HB 5492

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Full Text of HB5492
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	HB5492 - 104th General Assembly
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			House Amendment 001
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		HB5492 Enrolled		LRB104 18985 BAB 32430 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
		HB5492 Enrolled	- 2 -	LRB104 18985 BAB 32430 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.)
		HB5492 Enrolled	- 3 -	LRB104 18985 BAB 32430 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
		HB5492 Enrolled	- 4 -	LRB104 18985 BAB 32430 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,
		HB5492 Enrolled	- 5 -	LRB104 18985 BAB 32430 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
		HB5492 Enrolled	- 6 -	LRB104 18985 BAB 32430 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,
		HB5492 Enrolled	- 7 -	LRB104 18985 BAB 32430 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.)
		HB5492 Enrolled	- 8 -	LRB104 18985 BAB 32430 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
		HB5492 Enrolled	- 9 -	LRB104 18985 BAB 32430 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
		HB5492 Enrolled	- 10 -	LRB104 18985 BAB 32430 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.
		HB5492 Enrolled	- 11 -	LRB104 18985 BAB 32430 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,
		HB5492 Enrolled	- 12 -	LRB104 18985 BAB 32430 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
		HB5492 Enrolled	- 13 -	LRB104 18985 BAB 32430 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;
		HB5492 Enrolled	- 14 -	LRB104 18985 BAB 32430 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 January 1, 2028 shall provide coverage 
21for up to a 6-month supply of prescription hormone therapy, 
22and the necessary supplies for self-administration, that is 
23prescribed by a provider within the provider's scope of 
24practice and dispensed at one time for an enrollee by a 
		HB5492 Enrolled	- 15 -	LRB104 18985 BAB 32430 b
1provider or pharmacist, or at a location licensed or otherwise 
2authorized to dispense drugs or supplies. If the prescription 
3hormone therapy is a controlled substance, the policy shall 
4provide coverage for the maximum supply allowed under State 
5and federal law to be obtained at one time by the insured.
6    (2) Except as otherwise provided in this Code, this 
7Section does not prohibit an individual or group policy of 
8accident and health insurance amended, delivered, issued, or 
9renewed on or after January 1, 2028 from limiting refills that 
10may be obtained in the last quarter of the plan year if a 
116-month supply of the prescription hormone therapy has already 
12been dispensed during the plan year.
13    (3) This Section does not require a provider to prescribe, 
14furnish, or dispense 6 months of prescription hormone therapy 
15at one time.
16    (4) To the extent not otherwise prohibited under this 
17Section or State or federal law, health plans may apply drug 
18utilization management strategies to prescription drugs 
19covered under paragraph (1) of this subsection.
20    (5) If an individual or group policy of accident and 
21health insurance amended, delivered, issued, or renewed in 
22this State on or after January 1, 2028 delegates 
23responsibilities under this Section to a contracted entity, 
24including a medical group or independent practice association, 
25the delegated entity shall comply with this Section.
26    (c) This Section does not deny or restrict the 
		HB5492 Enrolled	- 16 -	LRB104 18985 BAB 32430 b
1Department's authority to ensure plan compliance when an 
2individual or group policy of accident and health insurance 
3provides coverage for prescription hormone therapy.
4    Section 30. The Health Maintenance Organization Act is
5amended by changing Section 5-3 as follows:
6    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
7    Sec. 5-3. Illinois Insurance Code provisions.
8    (a) Health Maintenance Organizations shall be subject to
9the provisions of Sections 133, 134, 136, 137, 139, 140,
10141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
11152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
12155.49, 352c, 355.2, 355.3, 355.6, 355.7, 355b, 355c, 356f,
13356g, 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
14356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
15356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
16356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
17356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
18356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
19356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,
20356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
21356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
22356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
23356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,
24356z.76, 356z.77, 356z.78, 356z.79, 356z.80, 356z.81, 356z.82, 
		HB5492 Enrolled	- 17 -	LRB104 18985 BAB 32430 b
1356z.83, 356z.84, 356z.85, 356z.88, 364, 364.01, 364.3, 367.2,
2367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370a, 370c,
3370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444,
4and 444.1, paragraph (c) of subsection (2) of Section 367, and
5Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
6XXVI, and XXXIIB of the Illinois Insurance Code.
7    (b) For purposes of the Illinois Insurance Code, except
8for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
9Health Maintenance Organizations in the following categories
10are deemed to be "domestic companies":
11        (1) a corporation authorized under the Dental Service
12    Plan Act or the Voluntary Health Services Plans Act;
13        (2) a corporation organized under the laws of this
14    State; or
15        (3) a corporation organized under the laws of another
16    state, 30% or more of the enrollees of which are residents
17    of this State, except a corporation subject to
18    substantially the same requirements in its state of
19    organization as is a "domestic company" under Article VIII
20    1/2 of the Illinois Insurance Code.
21    (c) In considering the merger, consolidation, or other
22acquisition of control of a Health Maintenance Organization
23pursuant to Article VIII 1/2 of the Illinois Insurance Code,
24        (1) the Director shall give primary consideration to
25    the continuation of benefits to enrollees and the
26    financial conditions of the acquired Health Maintenance
		HB5492 Enrolled	- 18 -	LRB104 18985 BAB 32430 b
1    Organization after the merger, consolidation, or other
2    acquisition of control takes effect;
3        (2)(i) the criteria specified in subsection (1)(b) of
4    Section 131.8 of the Illinois Insurance Code shall not
5    apply and (ii) the Director, in making his determination
6    with respect to the merger, consolidation, or other
7    acquisition of control, need not take into account the
8    effect on competition of the merger, consolidation, or
9    other acquisition of control;
10        (3) the Director shall have the power to require the
11    following information:
12            (A) certification by an independent actuary of the
13        adequacy of the reserves of the Health Maintenance
14        Organization sought to be acquired;
15            (B) pro forma financial statements reflecting the
16        combined balance sheets of the acquiring company and
17        the Health Maintenance Organization sought to be
18        acquired as of the end of the preceding year and as of
19        a date 90 days prior to the acquisition, as well as pro
20        forma financial statements reflecting projected
21        combined operation for a period of 2 years;
22            (C) a pro forma business plan detailing an
23        acquiring party's plans with respect to the operation
24        of the Health Maintenance Organization sought to be
25        acquired for a period of not less than 3 years; and
26            (D) such other information as the Director shall
		HB5492 Enrolled	- 19 -	LRB104 18985 BAB 32430 b
1        require.
2    (d) The provisions of Article VIII 1/2 of the Illinois
3Insurance Code and this Section 5-3 shall apply to the sale by
4any health maintenance organization of greater than 10% of its
5enrollee population (including, without limitation, the health
6maintenance organization's right, title, and interest in and
7to its health care certificates).
8    (e) In considering any management contract or service
9agreement subject to Section 141.1 of the Illinois Insurance
10Code, the Director (i) shall, in addition to the criteria
11specified in Section 141.2 of the Illinois Insurance Code,
12take into account the effect of the management contract or
13service agreement on the continuation of benefits to enrollees
14and the financial condition of the health maintenance
15organization to be managed or serviced, and (ii) need not take
16into account the effect of the management contract or service
17agreement on competition.
18    (f) Except for small employer groups as defined in the
19Small Employer Rating, Renewability and Portability Health
20Insurance Act and except for medicare supplement policies as
21defined in Section 363 of the Illinois Insurance Code, a
22Health Maintenance Organization may by contract agree with a
23group or other enrollment unit to effect refunds or charge
24additional premiums under the following terms and conditions:
25        (i) the amount of, and other terms and conditions with
26    respect to, the refund or additional premium are set forth
		HB5492 Enrolled	- 20 -	LRB104 18985 BAB 32430 b
1    in the group or enrollment unit contract agreed in advance
2    of the period for which a refund is to be paid or
3    additional premium is to be charged (which period shall
4    not be less than one year); and
5        (ii) the amount of the refund or additional premium
6    shall not exceed 20% of the Health Maintenance
7    Organization's profitable or unprofitable experience with
8    respect to the group or other enrollment unit for the
9    period (and, for purposes of a refund or additional
10    premium, the profitable or unprofitable experience shall
11    be calculated taking into account a pro rata share of the
12    Health Maintenance Organization's administrative and
13    marketing expenses, but shall not include any refund to be
14    made or additional premium to be paid pursuant to this
15    subsection (f)). The Health Maintenance Organization and
16    the group or enrollment unit may agree that the profitable
17    or unprofitable experience may be calculated taking into
18    account the refund period and the immediately preceding 2
19    plan years.
20    The Health Maintenance Organization shall include a
21statement in the evidence of coverage issued to each enrollee
22describing the possibility of a refund or additional premium,
23and upon request of any group or enrollment unit, provide to
24the group or enrollment unit a description of the method used
25to calculate (1) the Health Maintenance Organization's
26profitable experience with respect to the group or enrollment
		HB5492 Enrolled	- 21 -	LRB104 18985 BAB 32430 b
1unit and the resulting refund to the group or enrollment unit
2or (2) the Health Maintenance Organization's unprofitable
3experience with respect to the group or enrollment unit and
4the resulting additional premium to be paid by the group or
5enrollment unit.
6    In no event shall the Illinois Health Maintenance
7Organization Guaranty Association be liable to pay any
8contractual obligation of an insolvent organization to pay any
9refund authorized under this Section.
10    (g) Rulemaking authority to implement Public Act 95-1045,
11if any, is conditioned on the rules being adopted in
12accordance with all provisions of the Illinois Administrative
13Procedure Act and all rules and procedures of the Joint
14Committee on Administrative Rules; any purported rule not so
15adopted, for whatever reason, is unauthorized.
16(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
17103-123, eff. 1-1-24; 103-154, eff. 6-30-23; 103-420, eff.
181-1-24; 103-426, eff. 8-4-23; 103-445, eff. 1-1-24; 103-551,
19eff. 8-11-23; 103-605, eff. 7-1-24; 103-618, eff. 1-1-25;
20103-649, eff. 1-1-25; 103-656, eff. 1-1-25; 103-700, eff.
211-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
22eff. 8-2-24; 103-758, eff. 1-1-25; 103-777, eff. 8-2-24;
23103-808, eff. 1-1-26; 103-914, eff. 1-1-25; 103-918, eff.
241-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-28,
25eff. 1-1-26; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73,
26eff. 1-1-26; 104-98, eff. 1-1-26; 104-289, eff. 1-1-26;
		HB5492 Enrolled	- 22 -	LRB104 18985 BAB 32430 b
1104-324, eff. 1-1-26; 104-334, eff. 8-15-25; 104-379, eff.
21-1-26; 104-417, eff. 8-15-25; revised 11-21-25.)
3    Section 35. The Limited Health Service Organization Act is
4amended by changing Section 4003 as follows:
5    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
6    Sec. 4003. Illinois Insurance Code provisions. Limited
7health service organizations shall be subject to the
8provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
9141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
10154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
11355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
12356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
13356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
14356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
15356z.73, 356z.74, 356z.75, 356z.79, 356z.80, 356z.81, 356z.83, 
16356z.84, 356z.85, 356z.88, 364.3, 368a, 370a, 401, 401.1, 402,
17403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles
18IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
19XXXIIB of the Illinois Insurance Code. Nothing in this Section
20shall require a limited health care plan to cover any service
21that is not a limited health service. For purposes of the
22Illinois Insurance Code, except for Sections 444 and 444.1 and
23Articles XIII and XIII 1/2, limited health service
24organizations in the following categories are deemed to be
		HB5492 Enrolled	- 23 -	LRB104 18985 BAB 32430 b
1domestic companies:
2        (1) a corporation under the laws of this State; or
3        (2) a corporation organized under the laws of another
4    state, 30% or more of the enrollees of which are residents
5    of this State, except a corporation subject to
6    substantially the same requirements in its state of
7    organization as is a domestic company under Article VIII
8    1/2 of the Illinois Insurance Code.
9(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
10103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, eff.
111-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25; 103-656,
12eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24;
13103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff.
141-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-42,
15eff. 8-1-25; 104-73, eff. 1-1-26; 104-98, eff. 1-1-26;
16104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-334, eff.
178-15-25; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25; revised
1811-21-25.)
19    Section 40. The Voluntary Health Services Plans Act is
20amended by changing Section 10 as follows:
21    (215 ILCS 165/10)  (from Ch. 32, par. 604)
22    Sec. 10. Application of Illinois Insurance Code
23provisions. Health services plan corporations and all persons
24interested therein or dealing therewith shall be subject to
		HB5492 Enrolled	- 24 -	LRB104 18985 BAB 32430 b
1the provisions of Articles IIA and XII 1/2 and Sections 3.1,
2133, 136, 139, 140, 143, 143.31, 143c, 149, 155.22a, 155.37,
3354, 355.2, 355.3, 355.7, 355b, 355d, 356g, 356g.5, 356g.5-1,
4356m, 356q, 356r, 356t, 356u, 356u.10, 356v, 356w, 356x, 356y,
5356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
6356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
7356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26,
8356z.29, 356z.30, 356z.32, 356z.32a, 356z.33, 356z.40,
9356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.56,
10356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.67,
11356z.68, 356z.71, 356z.72, 356z.74, 356z.75, 356z.77, 356z.79,
12356z.80, 356z.81, 356z.83, 356z.84, 356z.85, 356z.88, 364.01,
13364.3, 367.2, 368a, 370a, 401, 401.1, 402, 403, 403A, 408,
14408.2, and 412, and paragraphs (7) and (15) of Section 367 of
15the Illinois Insurance Code.
16    Rulemaking authority to implement Public Act 95-1045, if
17any, is conditioned on the rules being adopted in accordance
18with all provisions of the Illinois Administrative Procedure
19Act and all rules and procedures of the Joint Committee on
20Administrative Rules; any purported rule not so adopted, for
21whatever reason, is unauthorized.
22(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
23103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-551, eff.
248-11-23; 103-605, eff. 7-1-24; 103-656, eff. 1-1-25; 103-718,
25eff. 7-19-24; 103-751, eff. 8-2-24; 103-753, eff. 8-2-24;
26103-758, eff. 1-1-25; 103-832, eff. 1-1-25; 103-914, eff.
		HB5492 Enrolled	- 25 -	LRB104 18985 BAB 32430 b
11-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1,
2eff. 6-9-25; 104-28, eff. 1-1-26; 104-42, eff. 8-1-25; 104-73,
3eff. 1-1-26; 104-98, eff. 1-1-26; 104-289, eff. 1-1-26;
4104-324, eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff.
58-15-25; revised 11-21-25.)
6    Section 45. The Illinois Public Aid Code is amended by
7changing Section 5-16.8 as follows:
8    (305 ILCS 5/5-16.8)
9    Sec. 5-16.8. Required health benefits. The medical
10assistance program shall (i) provide the post-mastectomy care
11benefits required to be covered by a policy of accident and
12health insurance under Section 356t and the coverage required
13under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
14356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
15356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64,
16356z.67, 356z.71, [and] 356z.75, [and] 356z.80, 356z.84, 356z.85, 
17and 356z.88 of the Illinois Insurance Code, (ii) be subject to
18the provisions of Sections 356z.19, 356z.44, 356z.49, 364.01,
19370c, and 370c.1 of the Illinois Insurance Code, and (iii) be
20subject to the provisions of subsection (d-5) of Section 10 of
21the Network Adequacy and Transparency Act.
22    The Department, by rule, shall adopt a model similar to
23the requirements of Section 356z.39 of the Illinois Insurance
24Code.
		HB5492 Enrolled	- 26 -	LRB104 18985 BAB 32430 b
1    On and after July 1, 2012, the Department shall reduce any
2rate of reimbursement for services or other payments or alter
3any methodologies authorized by this Code to reduce any rate
4of reimbursement for services or other payments in accordance
5with Section 5-5e.
6    To ensure full access to the benefits set forth in this
7Section, on and after January 1, 2016, the Department shall
8ensure that provider and hospital reimbursement for
9post-mastectomy care benefits required under this Section are
10no lower than the Medicare reimbursement rate.
11(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
12103-420, eff. 1-1-24; 103-605, eff. 7-1-24; 103-703, eff.
131-1-25; 103-758, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-73,
14eff. 1-1-26; 104-324, eff. 1-1-26; 104-379, eff. 1-1-26;
15104-417, eff. 8-15-25; revised 11-21-25.)
16    Section 95. No acceleration or delay. Where this Act makes
17changes in a statute that is represented in this Act by text
18that is not yet or no longer in effect (for example, a Section
19represented by multiple versions), the use of that text does
20not accelerate or delay the taking effect of (i) the changes
21made by this Act or (ii) provisions derived from any other
22Public Act.