103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1344 Introduced 2/6/2023, by Sen. Celina Villanueva SYNOPSIS AS INTRODUCED: 215 ILCS 5/356z.60 Amends the Illinois Insurance Code. Provides that an individual or group policy of accident and health insurance amended, delivered, issued, or renewed in the State on or after (rather than only after) January 1, 2024 shall provide coverage for all abortifacients, hormonal therapy medication, human immunodeficiency virus pre-exposure prophylaxis and post-exposure prophylaxis drugs approved by the United States Food and Drug Administration, and follow-up services related to that coverage. Effective immediately. LRB103 28584 LNS 54965 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1344 Introduced 2/6/2023, by Sen. Celina Villanueva SYNOPSIS AS INTRODUCED: 215 ILCS 5/356z.60 215 ILCS 5/356z.60 Amends the Illinois Insurance Code. Provides that an individual or group policy of accident and health insurance amended, delivered, issued, or renewed in the State on or after (rather than only after) January 1, 2024 shall provide coverage for all abortifacients, hormonal therapy medication, human immunodeficiency virus pre-exposure prophylaxis and post-exposure prophylaxis drugs approved by the United States Food and Drug Administration, and follow-up services related to that coverage. Effective immediately. LRB103 28584 LNS 54965 b LRB103 28584 LNS 54965 b A BILL FOR
103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1344 Introduced 2/6/2023, by Sen. Celina Villanueva SYNOPSIS AS INTRODUCED:
215 ILCS 5/356z.60 215 ILCS 5/356z.60
215 ILCS 5/356z.60
Amends the Illinois Insurance Code. Provides that an individual or group policy of accident and health insurance amended, delivered, issued, or renewed in the State on or after (rather than only after) January 1, 2024 shall provide coverage for all abortifacients, hormonal therapy medication, human immunodeficiency virus pre-exposure prophylaxis and post-exposure prophylaxis drugs approved by the United States Food and Drug Administration, and follow-up services related to that coverage. Effective immediately.
LRB103 28584 LNS 54965 b LRB103 28584 LNS 54965 b
LRB103 28584 LNS 54965 b
A BILL FOR
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SB1344 LRB103 28584 LNS 54965 b
1 AN ACT concerning regulation.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Illinois Insurance Code is amended by
5 changing Section 356z.60 as follows:
6 (215 ILCS 5/356z.60)
7 Sec. 356z.60. Coverage for abortifacients, hormonal
8 therapy, and human immunodeficiency virus pre-exposure
9 prophylaxis and post-exposure prophylaxis.
10 (a) As used in this Section:
11 "Abortifacients" means any medication administered to
12 terminate a pregnancy by a health care professional.
13 "Health care professional" means a physician licensed to
14 practice medicine in all of its branches, licensed advanced
15 practice registered nurse, or physician assistant.
16 "Hormonal therapy medication" means hormonal treatment
17 administered to treat gender dysphoria.
18 "Therapeutic equivalent version" means drugs, devices, or
19 products that can be expected to have the same clinical effect
20 and safety profile when administered to patients under the
21 conditions specified in the labeling and that satisfy the
22 following general criteria:
23 (1) it is approved as safe and effective;
103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1344 Introduced 2/6/2023, by Sen. Celina Villanueva SYNOPSIS AS INTRODUCED:
215 ILCS 5/356z.60 215 ILCS 5/356z.60
215 ILCS 5/356z.60
Amends the Illinois Insurance Code. Provides that an individual or group policy of accident and health insurance amended, delivered, issued, or renewed in the State on or after (rather than only after) January 1, 2024 shall provide coverage for all abortifacients, hormonal therapy medication, human immunodeficiency virus pre-exposure prophylaxis and post-exposure prophylaxis drugs approved by the United States Food and Drug Administration, and follow-up services related to that coverage. Effective immediately.
LRB103 28584 LNS 54965 b LRB103 28584 LNS 54965 b
LRB103 28584 LNS 54965 b
A BILL FOR
215 ILCS 5/356z.60
LRB103 28584 LNS 54965 b
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1 (2) it is a pharmaceutical equivalent in that it:
2 (A) contains identical amounts of the same active
3 drug ingredient in the same dosage form and route of
4 administration; and
5 (B) meets compendial or other applicable standards
6 of strength, quality, purity, and identity;
7 (3) it is bioequivalent in that:
8 (A) it does not present a known or potential
9 bioequivalence problem and it meets an acceptable in
10 vitro standard; or
11 (B) if it does present such a known or potential
12 problem, it is shown to meet an appropriate
13 bioequivalence standard;
14 (4) it is adequately labeled; and
15 (5) it is manufactured in compliance with Current Good
16 Manufacturing Practice regulations adopted by the United
17 States Food and Drug Administration.
18 (b) An individual or group policy of accident and health
19 insurance amended, delivered, issued, or renewed in this State
20 on or after January 1, 2024 shall provide coverage for all
21 abortifacients, hormonal therapy medication, human
22 immunodeficiency virus pre-exposure prophylaxis and
23 post-exposure prophylaxis drugs approved by the United States
24 Food and Drug Administration, and follow-up services related
25 to that coverage, including, but not limited to, management of
26 side effects, medication self-management or adherence
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1 counseling, risk reduction strategies, and mental health
2 counseling.
3 (c) The coverage required under subsection (b) is subject
4 to the following conditions:
5 (1) If the United States Food and Drug Administration
6 has approved one or more therapeutic equivalent versions
7 of an abortifacient drug, a policy is not required to
8 include all such therapeutic equivalent versions in its
9 formulary so long as at least one is included and covered
10 without cost sharing and in accordance with this Section.
11 (2) If an individual's attending provider recommends a
12 particular drug approved by the United States Food and
13 Drug Administration based on a determination of medical
14 necessity with respect to that individual, the plan or
15 issuer must defer to the determination of the attending
16 provider and must cover that service or item without cost
17 sharing.
18 (3) If a drug is not covered, plans and issuers must
19 have an easily accessible, transparent, and sufficiently
20 expedient process that is not unduly burdensome on the
21 individual or a provider or other individual acting as a
22 patient's authorized representative to ensure coverage
23 without cost sharing.
24 (d) Except as otherwise provided in this Section, a policy
25 subject to this Section shall not impose a deductible,
26 coinsurance, copayment, or any other cost-sharing requirement
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1 on the coverage provided. The provisions of this subsection do
2 not apply to coverage of procedures to the extent such
3 coverage would disqualify a high-deductible health plan from
4 eligibility for a health savings account pursuant to the
5 federal Internal Revenue Code, 26 U.S.C. 223.
6 (e) Except as otherwise authorized under this Section, a
7 policy shall not impose any restrictions or delays on the
8 coverage required under this Section.
9 (f) The coverage requirements in this Section for
10 abortifacients do not, pursuant to 42 U.S.C. 18054(a)(6),
11 apply to a multistate plan that does not provide coverage for
12 abortion.
13 (g) If the Department concludes that enforcement of any
14 coverage requirement of this Section for abortifacients may
15 adversely affect the allocation of federal funds to this
16 State, the Department may grant an exemption to that
17 requirement, but only to the minimum extent necessary to
18 ensure the continued receipt of federal funds.
19 (Source: P.A. 102-1117, eff. 1-13-23.)
20 Section 99. Effective date. This Act takes effect upon
21 becoming law.
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