Illinois 2023-2024 Regular Session

Illinois Senate Bill SB2572 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2572 Introduced 5/2/2023, by Sen. Cristina Castro SYNOPSIS AS INTRODUCED: See Index Amends the Illinois Insurance Code. In provisions concerning infertility coverage, provides that no group policy of accident and health insurance providing coverage for more than 25 employees that provides pregnancy related benefits may be issued, amended, delivered, or renewed in the State on or after January 1, 2024 unless the policy contains coverage for the diagnosis and treatment of infertility, including procedures necessary to screen or diagnose a fertilized egg before implantation. Provides that coverage for procedures for in vitro fertilization, gamete intrafallopian tube transfer, or zygote intrafallopian tube transfer shall be required only if the procedures comply with specified requirements. Provides that a group or individual policy of accident and health insurance providing coverage for more than 25 employees that is amended, delivered, issued, or renewed on or after January 1, 2024 shall provide, for individuals 45 years of age and older, coverage for an annual menopause health visit. Provides that a group or individual policy of accident and health insurance providing coverage for more than 25 employees that is amended, delivered, issued, or renewed on or after January 1, 2024 shall provide coverage for all types of injectable medicines prescribed on-label or off-label to improve glucose or weight loss for use by adults diagnosed or previously diagnosed with prediabetes, gestational diabetes, or obesity. Makes other changes. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code. Effective immediately. LRB103 32124 BMS 61192 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2572 Introduced 5/2/2023, by Sen. Cristina Castro SYNOPSIS AS INTRODUCED: See Index See Index Amends the Illinois Insurance Code. In provisions concerning infertility coverage, provides that no group policy of accident and health insurance providing coverage for more than 25 employees that provides pregnancy related benefits may be issued, amended, delivered, or renewed in the State on or after January 1, 2024 unless the policy contains coverage for the diagnosis and treatment of infertility, including procedures necessary to screen or diagnose a fertilized egg before implantation. Provides that coverage for procedures for in vitro fertilization, gamete intrafallopian tube transfer, or zygote intrafallopian tube transfer shall be required only if the procedures comply with specified requirements. Provides that a group or individual policy of accident and health insurance providing coverage for more than 25 employees that is amended, delivered, issued, or renewed on or after January 1, 2024 shall provide, for individuals 45 years of age and older, coverage for an annual menopause health visit. Provides that a group or individual policy of accident and health insurance providing coverage for more than 25 employees that is amended, delivered, issued, or renewed on or after January 1, 2024 shall provide coverage for all types of injectable medicines prescribed on-label or off-label to improve glucose or weight loss for use by adults diagnosed or previously diagnosed with prediabetes, gestational diabetes, or obesity. Makes other changes. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code. Effective immediately. LRB103 32124 BMS 61192 b LRB103 32124 BMS 61192 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2572 Introduced 5/2/2023, by Sen. Cristina Castro SYNOPSIS AS INTRODUCED:
3	3	See Index See Index
4	4	See Index
5	5	Amends the Illinois Insurance Code. In provisions concerning infertility coverage, provides that no group policy of accident and health insurance providing coverage for more than 25 employees that provides pregnancy related benefits may be issued, amended, delivered, or renewed in the State on or after January 1, 2024 unless the policy contains coverage for the diagnosis and treatment of infertility, including procedures necessary to screen or diagnose a fertilized egg before implantation. Provides that coverage for procedures for in vitro fertilization, gamete intrafallopian tube transfer, or zygote intrafallopian tube transfer shall be required only if the procedures comply with specified requirements. Provides that a group or individual policy of accident and health insurance providing coverage for more than 25 employees that is amended, delivered, issued, or renewed on or after January 1, 2024 shall provide, for individuals 45 years of age and older, coverage for an annual menopause health visit. Provides that a group or individual policy of accident and health insurance providing coverage for more than 25 employees that is amended, delivered, issued, or renewed on or after January 1, 2024 shall provide coverage for all types of injectable medicines prescribed on-label or off-label to improve glucose or weight loss for use by adults diagnosed or previously diagnosed with prediabetes, gestational diabetes, or obesity. Makes other changes. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code. Effective immediately.
6	6	LRB103 32124 BMS 61192 b LRB103 32124 BMS 61192 b
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8	8	A BILL FOR
9	9	SB2572LRB103 32124 BMS 61192 b SB2572 LRB103 32124 BMS 61192 b
10	10	SB2572 LRB103 32124 BMS 61192 b
11	11	1 AN ACT concerning regulation.
12	12	2 Be it enacted by the People of the State of Illinois,
13	13	3 represented in the General Assembly:
14	14	4 Section 5. The State Employees Group Insurance Act of 1971
15	15	5 is amended by changing Section 6.11 as follows:
16	16	6 (5 ILCS 375/6.11)
17	17	7 (Text of Section before amendment by P.A. 102-768)
18	18	8 Sec. 6.11. Required health benefits; Illinois Insurance
19	19	9 Code requirements. The program of health benefits shall
20	20	10 provide the post-mastectomy care benefits required to be
21	21	11 covered by a policy of accident and health insurance under
22	22	12 Section 356t of the Illinois Insurance Code. The program of
23	23	13 health benefits shall provide the coverage required under
24	24	14 Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
25	25	15 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
26	26	16 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
27	27	17 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
28	28	18 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
29	29	19 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60,
30	30	20 356z.61, and 356z.62 of the Illinois Insurance Code. The
31	31	21 program of health benefits must comply with Sections 155.22a,
32	32	22 155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
33	33	23 the Illinois Insurance Code. The Department of Insurance shall
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37	37	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2572 Introduced 5/2/2023, by Sen. Cristina Castro SYNOPSIS AS INTRODUCED:
38	38	See Index See Index
39	39	See Index
40	40	Amends the Illinois Insurance Code. In provisions concerning infertility coverage, provides that no group policy of accident and health insurance providing coverage for more than 25 employees that provides pregnancy related benefits may be issued, amended, delivered, or renewed in the State on or after January 1, 2024 unless the policy contains coverage for the diagnosis and treatment of infertility, including procedures necessary to screen or diagnose a fertilized egg before implantation. Provides that coverage for procedures for in vitro fertilization, gamete intrafallopian tube transfer, or zygote intrafallopian tube transfer shall be required only if the procedures comply with specified requirements. Provides that a group or individual policy of accident and health insurance providing coverage for more than 25 employees that is amended, delivered, issued, or renewed on or after January 1, 2024 shall provide, for individuals 45 years of age and older, coverage for an annual menopause health visit. Provides that a group or individual policy of accident and health insurance providing coverage for more than 25 employees that is amended, delivered, issued, or renewed on or after January 1, 2024 shall provide coverage for all types of injectable medicines prescribed on-label or off-label to improve glucose or weight loss for use by adults diagnosed or previously diagnosed with prediabetes, gestational diabetes, or obesity. Makes other changes. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code. Effective immediately.
41	41	LRB103 32124 BMS 61192 b LRB103 32124 BMS 61192 b
42	42	LRB103 32124 BMS 61192 b
43	43	A BILL FOR
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49	49	See Index
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68	68	1 enforce the requirements of this Section with respect to
69	69	2 Sections 370c and 370c.1 of the Illinois Insurance Code; all
70	70	3 other requirements of this Section shall be enforced by the
71	71	4 Department of Central Management Services.
72	72	5 Rulemaking authority to implement Public Act 95-1045, if
73	73	6 any, is conditioned on the rules being adopted in accordance
74	74	7 with all provisions of the Illinois Administrative Procedure
75	75	8 Act and all rules and procedures of the Joint Committee on
76	76	9 Administrative Rules; any purported rule not so adopted, for
77	77	10 whatever reason, is unauthorized.
78	78	11 (Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
79	79	12 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
80	80	13 1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
81	81	14 eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
82	82	15 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
83	83	16 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
84	84	17 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
85	85	18 revised 12-13-22.)
86	86	19 (Text of Section after amendment by P.A. 102-768)
87	87	20 Sec. 6.11. Required health benefits; Illinois Insurance
88	88	21 Code requirements. The program of health benefits shall
89	89	22 provide the post-mastectomy care benefits required to be
90	90	23 covered by a policy of accident and health insurance under
91	91	24 Section 356t of the Illinois Insurance Code. The program of
92	92	25 health benefits shall provide the coverage required under
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103	103	1 Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
104	104	2 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
105	105	3 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
106	106	4 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
107	107	5 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
108	108	6 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, and
109	109	7 356z.60, 356z.61, and 356z.62 of the Illinois Insurance Code.
110	110	8 The program of health benefits must comply with Sections
111	111	9 155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article
112	112	10 XXXIIB of the Illinois Insurance Code. The Department of
113	113	11 Insurance shall enforce the requirements of this Section with
114	114	12 respect to Sections 370c and 370c.1 of the Illinois Insurance
115	115	13 Code; all other requirements of this Section shall be enforced
116	116	14 by the Department of Central Management Services.
117	117	15 Rulemaking authority to implement Public Act 95-1045, if
118	118	16 any, is conditioned on the rules being adopted in accordance
119	119	17 with all provisions of the Illinois Administrative Procedure
120	120	18 Act and all rules and procedures of the Joint Committee on
121	121	19 Administrative Rules; any purported rule not so adopted, for
122	122	20 whatever reason, is unauthorized.
123	123	21 (Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
124	124	22 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
125	125	23 1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
126	126	24 eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
127	127	25 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
128	128	26 1-1-23; 102-768, eff. 1-1-24; 102-804, eff. 1-1-23; 102-813,
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139	139	1 eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. 1-1-23;
140	140	2 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
141	141	3 Section 10. The Counties Code is amended by changing
142	142	4 Section 5-1069.3 as follows:
143	143	5 (55 ILCS 5/5-1069.3)
144	144	6 Sec. 5-1069.3. Required health benefits. If a county,
145	145	7 including a home rule county, is a self-insurer for purposes
146	146	8 of providing health insurance coverage for its employees, the
147	147	9 coverage shall include coverage for the post-mastectomy care
148	148	10 benefits required to be covered by a policy of accident and
149	149	11 health insurance under Section 356t and the coverage required
150	150	12 under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w,
151	151	13 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
152	152	14 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
153	153	15 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36,
154	154	16 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
155	155	17 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60,
156	156	18 356z.61, and 356z.62 of the Illinois Insurance Code. The
157	157	19 coverage shall comply with Sections 155.22a, 355b, 356z.19,
158	158	20 and 370c of the Illinois Insurance Code. The Department of
159	159	21 Insurance shall enforce the requirements of this Section. The
160	160	22 requirement that health benefits be covered as provided in
161	161	23 this Section is an exclusive power and function of the State
162	162	24 and is a denial and limitation under Article VII, Section 6,
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173	173	1 subsection (h) of the Illinois Constitution. A home rule
174	174	2 county to which this Section applies must comply with every
175	175	3 provision of this Section.
176	176	4 Rulemaking authority to implement Public Act 95-1045, if
177	177	5 any, is conditioned on the rules being adopted in accordance
178	178	6 with all provisions of the Illinois Administrative Procedure
179	179	7 Act and all rules and procedures of the Joint Committee on
180	180	8 Administrative Rules; any purported rule not so adopted, for
181	181	9 whatever reason, is unauthorized.
182	182	10 (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
183	183	11 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
184	184	12 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
185	185	13 eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
186	186	14 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
187	187	15 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
188	188	16 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
189	189	17 102-1117, eff. 1-13-23.)
190	190	18 Section 15. The Illinois Municipal Code is amended by
191	191	19 changing Section 10-4-2.3 as follows:
192	192	20 (65 ILCS 5/10-4-2.3)
193	193	21 Sec. 10-4-2.3. Required health benefits. If a
194	194	22 municipality, including a home rule municipality, is a
195	195	23 self-insurer for purposes of providing health insurance
196	196	24 coverage for its employees, the coverage shall include
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207	207	1 coverage for the post-mastectomy care benefits required to be
208	208	2 covered by a policy of accident and health insurance under
209	209	3 Section 356t and the coverage required under Sections 356g,
210	210	4 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, 356z.4,
211	211	5 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
212	212	6 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
213	213	7 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
214	214	8 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
215	215	9 356z.56, 356z.57, 356z.59, and 356z.60, 356z.61, and 356z.62
216	216	10 of the Illinois Insurance Code. The coverage shall comply with
217	217	11 Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
218	218	12 Insurance Code. The Department of Insurance shall enforce the
219	219	13 requirements of this Section. The requirement that health
220	220	14 benefits be covered as provided in this is an exclusive power
221	221	15 and function of the State and is a denial and limitation under
222	222	16 Article VII, Section 6, subsection (h) of the Illinois
223	223	17 Constitution. A home rule municipality to which this Section
224	224	18 applies must comply with every provision of this Section.
225	225	19 Rulemaking authority to implement Public Act 95-1045, if
226	226	20 any, is conditioned on the rules being adopted in accordance
227	227	21 with all provisions of the Illinois Administrative Procedure
228	228	22 Act and all rules and procedures of the Joint Committee on
229	229	23 Administrative Rules; any purported rule not so adopted, for
230	230	24 whatever reason, is unauthorized.
231	231	25 (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
232	232	26 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
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243	243	1 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
244	244	2 eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
245	245	3 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
246	246	4 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
247	247	5 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
248	248	6 102-1117, eff. 1-13-23.)
249	249	7 Section 20. The School Code is amended by changing Section
250	250	8 10-22.3f as follows:
251	251	9 (105 ILCS 5/10-22.3f)
252	252	10 Sec. 10-22.3f. Required health benefits. Insurance
253	253	11 protection and benefits for employees shall provide the
254	254	12 post-mastectomy care benefits required to be covered by a
255	255	13 policy of accident and health insurance under Section 356t and
256	256	14 the coverage required under Sections 356g, 356g.5, 356g.5-1,
257	257	15 356m, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
258	258	16 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
259	259	17 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
260	260	18 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
261	261	19 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60,
262	262	20 356z.61, and 356z.62 of the Illinois Insurance Code. Insurance
263	263	21 policies shall comply with Section 356z.19 of the Illinois
264	264	22 Insurance Code. The coverage shall comply with Sections
265	265	23 155.22a, 355b, and 370c of the Illinois Insurance Code. The
266	266	24 Department of Insurance shall enforce the requirements of this
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277	277	1 Section.
278	278	2 Rulemaking authority to implement Public Act 95-1045, if
279	279	3 any, is conditioned on the rules being adopted in accordance
280	280	4 with all provisions of the Illinois Administrative Procedure
281	281	5 Act and all rules and procedures of the Joint Committee on
282	282	6 Administrative Rules; any purported rule not so adopted, for
283	283	7 whatever reason, is unauthorized.
284	284	8 (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
285	285	9 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
286	286	10 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
287	287	11 eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22;
288	288	12 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, eff.
289	289	13 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
290	290	14 eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
291	291	15 Section 25. The Illinois Insurance Code is amended by
292	292	16 changing Section 356m and by adding Sections 356z.61 and
293	293	17 356z.62 as follows:
294	294	18 (215 ILCS 5/356m) (from Ch. 73, par. 968m)
295	295	19 Sec. 356m. Infertility coverage.
296	296	20 (a) No group policy of accident and health insurance
297	297	21 providing coverage for more than 25 employees that provides
298	298	22 pregnancy related benefits may be issued, amended, delivered,
299	299	23 or renewed in this State after January 1, 2016 and through
300	300	24 December 31, 2023 the effective date of this amendatory Act of
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311	311	1 the 99th General Assembly unless the policy contains coverage
312	312	2 for the diagnosis and treatment of infertility including, but
313	313	3 not limited to, in vitro fertilization, uterine embryo lavage,
314	314	4 embryo transfer, artificial insemination, gamete
315	315	5 intrafallopian tube transfer, zygote intrafallopian tube
316	316	6 transfer, and low tubal ovum transfer.
317	317	7 (a-5) No group policy of accident and health insurance
318	318	8 providing coverage for more than 25 employees that provides
319	319	9 pregnancy related benefits may be issued, amended, delivered,
320	320	10 or renewed in this State on or after January 1, 2024 unless the
321	321	11 policy contains coverage for the diagnosis and treatment of
322	322	12 infertility, including, but not limited to, in vitro
323	323	13 fertilization, uterine embryo lavage, embryo transfer,
324	324	14 artificial insemination, gamete intrafallopian tube transfer,
325	325	15 zygote intrafallopian tube transfer, and low tubal ovum
326	326	16 transfer. The coverage required shall include procedures
327	327	17 necessary to screen or diagnose a fertilized egg before
328	328	18 implantation, including, but not limited to, preimplantation
329	329	19 genetic diagnosis, preimplantation genetic screening, and
330	330	20 prenatal genetic diagnosis. Coverage for procedures for in
331	331	21 vitro fertilization, gamete intrafallopian tube transfer, or
332	332	22 zygote intrafallopian tube transfer shall be required only if
333	333	23 the procedures:
334	334	24 (1) are considered medically appropriate based on
335	335	25 clinical guidelines or standards developed by the American
336	336	26 Society for Reproductive Medicine, the American College of
337	337
338	338
339	339
340	340
341	341
342	342	SB2572 - 9 - LRB103 32124 BMS 61192 b
343	343
344	344
345	345	SB2572- 10 -LRB103 32124 BMS 61192 b SB2572 - 10 - LRB103 32124 BMS 61192 b
346	346	SB2572 - 10 - LRB103 32124 BMS 61192 b
347	347	1 Obstetricians and Gynecologists, or the Society for
348	348	2 Assisted Reproductive Technology; and
349	349	3 (2) are performed at medical facilities or clinics
350	350	4 that conform to the American College of Obstetricians and
351	351	5 Gynecologists guidelines for in vitro fertilization or the
352	352	6 American Society for Reproductive Medicine minimum
353	353	7 standards for practices offering assisted reproductive
354	354	8 technologies.
355	355	9 (b) The coverage required under subsection (a) for
356	356	10 procedures for in vitro fertilization, gamete intrafallopian
357	357	11 tube transfer, or zygote intrafallopian tube transfer shall be
358	358	12 required only if is subject to the following conditions:
359	359	13 (1) Coverage for procedures for in vitro
360	360	14 fertilization, gamete intrafallopian tube transfer, or
361	361	15 zygote intrafallopian tube transfer shall be required only
362	362	16 if:
363	363	17 (1) (A) the covered individual has been unable to
364	364	18 attain a viable pregnancy, maintain a viable pregnancy, or
365	365	19 sustain a successful pregnancy through reasonable, less
366	366	20 costly medically appropriate infertility treatments for
367	367	21 which coverage is available under the policy, plan, or
368	368	22 contract;
369	369	23 (2) (B) the covered individual has not undergone 4
370	370	24 completed oocyte retrievals, except that if a live birth
371	371	25 follows a completed oocyte retrieval, then 2 more
372	372	26 completed oocyte retrievals shall be covered; and
373	373
374	374
375	375
376	376
377	377
378	378	SB2572 - 10 - LRB103 32124 BMS 61192 b
379	379
380	380
381	381	SB2572- 11 -LRB103 32124 BMS 61192 b SB2572 - 11 - LRB103 32124 BMS 61192 b
382	382	SB2572 - 11 - LRB103 32124 BMS 61192 b
383	383	1 (3) (C) the procedures are performed at medical
384	384	2 facilities that conform to the American College of
385	385	3 Obstetric and Gynecology guidelines for in vitro
386	386	4 fertilization clinics or to the American Fertility Society
387	387	5 minimal standards for programs of in vitro fertilization.
388	388	6 (2) The procedures required to be covered under this
389	389	7 Section are not required to be contained in any policy or
390	390	8 plan issued to or by a religious institution or
391	391	9 organization or to or by an entity sponsored by a
392	392	10 religious institution or organization that finds the
393	393	11 procedures required to be covered under this Section to
394	394	12 violate its religious and moral teachings and beliefs.
395	395	13 (c) As used in this Section, "infertility" means a
396	396	14 disease, condition, or status characterized by:
397	397	15 (1) a failure to establish a pregnancy or to carry a
398	398	16 pregnancy to live birth after 12 months of regular,
399	399	17 unprotected sexual intercourse if the woman is 35 years of
400	400	18 age or younger, or after 6 months of regular, unprotected
401	401	19 sexual intercourse if the woman is over 35 years of age;
402	402	20 conceiving but having a miscarriage does not restart the
403	403	21 12-month or 6-month term for determining infertility;
404	404	22 (2) a person's inability to reproduce either as a
405	405	23 single individual or with a partner without medical
406	406	24 intervention; or
407	407	25 (3) a licensed physician's findings based on a
408	408	26 patient's medical, sexual, and reproductive history, age,
409	409
410	410
411	411
412	412
413	413
414	414	SB2572 - 11 - LRB103 32124 BMS 61192 b
415	415
416	416
417	417	SB2572- 12 -LRB103 32124 BMS 61192 b SB2572 - 12 - LRB103 32124 BMS 61192 b
418	418	SB2572 - 12 - LRB103 32124 BMS 61192 b
419	419	1 physical findings, or diagnostic testing.
420	420	2 (d) A policy, contract, or certificate may not impose any
421	421	3 exclusions, limitations, or other restrictions on coverage of
422	422	4 fertility medications that are different from those imposed on
423	423	5 any other prescription medications, nor may it impose any
424	424	6 exclusions, limitations, or other restrictions on coverage of
425	425	7 any fertility services based on a covered individual's
426	426	8 participation in fertility services provided by or to a third
427	427	9 party, nor may it impose deductibles, copayments, coinsurance,
428	428	10 benefit maximums, waiting periods, or any other limitations on
429	429	11 coverage for the diagnosis of infertility, treatment for
430	430	12 infertility, and standard fertility preservation services,
431	431	13 except as provided in this Section, that are different from
432	432	14 those imposed upon benefits for services not related to
433	433	15 infertility.
434	434	16 (e) The procedures required to be covered under this
435	435	17 Section are not required to be contained in any policy or plan
436	436	18 issued to or by a religious institution or organization or to
437	437	19 or by an entity sponsored by a religious institution or
438	438	20 organization that finds the procedures required to be covered
439	439	21 under this Section to violate its religious and moral
440	440	22 teachings and beliefs.
441	441	23 (Source: P.A. 102-170, eff. 1-1-22.)
442	442	24 (215 ILCS 5/356z.61 new)
443	443	25 Sec. 356z.61. Coverage for annual menopause health visit.
444	444
445	445
446	446
447	447
448	448
449	449	SB2572 - 12 - LRB103 32124 BMS 61192 b
450	450
451	451
452	452	SB2572- 13 -LRB103 32124 BMS 61192 b SB2572 - 13 - LRB103 32124 BMS 61192 b
453	453	SB2572 - 13 - LRB103 32124 BMS 61192 b
454	454	1 A group or individual policy of accident and health insurance
455	455	2 providing coverage for more than 25 employees that is amended,
456	456	3 delivered, issued, or renewed on or after January 1, 2024
457	457	4 shall provide, for individuals 45 years of age and older,
458	458	5 coverage for an annual menopause health visit. A policy
459	459	6 subject to this Section shall not impose a deductible,
460	460	7 coinsurance, copayment, or any other cost-sharing requirement
461	461	8 on the coverage provided; except that this Section does not
462	462	9 apply to this coverage to the extent such coverage would
463	463	10 disqualify a high-deductible health plan from eligibility from
464	464	11 a health savings account pursuant to Section 223 of the
465	465	12 Internal Revenue Code.
466	466	13 (215 ILCS 5/356z.62 new)
467	467	14 Sec. 356z.62. Coverage for injectable medicines to improve
468	468	15 glucose or weight loss. A group or individual policy of
469	469	16 accident and health insurance providing coverage for more than
470	470	17 25 employees that is amended, delivered, issued, or renewed on
471	471	18 or after January 1, 2024 shall provide coverage for all types
472	472	19 of injectable medicines prescribed on-label or off-label to
473	473	20 improve glucose or weight loss for use by adults diagnosed or
474	474	21 previously diagnosed with prediabetes, gestational diabetes,
475	475	22 or obesity.
476	476	23 Section 30. The Health Maintenance Organization Act is
477	477	24 amended by changing Section 5-3 as follows:
478	478
479	479
480	480
481	481
482	482
483	483	SB2572 - 13 - LRB103 32124 BMS 61192 b
484	484
485	485
486	486	SB2572- 14 -LRB103 32124 BMS 61192 b SB2572 - 14 - LRB103 32124 BMS 61192 b
487	487	SB2572 - 14 - LRB103 32124 BMS 61192 b
488	488	1 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
489	489	2 Sec. 5-3. Insurance Code provisions.
490	490	3 (a) Health Maintenance Organizations shall be subject to
491	491	4 the provisions of Sections 133, 134, 136, 137, 139, 140,
492	492	5 141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
493	493	6 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
494	494	7 355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x,
495	495	8 356y, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
496	496	9 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
497	497	10 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
498	498	11 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
499	499	12 356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48,
500	500	13 356z.50, 356z.51, 356z.53 256z.53, 356z.54, 356z.56, 356z.57,
501	501	14 356z.59, 356z.60, 356z.61, 356z.62, 364, 364.01, 364.3, 367.2,
502	502	15 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1,
503	503	16 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and
504	504	17 444.1, paragraph (c) of subsection (2) of Section 367, and
505	505	18 Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
506	506	19 XXVI, and XXXIIB of the Illinois Insurance Code.
507	507	20 (b) For purposes of the Illinois Insurance Code, except
508	508	21 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
509	509	22 Health Maintenance Organizations in the following categories
510	510	23 are deemed to be "domestic companies":
511	511	24 (1) a corporation authorized under the Dental Service
512	512	25 Plan Act or the Voluntary Health Services Plans Act;
513	513
514	514
515	515
516	516
517	517
518	518	SB2572 - 14 - LRB103 32124 BMS 61192 b
519	519
520	520
521	521	SB2572- 15 -LRB103 32124 BMS 61192 b SB2572 - 15 - LRB103 32124 BMS 61192 b
522	522	SB2572 - 15 - LRB103 32124 BMS 61192 b
523	523	1 (2) a corporation organized under the laws of this
524	524	2 State; or
525	525	3 (3) a corporation organized under the laws of another
526	526	4 state, 30% or more of the enrollees of which are residents
527	527	5 of this State, except a corporation subject to
528	528	6 substantially the same requirements in its state of
529	529	7 organization as is a "domestic company" under Article VIII
530	530	8 1/2 of the Illinois Insurance Code.
531	531	9 (c) In considering the merger, consolidation, or other
532	532	10 acquisition of control of a Health Maintenance Organization
533	533	11 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
534	534	12 (1) the Director shall give primary consideration to
535	535	13 the continuation of benefits to enrollees and the
536	536	14 financial conditions of the acquired Health Maintenance
537	537	15 Organization after the merger, consolidation, or other
538	538	16 acquisition of control takes effect;
539	539	17 (2)(i) the criteria specified in subsection (1)(b) of
540	540	18 Section 131.8 of the Illinois Insurance Code shall not
541	541	19 apply and (ii) the Director, in making his determination
542	542	20 with respect to the merger, consolidation, or other
543	543	21 acquisition of control, need not take into account the
544	544	22 effect on competition of the merger, consolidation, or
545	545	23 other acquisition of control;
546	546	24 (3) the Director shall have the power to require the
547	547	25 following information:
548	548	26 (A) certification by an independent actuary of the
549	549
550	550
551	551
552	552
553	553
554	554	SB2572 - 15 - LRB103 32124 BMS 61192 b
555	555
556	556
557	557	SB2572- 16 -LRB103 32124 BMS 61192 b SB2572 - 16 - LRB103 32124 BMS 61192 b
558	558	SB2572 - 16 - LRB103 32124 BMS 61192 b
559	559	1 adequacy of the reserves of the Health Maintenance
560	560	2 Organization sought to be acquired;
561	561	3 (B) pro forma financial statements reflecting the
562	562	4 combined balance sheets of the acquiring company and
563	563	5 the Health Maintenance Organization sought to be
564	564	6 acquired as of the end of the preceding year and as of
565	565	7 a date 90 days prior to the acquisition, as well as pro
566	566	8 forma financial statements reflecting projected
567	567	9 combined operation for a period of 2 years;
568	568	10 (C) a pro forma business plan detailing an
569	569	11 acquiring party's plans with respect to the operation
570	570	12 of the Health Maintenance Organization sought to be
571	571	13 acquired for a period of not less than 3 years; and
572	572	14 (D) such other information as the Director shall
573	573	15 require.
574	574	16 (d) The provisions of Article VIII 1/2 of the Illinois
575	575	17 Insurance Code and this Section 5-3 shall apply to the sale by
576	576	18 any health maintenance organization of greater than 10% of its
577	577	19 enrollee population (including without limitation the health
578	578	20 maintenance organization's right, title, and interest in and
579	579	21 to its health care certificates).
580	580	22 (e) In considering any management contract or service
581	581	23 agreement subject to Section 141.1 of the Illinois Insurance
582	582	24 Code, the Director (i) shall, in addition to the criteria
583	583	25 specified in Section 141.2 of the Illinois Insurance Code,
584	584	26 take into account the effect of the management contract or
585	585
586	586
587	587
588	588
589	589
590	590	SB2572 - 16 - LRB103 32124 BMS 61192 b
591	591
592	592
593	593	SB2572- 17 -LRB103 32124 BMS 61192 b SB2572 - 17 - LRB103 32124 BMS 61192 b
594	594	SB2572 - 17 - LRB103 32124 BMS 61192 b
595	595	1 service agreement on the continuation of benefits to enrollees
596	596	2 and the financial condition of the health maintenance
597	597	3 organization to be managed or serviced, and (ii) need not take
598	598	4 into account the effect of the management contract or service
599	599	5 agreement on competition.
600	600	6 (f) Except for small employer groups as defined in the
601	601	7 Small Employer Rating, Renewability and Portability Health
602	602	8 Insurance Act and except for medicare supplement policies as
603	603	9 defined in Section 363 of the Illinois Insurance Code, a
604	604	10 Health Maintenance Organization may by contract agree with a
605	605	11 group or other enrollment unit to effect refunds or charge
606	606	12 additional premiums under the following terms and conditions:
607	607	13 (i) the amount of, and other terms and conditions with
608	608	14 respect to, the refund or additional premium are set forth
609	609	15 in the group or enrollment unit contract agreed in advance
610	610	16 of the period for which a refund is to be paid or
611	611	17 additional premium is to be charged (which period shall
612	612	18 not be less than one year); and
613	613	19 (ii) the amount of the refund or additional premium
614	614	20 shall not exceed 20% of the Health Maintenance
615	615	21 Organization's profitable or unprofitable experience with
616	616	22 respect to the group or other enrollment unit for the
617	617	23 period (and, for purposes of a refund or additional
618	618	24 premium, the profitable or unprofitable experience shall
619	619	25 be calculated taking into account a pro rata share of the
620	620	26 Health Maintenance Organization's administrative and
621	621
622	622
623	623
624	624
625	625
626	626	SB2572 - 17 - LRB103 32124 BMS 61192 b
627	627
628	628
629	629	SB2572- 18 -LRB103 32124 BMS 61192 b SB2572 - 18 - LRB103 32124 BMS 61192 b
630	630	SB2572 - 18 - LRB103 32124 BMS 61192 b
631	631	1 marketing expenses, but shall not include any refund to be
632	632	2 made or additional premium to be paid pursuant to this
633	633	3 subsection (f)). The Health Maintenance Organization and
634	634	4 the group or enrollment unit may agree that the profitable
635	635	5 or unprofitable experience may be calculated taking into
636	636	6 account the refund period and the immediately preceding 2
637	637	7 plan years.
638	638	8 The Health Maintenance Organization shall include a
639	639	9 statement in the evidence of coverage issued to each enrollee
640	640	10 describing the possibility of a refund or additional premium,
641	641	11 and upon request of any group or enrollment unit, provide to
642	642	12 the group or enrollment unit a description of the method used
643	643	13 to calculate (1) the Health Maintenance Organization's
644	644	14 profitable experience with respect to the group or enrollment
645	645	15 unit and the resulting refund to the group or enrollment unit
646	646	16 or (2) the Health Maintenance Organization's unprofitable
647	647	17 experience with respect to the group or enrollment unit and
648	648	18 the resulting additional premium to be paid by the group or
649	649	19 enrollment unit.
650	650	20 In no event shall the Illinois Health Maintenance
651	651	21 Organization Guaranty Association be liable to pay any
652	652	22 contractual obligation of an insolvent organization to pay any
653	653	23 refund authorized under this Section.
654	654	24 (g) Rulemaking authority to implement Public Act 95-1045,
655	655	25 if any, is conditioned on the rules being adopted in
656	656	26 accordance with all provisions of the Illinois Administrative
657	657
658	658
659	659
660	660
661	661
662	662	SB2572 - 18 - LRB103 32124 BMS 61192 b
663	663
664	664
665	665	SB2572- 19 -LRB103 32124 BMS 61192 b SB2572 - 19 - LRB103 32124 BMS 61192 b
666	666	SB2572 - 19 - LRB103 32124 BMS 61192 b
667	667	1 Procedure Act and all rules and procedures of the Joint
668	668	2 Committee on Administrative Rules; any purported rule not so
669	669	3 adopted, for whatever reason, is unauthorized.
670	670	4 (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
671	671	5 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
672	672	6 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
673	673	7 eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
674	674	8 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
675	675	9 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
676	676	10 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
677	677	11 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
678	678	12 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
679	679	13 eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.)
680	680	14 Section 35. The Limited Health Service Organization Act is
681	681	15 amended by changing Section 4003 as follows:
682	682	16 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
683	683	17 Sec. 4003. Illinois Insurance Code provisions. Limited
684	684	18 health service organizations shall be subject to the
685	685	19 provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
686	686	20 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
687	687	21 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
688	688	22 355b, 356m, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21,
689	689	23 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
690	690	24 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
691	691
692	692
693	693
694	694
695	695
696	696	SB2572 - 19 - LRB103 32124 BMS 61192 b
697	697
698	698
699	699	SB2572- 20 -LRB103 32124 BMS 61192 b SB2572 - 20 - LRB103 32124 BMS 61192 b
700	700	SB2572 - 20 - LRB103 32124 BMS 61192 b
701	701	1 356z.57, 356z.59, 356z.61, 356z.62, 364.3, 368a, 401, 401.1,
702	702	2 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and
703	703	3 Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and
704	704	4 XXVI of the Illinois Insurance Code. Nothing in this Section
705	705	5 shall require a limited health care plan to cover any service
706	706	6 that is not a limited health service. For purposes of the
707	707	7 Illinois Insurance Code, except for Sections 444 and 444.1 and
708	708	8 Articles XIII and XIII 1/2, limited health service
709	709	9 organizations in the following categories are deemed to be
710	710	10 domestic companies:
711	711	11 (1) a corporation under the laws of this State; or
712	712	12 (2) a corporation organized under the laws of another
713	713	13 state, 30% or more of the enrollees of which are residents
714	714	14 of this State, except a corporation subject to
715	715	15 substantially the same requirements in its state of
716	716	16 organization as is a domestic company under Article VIII
717	717	17 1/2 of the Illinois Insurance Code.
718	718	18 (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
719	719	19 101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff.
720	720	20 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642,
721	721	21 eff. 1-1-22; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
722	722	22 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff.
723	723	23 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
724	724	24 Section 40. The Voluntary Health Services Plans Act is
725	725	25 amended by changing Section 10 as follows:
726	726
727	727
728	728
729	729
730	730
731	731	SB2572 - 20 - LRB103 32124 BMS 61192 b
732	732
733	733
734	734	SB2572- 21 -LRB103 32124 BMS 61192 b SB2572 - 21 - LRB103 32124 BMS 61192 b
735	735	SB2572 - 21 - LRB103 32124 BMS 61192 b
736	736	1 (215 ILCS 165/10) (from Ch. 32, par. 604)
737	737	2 Sec. 10. Application of Insurance Code provisions. Health
738	738	3 services plan corporations and all persons interested therein
739	739	4 or dealing therewith shall be subject to the provisions of
740	740	5 Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
741	741	6 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
742	742	7 356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t, 356u, 356v,
743	743	8 356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a,
744	744	9 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
745	745	10 356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22,
746	746	11 356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
747	747	12 356z.33, 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
748	748	13 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62,
749	749	14 364.01, 364.3, 367.2, 368a, 401, 401.1, 402, 403, 403A, 408,
750	750	15 408.2, and 412, and paragraphs (7) and (15) of Section 367 of
751	751	16 the Illinois Insurance Code.
752	752	17 Rulemaking authority to implement Public Act 95-1045, if
753	753	18 any, is conditioned on the rules being adopted in accordance
754	754	19 with all provisions of the Illinois Administrative Procedure
755	755	20 Act and all rules and procedures of the Joint Committee on
756	756	21 Administrative Rules; any purported rule not so adopted, for
757	757	22 whatever reason, is unauthorized.
758	758	23 (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
759	759	24 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.
760	760	25 1-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306,
761	761
762	762
763	763
764	764
765	765
766	766	SB2572 - 21 - LRB103 32124 BMS 61192 b
767	767
768	768
769	769	SB2572- 22 -LRB103 32124 BMS 61192 b SB2572 - 22 - LRB103 32124 BMS 61192 b
770	770	SB2572 - 22 - LRB103 32124 BMS 61192 b
771	771	1 eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21;
772	772	2 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff.
773	773	3 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
774	774	4 eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23;
775	775	5 102-1117, eff. 1-13-23.)
776	776	6 Section 45. The Illinois Public Aid Code is amended by
777	777	7 changing Section 5-16.8 as follows:
778	778	8 (305 ILCS 5/5-16.8)
779	779	9 Sec. 5-16.8. Required health benefits. The medical
780	780	10 assistance program shall (i) provide the post-mastectomy care
781	781	11 benefits required to be covered by a policy of accident and
782	782	12 health insurance under Section 356t and the coverage required
783	783	13 under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
784	784	14 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
785	785	15 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, and 356z.60, and
786	786	16 356z.62 of the Illinois Insurance Code, (ii) be subject to the
787	787	17 provisions of Sections 356z.19, 356z.44, 356z.49, 364.01,
788	788	18 370c, and 370c.1 of the Illinois Insurance Code, and (iii) be
789	789	19 subject to the provisions of subsection (d-5) of Section 10 of
790	790	20 the Network Adequacy and Transparency Act.
791	791	21 The Department, by rule, shall adopt a model similar to
792	792	22 the requirements of Section 356z.39 of the Illinois Insurance
793	793	23 Code.
794	794	24 On and after July 1, 2012, the Department shall reduce any
795	795
796	796
797	797
798	798
799	799
800	800	SB2572 - 22 - LRB103 32124 BMS 61192 b
801	801
802	802
803	803	SB2572- 23 -LRB103 32124 BMS 61192 b SB2572 - 23 - LRB103 32124 BMS 61192 b
804	804	SB2572 - 23 - LRB103 32124 BMS 61192 b
805	805	1 rate of reimbursement for services or other payments or alter
806	806	2 any methodologies authorized by this Code to reduce any rate
807	807	3 of reimbursement for services or other payments in accordance
808	808	4 with Section 5-5e.
809	809	5 To ensure full access to the benefits set forth in this
810	810	6 Section, on and after January 1, 2016, the Department shall
811	811	7 ensure that provider and hospital reimbursement for
812	812	8 post-mastectomy care benefits required under this Section are
813	813	9 no lower than the Medicare reimbursement rate.
814	814	10 (Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20;
815	815	11 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff.
816	816	12 1-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144,
817	817	13 eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
818	818	14 102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff.
819	819	15 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093,
820	820	16 eff. 1-1-23; 102-1117, eff. 1-13-23.)
821	821	17 Section 95. No acceleration or delay. Where this Act makes
822	822	18 changes in a statute that is represented in this Act by text
823	823	19 that is not yet or no longer in effect (for example, a Section
824	824	20 represented by multiple versions), the use of that text does
825	825	21 not accelerate or delay the taking effect of (i) the changes
826	826	22 made by this Act or (ii) provisions derived from any other
827	827	23 Public Act.
828	828	24 Section 99. Effective date. This Act takes effect upon
829	829	25 becoming law.
830	830	SB2572- 24 -LRB103 32124 BMS 61192 b 1 INDEX 2 Statutes amended in order of appearance SB2572- 24 -LRB103 32124 BMS 61192 b SB2572 - 24 - LRB103 32124 BMS 61192 b 1 INDEX 2 Statutes amended in order of appearance
831	831	SB2572- 24 -LRB103 32124 BMS 61192 b SB2572 - 24 - LRB103 32124 BMS 61192 b
832	832	SB2572 - 24 - LRB103 32124 BMS 61192 b
833	833	1 INDEX
834	834	2 Statutes amended in order of appearance
835	835
836	836
837	837
838	838
839	839
840	840	SB2572 - 23 - LRB103 32124 BMS 61192 b
841	841
842	842
843	843
844	844	SB2572- 24 -LRB103 32124 BMS 61192 b SB2572 - 24 - LRB103 32124 BMS 61192 b
845	845	SB2572 - 24 - LRB103 32124 BMS 61192 b
846	846	1 INDEX
847	847	2 Statutes amended in order of appearance
848	848
849	849
850	850
851	851
852	852
853	853	SB2572 - 24 - LRB103 32124 BMS 61192 b