Public Act 103-0420
HB1565 EnrolledLRB103 25816 BMS 52167 b HB1565 Enrolled LRB103 25816 BMS 52167 b
HB1565 Enrolled LRB103 25816 BMS 52167 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The State Employees Group Insurance Act of 1971
is amended by changing Section 6.11 as follows:
(5 ILCS 375/6.11)
(Text of Section before amendment by P.A. 102-768)
Sec. 6.11. Required health benefits; Illinois Insurance
Code requirements. The program of health benefits shall
provide the post-mastectomy care benefits required to be
covered by a policy of accident and health insurance under
Section 356t of the Illinois Insurance Code. The program of
health benefits shall provide the coverage required under
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and
356z.61 of the Illinois Insurance Code. The program of health
benefits must comply with Sections 155.22a, 155.37, 355b,
356z.19, 370c, and 370c.1 and Article XXXIIB of the Illinois
Insurance Code. The Department of Insurance shall enforce the
HB1565 Enrolled LRB103 25816 BMS 52167 b
requirements of this Section with respect to Sections 370c and
370c.1 of the Illinois Insurance Code; all other requirements
of this Section shall be enforced by the Department of Central
Management Services.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
revised 12-13-22.)
(Text of Section after amendment by P.A. 102-768)
Sec. 6.11. Required health benefits; Illinois Insurance
Code requirements. The program of health benefits shall
provide the post-mastectomy care benefits required to be
covered by a policy of accident and health insurance under
Section 356t of the Illinois Insurance Code. The program of
health benefits shall provide the coverage required under
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, and
356z.60, and 356z.61 of the Illinois Insurance Code. The
program of health benefits must comply with Sections 155.22a,
155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
the Illinois Insurance Code. The Department of Insurance shall
enforce the requirements of this Section with respect to
Sections 370c and 370c.1 of the Illinois Insurance Code; all
other requirements of this Section shall be enforced by the
Department of Central Management Services.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
1-1-23; 102-768, eff. 1-1-24; 102-804, eff. 1-1-23; 102-813,
eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. 1-1-23;
102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
Section 10. The Counties Code is amended by changing
Section 5-1069.3 as follows:
(55 ILCS 5/5-1069.3)
Sec. 5-1069.3. Required health benefits. If a county,
including a home rule county, is a self-insurer for purposes
of providing health insurance coverage for its employees, the
coverage shall include coverage for the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,
356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53,
356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61
of the Illinois Insurance Code. The coverage shall comply with
Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
Insurance Code. The Department of Insurance shall enforce the
requirements of this Section. The requirement that health
benefits be covered as provided in this Section is an
exclusive power and function of the State and is a denial and
limitation under Article VII, Section 6, subsection (h) of the
Illinois Constitution. A home rule county to which this
Section applies must comply with every provision of this
Section.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
102-1117, eff. 1-13-23.)
Section 15. The Illinois Municipal Code is amended by
changing Section 10-4-2.3 as follows:
(65 ILCS 5/10-4-2.3)
Sec. 10-4-2.3. Required health benefits. If a
municipality, including a home rule municipality, is a
self-insurer for purposes of providing health insurance
coverage for its employees, the coverage shall include
coverage for the post-mastectomy care benefits required to be
covered by a policy of accident and health insurance under
Section 356t and the coverage required under Sections 356g,
356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61 of the
Illinois Insurance Code. The coverage shall comply with
Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
Insurance Code. The Department of Insurance shall enforce the
requirements of this Section. The requirement that health
benefits be covered as provided in this is an exclusive power
and function of the State and is a denial and limitation under
Article VII, Section 6, subsection (h) of the Illinois
Constitution. A home rule municipality to which this Section
applies must comply with every provision of this Section.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
102-1117, eff. 1-13-23.)
Section 20. The School Code is amended by changing Section
10-22.3f as follows:
(105 ILCS 5/10-22.3f)
Sec. 10-22.3f. Required health benefits. Insurance
protection and benefits for employees shall provide the
post-mastectomy care benefits required to be covered by a
policy of accident and health insurance under Section 356t and
the coverage required under Sections 356g, 356g.5, 356g.5-1,
356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and
356z.61 of the Illinois Insurance Code. Insurance policies
shall comply with Section 356z.19 of the Illinois Insurance
Code. The coverage shall comply with Sections 155.22a, 355b,
and 370c of the Illinois Insurance Code. The Department of
Insurance shall enforce the requirements of this Section.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22;
102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, eff.
1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
Section 25. The Illinois Insurance Code is amended by
adding Section 356z.61 as follows:
(215 ILCS 5/356z.61 new)
Sec. 356z.61. Coverage of prescription estrogen.
(a) A group or individual policy of accident and health
insurance or a managed care plan that is amended, delivered,
issued, or renewed on or after January 1, 2025 and that
provides coverage for prescription drugs shall include
coverage for one or more therapeutic equivalent versions of
vaginal estrogen in its formulary.
(b) If a particular vaginal estrogen product or its
therapeutic equivalent version approved by the United States
Food and Drug Administration is determined to be medically
necessary, the issuer must cover that service or item pursuant
to the cost-sharing requirement contained in subsection (c).
(c) A policy subject to this Section shall not impose a
deductible, copayment, or any other cost sharing requirement
that exceeds any deductible, coinsurance, copayment, or any
other cost-sharing requirement imposed on any prescription
drug authorized for the treatment of erectile dysfunction
covered by the policy; except that this subsection does not
apply to coverage of vaginal estrogen to the extent such
coverage would disqualify a high-deductible health plan from
eligibility for a health savings account pursuant to Section
223 of the Internal Revenue Code.
(d) As used in this Section, "therapeutic equivalent
version" has the meaning given to that term in paragraph (2) of
subsection (a) of Section 356z.4.
Section 30. The Health Maintenance Organization Act is
amended by changing Section 5-3 as follows:
(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
Sec. 5-3. Insurance Code provisions.
(a) Health Maintenance Organizations shall be subject to
the provisions of Sections 133, 134, 136, 137, 139, 140,
141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x,
356y, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48,
356z.50, 356z.51, 356z.53 256z.53, 356z.54, 356z.56, 356z.57,
356z.59, 356z.60, 356z.61, 364, 364.01, 364.3, 367.2, 367.2-5,
367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1,
402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
paragraph (c) of subsection (2) of Section 367, and Articles
IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
XXXIIB of the Illinois Insurance Code.
(b) For purposes of the Illinois Insurance Code, except
for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
Health Maintenance Organizations in the following categories
are deemed to be "domestic companies":
(1) a corporation authorized under the Dental Service
Plan Act or the Voluntary Health Services Plans Act;
(2) a corporation organized under the laws of this
State; or
(3) a corporation organized under the laws of another
state, 30% or more of the enrollees of which are residents
of this State, except a corporation subject to
substantially the same requirements in its state of
organization as is a "domestic company" under Article VIII
1/2 of the Illinois Insurance Code.
(c) In considering the merger, consolidation, or other
acquisition of control of a Health Maintenance Organization
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
(1) the Director shall give primary consideration to
the continuation of benefits to enrollees and the
financial conditions of the acquired Health Maintenance
Organization after the merger, consolidation, or other
acquisition of control takes effect;
(2)(i) the criteria specified in subsection (1)(b) of
Section 131.8 of the Illinois Insurance Code shall not
apply and (ii) the Director, in making his determination
with respect to the merger, consolidation, or other
acquisition of control, need not take into account the
effect on competition of the merger, consolidation, or
other acquisition of control;
(3) the Director shall have the power to require the
following information:
(A) certification by an independent actuary of the
adequacy of the reserves of the Health Maintenance
Organization sought to be acquired;
(B) pro forma financial statements reflecting the
combined balance sheets of the acquiring company and
the Health Maintenance Organization sought to be
acquired as of the end of the preceding year and as of
a date 90 days prior to the acquisition, as well as pro
forma financial statements reflecting projected
combined operation for a period of 2 years;
(C) a pro forma business plan detailing an
acquiring party's plans with respect to the operation
of the Health Maintenance Organization sought to be
acquired for a period of not less than 3 years; and
(D) such other information as the Director shall
require.
(d) The provisions of Article VIII 1/2 of the Illinois
Insurance Code and this Section 5-3 shall apply to the sale by
any health maintenance organization of greater than 10% of its
enrollee population (including without limitation the health
maintenance organization's right, title, and interest in and
to its health care certificates).
(e) In considering any management contract or service
agreement subject to Section 141.1 of the Illinois Insurance
Code, the Director (i) shall, in addition to the criteria
specified in Section 141.2 of the Illinois Insurance Code,
take into account the effect of the management contract or
service agreement on the continuation of benefits to enrollees
and the financial condition of the health maintenance
organization to be managed or serviced, and (ii) need not take
into account the effect of the management contract or service
agreement on competition.
(f) Except for small employer groups as defined in the
Small Employer Rating, Renewability and Portability Health
Insurance Act and except for medicare supplement policies as
defined in Section 363 of the Illinois Insurance Code, a
Health Maintenance Organization may by contract agree with a
group or other enrollment unit to effect refunds or charge
additional premiums under the following terms and conditions:
(i) the amount of, and other terms and conditions with
respect to, the refund or additional premium are set forth
in the group or enrollment unit contract agreed in advance
of the period for which a refund is to be paid or
additional premium is to be charged (which period shall
not be less than one year); and
(ii) the amount of the refund or additional premium
shall not exceed 20% of the Health Maintenance
Organization's profitable or unprofitable experience with
respect to the group or other enrollment unit for the
period (and, for purposes of a refund or additional
premium, the profitable or unprofitable experience shall
be calculated taking into account a pro rata share of the
Health Maintenance Organization's administrative and
marketing expenses, but shall not include any refund to be
made or additional premium to be paid pursuant to this
subsection (f)). The Health Maintenance Organization and
the group or enrollment unit may agree that the profitable
or unprofitable experience may be calculated taking into
account the refund period and the immediately preceding 2
plan years.
The Health Maintenance Organization shall include a
statement in the evidence of coverage issued to each enrollee
describing the possibility of a refund or additional premium,
and upon request of any group or enrollment unit, provide to
the group or enrollment unit a description of the method used
to calculate (1) the Health Maintenance Organization's
profitable experience with respect to the group or enrollment
unit and the resulting refund to the group or enrollment unit
or (2) the Health Maintenance Organization's unprofitable
experience with respect to the group or enrollment unit and
the resulting additional premium to be paid by the group or
enrollment unit.
In no event shall the Illinois Health Maintenance
Organization Guaranty Association be liable to pay any
contractual obligation of an insolvent organization to pay any
refund authorized under this Section.
(g) Rulemaking authority to implement Public Act 95-1045,
if any, is conditioned on the rules being adopted in
accordance with all provisions of the Illinois Administrative
Procedure Act and all rules and procedures of the Joint
Committee on Administrative Rules; any purported rule not so
adopted, for whatever reason, is unauthorized.
(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
1-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.)
Section 35. The Limited Health Service Organization Act is
amended by changing Section 4003 as follows:
(215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
Sec. 4003. Illinois Insurance Code provisions. Limited
health service organizations shall be subject to the
provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, 356z.22,
356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.57,
356z.59, 356z.61, 364.3, 368a, 401, 401.1, 402, 403, 403A,
408, 408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII
1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the
Illinois Insurance Code. Nothing in this Section shall require
a limited health care plan to cover any service that is not a
limited health service. For purposes of the Illinois Insurance
Code, except for Sections 444 and 444.1 and Articles XIII and
XIII 1/2, limited health service organizations in the
following categories are deemed to be domestic companies:
(1) a corporation under the laws of this State; or
(2) a corporation organized under the laws of another
state, 30% or more of the enrollees of which are residents
of this State, except a corporation subject to
substantially the same requirements in its state of
organization as is a domestic company under Article VIII
1/2 of the Illinois Insurance Code.
(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff.
1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642,
eff. 1-1-22; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff.
1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
Section 40. The Voluntary Health Services Plans Act is
amended by changing Section 10 as follows:
(215 ILCS 165/10) (from Ch. 32, par. 604)
Sec. 10. Application of Insurance Code provisions. Health
services plan corporations and all persons interested therein
or dealing therewith shall be subject to the provisions of
Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 364.01, 364.3,
367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
and paragraphs (7) and (15) of Section 367 of the Illinois
Insurance Code.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.
1-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306,
eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21;
102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff.
1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23;
102-1117, eff. 1-13-23.)
Section 45. The Illinois Public Aid Code is amended by
changing Section 5-16.8 as follows:
(305 ILCS 5/5-16.8)
Sec. 5-16.8. Required health benefits. The medical
assistance program shall (i) provide the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
356z.47, 356z.51, 356z.53, 356z.56, 356z.59, and 356z.60, and
356z.61 of the Illinois Insurance Code, (ii) be subject to the
provisions of Sections 356z.19, 356z.44, 356z.49, 364.01,
370c, and 370c.1 of the Illinois Insurance Code, and (iii) be
subject to the provisions of subsection (d-5) of Section 10 of
the Network Adequacy and Transparency Act.
The Department, by rule, shall adopt a model similar to
the requirements of Section 356z.39 of the Illinois Insurance
Code.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate
of reimbursement for services or other payments in accordance
with Section 5-5e.
To ensure full access to the benefits set forth in this
Section, on and after January 1, 2016, the Department shall
ensure that provider and hospital reimbursement for
post-mastectomy care benefits required under this Section are
no lower than the Medicare reimbursement rate.
(Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20;
101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff.
1-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144,
eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff.
1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093,
eff. 1-1-23; 102-1117, eff. 1-13-23.)