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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB3549

Introduced 2/5/2026, by Sen. Napoleon Harris, III

SYNOPSIS AS INTRODUCED:

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

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

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

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

Amends the Accident and Health Article of the Illinois Insurance
Code. Provides that an individual or group policy of accident and health
insurance that is amended, delivered, issued, or renewed on or after
January 1, 2028 shall cover a medically necessary coronary calcium scan
and scoring every 36 months for individuals over the age of 40. Defines
"coronary calcium scan and scoring". Makes conforming changes in 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 Medical Assistance Article of the Illinois Public Aid
Code. Effective January 1, 2027.
LRB104 16024 BAB 29282 b

A BILL FOR

SB3549
LRB104 16024 BAB 29282 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
15
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10,
16
356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
17
356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
18
356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
19
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
20
356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
21
356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70,
22
356z.71, 356z.74, 356z.76,
and
356z.77,
and

356z.81, and
23
356z.88

356z.80
of the Illinois Insurance Code. The program of

SB3549
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LRB104 16024 BAB 29282 b
1
health benefits must comply with Sections 155.22a, 155.37,
2
355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the
3
Illinois Insurance Code. The program of health benefits shall
4
provide the coverage required under Section 356m of the
5
Illinois Insurance Code and, for the employees of the State
6
Employee Group Insurance Program only, the coverage as also
7
provided in Section 6.11B of this Act. The Department of
8
Insurance shall enforce the requirements of this Section with
9
respect to Sections 370c and 370c.1 of the Illinois Insurance
10
Code; all other requirements of this Section shall be enforced
11
by the Department of Central Management Services.
12

Rulemaking authority to implement Public Act 95-1045, if
13
any, is conditioned on the rules being adopted in accordance
14
with all provisions of the Illinois Administrative Procedure
15
Act and all rules and procedures of the Joint Committee on
16
Administrative Rules; any purported rule not so adopted, for
17
whatever reason, is unauthorized.
18
(Source: P.A. 103-8, eff. 1-1-24; 103-84, eff. 1-1-24; 103-91,
19
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
20
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
21
7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-870,
22
eff. 1-1-25; 103-914, eff. 1-1-25; 103-918, eff. 1-1-25;
23
103-951, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-42, eff.
24
8-1-25; 104-417, eff. 8-15-25; revised 10-1-25.)

25

(Text of Section after amendment by P.A. 104-27, 104-68,

SB3549
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LRB104 16024 BAB 29282 b
1
104-73, 104-289, 104-324, and 104-379 but before amendment by
2
P.A. 104-1
)
3

Sec. 6.11.
Required health benefits; Illinois Insurance
4
Code requirements.
The program of health benefits shall
5
provide the post-mastectomy care benefits required to be
6
covered by a policy of accident and health insurance under
7
Section 356t of the Illinois Insurance Code. The program of
8
health benefits shall provide the coverage required under
9
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10,
10
356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
11
356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
12
356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
13
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
14
356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
15
356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70,
16
356z.71, 356z.74, 356z.76,
and
356z.77,
and
356z.80
, 356z.81,
17
356z.82, 356z.83, 356z.84, 356z.85, and 356z.88
of the
18
Illinois Insurance Code. The program of health benefits must
19
comply with Sections 155.22a, 155.37, 355b, 356z.19, 370c, and
20
370c.1 and Article XXXIIB of the Illinois Insurance Code. The
21
program of health benefits shall provide the coverage required
22
under Section 356m of the Illinois Insurance Code and, for the
23
employees of the State Employee Group Insurance Program only,
24
the coverage as also provided in Section 6.11B of this Act. The
25
Department of Insurance shall enforce the requirements of this
26
Section with respect to Sections 370c and 370c.1 and Article

SB3549
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LRB104 16024 BAB 29282 b
1
XXXIIB of the Illinois Insurance Code; all other requirements
2
of this Section shall be enforced by the Department of Central
3
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; 104-27, eff.
16
1-1-26, 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
17
1-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,
18
eff. 1-1-26; 104-417, eff. 8-15-25; revised 10-1-25.)

19

(Text of Section after amendment by P.A. 104-1
)
20

Sec. 6.11.
Required health benefits; Illinois Insurance
21
Code requirements.
The program of health benefits shall
22
provide the post-mastectomy care benefits required to be
23
covered by a policy of accident and health insurance under
24
Section 356t of the Illinois Insurance Code. The program of
25
health benefits shall provide the coverage required under

SB3549
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LRB104 16024 BAB 29282 b
1
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10,
2
356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
3
356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
4
356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
5
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
6
356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
7
356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70,
8
356z.71, 356z.74, 356z.76,
and
356z.77,
356z.79,

and
356z.80
,
9
356z.81, 356z.82, 356z.83, 356z.84, 356z.85, and 356z.88
of
10
the Illinois Insurance Code. The program of health benefits
11
must comply with Sections 155.22a, 155.37, 355b, 356z.19,
12
370c, and 370c.1 and Article XXXIIB of the Illinois Insurance
13
Code. The program of health benefits shall provide the
14
coverage required under Section 356m of the Illinois Insurance
15
Code and, for the employees of the State Employee Group
16
Insurance Program only, the coverage as also provided in
17
Section 6.11B of this Act. The Department of Insurance shall
18
enforce the requirements of this Section with respect to
19
Sections 370c and 370c.1 and Article XXXIIB of the Illinois
20
Insurance Code; all other requirements of this Section shall
21
be enforced by the Department of Central Management Services.
22

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

SB3549
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LRB104 16024 BAB 29282 b
1
whatever reason, is unauthorized.
2
(Source: P.A. 103-8, eff. 1-1-24; 103-84, eff. 1-1-24; 103-91,
3
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
4
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
5
7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-870,
6
eff. 1-1-25; 103-914, eff. 1-1-25; 103-918, eff. 1-1-25;
7
103-951, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
8
7-1-27; 104-27, eff. 1-1-26, 104-42, eff. 8-1-25; 104-68, eff.
9
1-1-26; 104-73, eff. 1-1-26; 104-289, eff. 1-1-26; 104-324,
10
eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25;
11
revised 10-1-25.)

12

Section 10.
The Counties Code is amended by changing
13
Section 5-1069.3 as follows:

14

(55 ILCS 5/5-1069.3)
15

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

Sec. 5-1069.3.
Required health benefits.
If a county,
18
including a home rule county, is a self-insurer for purposes
19
of providing health insurance coverage for its employees, the
20
coverage shall include coverage for the post-mastectomy care
21
benefits required to be covered by a policy of accident and
22
health insurance under Section 356t and the coverage required
23
under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
24
356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,

SB3549
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LRB104 16024 BAB 29282 b
1
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
2
356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36,
3
356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 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, 356z.81,
and
356z.88

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

SB3549
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LRB104 16024 BAB 29282 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; 104-417, eff. 8-15-25; revised
3
10-1-25.)

4

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

Sec. 5-1069.3.
Required health benefits.
If a county,
7
including a home rule county, is a self-insurer for purposes
8
of providing health insurance coverage for its employees, the
9
coverage shall include coverage for the post-mastectomy care
10
benefits required to be covered by a policy of accident and
11
health insurance under Section 356t and the coverage required
12
under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
13
356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
14
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
15
356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36,
16
356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
17
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
18
356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71, 356z.74,
19
and
356z.77,
356z.79,

and
356z.80
, 356z.81, 356z.82, 356z.83,
20
356z.84, 356z.85, and 356z.88
of the Illinois Insurance Code.
21
The coverage shall comply with Sections 155.22a, 355b,
22
356z.19, and 370c of the Illinois Insurance Code. The
23
Department of Insurance shall enforce the requirements of this
24
Section. The requirement that health benefits be covered as
25
provided in this Section is an exclusive power and function of

SB3549
- 9 -
LRB104 16024 BAB 29282 b
1
the State and is a denial and limitation under Article VII,
2
Section 6, subsection (h) of the Illinois Constitution. A home
3
rule county to which this Section applies must comply with
4
every provision of this Section.
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; 103-535, eff.
13
8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
14
eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
15
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
16
6-9-25; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
17
1-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,
18
eff. 1-1-26; 104-417, eff. 8-15-25; revised 10-1-25.)

19

Section 15.
The Illinois Municipal Code is amended by
20
changing Section 10-4-2.3 as follows:

21

(65 ILCS 5/10-4-2.3)
22

(Text of Section before amendment by P.A. 104-68, 104-73,
23
104-289, 104-324, and 104-379
)
24

Sec. 10-4-2.3.
Required health benefits.
If a

SB3549
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LRB104 16024 BAB 29282 b
1
municipality, including a home rule municipality, is a
2
self-insurer for purposes of providing health insurance
3
coverage for its employees, the coverage shall include
4
coverage for the post-mastectomy care benefits required to be
5
covered by a policy of accident and health insurance under
6
Section 356t and the coverage required under Sections 356g,
7
356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
8
356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
9
356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
10
356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
11
356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
12
356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
13
356z.67, 356z.68, 356z.70, 356z.71, 356z.74,
and
356z.77,
14
356z.79, 356z.81,
and
356z.88

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

SB3549
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LRB104 16024 BAB 29282 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; 104-417, eff. 8-15-25; revised
10
10-2-25.)

11

(Text of Section after amendment by P.A. 104-68, 104-73,
12
104-289, 104-324, and 104-379
)
13

Sec. 10-4-2.3.
Required health benefits.
If a
14
municipality, including a home rule municipality, is a
15
self-insurer for purposes of providing health insurance
16
coverage for its employees, the coverage shall include
17
coverage for the post-mastectomy care benefits required to be
18
covered by a policy of accident and health insurance under
19
Section 356t and the coverage required under Sections 356g,
20
356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
21
356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
22
356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
23
356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
24
356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
25
356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,

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1
356z.67, 356z.68, 356z.70, 356z.71, 356z.74,
and
356z.77,
2
356z.79,

and
356z.80
, 356z.81, 356z.82, 356z.83, 356z.84,
3
356z.85, and 356z.88
of the Illinois Insurance Code. The
4
coverage shall comply with Sections 155.22a, 355b, 356z.19,
5
and 370c of the Illinois Insurance Code. The Department of
6
Insurance shall enforce the requirements of this Section. The
7
requirement that health benefits be covered as provided in
8
this is an exclusive power and function of the State and is a
9
denial and limitation under Article VII, Section 6, subsection
10
(h) of the Illinois Constitution. A home rule municipality to
11
which this Section applies must comply with every provision of
12
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; 104-42, 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 10-2-25.)

SB3549
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LRB104 16024 BAB 29282 b
1

Section 20.
The School Code is amended by changing Section
2
10-22.3f as follows:

3

(105 ILCS 5/10-22.3f)
4

(Text of Section before amendment by P.A. 104-27, 104-68,
5
104-73, 104-289, 104-324, and 104-379
)
6

Sec. 10-22.3f.
Required health benefits.
Insurance
7
protection and benefits for employees shall provide the
8
post-mastectomy care benefits required to be covered by a
9
policy of accident and health insurance under Section 356t and
10
the coverage required under Sections 356g, 356g.5, 356g.5-1,
11
356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a,
12
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14,
13
356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
14
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
15
356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
16
356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71,
17
356z.74,
and
356z.77,
356z.79, 356z.81,
and
356z.88

356z.80
of
18
the Illinois Insurance Code. Insurance policies shall comply
19
with Section 356z.19 of the Illinois Insurance Code. The
20
coverage shall comply with Sections 155.22a, 355b, and 370c of
21
the Illinois Insurance Code. The Department of Insurance shall
22
enforce the requirements of this Section.
23

Rulemaking authority to implement Public Act 95-1045, if
24
any, is conditioned on the rules being adopted in accordance

SB3549
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LRB104 16024 BAB 29282 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. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
6
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
7
8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
8
eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
9
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
10
6-9-25; 104-42, eff. 8-1-25; 104-417, eff. 8-15-25; revised
11
10-2-25.)

12

(Text of Section after amendment by P.A. 104-27, 104-68,
13
104-73, 104-289, 104-324, and 104-379
)
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,
25
356z.74,
and
356z.77,
356z.79,

and
356z.80
, 356z.81, 356z.82,

SB3549
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LRB104 16024 BAB 29282 b
1
356z.83, 356z.84, 356z.85, and 356z.88
of the Illinois
2
Insurance Code. Insurance policies shall comply with Section
3
356z.19 of the Illinois Insurance Code. The coverage shall
4
comply with Sections 155.22a, 355b, and 370c and Article
5
XXXIIB of the Illinois Insurance Code. The Department of
6
Insurance shall enforce the requirements of this Section.
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; 103-535, eff.
15
8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
16
eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
17
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
18
6-9-25; 104-27, eff. 1-1-26; 104-42, eff. 8-1-25; 104-68, eff.
19
1-1-26; 104-73, eff. 1-1-26; 104-289, eff. 1-1-26; 104-324,
20
eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25;
21
revised 10-2-25.)

22

Section 25.
The Illinois Insurance Code is amended by
23
adding Section 356z.88 as follows:

24

(215 ILCS 5/356z.88 new)

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LRB104 16024 BAB 29282 b
1

Sec. 356z.88.
Coronary calcium scan and scoring.

2

(a) As used in this Section, "coronary calcium scan and
3
scoring" means the use of computed tomography equipment to
4
produce pictures of the coronary arteries to locate blockages
5
or narrowing.
6

(b) An individual or group policy of accident and health
7
insurance that is amended, delivered, issued, or renewed on or
8
after January 1, 2028 shall cover a medically necessary
9
coronary calcium scan and scoring every 36 months for
10
individuals over the age of 40.

11

Section 30.
The Health Maintenance Organization Act is
12
amended by changing Section 5-3 as follows:

13

(215 ILCS 125/5-3)

(from Ch. 111 1/2, par. 1411.2)
14

(Text of Section before amendment by P.A. 103-808, 104-28,
15
104-68, 104-73, 104-98, 104-289, 104-324, and 104-379
)
16

Sec. 5-3.
Illinois
Insurance Code provisions.
17

(a) Health Maintenance Organizations shall be subject to
18
the provisions of Sections 133, 134, 136, 137, 139, 140,
19
141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
20
152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
21
155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g.5-1,
22
356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2, 356z.3a,
23
356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
24
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,

SB3549
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1
356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24, 356z.25,
2
356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32, 356z.33,
3
356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40,
4
356z.40a, 356z.41, 356z.44, 356z.45, 356z.46, 356z.47,
5
356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54, 356z.55,
6
356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61, 356z.62,
7
356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68, 356z.69,
8
356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75, 356z.76,
9
356z.77, 356z.78,
356z.79, 356z.81, 356z.88,

356z.80,
364,
10
364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d,
11
368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2,
12
409, 412, 444, and 444.1, paragraph (c) of subsection (2) of
13
Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
14
XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois Insurance
15
Code. Section
356z.81

365z.80
of the Illinois Insurance Code
16
is not applicable to health care plans under contract with the
17
Department of Healthcare and Family Services.
18

(b) For purposes of the Illinois Insurance Code, except
19
for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
20
Health Maintenance Organizations in the following categories
21
are deemed to be "domestic companies":
22

(1) a corporation authorized under the Dental Service
23

Plan Act or the Voluntary Health Services Plans Act;
24

(2) a corporation organized under the laws of this
25

State; or
26

(3) a corporation organized under the laws of another

SB3549
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LRB104 16024 BAB 29282 b
1

state, 30% or more of the enrollees of which are residents
2

of this State, except a corporation subject to
3

substantially the same requirements in its state of
4

organization as is a "domestic company" under Article VIII
5

1/2 of the Illinois Insurance Code.
6

(c) In considering the merger, consolidation, or other
7
acquisition of control of a Health Maintenance Organization
8
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
9

(1) the Director shall give primary consideration to
10

the continuation of benefits to enrollees and the
11

financial conditions of the acquired Health Maintenance
12

Organization after the merger, consolidation, or other
13

acquisition of control takes effect;
14

(2)(i) the criteria specified in subsection (1)(b) of
15

Section 131.8 of the Illinois Insurance Code shall not
16

apply and (ii) the Director, in making his determination
17

with respect to the merger, consolidation, or other
18

acquisition of control, need not take into account the
19

effect on competition of the merger, consolidation, or
20

other acquisition of control;
21

(3) the Director shall have the power to require the
22

following information:
23

(A) certification by an independent actuary of the
24

adequacy of the reserves of the Health Maintenance
25

Organization sought to be acquired;
26

(B) pro forma financial statements reflecting the

SB3549
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LRB104 16024 BAB 29282 b
1

combined balance sheets of the acquiring company and
2

the Health Maintenance Organization sought to be
3

acquired as of the end of the preceding year and as of
4

a date 90 days prior to the acquisition, as well as pro
5

forma financial statements reflecting projected
6

combined operation for a period of 2 years;
7

(C) a pro forma business plan detailing an
8

acquiring party's plans with respect to the operation
9

of the Health Maintenance Organization sought to be
10

acquired for a period of not less than 3 years; and
11

(D) such other information as the Director shall
12

require.
13

(d) The provisions of Article VIII 1/2 of the Illinois
14
Insurance Code and this Section 5-3 shall apply to the sale by
15
any health maintenance organization of greater than 10% of its
16
enrollee population (including, without limitation, the health
17
maintenance organization's right, title, and interest in and
18
to its health care certificates).
19

(e) In considering any management contract or service
20
agreement subject to Section 141.1 of the Illinois Insurance
21
Code, the Director (i) shall, in addition to the criteria
22
specified in Section 141.2 of the Illinois Insurance Code,
23
take into account the effect of the management contract or
24
service agreement on the continuation of benefits to enrollees
25
and the financial condition of the health maintenance
26
organization to be managed or serviced, and (ii) need not take

SB3549
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LRB104 16024 BAB 29282 b
1
into account the effect of the management contract or service
2
agreement on competition.
3

(f) Except for small employer groups as defined in the
4
Small Employer Rating, Renewability and Portability Health
5
Insurance Act and except for medicare supplement policies as
6
defined in Section 363 of the Illinois Insurance Code, a
7
Health Maintenance Organization may by contract agree with a
8
group or other enrollment unit to effect refunds or charge
9
additional premiums under the following terms and conditions:
10

(i) the amount of, and other terms and conditions with
11

respect to, the refund or additional premium are set forth
12

in the group or enrollment unit contract agreed in advance
13

of the period for which a refund is to be paid or
14

additional premium is to be charged (which period shall
15

not be less than one year); and
16

(ii) the amount of the refund or additional premium
17

shall not exceed 20% of the Health Maintenance
18

Organization's profitable or unprofitable experience with
19

respect to the group or other enrollment unit for the
20

period (and, for purposes of a refund or additional
21

premium, the profitable or unprofitable experience shall
22

be calculated taking into account a pro rata share of the
23

Health Maintenance Organization's administrative and
24

marketing expenses, but shall not include any refund to be
25

made or additional premium to be paid pursuant to this
26

subsection (f)). The Health Maintenance Organization and

SB3549
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LRB104 16024 BAB 29282 b
1

the group or enrollment unit may agree that the profitable
2

or unprofitable experience may be calculated taking into
3

account the refund period and the immediately preceding 2
4

plan years.
5

The Health Maintenance Organization shall include a
6
statement in the evidence of coverage issued to each enrollee
7
describing the possibility of a refund or additional premium,
8
and upon request of any group or enrollment unit, provide to
9
the group or enrollment unit a description of the method used
10
to calculate (1) the Health Maintenance Organization's
11
profitable experience with respect to the group or enrollment
12
unit and the resulting refund to the group or enrollment unit
13
or (2) the Health Maintenance Organization's unprofitable
14
experience with respect to the group or enrollment unit and
15
the resulting additional premium to be paid by the group or
16
enrollment unit.
17

In no event shall the Illinois Health Maintenance
18
Organization Guaranty Association be liable to pay any
19
contractual obligation of an insolvent organization to pay any
20
refund authorized under this Section.
21

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

SB3549
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LRB104 16024 BAB 29282 b
1
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
2
103-123, eff. 1-1-24; 103-154, eff. 6-30-23; 103-420, eff.
3
1-1-24; 103-426, eff. 8-4-23; 103-445, eff. 1-1-24; 103-551,
4
eff. 8-11-23; 103-605, eff. 7-1-24; 103-618, eff. 1-1-25;
5
103-649, eff. 1-1-25; 103-656, eff. 1-1-25; 103-700, eff.
6
1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
7
eff. 8-2-24; 103-758, eff. 1-1-25; 103-777, eff. 8-2-24;
8
103-914, eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff.
9
1-1-25; 104-1, eff. 6-9-25; 104-42, eff. 8-1-25; 104-334, eff.
10
8-15-25; 104-417, eff. 8-15-25; revised 10-3-25.)

11

(Text of Section after amendment by P.A. 103-808, 104-28,
12
104-68, 104-73, 104-98, 104-289, 104-324, and 104-379
)
13

Sec. 5-3.
Illinois Insurance Code provisions.
14

(a) Health Maintenance Organizations shall be subject to
15
the provisions of Sections 133, 134, 136, 137, 139, 140,
16
141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
17
152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
18
155.49, 352c, 355.2, 355.3, 355.6, 355.7, 355b, 355c, 356f,
19
356g, 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
20
356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
21
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
22
356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
23
356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
24
356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
25
356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,

SB3549
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LRB104 16024 BAB 29282 b
1
356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
2
356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
3
356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
4
356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,
5
356z.76, 356z.77, 356z.78,
356z.79,
356z.80,
356z.81, 356z.82,
6
356z.83, 356z.84, 356z.85, 356z.88,
364, 364.01, 364.3, 367.2,
7
367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370a, 370c,
8
370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444,
9
and 444.1, paragraph (c) of subsection (2) of Section 367, and
10
Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
11
XXVI, and XXXIIB of the Illinois Insurance Code.
12

(b) For purposes of the Illinois Insurance Code, except
13
for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
14
Health Maintenance Organizations in the following categories
15
are deemed to be "domestic companies":
16

(1) a corporation authorized under the Dental Service
17

Plan Act or the Voluntary Health Services Plans Act;
18

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

State; or
20

(3) a corporation organized under the laws of another
21

state, 30% or more of the enrollees of which are residents
22

of this State, except a corporation subject to
23

substantially the same requirements in its state of
24

organization as is a "domestic company" under Article VIII
25

1/2 of the Illinois Insurance Code.
26

(c) In considering the merger, consolidation, or other

SB3549
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LRB104 16024 BAB 29282 b
1
acquisition of control of a Health Maintenance Organization
2
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
3

(1) the Director shall give primary consideration to
4

the continuation of benefits to enrollees and the
5

financial conditions of the acquired Health Maintenance
6

Organization after the merger, consolidation, or other
7

acquisition of control takes effect;
8

(2)(i) the criteria specified in subsection (1)(b) of
9

Section 131.8 of the Illinois Insurance Code shall not
10

apply and (ii) the Director, in making his determination
11

with respect to the merger, consolidation, or other
12

acquisition of control, need not take into account the
13

effect on competition of the merger, consolidation, or
14

other acquisition of control;
15

(3) the Director shall have the power to require the
16

following information:
17

(A) certification by an independent actuary of the
18

adequacy of the reserves of the Health Maintenance
19

Organization sought to be acquired;
20

(B) pro forma financial statements reflecting the
21

combined balance sheets of the acquiring company and
22

the Health Maintenance Organization sought to be
23

acquired as of the end of the preceding year and as of
24

a date 90 days prior to the acquisition, as well as pro
25

forma financial statements reflecting projected
26

combined operation for a period of 2 years;

SB3549
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LRB104 16024 BAB 29282 b
1

(C) a pro forma business plan detailing an
2

acquiring party's plans with respect to the operation
3

of the Health Maintenance Organization sought to be
4

acquired for a period of not less than 3 years; and
5

(D) such other information as the Director shall
6

require.
7

(d) The provisions of Article VIII 1/2 of the Illinois
8
Insurance Code and this Section 5-3 shall apply to the sale by
9
any health maintenance organization of greater than 10% of its
10
enrollee population (including, without limitation, the health
11
maintenance organization's right, title, and interest in and
12
to its health care certificates).
13

(e) In considering any management contract or service
14
agreement subject to Section 141.1 of the Illinois Insurance
15
Code, the Director (i) shall, in addition to the criteria
16
specified in Section 141.2 of the Illinois Insurance Code,
17
take into account the effect of the management contract or
18
service agreement on the continuation of benefits to enrollees
19
and the financial condition of the health maintenance
20
organization to be managed or serviced, and (ii) need not take
21
into account the effect of the management contract or service
22
agreement on competition.
23

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

SB3549
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LRB104 16024 BAB 29282 b
1
Health Maintenance Organization may by contract agree with a
2
group or other enrollment unit to effect refunds or charge
3
additional premiums under the following terms and conditions:
4

(i) the amount of, and other terms and conditions with
5

respect to, the refund or additional premium are set forth
6

in the group or enrollment unit contract agreed in advance
7

of the period for which a refund is to be paid or
8

additional premium is to be charged (which period shall
9

not be less than one year); and
10

(ii) the amount of the refund or additional premium
11

shall not exceed 20% of the Health Maintenance
12

Organization's profitable or unprofitable experience with
13

respect to the group or other enrollment unit for the
14

period (and, for purposes of a refund or additional
15

premium, the profitable or unprofitable experience shall
16

be calculated taking into account a pro rata share of the
17

Health Maintenance Organization's administrative and
18

marketing expenses, but shall not include any refund to be
19

made or additional premium to be paid pursuant to this
20

subsection (f)). The Health Maintenance Organization and
21

the group or enrollment unit may agree that the profitable
22

or unprofitable experience may be calculated taking into
23

account the refund period and the immediately preceding 2
24

plan years.
25

The Health Maintenance Organization shall include a
26
statement in the evidence of coverage issued to each enrollee

SB3549
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LRB104 16024 BAB 29282 b
1
describing the possibility of a refund or additional premium,
2
and upon request of any group or enrollment unit, provide to
3
the group or enrollment unit a description of the method used
4
to calculate (1) the Health Maintenance Organization's
5
profitable experience with respect to the group or enrollment
6
unit and the resulting refund to the group or enrollment unit
7
or (2) the Health Maintenance Organization's unprofitable
8
experience with respect to the group or enrollment unit and
9
the resulting additional premium to be paid by the group or
10
enrollment unit.
11

In no event shall the Illinois Health Maintenance
12
Organization Guaranty Association be liable to pay any
13
contractual obligation of an insolvent organization to pay any
14
refund authorized under this Section.
15

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

SB3549
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LRB104 16024 BAB 29282 b
1
eff. 8-2-24; 103-758, eff. 1-1-25; 103-777, eff. 8-2-24;
2
103-808, eff. 1-1-26; 103-914, eff. 1-1-25; 103-918, eff.
3
1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-28,
4
eff. 1-1-26; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73,
5
eff. 1-1-26; 104-98, eff. 1-1-26; 104-289, eff. 1-1-26;
6
104-324, eff. 1-1-26; 104-334, eff. 8-15-25; 104-379, eff.
7
1-1-26; 104-417, eff. 8-15-25; revised 10-3-25.)

8

Section 35.
The Limited Health Service Organization Act is
9
amended by changing Section 4003 as follows:

10

(215 ILCS 130/4003)

(from Ch. 73, par. 1504-3)
11

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

Sec. 4003.
Illinois Insurance Code provisions.
Limited
14
health service organizations shall be subject to the
15
provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
16
141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
17
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
18
355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
19
356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
20
356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
21
356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
22
356z.73, 356z.74, 356z.75, 356z.79,
356z.81, 356z.88,

356z.80,

23
364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
24
444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,

SB3549
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LRB104 16024 BAB 29282 b
1
XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois Insurance
2
Code. Nothing in this Section shall require a limited health
3
care plan to cover any service that is not a limited health
4
service. For purposes of the Illinois Insurance Code, except
5
for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
6
limited health service organizations in the following
7
categories are deemed to be domestic companies:
8

(1) a corporation under the laws of this State; or
9

(2) a corporation organized under the laws of another
10

state, 30% or more of the enrollees of which are residents
11

of this State, except a corporation subject to
12

substantially the same requirements in its state of
13

organization as is a domestic company under Article VIII
14

1/2 of the Illinois Insurance Code.
15
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
16
103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, eff.
17
1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25; 103-656,
18
eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24;
19
103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff.
20
1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-42,
21
eff. 8-1-25; 104-334, eff. 8-15-25; 104-417, eff. 8-15-25;
22
revised 10-3-25.)

23

(Text of Section after amendment by P.A. 104-73, 104-98,
24
104-289, 104-324, and 104-379
)
25

Sec. 4003.
Illinois Insurance Code provisions.
Limited

SB3549
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LRB104 16024 BAB 29282 b
1
health service organizations shall be subject to the
2
provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
3
141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
4
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
5
355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
6
356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
7
356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
8
356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
9
356z.73, 356z.74, 356z.75, 356z.79, 356z.80,
356z.81, 356z.83,
10
356z.84, 356z.85, 356z.88,
364.3, 368a, 370a, 401, 401.1, 402,
11
403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles
12
IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
13
XXXIIB of the Illinois Insurance Code. Nothing in this Section
14
shall require a limited health care plan to cover any service
15
that is not a limited health service. For purposes of the
16
Illinois Insurance Code, except for Sections 444 and 444.1 and
17
Articles XIII and XIII 1/2, limited health service
18
organizations in the following categories are deemed to be
19
domestic companies:
20

(1) a corporation under the laws of this State; or
21

(2) a corporation organized under the laws of another
22

state, 30% or more of the enrollees of which are residents
23

of this State, except a corporation subject to
24

substantially the same requirements in its state of
25

organization as is a domestic company under Article VIII
26

1/2 of the Illinois Insurance Code.

SB3549
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LRB104 16024 BAB 29282 b
1
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
2
103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, eff.
3
1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25; 103-656,
4
eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24;
5
103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff.
6
1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-42,
7
eff. 8-1-25; 104-73, eff. 1-1-26; 104-98, eff. 1-1-26;
8
104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-334, eff.
9
8-15-25; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25; revised
10
10-3-25.)

11

Section 40.
The Voluntary Health Services Plans Act is
12
amended by changing Section 10 as follows:

13

(215 ILCS 165/10)

(from Ch. 32, par. 604)
14

(Text of Section before amendment by P.A. 104-28, 104-73,
15
104-98, 104-289, 104-324, and 104-379
)
16

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

SB3549
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LRB104 16024 BAB 29282 b
1
356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
2
356z.32, 356z.32a, 356z.33, 356z.40, 356z.41, 356z.46,
3
356z.47, 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59,
4
356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.71,
5
356z.72, 356z.74, 356z.75, 356z.77,
356z.79, 356z.81, 356z.88,

6
356z.80,
364.01, 364.3, 367.2, 368a, 401, 401.1, 402, 403,
7
403A, 408, 408.2, and 412, and paragraphs (7) and (15) of
8
Section 367 of the Illinois Insurance Code.
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; 103-551, eff.
17
8-11-23; 103-605, eff. 7-1-24; 103-656, eff. 1-1-25; 103-718,
18
eff. 7-19-24; 103-751, eff. 8-2-24; 103-753, eff. 8-2-24;
19
103-758, eff. 1-1-25; 103-832, eff. 1-1-25; 103-914, eff.
20
1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1,
21
eff. 6-9-25; 104-42, eff. 8-1-25; 104-417, eff. 8-15-25;
22
revised 10-3-25.)

23

(Text of Section after amendment by P.A. 104-28, 104-73,
24
104-98, 104-289, 104-324, and 104-379
)
25

Sec. 10.
Application of Illinois Insurance Code

SB3549
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LRB104 16024 BAB 29282 b
1
provisions.
Health services plan corporations and all persons
2
interested therein or dealing therewith shall be subject to
3
the provisions of Articles IIA and XII 1/2 and Sections 3.1,
4
133, 136, 139, 140, 143, 143.31, 143c, 149, 155.22a, 155.37,
5
354, 355.2, 355.3, 355.7, 355b, 355d, 356g, 356g.5, 356g.5-1,
6
356m, 356q, 356r, 356t, 356u, 356u.10, 356v, 356w, 356x, 356y,
7
356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
8
356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
9
356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26,
10
356z.29, 356z.30, 356z.32, 356z.32a, 356z.33, 356z.40,
11
356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.56,
12
356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.67,
13
356z.68, 356z.71, 356z.72, 356z.74, 356z.75, 356z.77,
356z.79,

14
356z.80,
356z.81, 356z.83, 356z.84, 356z.85, 356z.88,
364.01,
15
364.3, 367.2, 368a, 370a, 401, 401.1, 402, 403, 403A, 408,
16
408.2, and 412, and paragraphs (7) and (15) of Section 367 of
17
the Illinois Insurance Code.
18

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

SB3549
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LRB104 16024 BAB 29282 b
1
eff. 7-19-24; 103-751, eff. 8-2-24; 103-753, eff. 8-2-24;
2
103-758, eff. 1-1-25; 103-832, eff. 1-1-25; 103-914, eff.
3
1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1,
4
eff. 6-9-25; 104-28, eff. 1-1-26; 104-42, eff. 8-1-25; 104-73,
5
eff. 1-1-26; 104-98, eff. 1-1-26; 104-289, eff. 1-1-26;
6
104-324, eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff.
7
8-15-25; revised 10-3-25.)

8

Section 45.
The Illinois Public Aid Code is amended by
9
changing Section 5-16.8 as follows:

10

(305 ILCS 5/5-16.8)
11

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

Sec. 5-16.8.
Required health benefits.
The medical
14
assistance program shall (i) provide the post-mastectomy care
15
benefits required to be covered by a policy of accident and
16
health insurance under Section 356t and the coverage required
17
under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
18
356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
19
356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64,
20
356z.67, 356z.71,
and
356z.75
, and 356z.88
of the Illinois
21
Insurance Code, (ii) be subject to the provisions of Sections
22
356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the
23
Illinois Insurance Code, and (iii) be subject to the
24
provisions of subsection (d-5) of Section 10 of the Network

SB3549
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LRB104 16024 BAB 29282 b
1
Adequacy and Transparency 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,

SB3549
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LRB104 16024 BAB 29282 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, 356z.85,
4
and 356z.88
of the Illinois Insurance Code, (ii) be subject to
5
the 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.
9

The Department, by rule, shall adopt a model similar to
10
the requirements of Section 356z.39 of the Illinois Insurance
11
Code.
12

On and after July 1, 2012, the Department shall reduce any
13
rate of reimbursement for services or other payments or alter
14
any methodologies authorized by this Code to reduce any rate
15
of reimbursement for services or other payments in accordance
16
with Section 5-5e.
17

To ensure full access to the benefits set forth in this
18
Section, on and after January 1, 2016, the Department shall
19
ensure that provider and hospital reimbursement for
20
post-mastectomy care benefits required under this Section are
21
no lower than the Medicare reimbursement rate.
22
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
23
103-420, eff. 1-1-24; 103-605, eff. 7-1-24; 103-703, eff.
24
1-1-25; 103-758, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-73,
25
eff. 1-1-26; 104-324, eff. 1-1-26; 104-379, eff. 1-1-26;
26
104-417, eff. 8-15-25; revised 10-3-25.)

SB3549
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LRB104 16024 BAB 29282 b
1

Section 95.
No acceleration or delay.
Where this Act makes
2
changes in a statute that is represented in this Act by text
3
that is not yet or no longer in effect (for example, a Section
4
represented by multiple versions), the use of that text does
5
not accelerate or delay the taking effect of (i) the changes
6
made by this Act or (ii) provisions derived from any other
7
Public Act.

8

Section 99.
Effective date.
This Act takes effect January
9
1, 2027.

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