organization's
25
profitable experience with respect to the group or enrollment
26
unit and the resulting refund to the group or enrollment unit

HB5481
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LRB104 19193 BAB 32638 b
1
or (2) the Health Maintenance Organization's unprofitable
2
experience with respect to the group or enrollment unit and
3
the resulting additional premium to be paid by the group or
4
enrollment unit.
5

In no event shall the Illinois Health Maintenance
6
Organization Guaranty Association be liable to pay any
7
contractual obligation of an insolvent organization to pay any
8
refund authorized under this Section.
9

(g) Rulemaking authority to implement Public Act 95-1045,
10
if any, is conditioned on the rules being adopted in
11
accordance with all provisions of the Illinois Administrative
12
Procedure Act and all rules and procedures of the Joint
13
Committee on Administrative Rules; any purported rule not so
14
adopted, for whatever reason, is unauthorized.
15
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
16
103-123, eff. 1-1-24; 103-154, eff. 6-30-23; 103-420, eff.
17
1-1-24; 103-426, eff. 8-4-23; 103-445, eff. 1-1-24; 103-551,
18
eff. 8-11-23; 103-605, eff. 7-1-24; 103-618, eff. 1-1-25;
19
103-649, eff. 1-1-25; 103-656, eff. 1-1-25; 103-700, eff.
20
1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
21
eff. 8-2-24; 103-758, eff. 1-1-25; 103-777, eff. 8-2-24;
22
103-808, eff. 1-1-26; 103-914, eff. 1-1-25; 103-918, eff.
23
1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-28,
24
eff. 1-1-26; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73,
25
eff. 1-1-26; 104-98, eff. 1-1-26; 104-289, eff. 1-1-26;
26
104-324, eff. 1-1-26; 104-334, eff. 8-15-25; 104-379, eff.

HB5481
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LRB104 19193 BAB 32638 b
1
1-1-26; 104-417, eff. 8-15-25; revised 11-21-25.)

2

Section 35.
The Limited Health Service Organization Act is
3
amended by changing Section 4003 as follows:

4

(215 ILCS 130/4003)

(from Ch. 73, par. 1504-3)
5

Sec. 4003.
Illinois Insurance Code provisions.
Limited
6
health service organizations shall be subject to the
7
provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
8
141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
9
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
10
355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
11
356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
12
356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
13
356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
14
356z.73, 356z.74, 356z.75, 356z.79, 356z.80,
356z.81, 356z.83,
15
356z.84, 356z.85, 356z.88,
364.3, 368a, 370a, 401, 401.1, 402,
16
403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles
17
IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
18
XXXIIB of the Illinois Insurance Code. Nothing in this Section
19
shall require a limited health care plan to cover any service
20
that is not a limited health service. For purposes of the
21
Illinois Insurance Code, except for Sections 444 and 444.1 and
22
Articles XIII and XIII 1/2, limited health service
23
organizations in the following categories are deemed to be
24
domestic companies:

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LRB104 19193 BAB 32638 b
1

(1) a corporation under the laws of this State; or
2

(2) a corporation organized under the laws of another
3

state, 30% or more of the enrollees of which are residents
4

of this State, except a corporation subject to
5

substantially the same requirements in its state of
6

organization as is a domestic company under Article VIII
7

1/2 of the Illinois Insurance Code.
8
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
9
103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, eff.
10
1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25; 103-656,
11
eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24;
12
103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff.
13
1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-42,
14
eff. 8-1-25; 104-73, eff. 1-1-26; 104-98, eff. 1-1-26;
15
104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-334, eff.
16
8-15-25; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25; revised
17
11-21-25.)

18

Section 40.
The Voluntary Health Services Plans Act is
19
amended by changing Section 10 as follows:

20

(215 ILCS 165/10)

(from Ch. 32, par. 604)
21

Sec. 10.
Application of Illinois Insurance Code
22
provisions.
Health services plan corporations and all persons
23
interested therein or dealing therewith shall be subject to
24
the provisions of Articles IIA and XII 1/2 and Sections 3.1,

HB5481
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LRB104 19193 BAB 32638 b
1
133, 136, 139, 140, 143, 143.31, 143c, 149, 155.22a, 155.37,
2
354, 355.2, 355.3, 355.7, 355b, 355d, 356g, 356g.5, 356g.5-1,
3
356m, 356q, 356r, 356t, 356u, 356u.10, 356v, 356w, 356x, 356y,
4
356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
5
356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
6
356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26,
7
356z.29, 356z.30, 356z.32, 356z.32a, 356z.33, 356z.40,
8
356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.56,
9
356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.67,
10
356z.68, 356z.71, 356z.72, 356z.74, 356z.75, 356z.77,
356z.79,

11
356z.80,
356z.81, 356z.83, 356z.84, 356z.85, 356z.88,
364.01,
12
364.3, 367.2, 368a, 370a, 401, 401.1, 402, 403, 403A, 408,
13
408.2, and 412, and paragraphs (7) and (15) of Section 367 of
14
the Illinois Insurance Code.
15

Rulemaking authority to implement Public Act 95-1045, if
16
any, is conditioned on the rules being adopted in accordance
17
with all provisions of the Illinois Administrative Procedure
18
Act and all rules and procedures of the Joint Committee on
19
Administrative Rules; any purported rule not so adopted, for
20
whatever reason, is unauthorized.
21
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
22
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-551, eff.
23
8-11-23; 103-605, eff. 7-1-24; 103-656, eff. 1-1-25; 103-718,
24
eff. 7-19-24; 103-751, eff. 8-2-24; 103-753, eff. 8-2-24;
25
103-758, eff. 1-1-25; 103-832, eff. 1-1-25; 103-914, eff.
26
1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1,

HB5481
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LRB104 19193 BAB 32638 b
1
eff. 6-9-25; 104-28, eff. 1-1-26; 104-42, eff. 8-1-25; 104-73,
2
eff. 1-1-26; 104-98, eff. 1-1-26; 104-289, eff. 1-1-26;
3
104-324, eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff.
4
8-15-25; revised 11-21-25.)

5

Section 45.
The Illinois Public Aid Code is amended by
6
changing Section 5-16.8 as follows:

7

(305 ILCS 5/5-16.8)
8

Sec. 5-16.8.
Required health benefits.
The medical
9
assistance program shall (i) provide the post-mastectomy care
10
benefits required to be covered by a policy of accident and
11
health insurance under Section 356t and the coverage required
12
under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
13
356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
14
356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64,
15
356z.67, 356z.71,
and
356z.75,
and
356z.80
, 356z.84, and
16
356z.85
of the Illinois Insurance Code, (ii) be subject to the
17
provisions of Sections 356z.19, 356z.44, 356z.49,
356z.88,

18
364.01, 370c, and 370c.1 of the Illinois Insurance Code, and
19
(iii) be subject to the provisions of subsection (d-5) of
20
Section 10 of the Network Adequacy and Transparency Act.
21

The Department, by rule, shall adopt a model similar to
22
the requirements of Section 356z.39 of the Illinois Insurance
23
Code.
24

On and after July 1, 2012, the Department shall reduce any

HB5481
- 26 -
LRB104 19193 BAB 32638 b
1
rate of reimbursement for services or other payments or alter
2
any methodologies authorized by this Code to reduce any rate
3
of reimbursement for services or other payments in accordance
4
with Section 5-5e.
5

To ensure full access to the benefits set forth in this
6
Section, on and after January 1, 2016, the Department shall
7
ensure that provider and hospital reimbursement for
8
post-mastectomy care benefits required under this Section are
9
no lower than the Medicare reimbursement rate.
10
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
11
103-420, eff. 1-1-24; 103-605, eff. 7-1-24; 103-703, eff.
12
1-1-25; 103-758, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-73,
13
eff. 1-1-26; 104-324, eff. 1-1-26; 104-379, eff. 1-1-26;
14
104-417, eff. 8-15-25; revised 11-21-25.)

15

Section 95.
No acceleration or delay.
Where this Act makes
16
changes in a statute that is represented in this Act by text
17
that is not yet or no longer in effect (for example, a Section
18
represented by multiple versions), the use of that text does
19
not accelerate or delay the taking effect of (i) the changes
20
made by this Act or (ii) provisions derived from any other
21
Public Act.

22

Section 99.
Effective date.
This Act takes effect one year
23
after becoming law.

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