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Illinois General Assembly - Full Text of HB5492

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HB5492 Enrolled
LRB104 18985 BAB 32430 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, 356z.85, and 356z.88
of the
23
Illinois Insurance Code. The program of health benefits must

HB5492 Enrolled
- 2 -
LRB104 18985 BAB 32430 b
1
comply with Sections 155.22a, 155.37, 355b, 356z.19, 370c, and
2
370c.1 and Article XXXIIB of the Illinois Insurance Code. The
3
program of health benefits shall provide the coverage required
4
under Section 356m of the Illinois Insurance Code and, for the
5
employees of the State Employee Group Insurance Program only,
6
the coverage as also provided in Section 6.11B of this Act. The
7
Department of Insurance shall enforce the requirements of this
8
Section with respect to Sections 370c and 370c.1 and Article
9
XXXIIB of the Illinois Insurance Code; all other requirements
10
of this Section shall be enforced by the Department of Central
11
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.)

HB5492 Enrolled
- 3 -
LRB104 18985 BAB 32430 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, 356z.85, and 356z.88
of
17
the Illinois Insurance Code. The program of health benefits
18
must comply with Sections 155.22a, 155.37, 355b, 356z.19,
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

HB5492 Enrolled
- 4 -
LRB104 18985 BAB 32430 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,

HB5492 Enrolled
- 5 -
LRB104 18985 BAB 32430 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, 356z.85, and 356z.88
of the Illinois Insurance Code.
15
The coverage shall comply with Sections 155.22a, 355b,
16
356z.19, 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

HB5492 Enrolled
- 6 -
LRB104 18985 BAB 32430 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,

HB5492 Enrolled
- 7 -
LRB104 18985 BAB 32430 b
1
and
356z.77,
356z.79,

and
356z.80
, 356z.81, 356z.82, 356z.83,
2
356z.84, 356z.85, and 356z.88
of the Illinois Insurance Code.
3
The coverage shall comply with Sections 155.22a, 355b,
4
356z.19, 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.)

HB5492 Enrolled
- 8 -
LRB104 18985 BAB 32430 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,
20
356z.85, and 356z.88
of the Illinois Insurance Code. The
21
coverage shall comply with Sections 155.22a, 355b, 356z.19,
22
and 370c of the Illinois Insurance Code. The Department of
23
Insurance shall enforce the requirements of this Section. The
24
requirement that health benefits be covered as provided in

HB5492 Enrolled
- 9 -
LRB104 18985 BAB 32430 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

HB5492 Enrolled
- 10 -
LRB104 18985 BAB 32430 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,
11
356z.85, and 356z.88
of the Illinois Insurance Code. The
12
coverage shall comply with Sections 155.22a, 355b, 356z.19,
13
370c, and 370c.4 of the Illinois Insurance Code. The
14
Department of Insurance shall enforce the requirements of this
15
Section. The requirement that health benefits be covered as
16
provided in this
Section
is an exclusive power and function of
17
the State and is a denial and limitation under Article VII,
18
Section 6, subsection (h) of the Illinois Constitution. A home
19
rule municipality to which this Section applies must comply
20
with 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.

HB5492 Enrolled
- 11 -
LRB104 18985 BAB 32430 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,

HB5492 Enrolled
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LRB104 18985 BAB 32430 b
1
356z.74,
and
356z.77,
356z.79,

and
356z.80
, 356z.81, 356z.82,
2
356z.83, 356z.84, 356z.85, and 356z.88
of the Illinois
3
Insurance Code. Insurance policies shall comply with Section
4
356z.19 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

HB5492 Enrolled
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LRB104 18985 BAB 32430 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, 356z.85, and 356z.88
of the Illinois
12
Insurance Code. Insurance policies shall comply with Section
13
356z.19 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;

HB5492 Enrolled
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LRB104 18985 BAB 32430 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.
Coverage for prescription hormone therapy.
10

(a) For purposes of this Section, "prescription hormone
11
therapy" means all drugs approved by the United States Food
12
and Drug Administration that are used to medically suppress,
13
increase, or replace hormones that the body is not producing
14
at intended levels and the necessary supplies for
15
self-administration. "Prescription hormone therapy" does not
16
include glucagon-like peptide-1 and glucagon-like peptide-1
17
receptor agonists.

18

(b)(1) An individual or group policy of accident and
19
health insurance amended, delivered, issued, or renewed in
20
this State on or after January 1, 2028 shall provide coverage
21
for up to a 6-month supply of prescription hormone therapy,
22
and the necessary supplies for self-administration, that is
23
prescribed by a provider within the provider's scope of
24
practice and dispensed at one time for an enrollee by a

HB5492 Enrolled
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LRB104 18985 BAB 32430 b
1
provider or pharmacist, or at a location licensed or otherwise
2
authorized to dispense drugs or supplies. If the prescription
3
hormone therapy is a controlled substance, the policy shall
4
provide coverage for the maximum supply allowed under State
5
and federal law to be obtained at one time by the insured.
6

(2) Except as otherwise provided in this Code, this
7
Section does not prohibit an individual or group policy of
8
accident and health insurance amended, delivered, issued, or
9
renewed on or after January 1, 2028 from limiting refills that
10
may be obtained in the last quarter of the plan year if a
11
6-month supply of the prescription hormone therapy has already
12
been dispensed during the plan year.
13

(3) This Section does not require a provider to prescribe,
14
furnish, or dispense 6 months of prescription hormone therapy
15
at one time.
16

(4) To the extent not otherwise prohibited under this
17
Section or State or federal law, health plans may apply drug
18
utilization management strategies to prescription drugs
19
covered under paragraph (1) of this subsection.

20

(5) If an individual or group policy of accident and
21
health insurance amended, delivered, issued, or renewed in
22
this State on or after January 1, 2028 delegates
23
responsibilities under this Section to a contracted entity,
24
including a medical group or independent practice association,
25
the delegated entity shall comply with this Section.

26

(c) This Section does not deny or restrict the

HB5492 Enrolled
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LRB104 18985 BAB 32430 b
1
Department's authority to ensure plan compliance when an
2
individual or group policy of accident and health insurance
3
provides coverage for prescription hormone therapy.

4

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

6

(215 ILCS 125/5-3)

(from Ch. 111 1/2, par. 1411.2)
7

Sec. 5-3.
Illinois Insurance Code provisions.
8

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

HB5492 Enrolled
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LRB104 18985 BAB 32430 b
1
356z.83, 356z.84, 356z.85, 356z.88,
364, 364.01, 364.3, 367.2,
2
367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370a, 370c,
3
370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444,
4
and 444.1, paragraph (c) of subsection (2) of Section 367, and
5
Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
6
XXVI, and XXXIIB of the Illinois Insurance Code.
7

(b) For purposes of the Illinois Insurance Code, except
8
for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
9
Health Maintenance Organizations in the following categories
10
are deemed to be "domestic companies":
11

(1) a corporation authorized under the Dental Service
12

Plan Act or the Voluntary Health Services Plans Act;
13

(2) a corporation organized under the laws of this
14

State; or
15

(3) a corporation organized under the laws of another
16

state, 30% or more of the enrollees of which are residents
17

of this State, except a corporation subject to
18

substantially the same requirements in its state of
19

organization as is a "domestic company" under Article VIII
20

1/2 of the Illinois Insurance Code.
21

(c) In considering the merger, consolidation, or other
22
acquisition of control of a Health Maintenance Organization
23
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
24

(1) the Director shall give primary consideration to
25

the continuation of benefits to enrollees and the
26

financial conditions of the acquired Health Maintenance

HB5492 Enrolled
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LRB104 18985 BAB 32430 b
1

Organization after the merger, consolidation, or other
2

acquisition of control takes effect;
3

(2)(i) the criteria specified in subsection (1)(b) of
4

Section 131.8 of the Illinois Insurance Code shall not
5

apply and (ii) the Director, in making his determination
6

with respect to the merger, consolidation, or other
7

acquisition of control, need not take into account the
8

effect on competition of the merger, consolidation, or
9

other acquisition of control;
10

(3) the Director shall have the power to require the
11

following information:
12

(A) certification by an independent actuary of the
13

adequacy of the reserves of the Health Maintenance
14

Organization sought to be acquired;
15

(B) pro forma financial statements reflecting the
16

combined balance sheets of the acquiring company and
17

the Health Maintenance Organization sought to be
18

acquired as of the end of the preceding year and as of
19

a date 90 days prior to the acquisition, as well as pro
20

forma financial statements reflecting projected
21

combined operation for a period of 2 years;
22

(C) a pro forma business plan detailing an
23

acquiring party's plans with respect to the operation
24

of the Health Maintenance Organization sought to be
25

acquired for a period of not less than 3 years; and
26

(D) such other information as the Director shall

HB5492 Enrolled
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LRB104 18985 BAB 32430 b
1

require.
2

(d) The provisions of Article VIII 1/2 of the Illinois
3
Insurance Code and this Section 5-3 shall apply to the sale by
4
any health maintenance organization of greater than 10% of its
5
enrollee population (including, without limitation, the health
6
maintenance organization's right, title, and interest in and
7
to its health care certificates).
8

(e) In considering any management contract or service
9
agreement subject to Section 141.1 of the Illinois Insurance
10
Code, the Director (i) shall, in addition to the criteria
11
specified in Section 141.2 of the Illinois Insurance Code,
12
take into account the effect of the management contract or
13
service agreement on the continuation of benefits to enrollees
14
and the financial condition of the health maintenance
15
organization to be managed or serviced, and (ii) need not take
16
into account the effect of the management contract or service
17
agreement on competition.
18

(f) Except for small employer groups as defined in the
19
Small Employer Rating, Renewability and Portability Health
20
Insurance Act and except for medicare supplement policies as
21
defined in Section 363 of the Illinois Insurance Code, a
22
Health Maintenance Organization may by contract agree with a
23
group or other enrollment unit to effect refunds or charge
24
additional premiums under the following terms and conditions:
25

(i) the amount of, and other terms and conditions with
26

respect to, the refund or additional premium are set forth

HB5492 Enrolled
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LRB104 18985 BAB 32430 b
1

in the group or enrollment unit contract agreed in advance
2

of the period for which a refund is to be paid or
3

additional premium is to be charged (which period shall
4

not be less than one year); and
5

(ii) the amount of the refund or additional premium
6

shall not exceed 20% of the Health Maintenance
7

Organization's profitable or unprofitable experience with
8

respect to the group or other enrollment unit for the
9

period (and, for purposes of a refund or additional
10

premium, the profitable or unprofitable experience shall
11

be calculated taking into account a pro rata share of the
12

Health Maintenance Organization's administrative and
13

marketing expenses, but shall not include any refund to be
14

made or additional premium to be paid pursuant to this
15

subsection (f)). The Health Maintenance Organization and
16

the group or enrollment unit may agree that the profitable
17

or unprofitable experience may be calculated taking into
18

account the refund period and the immediately preceding 2
19

plan years.
20

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

HB5492 Enrolled
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LRB104 18985 BAB 32430 b
1
unit and the resulting refund to the group or enrollment unit
2
or (2) the Health Maintenance Organization's unprofitable
3
experience with respect to the group or enrollment unit and
4
the resulting additional premium to be paid by the group or
5
enrollment unit.
6

In no event shall the Illinois Health Maintenance
7
Organization Guaranty Association be liable to pay any
8
contractual obligation of an insolvent organization to pay any
9
refund authorized under this Section.
10

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

HB5492 Enrolled
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LRB104 18985 BAB 32430 b
1
104-324, eff. 1-1-26; 104-334, eff. 8-15-25; 104-379, eff.
2
1-1-26; 104-417, eff. 8-15-25; revised 11-21-25.)

3

Section 35.
The Limited Health Service Organization Act is
4
amended by changing Section 4003 as follows:

5

(215 ILCS 130/4003)

(from Ch. 73, par. 1504-3)
6

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

HB5492 Enrolled
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LRB104 18985 BAB 32430 b
1
domestic companies:
2

(1) a corporation under the laws of this State; or
3

(2) a corporation organized under the laws of another
4

state, 30% or more of the enrollees of which are residents
5

of this State, except a corporation subject to
6

substantially the same requirements in its state of
7

organization as is a domestic company under Article VIII
8

1/2 of the Illinois Insurance Code.
9
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
10
103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, eff.
11
1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25; 103-656,
12
eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24;
13
103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff.
14
1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-42,
15
eff. 8-1-25; 104-73, eff. 1-1-26; 104-98, eff. 1-1-26;
16
104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-334, eff.
17
8-15-25; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25; revised
18
11-21-25.)

19

Section 40.
The Voluntary Health Services Plans Act is
20
amended by changing Section 10 as follows:

21

(215 ILCS 165/10)

(from Ch. 32, par. 604)
22

Sec. 10.
Application of Illinois Insurance Code
23
provisions.
Health services plan corporations and all persons
24
interested therein or dealing therewith shall be subject to

HB5492 Enrolled
- 24 -
LRB104 18985 BAB 32430 b
1
the provisions of Articles IIA and XII 1/2 and Sections 3.1,
2
133, 136, 139, 140, 143, 143.31, 143c, 149, 155.22a, 155.37,
3
354, 355.2, 355.3, 355.7, 355b, 355d, 356g, 356g.5, 356g.5-1,
4
356m, 356q, 356r, 356t, 356u, 356u.10, 356v, 356w, 356x, 356y,
5
356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
6
356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
7
356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26,
8
356z.29, 356z.30, 356z.32, 356z.32a, 356z.33, 356z.40,
9
356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.56,
10
356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.67,
11
356z.68, 356z.71, 356z.72, 356z.74, 356z.75, 356z.77,
356z.79,

12
356z.80,
356z.81, 356z.83, 356z.84, 356z.85, 356z.88,
364.01,
13
364.3, 367.2, 368a, 370a, 401, 401.1, 402, 403, 403A, 408,
14
408.2, and 412, and paragraphs (7) and (15) of Section 367 of
15
the Illinois Insurance Code.
16

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

HB5492 Enrolled
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LRB104 18985 BAB 32430 b
1
1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1,
2
eff. 6-9-25; 104-28, eff. 1-1-26; 104-42, eff. 8-1-25; 104-73,
3
eff. 1-1-26; 104-98, eff. 1-1-26; 104-289, eff. 1-1-26;
4
104-324, eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff.
5
8-15-25; revised 11-21-25.)

6

Section 45.
The Illinois Public Aid Code is amended by
7
changing Section 5-16.8 as follows:

8

(305 ILCS 5/5-16.8)
9

Sec. 5-16.8.
Required health benefits.
The medical
10
assistance program shall (i) provide the post-mastectomy care
11
benefits required to be covered by a policy of accident and
12
health insurance under Section 356t and the coverage required
13
under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
14
356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
15
356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64,
16
356z.67, 356z.71,
and
356z.75,
and
356z.80
, 356z.84, 356z.85,
17
and 356z.88
of the Illinois Insurance Code, (ii) be subject to
18
the provisions of Sections 356z.19, 356z.44, 356z.49, 364.01,
19
370c, and 370c.1 of the Illinois Insurance Code, and (iii) be
20
subject to the provisions of subsection (d-5) of Section 10 of
21
the Network Adequacy and Transparency Act.
22

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

HB5492 Enrolled
- 26 -
LRB104 18985 BAB 32430 b
1

On and after July 1, 2012, the Department shall reduce any
2
rate of reimbursement for services or other payments or alter
3
any methodologies authorized by this Code to reduce any rate
4
of reimbursement for services or other payments in accordance
5
with Section 5-5e.
6

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

16

Section 95.
No acceleration or delay.
Where this Act makes
17
changes in a statute that is represented in this Act by text
18
that is not yet or no longer in effect (for example, a Section
19
represented by multiple versions), the use of that text does
20
not accelerate or delay the taking effect of (i) the changes
21
made by this Act or (ii) provisions derived from any other
22
Public Act.

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