Bill Amendment: IL HB4504 | 2023-2024 | 103rd General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: INS CD-INHALER COVERAGE
Status: 2024-04-19 - Rule 19(a) / Re-referred to Rules Committee [HB4504 Detail]
Download: Illinois-2023-HB4504-House_Amendment_001.html
Bill Title: INS CD-INHALER COVERAGE
Status: 2024-04-19 - Rule 19(a) / Re-referred to Rules Committee [HB4504 Detail]
Download: Illinois-2023-HB4504-House_Amendment_001.html
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1 | AMENDMENT TO HOUSE BILL 4504 | ||||||
2 | AMENDMENT NO. ______. Amend House Bill 4504 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The State Employees Group Insurance Act of | ||||||
5 | 1971 is amended by changing Section 6.11 as follows:
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6 | (5 ILCS 375/6.11) | ||||||
7 | Sec. 6.11. Required health benefits; Illinois Insurance | ||||||
8 | Code requirements. The program of health benefits shall | ||||||
9 | provide the post-mastectomy care benefits required to be | ||||||
10 | covered by a policy of accident and health insurance under | ||||||
11 | Section 356t of the Illinois Insurance Code. The program of | ||||||
12 | health benefits shall provide the coverage required under | ||||||
13 | Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, | ||||||
14 | 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, | ||||||
15 | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, | ||||||
16 | 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, |
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1 | 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, | ||||||
2 | 356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, | ||||||
3 | 356z.60, and 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, | ||||||
4 | and 356z.70 of the Illinois Insurance Code. The program of | ||||||
5 | health benefits must comply with Sections 155.22a, 155.37, | ||||||
6 | 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the | ||||||
7 | Illinois Insurance Code. The program of health benefits shall | ||||||
8 | provide the coverage required under Section 356m of the | ||||||
9 | Illinois Insurance Code and, for the employees of the State | ||||||
10 | Employee Group Insurance Program only, the coverage as also | ||||||
11 | provided in Section 6.11B of this Act. The Department of | ||||||
12 | Insurance shall enforce the requirements of this Section with | ||||||
13 | respect to Sections 370c and 370c.1 of the Illinois Insurance | ||||||
14 | Code; all other requirements of this Section shall be enforced | ||||||
15 | by the Department of Central Management Services. | ||||||
16 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
17 | any, is conditioned on the rules being adopted in accordance | ||||||
18 | with all provisions of the Illinois Administrative Procedure | ||||||
19 | Act and all rules and procedures of the Joint Committee on | ||||||
20 | Administrative Rules; any purported rule not so adopted, for | ||||||
21 | whatever reason, is unauthorized. | ||||||
22 | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||||||
23 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. | ||||||
24 | 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768, | ||||||
25 | eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | ||||||
26 | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. |
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1 | 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84, | ||||||
2 | eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24; | ||||||
3 | 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff. | ||||||
4 | 8-11-23; revised 8-29-23.)
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5 | Section 10. The Illinois Insurance Code is amended by | ||||||
6 | changing Section 356z.5 as follows:
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7 | (215 ILCS 5/356z.5) | ||||||
8 | Sec. 356z.5. Prescription inhalants. | ||||||
9 | (a) In this Section, "prescription inhaler" means a | ||||||
10 | prescribed medical device that delivers inhaled medications | ||||||
11 | used to treat breathing for persons suffering from asthma or | ||||||
12 | other life-threatening bronchial ailments. "Prescription | ||||||
13 | inhaler" includes metered-dose inhalers, nebulizers, and dry | ||||||
14 | powder inhalers. "Prescription inhaler" does not include | ||||||
15 | inhalers available over the counter without a prescription to | ||||||
16 | provide temporary relief from respiratory symptoms. | ||||||
17 | (b) A group or individual policy of accident and health | ||||||
18 | insurance or managed care plan amended, delivered, issued, or | ||||||
19 | renewed through December 31, 2025 after the effective date of | ||||||
20 | this amendatory Act of the 93rd General Assembly that provides | ||||||
21 | coverage for prescription drugs may not deny or limit coverage | ||||||
22 | for prescription inhalers inhalants to enable persons to | ||||||
23 | breathe when suffering from asthma or other life-threatening | ||||||
24 | bronchial ailments based upon any restriction on the number of |
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1 | days before an inhaler refill may be obtained if, contrary to | ||||||
2 | those restrictions, the inhalants have been ordered or | ||||||
3 | prescribed by the treating physician and are medically | ||||||
4 | appropriate. | ||||||
5 | (c) A group or individual policy of accident and health | ||||||
6 | insurance or managed care plan amended, delivered, issued, or | ||||||
7 | renewed on or after January 1, 2026 that provides coverage for | ||||||
8 | prescription drugs may not deny or limit, except as otherwise | ||||||
9 | provided in this subsection, coverage for prescription | ||||||
10 | inhalers to enable persons to breathe when suffering from | ||||||
11 | asthma or other life-threatening bronchial ailments based upon | ||||||
12 | any restriction on the number of days before an inhaler refill | ||||||
13 | may be obtained if, contrary to those restrictions, the | ||||||
14 | inhalants have been ordered or prescribed by the treating | ||||||
15 | physician and are medically appropriate. A group or individual | ||||||
16 | policy of accident and health insurance or managed care plan | ||||||
17 | subject to this subsection shall limit the total amount that a | ||||||
18 | covered person is required to pay for a covered prescription | ||||||
19 | inhaler to an amount not to exceed $25 dollars per 30-day | ||||||
20 | supply. | ||||||
21 | (d) Nothing in this Section prevents a group or individual | ||||||
22 | policy of accident and health insurance or managed care plan | ||||||
23 | from reducing a covered person's cost sharing to an amount | ||||||
24 | less than the amount specified in subsection (c). | ||||||
25 | (e) Coverage for prescription inhalers shall not be | ||||||
26 | subject to any deductible; except that this provision does not |
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