INS-EYE MEDICATION COVERAGE

Illinois General Assembly - Full Text of SB2921

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SB2921 - 104th General Assembly

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Senate Amendment 001

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SB2921 Enrolled
LRB104 15893 BAB 29120 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, 104-27,
8
104-68, 104-73, 104-289, 104-324, and 104-379
)
9

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

356z.80
of the

SB2921 Enrolled
- 2 -
LRB104 15893 BAB 29120 b
1
Illinois Insurance Code. The program of health benefits must
2
comply with Sections 155.22a, 155.37, 355b, 356z.19, 370c, and
3
370c.1 and Article XXXIIB of the Illinois Insurance Code. The
4
program of health benefits shall provide the coverage required
5
under Section 356m of the Illinois Insurance Code and, for the
6
employees of the State Employee Group Insurance Program only,
7
the coverage as also provided in Section 6.11B of this Act. The
8
Department of Insurance shall enforce the requirements of this
9
Section with respect to Sections 370c and 370c.1 of the
10
Illinois Insurance Code; all other requirements of this
11
Section shall be enforced by the Department of Central
12
Management Services.
13

Rulemaking authority to implement Public Act 95-1045, if
14
any, is conditioned on the rules being adopted in accordance
15
with all provisions of the Illinois Administrative Procedure
16
Act and all rules and procedures of the Joint Committee on
17
Administrative Rules; any purported rule not so adopted, for
18
whatever reason, is unauthorized.
19
(Source: P.A. 103-8, eff. 1-1-24; 103-84, eff. 1-1-24; 103-91,
20
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
21
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
22
7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-870,
23
eff. 1-1-25; 103-914, eff. 1-1-25; 103-918, eff. 1-1-25;
24
103-951, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-42, eff.
25
8-1-25; 104-417, eff. 8-15-25; revised 10-1-25.)

SB2921 Enrolled
- 3 -
LRB104 15893 BAB 29120 b
1

(Text of Section after amendment by P.A. 104-27, 104-68,
2
104-73, 104-289, 104-324, and 104-379 but before amendment by
3
P.A. 104-1
)
4

Sec. 6.11.
Required health benefits; Illinois Insurance
5
Code requirements.
The program of health benefits shall
6
provide the post-mastectomy care benefits required to be
7
covered by a policy of accident and health insurance under
8
Section 356t of the Illinois Insurance Code. The program of
9
health benefits shall provide the coverage required under
the
10
Topical Eye Medication Prescription Act and
Sections 356g,
11
356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
12
356z.2, 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.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33,
15
356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
16
356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, 356z.60,
17
356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71,
18
356z.74, 356z.76,
and
356z.77,
and
356z.80
, 356z.81, 356z.82,
19
356z.83, 356z.84, and 356z.85
of the Illinois Insurance Code.
20
The program of health benefits must comply with Sections
21
155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article
22
XXXIIB of the Illinois Insurance Code. The program of health
23
benefits shall provide the coverage required under Section
24
356m of the Illinois Insurance Code and, for the employees of
25
the State Employee Group Insurance Program only, the coverage
26
as also provided in Section 6.11B of this Act. The Department

SB2921 Enrolled
- 4 -
LRB104 15893 BAB 29120 b
1
of Insurance shall enforce the requirements of this Section
2
with respect to Sections 370c and 370c.1 and Article XXXIIB of
3
the Illinois Insurance Code; all other requirements of this
4
Section shall be enforced by the Department of Central
5
Management Services.
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. 103-8, eff. 1-1-24; 103-84, eff. 1-1-24; 103-91,
13
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
14
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
15
7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-870,
16
eff. 1-1-25; 103-914, eff. 1-1-25; 103-918, eff. 1-1-25;
17
103-951, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-27, eff.
18
1-1-26, 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
19
1-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,
20
eff. 1-1-26; 104-417, eff. 8-15-25; revised 10-1-25.)

21

(Text of Section after amendment by P.A. 104-1
)
22

Sec. 6.11.
Required health benefits; Illinois Insurance
23
Code requirements.
The program of health benefits shall
24
provide the post-mastectomy care benefits required to be
25
covered by a policy of accident and health insurance under

SB2921 Enrolled
- 5 -
LRB104 15893 BAB 29120 b
1
Section 356t of the Illinois Insurance Code. The program of
2
health benefits shall provide the coverage required under
the
3
Topical Eye Medication Prescription Act and
Sections 356g,
4
356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
5
356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
6
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
7
356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33,
8
356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
9
356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, 356z.60,
10
356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71,
11
356z.74, 356z.76,
and
356z.77,
356z.79,

and
356z.80
, 356z.81,
12
356z.82, 356z.83, 356z.84, and 356z.85
of the Illinois
13
Insurance Code. The program of health benefits must comply
14
with Sections 155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1
15
and Article XXXIIB of the Illinois Insurance Code. The program
16
of health benefits shall provide the coverage required under
17
Section 356m of the Illinois Insurance Code and, for the
18
employees of the State Employee Group Insurance Program only,
19
the coverage as also provided in Section 6.11B of this Act. The
20
Department of Insurance shall enforce the requirements of this
21
Section with respect to Sections 370c and 370c.1 and Article
22
XXXIIB of the Illinois Insurance Code; all other requirements
23
of this Section shall be enforced by the Department of Central
24
Management Services.
25

Rulemaking authority to implement Public Act 95-1045, if
26
any, is conditioned on the rules being adopted in accordance

SB2921 Enrolled
- 6 -
LRB104 15893 BAB 29120 b
1
with all provisions of the Illinois Administrative Procedure
2
Act and all rules and procedures of the Joint Committee on
3
Administrative Rules; any purported rule not so adopted, for
4
whatever reason, is unauthorized.
5
(Source: P.A. 103-8, eff. 1-1-24; 103-84, eff. 1-1-24; 103-91,
6
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
7
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
8
7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-870,
9
eff. 1-1-25; 103-914, eff. 1-1-25; 103-918, eff. 1-1-25;
10
103-951, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
11
7-1-27; 104-27, eff. 1-1-26, 104-42, eff. 8-1-25; 104-68, eff.
12
1-1-26; 104-73, eff. 1-1-26; 104-289, eff. 1-1-26; 104-324,
13
eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25;
14
revised 10-1-25.)

15

Section 10.
The Counties Code is amended by changing
16
Section 5-1069.3 as follows:

17

(55 ILCS 5/5-1069.3)
18

(Text of Section before amendment by P.A. 104-68, 104-73,
19
104-289, 104-324, and 104-379
)
20

Sec. 5-1069.3.
Required health benefits.
If a county,
21
including a home rule county, is a self-insurer for purposes
22
of providing health insurance coverage for its employees, the
23
coverage shall include coverage for the post-mastectomy care
24
benefits required to be covered by a policy of accident and

SB2921 Enrolled
- 7 -
LRB104 15893 BAB 29120 b
1
health insurance under Section 356t and the coverage required
2
under
the Topical Eye Medication Prescription Act and
Sections
3
356g, 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.81

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

Rulemaking authority to implement Public Act 95-1045, if
21
any, is conditioned on the rules being adopted in accordance
22
with all provisions of the Illinois Administrative Procedure
23
Act and all rules and procedures of the Joint Committee on
24
Administrative Rules; any purported rule not so adopted, for
25
whatever reason, is unauthorized.
26
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;

SB2921 Enrolled
- 8 -
LRB104 15893 BAB 29120 b
1
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
2
8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
3
eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
4
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
5
6-9-25; 104-42, eff. 8-1-25; 104-417, eff. 8-15-25; revised
6
10-1-25.)

7

(Text of Section after amendment by P.A. 104-68, 104-73,
8
104-289, 104-324, and 104-379
)
9

Sec. 5-1069.3.
Required health benefits.
If a county,
10
including a home rule county, is a self-insurer for purposes
11
of providing health insurance coverage for its employees, the
12
coverage shall include coverage for the post-mastectomy care
13
benefits required to be covered by a policy of accident and
14
health insurance under Section 356t and the coverage required
15
under
the Topical Eye Medication Prescription Act and
Sections
16
356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
17
356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
18
356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
19
356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
20
356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
21
356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
22
356z.67, 356z.68, 356z.70, 356z.71, 356z.74,
and
356z.77,
23
356z.79,

and
356z.80
, 356z.81, 356z.82, 356z.83, 356z.84, and
24
356z.85
of the Illinois Insurance Code. The coverage shall
25
comply with Sections 155.22a, 355b, 356z.19, and 370c of the

SB2921 Enrolled
- 9 -
LRB104 15893 BAB 29120 b
1
Illinois Insurance Code. The Department of Insurance shall
2
enforce the requirements of this Section. The requirement that
3
health benefits be covered as provided in this Section is an
4
exclusive power and function of the State and is a denial and
5
limitation under Article VII, Section 6, subsection (h) of the
6
Illinois Constitution. A home rule county to which this
7
Section applies must comply with every provision of this
8
Section.
9

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

23

Section 15.
The Illinois Municipal Code is amended by
24
changing Section 10-4-2.3 as follows:

SB2921 Enrolled
- 10 -
LRB104 15893 BAB 29120 b
1

(65 ILCS 5/10-4-2.3)
2

(Text of Section before amendment by P.A. 104-68, 104-73,
3
104-289, 104-324, and 104-379
)
4

Sec. 10-4-2.3.
Required health benefits.
If a
5
municipality, including a home rule municipality, is a
6
self-insurer for purposes of providing health insurance
7
coverage for its employees, the coverage shall include
8
coverage for the post-mastectomy care benefits required to be
9
covered by a policy of accident and health insurance under
10
Section 356t and the coverage required under
the Topical Eye
11
Medication Prescription Act and
Sections 356g, 356g.5,
12
356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4,
13
356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
14
356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
15
356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, 356z.45,
16
356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, 356z.56,
17
356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.67,
18
356z.68, 356z.70, 356z.71, 356z.74,
and
356z.77,
356z.79,
and
19
356z.81

356z.80
of the Illinois Insurance Code. The coverage
20
shall comply with Sections 155.22a, 355b, 356z.19, and 370c of
21
the Illinois Insurance Code. The Department of Insurance shall
22
enforce the requirements of this Section. The requirement that
23
health benefits be covered as provided in this is an exclusive
24
power and function of the State and is a denial and limitation
25
under Article VII, Section 6, subsection (h) of the Illinois
26
Constitution. A home rule municipality to which this Section

SB2921 Enrolled
- 11 -
LRB104 15893 BAB 29120 b
1
applies must comply with every provision of this Section.
2

Rulemaking authority to implement Public Act 95-1045, if
3
any, is conditioned on the rules being adopted in accordance
4
with all provisions of the Illinois Administrative Procedure
5
Act and all rules and procedures of the Joint Committee on
6
Administrative Rules; any purported rule not so adopted, for
7
whatever reason, is unauthorized.
8
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
9
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
10
8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
11
eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
12
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
13
6-9-25; 104-42, eff. 8-1-25; 104-417, eff. 8-15-25; revised
14
10-2-25.)

15

(Text of Section after amendment by P.A. 104-68, 104-73,
16
104-289, 104-324, and 104-379
)
17

Sec. 10-4-2.3.
Required health benefits.
If a
18
municipality, including a home rule municipality, is a
19
self-insurer for purposes of providing health insurance
20
coverage for its employees, the coverage shall include
21
coverage for the post-mastectomy care benefits required to be
22
covered by a policy of accident and health insurance under
23
Section 356t and the coverage required under
the Topical Eye
24
Medication Prescription Act and
Sections 356g, 356g.5,
25
356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4,

SB2921 Enrolled
- 12 -
LRB104 15893 BAB 29120 b
1
356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
2
356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
3
356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, 356z.45,
4
356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, 356z.56,
5
356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.67,
6
356z.68, 356z.70, 356z.71, 356z.74,
and
356z.77,
356z.79,

and

7
356z.80
, 356z.81, 356z.82, 356z.83, 356z.84, and 356z.85
of
8
the Illinois Insurance Code. The coverage shall comply with
9
Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
10
Insurance Code. The Department of Insurance shall enforce the
11
requirements of this Section. The requirement that health
12
benefits be covered as provided in this is an exclusive power
13
and function of the State and is a denial and limitation under
14
Article VII, Section 6, subsection (h) of the Illinois
15
Constitution. A home rule municipality to which this Section
16
applies must comply with every provision 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;

SB2921 Enrolled
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LRB104 15893 BAB 29120 b
1
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
2
6-9-25; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
3
1-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,
4
eff. 1-1-26; 104-417, eff. 8-15-25; revised 10-2-25.)

5

Section 20.
The School Code is amended by changing Section
6
10-22.3f as follows:

7

(105 ILCS 5/10-22.3f)
8

(Text of Section before amendment by P.A. 104-27, 104-68,
9
104-73, 104-289, 104-324, and 104-379
)
10

Sec. 10-22.3f.
Required health benefits.
Insurance
11
protection and benefits for employees shall provide the
12
post-mastectomy care benefits required to be covered by a
13
policy of accident and health insurance under Section 356t and
14
the coverage required under
the Topical Eye Medication
15
Prescription Act and
Sections 356g, 356g.5, 356g.5-1, 356m,
16
356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6,
17
356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
18
356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33,
19
356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
20
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
21
356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71, 356z.74,
22
and
356z.77,
356z.79,
and
356z.81

356z.80
of the Illinois
23
Insurance Code. Insurance policies shall comply with Section
24
356z.19 of the Illinois Insurance Code. The coverage shall

SB2921 Enrolled
- 14 -
LRB104 15893 BAB 29120 b
1
comply with Sections 155.22a, 355b, and 370c of the Illinois
2
Insurance Code. The Department of Insurance shall enforce the
3
requirements of this Section.
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. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
11
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
12
8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
13
eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
14
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
15
6-9-25; 104-42, eff. 8-1-25; 104-417, eff. 8-15-25; revised
16
10-2-25.)

17

(Text of Section after amendment by P.A. 104-27, 104-68,
18
104-73, 104-289, 104-324, and 104-379
)
19

Sec. 10-22.3f.
Required health benefits.
Insurance
20
protection and benefits for employees shall provide the
21
post-mastectomy care benefits required to be covered by a
22
policy of accident and health insurance under Section 356t and
23
the coverage required under
the Topical Eye Medication
24
Prescription Act and
Sections 356g, 356g.5, 356g.5-1, 356m,
25
356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6,

SB2921 Enrolled
- 15 -
LRB104 15893 BAB 29120 b
1
356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
2
356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33,
3
356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
4
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
5
356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71, 356z.74,
6
and
356z.77,
356z.79,

and
356z.80
, 356z.81, 356z.82, 356z.83,
7
356z.84, and 356z.85
of the Illinois Insurance Code. Insurance
8
policies shall comply with Section 356z.19 of the Illinois
9
Insurance Code. The coverage shall comply with Sections
10
155.22a, 355b, and 370c and Article XXXIIB of the Illinois
11
Insurance Code. The Department of Insurance shall enforce the
12
requirements of this Section.
13

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

SB2921 Enrolled
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LRB104 15893 BAB 29120 b
1
revised 10-2-25.)

2

Section 25.
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

(Text of Section before amendment by P.A. 103-808, 104-28,
6
104-68, 104-73, 104-98, 104-289, 104-324, and 104-379
)
7

Sec. 5-3.
Illinois
Insurance Code
and Topical Eye
8
Medication Prescription Act
provisions.
9

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

SB2921 Enrolled
- 17 -
LRB104 15893 BAB 29120 b
1
356z.72, 356z.73, 356z.74, 356z.75, 356z.76, 356z.77, 356z.78,
2
356z.79, 356z.81,

356z.80,
364, 364.01, 364.3, 367.2, 367.2-5,
3
367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1,
4
402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
5
paragraph (c) of subsection (2) of Section 367, and Articles
6
IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
7
XXXIIB of the Illinois Insurance Code. Section
356z.81

365z.80

8
of the Illinois Insurance Code is not applicable to health
9
care plans under contract with the Department of Healthcare
10
and Family Services.
11

(b) For purposes of the Illinois Insurance Code, except
12
for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
13
Health Maintenance Organizations in the following categories
14
are deemed to be "domestic companies":
15

(1) a corporation authorized under the Dental Service
16

Plan Act or the Voluntary Health Services Plans Act;
17

(2) a corporation organized under the laws of this
18

State; or
19

(3) a corporation organized under the laws of another
20

state, 30% or more of the enrollees of which are residents
21

of this State, except a corporation subject to
22

substantially the same requirements in its state of
23

organization as is a "domestic company" under Article VIII
24

1/2 of the Illinois Insurance Code.
25

(c) In considering the merger, consolidation, or other
26
acquisition of control of a Health Maintenance Organization

SB2921 Enrolled
- 18 -
LRB104 15893 BAB 29120 b
1
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
2

(1) the Director shall give primary consideration to
3

the continuation of benefits to enrollees and the
4

financial conditions of the acquired Health Maintenance
5

Organization after the merger, consolidation, or other
6

acquisition of control takes effect;
7

(2)(i) the criteria specified in subsection (1)(b) of
8

Section 131.8 of the Illinois Insurance Code shall not
9

apply and (ii) the Director, in making his determination
10

with respect to the merger, consolidation, or other
11

acquisition of control, need not take into account the
12

effect on competition of the merger, consolidation, or
13

other acquisition of control;
14

(3) the Director shall have the power to require the
15

following information:
16

(A) certification by an independent actuary of the
17

adequacy of the reserves of the Health Maintenance
18

Organization sought to be acquired;
19

(B) pro forma financial statements reflecting the
20

combined balance sheets of the acquiring company and
21

the Health Maintenance Organization sought to be
22

acquired as of the end of the preceding year and as of
23

a date 90 days prior to the acquisition, as well as pro
24

forma financial statements reflecting projected
25

combined operation for a period of 2 years;
26

(C) a pro forma business plan detailing an

SB2921 Enrolled
- 19 -
LRB104 15893 BAB 29120 b
1

acquiring party's plans with respect to the operation
2

of the Health Maintenance Organization sought to be
3

acquired for a period of not less than 3 years; and
4

(D) such other information as the Director shall
5

require.
6

(d) The provisions of Article VIII 1/2 of the Illinois
7
Insurance Code and this Section 5-3 shall apply to the sale by
8
any health maintenance organization of greater than 10% of its
9
enrollee population (including, without limitation, the health
10
maintenance organization's right, title, and interest in and
11
to its health care certificates).
12

(e) In considering any management contract or service
13
agreement subject to Section 141.1 of the Illinois Insurance
14
Code, the Director (i) shall, in addition to the criteria
15
specified in Section 141.2 of the Illinois Insurance Code,
16
take into account the effect of the management contract or
17
service agreement on the continuation of benefits to enrollees
18
and the financial condition of the health maintenance
19
organization to be managed or serviced, and (ii) need not take
20
into account the effect of the management contract or service
21
agreement on competition.
22

(f) Except for small employer groups as defined in the
23
Small Employer Rating, Renewability and Portability Health
24
Insurance Act and except for medicare supplement policies as
25
defined in Section 363 of the Illinois Insurance Code, a
26
Health Maintenance Organization may by contract agree with a

SB2921 Enrolled
- 20 -
LRB104 15893 BAB 29120 b
1
group or other enrollment unit to effect refunds or charge
2
additional premiums under the following terms and conditions:
3

(i) the amount of, and other terms and conditions with
4

respect to, the refund or additional premium are set forth
5

in the group or enrollment unit contract agreed in advance
6

of the period for which a refund is to be paid or
7

additional premium is to be charged (which period shall
8

not be less than one year); and
9

(ii) the amount of the refund or additional premium
10

shall not exceed 20% of the Health Maintenance
11

Organization's profitable or unprofitable experience with
12

respect to the group or other enrollment unit for the
13

period (and, for purposes of a refund or additional
14

premium, the profitable or unprofitable experience shall
15

be calculated taking into account a pro rata share of the
16

Health Maintenance Organization's administrative and
17

marketing expenses, but shall not include any refund to be
18

made or additional premium to be paid pursuant to this
19

subsection (f)). The Health Maintenance Organization and
20

the group or enrollment unit may agree that the profitable
21

or unprofitable experience may be calculated taking into
22

account the refund period and the immediately preceding 2
23

plan years.
24

The Health Maintenance Organization shall include a
25
statement in the evidence of coverage issued to each enrollee
26
describing the possibility of a refund or additional premium,

SB2921 Enrolled
- 21 -
LRB104 15893 BAB 29120 b
1
and upon request of any group or enrollment unit, provide to
2
the group or enrollment unit a description of the method used
3
to calculate (1) the Health Maintenance Organization's
4
profitable experience with respect to the group or enrollment
5
unit and the resulting refund to the group or enrollment unit
6
or (2) the Health Maintenance Organization's unprofitable
7
experience with respect to the group or enrollment unit and
8
the resulting additional premium to be paid by the group or
9
enrollment unit.
10

In no event shall the Illinois Health Maintenance
11
Organization Guaranty Association be liable to pay any
12
contractual obligation of an insolvent organization to pay any
13
refund authorized under this Section.
14

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

SB2921 Enrolled
- 22 -
LRB104 15893 BAB 29120 b
1
103-914, eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff.
2
1-1-25; 104-1, eff. 6-9-25; 104-42, eff. 8-1-25; 104-334, eff.
3
8-15-25; 104-417, eff. 8-15-25; revised 10-3-25.)

4

(Text of Section after amendment by P.A. 103-808, 104-28,
5
104-68, 104-73, 104-98, 104-289, 104-324, and 104-379
)
6

Sec. 5-3.
Illinois Insurance Code
and Topical Eye
7
Medication Prescription Act
provisions.
8

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

SB2921 Enrolled
- 23 -
LRB104 15893 BAB 29120 b
1
356z.84, 356z.85,
364, 364.01, 364.3, 367.2, 367.2-5, 367i,
2
368a, 368b, 368c, 368d, 368e, 370a, 370c, 370c.1, 401, 401.1,
3
402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
4
paragraph (c) of subsection (2) of Section 367, and Articles
5
IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
6
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

SB2921 Enrolled
- 24 -
LRB104 15893 BAB 29120 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

SB2921 Enrolled
- 25 -
LRB104 15893 BAB 29120 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

SB2921 Enrolled
- 26 -
LRB104 15893 BAB 29120 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

SB2921 Enrolled
- 27 -
LRB104 15893 BAB 29120 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;

SB2921 Enrolled
- 28 -
LRB104 15893 BAB 29120 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 10-3-25.)

3

Section 30.
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

(Text of Section before amendment by P.A. 104-73, 104-98,
7
104-289, 104-324, and 104-379
)
8

Sec. 4003.
Illinois Insurance Code
and Topical Eye
9
Medication Prescription Act
provisions.
Limited health service
10
organizations shall be subject to the provisions of
the
11
Topical Eye Medication Prescription Act and
Sections 133, 134,
12
136, 137, 139, 140, 141.1, 141.2, 141.3, 143, 143.31, 143c,
13
147, 148, 149, 151, 152, 153, 154, 154.5, 154.6, 154.7, 154.8,
14
155.04, 155.37, 155.49, 352c, 355.2, 355.3, 355b, 355d, 356m,
15
356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, 356z.22,
16
356z.25, 356z.26, 356z.29, 356z.32, 356z.33, 356z.41, 356z.46,
17
356z.47, 356z.51, 356z.53, 356z.54, 356z.57, 356z.59, 356z.61,
18
356z.64, 356z.67, 356z.68, 356z.71, 356z.73, 356z.74, 356z.75,
19
356z.79,
356z.81,

356z.80,
364.3, 368a, 401, 401.1, 402, 403,
20
403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles IIA,
21
VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB
22
of the Illinois Insurance Code. Nothing in this Section shall
23
require a limited health care plan to cover any service that is
24
not a limited health service. For purposes of the Illinois

SB2921 Enrolled
- 29 -
LRB104 15893 BAB 29120 b
1
Insurance Code, except for Sections 444 and 444.1 and Articles
2
XIII and XIII 1/2, limited health service organizations in the
3
following categories are deemed to be domestic companies:
4

(1) a corporation under the laws of this State; or
5

(2) a corporation organized under the laws of another
6

state, 30% or more of the enrollees of which are residents
7

of this State, except a corporation subject to
8

substantially the same requirements in its state of
9

organization as is a domestic company under Article VIII
10

1/2 of the Illinois Insurance Code.
11
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
12
103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, eff.
13
1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25; 103-656,
14
eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24;
15
103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff.
16
1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-42,
17
eff. 8-1-25; 104-334, eff. 8-15-25; 104-417, eff. 8-15-25;
18
revised 10-3-25.)

19

(Text of Section after amendment by P.A. 104-73, 104-98,
20
104-289, 104-324, and 104-379
)
21

Sec. 4003.
Illinois Insurance Code
and Topical Eye
22
Medication Prescription Act
provisions.
Limited health service
23
organizations shall be subject to the provisions of
the
24
Topical Eye Medication Prescription Act and
Sections 133, 134,
25
136, 137, 139, 140, 141.1, 141.2, 141.3, 143, 143.31, 143c,

SB2921 Enrolled
- 30 -
LRB104 15893 BAB 29120 b
1
147, 148, 149, 151, 152, 153, 154, 154.5, 154.6, 154.7, 154.8,
2
155.04, 155.37, 155.49, 352c, 355.2, 355.3, 355b, 355d, 356m,
3
356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, 356z.22,
4
356z.25, 356z.26, 356z.29, 356z.32, 356z.33, 356z.41, 356z.46,
5
356z.47, 356z.51, 356z.53, 356z.54, 356z.57, 356z.59, 356z.61,
6
356z.64, 356z.67, 356z.68, 356z.71, 356z.73, 356z.74, 356z.75,
7
356z.79, 356z.80,
356z.81, 356z.83, 356z.84, 356z.85,
364.3,
8
368a, 370a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
9
444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
10
XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois Insurance
11
Code. Nothing in this Section shall require a limited health
12
care plan to cover any service that is not a limited health
13
service. For purposes of the Illinois Insurance Code, except
14
for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
15
limited health service organizations in the following
16
categories are deemed to be domestic companies:
17

(1) a corporation under the laws of this State; or
18

(2) a corporation organized under the laws of another
19

state, 30% or more of the enrollees of which are residents
20

of this State, except a corporation subject to
21

substantially the same requirements in its state of
22

organization as is a domestic company under Article VIII
23

1/2 of the Illinois Insurance Code.
24
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
25
103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, eff.
26
1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25; 103-656,

SB2921 Enrolled
- 31 -
LRB104 15893 BAB 29120 b
1
eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24;
2
103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff.
3
1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-42,
4
eff. 8-1-25; 104-73, eff. 1-1-26; 104-98, eff. 1-1-26;
5
104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-334, eff.
6
8-15-25; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25; revised
7
10-3-25.)

8

Section 35.
The Voluntary Health Services Plans Act is
9
amended by changing Section 10 as follows:

10

(215 ILCS 165/10)

(from Ch. 32, par. 604)
11

(Text of Section before amendment by P.A. 104-28, 104-73,
12
104-98, 104-289, 104-324, and 104-379
)
13

Sec. 10.
Application of Insurance Code
and Topical Eye
14
Medication Prescription Act
provisions.
Health services plan
15
corporations and all persons interested therein or dealing
16
therewith shall be subject to the provisions of
the Topical
17
Eye Medication Prescription Act and
Articles IIA and XII 1/2
18
and Sections 3.1, 133, 136, 139, 140, 143, 143.31, 143c, 149,
19
155.22a, 155.37, 354, 355.2, 355.3, 355b, 355d, 356g, 356g.5,
20
356g.5-1, 356m, 356q, 356r, 356t, 356u, 356u.10, 356v, 356w,
21
356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
22
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
23
356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
24
356z.26, 356z.29, 356z.30, 356z.32, 356z.32a, 356z.33,

SB2921 Enrolled
- 32 -
LRB104 15893 BAB 29120 b
1
356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
2
356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
3
356z.67, 356z.68, 356z.71, 356z.72, 356z.74, 356z.75, 356z.77,
4
356z.79, 356z.81,

356z.80,
364.01, 364.3, 367.2, 368a, 401,
5
401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
6
and (15) of Section 367 of the Illinois Insurance Code.
7

Rulemaking authority to implement Public Act 95-1045, if
8
any, is conditioned on the rules being adopted in accordance
9
with all provisions of the Illinois Administrative Procedure
10
Act and all rules and procedures of the Joint Committee on
11
Administrative Rules; any purported rule not so adopted, for
12
whatever reason, is unauthorized.
13
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
14
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-551, eff.
15
8-11-23; 103-605, eff. 7-1-24; 103-656, eff. 1-1-25; 103-718,
16
eff. 7-19-24; 103-751, eff. 8-2-24; 103-753, eff. 8-2-24;
17
103-758, eff. 1-1-25; 103-832, eff. 1-1-25; 103-914, eff.
18
1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1,
19
eff. 6-9-25; 104-42, eff. 8-1-25; 104-417, eff. 8-15-25;
20
revised 10-3-25.)

21

(Text of Section after amendment by P.A. 104-28, 104-73,
22
104-98, 104-289, 104-324, and 104-379
)
23

Sec. 10.
Application of Illinois Insurance Code
and
24
Topical Eye Medication Prescription Act
provisions.
Health
25
services plan corporations and all persons interested therein

SB2921 Enrolled
- 33 -
LRB104 15893 BAB 29120 b
1
or dealing therewith shall be subject to the provisions of
the
2
Topical Eye Medication Prescription Act and
Articles IIA and
3
XII 1/2 and Sections 3.1, 133, 136, 139, 140, 143, 143.31,
4
143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355.7, 355b,
5
355d, 356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t, 356u,
6
356u.10, 356v, 356w, 356x, 356y, 356z.1, 356z.2, 356z.3a,
7
356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
8
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18, 356z.19,
9
356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
10
356z.32a, 356z.33, 356z.40, 356z.41, 356z.46, 356z.47,
11
356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
12
356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.71, 356z.72,
13
356z.74, 356z.75, 356z.77,
356z.79,
356z.80,
356z.81, 356z.83,
14
356z.84, 356z.85,
364.01, 364.3, 367.2, 368a, 370a, 401,
15
401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
16
and (15) of Section 367 of the Illinois Insurance Code.
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; 103-551, eff.
25
8-11-23; 103-605, eff. 7-1-24; 103-656, eff. 1-1-25; 103-718,
26
eff. 7-19-24; 103-751, eff. 8-2-24; 103-753, eff. 8-2-24;

SB2921 Enrolled
- 34 -
LRB104 15893 BAB 29120 b
1
103-758, eff. 1-1-25; 103-832, eff. 1-1-25; 103-914, eff.
2
1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1,
3
eff. 6-9-25; 104-28, eff. 1-1-26; 104-42, eff. 8-1-25; 104-73,
4
eff. 1-1-26; 104-98, eff. 1-1-26; 104-289, eff. 1-1-26;
5
104-324, eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff.
6
8-15-25; revised 10-3-25.)

7

Section 40.
The Illinois Public Aid Code is amended by
8
changing Section 5-16.8 as follows:

9

(305 ILCS 5/5-16.8)
10

(Text of Section before amendment by P.A. 104-73, 104-324,
11
and 104-379
)
12

Sec. 5-16.8.
Required health benefits.
The medical
13
assistance program shall (i) provide the post-mastectomy care
14
benefits required to be covered by a policy of accident and
15
health insurance under Section 356t and the coverage required
16
under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
17
356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
18
356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64,
19
356z.67, 356z.71, and 356z.75 of the Illinois Insurance Code,
20
(ii) be subject to the provisions of Sections 356z.19,
21
356z.44, 356z.49, 364.01, 370c, and 370c.1 of the Illinois
22
Insurance Code,
and
(iii) be subject to the provisions of
23
subsection (d-5) of Section 10 of the Network Adequacy and
24
Transparency Act
, and (iv) be subject to the provisions of the

SB2921 Enrolled
- 35 -
LRB104 15893 BAB 29120 b
1
Topical Eye Medication Prescription Act
.
2

The Department, by rule, shall adopt a model similar to
3
the requirements of Section 356z.39 of the Illinois Insurance
4
Code.
5

On and after July 1, 2012, the Department shall reduce any
6
rate of reimbursement for services or other payments or alter
7
any methodologies authorized by this Code to reduce any rate
8
of reimbursement for services or other payments in accordance
9
with Section 5-5e.
10

To ensure full access to the benefits set forth in this
11
Section, on and after January 1, 2016, the Department shall
12
ensure that provider and hospital reimbursement for
13
post-mastectomy care benefits required under this Section are
14
no lower than the Medicare reimbursement rate.
15
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
16
103-420, eff. 1-1-24; 103-605, eff. 7-1-24; 103-703, eff.
17
1-1-25; 103-758, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-417,
18
eff. 8-15-25.)

19

(Text of Section after amendment by P.A. 104-73, 104-324,
20
and 104-379
)
21

Sec. 5-16.8.
Required health benefits.
The medical
22
assistance program shall (i) provide the post-mastectomy care
23
benefits required to be covered by a policy of accident and
24
health insurance under Section 356t and the coverage required
25
under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,

SB2921 Enrolled
- 36 -
LRB104 15893 BAB 29120 b
1
356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
2
356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64,
3
356z.67, 356z.71,
and
356z.75,
and
356z.80
, 356z.84, and
4
356z.85
of the Illinois Insurance Code, (ii) be subject to the
5
provisions of Sections 356z.19, 356z.44, 356z.49, 364.01,
6
370c, and 370c.1 of the Illinois Insurance Code,
and
(iii) be
7
subject to the provisions of subsection (d-5) of Section 10 of
8
the Network Adequacy and Transparency Act
, and (iv) be subject
9
to the provisions of the Topical Eye Medication Prescription
10
Act
.
11

The Department, by rule, shall adopt a model similar to
12
the requirements of Section 356z.39 of the Illinois Insurance
13
Code.
14

On and after July 1, 2012, the Department shall reduce any
15
rate of reimbursement for services or other payments or alter
16
any methodologies authorized by this Code to reduce any rate
17
of reimbursement for services or other payments in accordance
18
with Section 5-5e.
19

To ensure full access to the benefits set forth in this
20
Section, on and after January 1, 2016, the Department shall
21
ensure that provider and hospital reimbursement for
22
post-mastectomy care benefits required under this Section are
23
no lower than the Medicare reimbursement rate.
24
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
25
103-420, eff. 1-1-24; 103-605, eff. 7-1-24; 103-703, eff.
26
1-1-25; 103-758, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-73,

SB2921 Enrolled
- 37 -
LRB104 15893 BAB 29120 b
1
eff. 1-1-26; 104-324, eff. 1-1-26; 104-379, eff. 1-1-26;
2
104-417, eff. 8-15-25; revised 10-3-25.)

3

Section 95.
No acceleration or delay.
Where this Act makes
4
changes in a statute that is represented in this Act by text
5
that is not yet or no longer in effect (for example, a Section
6
represented by multiple versions), the use of that text does
7
not accelerate or delay the taking effect of (i) the changes
8
made by this Act or (ii) provisions derived from any other
9
Public Act.

10

Section 99.
Effective date.
This Act takes effect January
11
1, 2028.

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