IL HB0104

Requires health insurance companies, managed care organizations, pharmacy benefit managers, and self-insured plans operating in Illinois to provide quarterly coverage information to the Department of Healthcare and Family Services upon request, including enrollment periods, plan details, and covered individuals.

Health insurers must accept the state's right to recover costs for medical services paid by state programs and allow assignment of payment rights from individuals to the state for services already covered by state medical assistance programs.

Insurers must respond to state inquiries about health care claims submitted within 3 years of service and cannot deny claims solely based on submission date, claim form type, or lack of point-of-sale documentation if submitted within the 3-year window.

Establishes administrative penalties up to $10,000 per day (after a 180-day compliance period) for entities failing to provide required insurance information, with the Department of Insurance able to initiate regulatory proceedings based on certification by the Department of Healthcare and Family Services.

Creates new Section 12-4.45 in the Illinois Public Aid Code requiring insurers to provide eligibility data in federally recommended formats and directing penalty recoveries into the Public Aid Recoveries Trust Fund for collection and administrative expenses.