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SB2838 - 104th General Assembly

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Senate Amendment 001

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SB2838 Enrolled
LRB104 17737 BAB 31168 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 Illinois Insurance Code is amended by
5
adding Sections 356z.88, 370u, and 511.119 as follows:

6

(215 ILCS 5/356z.88 new)
7

Sec. 356z.88.
Hearing care plans and discounted hearing
8
care plans.
9

(a) Definitions. In this Section:
10

"Administrator" means any administrator as defined in
11
Section 370g or 511.101 of this Code.
12

"Cost sharing" has the meaning given to that term in
13
Section 356z.3a of this Code.
14

"Covered items" means items for which reimbursement or
15
capitation from an enrollee's hearing care plan is provided to
16
a hearing instrument professional or for which a reimbursement
17
or discount is provided to an enrollee under a hearing care
18
plan or discounted hearing care plan.
19

"Covered items" includes, but is not limited to,
20
prescription hearing aids, earmolds, domes or inserts,
21
assistive listening devices, and hearing aid supplies and
22
accessories. "Covered items" does not include over-the-counter
23
hearing aids as defined in 21 CFR 800.30(b).

SB2838 Enrolled
- 2 -
LRB104 17737 BAB 31168 b
1

"Covered services" means services for which reimbursement
2
or capitation from an enrollee's hearing care plan is provided
3
to a hearing instrument professional or for which a
4
reimbursement or discount is provided to an enrollee under a
5
hearing care plan or discounted hearing care plan.
6

"Discount hearing care benefit" means a hearing care
7
benefit that is offered in a discounted hearing care plan.
8

"Discounted hearing care plan" means a discounted health
9
care services plan, as defined in 50 Ill. Adm. Code 2051.220,
10
that provides discounts for covered items or services.
11

"Enrollee" means any individual enrolled in a hearing care
12
plan or a beneficiary of a discounted hearing care plan.
13

"Excepted benefits" has the meaning given to that term in
14
42 U.S.C. 300gg-91(c) and federal regulations thereunder.
15

"Funded hearing care benefit" means hearing care benefits
16
that are offered in the enrollee's hearing care plan contract.
17

"Health insurance coverage" has the meaning given to that
18
term in Section 5 of the Illinois Health Insurance Portability
19
and Accountability Act.
20

"Health insurance issuer" has the meaning given to that
21
term in Section 5 of the Illinois Health Insurance Portability
22
and Accountability Act.
23

"Hearing care benefits" means the covered items or covered
24
services listed or otherwise covered in the contract or plan
25
documents for an enrollee's hearing care plan or discounted
26
hearing care plan.

SB2838 Enrolled
- 3 -
LRB104 17737 BAB 31168 b
1

"Hearing care organization" means a health insurance
2
issuer or administrator formed under the laws of this State or
3
another state that issues or administers a hearing care plan
4
or discounted hearing care plan.
5

"Hearing care plan" means any policy, certificate,
6
contract, or other plan of health insurance coverage, whether
7
excepted benefits or any other coverage, that provides
8
coverage for covered items and covered services.
9

"Hearing instrument professional" means a person who is
10
licensed in this State as an audiologist, a hearing instrument
11
dispenser, or a physician.
12

"Manufacturer" means the legal person, including any
13
business entity or other form of organization, that
14
manufactures and distributes hearing aids, earmolds, domes or
15
inserts, assistive listening devices, and hearing aid supplies
16
and accessories.
17

"Noncovered items and services" means items and services
18
that are not funded or discounted by the enrollee's hearing
19
care plan or discounted hearing care plan and where the
20
enrollee is fully responsible for the cost of the item or
21
service.
22

"Prescription hearing aid" means any instrument or device,
23
including an instrument or device dispensed pursuant to a
24
prescription or order, that is designed, intended, or offered
25
for the purpose of improving a person's hearing and any parts,
26
attachments, or accessories, including earmolds.

SB2838 Enrolled
- 4 -
LRB104 17737 BAB 31168 b
1

"Prescription hearing aid" does not include batteries,
2
cords, and individual or group auditory training devices and
3
any instrument or device used by a public utility in providing
4
telephone or other communication services.
5

"Routine hearing care services" means services that lack
6
medical necessity, such as pass or fail hearing screenings,
7
that are used to determine the need for additional diagnostic
8
hearing testing.
9

"Subcontractor" means any company, group, or third-party
10
entity, including agents, servants, partially owned or wholly
11
owned subsidiaries, and controlled organizations, that the
12
hearing care organization contracts with to supply items or
13
service for a hearing instrument professional or enrollee to
14
fulfill the benefit plan of a hearing care plan or discounted
15
hearing care plan.

16

(b) No hearing care organization that is an issuer or
17
administrator of a hearing care plan or discounted hearing
18
care plan issued, delivered, amended, or renewed on or after
19
the effective date of this amendatory Act of the 104th General
20
Assembly shall issue or renew a contract that requires a
21
hearing instrument professional, as a condition of
22
participation in the hearing care plan or discounted hearing
23
care plan, to provide items or services to an enrollee at a fee
24
set by the hearing care plan or discounted hearing care plan
25
unless the items and services are covered items or covered
26
services under the hearing care plan or discounted hearing

SB2838 Enrolled
- 5 -
LRB104 17737 BAB 31168 b
1
care plan.
2

(c) A hearing instrument professional who chooses not to
3
accept as payment an amount set by a hearing care plan or
4
discounted hearing care plan for items and services that are
5
not covered by the hearing care plan or discounted hearing
6
care plan shall:
7

(1) post, in a conspicuous place, a notice stating the
8

following: "IMPORTANT: This hearing instrument
9

professional does not accept the fee schedule set by your
10

hearing care plan for hearing care items and services that
11

are not covered benefits under your plan, when the item or
12

service is provided prior to the hearing aid fitting,
13

after one year following the initial fitting of the
14

hearing aids, or after all of the allowed service visits
15

are exhausted. In these cases, the hearing instrument
16

professional may charge his or her usual and customary
17

fees for those items and services. This hearing instrument
18

professional will provide you with an estimated cost for
19

each noncovered item or service in accordance with the No
20

Surprises Act."; or
21

(2) provide the information required under paragraph
22

(1) in a document provided by the hearing instrument
23

professional to the patient.
24

(d) Hearing care benefits must be communicated in writing
25
by the hearing care organization to an enrollee, prospective
26
enrollee, and the hearing instrument professional. Covered

SB2838 Enrolled
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LRB104 17737 BAB 31168 b
1
items and services subject to de minimis reimbursement are not
2
required to be listed in this communication. Noncovered items
3
and noncovered services must be identified in the hearing care
4
plan's marketing materials, contract, and plan documents.
5

(e) No hearing care organization or its officers,
6
directors, agents, and employees may represent a discount
7
hearing care benefit as a funded hearing care benefit. A
8
hearing care organization must clearly list and document, in
9
the schedule of benefits and in marketing materials and plan
10
documents, the specific cost sharing amounts to hearing care
11
benefits provided by both in-network and out-of-network
12
providers of a hearing care plan or, in the case of a
13
discounted hearing care plan, the specific discounted amounts
14
for the discount hearing care benefits provided by preferred
15
providers.
16

(f) A hearing care plan or discounted hearing care plan
17
may provide hearing care benefits that include routine hearing
18
care services and medically necessary diagnostic hearing
19
services in accordance with guidance promulgated by the
20
Centers for Medicare and Medicaid Services. If hearing care
21
benefits or discount hearing care benefits include routine
22
hearing testing for the purpose of fitting or modifying a
23
hearing aid, the hearing instrument professional shall be
24
reimbursed, by the hearing care organization, by the enrollee,
25
or by both, as applicable under the terms of the plan, for the
26
costs of performing the testing regardless of whether the

SB2838 Enrolled
- 7 -
LRB104 17737 BAB 31168 b
1
enrollee proceeds with the purchase of a prescription hearing
2
aid.
3

(g) If a hearing care organization is owned or operated,
4
in whole or in part, by a hearing aid manufacturer and that
5
manufacturer offers prescription hearing aids within the
6
hearing care benefits of a hearing care plan or discounted
7
hearing care plan, that hearing care organization must
8
disclose, on its websites for enrollees or potential
9
enrollees, in its marketing communications, and in its
10
benefits or plan documents, its ownership or operational
11
interest and specify which prescription hearing aids are
12
available within the hearing care plan or discounted hearing
13
care plan it issues or administers.
14

(h) The provisions of this Section apply to any
15
subcontractors used by a hearing care organization to supply
16
items or services to a hearing instrument professional.

17

(215 ILCS 5/370u new)
18

Sec. 370u.
Hearing care plans and discounted hearing care
19
plans.
All administrators of hearing care plans or discounted
20
hearing care plans must comply with Section 356z.88 of this
21
Code.

22

(215 ILCS 5/511.119 new)
23

Sec. 511.119.
Hearing care plans.
All administrators of
24
hearing care plans must comply with Section 356z.88 of this

SB2838 Enrolled
- 8 -
LRB104 17737 BAB 31168 b
1
Code.

2

Section 10.
The Health Maintenance Organization Act is
3
amended by changing Section 5-3 as follows:

4

(215 ILCS 125/5-3)

(from Ch. 111 1/2, par. 1411.2)
5

Sec. 5-3.
Illinois Insurance Code provisions.
6

(a) Health Maintenance Organizations shall be subject to
7
the provisions of Sections 133, 134, 136, 137, 139, 140,
8
141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
9
152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
10
155.49, 352c, 355.2, 355.3, 355.6, 355.7, 355b, 355c, 356f,
11
356g, 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
12
356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
13
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
14
356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
15
356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
16
356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
17
356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,
18
356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
19
356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
20
356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
21
356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,
22
356z.76, 356z.77, 356z.78,
356z.79,
356z.80,
356z.81, 356z.82,
23
356z.83, 356z.84, 356z.85, 356z.88,
364, 364.01, 364.3, 367.2,
24
367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370a, 370c,

SB2838 Enrolled
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LRB104 17737 BAB 31168 b
1
370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444,
2
and 444.1, paragraph (c) of subsection (2) of Section 367, and
3
Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
4
XXVI, and XXXIIB of the Illinois Insurance Code.
5

(b) For purposes of the Illinois Insurance Code, except
6
for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
7
Health Maintenance Organizations in the following categories
8
are deemed to be "domestic companies":
9

(1) a corporation authorized under the Dental Service
10

Plan Act or the Voluntary Health Services Plans Act;
11

(2) a corporation organized under the laws of this
12

State; or
13

(3) a corporation organized under the laws of another
14

state, 30% or more of the enrollees of which are residents
15

of this State, except a corporation subject to
16

substantially the same requirements in its state of
17

organization as is a "domestic company" under Article VIII
18

1/2 of the Illinois Insurance Code.
19

(c) In considering the merger, consolidation, or other
20
acquisition of control of a Health Maintenance Organization
21
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
22

(1) the Director shall give primary consideration to
23

the continuation of benefits to enrollees and the
24

financial conditions of the acquired Health Maintenance
25

Organization after the merger, consolidation, or other
26

acquisition of control takes effect;

SB2838 Enrolled
- 10 -
LRB104 17737 BAB 31168 b
1

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

Section 131.8 of the Illinois Insurance Code shall not
3

apply and (ii) the Director, in making his determination
4

with respect to the merger, consolidation, or other
5

acquisition of control, need not take into account the
6

effect on competition of the merger, consolidation, or
7

other acquisition of control;
8

(3) the Director shall have the power to require the
9

following information:
10

(A) certification by an independent actuary of the
11

adequacy of the reserves of the Health Maintenance
12

Organization sought to be acquired;
13

(B) pro forma financial statements reflecting the
14

combined balance sheets of the acquiring company and
15

the Health Maintenance Organization sought to be
16

acquired as of the end of the preceding year and as of
17

a date 90 days prior to the acquisition, as well as pro
18

forma financial statements reflecting projected
19

combined operation for a period of 2 years;
20

(C) a pro forma business plan detailing an
21

acquiring party's plans with respect to the operation
22

of the Health Maintenance Organization sought to be
23

acquired for a period of not less than 3 years; and
24

(D) such other information as the Director shall
25

require.
26

(d) The provisions of Article VIII 1/2 of the Illinois

SB2838 Enrolled
- 11 -
LRB104 17737 BAB 31168 b
1
Insurance Code and this Section 5-3 shall apply to the sale by
2
any health maintenance organization of greater than 10% of its
3
enrollee population (including, without limitation, the health
4
maintenance organization's right, title, and interest in and
5
to its health care certificates).
6

(e) In considering any management contract or service
7
agreement subject to Section 141.1 of the Illinois Insurance
8
Code, the Director (i) shall, in addition to the criteria
9
specified in Section 141.2 of the Illinois Insurance Code,
10
take into account the effect of the management contract or
11
service agreement on the continuation of benefits to enrollees
12
and the financial condition of the health maintenance
13
organization to be managed or serviced, and (ii) need not take
14
into account the effect of the management contract or service
15
agreement on competition.
16

(f) Except for small employer groups as defined in the
17
Small Employer Rating, Renewability and Portability Health
18
Insurance Act and except for medicare supplement policies as
19
defined in Section 363 of the Illinois Insurance Code, a
20
Health Maintenance Organization may by contract agree with a
21
group or other enrollment unit to effect refunds or charge
22
additional premiums under the following terms and conditions:
23

(i) the amount of, and other terms and conditions with
24

respect to, the refund or additional premium are set forth
25

in the group or enrollment unit contract agreed in advance
26

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

SB2838 Enrolled
- 12 -
LRB104 17737 BAB 31168 b
1

additional premium is to be charged (which period shall
2

not be less than one year); and
3

(ii) the amount of the refund or additional premium
4

shall not exceed 20% of the Health Maintenance
5

Organization's profitable or unprofitable experience with
6

respect to the group or other enrollment unit for the
7

period (and, for purposes of a refund or additional
8

premium, the profitable or unprofitable experience shall
9

be calculated taking into account a pro rata share of the
10

Health Maintenance Organization's administrative and
11

marketing expenses, but shall not include any refund to be
12

made or additional premium to be paid pursuant to this
13

subsection (f)). The Health Maintenance Organization and
14

the group or enrollment unit may agree that the profitable
15

or unprofitable experience may be calculated taking into
16

account the refund period and the immediately preceding 2
17

plan years.
18

The Health Maintenance Organization shall include a
19
statement in the evidence of coverage issued to each enrollee
20
describing the possibility of a refund or additional premium,
21
and upon request of any group or enrollment unit, provide to
22
the group or enrollment unit a description of the method used
23
to calculate (1) the Health Maintenance Organization's
24
profitable experience with respect to the group or enrollment
25
unit and the resulting refund to the group or enrollment unit
26
or (2) the Health Maintenance Organization's unprofitable

SB2838 Enrolled
- 13 -
LRB104 17737 BAB 31168 b
1
experience with respect to the group or enrollment unit and
2
the resulting additional premium to be paid by the group or
3
enrollment unit.
4

In no event shall the Illinois Health Maintenance
5
Organization Guaranty Association be liable to pay any
6
contractual obligation of an insolvent organization to pay any
7
refund authorized under this Section.
8

(g) Rulemaking authority to implement Public Act 95-1045,
9
if any, is conditioned on the rules being adopted in
10
accordance with all provisions of the Illinois Administrative
11
Procedure Act and all rules and procedures of the Joint
12
Committee on Administrative Rules; any purported rule not so
13
adopted, for whatever reason, is unauthorized.
14
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
15
103-123, eff. 1-1-24; 103-154, eff. 6-30-23; 103-420, eff.
16
1-1-24; 103-426, eff. 8-4-23; 103-445, eff. 1-1-24; 103-551,
17
eff. 8-11-23; 103-605, eff. 7-1-24; 103-618, eff. 1-1-25;
18
103-649, eff. 1-1-25; 103-656, eff. 1-1-25; 103-700, eff.
19
1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
20
eff. 8-2-24; 103-758, eff. 1-1-25; 103-777, eff. 8-2-24;
21
103-808, eff. 1-1-26; 103-914, eff. 1-1-25; 103-918, eff.
22
1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-28,
23
eff. 1-1-26; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73,
24
eff. 1-1-26; 104-98, eff. 1-1-26; 104-289, eff. 1-1-26;
25
104-324, eff. 1-1-26; 104-334, eff. 8-15-25; 104-379, eff.
26
1-1-26; 104-417, eff. 8-15-25; revised 11-21-25.)

SB2838 Enrolled
- 14 -
LRB104 17737 BAB 31168 b
1

Section 15.
The Limited Health Service Organization Act is
2
amended by changing Section 4003 as follows:

3

(215 ILCS 130/4003)

(from Ch. 73, par. 1504-3)
4

Sec. 4003.
Illinois Insurance Code provisions.
Limited
5
health service organizations shall be subject to the
6
provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
7
141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
8
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
9
355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
10
356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
11
356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
12
356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
13
356z.73, 356z.74, 356z.75, 356z.79, 356z.80,
356z.81, 356z.83,
14
356z.84, 356z.85, 356z.88,
364.3, 368a, 370a, 401, 401.1, 402,
15
403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles
16
IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
17
XXXIIB of the Illinois Insurance Code. Nothing in this Section
18
shall require a limited health care plan to cover any service
19
that is not a limited health service. For purposes of the
20
Illinois Insurance Code, except for Sections 444 and 444.1 and
21
Articles XIII and XIII 1/2, limited health service
22
organizations in the following categories are deemed to be
23
domestic companies:
24

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

SB2838 Enrolled
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LRB104 17737 BAB 31168 b
1

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

state, 30% or more of the enrollees of which are residents
3

of this State, except a corporation subject to
4

substantially the same requirements in its state of
5

organization as is a domestic company under Article VIII
6

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

17

Section 99.
Effective date.
This Act takes effect January
18
1, 2027.

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