SB 3525

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Full Text of SB3525
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	SB3525 - 104th General Assembly
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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB3525
Introduced 2/5/2026, by Sen. Lakesia Collins
SYNOPSIS AS INTRODUCED:
5 ILCS 375/6.11
55 ILCS 5/5-1069.3
65 ILCS 5/10-4-2.3
105 ILCS 5/10-22.3f
215 ILCS 5/356z.88 new
215 ILCS 125/5-3	  from Ch. 111 1/2, par. 1411.2
215 ILCS 130/4003	  from Ch. 73, par. 1504-3
215 ILCS 165/10	  from Ch. 32, par. 604
225 ILCS 85/45 new
305 ILCS 5/5-16.8
Amends the Illinois Insurance Code. Sets forth provisions requiring an individual or group policy of accident and health insurance amended, delivered, issued, or renewed in this State on or after the effective date of the amendatory Act to provide coverage for up to a 12-month supply of prescription hormone therapy, and the necessary supplies for self-administration, that is prescribed by a network provider within the provider's scope of practice and dispensed at one time for an enrollee by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies. Amends the Pharmacy Practice Act. Provides that, notwithstanding any other provision of law, a dispensing provider or pharmacist shall dispense, at a patient's request, up to a 12-month supply of a prescription hormone therapy and the necessary supplies for self-administration pursuant to a valid prescription that specifies an initial quantity followed by periodic refills, except as specified. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require coverage under the provisions of those Acts.
LRB104 19064 BAB 32509 b
A BILL FOR
		SB3525		LRB104 19064 BAB 32509 b
1    AN ACT concerning regulation.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Section 6.11 as follows:
6    (5 ILCS 375/6.11)
7    (Text of Section before amendment by P.A. 104-1)
8    Sec. 6.11. Required health benefits; Illinois Insurance
9Code requirements. The program of health benefits shall
10provide the post-mastectomy care benefits required to be
11covered by a policy of accident and health insurance under
12Section 356t of the Illinois Insurance Code. The program of
13health benefits shall provide the coverage required under
14Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10,
15356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
16356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
17356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
18356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
19356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
20356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70,
21356z.71, 356z.74, 356z.76, [and] 356z.77, [and] 356z.80, 356z.81, 
22356z.82, 356z.83, 356z.84, 356z.85, and 356z.88 of the
23Illinois Insurance Code. The program of health benefits must
		SB3525	- 2 -	LRB104 19064 BAB 32509 b
1comply with Sections 155.22a, 155.37, 355b, 356z.19, 370c, and
2370c.1 and Article XXXIIB of the Illinois Insurance Code. The
3program of health benefits shall provide the coverage required
4under Section 356m of the Illinois Insurance Code and, for the
5employees of the State Employee Group Insurance Program only,
6the coverage as also provided in Section 6.11B of this Act. The
7Department of Insurance shall enforce the requirements of this
8Section with respect to Sections 370c and 370c.1 and Article
9XXXIIB of the Illinois Insurance Code; all other requirements
10of this Section shall be enforced by the Department of Central
11Management Services.
12    Rulemaking authority to implement Public Act 95-1045, if
13any, is conditioned on the rules being adopted in accordance
14with all provisions of the Illinois Administrative Procedure
15Act and all rules and procedures of the Joint Committee on
16Administrative Rules; any purported rule not so adopted, for
17whatever reason, is unauthorized.
18(Source: P.A. 103-8, eff. 1-1-24; 103-84, eff. 1-1-24; 103-91,
19eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
20103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
217-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-870,
22eff. 1-1-25; 103-914, eff. 1-1-25; 103-918, eff. 1-1-25;
23103-951, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-27, eff.
241-1-26, 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
251-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,
26eff. 1-1-26; 104-417, eff. 8-15-25; revised 11-19-25.)
		SB3525	- 3 -	LRB104 19064 BAB 32509 b
1    (Text of Section after amendment by P.A. 104-1)
2    Sec. 6.11. Required health benefits; Illinois Insurance
3Code requirements. The program of health benefits shall
4provide the post-mastectomy care benefits required to be
5covered by a policy of accident and health insurance under
6Section 356t of the Illinois Insurance Code. The program of
7health benefits shall provide the coverage required under
8Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10,
9356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
10356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
11356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
12356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
13356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
14356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70,
15356z.71, 356z.74, 356z.76, [and] 356z.77, 356z.79, [and] 356z.80, 
16356z.81, 356z.82, 356z.83, 356z.84, 356z.85, and 356z.88 of
17the Illinois Insurance Code. The program of health benefits
18must comply with Sections 155.22a, 155.37, 355b, 356z.19,
19370c, and 370c.1 and Article XXXIIB of the Illinois Insurance
20Code. The program of health benefits shall provide the
21coverage required under Section 356m of the Illinois Insurance
22Code and, for the employees of the State Employee Group
23Insurance Program only, the coverage as also provided in
24Section 6.11B of this Act. The Department of Insurance shall
25enforce the requirements of this Section with respect to
		SB3525	- 4 -	LRB104 19064 BAB 32509 b
1Sections 370c and 370c.1 and Article XXXIIB of the Illinois
2Insurance Code; all other requirements of this Section shall
3be enforced by the Department of Central Management Services.
4    Rulemaking authority to implement Public Act 95-1045, if
5any, is conditioned on the rules being adopted in accordance
6with all provisions of the Illinois Administrative Procedure
7Act and all rules and procedures of the Joint Committee on
8Administrative Rules; any purported rule not so adopted, for
9whatever reason, is unauthorized.
10(Source: P.A. 103-8, eff. 1-1-24; 103-84, eff. 1-1-24; 103-91,
11eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
12103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
137-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-870,
14eff. 1-1-25; 103-914, eff. 1-1-25; 103-918, eff. 1-1-25;
15103-951, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
167-1-27; 104-27, eff. 1-1-26, 104-42, eff. 8-1-25; 104-68, eff.
171-1-26; 104-73, eff. 1-1-26; 104-289, eff. 1-1-26; 104-324,
18eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25;
19revised 11-19-25.)
20    Section 10. The Counties Code is amended by changing
21Section 5-1069.3 as follows:
22    (55 ILCS 5/5-1069.3)
23    (Text of Section before amendment by P.A. 104-446)
24    Sec. 5-1069.3. Required health benefits. If a county,
		SB3525	- 5 -	LRB104 19064 BAB 32509 b
1including a home rule county, is a self-insurer for purposes
2of providing health insurance coverage for its employees, the
3coverage shall include coverage for the post-mastectomy care
4benefits required to be covered by a policy of accident and
5health insurance under Section 356t and the coverage required
6under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
7356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
8356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
9356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36,
10356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
11356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
12356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71, 356z.74,
13[and] 356z.77, 356z.79, [and] 356z.80, 356z.81, 356z.82, 356z.83, 
14356z.84, 356z.85, and 356z.88 of the Illinois Insurance Code.
15The coverage shall comply with Sections 155.22a, 355b,
16356z.19, and 370c of the Illinois Insurance Code. The
17Department of Insurance shall enforce the requirements of this
18Section. The requirement that health benefits be covered as
19provided in this Section is an exclusive power and function of
20the State and is a denial and limitation under Article VII,
21Section 6, subsection (h) of the Illinois Constitution. A home
22rule county to which this Section applies must comply with
23every provision of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if
25any, is conditioned on the rules being adopted in accordance
26with all provisions of the Illinois Administrative Procedure
		SB3525	- 6 -	LRB104 19064 BAB 32509 b
1Act and all rules and procedures of the Joint Committee on
2Administrative Rules; any purported rule not so adopted, for
3whatever reason, is unauthorized.
4(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
5103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
68-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
7eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
8103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
96-9-25; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
101-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,
11eff. 1-1-26; 104-417, eff. 8-15-25; revised 1-7-26.)
12    (Text of Section after amendment by P.A. 104-446)
13    Sec. 5-1069.3. Required health benefits. If a county,
14including a home rule county, is a self-insurer for purposes
15of providing health insurance coverage for its employees, the
16coverage shall include coverage for the post-mastectomy care
17benefits required to be covered by a policy of accident and
18health insurance under Section 356t and the coverage required
19under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
20356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
21356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
22356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36,
23356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
24356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
25356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71, 356z.74,
		SB3525	- 7 -	LRB104 19064 BAB 32509 b
1[and] 356z.77, 356z.79, [and] 356z.80, 356z.81, 356z.82, 356z.83, 
2356z.84, 356z.85, and 356z.88 of the Illinois Insurance Code.
3The coverage shall comply with Sections 155.22a, 355b,
4356z.19, 370c, and 370c.4 of the Illinois Insurance Code. The
5Department of Insurance shall enforce the requirements of this
6Section. The requirement that health benefits be covered as
7provided in this Section is an exclusive power and function of
8the State and is a denial and limitation under Article VII,
9Section 6, subsection (h) of the Illinois Constitution. A home
10rule county to which this Section applies must comply with
11every provision of this Section.
12    Rulemaking authority to implement Public Act 95-1045, if
13any, is conditioned on the rules being adopted in accordance
14with all provisions of the Illinois Administrative Procedure
15Act and all rules and procedures of the Joint Committee on
16Administrative Rules; any purported rule not so adopted, for
17whatever reason, is unauthorized.
18(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
19103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
208-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
21eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
22103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
236-9-25; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
241-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,
25eff. 1-1-26; 104-417, eff. 8-15-25; 104-446, eff. 6-1-26;
26revised 1-7-26.)
		SB3525	- 8 -	LRB104 19064 BAB 32509 b
1    Section 15. The Illinois Municipal Code is amended by
2changing Section 10-4-2.3 as follows:
3    (65 ILCS 5/10-4-2.3)
4    (Text of Section before amendment by P.A. 104-446)
5    Sec. 10-4-2.3. Required health benefits. If a
6municipality, including a home rule municipality, is a
7self-insurer for purposes of providing health insurance
8coverage for its employees, the coverage shall include
9coverage for the post-mastectomy care benefits required to be
10covered by a policy of accident and health insurance under
11Section 356t and the coverage required under Sections 356g,
12356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
13356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
14356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
15356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
16356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
17356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
18356z.67, 356z.68, 356z.70, 356z.71, 356z.74, [and] 356z.77,
19356z.79, [and] 356z.80, 356z.81, 356z.82, 356z.83, 356z.84, 
20356z.85, and 356z.88 of the Illinois Insurance Code. The
21coverage shall comply with Sections 155.22a, 355b, 356z.19,
22and 370c of the Illinois Insurance Code. The Department of
23Insurance shall enforce the requirements of this Section. The
24requirement that health benefits be covered as provided in
		SB3525	- 9 -	LRB104 19064 BAB 32509 b
1this Section is an exclusive power and function of the State
2and is a denial and limitation under Article VII, Section 6,
3subsection (h) of the Illinois Constitution. A home rule
4municipality to which this Section applies must comply with
5every provision of this Section.
6    Rulemaking authority to implement Public Act 95-1045, if
7any, is conditioned on the rules being adopted in accordance
8with all provisions of the Illinois Administrative Procedure
9Act and all rules and procedures of the Joint Committee on
10Administrative Rules; any purported rule not so adopted, for
11whatever reason, is unauthorized.
12(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
13103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
148-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
15eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
16103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
176-9-25; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
181-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,
19eff. 1-1-26; 104-417, eff. 8-15-25; revised 1-8-26.)
20    (Text of Section after amendment by P.A. 104-446)
21    Sec. 10-4-2.3. Required health benefits. If a
22municipality, including a home rule municipality, is a
23self-insurer for purposes of providing health insurance
24coverage for its employees, the coverage shall include
25coverage for the post-mastectomy care benefits required to be
		SB3525	- 10 -	LRB104 19064 BAB 32509 b
1covered by a policy of accident and health insurance under
2Section 356t and the coverage required under Sections 356g,
3356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
4356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
5356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
6356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
7356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
8356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
9356z.67, 356z.68, 356z.70, 356z.71, 356z.74, [and] 356z.77,
10356z.79, [and] 356z.80, 356z.81, 356z.82, 356z.83, 356z.84, 
11356z.85, and 356z.88 of the Illinois Insurance Code. The
12coverage shall comply with Sections 155.22a, 355b, 356z.19,
13370c, and 370c.4 of the Illinois Insurance Code. The
14Department of Insurance shall enforce the requirements of this
15Section. The requirement that health benefits be covered as
16provided in this Section is an exclusive power and function of
17the State and is a denial and limitation under Article VII,
18Section 6, subsection (h) of the Illinois Constitution. A home
19rule municipality to which this Section applies must comply
20with every provision of this Section.
21    Rulemaking authority to implement Public Act 95-1045, if
22any, is conditioned on the rules being adopted in accordance
23with all provisions of the Illinois Administrative Procedure
24Act and all rules and procedures of the Joint Committee on
25Administrative Rules; any purported rule not so adopted, for
26whatever reason, is unauthorized.
		SB3525	- 11 -	LRB104 19064 BAB 32509 b
1(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
2103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
38-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
4eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
5103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
66-9-25; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
71-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,
8eff. 1-1-26; 104-417, eff. 8-15-25; 104-446, eff. 6-1-26;
9revised 1-8-26.)
10    Section 20. The School Code is amended by changing Section
1110-22.3f as follows:
12    (105 ILCS 5/10-22.3f)
13    (Text of Section before amendment by P.A. 104-446)
14    Sec. 10-22.3f. Required health benefits. Insurance
15protection and benefits for employees shall provide the
16post-mastectomy care benefits required to be covered by a
17policy of accident and health insurance under Section 356t and
18the coverage required under Sections 356g, 356g.5, 356g.5-1,
19356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a,
20356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14,
21356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
22356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
23356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
24356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71,
		SB3525	- 12 -	LRB104 19064 BAB 32509 b
1356z.74, [and] 356z.77, 356z.79, [and] 356z.80, 356z.81, 356z.82, 
2356z.83, 356z.84, 356z.85, and 356z.88 of the Illinois
3Insurance Code. Insurance policies shall comply with Section
4356z.19 of the Illinois Insurance Code. The coverage shall
5comply with Sections 155.22a, 355b, and 370c and Article
6XXXIIB of the Illinois Insurance Code. The Department of
7Insurance shall enforce the requirements of this Section.
8    Rulemaking authority to implement Public Act 95-1045, if
9any, is conditioned on the rules being adopted in accordance
10with all provisions of the Illinois Administrative Procedure
11Act and all rules and procedures of the Joint Committee on
12Administrative Rules; any purported rule not so adopted, for
13whatever reason, is unauthorized.
14(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
15103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
168-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
17eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
18103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
196-9-25; 104-27, eff. 1-1-26; 104-42, eff. 8-1-25; 104-68, eff.
201-1-26; 104-73, eff. 1-1-26; 104-289, eff. 1-1-26; 104-324,
21eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25;
22revised 1-8-26.)
23    (Text of Section after amendment by P.A. 104-446)
24    Sec. 10-22.3f. Required health benefits. Insurance
25protection and benefits for employees shall provide the
		SB3525	- 13 -	LRB104 19064 BAB 32509 b
1post-mastectomy care benefits required to be covered by a
2policy of accident and health insurance under Section 356t and
3the coverage required under Sections 356g, 356g.5, 356g.5-1,
4356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a,
5356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14,
6356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
7356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
8356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
9356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71,
10356z.74, [and] 356z.77, 356z.79, [and] 356z.80, 356z.81, 356z.82, 
11356z.83, 356z.84, 356z.85, and 356z.88 of the Illinois
12Insurance Code. Insurance policies shall comply with Section
13356z.19 of the Illinois Insurance Code. The coverage shall
14comply with Sections 155.22a, 355b, 370c, and 370c.4 and
15Article XXXIIB of the Illinois Insurance Code. The Department
16of Insurance shall enforce the requirements of this Section.
17    Rulemaking authority to implement Public Act 95-1045, if
18any, is conditioned on the rules being adopted in accordance
19with all provisions of the Illinois Administrative Procedure
20Act and all rules and procedures of the Joint Committee on
21Administrative Rules; any purported rule not so adopted, for
22whatever reason, is unauthorized.
23(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
24103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff.
258-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718,
26eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25;
		SB3525	- 14 -	LRB104 19064 BAB 32509 b
1103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
26-9-25; 104-27, eff. 1-1-26; 104-42, eff. 8-1-25; 104-68, eff.
31-1-26; 104-73, eff. 1-1-26; 104-289, eff. 1-1-26; 104-324,
4eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25;
5104-446, eff. 6-1-26; revised 1-8-26.)
6    Section 25. The Illinois Insurance Code is amended by
7adding Section 356z.88 as follows:
8    (215 ILCS 5/356z.88 new)
9    Sec. 356z.88. Coverage for prescription hormone therapy.
10    (a) For purposes of this Section, "prescription hormone 
11therapy" means all drugs approved by the United States Food 
12and Drug Administration that are used to medically suppress, 
13increase, or replace hormones that the body is not producing 
14at intended levels and the necessary supplies for 
15self-administration. "Prescription hormone therapy" does not 
16include glucagon-like peptide-1 and glucagon-like peptide-1 
17receptor agonists.
18    (b)(1) An individual or group policy of accident and 
19health insurance amended, delivered, issued, or renewed in 
20this State on or after the effective date of this amendatory 
21Act of the 104th General Assembly shall provide coverage for 
22up to a 12-month supply of prescription hormone therapy, and 
23the necessary supplies for self-administration, that is 
24prescribed by a network provider within the provider's scope 
		SB3525	- 15 -	LRB104 19064 BAB 32509 b
1of practice and dispensed at one time for an enrollee by a 
2provider or pharmacist, or at a location licensed or otherwise 
3authorized to dispense drugs or supplies.
4    (2) This Section does not require an individual or group 
5policy of accident and health insurance amended, delivered, 
6issued, or renewed in this State on or after the effective date 
7of this amendatory Act of the 104th General Assembly to cover 
8prescription hormone therapy provided by an out-of-network 
9provider, pharmacy, or location licensed or otherwise 
10authorized to dispense drugs or supplies, except as may 
11otherwise be authorized by State or federal law or by the 
12plan's policies governing out-of-network coverage. If 
13prescriptions for medically necessary prescription hormone 
14therapy are unavailable to a plan enrollee within the plan's 
15network, the plan shall arrange for the prescription hormone 
16therapy to be provided by an out-of-network provider.
17    (3) This Section does not prohibit an individual or group 
18policy of accident and health insurance amended, delivered, 
19issued, or renewed in this State on or after the effective date 
20of this amendatory Act of the 104th General Assembly from 
21limiting refills that may be obtained in the last quarter of 
22the plan year if a 12-month supply of the prescription hormone 
23therapy has already been dispensed during the plan year.
24    (4) This Section does not require a provider to prescribe, 
25furnish, or dispense 12 months of prescription hormone therapy 
26at one time.
		SB3525	- 16 -	LRB104 19064 BAB 32509 b
1    (5) To the extent not otherwise prohibited under this 
2Section or State or federal law, health plans may apply drug 
3utilization management strategies to prescription drugs 
4covered under paragraph (1) of this subsection.
5    (6) If an individual or group policy of accident and 
6health insurance amended, delivered, issued, or renewed in 
7this State on or after the effective date of this amendatory 
8Act of the 104th General Assembly delegates responsibilities 
9under this Section to a contracted entity, including a medical 
10group or independent practice association, the delegated 
11entity shall comply with this Section.
12    (c) This Section does not deny or restrict the 
13Department's authority to ensure plan compliance when an 
14individual or group policy of accident and health insurance 
15amended, delivered, issued, or renewed in this State on or 
16after the effective date of this amendatory Act of the 104th 
17General Assembly provides coverage for prescription hormone 
18therapy.
19    Section 30. The Health Maintenance Organization Act is
20amended by changing Section 5-3 as follows:
21    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
22    Sec. 5-3. Illinois Insurance Code provisions.
23    (a) Health Maintenance Organizations shall be subject to
24the provisions of Sections 133, 134, 136, 137, 139, 140,
		SB3525	- 17 -	LRB104 19064 BAB 32509 b
1141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
2152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
3155.49, 352c, 355.2, 355.3, 355.6, 355.7, 355b, 355c, 356f,
4356g, 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
5356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
6356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
7356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
8356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
9356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
10356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,
11356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
12356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
13356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
14356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,
15356z.76, 356z.77, 356z.78, 356z.79, 356z.80, 356z.81, 356z.82, 
16356z.83, 356z.84, 356z.85, 356z.88, 364, 364.01, 364.3, 367.2,
17367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370a, 370c,
18370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444,
19and 444.1, paragraph (c) of subsection (2) of Section 367, and
20Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
21XXVI, and XXXIIB of the Illinois Insurance Code.
22    (b) For purposes of the Illinois Insurance Code, except
23for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
24Health Maintenance Organizations in the following categories
25are deemed to be "domestic companies":
26        (1) a corporation authorized under the Dental Service
		SB3525	- 18 -	LRB104 19064 BAB 32509 b
1    Plan Act or the Voluntary Health Services Plans Act;
2        (2) a corporation organized under the laws of this
3    State; or
4        (3) a corporation organized under the laws of another
5    state, 30% or more of the enrollees of which are residents
6    of this State, except a corporation subject to
7    substantially the same requirements in its state of
8    organization as is a "domestic company" under Article VIII
9    1/2 of the Illinois Insurance Code.
10    (c) In considering the merger, consolidation, or other
11acquisition of control of a Health Maintenance Organization
12pursuant to Article VIII 1/2 of the Illinois Insurance Code,
13        (1) the Director shall give primary consideration to
14    the continuation of benefits to enrollees and the
15    financial conditions of the acquired Health Maintenance
16    Organization after the merger, consolidation, or other
17    acquisition of control takes effect;
18        (2)(i) the criteria specified in subsection (1)(b) of
19    Section 131.8 of the Illinois Insurance Code shall not
20    apply and (ii) the Director, in making his determination
21    with respect to the merger, consolidation, or other
22    acquisition of control, need not take into account the
23    effect on competition of the merger, consolidation, or
24    other acquisition of control;
25        (3) the Director shall have the power to require the
26    following information:
		SB3525	- 19 -	LRB104 19064 BAB 32509 b
1            (A) certification by an independent actuary of the
2        adequacy of the reserves of the Health Maintenance
3        Organization sought to be acquired;
4            (B) pro forma financial statements reflecting the
5        combined balance sheets of the acquiring company and
6        the Health Maintenance Organization sought to be
7        acquired as of the end of the preceding year and as of
8        a date 90 days prior to the acquisition, as well as pro
9        forma financial statements reflecting projected
10        combined operation for a period of 2 years;
11            (C) a pro forma business plan detailing an
12        acquiring party's plans with respect to the operation
13        of the Health Maintenance Organization sought to be
14        acquired for a period of not less than 3 years; and
15            (D) such other information as the Director shall
16        require.
17    (d) The provisions of Article VIII 1/2 of the Illinois
18Insurance Code and this Section 5-3 shall apply to the sale by
19any health maintenance organization of greater than 10% of its
20enrollee population (including, without limitation, the health
21maintenance organization's right, title, and interest in and
22to its health care certificates).
23    (e) In considering any management contract or service
24agreement subject to Section 141.1 of the Illinois Insurance
25Code, the Director (i) shall, in addition to the criteria
26specified in Section 141.2 of the Illinois Insurance Code,
		SB3525	- 20 -	LRB104 19064 BAB 32509 b
1take into account the effect of the management contract or
2service agreement on the continuation of benefits to enrollees
3and the financial condition of the health maintenance
4organization to be managed or serviced, and (ii) need not take
5into account the effect of the management contract or service
6agreement on competition.
7    (f) Except for small employer groups as defined in the
8Small Employer Rating, Renewability and Portability Health
9Insurance Act and except for medicare supplement policies as
10defined in Section 363 of the Illinois Insurance Code, a
11Health Maintenance Organization may by contract agree with a
12group or other enrollment unit to effect refunds or charge
13additional premiums under the following terms and conditions:
14        (i) the amount of, and other terms and conditions with
15    respect to, the refund or additional premium are set forth
16    in the group or enrollment unit contract agreed in advance
17    of the period for which a refund is to be paid or
18    additional premium is to be charged (which period shall
19    not be less than one year); and
20        (ii) the amount of the refund or additional premium
21    shall not exceed 20% of the Health Maintenance
22    Organization's profitable or unprofitable experience with
23    respect to the group or other enrollment unit for the
24    period (and, for purposes of a refund or additional
25    premium, the profitable or unprofitable experience shall
26    be calculated taking into account a pro rata share of the
		SB3525	- 21 -	LRB104 19064 BAB 32509 b
1    Health Maintenance Organization's administrative and
2    marketing expenses, but shall not include any refund to be
3    made or additional premium to be paid pursuant to this
4    subsection (f)). The Health Maintenance Organization and
5    the group or enrollment unit may agree that the profitable
6    or unprofitable experience may be calculated taking into
7    account the refund period and the immediately preceding 2
8    plan years.
9    The Health Maintenance Organization shall include a
10statement in the evidence of coverage issued to each enrollee
11describing the possibility of a refund or additional premium,
12and upon request of any group or enrollment unit, provide to
13the group or enrollment unit a description of the method used
14to calculate (1) the Health Maintenance Organization's
15profitable experience with respect to the group or enrollment
16unit and the resulting refund to the group or enrollment unit
17or (2) the Health Maintenance Organization's unprofitable
18experience with respect to the group or enrollment unit and
19the resulting additional premium to be paid by the group or
20enrollment unit.
21    In no event shall the Illinois Health Maintenance
22Organization Guaranty Association be liable to pay any
23contractual obligation of an insolvent organization to pay any
24refund authorized under this Section.
25    (g) Rulemaking authority to implement Public Act 95-1045,
26if any, is conditioned on the rules being adopted in
		SB3525	- 22 -	LRB104 19064 BAB 32509 b
1accordance with all provisions of the Illinois Administrative
2Procedure Act and all rules and procedures of the Joint
3Committee on Administrative Rules; any purported rule not so
4adopted, for whatever reason, is unauthorized.
5(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
6103-123, eff. 1-1-24; 103-154, eff. 6-30-23; 103-420, eff.
71-1-24; 103-426, eff. 8-4-23; 103-445, eff. 1-1-24; 103-551,
8eff. 8-11-23; 103-605, eff. 7-1-24; 103-618, eff. 1-1-25;
9103-649, eff. 1-1-25; 103-656, eff. 1-1-25; 103-700, eff.
101-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
11eff. 8-2-24; 103-758, eff. 1-1-25; 103-777, eff. 8-2-24;
12103-808, eff. 1-1-26; 103-914, eff. 1-1-25; 103-918, eff.
131-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-28,
14eff. 1-1-26; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73,
15eff. 1-1-26; 104-98, eff. 1-1-26; 104-289, eff. 1-1-26;
16104-324, eff. 1-1-26; 104-334, eff. 8-15-25; 104-379, eff.
171-1-26; 104-417, eff. 8-15-25; revised 11-21-25.)
18    Section 35. The Limited Health Service Organization Act is
19amended by changing Section 4003 as follows:
20    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
21    Sec. 4003. Illinois Insurance Code provisions. Limited
22health service organizations shall be subject to the
23provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
24141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
		SB3525	- 23 -	LRB104 19064 BAB 32509 b
1154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
2355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
3356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
4356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
5356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
6356z.73, 356z.74, 356z.75, 356z.79, 356z.80, 356z.81, 356z.83, 
7356z.84, 356z.85, 356z.88, 364.3, 368a, 370a, 401, 401.1, 402,
8403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles
9IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
10XXXIIB of the Illinois Insurance Code. Nothing in this Section
11shall require a limited health care plan to cover any service
12that is not a limited health service. For purposes of the
13Illinois Insurance Code, except for Sections 444 and 444.1 and
14Articles XIII and XIII 1/2, limited health service
15organizations in the following categories are deemed to be
16domestic companies:
17        (1) a corporation under the laws of this State; or
18        (2) a corporation organized under the laws of another
19    state, 30% or more of the enrollees of which are residents
20    of this State, except a corporation subject to
21    substantially the same requirements in its state of
22    organization as is a domestic company under Article VIII
23    1/2 of the Illinois Insurance Code.
24(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
25103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, eff.
261-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25; 103-656,
		SB3525	- 24 -	LRB104 19064 BAB 32509 b
1eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24;
2103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff.
31-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-42,
4eff. 8-1-25; 104-73, eff. 1-1-26; 104-98, eff. 1-1-26;
5104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-334, eff.
68-15-25; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25; revised
711-21-25.)
8    Section 40. The Voluntary Health Services Plans Act is
9amended by changing Section 10 as follows:
10    (215 ILCS 165/10)  (from Ch. 32, par. 604)
11    Sec. 10. Application of Illinois Insurance Code
12provisions. Health services plan corporations and all persons
13interested therein or dealing therewith shall be subject to
14the provisions of Articles IIA and XII 1/2 and Sections 3.1,
15133, 136, 139, 140, 143, 143.31, 143c, 149, 155.22a, 155.37,
16354, 355.2, 355.3, 355.7, 355b, 355d, 356g, 356g.5, 356g.5-1,
17356m, 356q, 356r, 356t, 356u, 356u.10, 356v, 356w, 356x, 356y,
18356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
19356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
20356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26,
21356z.29, 356z.30, 356z.32, 356z.32a, 356z.33, 356z.40,
22356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.56,
23356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.67,
24356z.68, 356z.71, 356z.72, 356z.74, 356z.75, 356z.77, 356z.79,
		SB3525	- 25 -	LRB104 19064 BAB 32509 b
1356z.80, 356z.81, 356z.83, 356z.84, 356z.85, 356z.88, 364.01,
2364.3, 367.2, 368a, 370a, 401, 401.1, 402, 403, 403A, 408,
3408.2, and 412, and paragraphs (7) and (15) of Section 367 of
4the Illinois Insurance Code.
5    Rulemaking authority to implement Public Act 95-1045, if
6any, is conditioned on the rules being adopted in accordance
7with all provisions of the Illinois Administrative Procedure
8Act and all rules and procedures of the Joint Committee on
9Administrative Rules; any purported rule not so adopted, for
10whatever reason, is unauthorized.
11(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
12103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-551, eff.
138-11-23; 103-605, eff. 7-1-24; 103-656, eff. 1-1-25; 103-718,
14eff. 7-19-24; 103-751, eff. 8-2-24; 103-753, eff. 8-2-24;
15103-758, eff. 1-1-25; 103-832, eff. 1-1-25; 103-914, eff.
161-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1,
17eff. 6-9-25; 104-28, eff. 1-1-26; 104-42, eff. 8-1-25; 104-73,
18eff. 1-1-26; 104-98, eff. 1-1-26; 104-289, eff. 1-1-26;
19104-324, eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff.
208-15-25; revised 11-21-25.)
21    Section 45. The Pharmacy Practice Act is amended by adding
22Section 45 as follows:
23    (225 ILCS 85/45 new)
24    Sec. 45. Prescription hormone therapy.
		SB3525	- 26 -	LRB104 19064 BAB 32509 b
1    (a) For purposes of this Section, "prescription hormone 
2therapy" means all drugs approved by the United States Food 
3and Drug Administration that are used to medically suppress, 
4increase, or replace hormones that the body is not producing 
5at intended levels and the necessary supplies for 
6self-administration. "Prescription hormone therapy" does not 
7include glucagon-like peptide-1 and glucagon-like peptide-1 
8receptor agonists.
9    (b) Notwithstanding any other provision of law, a 
10dispensing provider or pharmacist shall dispense, at a 
11patient's request, up to a 12-month supply of a prescription 
12hormone therapy and the necessary supplies for 
13self-administration pursuant to a valid prescription that 
14specifies an initial quantity followed by periodic refills, 
15unless any of the following is true:
16        (1) The patient requests a smaller supply.
17        (2) The prescribing provider instructs that the 
18    patient must have a smaller supply.
19        (3) The prescribing provider temporarily limits 
20    refills to a 90-day supply due to an acute dispensing 
21    shortage, so long as those limits are rescinded at the 
22    first opportunity of a regularly reinstated, sustainable 
23    supply.
24        (4) The prescription hormone therapy is a controlled 
25    substance. If the prescription hormone therapy is a 
26    controlled substance, the pharmacist shall dispense the 
		SB3525	- 27 -	LRB104 19064 BAB 32509 b
1    maximum supply allowed under State and federal law to be 
2    obtained at one time by the patient.
3    Section 50. The Illinois Public Aid Code is amended by
4changing Section 5-16.8 as follows:
5    (305 ILCS 5/5-16.8)
6    Sec. 5-16.8. Required health benefits. The medical
7assistance program shall (i) provide the post-mastectomy care
8benefits required to be covered by a policy of accident and
9health insurance under Section 356t and the coverage required
10under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
11356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
12356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64,
13356z.67, 356z.71, [and] 356z.75, [and] 356z.80, 356z.84, 356z.85, 
14and 356z.88 of the Illinois Insurance Code, (ii) be subject to
15the provisions of Sections 356z.19, 356z.44, 356z.49, 364.01,
16370c, and 370c.1 of the Illinois Insurance Code, and (iii) be
17subject to the provisions of subsection (d-5) of Section 10 of
18the Network Adequacy and Transparency Act.
19    The Department, by rule, shall adopt a model similar to
20the requirements of Section 356z.39 of the Illinois Insurance
21Code.
22    On and after July 1, 2012, the Department shall reduce any
23rate of reimbursement for services or other payments or alter
24any methodologies authorized by this Code to reduce any rate
		SB3525	- 28 -	LRB104 19064 BAB 32509 b
1of reimbursement for services or other payments in accordance
2with Section 5-5e.
3    To ensure full access to the benefits set forth in this
4Section, on and after January 1, 2016, the Department shall
5ensure that provider and hospital reimbursement for
6post-mastectomy care benefits required under this Section are
7no lower than the Medicare reimbursement rate.
8(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
9103-420, eff. 1-1-24; 103-605, eff. 7-1-24; 103-703, eff.
101-1-25; 103-758, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-73,
11eff. 1-1-26; 104-324, eff. 1-1-26; 104-379, eff. 1-1-26;
12104-417, eff. 8-15-25; revised 11-21-25.)
13    Section 95. No acceleration or delay. Where this Act makes
14changes in a statute that is represented in this Act by text
15that is not yet or no longer in effect (for example, a Section
16represented by multiple versions), the use of that text does
17not accelerate or delay the taking effect of (i) the changes
18made by this Act or (ii) provisions derived from any other
19Public Act.