Illinois 2025-2026 Regular Session

Illinois Senate Bill SB2286 Compare Versions

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

Old	New	Differences
1	1	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB2286 Introduced 2/7/2025, by Sen. Mike Simmons SYNOPSIS AS INTRODUCED: 215 ILCS 5/356z.62215 ILCS 200/78 new Amends the Prior Authorization Reform Act. Provides that, notwithstanding any other provision of law, a health insurance issuer or a contracted utilization review organization may not require prior authorization for preventive health services recommended by a health care professional. Amends the Illinois Insurance Code. Provides that a policy of group health insurance coverage or individual health insurance coverage shall, at a minimum, provide coverage and shall not require prior authorization or impose any cost-sharing requirements, including a copayment, coinsurance, or deductible, for specified preventive health services. Effective January 1, 2027. LRB104 10418 BAB 20493 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB2286 Introduced 2/7/2025, by Sen. Mike Simmons SYNOPSIS AS INTRODUCED: 215 ILCS 5/356z.62215 ILCS 200/78 new 215 ILCS 5/356z.62 215 ILCS 200/78 new Amends the Prior Authorization Reform Act. Provides that, notwithstanding any other provision of law, a health insurance issuer or a contracted utilization review organization may not require prior authorization for preventive health services recommended by a health care professional. Amends the Illinois Insurance Code. Provides that a policy of group health insurance coverage or individual health insurance coverage shall, at a minimum, provide coverage and shall not require prior authorization or impose any cost-sharing requirements, including a copayment, coinsurance, or deductible, for specified preventive health services. Effective January 1, 2027. LRB104 10418 BAB 20493 b LRB104 10418 BAB 20493 b A BILL FOR
2	2	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB2286 Introduced 2/7/2025, by Sen. Mike Simmons SYNOPSIS AS INTRODUCED:
3	3	215 ILCS 5/356z.62215 ILCS 200/78 new 215 ILCS 5/356z.62 215 ILCS 200/78 new
4	4	215 ILCS 5/356z.62
5	5	215 ILCS 200/78 new
6	6	Amends the Prior Authorization Reform Act. Provides that, notwithstanding any other provision of law, a health insurance issuer or a contracted utilization review organization may not require prior authorization for preventive health services recommended by a health care professional. Amends the Illinois Insurance Code. Provides that a policy of group health insurance coverage or individual health insurance coverage shall, at a minimum, provide coverage and shall not require prior authorization or impose any cost-sharing requirements, including a copayment, coinsurance, or deductible, for specified preventive health services. Effective January 1, 2027.
7	7	LRB104 10418 BAB 20493 b LRB104 10418 BAB 20493 b
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9	9	A BILL FOR
10	10	SB2286LRB104 10418 BAB 20493 b SB2286 LRB104 10418 BAB 20493 b
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12	12	1 AN ACT concerning regulation.
13	13	2 Be it enacted by the People of the State of Illinois,
14	14	3 represented in the General Assembly:
15	15	4 Section 5. The Illinois Insurance Code is amended by
16	16	5 changing Section 356z.62 as follows:
17	17	6 (215 ILCS 5/356z.62)
18	18	7 Sec. 356z.62. Coverage of preventive health services.
19	19	8 (a) A policy of group health insurance coverage or
20	20	9 individual health insurance coverage as defined in Section 5
21	21	10 of the Illinois Health Insurance Portability and
22	22	11 Accountability Act shall, at a minimum, provide coverage for
23	23	12 and shall not require prior authorization or impose any
24	24	13 cost-sharing requirements, including a copayment, coinsurance,
25	25	14 or deductible, for:
26	26	15 (1) evidence-based items or services that have in
27	27	16 effect a rating of "A" or "B" in the current
28	28	17 recommendations of the United States Preventive Services
29	29	18 Task Force;
30	30	19 (2) immunizations that have in effect a recommendation
31	31	20 from the Advisory Committee on Immunization Practices of
32	32	21 the Centers for Disease Control and Prevention with
33	33	22 respect to the individual involved;
34	34	23 (3) with respect to infants, children, and
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38	38	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB2286 Introduced 2/7/2025, by Sen. Mike Simmons SYNOPSIS AS INTRODUCED:
39	39	215 ILCS 5/356z.62215 ILCS 200/78 new 215 ILCS 5/356z.62 215 ILCS 200/78 new
40	40	215 ILCS 5/356z.62
41	41	215 ILCS 200/78 new
42	42	Amends the Prior Authorization Reform Act. Provides that, notwithstanding any other provision of law, a health insurance issuer or a contracted utilization review organization may not require prior authorization for preventive health services recommended by a health care professional. Amends the Illinois Insurance Code. Provides that a policy of group health insurance coverage or individual health insurance coverage shall, at a minimum, provide coverage and shall not require prior authorization or impose any cost-sharing requirements, including a copayment, coinsurance, or deductible, for specified preventive health services. Effective January 1, 2027.
43	43	LRB104 10418 BAB 20493 b LRB104 10418 BAB 20493 b
44	44	LRB104 10418 BAB 20493 b
45	45	A BILL FOR
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51	51	215 ILCS 5/356z.62
52	52	215 ILCS 200/78 new
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71	71	1 adolescents, evidence-informed preventive care and
72	72	2 screenings provided for in the comprehensive guidelines
73	73	3 supported by the Health Resources and Services
74	74	4 Administration; and
75	75	5 (4) with respect to women, such additional preventive
76	76	6 care and screenings not described in paragraph (1) of this
77	77	7 subsection (a) as provided for in comprehensive guidelines
78	78	8 supported by the Health Resources and Services
79	79	9 Administration for purposes of this paragraph.
80	80	10 (b) For purposes of this Section, and for purposes of any
81	81	11 other provision of State law, recommendations of the United
82	82	12 States Preventive Services Task Force regarding breast cancer
83	83	13 screening, mammography, and prevention issued in or around
84	84	14 November 2009 are not considered to be current.
85	85	15 (c) For office visits:
86	86	16 (1) if an item or service described in subsection (a)
87	87	17 is billed separately or is tracked as individual encounter
88	88	18 data separately from an office visit, then a policy may
89	89	19 impose cost-sharing requirements with respect to the
90	90	20 office visit;
91	91	21 (2) if an item or service described in subsection (a)
92	92	22 is not billed separately or is not tracked as individual
93	93	23 encounter data separately from an office visit and the
94	94	24 primary purpose of the office visit is the delivery of
95	95	25 such an item or service, then a policy may not impose
96	96	26 cost-sharing requirements with respect to the office
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107	107	1 visit; and
108	108	2 (3) if an item or service described in subsection (a)
109	109	3 is not billed separately or is not tracked as individual
110	110	4 encounter data separately from an office visit and the
111	111	5 primary purpose of the office visit is not the delivery of
112	112	6 such an item or service, then a policy may impose
113	113	7 cost-sharing requirements with respect to the office
114	114	8 visit.
115	115	9 (d) A policy must provide coverage pursuant to subsection
116	116	10 (a) for plan or policy years that begin on or after the date
117	117	11 that is one year after the date the recommendation or
118	118	12 guideline is issued. If a recommendation or guideline is in
119	119	13 effect on the first day of the plan or policy year, the policy
120	120	14 shall cover the items and services specified in the
121	121	15 recommendation or guideline through the last day of the plan
122	122	16 or policy year unless either:
123	123	17 (1) a recommendation under paragraph (1) of subsection
124	124	18 (a) is downgraded to a "D" rating; or
125	125	19 (2) the item or service is subject to a safety recall
126	126	20 or is otherwise determined to pose a significant safety
127	127	21 concern by a federal agency authorized to regulate the
128	128	22 item or service during the plan or policy year.
129	129	23 (e) Network limitations.
130	130	24 (1) Subject to paragraph (3) of this subsection,
131	131	25 nothing in this Section requires coverage for items or
132	132	26 services described in subsection (a) that are delivered by
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143	143	1 an out-of-network provider under a health maintenance
144	144	2 organization health care plan, other than a
145	145	3 point-of-service contract, or under a voluntary health
146	146	4 services plan that generally excludes coverage for
147	147	5 out-of-network services except as otherwise required by
148	148	6 law.
149	149	7 (2) Subject to paragraph (3) of this subsection,
150	150	8 nothing in this Section precludes a policy with a
151	151	9 preferred provider program under Article XX-1/2 of this
152	152	10 Code, a health maintenance organization point-of-service
153	153	11 contract, or a similarly designed voluntary health
154	154	12 services plan from imposing cost-sharing requirements for
155	155	13 items or services described in subsection (a) that are
156	156	14 delivered by an out-of-network provider.
157	157	15 (3) If a policy does not have in its network a provider
158	158	16 who can provide an item or service described in subsection
159	159	17 (a), then the policy must cover the item or service when
160	160	18 performed by an out-of-network provider and it may not
161	161	19 impose cost-sharing with respect to the item or service.
162	162	20 (f) Nothing in this Section prevents a company from using
163	163	21 reasonable medical management techniques to determine the
164	164	22 frequency, method, treatment, or setting for an item or
165	165	23 service described in subsection (a) to the extent not
166	166	24 specified in the recommendation or guideline.
167	167	25 (g) Nothing in this Section shall be construed to prohibit
168	168	26 a policy from providing coverage for items or services in
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179	179	1 addition to those required under subsection (a) or from
180	180	2 denying coverage for items or services that are not required
181	181	3 under subsection (a). Unless prohibited by other law, a policy
182	182	4 may impose cost-sharing requirements for a treatment not
183	183	5 described in subsection (a) even if the treatment results from
184	184	6 an item or service described in subsection (a). Nothing in
185	185	7 this Section shall be construed to limit coverage requirements
186	186	8 provided under other law.
187	187	9 (h) The Director may develop guidelines to permit a
188	188	10 company to utilize value-based insurance designs. In the
189	189	11 absence of guidelines developed by the Director, any such
190	190	12 guidelines developed by the Secretary of the U.S. Department
191	191	13 of Health and Human Services that are in force under 42 U.S.C.
192	192	14 300gg-13 shall apply.
193	193	15 (i) For student health insurance coverage as defined at 45
194	194	16 CFR 147.145, student administrative health fees are not
195	195	17 considered cost-sharing requirements with respect to
196	196	18 preventive services specified under subsection (a). As used in
197	197	19 this subsection, "student administrative health fee" means a
198	198	20 fee charged by an institution of higher education on a
199	199	21 periodic basis to its students to offset the cost of providing
200	200	22 health care through health clinics regardless of whether the
201	201	23 students utilize the health clinics or enroll in student
202	202	24 health insurance coverage.
203	203	25 (j) For any recommendation or guideline specifically
204	204	26 referring to women or men, a company shall not deny or limit
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215	215	1 the coverage required or a claim made under subsection (a)
216	216	2 based solely on the individual's recorded sex or actual or
217	217	3 perceived gender identity, or for the reason that the
218	218	4 individual is gender nonconforming, intersex, transgender, or
219	219	5 has undergone, or is in the process of undergoing, gender
220	220	6 transition, if, notwithstanding the sex or gender assigned at
221	221	7 birth, the covered individual meets the conditions for the
222	222	8 recommendation or guideline at the time the item or service is
223	223	9 furnished.
224	224	10 (k) This Section does not apply to grandfathered health
225	225	11 plans, excepted benefits, or short-term, limited-duration
226	226	12 health insurance coverage.
227	227	13 (Source: P.A. 103-551, eff. 8-11-23.)
228	228	14 Section 10. The Prior Authorization Reform Act is amended
229	229	15 by adding Section 78 as follows:
230	230	16 (215 ILCS 200/78 new)
231	231	17 Sec. 78. Prior authorization for preventive care
232	232	18 recommended by a physician. Notwithstanding any other
233	233	19 provision of law, a health insurance issuer or a contracted
234	234	20 utilization review organization may not require prior
235	235	21 authorization for preventive health services recommended by a
236	236	22 health care professional, as defined in Section 10 of the
237	237	23 Managed Care Reform and Patient Rights Act.
238	238	24 Section 99. Effective date. This Act takes effect January
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