PRESCRIPTION HORMONE THERAPY

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB3525

Introduced 2/5/2026, by Sen. Lakesia Collins

SYNOPSIS AS INTRODUCED:

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

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

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

from Ch. 32, par. 604
225 ILCS 85/45 new
305 ILCS 5/5-16.8

Amends the Illinois Insurance Code. Sets forth provisions requiring
an individual or group policy of accident and health insurance amended,
delivered, issued, or renewed in this State on or after the effective date
of the amendatory Act to provide coverage for up to a 12-month supply of
prescription hormone therapy, and the necessary supplies for
self-administration, that is prescribed by a network provider within the
provider's scope of practice and dispensed at one time for an enrollee by a
provider or pharmacist, or at a location licensed or otherwise authorized
to dispense drugs or supplies. Amends the Pharmacy Practice Act. Provides
that, notwithstanding any other provision of law, a dispensing provider or
pharmacist shall dispense, at a patient's request, up to a 12-month supply
of a prescription hormone therapy and the necessary supplies for
self-administration pursuant to a valid prescription that specifies an
initial quantity followed by periodic refills, except as specified. Amends
the State Employees Group Insurance Act of 1971, the Counties Code, the
Illinois Municipal Code, the School Code, the Health Maintenance
Organization Act, the Limited Health Service Organization Act, the
Voluntary Health Services Plans Act, and the Illinois Public Aid Code to
require coverage under the provisions of those Acts.
LRB104 19064 BAB 32509 b

A BILL FOR

SB3525
LRB104 19064 BAB 32509 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

SB3525
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LRB104 19064 BAB 32509 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.)

SB3525
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LRB104 19064 BAB 32509 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

SB3525
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LRB104 19064 BAB 32509 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,

SB3525
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LRB104 19064 BAB 32509 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

SB3525
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LRB104 19064 BAB 32509 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,

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LRB104 19064 BAB 32509 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.)

SB3525
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LRB104 19064 BAB 32509 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

SB3525
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LRB104 19064 BAB 32509 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

SB3525
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LRB104 19064 BAB 32509 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.

SB3525
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LRB104 19064 BAB 32509 b
1
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
2
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
3
8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
4
eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
5
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
6
6-9-25; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
7
1-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,
8
eff. 1-1-26; 104-417, eff. 8-15-25; 104-446, eff. 6-1-26;
9
revised 1-8-26.)

10

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

12

(105 ILCS 5/10-22.3f)
13

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

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

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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

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LRB104 19064 BAB 32509 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;

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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 the effective date of this amendatory
21
Act of the 104th General Assembly shall provide coverage for
22
up to a 12-month supply of prescription hormone therapy, and
23
the necessary supplies for self-administration, that is
24
prescribed by a network provider within the provider's scope

SB3525
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LRB104 19064 BAB 32509 b
1
of practice and dispensed at one time for an enrollee by a
2
provider or pharmacist, or at a location licensed or otherwise
3
authorized to dispense drugs or supplies.
4

(2) This Section does not require an individual or group
5
policy of accident and health insurance amended, delivered,
6
issued, or renewed in this State on or after the effective date
7
of this amendatory Act of the 104th General Assembly to cover
8
prescription hormone therapy provided by an out-of-network
9
provider, pharmacy, or location licensed or otherwise
10
authorized to dispense drugs or supplies, except as may
11
otherwise be authorized by State or federal law or by the
12
plan's policies governing out-of-network coverage. If
13
prescriptions for medically necessary prescription hormone
14
therapy are unavailable to a plan enrollee within the plan's
15
network, the plan shall arrange for the prescription hormone
16
therapy to be provided by an out-of-network provider.
17

(3) This Section does not prohibit an individual or group
18
policy of accident and health insurance amended, delivered,
19
issued, or renewed in this State on or after the effective date
20
of this amendatory Act of the 104th General Assembly from
21
limiting refills that may be obtained in the last quarter of
22
the plan year if a 12-month supply of the prescription hormone
23
therapy has already been dispensed during the plan year.
24

(4) This Section does not require a provider to prescribe,
25
furnish, or dispense 12 months of prescription hormone therapy
26
at one time.

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LRB104 19064 BAB 32509 b
1

(5) To the extent not otherwise prohibited under this
2
Section or State or federal law, health plans may apply drug
3
utilization management strategies to prescription drugs
4
covered under paragraph (1) of this subsection.

5

(6) If an individual or group policy of accident and
6
health insurance amended, delivered, issued, or renewed in
7
this State on or after the effective date of this amendatory
8
Act of the 104th General Assembly delegates responsibilities
9
under this Section to a contracted entity, including a medical
10
group or independent practice association, the delegated
11
entity shall comply with this Section.

12

(c) This Section does not deny or restrict the
13
Department's authority to ensure plan compliance when an
14
individual or group policy of accident and health insurance
15
amended, delivered, issued, or renewed in this State on or
16
after the effective date of this amendatory Act of the 104th
17
General Assembly provides coverage for prescription hormone
18
therapy.

19

Section 30.
The Health Maintenance Organization Act is
20
amended by changing Section 5-3 as follows:

21

(215 ILCS 125/5-3)

(from Ch. 111 1/2, par. 1411.2)
22

Sec. 5-3.
Illinois Insurance Code provisions.
23

(a) Health Maintenance Organizations shall be subject to
24
the provisions of Sections 133, 134, 136, 137, 139, 140,

SB3525
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LRB104 19064 BAB 32509 b
1
141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
2
152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
3
155.49, 352c, 355.2, 355.3, 355.6, 355.7, 355b, 355c, 356f,
4
356g, 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
5
356z.3a, 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.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
8
356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
9
356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
10
356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,
11
356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
12
356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
13
356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
14
356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,
15
356z.76, 356z.77, 356z.78,
356z.79,
356z.80,
356z.81, 356z.82,
16
356z.83, 356z.84, 356z.85, 356z.88,
364, 364.01, 364.3, 367.2,
17
367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370a, 370c,
18
370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444,
19
and 444.1, paragraph (c) of subsection (2) of Section 367, and
20
Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
21
XXVI, and XXXIIB of the Illinois Insurance Code.
22

(b) For purposes of the Illinois Insurance Code, except
23
for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
24
Health Maintenance Organizations in the following categories
25
are deemed to be "domestic companies":
26

(1) a corporation authorized under the Dental Service

SB3525
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LRB104 19064 BAB 32509 b
1

Plan Act or the Voluntary Health Services Plans Act;
2

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

State; or
4

(3) a corporation organized under the laws of another
5

state, 30% or more of the enrollees of which are residents
6

of this State, except a corporation subject to
7

substantially the same requirements in its state of
8

organization as is a "domestic company" under Article VIII
9

1/2 of the Illinois Insurance Code.
10

(c) In considering the merger, consolidation, or other
11
acquisition of control of a Health Maintenance Organization
12
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
13

(1) the Director shall give primary consideration to
14

the continuation of benefits to enrollees and the
15

financial conditions of the acquired Health Maintenance
16

Organization after the merger, consolidation, or other
17

acquisition of control takes effect;
18

(2)(i) the criteria specified in subsection (1)(b) of
19

Section 131.8 of the Illinois Insurance Code shall not
20

apply and (ii) the Director, in making his determination
21

with respect to the merger, consolidation, or other
22

acquisition of control, need not take into account the
23

effect on competition of the merger, consolidation, or
24

other acquisition of control;
25

(3) the Director shall have the power to require the
26

following information:

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1

(A) certification by an independent actuary of the
2

adequacy of the reserves of the Health Maintenance
3

Organization sought to be acquired;
4

(B) pro forma financial statements reflecting the
5

combined balance sheets of the acquiring company and
6

the Health Maintenance Organization sought to be
7

acquired as of the end of the preceding year and as of
8

a date 90 days prior to the acquisition, as well as pro
9

forma financial statements reflecting projected
10

combined operation for a period of 2 years;
11

(C) a pro forma business plan detailing an
12

acquiring party's plans with respect to the operation
13

of the Health Maintenance Organization sought to be
14

acquired for a period of not less than 3 years; and
15

(D) such other information as the Director shall
16

require.
17

(d) The provisions of Article VIII 1/2 of the Illinois
18
Insurance Code and this Section 5-3 shall apply to the sale by
19
any health maintenance organization of greater than 10% of its
20
enrollee population (including, without limitation, the health
21
maintenance organization's right, title, and interest in and
22
to its health care certificates).
23

(e) In considering any management contract or service
24
agreement subject to Section 141.1 of the Illinois Insurance
25
Code, the Director (i) shall, in addition to the criteria
26
specified in Section 141.2 of the Illinois Insurance Code,

SB3525
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LRB104 19064 BAB 32509 b
1
take into account the effect of the management contract or
2
service agreement on the continuation of benefits to enrollees
3
and the financial condition of the health maintenance
4
organization to be managed or serviced, and (ii) need not take
5
into account the effect of the management contract or service
6
agreement on competition.
7

(f) Except for small employer groups as defined in the
8
Small Employer Rating, Renewability and Portability Health
9
Insurance Act and except for medicare supplement policies as
10
defined in Section 363 of the Illinois Insurance Code, a
11
Health Maintenance Organization may by contract agree with a
12
group or other enrollment unit to effect refunds or charge
13
additional premiums under the following terms and conditions:
14

(i) the amount of, and other terms and conditions with
15

respect to, the refund or additional premium are set forth
16

in the group or enrollment unit contract agreed in advance
17

of the period for which a refund is to be paid or
18

additional premium is to be charged (which period shall
19

not be less than one year); and
20

(ii) the amount of the refund or additional premium
21

shall not exceed 20% of the Health Maintenance
22

Organization's profitable or unprofitable experience with
23

respect to the group or other enrollment unit for the
24

period (and, for purposes of a refund or additional
25

premium, the profitable or unprofitable experience shall
26

be calculated taking into account a pro rata share of the

SB3525
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LRB104 19064 BAB 32509 b
1

Health Maintenance Organization's administrative and
2

marketing expenses, but shall not include any refund to be
3

made or additional premium to be paid pursuant to this
4

subsection (f)). The Health Maintenance Organization and
5

the group or enrollment unit may agree that the profitable
6

or unprofitable experience may be calculated taking into
7

account the refund period and the immediately preceding 2
8

plan years.
9

The Health Maintenance Organization shall include a
10
statement in the evidence of coverage issued to each enrollee
11
describing the possibility of a refund or additional premium,
12
and upon request of any group or enrollment unit, provide to
13
the group or enrollment unit a description of the method used
14
to calculate (1) the Health Maintenance Organization's
15
profitable experience with respect to the group or enrollment
16
unit and the resulting refund to the group or enrollment unit
17
or (2) the Health Maintenance Organization's unprofitable
18
experience with respect to the group or enrollment unit and
19
the resulting additional premium to be paid by the group or
20
enrollment unit.
21

In no event shall the Illinois Health Maintenance
22
Organization Guaranty Association be liable to pay any
23
contractual obligation of an insolvent organization to pay any
24
refund authorized under this Section.
25

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

SB3525
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LRB104 19064 BAB 32509 b
1
accordance with all provisions of the Illinois Administrative
2
Procedure Act and all rules and procedures of the Joint
3
Committee on Administrative Rules; any purported rule not so
4
adopted, for whatever reason, is unauthorized.
5
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
6
103-123, eff. 1-1-24; 103-154, eff. 6-30-23; 103-420, eff.
7
1-1-24; 103-426, eff. 8-4-23; 103-445, eff. 1-1-24; 103-551,
8
eff. 8-11-23; 103-605, eff. 7-1-24; 103-618, eff. 1-1-25;
9
103-649, eff. 1-1-25; 103-656, eff. 1-1-25; 103-700, eff.
10
1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
11
eff. 8-2-24; 103-758, eff. 1-1-25; 103-777, eff. 8-2-24;
12
103-808, eff. 1-1-26; 103-914, eff. 1-1-25; 103-918, eff.
13
1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-28,
14
eff. 1-1-26; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73,
15
eff. 1-1-26; 104-98, eff. 1-1-26; 104-289, eff. 1-1-26;
16
104-324, eff. 1-1-26; 104-334, eff. 8-15-25; 104-379, eff.
17
1-1-26; 104-417, eff. 8-15-25; revised 11-21-25.)

18

Section 35.
The Limited Health Service Organization Act is
19
amended by changing Section 4003 as follows:

20

(215 ILCS 130/4003)

(from Ch. 73, par. 1504-3)
21

Sec. 4003.
Illinois Insurance Code provisions.
Limited
22
health service organizations shall be subject to the
23
provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
24
141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,

SB3525
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LRB104 19064 BAB 32509 b
1
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
2
355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
3
356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
4
356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
5
356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
6
356z.73, 356z.74, 356z.75, 356z.79, 356z.80,
356z.81, 356z.83,
7
356z.84, 356z.85, 356z.88,
364.3, 368a, 370a, 401, 401.1, 402,
8
403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles
9
IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
10
XXXIIB of the Illinois Insurance Code. Nothing in this Section
11
shall require a limited health care plan to cover any service
12
that is not a limited health service. For purposes of the
13
Illinois Insurance Code, except for Sections 444 and 444.1 and
14
Articles XIII and XIII 1/2, limited health service
15
organizations in the following categories are deemed to be
16
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,

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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
11-21-25.)

8

Section 40.
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

Sec. 10.
Application of Illinois Insurance Code
12
provisions.
Health services plan corporations and all persons
13
interested therein or dealing therewith shall be subject to
14
the provisions of Articles IIA and XII 1/2 and Sections 3.1,
15
133, 136, 139, 140, 143, 143.31, 143c, 149, 155.22a, 155.37,
16
354, 355.2, 355.3, 355.7, 355b, 355d, 356g, 356g.5, 356g.5-1,
17
356m, 356q, 356r, 356t, 356u, 356u.10, 356v, 356w, 356x, 356y,
18
356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
19
356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
20
356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26,
21
356z.29, 356z.30, 356z.32, 356z.32a, 356z.33, 356z.40,
22
356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.56,
23
356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.67,
24
356z.68, 356z.71, 356z.72, 356z.74, 356z.75, 356z.77,
356z.79,

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LRB104 19064 BAB 32509 b
1
356z.80,
356z.81, 356z.83, 356z.84, 356z.85, 356z.88,
364.01,
2
364.3, 367.2, 368a, 370a, 401, 401.1, 402, 403, 403A, 408,
3
408.2, and 412, and paragraphs (7) and (15) of Section 367 of
4
the Illinois Insurance Code.
5

Rulemaking authority to implement Public Act 95-1045, if
6
any, is conditioned on the rules being adopted in accordance
7
with all provisions of the Illinois Administrative Procedure
8
Act and all rules and procedures of the Joint Committee on
9
Administrative Rules; any purported rule not so adopted, for
10
whatever reason, is unauthorized.
11
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
12
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-551, eff.
13
8-11-23; 103-605, eff. 7-1-24; 103-656, eff. 1-1-25; 103-718,
14
eff. 7-19-24; 103-751, eff. 8-2-24; 103-753, eff. 8-2-24;
15
103-758, eff. 1-1-25; 103-832, eff. 1-1-25; 103-914, eff.
16
1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1,
17
eff. 6-9-25; 104-28, eff. 1-1-26; 104-42, eff. 8-1-25; 104-73,
18
eff. 1-1-26; 104-98, eff. 1-1-26; 104-289, eff. 1-1-26;
19
104-324, eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff.
20
8-15-25; revised 11-21-25.)

21

Section 45.
The Pharmacy Practice Act is amended by adding
22
Section 45 as follows:

23

(225 ILCS 85/45 new)
24

Sec. 45.
Prescription hormone therapy.

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1

(a) For purposes of this Section, "prescription hormone
2
therapy" means all drugs approved by the United States Food
3
and Drug Administration that are used to medically suppress,
4
increase, or replace hormones that the body is not producing
5
at intended levels and the necessary supplies for
6
self-administration. "Prescription hormone therapy" does not
7
include glucagon-like peptide-1 and glucagon-like peptide-1
8
receptor agonists.

9

(b) Notwithstanding any other provision of law, a
10
dispensing provider or pharmacist shall dispense, at a
11
patient's request, up to a 12-month supply of a prescription
12
hormone therapy and the necessary supplies for
13
self-administration pursuant to a valid prescription that
14
specifies an initial quantity followed by periodic refills,
15
unless any of the following is true:
16

(1) The patient requests a smaller supply.
17

(2) The prescribing provider instructs that the
18

patient must have a smaller supply.
19

(3) The prescribing provider temporarily limits
20

refills to a 90-day supply due to an acute dispensing
21

shortage, so long as those limits are rescinded at the
22

first opportunity of a regularly reinstated, sustainable
23

supply.
24

(4) The prescription hormone therapy is a controlled
25

substance. If the prescription hormone therapy is a
26

controlled substance, the pharmacist shall dispense the

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1

maximum supply allowed under State and federal law to be
2

obtained at one time by the patient.

3

Section 50.
The Illinois Public Aid Code is amended by
4
changing Section 5-16.8 as follows:

5

(305 ILCS 5/5-16.8)
6

Sec. 5-16.8.
Required health benefits.
The medical
7
assistance program shall (i) provide the post-mastectomy care
8
benefits required to be covered by a policy of accident and
9
health insurance under Section 356t and the coverage required
10
under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
11
356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
12
356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64,
13
356z.67, 356z.71,
and
356z.75,
and
356z.80
, 356z.84, 356z.85,
14
and 356z.88
of the Illinois Insurance Code, (ii) be subject to
15
the provisions of Sections 356z.19, 356z.44, 356z.49, 364.01,
16
370c, and 370c.1 of the Illinois Insurance Code, and (iii) be
17
subject to the provisions of subsection (d-5) of Section 10 of
18
the Network Adequacy and Transparency Act.
19

The Department, by rule, shall adopt a model similar to
20
the requirements of Section 356z.39 of the Illinois Insurance
21
Code.
22

On and after July 1, 2012, the Department shall reduce any
23
rate of reimbursement for services or other payments or alter
24
any methodologies authorized by this Code to reduce any rate

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LRB104 19064 BAB 32509 b
1
of reimbursement for services or other payments in accordance
2
with Section 5-5e.
3

To ensure full access to the benefits set forth in this
4
Section, on and after January 1, 2016, the Department shall
5
ensure that provider and hospital reimbursement for
6
post-mastectomy care benefits required under this Section are
7
no lower than the Medicare reimbursement rate.
8
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
9
103-420, eff. 1-1-24; 103-605, eff. 7-1-24; 103-703, eff.
10
1-1-25; 103-758, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-73,
11
eff. 1-1-26; 104-324, eff. 1-1-26; 104-379, eff. 1-1-26;
12
104-417, eff. 8-15-25; revised 11-21-25.)

13

Section 95.
No acceleration or delay.
Where this Act makes
14
changes in a statute that is represented in this Act by text
15
that is not yet or no longer in effect (for example, a Section
16
represented by multiple versions), the use of that text does
17
not accelerate or delay the taking effect of (i) the changes
18
made by this Act or (ii) provisions derived from any other
19
Public Act.

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