IllinoisHB5393104th General Assembly (2025–2026)HouseWALLET

LIMITED HEALTH SERVICE ORGS

Sponsored By: Sponsor information unavailable

Signed by Governor

Summary

Amends the Limited Health Service Organization Act. Makes changes to defined terms. In provisions concerning the offering of a point-of-sale contract by a limited health service organization (LHSO), removes a provision requiring the LHSO to include an annual maximum benefit allowance not to exceed $2,500 per year that is separate from any limits or allowances applied to in-plan services. Provides that, if an LHSO expends in any calendar quarter more than 20% of its total limited health services expenditures for all its members for out-of-plan covered services, then specified limitations shall not apply subject to the LHSO minimum capital and surplus requirements applicable to a life, accident, and health insurance company. Makes other changes.

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 1 benefits, 0 costs, 2 mixed.

New limits on plans’ out-of-plan coverage

Point-of-service plans no longer have to include a separate yearly allowance for out-of-plan care. The old rule capped that required allowance at $2,500, but plans can still offer one. Plans generally cannot spend more than 20% of total limited health service costs on out-of-plan care in a calendar quarter. A plan that exceeds the cap by more than 2% must restore compliance by the end of the next quarter; meeting the required capital and surplus level exempts it from the cap for that quarter. If a plan fails to show compliance in the next quarterly report, it cannot offer coverage to new groups or renew existing groups’ coverage. The Director no longer has express power to grant an exception to that restriction.

Who counts for limited health coverage

The law lists dental, vision, drug, and foot-care services as limited health services. Hospital, medical, surgical, or emergency care qualifies only when provided as part of those services. Ambulance and lab services are no longer expressly listed. A person or dependent entitled to services under a qualifying contract counts as an enrollee, even without enrollment in a limited health care plan.

Limited health plans gain payment options

Limited health care plans can provide or arrange services using a fixed prepaid amount or a prepaid amount for each person. The law removes the requirement to issue evidence of coverage in exchange for a per-person prepaid sum. These options do not guarantee lower costs for enrollees.

Sponsors & Cosponsors

Sponsors

There is no primary sponsor on record.

Cosponsors

  • Ann M. Williams

    Democratic • House

  • Bob Morgan

    Democratic • House

  • Cristina Castro

    Democratic • Senate

  • Daniel Didech

    Democratic • House

Roll Call Votes

All Roll Calls

Yes: 312 • No: 0

House vote • 5/31/2026

Senate Floor Amendment No. 1 House Concurs

Yes: 116 • No: 0

House vote • 5/29/2026

Senate Floor Amendment No. 1 Motion to Concur Recommends Be Adopted Insurance Committee;

Yes: 16 • No: 0

Senate vote • 5/28/2026

Third Reading - Passed;

Yes: 58 • No: 0

Senate vote • 4/29/2026

Do Pass Insurance;

Yes: 9 • No: 0

House vote • 4/9/2026

Third Reading - Short Debate - Passed

Yes: 98 • No: 0

House vote • 3/24/2026

Do Pass / Short Debate Insurance Committee;

Yes: 15 • No: 0

Actions Timeline

  1. Public Act . . . . . . . . . 104-0562

    7/10/2026House
  2. Effective Date January 1, 2027

    7/10/2026House
  3. Governor Approved

    7/10/2026House
  4. Sent to the Governor

    6/26/2026House
  5. Passed Both Houses

    5/31/2026House
  6. House Concurs

    5/31/2026House
  7. Senate Floor Amendment No. 1 House Concurs 116-000-000

    5/31/2026House
  8. Senate Floor Amendment No. 1 Motion to Concur Recommends Be Adopted Insurance Committee; 016-000-000

    5/29/2026House
  9. Added Chief Co-Sponsor Rep. Bob Morgan

    5/29/2026House
  10. Senate Floor Amendment No. 1 Motion to Concur Rules Referred to Insurance Committee

    5/29/2026House
  11. Senate Floor Amendment No. 1 Motion to Concur Referred to Rules Committee

    5/28/2026House
  12. Senate Floor Amendment No. 1 Motion Filed Concur Rep. Ann M. Williams

    5/28/2026House
  13. Placed on Calendar Order of Concurrence Senate Amendment(s) 1

    5/28/2026House
  14. Arrived in House

    5/28/2026House
  15. Third Reading - Passed; 058-000-000

    5/28/2026Senate
  16. Placed on Calendar Order of 3rd Reading

    5/28/2026Senate
  17. Senate Floor Amendment No. 1 Adopted; Castro

    5/28/2026Senate
  18. Recalled to Second Reading

    5/28/2026Senate
  19. Rule 2-10 Third Reading Deadline Established As May 31, 2026

    5/22/2026Senate
  20. Senate Floor Amendment No. 1 Be Approved for Consideration Assignments

    5/13/2026Senate
  21. Senate Floor Amendment No. 1 Referred to Assignments

    5/12/2026Senate
  22. Senate Floor Amendment No. 1 Filed with Secretary by Sen. Cristina Castro

    5/12/2026Senate
  23. Placed on Calendar Order of 3rd Reading May 5, 2026

    4/30/2026Senate
  24. Second Reading

    4/30/2026Senate
  25. Placed on Calendar Order of 2nd Reading April 30, 2026

    4/29/2026Senate

Bill Text

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