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HB 3561

Illinois House•In House Committee

Summary

HB 3561, “INS CD-EGG & PEANUT ALLERGY”, was introduced in the House on Feb 7, 2025 by Rep. Dagmara Avelar (D). It was referred to Rules, and last saw action on Mar 21, 2025: Rule 19(a) / Re-referred to Rules Committee.

Record

Text

HB 3561 has no co-sponsors and has not gone to a roll call.

hb3561/introduced.txt
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Full Text of HB3561
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	HB3561 - 104th General Assembly
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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB3561
Introduced 2/18/2025, by Rep. Dagmara Avelar
SYNOPSIS AS INTRODUCED:
See Index
Amends the Illinois Insurance Code. Requires a group or individual policy of accident and health insurance or a managed care plan to provide coverage for at least one early egg allergen introduction dietary supplement and one early peanut allergen introduction dietary supplement. Provides that the required coverage shall be provided at no cost to a covered individual, including deductible payments and cost-sharing amounts charged once a deductible is met. Except as otherwise provided, nothing in the provisions prevents the operation of such a policy provision as a deductible, coinsurance, allowable charge limitation, coordination of benefits, or a provision restricting coverage to services by a licensed, certified, or carrier-approved provider or facility. Provides that the required coverage does not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, disability income, or other limited benefit health insurance policies, and that the cost-sharing limitation does not apply to a catastrophic health plan to the extent the cost-sharing limitation would cause the plan to fail to be treated as a catastrophic plan under federal law. Provides that the cost-sharing limitation does not apply to a high deductible health plan to the extent this cost-sharing limitation would cause the plan to fail to be treated as a high deductible health plan under specified provisions of the Internal Revenue Code. Provides that, if the cost-sharing limitation would result in an enrollee becoming ineligible for a health savings account under federal law, the cost-sharing limitation only applies to a qualified high deductible health plan after the enrollee's deductible has been met. 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 those provisions.
LRB104 10745 BAB 20824 b
A BILL FOR
		HB3561		LRB104 10745 BAB 20824 b
    AN ACT concerning regulation.
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
    Section 5. The State Employees Group Insurance Act of 1971
is amended by changing Section 6.11 as follows:
    (5 ILCS 375/6.11)
    Sec. 6.11. Required health benefits; Illinois Insurance
Code requirements. The program of health benefits shall
provide the post-mastectomy care benefits required to be
covered by a policy of accident and health insurance under
Section 356t of the Illinois Insurance Code. The program of
health benefits shall provide the coverage required under
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10,
356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, [and]
356z.70, [and] 356z.71, 356z.74, 356z.76, 356z.77, and 356z.80
of the Illinois Insurance Code. The program of health benefits
must comply with Sections 155.22a, 155.37, 355b, 356z.19,
370c, and 370c.1 and Article XXXIIB of the Illinois Insurance
		HB3561	- 2 -	LRB104 10745 BAB 20824 b
Code. The program of health benefits shall provide the
coverage required under Section 356m of the Illinois Insurance
Code and, for the employees of the State Employee Group
Insurance Program only, the coverage as also provided in
Section 6.11B of this Act. The Department of Insurance shall
enforce the requirements of this Section with respect to
Sections 370c and 370c.1 of the Illinois Insurance Code; all
other requirements of this Section shall be enforced by the
Department of Central Management Services.
    Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
8-11-23; 103-605, eff. 7-1-24; 103-718, eff. 7-19-24; 103-751,
eff. 8-2-24; 103-870, eff. 1-1-25; 103-914, eff. 1-1-25;
103-918, eff. 1-1-25; 103-951, eff. 1-1-25; 103-1024, eff.
		HB3561	- 3 -	LRB104 10745 BAB 20824 b
1-1-25; revised 11-26-24.)
    Section 10. The Counties Code is amended by changing
Section 5-1069.3 as follows:
    (55 ILCS 5/5-1069.3)
    Sec. 5-1069.3. Required health benefits. If a county,
including a home rule county, is a self-insurer for purposes
of providing health insurance coverage for its employees, the
coverage shall include coverage for the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36,
356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
356z.62, 356z.64, 356z.67, 356z.68, [and] 356z.70, [and] 356z.71, 
356z.74, 356z.77, and 356z.80 of the Illinois Insurance Code.
The coverage shall comply with Sections 155.22a, 355b,
356z.19, and 370c of the Illinois Insurance Code. The
Department of Insurance shall enforce the requirements of this
Section. The requirement that health benefits be covered as
provided in this Section is an exclusive power and function of
the State and is a denial and limitation under Article VII,
		HB3561	- 4 -	LRB104 10745 BAB 20824 b
Section 6, subsection (h) of the Illinois Constitution. A home
rule county to which this Section applies must comply with
every provision of this Section.
    Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
revised 11-26-24.)
    Section 15. The Illinois Municipal Code is amended by
changing Section 10-4-2.3 as follows:
    (65 ILCS 5/10-4-2.3)
    Sec. 10-4-2.3. Required health benefits. If a
		HB3561	- 5 -	LRB104 10745 BAB 20824 b
municipality, including a home rule municipality, is a
self-insurer for purposes of providing health insurance
coverage for its employees, the coverage shall include
coverage for the post-mastectomy care benefits required to be
covered by a policy of accident and health insurance under
Section 356t and the coverage required under Sections 356g,
356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
356z.67, 356z.68, [and] 356z.70, [and] 356z.71, 356z.74, 356z.77, 
and 356z.80 of the Illinois Insurance Code. The coverage shall
comply with Sections 155.22a, 355b, 356z.19, and 370c of the
Illinois Insurance Code. The Department of Insurance shall
enforce the requirements of this Section. The requirement that
health benefits be covered as provided in this is an exclusive
power and function of the State and is a denial and limitation
under Article VII, Section 6, subsection (h) of the Illinois
Constitution. A home rule municipality to which this Section
applies must comply with every provision of this Section.
    Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
		HB3561	- 6 -	LRB104 10745 BAB 20824 b
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
revised 11-26-24.)
    Section 20. The School Code is amended by changing Section
10-22.3f as follows:
    (105 ILCS 5/10-22.3f)
    Sec. 10-22.3f. Required health benefits. Insurance
protection and benefits for employees shall provide the
post-mastectomy care benefits required to be covered by a
policy of accident and health insurance under Section 356t and
the coverage required under Sections 356g, 356g.5, 356g.5-1,
356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14,
356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
		HB3561	- 7 -	LRB104 10745 BAB 20824 b
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
356z.61, 356z.62, 356z.64, 356z.67, 356z.68, [and] 356z.70, [and]
356z.71, 356z.74, 356z.77, and 356z.80 of the Illinois
Insurance Code. Insurance policies shall comply with Section
356z.19 of the Illinois Insurance Code. The coverage shall
comply with Sections 155.22a, 355b, and 370c of the Illinois
Insurance Code. The Department of Insurance shall enforce the
requirements of this Section.
    Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718, eff.
7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918,
eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
		HB3561	- 8 -	LRB104 10745 BAB 20824 b
    Section 22. The Illinois Insurance Code is amended by
adding Section 356z.80 as follows:
    (5 ILCS 375/356z.80 new)
    Sec. 356z.80. Coverage for allergenic protein dietary 
supplements.
    (a) As used in this Section:
    "Dietary supplement" has the meaning given to that term in 
the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. 321.
    "Early egg allergen introduction dietary supplement" means 
a dietary supplement that is prescribed to an infant by a 
health care provider and contains sufficient infant-safe, 
well-cooked egg protein to reduce the risk of food allergies.
    "Early peanut allergen introduction dietary supplement" 
means a dietary supplement that is prescribed to an infant by a 
health care provider and contains sufficient infant-safe 
peanut protein to reduce the risk of food allergies.
    "Health care provider" or "provider" means a physician, 
hospital facility, or other health care practitioner licensed, 
accredited, or certified to perform specified health care 
services consistent with State law, responsible for 
recommending health care services on behalf of a covered 
person.
    "Infant" means a child who has not attained the age of one 
year.
    (b) A group or individual policy of accident and health 
		HB3561	- 9 -	LRB104 10745 BAB 20824 b
insurance or a managed care plan that is amended, delivered, 
issued, or renewed on or after January 1, 2027 shall provide 
coverage for at least one early egg allergen introduction 
dietary supplement and at least one early peanut allergen 
introduction dietary supplement.
    The coverage required under this subsection shall be 
provided at no cost to a covered individual, including 
deductible payments and cost-sharing amounts charged once a 
deductible is met.
    (c) Except as provided under subsection (b) of this 
Section, nothing in this Section prevents the operation of a 
policy provision required by this Section as a deductible, 
coinsurance, allowable charge limitation, coordination of 
benefits, or a provision restricting coverage to services by a 
licensed, certified, or carrier-approved provider or facility.
    (d) This Section does not apply to accident-only, 
specified disease, hospital indemnity, Medicare supplement, 
long-term care, disability income, or other limited benefit 
health insurance policies.
    (e) The cost-sharing limitation under subsection (b) does 
not apply to:
        (1) a catastrophic health plan to the extent this 
    cost-sharing limitation would cause the plan to fail to be 
    treated as a catastrophic plan under 42 U.S.C. 18022(e).
        (2) a high deductible health plan to the extent this 
    cost-sharing limitation would cause the plan to fail to be 
		HB3561	- 10 -	LRB104 10745 BAB 20824 b
    treated as a high deductible health plan under Section 
    223(c)(2) of the Internal Revenue Code.
    If the cost-sharing limitation under subsection (b) would 
result in an enrollee becoming ineligible for a health savings 
account under federal law, this cost-sharing limitation only 
applies to a qualified high deductible health plan after the 
enrollee's deductible has been met.
    Section 25. The Health Maintenance Organization Act is
amended by changing Section 5-3 as follows:
    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
    (Text of Section before amendment by P.A. 103-808)
    Sec. 5-3. Insurance Code provisions.
    (a) Health Maintenance Organizations shall be subject to
the provisions of Sections 133, 134, 136, 137, 139, 140,
141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g.5-1,
356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2, 356z.3a,
356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24, 356z.25,
356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32, 356z.33,
356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40,
356z.40a, 356z.41, 356z.44, 356z.45, 356z.46, 356z.47,
		HB3561	- 11 -	LRB104 10745 BAB 20824 b
356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54, 356z.55,
356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61, 356z.62,
356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68, 356z.69,
356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75, 356z.77, 
356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
subsection (2) of Section 367, and Articles IIA, VIII 1/2,
XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
Illinois Insurance Code.
    (b) For purposes of the Illinois Insurance Code, except
for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
Health Maintenance Organizations in the following categories
are deemed to be "domestic companies":
        (1) a corporation authorized under the Dental Service
    Plan Act or the Voluntary Health Services Plans Act;
        (2) a corporation organized under the laws of this
    State; or
        (3) a corporation organized under the laws of another
    state, 30% or more of the enrollees of which are residents
    of this State, except a corporation subject to
    substantially the same requirements in its state of
    organization as is a "domestic company" under Article VIII
    1/2 of the Illinois Insurance Code.
    (c) In considering the merger, consolidation, or other
acquisition of control of a Health Maintenance Organization
		HB3561	- 12 -	LRB104 10745 BAB 20824 b
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
        (1) the Director shall give primary consideration to
    the continuation of benefits to enrollees and the
    financial conditions of the acquired Health Maintenance
    Organization after the merger, consolidation, or other
    acquisition of control takes effect;
        (2)(i) the criteria specified in subsection (1)(b) of
    Section 131.8 of the Illinois Insurance Code shall not
    apply and (ii) the Director, in making his determination
    with respect to the merger, consolidation, or other
    acquisition of control, need not take into account the
    effect on competition of the merger, consolidation, or
    other acquisition of control;
        (3) the Director shall have the power to require the
    following information:
            (A) certification by an independent actuary of the
        adequacy of the reserves of the Health Maintenance
        Organization sought to be acquired;
            (B) pro forma financial statements reflecting the
        combined balance sheets of the acquiring company and
        the Health Maintenance Organization sought to be
        acquired as of the end of the preceding year and as of
        a date 90 days prior to the acquisition, as well as pro
        forma financial statements reflecting projected
        combined operation for a period of 2 years;
            (C) a pro forma business plan detailing an
		HB3561	- 13 -	LRB104 10745 BAB 20824 b
        acquiring party's plans with respect to the operation
        of the Health Maintenance Organization sought to be
        acquired for a period of not less than 3 years; and
            (D) such other information as the Director shall
        require.
    (d) The provisions of Article VIII 1/2 of the Illinois
Insurance Code and this Section 5-3 shall apply to the sale by
any health maintenance organization of greater than 10% of its
enrollee population (including, without limitation, the health
maintenance organization's right, title, and interest in and
to its health care certificates).
    (e) In considering any management contract or service
agreement subject to Section 141.1 of the Illinois Insurance
Code, the Director (i) shall, in addition to the criteria
specified in Section 141.2 of the Illinois Insurance Code,
take into account the effect of the management contract or
service agreement on the continuation of benefits to enrollees
and the financial condition of the health maintenance
organization to be managed or serviced, and (ii) need not take
into account the effect of the management contract or service
agreement on competition.
    (f) Except for small employer groups as defined in the
Small Employer Rating, Renewability and Portability Health
Insurance Act and except for medicare supplement policies as
defined in Section 363 of the Illinois Insurance Code, a
Health Maintenance Organization may by contract agree with a
		HB3561	- 14 -	LRB104 10745 BAB 20824 b
group or other enrollment unit to effect refunds or charge
additional premiums under the following terms and conditions:
        (i) the amount of, and other terms and conditions with
    respect to, the refund or additional premium are set forth
    in the group or enrollment unit contract agreed in advance
    of the period for which a refund is to be paid or
    additional premium is to be charged (which period shall
    not be less than one year); and
        (ii) the amount of the refund or additional premium
    shall not exceed 20% of the Health Maintenance
    Organization's profitable or unprofitable experience with
    respect to the group or other enrollment unit for the
    period (and, for purposes of a refund or additional
    premium, the profitable or unprofitable experience shall
    be calculated taking into account a pro rata share of the
    Health Maintenance Organization's administrative and
    marketing expenses, but shall not include any refund to be
    made or additional premium to be paid pursuant to this
    subsection (f)). The Health Maintenance Organization and
    the group or enrollment unit may agree that the profitable
    or unprofitable experience may be calculated taking into
    account the refund period and the immediately preceding 2
    plan years.
    The Health Maintenance Organization shall include a
statement in the evidence of coverage issued to each enrollee
describing the possibility of a refund or additional premium,
		HB3561	- 15 -	LRB104 10745 BAB 20824 b
and upon request of any group or enrollment unit, provide to
the group or enrollment unit a description of the method used
to calculate (1) the Health Maintenance Organization's
profitable experience with respect to the group or enrollment
unit and the resulting refund to the group or enrollment unit
or (2) the Health Maintenance Organization's unprofitable
experience with respect to the group or enrollment unit and
the resulting additional premium to be paid by the group or
enrollment unit.
    In no event shall the Illinois Health Maintenance
Organization Guaranty Association be liable to pay any
contractual obligation of an insolvent organization to pay any
refund authorized under this Section.
    (g) Rulemaking authority to implement Public Act 95-1045,
if any, is conditioned on the rules being adopted in
accordance with all provisions of the Illinois Administrative
Procedure Act and all rules and procedures of the Joint
Committee on Administrative Rules; any purported rule not so
adopted, for whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
		HB3561	- 16 -	LRB104 10745 BAB 20824 b
103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
103-777, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918, eff.
1-1-25; 103-1024, eff. 1-1-25; revised 9-26-24.)
    (Text of Section after amendment by P.A. 103-808)
    Sec. 5-3. Insurance Code provisions.
    (a) Health Maintenance Organizations shall be subject to
the provisions of Sections 133, 134, 136, 137, 139, 140,
141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g,
356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,
356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
		HB3561	- 17 -	LRB104 10745 BAB 20824 b
356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75, 
356z.77, 356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i,
368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402,
403, 403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c)
of subsection (2) of Section 367, and Articles IIA, VIII 1/2,
XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
Illinois Insurance Code.
    (b) For purposes of the Illinois Insurance Code, except
for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
Health Maintenance Organizations in the following categories
are deemed to be "domestic companies":
        (1) a corporation authorized under the Dental Service
    Plan Act or the Voluntary Health Services Plans Act;
        (2) a corporation organized under the laws of this
    State; or
        (3) a corporation organized under the laws of another
    state, 30% or more of the enrollees of which are residents
    of this State, except a corporation subject to
    substantially the same requirements in its state of
    organization as is a "domestic company" under Article VIII
    1/2 of the Illinois Insurance Code.
    (c) In considering the merger, consolidation, or other
acquisition of control of a Health Maintenance Organization
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
        (1) the Director shall give primary consideration to
    the continuation of benefits to enrollees and the
		HB3561	- 18 -	LRB104 10745 BAB 20824 b
    financial conditions of the acquired Health Maintenance
    Organization after the merger, consolidation, or other
    acquisition of control takes effect;
        (2)(i) the criteria specified in subsection (1)(b) of
    Section 131.8 of the Illinois Insurance Code shall not
    apply and (ii) the Director, in making his determination
    with respect to the merger, consolidation, or other
    acquisition of control, need not take into account the
    effect on competition of the merger, consolidation, or
    other acquisition of control;
        (3) the Director shall have the power to require the
    following information:
            (A) certification by an independent actuary of the
        adequacy of the reserves of the Health Maintenance
        Organization sought to be acquired;
            (B) pro forma financial statements reflecting the
        combined balance sheets of the acquiring company and
        the Health Maintenance Organization sought to be
        acquired as of the end of the preceding year and as of
        a date 90 days prior to the acquisition, as well as pro
        forma financial statements reflecting projected
        combined operation for a period of 2 years;
            (C) a pro forma business plan detailing an
        acquiring party's plans with respect to the operation
        of the Health Maintenance Organization sought to be
        acquired for a period of not less than 3 years; and
		HB3561	- 19 -	LRB104 10745 BAB 20824 b
            (D) such other information as the Director shall
        require.
    (d) The provisions of Article VIII 1/2 of the Illinois
Insurance Code and this Section 5-3 shall apply to the sale by
any health maintenance organization of greater than 10% of its
enrollee population (including, without limitation, the health
maintenance organization's right, title, and interest in and
to its health care certificates).
    (e) In considering any management contract or service
agreement subject to Section 141.1 of the Illinois Insurance
Code, the Director (i) shall, in addition to the criteria
specified in Section 141.2 of the Illinois Insurance Code,
take into account the effect of the management contract or
service agreement on the continuation of benefits to enrollees
and the financial condition of the health maintenance
organization to be managed or serviced, and (ii) need not take
into account the effect of the management contract or service
agreement on competition.
    (f) Except for small employer groups as defined in the
Small Employer Rating, Renewability and Portability Health
Insurance Act and except for medicare supplement policies as
defined in Section 363 of the Illinois Insurance Code, a
Health Maintenance Organization may by contract agree with a
group or other enrollment unit to effect refunds or charge
additional premiums under the following terms and conditions:
        (i) the amount of, and other terms and conditions with
		HB3561	- 20 -	LRB104 10745 BAB 20824 b
    respect to, the refund or additional premium are set forth
    in the group or enrollment unit contract agreed in advance
    of the period for which a refund is to be paid or
    additional premium is to be charged (which period shall
    not be less than one year); and
        (ii) the amount of the refund or additional premium
    shall not exceed 20% of the Health Maintenance
    Organization's profitable or unprofitable experience with
    respect to the group or other enrollment unit for the
    period (and, for purposes of a refund or additional
    premium, the profitable or unprofitable experience shall
    be calculated taking into account a pro rata share of the
    Health Maintenance Organization's administrative and
    marketing expenses, but shall not include any refund to be
    made or additional premium to be paid pursuant to this
    subsection (f)). The Health Maintenance Organization and
    the group or enrollment unit may agree that the profitable
    or unprofitable experience may be calculated taking into
    account the refund period and the immediately preceding 2
    plan years.
    The Health Maintenance Organization shall include a
statement in the evidence of coverage issued to each enrollee
describing the possibility of a refund or additional premium,
and upon request of any group or enrollment unit, provide to
the group or enrollment unit a description of the method used
to calculate (1) the Health Maintenance Organization's
		HB3561	- 21 -	LRB104 10745 BAB 20824 b
profitable experience with respect to the group or enrollment
unit and the resulting refund to the group or enrollment unit
or (2) the Health Maintenance Organization's unprofitable
experience with respect to the group or enrollment unit and
the resulting additional premium to be paid by the group or
enrollment unit.
    In no event shall the Illinois Health Maintenance
Organization Guaranty Association be liable to pay any
contractual obligation of an insolvent organization to pay any
refund authorized under this Section.
    (g) Rulemaking authority to implement Public Act 95-1045,
if any, is conditioned on the rules being adopted in
accordance with all provisions of the Illinois Administrative
Procedure Act and all rules and procedures of the Joint
Committee on Administrative Rules; any purported rule not so
adopted, for whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
		HB3561	- 22 -	LRB104 10745 BAB 20824 b
103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
103-777, eff. 8-2-24; 103-808, eff. 1-1-26; 103-914, eff.
1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; revised
11-26-24.)
    Section 30. The Limited Health Service Organization Act is
amended by changing Section 4003 as follows:
    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
    Sec. 4003. Illinois Insurance Code provisions. Limited
health service organizations shall be subject to the
provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
356z.73, 356z.74, 356z.75, 356z.80, 364.3, 368a, 401, 401.1,
402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and
Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and
XXVI of the Illinois Insurance Code. Nothing in this Section
shall require a limited health care plan to cover any service
that is not a limited health service. For purposes of the
		HB3561	- 23 -	LRB104 10745 BAB 20824 b
Illinois Insurance Code, except for Sections 444 and 444.1 and
Articles XIII and XIII 1/2, limited health service
organizations in the following categories are deemed to be
domestic companies:
        (1) a corporation under the laws of this State; or
        (2) a corporation organized under the laws of another
    state, 30% or more of the enrollees of which are residents
    of this State, except a corporation subject to
    substantially the same requirements in its state of
    organization as is a domestic company under Article VIII
    1/2 of the Illinois Insurance Code.
(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
eff. 1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25;
103-656, eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff.
7-19-24; 103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832,
eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
    Section 35. The Voluntary Health Services Plans Act is
amended by changing Section 10 as follows:
    (215 ILCS 165/10)  (from Ch. 32, par. 604)
		HB3561	- 24 -	LRB104 10745 BAB 20824 b
    Sec. 10. Application of Insurance Code provisions. Health
services plan corporations and all persons interested therein
or dealing therewith shall be subject to the provisions of
Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
143, 143.31, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3,
355b, 355d, 356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t,
356u, 356u.10, 356v, 356w, 356x, 356y, 356z.1, 356z.2,
356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
356z.32, 356z.32a, 356z.33, 356z.40, 356z.41, 356z.46,
356z.47, 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59,
356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.71,
356z.72, 356z.74, 356z.75, 356z.77, 356z.80, 364.01, 364.3,
367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
and paragraphs (7) and (15) of Section 367 of the Illinois
Insurance Code.
    Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
		HB3561	- 25 -	LRB104 10745 BAB 20824 b
eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-656, eff.
1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff. 1-1-25;
103-914, eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff.
1-1-25; revised 11-26-24.)
    Section 40. The Illinois Public Aid Code is amended by
changing Section 5-16.8 as follows:
    (305 ILCS 5/5-16.8)
    Sec. 5-16.8. Required health benefits. The medical
assistance program shall (i) provide the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64,
[and] 356z.67, [and] 356z.71, 356z.75, and 356z.80 of the Illinois
Insurance Code, (ii) be subject to the provisions of Sections
356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the
Illinois Insurance Code, and (iii) be subject to the
provisions of subsection (d-5) of Section 10 of the Network
		HB3561	- 26 -	LRB104 10745 BAB 20824 b
Adequacy and Transparency Act.
    The Department, by rule, shall adopt a model similar to
the requirements of Section 356z.39 of the Illinois Insurance
Code.
    On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate
of reimbursement for services or other payments in accordance
with Section 5-5e.
    To ensure full access to the benefits set forth in this
Section, on and after January 1, 2016, the Department shall
ensure that provider and hospital reimbursement for
post-mastectomy care benefits required under this Section are
no lower than the Medicare reimbursement rate.
(Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
1-1-24; 103-420, eff. 1-1-24; 103-605, eff. 7-1-24; 103-703,
eff. 1-1-25; 103-758, eff. 1-1-25; 103-1024, eff. 1-1-25;
revised 11-26-24.)
    Section 95. No acceleration or delay. Where this Act makes
changes in a statute that is represented in this Act by text
that is not yet or no longer in effect (for example, a Section
		HB3561	- 27 -	LRB104 10745 BAB 20824 b
represented by multiple versions), the use of that text does
not accelerate or delay the taking effect of (i) the changes
made by this Act or (ii) provisions derived from any other
Public Act.
		HB3561	- 28 -	LRB104 10745 BAB 20824 b
  INDEX
  Statutes amended in order of appearance
    5 ILCS 375/6.11
    55 ILCS 5/5-1069.3
    65 ILCS 5/10-4-2.3
    105 ILCS 5/10-22.3f
    5 ILCS 375/356z.80 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 Illinois Insurance Code. Requires a group or individual policy of accident and health insurance or a managed care plan to provide coverage for at least one early egg allergen introduction dietary supplement and one early peanut allergen introduction dietary supplement. Provides that the required coverage shall be provided at no cost to a covered individual, including deductible payments and cost-sharing amounts charged once a deductible is met. Except as otherwise provided, nothing in the provisions prevents the operation of such a policy provision as a deductible, coinsurance, allowable charge limitation, coordination of benefits, or a provision restricting coverage to services by a licensed, certified, or carrier-approved provider or facility. Provides that the required coverage does not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, disability income, or other limited benefit health insurance policies, and that the cost-sharing limitation does not apply to a catastrophic health plan to the extent the cost-sharing limitation would cause the plan to fail to be treated as a catastrophic plan under federal law. Provides that the cost-sharing limitation does not apply to a high deductible health plan to the extent this cost-sharing limitation would cause the plan to fail to be treated as a high deductible health plan under specified provisions of the Internal Revenue Code. Provides that, if the cost-sharing limitation would result in an enrollee becoming ineligible for a health savings account under federal law, the cost-sharing limitation only applies to a qualified high deductible health plan after the enrollee's deductible has been met. 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 those provisions.

Sponsors

Rep. Dagmara Avelar (D) sponsors HB 3561 alone.

Dagmara Avelar

Rep. · D–85 · Sponsor

Committees

HB 3561 went before 3 committees: Rules, Insurance and Insurance: Policy.

Rules
Rules
Referred to · Feb 18, 2025 · 5,290 Bills
Insurance
Insurance
Referred to · Mar 11, 2025
Insurance: Policy
Insurance: Policy
Referred to · Mar 19, 2025

History

HB 3561 has taken 6 actions since Feb 7, 2025, the latest on Mar 21, 2025.

ChamberAction
Mar 21, 2025
House
Rule 19(a) / Re-referred to Rules Committee
Mar 19, 2025
House
To Insurance Policy Subcommittee
Mar 11, 2025
House
Assigned to Insurance Committee
Feb 18, 2025
House
First Reading
Feb 18, 2025
House
Referred to Rules Committee

Votes

HB 3561 has not gone to a roll call.

Source: ilga.gov · legiscan.com