IL
Illinois Senate Bill SB2639

Illinois 2023-2024 Regular Session

Illinois Senate Bill SB2639 Compare Versions

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1-SB2639 EngrossedLRB103 35235 RPS 65226 b SB2639 Engrossed LRB103 35235 RPS 65226 b
2- SB2639 Engrossed LRB103 35235 RPS 65226 b
1+103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2639 Introduced 11/7/2023, by Sen. Michael E. Hastings SYNOPSIS AS INTRODUCED: 215 ILCS 5/356m from Ch. 73, par. 968m Amends the Illinois Insurance Code. Provides that, for a group policy of accident and health insurance providing coverage for more than 25 employees that provides pregnancy related benefits that is issued, amended, delivered, or renewed in this State after the effective date of the amendatory Act, if a covered individual obtains, from a physician licensed to practice medicine in all its branches, a recommendation approving the covered individual to seek in vitro fertilization, gamete intrafallopian tube transfer, or zygote intrafallopian tube transfer based on any of the following: the covered individual's medical, sexual, and reproductive history; the covered individual's age; physical findings; or diagnostic testing, then the procedure shall be covered without any other restrictions or requirements. LRB103 35235 RPS 65226 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2639 Introduced 11/7/2023, by Sen. Michael E. Hastings SYNOPSIS AS INTRODUCED: 215 ILCS 5/356m from Ch. 73, par. 968m 215 ILCS 5/356m from Ch. 73, par. 968m Amends the Illinois Insurance Code. Provides that, for a group policy of accident and health insurance providing coverage for more than 25 employees that provides pregnancy related benefits that is issued, amended, delivered, or renewed in this State after the effective date of the amendatory Act, if a covered individual obtains, from a physician licensed to practice medicine in all its branches, a recommendation approving the covered individual to seek in vitro fertilization, gamete intrafallopian tube transfer, or zygote intrafallopian tube transfer based on any of the following: the covered individual's medical, sexual, and reproductive history; the covered individual's age; physical findings; or diagnostic testing, then the procedure shall be covered without any other restrictions or requirements. LRB103 35235 RPS 65226 b LRB103 35235 RPS 65226 b A BILL FOR
2+103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2639 Introduced 11/7/2023, by Sen. Michael E. Hastings SYNOPSIS AS INTRODUCED:
3+215 ILCS 5/356m from Ch. 73, par. 968m 215 ILCS 5/356m from Ch. 73, par. 968m
4+215 ILCS 5/356m from Ch. 73, par. 968m
5+Amends the Illinois Insurance Code. Provides that, for a group policy of accident and health insurance providing coverage for more than 25 employees that provides pregnancy related benefits that is issued, amended, delivered, or renewed in this State after the effective date of the amendatory Act, if a covered individual obtains, from a physician licensed to practice medicine in all its branches, a recommendation approving the covered individual to seek in vitro fertilization, gamete intrafallopian tube transfer, or zygote intrafallopian tube transfer based on any of the following: the covered individual's medical, sexual, and reproductive history; the covered individual's age; physical findings; or diagnostic testing, then the procedure shall be covered without any other restrictions or requirements.
6+LRB103 35235 RPS 65226 b LRB103 35235 RPS 65226 b
7+ LRB103 35235 RPS 65226 b
8+A BILL FOR
9+SB2639LRB103 35235 RPS 65226 b SB2639 LRB103 35235 RPS 65226 b
10+ SB2639 LRB103 35235 RPS 65226 b
311 1 AN ACT concerning regulation.
412 2 Be it enacted by the People of the State of Illinois,
513 3 represented in the General Assembly:
6-4 Section 5. The Counties Code is amended by changing
7-5 Section 5-1069.3 as follows:
8-6 (55 ILCS 5/5-1069.3)
9-7 Sec. 5-1069.3. Required health benefits. If a county,
10-8 including a home rule county, is a self-insurer for purposes
11-9 of providing health insurance coverage for its employees, the
12-10 coverage shall include coverage for the post-mastectomy care
13-11 benefits required to be covered by a policy of accident and
14-12 health insurance under Section 356t and the coverage required
15-13 under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w,
16-14 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
17-15 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
18-16 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36,
19-17 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
20-18 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
21-19 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
22-20 of the Illinois Insurance Code. The coverage shall comply with
23-21 Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
24-22 Insurance Code. The Department of Insurance shall enforce the
25-23 requirements of this Section. The requirement that health
14+4 Section 5. The Illinois Insurance Code is amended by
15+5 changing Section 356m as follows:
16+6 (215 ILCS 5/356m) (from Ch. 73, par. 968m)
17+7 Sec. 356m. Infertility coverage.
18+8 (a) No group policy of accident and health insurance
19+9 providing coverage for more than 25 employees that provides
20+10 pregnancy related benefits may be issued, amended, delivered,
21+11 or renewed in this State after the effective date of this
22+12 amendatory Act of the 99th General Assembly unless the policy
23+13 contains coverage for the diagnosis and treatment of
24+14 infertility including, but not limited to, in vitro
25+15 fertilization, uterine embryo lavage, embryo transfer,
26+16 artificial insemination, gamete intrafallopian tube transfer,
27+17 zygote intrafallopian tube transfer, and low tubal ovum
28+18 transfer.
29+19 (b) The coverage required under subsection (a) is subject
30+20 to the following conditions:
31+21 (1) Coverage for procedures for in vitro
32+22 fertilization, gamete intrafallopian tube transfer, or
33+23 zygote intrafallopian tube transfer shall be required only
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34-1 benefits be covered as provided in this Section is an
35-2 exclusive power and function of the State and is a denial and
36-3 limitation under Article VII, Section 6, subsection (h) of the
37-4 Illinois Constitution. A home rule county to which this
38-5 Section applies must comply with every provision of this
39-6 Section.
40-7 Rulemaking authority to implement Public Act 95-1045, if
41-8 any, is conditioned on the rules being adopted in accordance
42-9 with all provisions of the Illinois Administrative Procedure
43-10 Act and all rules and procedures of the Joint Committee on
44-11 Administrative Rules; any purported rule not so adopted, for
45-12 whatever reason, is unauthorized.
46-13 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
47-14 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
48-15 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
49-16 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
50-17 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
51-18 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
52-19 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
53-20 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
54-21 8-29-23.)
55-22 Section 10. The Illinois Municipal Code is amended by
56-23 changing Section 10-4-2.3 as follows:
57-24 (65 ILCS 5/10-4-2.3)
37+103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2639 Introduced 11/7/2023, by Sen. Michael E. Hastings SYNOPSIS AS INTRODUCED:
38+215 ILCS 5/356m from Ch. 73, par. 968m 215 ILCS 5/356m from Ch. 73, par. 968m
39+215 ILCS 5/356m from Ch. 73, par. 968m
40+Amends the Illinois Insurance Code. Provides that, for a group policy of accident and health insurance providing coverage for more than 25 employees that provides pregnancy related benefits that is issued, amended, delivered, or renewed in this State after the effective date of the amendatory Act, if a covered individual obtains, from a physician licensed to practice medicine in all its branches, a recommendation approving the covered individual to seek in vitro fertilization, gamete intrafallopian tube transfer, or zygote intrafallopian tube transfer based on any of the following: the covered individual's medical, sexual, and reproductive history; the covered individual's age; physical findings; or diagnostic testing, then the procedure shall be covered without any other restrictions or requirements.
41+LRB103 35235 RPS 65226 b LRB103 35235 RPS 65226 b
42+ LRB103 35235 RPS 65226 b
43+A BILL FOR
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68-1 Sec. 10-4-2.3. Required health benefits. If a
69-2 municipality, including a home rule municipality, is a
70-3 self-insurer for purposes of providing health insurance
71-4 coverage for its employees, the coverage shall include
72-5 coverage for the post-mastectomy care benefits required to be
73-6 covered by a policy of accident and health insurance under
74-7 Section 356t and the coverage required under Sections 356g,
75-8 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, 356z.4,
76-9 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
77-10 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
78-11 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
79-12 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
80-13 356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
81-14 356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois
82-15 Insurance Code. The coverage shall comply with Sections
83-16 155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
84-17 Code. The Department of Insurance shall enforce the
85-18 requirements of this Section. The requirement that health
86-19 benefits be covered as provided in this is an exclusive power
87-20 and function of the State and is a denial and limitation under
88-21 Article VII, Section 6, subsection (h) of the Illinois
89-22 Constitution. A home rule municipality to which this Section
90-23 applies must comply with every provision of this Section.
91-24 Rulemaking authority to implement Public Act 95-1045, if
92-25 any, is conditioned on the rules being adopted in accordance
93-26 with all provisions of the Illinois Administrative Procedure
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104-1 Act and all rules and procedures of the Joint Committee on
105-2 Administrative Rules; any purported rule not so adopted, for
106-3 whatever reason, is unauthorized.
107-4 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
108-5 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
109-6 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
110-7 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
111-8 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
112-9 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
113-10 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
114-11 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
115-12 8-29-23.)
116-13 Section 15. The School Code is amended by changing Section
117-14 10-22.3f as follows:
118-15 (105 ILCS 5/10-22.3f)
119-16 Sec. 10-22.3f. Required health benefits. Insurance
120-17 protection and benefits for employees shall provide the
121-18 post-mastectomy care benefits required to be covered by a
122-19 policy of accident and health insurance under Section 356t and
123-20 the coverage required under Sections 356g, 356g.5, 356g.5-1,
124-21 356m, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
125-22 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
126-23 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
127-24 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
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68+1 if:
69+2 (A) the covered individual has been unable to
70+3 attain a viable pregnancy, maintain a viable
71+4 pregnancy, or sustain a successful pregnancy through
72+5 reasonable, less costly medically appropriate
73+6 infertility treatments for which coverage is available
74+7 under the policy, plan, or contract;
75+8 (B) the covered individual has not undergone 4
76+9 completed oocyte retrievals, except that if a live
77+10 birth follows a completed oocyte retrieval, then 2
78+11 more completed oocyte retrievals shall be covered; and
79+12 (C) the procedures are performed at medical
80+13 facilities that conform to the American College of
81+14 Obstetric and Gynecology guidelines for in vitro
82+15 fertilization clinics or to the American Fertility
83+16 Society minimal standards for programs of in vitro
84+17 fertilization.
85+18 (1.5) For a group policy of accident and health
86+19 insurance providing coverage for more than 25 employees
87+20 that provides pregnancy related benefits that is issued,
88+21 amended, delivered, or renewed in this State after the
89+22 effective date of this amendatory Act of the 103rd General
90+23 Assembly, if the requirements of paragraph (1) are met or
91+24 if the covered individual obtains, from a physician
92+25 licensed to practice medicine in all its branches, a
93+26 recommendation approving the covered individual to seek in
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138-1 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
139-2 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
140-3 of the Illinois Insurance Code. Insurance policies shall
141-4 comply with Section 356z.19 of the Illinois Insurance Code.
142-5 The coverage shall comply with Sections 155.22a, 355b, and
143-6 370c of the Illinois Insurance Code. The Department of
144-7 Insurance shall enforce the requirements of this Section.
145-8 Rulemaking authority to implement Public Act 95-1045, if
146-9 any, is conditioned on the rules being adopted in accordance
147-10 with all provisions of the Illinois Administrative Procedure
148-11 Act and all rules and procedures of the Joint Committee on
149-12 Administrative Rules; any purported rule not so adopted, for
150-13 whatever reason, is unauthorized.
151-14 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
152-15 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
153-16 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
154-17 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
155-18 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
156-19 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
157-20 eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
158-21 103-551, eff. 8-11-23; revised 8-29-23.)
159-22 Section 20. The Illinois Insurance Code is amended by
160-23 changing Section 356m as follows:
161-24 (215 ILCS 5/356m) (from Ch. 73, par. 968m)
102+SB2639- 3 -LRB103 35235 RPS 65226 b SB2639 - 3 - LRB103 35235 RPS 65226 b
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104+1 vitro fertilization, gamete intrafallopian tube transfer,
105+2 or zygote intrafallopian tube transfer based on any of the
106+3 following: (i) the covered individual's medical, sexual,
107+4 and reproductive history; (ii) the covered individual's
108+5 age; (iii) physical findings; or (iv) diagnostic testing,
109+6 then the procedure shall be covered without any other
110+7 restrictions or requirements.
111+8 (2) The procedures required to be covered under this
112+9 Section are not required to be contained in any policy or
113+10 plan issued to or by a religious institution or
114+11 organization or to or by an entity sponsored by a
115+12 religious institution or organization that finds the
116+13 procedures required to be covered under this Section to
117+14 violate its religious and moral teachings and beliefs.
118+15 (c) As used in this Section, "infertility" means a
119+16 disease, condition, or status characterized by:
120+17 (1) a failure to establish a pregnancy or to carry a
121+18 pregnancy to live birth after 12 months of regular,
122+19 unprotected sexual intercourse if the woman is 35 years of
123+20 age or younger, or after 6 months of regular, unprotected
124+21 sexual intercourse if the woman is over 35 years of age;
125+22 conceiving but having a miscarriage does not restart the
126+23 12-month or 6-month term for determining infertility;
127+24 (2) a person's inability to reproduce either as a
128+25 single individual or with a partner without medical
129+26 intervention; or
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172-1 Sec. 356m. Infertility coverage.
173-2 (a) No group policy of accident and health insurance
174-3 providing coverage for more than 25 employees that provides
175-4 pregnancy-related pregnancy related benefits may be issued,
176-5 amended, delivered, or renewed in this State after the
177-6 effective date of this amendatory Act of the 99th General
178-7 Assembly unless the policy contains coverage for the diagnosis
179-8 and treatment of infertility including, but not limited to, in
180-9 vitro fertilization, uterine embryo lavage, embryo transfer,
181-10 artificial insemination, gamete intrafallopian tube transfer,
182-11 zygote intrafallopian tube transfer, and low tubal ovum
183-12 transfer.
184-13 (b) The coverage required under subsection (a) is subject
185-14 to the following conditions:
186-15 (1) Coverage for procedures for in vitro
187-16 fertilization, gamete intrafallopian tube transfer, or
188-17 zygote intrafallopian tube transfer shall be required only
189-18 if:
190-19 (A) the covered individual has been unable to
191-20 attain a viable pregnancy, maintain a viable
192-21 pregnancy, or sustain a successful pregnancy through
193-22 reasonable, less costly medically appropriate
194-23 infertility treatments for which coverage is available
195-24 under the policy, plan, or contract;
196-25 (B) the covered individual has not undergone 4
197-26 completed oocyte retrievals, except that if a live
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208-1 birth follows a completed oocyte retrieval, then 2
209-2 more completed oocyte retrievals shall be covered; and
210-3 (C) the procedures are performed at medical
211-4 facilities that conform to the American College of
212-5 Obstetric and Gynecology guidelines for in vitro
213-6 fertilization clinics or to the American Fertility
214-7 Society minimal standards for programs of in vitro
215-8 fertilization.
216-9 (1.5) For a group policy of accident and health
217-10 insurance that provides pregnancy-related benefits that is
218-11 issued, amended, delivered, or renewed in this State after
219-12 January 1, 2026, if the requirements of paragraph (1) are
220-13 met or if the covered individual obtains, from a physician
221-14 licensed to practice medicine in all its branches, a
222-15 recommendation approving the covered individual to seek in
223-16 vitro fertilization, gamete intrafallopian tube transfer,
224-17 or zygote intrafallopian tube transfer based on any of the
225-18 following: (i) the covered individual's medical, sexual,
226-19 and reproductive history; (ii) the covered individual's
227-20 age; (iii) physical findings; or (iv) diagnostic testing,
228-21 then the procedure shall be covered without any other
229-22 restrictions or requirements.
230-23 (2) The procedures required to be covered under this
231-24 Section are not required to be contained in any policy or
232-25 plan issued to or by a religious institution or
233-26 organization or to or by an entity sponsored by a
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244-1 religious institution or organization that finds the
245-2 procedures required to be covered under this Section to
246-3 violate its religious and moral teachings and beliefs.
247-4 (c) As used in this Section, "infertility" means a
248-5 disease, condition, or status characterized by:
249-6 (1) a failure to establish a pregnancy or to carry a
250-7 pregnancy to live birth after 12 months of regular,
251-8 unprotected sexual intercourse if the woman is 35 years of
252-9 age or younger, or after 6 months of regular, unprotected
253-10 sexual intercourse if the woman is over 35 years of age;
254-11 conceiving but having a miscarriage does not restart the
255-12 12-month or 6-month term for determining infertility;
256-13 (2) a person's inability to reproduce either as a
257-14 single individual or with a partner without medical
258-15 intervention; or
259-16 (3) a licensed physician's findings based on a
260-17 patient's medical, sexual, and reproductive history, age,
261-18 physical findings, or diagnostic testing.
262-19 (d) A policy, contract, or certificate may not impose any
263-20 exclusions, limitations, or other restrictions on coverage of
264-21 fertility medications that are different from those imposed on
265-22 any other prescription medications, nor may it impose any
266-23 exclusions, limitations, or other restrictions on coverage of
267-24 any fertility services based on a covered individual's
268-25 participation in fertility services provided by or to a third
269-26 party, nor may it impose deductibles, copayments, coinsurance,
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280-1 benefit maximums, waiting periods, or any other limitations on
281-2 coverage for the diagnosis of infertility, treatment for
282-3 infertility, and standard fertility preservation services,
283-4 except as provided in this Section, that are different from
284-5 those imposed upon benefits for services not related to
285-6 infertility.
286-7 (Source: P.A. 102-170, eff. 1-1-22.)
287-8 Section 25. The Limited Health Service Organization Act is
288-9 amended by changing Section 4003 as follows:
289-10 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
290-11 Sec. 4003. Illinois Insurance Code provisions. Limited
291-12 health service organizations shall be subject to the
292-13 provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
293-14 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
294-15 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2,
295-16 355.3, 355b, 356m, 356q, 356v, 356z.4, 356z.4a, 356z.10,
296-17 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a,
297-18 356z.32, 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
298-19 356z.54, 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68,
299-20 364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
300-21 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
301-22 XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
302-23 Nothing in this Section shall require a limited health care
303-24 plan to cover any service that is not a limited health service.
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314-1 For purposes of the Illinois Insurance Code, except for
315-2 Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
316-3 health service organizations in the following categories are
317-4 deemed to be domestic companies:
318-5 (1) a corporation under the laws of this State; or
319-6 (2) a corporation organized under the laws of another
320-7 state, 30% or more of the enrollees of which are residents
321-8 of this State, except a corporation subject to
322-9 substantially the same requirements in its state of
323-10 organization as is a domestic company under Article VIII
324-11 1/2 of the Illinois Insurance Code.
325-12 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
326-13 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
327-14 1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
328-15 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
329-16 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
330-17 1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
331-18 eff. 1-1-24; revised 8-29-23.)
332-19 Section 30. The Voluntary Health Services Plans Act is
333-20 amended by changing Section 10 as follows:
334-21 (215 ILCS 165/10) (from Ch. 32, par. 604)
335-22 Sec. 10. Application of Insurance Code provisions. Health
336-23 services plan corporations and all persons interested therein
337-24 or dealing therewith shall be subject to the provisions of
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348-1 Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
349-2 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
350-3 356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t, 356u, 356v,
351-4 356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a,
352-5 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
353-6 356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22,
354-7 356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
355-8 356z.33, 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
356-9 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62,
357-10 356z.64, 356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401,
358-11 401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
359-12 and (15) of Section 367 of the Illinois Insurance Code.
360-13 Rulemaking authority to implement Public Act 95-1045, if
361-14 any, is conditioned on the rules being adopted in accordance
362-15 with all provisions of the Illinois Administrative Procedure
363-16 Act and all rules and procedures of the Joint Committee on
364-17 Administrative Rules; any purported rule not so adopted, for
365-18 whatever reason, is unauthorized.
366-19 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
367-20 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
368-21 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
369-22 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
370-23 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
371-24 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
372-25 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
373-26 103-551, eff. 8-11-23; revised 8-29-23.)
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384-1 Section 35. The Illinois Public Aid Code is amended by
385-2 changing Section 5-16.8 as follows:
386-3 (305 ILCS 5/5-16.8)
387-4 Sec. 5-16.8. Required health benefits. The medical
388-5 assistance program shall (i) provide the post-mastectomy care
389-6 benefits required to be covered by a policy of accident and
390-7 health insurance under Section 356t and the coverage required
391-8 under Sections 356g.5, 356m, 356q, 356u, 356w, 356x, 356z.6,
392-9 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
393-10 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and
394-11 356z.61, 356z.64, and 356z.67 of the Illinois Insurance Code,
395-12 (ii) be subject to the provisions of Sections 356z.19,
396-13 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the Illinois
397-14 Insurance Code, and (iii) be subject to the provisions of
398-15 subsection (d-5) of Section 10 of the Network Adequacy and
399-16 Transparency Act.
400-17 The Department, by rule, shall adopt a model similar to
401-18 the requirements of Section 356z.39 of the Illinois Insurance
402-19 Code.
403-20 On and after July 1, 2012, the Department shall reduce any
404-21 rate of reimbursement for services or other payments or alter
405-22 any methodologies authorized by this Code to reduce any rate
406-23 of reimbursement for services or other payments in accordance
407-24 with Section 5-5e.
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418-1 To ensure full access to the benefits set forth in this
419-2 Section, on and after January 1, 2016, the Department shall
420-3 ensure that provider and hospital reimbursement for
421-4 post-mastectomy care benefits required under this Section are
422-5 no lower than the Medicare reimbursement rate.
423-6 (Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
424-7 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
425-8 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
426-9 eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
427-10 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
428-11 1-1-24; 103-420, eff. 1-1-24; revised 12-15-23.)
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