Text of IL HB 5492 (2026)

104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB5492 Introduced , by Rep. Katie Stuart SYNOPSIS AS INTRODUCED: 5 ILCS 375/6.11 215 ILCS 5/356z.88 new 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 January 1, 2028 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 and the Illinois Public Aid Code to require coverage under the provisions of those Acts. LRB104 18985 BAB 32430 b A BILL FOR HB5492LRB104 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- 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- 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- 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 Illinois Insurance Code is amended by 21adding Section 356z.88 as follows: 22 (215 ILCS 5/356z.88 new) 23 Sec. 356z.88. Coverage for prescription hormone therapy. 24 (a) For purposes of this Section, "prescription hormone HB5492- 5 -LRB104 18985 BAB 32430 b 1therapy" means all drugs approved by the United States Food 2and Drug Administration that are used to medically suppress, 3increase, or replace hormones that the body is not producing 4at intended levels and the necessary supplies for 5self-administration. "Prescription hormone therapy" does not 6include glucagon-like peptide-1 and glucagon-like peptide-1 7receptor agonists. 8 (b)(1) An individual or group policy of accident and 9health insurance amended, delivered, issued, or renewed in 10this State on or after January 1, 2028 shall provide coverage 11for up to a 12-month supply of prescription hormone therapy, 12and the necessary supplies for self-administration, that is 13prescribed by a network provider within the provider's scope 14of practice and dispensed at one time for an enrollee by a 15provider or pharmacist, or at a location licensed or otherwise 16authorized to dispense drugs or supplies. 17 (2) This Section does not require an individual or group 18policy of accident and health insurance amended, delivered, 19issued, or renewed in this State on or after January 1, 2028 to 20cover prescription hormone therapy provided by an 21out-of-network provider, pharmacy, or location licensed or 22otherwise authorized to dispense drugs or supplies, except as 23may otherwise be authorized by State or federal law or by the 24plan's policies governing out-of-network coverage. If 25prescriptions for medically necessary prescription hormone 26therapy are unavailable to a plan enrollee within the plan's HB5492- 6 -LRB104 18985 BAB 32430 b 1network, the plan shall arrange for the prescription hormone 2therapy to be provided by an out-of-network provider. 3 (3) This Section does not prohibit an individual or group 4policy of accident and health insurance amended, delivered, 5issued, or renewed on or after January 1, 2028 from limiting 6refills that may be obtained in the last quarter of the plan 7year if a 12-month supply of the prescription hormone therapy 8has already been dispensed during the plan year. 9 (4) This Section does not require a provider to prescribe, 10furnish, or dispense 12 months of prescription hormone therapy 11at one time. 12 (5) To the extent not otherwise prohibited under this 13Section or State or federal law, health plans may apply drug 14utilization management strategies to prescription drugs 15covered under paragraph (1) of this subsection. 16 (6) If an individual or group policy of accident and 17health insurance amended, delivered, issued, or renewed in 18this State on or after January 1, 2028 delegates 19responsibilities under this Section to a contracted entity, 20including a medical group or independent practice association, 21the delegated entity shall comply with this Section. 22 (c) This Section does not deny or restrict the 23Department's authority to ensure plan compliance when an 24individual or group policy of accident and health insurance 25provides coverage for prescription hormone therapy. HB5492- 7 -LRB104 18985 BAB 32430 b 1 Section 15. The Pharmacy Practice Act is amended by adding 2Section 45 as follows: 3 (225 ILCS 85/45 new) 4 Sec. 45. Prescription hormone therapy. 5 (a) For purposes of this Section, "prescription hormone 6therapy" means all drugs approved by the United States Food 7and Drug Administration that are used to medically suppress, 8increase, or replace hormones that the body is not producing 9at intended levels and the necessary supplies for 10self-administration. "Prescription hormone therapy" does not 11include glucagon-like peptide-1 and glucagon-like peptide-1 12receptor agonists. 13 (b) Notwithstanding any other provision of law, a 14dispensing provider or pharmacist shall dispense, at a 15patient's request, up to a 12-month supply of a prescription 16hormone therapy and the necessary supplies for 17self-administration pursuant to a valid prescription that 18specifies an initial quantity followed by periodic refills, 19unless any of the following is true: 20 (1) The patient requests a smaller supply. 21 (2) The prescribing provider instructs that the 22 patient must have a smaller supply. 23 (3) The prescribing provider temporarily limits 24 refills to a 90-day supply due to an acute dispensing 25 shortage, so long as those limits are rescinded at the HB5492- 8 -LRB104 18985 BAB 32430 b 1 first opportunity of a regularly reinstated, sustainable 2 supply. 3 (4) The prescription hormone therapy is a controlled 4 substance. If the prescription hormone therapy is a 5 controlled substance, the pharmacist shall dispense the 6 maximum supply allowed under State and federal law to be 7 obtained at one time by the patient. 8 Section 45. The Illinois Public Aid Code is amended by 9changing Section 5-16.8 as follows: 10 (305 ILCS 5/5-16.8) 11 Sec. 5-16.8. Required health benefits. The medical 12assistance program shall (i) provide the post-mastectomy care 13benefits required to be covered by a policy of accident and 14health insurance under Section 356t and the coverage required 15under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6, 16356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46, 17356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64, 18356z.67, 356z.71, and 356z.75, and 356z.80, 356z.84, 356z.85, 19and 356z.88 of the Illinois Insurance Code, (ii) be subject to 20the provisions of Sections 356z.19, 356z.44, 356z.49, 364.01, 21370c, and 370c.1 of the Illinois Insurance Code, and (iii) be 22subject to the provisions of subsection (d-5) of Section 10 of 23the Network Adequacy and Transparency Act. 24 The Department, by rule, shall adopt a model similar to HB5492- 9 -LRB104 18985 BAB 32430 b 1the requirements of Section 356z.39 of the Illinois Insurance 2Code. 3 On and after July 1, 2012, the Department shall reduce any 4rate of reimbursement for services or other payments or alter 5any methodologies authorized by this Code to reduce any rate 6of reimbursement for services or other payments in accordance 7with Section 5-5e. 8 To ensure full access to the benefits set forth in this 9Section, on and after January 1, 2016, the Department shall 10ensure that provider and hospital reimbursement for 11post-mastectomy care benefits required under this Section are 12no lower than the Medicare reimbursement rate. 13(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 14103-420, eff. 1-1-24; 103-605, eff. 7-1-24; 103-703, eff. 151-1-25; 103-758, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-73, 16eff. 1-1-26; 104-324, eff. 1-1-26; 104-379, eff. 1-1-26; 17104-417, eff. 8-15-25; revised 11-21-25.) 18 Section 95. No acceleration or delay. Where this Act makes 19changes in a statute that is represented in this Act by text 20that is not yet or no longer in effect (for example, a Section 21represented by multiple versions), the use of that text does 22not accelerate or delay the taking effect of (i) the changes 23made by this Act or (ii) provisions derived from any other 24Public Act.

HB5492 EnrolledLRB104 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, 13and 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 1and 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.