Bill Text: IL SB2639 | 2023-2024 | 103rd General Assembly | Engrossed

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Bill Title: Reinserts the provisions of the introduced bill with the following changes. Provides that, for a group policy of accident and health insurance that provides pregnancy related benefits (rather than providing coverage for more than 25 employees that provides pregnancy-related benefits) that is issued, amended, delivered, or renewed in this State after January 1, 2026 (rather than 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. Amends the Counties Code, the Illinois Municipal Code, the School Code, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require plans under those Acts to comply with provisions of the Illinois Insurance Code requiring coverage for the diagnosis and treatment of infertility. Adds a January 1, 2026 effective date.

Spectrum: Moderate Partisan Bill (Democrat 32-6)

Status: (Engrossed) 2024-05-03 - Rule 19(a) / Re-referred to Rules Committee [SB2639 Detail]

Download: Illinois-2023-SB2639-Engrossed.html

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SB2639 Engrossed LRB103 35235 RPS 65226 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Counties Code is amended by changing
Section 5-1069.3 as follows:
(55 ILCS 5/5-1069.3)
Sec. 5-1069.3. Required health benefits. If a county,
including a home rule county, is a self-insurer for purposes
of providing health insurance coverage for its employees, the
coverage shall include coverage for the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w,
356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36,
356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
of the Illinois Insurance Code. The coverage shall comply with
Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
Insurance Code. The Department of Insurance shall enforce the
requirements of this Section. The requirement that health

SB2639 Engrossed - 2 - LRB103 35235 RPS 65226 b
benefits be covered as provided in this Section is an
exclusive power and function of the State and is a denial and
limitation under Article VII, Section 6, subsection (h) of the
Illinois Constitution. A home rule county to which this
Section applies must comply with every provision of this
Section.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
8-29-23.)
Section 10. The Illinois Municipal Code is amended by
changing Section 10-4-2.3 as follows:
(65 ILCS 5/10-4-2.3)

SB2639 Engrossed - 3 - LRB103 35235 RPS 65226 b
Sec. 10-4-2.3. Required health benefits. If a
municipality, including a home rule municipality, is a
self-insurer for purposes of providing health insurance
coverage for its employees, the coverage shall include
coverage for the post-mastectomy care benefits required to be
covered by a policy of accident and health insurance under
Section 356t and the coverage required under Sections 356g,
356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, 356z.4,
356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois
Insurance Code. The coverage shall comply with Sections
155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
Code. The Department of Insurance shall enforce the
requirements of this Section. The requirement that health
benefits be covered as provided in this is an exclusive power
and function of the State and is a denial and limitation under
Article VII, Section 6, subsection (h) of the Illinois
Constitution. A home rule municipality to which this Section
applies must comply with every provision of this Section.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure

SB2639 Engrossed - 4 - LRB103 35235 RPS 65226 b
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
8-29-23.)
Section 15. The School Code is amended by changing Section
10-22.3f as follows:
(105 ILCS 5/10-22.3f)
Sec. 10-22.3f. Required health benefits. Insurance
protection and benefits for employees shall provide the
post-mastectomy care benefits required to be covered by a
policy of accident and health insurance under Section 356t and
the coverage required under Sections 356g, 356g.5, 356g.5-1,
356m, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,

SB2639 Engrossed - 5 - LRB103 35235 RPS 65226 b
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
of the Illinois Insurance Code. Insurance policies shall
comply with Section 356z.19 of the Illinois Insurance Code.
The coverage shall comply with Sections 155.22a, 355b, and
370c of the Illinois Insurance Code. The Department of
Insurance shall enforce the requirements of this Section.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
103-551, eff. 8-11-23; revised 8-29-23.)
Section 20. The Illinois Insurance Code is amended by
changing Section 356m as follows:
(215 ILCS 5/356m) (from Ch. 73, par. 968m)

SB2639 Engrossed - 6 - LRB103 35235 RPS 65226 b
Sec. 356m. Infertility coverage.
(a) No group policy of accident and health insurance
providing coverage for more than 25 employees that provides
pregnancy-related pregnancy related benefits may be issued,
amended, delivered, or renewed in this State after the
effective date of this amendatory Act of the 99th General
Assembly unless the policy contains coverage for the diagnosis
and treatment of infertility including, but not limited to, in
vitro fertilization, uterine embryo lavage, embryo transfer,
artificial insemination, gamete intrafallopian tube transfer,
zygote intrafallopian tube transfer, and low tubal ovum
transfer.
(b) The coverage required under subsection (a) is subject
to the following conditions:
(1) Coverage for procedures for in vitro
fertilization, gamete intrafallopian tube transfer, or
zygote intrafallopian tube transfer shall be required only
if:
(A) the covered individual has been unable to
attain a viable pregnancy, maintain a viable
pregnancy, or sustain a successful pregnancy through
reasonable, less costly medically appropriate
infertility treatments for which coverage is available
under the policy, plan, or contract;
(B) the covered individual has not undergone 4
completed oocyte retrievals, except that if a live

SB2639 Engrossed - 7 - LRB103 35235 RPS 65226 b
birth follows a completed oocyte retrieval, then 2
more completed oocyte retrievals shall be covered; and
(C) the procedures are performed at medical
facilities that conform to the American College of
Obstetric and Gynecology guidelines for in vitro
fertilization clinics or to the American Fertility
Society minimal standards for programs of in vitro
fertilization.
(1.5) For a group policy of accident and health
insurance that provides pregnancy-related benefits that is
issued, amended, delivered, or renewed in this State after
January 1, 2026, if the requirements of paragraph (1) are
met or if the 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: (i) the covered individual's medical, sexual,
and reproductive history; (ii) the covered individual's
age; (iii) physical findings; or (iv) diagnostic testing,
then the procedure shall be covered without any other
restrictions or requirements.
(2) The procedures required to be covered under this
Section are not required to be contained in any policy or
plan issued to or by a religious institution or
organization or to or by an entity sponsored by a

SB2639 Engrossed - 8 - LRB103 35235 RPS 65226 b
religious institution or organization that finds the
procedures required to be covered under this Section to
violate its religious and moral teachings and beliefs.
(c) As used in this Section, "infertility" means a
disease, condition, or status characterized by:
(1) a failure to establish a pregnancy or to carry a
pregnancy to live birth after 12 months of regular,
unprotected sexual intercourse if the woman is 35 years of
age or younger, or after 6 months of regular, unprotected
sexual intercourse if the woman is over 35 years of age;
conceiving but having a miscarriage does not restart the
12-month or 6-month term for determining infertility;
(2) a person's inability to reproduce either as a
single individual or with a partner without medical
intervention; or
(3) a licensed physician's findings based on a
patient's medical, sexual, and reproductive history, age,
physical findings, or diagnostic testing.
(d) A policy, contract, or certificate may not impose any
exclusions, limitations, or other restrictions on coverage of
fertility medications that are different from those imposed on
any other prescription medications, nor may it impose any
exclusions, limitations, or other restrictions on coverage of
any fertility services based on a covered individual's
participation in fertility services provided by or to a third
party, nor may it impose deductibles, copayments, coinsurance,

SB2639 Engrossed - 9 - LRB103 35235 RPS 65226 b
benefit maximums, waiting periods, or any other limitations on
coverage for the diagnosis of infertility, treatment for
infertility, and standard fertility preservation services,
except as provided in this Section, that are different from
those imposed upon benefits for services not related to
infertility.
(Source: P.A. 102-170, eff. 1-1-22.)
Section 25. The Limited Health Service Organization Act is
amended by changing Section 4003 as follows:
(215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
Sec. 4003. Illinois Insurance Code provisions. Limited
health service organizations shall be subject to the
provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2,
355.3, 355b, 356m, 356q, 356v, 356z.4, 356z.4a, 356z.10,
356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a,
356z.32, 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
356z.54, 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68,
364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
Nothing in this Section shall require a limited health care
plan to cover any service that is not a limited health service.

SB2639 Engrossed - 10 - LRB103 35235 RPS 65226 b
For purposes of the Illinois Insurance Code, except for
Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
health service organizations in the following categories are
deemed to be domestic companies:
(1) a corporation under the laws of this State; or
(2) a corporation organized under the laws of another
state, 30% or more of the enrollees of which are residents
of this State, except a corporation subject to
substantially the same requirements in its state of
organization as is a domestic company under Article VIII
1/2 of the Illinois Insurance Code.
(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
eff. 1-1-24; revised 8-29-23.)
Section 30. The Voluntary Health Services Plans Act is
amended by changing Section 10 as follows:
(215 ILCS 165/10) (from Ch. 32, par. 604)
Sec. 10. Application of Insurance Code provisions. Health
services plan corporations and all persons interested therein
or dealing therewith shall be subject to the provisions of

SB2639 Engrossed - 11 - LRB103 35235 RPS 65226 b
Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t, 356u, 356v,
356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a,
356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22,
356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
356z.33, 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62,
356z.64, 356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401,
401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
and (15) of Section 367 of the Illinois Insurance Code.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
103-551, eff. 8-11-23; revised 8-29-23.)

SB2639 Engrossed - 12 - LRB103 35235 RPS 65226 b
Section 35. The Illinois Public Aid Code is amended by
changing Section 5-16.8 as follows:
(305 ILCS 5/5-16.8)
Sec. 5-16.8. Required health benefits. The medical
assistance program shall (i) provide the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356g.5, 356m, 356q, 356u, 356w, 356x, 356z.6,
356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and
356z.61, 356z.64, and 356z.67 of the Illinois Insurance Code,
(ii) be subject to the provisions of Sections 356z.19,
356z.44, 356z.49, 364.01, 370c, and 370c.1 of the Illinois
Insurance Code, and (iii) be subject to the provisions of
subsection (d-5) of Section 10 of the Network Adequacy and
Transparency Act.
The Department, by rule, shall adopt a model similar to
the requirements of Section 356z.39 of the Illinois Insurance
Code.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate
of reimbursement for services or other payments in accordance
with Section 5-5e.

SB2639 Engrossed - 13 - LRB103 35235 RPS 65226 b
To ensure full access to the benefits set forth in this
Section, on and after January 1, 2016, the Department shall
ensure that provider and hospital reimbursement for
post-mastectomy care benefits required under this Section are
no lower than the Medicare reimbursement rate.
(Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
1-1-24; 103-420, eff. 1-1-24; revised 12-15-23.)