IllinoisHB5393104th General Assembly (2025–2026)HouseWALLET

LIMITED HEALTH SERVICE ORGS

Sponsored By: Sponsor information unavailable

Became Law

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

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

Out-of-network benefits capped at $2,500

If you are in a limited health service point‑of‑service plan, out‑of‑network benefits are capped at $2,500 per year. Plans may set separate annual out‑of‑network out‑of‑pocket limits and lifetime caps. They may also limit or exclude some services when used out of network. After you hit these limits, you pay the rest.

Tighter limits on plans out-of-network spending

Plans that offer POS must keep out‑of‑network spending to 20% or less each quarter. If they go over by up to 2%, they must fix it by the end of the next quarter. If they do not show compliance, they cannot sell or renew the POS option for groups until they do. A $250‑per‑day penalty can apply after notice and hearing. Plans must file quarterly statements and track out‑of‑network use so the state can check compliance.

Network-first rules for limited health plans

Plans must treat all legally required limited health services as in‑network. They must also offer financial incentives to use in‑network providers. If a service is offered out of network, it must also be offered in network. When a group is offered a POS option and a provider is available, all eligible members in that group can enroll.

State approval and safeguards for point-of-service plans

A plan cannot issue a POS option until the Director approves its compliance plan. The plan must show it can design benefits, process claims, and report accurate data. It must keep an extra statutory deposit and show enough money and systems to control enrollment, use, and costs. POS offerings must also follow Sections 356w and 356x of the Illinois Insurance Code.

Some care treated as out-of-network

Emergency care, authorized referrals, and some urgent out‑of‑area care are not counted as POS benefits. If you get care without required plan authorization, the plan may treat it as out of network. In these cases, out‑of‑network rules can apply and you may pay more.

Sponsors & Cosponsors

Sponsors

There is no primary sponsor on record.

Cosponsors

  • Ann M. Williams

    Affiliation unavailable

  • Bob Morgan

    Affiliation unavailable

  • Cristina Castro

    Affiliation unavailable

  • Daniel Didech

    Affiliation unavailable

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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