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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB3864

Introduced 2/6/2026, by Sen. John F. Curran

SYNOPSIS AS INTRODUCED:

215 ILCS 5/356e

from Ch. 73, par. 968e
215 ILCS 5/367

from Ch. 73, par. 979

Amends the Illinois Insurance Code. In provisions requiring policies
of group accident and health insurance to provide coverage for certain
examination and testing services provided to a victim of specified
criminal offenses, prohibits the policy from imposing a deductible,
coinsurance, copayment, or any other cost-sharing requirement on the
coverage provided, except to the extent that the coverage would disqualify
a high-deductible health plan from eligibility for a health savings
account under the Internal Revenue Code. Effective January 1, 2027.
LRB104 18638 BAB 32081 b

A BILL FOR

SB3864
LRB104 18638 BAB 32081 b
1

AN ACT concerning regulation.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 5.
The Illinois Insurance Code is amended by
5
changing Sections 356e and 367 as follows:

6

(215 ILCS 5/356e)

(from Ch. 73, par. 968e)
7

Sec. 356e.
Victims of certain offenses.
8

(1) No individual policy of accident and health insurance,
9
which provides benefits for hospital or medical expenses based
10
upon the actual expenses incurred, delivered
,
or issued for
11
delivery to any person in this State shall contain any
12
specific exception to coverage which would preclude the
13
payment under that policy of actual expenses incurred in the
14
examination and testing of a victim of an offense defined in
15
Sections 11-1.20 through 11-1.60 or 12-13 through 12-16 of the
16
Criminal Code of 1961 or the Criminal Code of 2012, or an
17
attempt to commit such offense to establish that sexual
18
contact did occur or did not occur, and to establish the
19
presence or absence of sexually transmitted disease or
20
infection, and examination and treatment of injuries and
21
trauma sustained by a victim of such offense arising out of the
22
offense.
A policy subject to this subsection (1) shall not
23
impose a deductible, coinsurance, copayment, or any other

SB3864
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LRB104 18638 BAB 32081 b
1
cost-sharing requirement on the coverage provided, except that
2
this subsection does not apply to the extent that the coverage
3
would disqualify a high-deductible health plan from
4
eligibility for a health savings account pursuant to Section
5
223 of the Internal Revenue Code.
Every policy of accident and
6
health insurance which specifically provides benefits for
7
routine physical examinations shall provide full coverage for
8
expenses incurred in the examination and testing of a victim
9
of an offense defined in Sections 11-1.20 through 11-1.60 or
10
12-13 through 12-16 of the Criminal Code of 1961 or the
11
Criminal Code of 2012, or an attempt to commit such offense as
12
set forth in this Section. This Section shall not apply to a
13
policy which covers hospital and medical expenses for
14
specified illnesses or injuries only.
15

(2) For purposes of enabling the recovery of State funds,
16
any insurance carrier subject to this Section shall upon
17
reasonable demand by the Department of Public Health disclose
18
the names and identities of its insureds entitled to benefits
19
under this provision to the Department of Public Health
20
whenever the Department of Public Health has determined that
21
it has paid, or is about to pay, hospital or medical expenses
22
for which an insurance carrier is liable under this Section.
23
All information received by the Department of Public Health
24
under this provision shall be held on a confidential basis and
25
shall not be subject to subpoena and shall not be made public
26
by the Department of Public Health or used for any purpose

SB3864
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LRB104 18638 BAB 32081 b
1
other than that authorized by this Section.
2

(3) Whenever the Department of Public Health finds that it
3
has paid all or part of any hospital or medical expenses which
4
an insurance carrier is obligated to pay under this Section,
5
the Department of Public Health shall be entitled to receive
6
reimbursement for its payments from such insurance carrier
7
provided that the Department of Public Health has notified the
8
insurance carrier of its claims before the carrier has paid
9
such benefits to its insureds or in behalf of its insureds.
10
(Source: P.A. 103-718, eff. 7-19-24.)

11

(215 ILCS 5/367)

(from Ch. 73, par. 979)
12

Sec. 367.
Group accident and health insurance.
13

(1) Group accident and health insurance is hereby declared
14
to be that form of accident and health insurance covering not
15
less than 2 employees, members, or employees of members,
16
written under a master policy issued to any governmental
17
corporation, unit, agency or department thereof, or to any
18
corporation, copartnership, individual employer, or to any
19
association upon application of an executive officer or
20
trustee of such association having a constitution or bylaws
21
and formed in good faith for purposes other than that of
22
obtaining insurance, where officers, members, employees,
23
employees of members or classes or department thereof, may be
24
insured for their individual benefit. In addition a group
25
accident and health policy may be written to insure any group

SB3864
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LRB104 18638 BAB 32081 b
1
which may be insured under a group life insurance policy. The
2
term "employees" shall include the officers, managers and
3
employees of subsidiary or affiliated corporations, and the
4
individual proprietors, partners and employees of affiliated
5
individuals and firms, when the business of such subsidiary or
6
affiliated corporations, firms or individuals, is controlled
7
by a common employer through stock ownership, contract or
8
otherwise.
9

(2) Any insurance company authorized to write accident and
10
health insurance in this State shall have power to issue group
11
accident and health policies. No policy of group accident and
12
health insurance may be issued or delivered in this State
13
unless a copy of the form thereof shall have been filed with
14
the department and approved by it in accordance with Section
15
355, and it contains in substance those provisions contained
16
in Sections 357.1 through 357.30 as may be applicable to group
17
accident and health insurance and the following provisions:
18

(a) A provision that the policy, the application of
19

the employer, or executive officer or trustee of any
20

association, and the individual applications, if any, of
21

the employees, members or employees of members insured
22

shall constitute the entire contract between the parties,
23

and that all statements made by the employer, or the
24

executive officer or trustee, or by the individual
25

employees, members or employees of members shall (in the
26

absence of fraud) be deemed representations and not

SB3864
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LRB104 18638 BAB 32081 b
1

warranties, and that no such statement shall be used in
2

defense to a claim under the policy, unless it is
3

contained in a written application.
4

(b) A provision that the insurer will issue to the
5

employer, or to the executive officer or trustee of the
6

association, for delivery to the employee, member or
7

employee of a member, who is insured under such policy, an
8

individual certificate setting forth a statement as to the
9

insurance protection to which he is entitled and to whom
10

payable.
11

(c) A provision that to the group or class thereof
12

originally insured shall be added from time to time all
13

new employees of the employer, members of the association
14

or employees of members eligible to and applying for
15

insurance in such group or class.
16

(3) Anything in this code to the contrary notwithstanding,
17
any group accident and health policy may provide that all or
18
any portion of any indemnities provided by any such policy on
19
account of hospital, nursing, medical or surgical services,
20
may, at the insurer's option, be paid directly to the hospital
21
or person rendering such services; but the policy may not
22
require that the service be rendered by a particular hospital
23
or person. Payment so made shall discharge the insurer's
24
obligation with respect to the amount of insurance so paid.
25
Nothing in this subsection (3) shall prohibit an insurer from
26
providing incentives for insureds to utilize the services of a

SB3864
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LRB104 18638 BAB 32081 b
1
particular hospital or person.
2

(4) Special group policies may be issued to school
3
districts providing medical or hospital service, or both, for
4
pupils of the district injured while participating in any
5
athletic activity under the jurisdiction of or sponsored or
6
controlled by the district or the authorities of any school
7
thereof. The provisions of this Section governing the issuance
8
of group accident and health insurance shall, insofar as
9
applicable, control the issuance of such policies issued to
10
schools.
11

(5) No policy of group accident and health insurance may
12
be issued or delivered in this State unless it provides that
13
upon the death of the insured employee or group member the
14
dependents' coverage, if any, continues for a period of at
15
least 90 days subject to any other policy provisions relating
16
to termination of dependents' coverage.
17

(6) No group hospital policy covering miscellaneous
18
hospital expenses issued or delivered in this State shall
19
contain any exception or exclusion from coverage which would
20
preclude the payment of expenses incurred for the processing
21
and administration of blood and its components.
22

(7) No policy of group accident and health insurance,
23
delivered in this State more than 120 days after the effective
24
day of the Section, which provides inpatient hospital coverage
25
for sicknesses shall exclude from such coverage the treatment
26
of alcoholism. This subsection shall not apply to a policy

SB3864
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LRB104 18638 BAB 32081 b
1
which covers only specified sicknesses.
2

(8) No policy of group accident and health insurance,
3
which provides benefits for hospital or medical expenses based
4
upon the actual expenses incurred, issued
,
or delivered in
5
this State shall contain any specific exception to coverage
6
which would preclude the payment of actual expenses incurred
7
in the examination and testing of a victim of an offense
8
defined in Sections 11-1.20 through 11-1.60 or 12-13 through
9
12-16 of the Criminal Code of 1961 or the Criminal Code of
10
2012, or an attempt to commit such offense, to establish that
11
sexual contact did occur or did not occur, and to establish the
12
presence or absence of sexually transmitted disease or
13
infection, and examination and treatment of injuries and
14
trauma sustained by the victim of such offense, arising out of
15
the offense. Every group policy of accident and health
16
insurance which specifically provides benefits for routine
17
physical examinations shall provide full coverage for expenses
18
incurred in the examination and testing of a victim of an
19
offense defined in Sections 11-1.20 through 11-1.60 or 12-13
20
through 12-16 of the Criminal Code of 1961 or the Criminal Code
21
of 2012, or an attempt to commit such offense, as set forth in
22
this Section. This subsection shall not apply to a policy
23
which covers hospital and medical expenses for specified
24
illnesses and injuries only.
A policy subject to this
25
subsection (8) shall not impose a deductible, coinsurance,
26
copayment, or any other cost-sharing requirement on the

SB3864
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LRB104 18638 BAB 32081 b
1
coverage provided, except that this subsection does not apply
2
to the extent that the coverage would disqualify a
3
high-deductible health plan from eligibility for a health
4
savings account pursuant to Section 223 of the Internal
5
Revenue Code.

6

(9) For purposes of enabling the recovery of State funds,
7
any insurance carrier subject to this Section shall upon
8
reasonable demand by the Department of Public Health disclose
9
the names and identities of its insureds entitled to benefits
10
under this provision to the Department of Public Health
11
whenever the Department of Public Health has determined that
12
it has paid, or is about to pay, hospital or medical expenses
13
for which an insurance carrier is liable under this Section.
14
All information received by the Department of Public Health
15
under this provision shall be held on a confidential basis and
16
shall not be subject to subpoena and shall not be made public
17
by the Department of Public Health or used for any purpose
18
other than that authorized by this Section.
19

(10) Whenever the Department of Public Health finds that
20
it has paid all or part of any hospital or medical expenses
21
which an insurance carrier is obligated to pay under this
22
Section, the Department of Public Health shall be entitled to
23
receive reimbursement for its payments from such insurance
24
carrier provided that the Department of Public Health has
25
notified the insurance carrier of its claim before the carrier
26
has paid the benefits to its insureds or the insureds'

SB3864
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LRB104 18638 BAB 32081 b
1
assignees.
2

(11) (a) No group hospital, medical or surgical expense
3

policy shall contain any provision whereby benefits
4

otherwise payable thereunder are subject to reduction
5

solely on account of the existence of similar benefits
6

provided under other group or group-type accident and
7

sickness insurance policies where such reduction would
8

operate to reduce total benefits payable under these
9

policies below an amount equal to 100% of total allowable
10

expenses provided under these policies.
11

(b) When dependents of insureds are covered under 2
12

policies, both of which contain coordination of benefits
13

provisions, benefits of the policy of the insured whose
14

birthday falls earlier in the year are determined before
15

those of the policy of the insured whose birthday falls
16

later in the year. Birthday, as used herein, refers only
17

to the month and day in a calendar year, not the year in
18

which the person was born. The Department of Insurance
19

shall promulgate rules defining the order of benefit
20

determination pursuant to this paragraph (b).
21

(12) Every group policy under this Section shall be
22
subject to the provisions of Sections 356g and 356n of this
23
Code.
24

(13) No accident and health insurer providing coverage for
25
hospital or medical expenses on an expense incurred basis
26
shall deny reimbursement for an otherwise covered expense

SB3864
- 10 -
LRB104 18638 BAB 32081 b
1
incurred for any organ transplantation procedure solely on the
2
basis that such procedure is deemed experimental or
3
investigational unless supported by the determination of the
4
Office of Health Care Technology Assessment within the Agency
5
for Health Care Policy and Research within the federal
6
Department of Health and Human Services that such procedure is
7
either experimental or investigational or that there is
8
insufficient data or experience to determine whether an organ
9
transplantation procedure is clinically acceptable. If an
10
accident and health insurer has made written request, or had
11
one made on its behalf by a national organization, for
12
determination by the Office of Health Care Technology
13
Assessment within the Agency for Health Care Policy and
14
Research within the federal Department of Health and Human
15
Services as to whether a specific organ transplantation
16
procedure is clinically acceptable and said organization fails
17
to respond to such a request within a period of 90 days, the
18
failure to act may be deemed a determination that the
19
procedure is deemed to be experimental or investigational.
20

(14) Whenever a claim for benefits by an insured under a
21
dental prepayment program is denied or reduced, based on the
22
review of x-ray films, such review must be performed by a
23
dentist.
24
(Source: P.A. 96-1551, eff. 7-1-11; 97-1150, eff. 1-25-13
.)

25

Section 99.
Effective date.
This Act takes effect January
26
1, 2027.

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