HB5393 Amends Limited Health Service Organization Act, Removes $2,500 Annual Benefit Cap
Summary
Illinois Governor signed HB5393 into law, amending the Limited Health Service Organization Act. The bill removes a provision requiring LHSOs to include an annual maximum benefit allowance not exceeding $2,500 per year in point-of-sale contracts. It also modifies expenditure limitations, providing that if an LHSO expends more than 20% of total limited health services expenditures on out-of-plan covered services in any calendar quarter, specified limitations shall not apply subject to applicable capital and surplus requirements.
What changed
HB5393 removes a mandatory annual maximum benefit allowance cap of $2,500 that LHSOs were required to include in point-of-sale contracts. The bill also introduces a new quarter-based trigger: if an LHSO expends more than 20% of total limited health services expenditures for out-of-plan covered services in any calendar quarter, certain limitations are suspended, provided the LHSO meets minimum capital and surplus requirements comparable to life, accident, and health insurance companies.
Affected parties, including limited health service organizations and healthcare providers operating under LHSO arrangements, should monitor Illinois Department of Insurance guidance on implementation. Compliance teams should review current contract structures and financial policies to ensure alignment with the new expenditure monitoring requirements and capital standards.
What to do next
- Monitor for implementing regulations from the Illinois Department of Insurance
- Review and update LHSO financial policies to ensure compliance with new quarter-based expenditure thresholds
- Verify capital and surplus requirements against life, accident, and health insurance company standards
Archived snapshot
Apr 11, 2026GovPing captured this document from the original source. If the source has since changed or been removed, this is the text as it existed at that time.
ChangeBridge / Illinois / HB5393 Signed by Governor HB5393 House Bill Signed by Governor 2026-04-09
LIMITED HEALTH SERVICE ORGS
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.
Bill Details
State Illinois
Session 104th General Assembly
Chamber House
Committee Assignments
Official Source www.ilga.gov/Legislation/BillStatus?DocNum...
LegiScan View on LegiScan
Sponsors
Ann Williams (Rep - D) Daniel Didech (Rep - D) Cristina Castro (Sen - D)
Action History
2026-04-10 S Referred to Assignments 2026-04-10 S First Reading 2026-04-10 S Chief Senate Sponsor Sen. Cristina Castro 2026-04-10 S Placed on Calendar Order of First Reading 2026-04-10 S Arrive in Senate 2026-04-09 H Third Reading - Short Debate - Passed 098-000-000 2026-04-07 H Placed on Calendar Order of 3rd Reading - Short Debate 2026-04-07 H Second Reading - Short Debate 2026-03-25 H Placed on Calendar 2nd Reading - Short Debate 2026-03-24 H Do Pass / Short Debate Insurance Committee; 015-000-000 2026-03-24 H Added Chief Co-Sponsor Rep. Daniel Didech 2026-03-18 H Assigned to Insurance Committee 2026-02-10 H Referred to Rules Committee 2026-02-10 H First Reading 2026-02-06 H Filed with the Clerk by Rep. Ann M. Williams
Committee Referrals
2026-02-10 H Rules 2026-03-18 H Insurance 2026-04-10 S Assignments
Bill Text Versions
2026-02-06 Introduced 2026-04-07 Engrossed Legislative data powered by LegiScan (CC BY 4.0)
Named provisions
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