Bill Amendment: IL HB4112 | 2023-2024 | 103rd General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: INS CD-INFERTILITY COVERAGE
Status: 2025-01-07 - Session Sine Die [HB4112 Detail]
Download: Illinois-2023-HB4112-House_Amendment_001.html
Bill Title: INS CD-INFERTILITY COVERAGE
Status: 2025-01-07 - Session Sine Die [HB4112 Detail]
Download: Illinois-2023-HB4112-House_Amendment_001.html
| |||||||
| |||||||
1 | AMENDMENT TO HOUSE BILL 4112 | ||||||
2 | AMENDMENT NO. ______. Amend House Bill 4112 by replacing | ||||||
3 | everything after the enacting clause with the following:
| ||||||
4 | "Section 5. The State Employees Group Insurance Act of | ||||||
5 | 1971 is amended by changing Section 6.11B as follows:
| ||||||
6 | (5 ILCS 375/6.11B) | ||||||
7 | Sec. 6.11B. Infertility coverage. | ||||||
8 | (a) Beginning on January 1, 2024, the State Employees | ||||||
9 | Group Insurance Program shall provide coverage for the | ||||||
10 | diagnosis and treatment of infertility, including, but not | ||||||
11 | limited to, in vitro fertilization, uterine embryo lavage, | ||||||
12 | embryo transfer, artificial insemination, gamete | ||||||
13 | intrafallopian tube transfer, zygote intrafallopian tube | ||||||
14 | transfer, and low tubal ovum transfer. The coverage required | ||||||
15 | shall include procedures necessary to screen or diagnose a | ||||||
16 | fertilized egg before implantation, including, but not limited |
| |||||||
| |||||||
1 | to, preimplantation genetic diagnosis, preimplantation genetic | ||||||
2 | screening, and prenatal genetic diagnosis. | ||||||
3 | (b) Beginning on January 1, 2024, coverage under this | ||||||
4 | Section for procedures for in vitro fertilization, gamete | ||||||
5 | intrafallopian tube transfer, or zygote intrafallopian tube | ||||||
6 | transfer shall be required only if the procedures: | ||||||
7 | (1) are considered medically appropriate based on | ||||||
8 | clinical guidelines or standards developed by the American | ||||||
9 | Society for Reproductive Medicine, the American College of | ||||||
10 | Obstetricians and Gynecologists, or the Society for | ||||||
11 | Assisted Reproductive Technology; and | ||||||
12 | (2) are performed at medical facilities or clinics | ||||||
13 | that conform to the American College of Obstetricians and | ||||||
14 | Gynecologists guidelines for in vitro fertilization or the | ||||||
15 | American Society for Reproductive Medicine minimum | ||||||
16 | standards for practices offering assisted reproductive | ||||||
17 | technologies. | ||||||
18 | (c) As used in this Section, "infertility" means a | ||||||
19 | disease, condition, or status characterized by: | ||||||
20 | (1) a failure to establish a pregnancy or to carry a | ||||||
21 | pregnancy to live birth after 12 months of regular, | ||||||
22 | unprotected sexual intercourse if the woman is 35 years of | ||||||
23 | age or younger, or after 6 months of regular, unprotected | ||||||
24 | sexual intercourse if the woman is over 35 years of age; | ||||||
25 | conceiving but having a miscarriage does not restart the | ||||||
26 | 12-month or 6-month term for determining infertility; |
| |||||||
| |||||||
1 | (2) a person's inability to reproduce either as a | ||||||
2 | single individual or with a partner without medical | ||||||
3 | intervention; or | ||||||
4 | (3) a licensed physician's findings based on a | ||||||
5 | patient's medical, sexual, and reproductive history, age, | ||||||
6 | physical findings, or diagnostic testing. | ||||||
7 | (d) The State Employees Group Insurance Program may not | ||||||
8 | impose any exclusions, limitations, or other restrictions on | ||||||
9 | coverage of fertility medications that are different from | ||||||
10 | those imposed on any other prescription medications, nor may | ||||||
11 | it impose any exclusions, limitations, or other restrictions | ||||||
12 | on coverage of any fertility services based on a covered | ||||||
13 | individual's participation in fertility services provided by | ||||||
14 | or to a third party, nor may it impose deductibles, | ||||||
15 | copayments, coinsurance, benefit maximums, waiting periods, or | ||||||
16 | any other limitations on coverage for the diagnosis of | ||||||
17 | infertility, treatment for infertility, and standard fertility | ||||||
18 | preservation services, except as provided in this Section, | ||||||
19 | that are different from those imposed upon benefits for | ||||||
20 | services not related to infertility. | ||||||
21 | (e) This Section applies only to coverage provided on or | ||||||
22 | after January 1, 2024 and before January 1, 2026. | ||||||
23 | (f) This Section is repealed on January 1, 2026. | ||||||
24 | (Source: P.A. 103-8, eff. 1-1-24 .)
| ||||||
25 | Section 10. The Counties Code is amended by changing |
| |||||||
| |||||||
1 | Section 5-1069.3 as follows:
| ||||||
2 | (55 ILCS 5/5-1069.3) | ||||||
3 | Sec. 5-1069.3. Required health benefits. If a county, | ||||||
4 | including a home rule county, is a self-insurer for purposes | ||||||
5 | of providing health insurance coverage for its employees, the | ||||||
6 | coverage shall include coverage for the post-mastectomy care | ||||||
7 | benefits required to be covered by a policy of accident and | ||||||
8 | health insurance under Section 356t and the coverage required | ||||||
9 | under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, | ||||||
10 | 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | ||||||
11 | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, | ||||||
12 | 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, | ||||||
13 | 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, | ||||||
14 | 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and | ||||||
15 | 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, and 356z.70 | ||||||
16 | of the Illinois Insurance Code. The coverage shall comply with | ||||||
17 | Sections 155.22a, 355b, 356z.19, and 370c of the Illinois | ||||||
18 | Insurance Code. The Department of Insurance shall enforce the | ||||||
19 | requirements of this Section. The requirement that health | ||||||
20 | benefits be covered as provided in this Section is an | ||||||
21 | exclusive power and function of the State and is a denial and | ||||||
22 | limitation under Article VII, Section 6, subsection (h) of the | ||||||
23 | Illinois Constitution. A home rule county to which this | ||||||
24 | Section applies must comply with every provision of this | ||||||
25 | Section. |
| |||||||
| |||||||
1 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
2 | any, is conditioned on the rules being adopted in accordance | ||||||
3 | with all provisions of the Illinois Administrative Procedure | ||||||
4 | Act and all rules and procedures of the Joint Committee on | ||||||
5 | Administrative Rules; any purported rule not so adopted, for | ||||||
6 | whatever reason, is unauthorized. | ||||||
7 | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||||||
8 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||||||
9 | 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, | ||||||
10 | eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | ||||||
11 | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | ||||||
12 | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | ||||||
13 | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | ||||||
14 | 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised | ||||||
15 | 8-29-23.)
| ||||||
16 | Section 15. The Illinois Municipal Code is amended by | ||||||
17 | changing Section 10-4-2.3 as follows:
| ||||||
18 | (65 ILCS 5/10-4-2.3) | ||||||
19 | Sec. 10-4-2.3. Required health benefits. If a | ||||||
20 | municipality, including a home rule municipality, is a | ||||||
21 | self-insurer for purposes of providing health insurance | ||||||
22 | coverage for its employees, the coverage shall include | ||||||
23 | coverage for the post-mastectomy care benefits required to be | ||||||
24 | covered by a policy of accident and health insurance under |
| |||||||
| |||||||
1 | Section 356t and the coverage required under Sections 356g, | ||||||
2 | 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, 356z.4, | ||||||
3 | 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, | ||||||
4 | 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | ||||||
5 | 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, | ||||||
6 | 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, | ||||||
7 | 356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62 , | ||||||
8 | 356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois | ||||||
9 | Insurance Code. The coverage shall comply with Sections | ||||||
10 | 155.22a, 355b, 356z.19, and 370c of the Illinois Insurance | ||||||
11 | Code. The Department of Insurance shall enforce the | ||||||
12 | requirements of this Section. The requirement that health | ||||||
13 | benefits be covered as provided in this is an exclusive power | ||||||
14 | and function of the State and is a denial and limitation under | ||||||
15 | Article VII, Section 6, subsection (h) of the Illinois | ||||||
16 | Constitution. A home rule municipality to which this Section | ||||||
17 | applies must comply with every provision of this Section. | ||||||
18 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
19 | any, is conditioned on the rules being adopted in accordance | ||||||
20 | with all provisions of the Illinois Administrative Procedure | ||||||
21 | Act and all rules and procedures of the Joint Committee on | ||||||
22 | Administrative Rules; any purported rule not so adopted, for | ||||||
23 | whatever reason, is unauthorized. | ||||||
24 | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||||||
25 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||||||
26 | 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, |
| |||||||
| |||||||
1 | eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | ||||||
2 | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | ||||||
3 | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | ||||||
4 | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | ||||||
5 | 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised | ||||||
6 | 8-29-23.)
| ||||||
7 | Section 20. The School Code is amended by changing Section | ||||||
8 | 10-22.3f as follows:
| ||||||
9 | (105 ILCS 5/10-22.3f) | ||||||
10 | Sec. 10-22.3f. Required health benefits. Insurance | ||||||
11 | protection and benefits for employees shall provide the | ||||||
12 | post-mastectomy care benefits required to be covered by a | ||||||
13 | policy of accident and health insurance under Section 356t and | ||||||
14 | the coverage required under Sections 356g, 356g.5, 356g.5-1, | ||||||
15 | 356m, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, | ||||||
16 | 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, | ||||||
17 | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | ||||||
18 | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | ||||||
19 | 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and | ||||||
20 | 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, and 356z.70 | ||||||
21 | of the Illinois Insurance Code. Insurance policies shall | ||||||
22 | comply with Section 356z.19 of the Illinois Insurance Code. | ||||||
23 | The coverage shall comply with Sections 155.22a, 355b, and | ||||||
24 | 370c of the Illinois Insurance Code. The Department of |
| |||||||
| |||||||
1 | Insurance shall enforce the requirements of this Section. | ||||||
2 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
3 | any, is conditioned on the rules being adopted in accordance | ||||||
4 | with all provisions of the Illinois Administrative Procedure | ||||||
5 | Act and all rules and procedures of the Joint Committee on | ||||||
6 | Administrative Rules; any purported rule not so adopted, for | ||||||
7 | whatever reason, is unauthorized. | ||||||
8 | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||||||
9 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. | ||||||
10 | 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, | ||||||
11 | eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; | ||||||
12 | 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. | ||||||
13 | 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, | ||||||
14 | eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; | ||||||
15 | 103-551, eff. 8-11-23; revised 8-29-23.)
| ||||||
16 | Section 25. The Illinois Insurance Code is amended by | ||||||
17 | changing Section 356m as follows:
| ||||||
18 | (215 ILCS 5/356m) (from Ch. 73, par. 968m) | ||||||
19 | Sec. 356m. Infertility coverage. | ||||||
20 | (a) No group policy of accident and health insurance | ||||||
21 | providing coverage for more than 25 employees that provides | ||||||
22 | pregnancy related benefits may be issued, amended, delivered, | ||||||
23 | or renewed in this State after January 1, 2016 through | ||||||
24 | December 31, 2025 the effective date of this amendatory Act of |
| |||||||
| |||||||
1 | the 99th General Assembly unless the policy contains coverage | ||||||
2 | for the diagnosis and treatment of infertility including, but | ||||||
3 | not limited to, in vitro fertilization, uterine embryo lavage, | ||||||
4 | embryo transfer, artificial insemination, gamete | ||||||
5 | intrafallopian tube transfer, zygote intrafallopian tube | ||||||
6 | transfer, and low tubal ovum transfer. | ||||||
7 | (a-5) No group policy of accident and health insurance | ||||||
8 | that provides pregnancy related benefits may be issued, | ||||||
9 | amended, delivered, or renewed in this State on or after | ||||||
10 | January 1, 2026 unless the policy contains coverage for the | ||||||
11 | diagnosis and treatment of infertility, including, but not | ||||||
12 | limited to, in vitro fertilization, uterine embryo lavage, | ||||||
13 | embryo transfer, artificial insemination, gamete | ||||||
14 | intrafallopian tube transfer, zygote intrafallopian tube | ||||||
15 | transfer, and low tubal ovum transfer and procedures necessary | ||||||
16 | to screen or diagnose a fertilized egg before implantation, | ||||||
17 | including, but not limited to, preimplantation genetic | ||||||
18 | diagnosis, preimplantation genetic screening, and prenatal | ||||||
19 | genetic diagnosis. Coverage under this subsection for the | ||||||
20 | diagnosis and treatment of infertility shall be required only | ||||||
21 | if the procedures: | ||||||
22 | (1) are considered medically appropriate by the | ||||||
23 | patient's medical provider based on clinical guidelines or | ||||||
24 | standards developed by the American Society for | ||||||
25 | Reproductive Medicine, the American College of | ||||||
26 | Obstetricians and Gynecologists, or the Society for |
| |||||||
| |||||||
1 | Assisted Reproductive Technology; and | ||||||
2 | (2) are performed at medical facilities or clinics | ||||||
3 | that conform to the American College of Obstetricians and | ||||||
4 | Gynecologists guidelines for in vitro fertilization or the | ||||||
5 | American Society for Reproductive Medicine minimum | ||||||
6 | standards for practices offering assisted reproductive | ||||||
7 | technologies. | ||||||
8 | (b) The coverage required under subsection (a) for | ||||||
9 | procedures for in vitro fertilization, gamete intrafallopian | ||||||
10 | tube transfer, or zygote intrafallopian tube transfer shall be | ||||||
11 | required only if: is subject to the following conditions: | ||||||
12 | (1) Coverage for procedures for in vitro | ||||||
13 | fertilization, gamete intrafallopian tube transfer, or | ||||||
14 | zygote intrafallopian tube transfer shall be required only | ||||||
15 | if: | ||||||
16 | (1) (A) the covered individual has been unable to | ||||||
17 | attain a viable pregnancy, maintain a viable pregnancy, or | ||||||
18 | sustain a successful pregnancy through reasonable, less | ||||||
19 | costly medically appropriate infertility treatments for | ||||||
20 | which coverage is available under the policy, plan, or | ||||||
21 | contract; | ||||||
22 | (2) (B) the covered individual has not undergone 4 | ||||||
23 | completed oocyte retrievals, except that if a live birth | ||||||
24 | follows a completed oocyte retrieval, then 2 more | ||||||
25 | completed oocyte retrievals shall be covered; and | ||||||
26 | (3) (C) the procedures are performed at medical |
| |||||||
| |||||||
1 | facilities that conform to the American College of | ||||||
2 | Obstetric and Gynecology guidelines for in vitro | ||||||
3 | fertilization clinics or to the American Fertility Society | ||||||
4 | minimal standards for programs of in vitro fertilization. | ||||||
5 | (2) The procedures required to be covered under this | ||||||
6 | Section are not required to be contained in any policy or | ||||||
7 | plan issued to or by a religious institution or | ||||||
8 | organization or to or by an entity sponsored by a | ||||||
9 | religious institution or organization that finds the | ||||||
10 | procedures required to be covered under this Section to | ||||||
11 | violate its religious and moral teachings and beliefs. | ||||||
12 | (c) As used in this Section, "infertility" means a | ||||||
13 | disease, condition, or status characterized by: | ||||||
14 | (1) a failure to establish a pregnancy or to carry a | ||||||
15 | pregnancy to live birth after 12 months of regular, | ||||||
16 | unprotected sexual intercourse if the woman is 35 years of | ||||||
17 | age or younger, or after 6 months of regular, unprotected | ||||||
18 | sexual intercourse if the woman is over 35 years of age; | ||||||
19 | conceiving but having a miscarriage does not restart the | ||||||
20 | 12-month or 6-month term for determining infertility; | ||||||
21 | (2) a person's inability to reproduce either as a | ||||||
22 | single individual or with a partner without medical | ||||||
23 | intervention; or | ||||||
24 | (3) a licensed physician's findings based on a | ||||||
25 | patient's medical, sexual, and reproductive history, age, | ||||||
26 | physical findings, or diagnostic testing. |
| |||||||
| |||||||
1 | (d) A policy, contract, or certificate may not impose any | ||||||
2 | exclusions, limitations, or other restrictions on coverage of | ||||||
3 | fertility medications that are different from those imposed on | ||||||
4 | any other prescription medications, nor may it impose any | ||||||
5 | exclusions, limitations, or other restrictions on coverage of | ||||||
6 | any fertility services based on a covered individual's | ||||||
7 | participation in fertility services provided by or to a third | ||||||
8 | party, nor may it impose deductibles, copayments, coinsurance, | ||||||
9 | benefit maximums, waiting periods, or any other limitations on | ||||||
10 | coverage for the diagnosis of infertility, treatment for | ||||||
11 | infertility, and standard fertility preservation services, | ||||||
12 | except as provided in this Section, that are different from | ||||||
13 | those imposed upon benefits for services not related to | ||||||
14 | infertility. | ||||||
15 | (e) The procedures required to be covered under this | ||||||
16 | Section are not required to be contained in any policy or plan | ||||||
17 | issued to or by a religious institution or organization or to | ||||||
18 | or by an entity sponsored by a religious institution or | ||||||
19 | organization that finds the procedures required to be covered | ||||||
20 | under this Section to violate its religious and moral | ||||||
21 | teachings and beliefs. | ||||||
22 | (Source: P.A. 102-170, eff. 1-1-22 .)
| ||||||
23 | Section 30. The Limited Health Service Organization Act is | ||||||
24 | amended by changing Section 4003 as follows:
|
| |||||||
| |||||||
1 | (215 ILCS 130/4003) (from Ch. 73, par. 1504-3) | ||||||
2 | Sec. 4003. Illinois Insurance Code provisions. Limited | ||||||
3 | health service organizations shall be subject to the | ||||||
4 | provisions of Sections 133, 134, 136, 137, 139, 140, 141.1, | ||||||
5 | 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, | ||||||
6 | 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2, | ||||||
7 | 355.3, 355b, 356m, 356q, 356v, 356z.4, 356z.4a, 356z.10, | ||||||
8 | 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, | ||||||
9 | 356z.32, 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, | ||||||
10 | 356z.54, 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, | ||||||
11 | 364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, | ||||||
12 | 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, | ||||||
13 | XIII 1/2, XXV, and XXVI of the Illinois Insurance Code. | ||||||
14 | Nothing in this Section shall require a limited health care | ||||||
15 | plan to cover any service that is not a limited health service. | ||||||
16 | For purposes of the Illinois Insurance Code, except for | ||||||
17 | Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited | ||||||
18 | health service organizations in the following categories are | ||||||
19 | deemed to be domestic companies: | ||||||
20 | (1) a corporation under the laws of this State; or | ||||||
21 | (2) a corporation organized under the laws of another | ||||||
22 | state, 30% or more of the enrollees of which are residents | ||||||
23 | of this State, except a corporation subject to | ||||||
24 | substantially the same requirements in its state of | ||||||
25 | organization as is a domestic company under Article VIII | ||||||
26 | 1/2 of the Illinois Insurance Code. |
| |||||||
| |||||||
1 | (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; | ||||||
2 | 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff. | ||||||
3 | 1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816, | ||||||
4 | eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; | ||||||
5 | 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. | ||||||
6 | 1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, | ||||||
7 | eff. 1-1-24; revised 8-29-23.)
| ||||||
8 | Section 35. The Voluntary Health Services Plans Act is | ||||||
9 | amended by changing Section 10 as follows:
| ||||||
10 | (215 ILCS 165/10) (from Ch. 32, par. 604) | ||||||
11 | Sec. 10. Application of Insurance Code provisions. Health | ||||||
12 | services plan corporations and all persons interested therein | ||||||
13 | or dealing therewith shall be subject to the provisions of | ||||||
14 | Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140, | ||||||
15 | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, | ||||||
16 | 356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t, 356u, 356v, | ||||||
17 | 356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, | ||||||
18 | 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, | ||||||
19 | 356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, | ||||||
20 | 356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, | ||||||
21 | 356z.33, 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, | ||||||
22 | 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, | ||||||
23 | 356z.64, 356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401, | ||||||
24 | 401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7) |
| |||||||
| |||||||
1 | and (15) of Section 367 of the Illinois Insurance Code. | ||||||
2 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
3 | any, is conditioned on the rules being adopted in accordance | ||||||
4 | with all provisions of the Illinois Administrative Procedure | ||||||
5 | Act and all rules and procedures of the Joint Committee on | ||||||
6 | Administrative Rules; any purported rule not so adopted, for | ||||||
7 | whatever reason, is unauthorized. | ||||||
8 | (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; | ||||||
9 | 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. | ||||||
10 | 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, | ||||||
11 | eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; | ||||||
12 | 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. | ||||||
13 | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | ||||||
14 | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | ||||||
15 | 103-551, eff. 8-11-23; revised 8-29-23.)
| ||||||
16 | Section 40. The Illinois Public Aid Code is amended by | ||||||
17 | changing Section 5-16.8 as follows:
| ||||||
18 | (305 ILCS 5/5-16.8) | ||||||
19 | Sec. 5-16.8. Required health benefits. The medical | ||||||
20 | assistance program shall (i) provide the post-mastectomy care | ||||||
21 | benefits required to be covered by a policy of accident and | ||||||
22 | health insurance under Section 356t and the coverage required | ||||||
23 | under Sections 356g.5, 356m, 356q, 356u, 356w, 356x, 356z.6, | ||||||
24 | 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46, |
| |||||||
| |||||||
1 | 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and | ||||||
2 | 356z.61 , 356z.64, and 356z.67 of the Illinois Insurance Code, | ||||||
3 | (ii) be subject to the provisions of Sections 356z.19, | ||||||
4 | 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the Illinois | ||||||
5 | Insurance Code, and (iii) be subject to the provisions of | ||||||
6 | subsection (d-5) of Section 10 of the Network Adequacy and | ||||||
7 | Transparency Act. | ||||||
8 | The Department, by rule, shall adopt a model similar to | ||||||
9 | the requirements of Section 356z.39 of the Illinois Insurance | ||||||
10 | Code. | ||||||
11 | On and after July 1, 2012, the Department shall reduce any | ||||||
12 | rate of reimbursement for services or other payments or alter | ||||||
13 | any methodologies authorized by this Code to reduce any rate | ||||||
14 | of reimbursement for services or other payments in accordance | ||||||
15 | with Section 5-5e. | ||||||
16 | To ensure full access to the benefits set forth in this | ||||||
17 | Section, on and after January 1, 2016, the Department shall | ||||||
18 | ensure that provider and hospital reimbursement for | ||||||
19 | post-mastectomy care benefits required under this Section are | ||||||
20 | no lower than the Medicare reimbursement rate. | ||||||
21 | (Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22; | ||||||
22 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff. | ||||||
23 | 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813, | ||||||
24 | eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23; | ||||||
25 | 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. | ||||||
26 | 1-1-24; 103-420, eff. 1-1-24; revised 12-15-23.)
|
| |||||||
| |||||||