Sen. Michael E. Hastings

Filed: 4/10/2024

 

 


 

 


 
10300SB2639sam002LRB103 35235 RPS 72174 a

1
AMENDMENT TO SENATE BILL 2639

2    AMENDMENT NO. ______. Amend Senate Bill 2639 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Counties Code is amended by changing
5Section 5-1069.3 as follows:
 
6    (55 ILCS 5/5-1069.3)
7    Sec. 5-1069.3. Required health benefits. If a county,
8including a home rule county, is a self-insurer for purposes
9of providing health insurance coverage for its employees, the
10coverage shall include coverage for the post-mastectomy care
11benefits required to be covered by a policy of accident and
12health insurance under Section 356t and the coverage required
13under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w,
14356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
16356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36,

 

 

10300SB2639sam002- 2 -LRB103 35235 RPS 72174 a

1356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
2356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
3356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
4of the Illinois Insurance Code. The coverage shall comply with
5Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
6Insurance Code. The Department of Insurance shall enforce the
7requirements of this Section. The requirement that health
8benefits be covered as provided in this Section is an
9exclusive power and function of the State and is a denial and
10limitation under Article VII, Section 6, subsection (h) of the
11Illinois Constitution. A home rule county to which this
12Section applies must comply with every provision of this
13Section.
14    Rulemaking authority to implement Public Act 95-1045, if
15any, is conditioned on the rules being adopted in accordance
16with all provisions of the Illinois Administrative Procedure
17Act and all rules and procedures of the Joint Committee on
18Administrative Rules; any purported rule not so adopted, for
19whatever reason, is unauthorized.
20(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
21102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
221-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
23eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
24102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
251-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
26eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;

 

 

10300SB2639sam002- 3 -LRB103 35235 RPS 72174 a

1103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
28-29-23.)
 
3    Section 10. The Illinois Municipal Code is amended by
4changing Section 10-4-2.3 as follows:
 
5    (65 ILCS 5/10-4-2.3)
6    Sec. 10-4-2.3. Required health benefits. If a
7municipality, including a home rule municipality, is a
8self-insurer for purposes of providing health insurance
9coverage for its employees, the coverage shall include
10coverage for the post-mastectomy care benefits required to be
11covered by a policy of accident and health insurance under
12Section 356t and the coverage required under Sections 356g,
13356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, 356z.4,
14356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
15356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
16356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
17356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
18356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
19356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois
20Insurance Code. The coverage shall comply with Sections
21155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
22Code. The Department of Insurance shall enforce the
23requirements of this Section. The requirement that health
24benefits be covered as provided in this is an exclusive power

 

 

10300SB2639sam002- 4 -LRB103 35235 RPS 72174 a

1and function of the State and is a denial and limitation under
2Article VII, Section 6, subsection (h) of the Illinois
3Constitution. A home rule municipality to which this Section
4applies must comply with every provision of this Section.
5    Rulemaking authority to implement Public Act 95-1045, if
6any, is conditioned on the rules being adopted in accordance
7with all provisions of the Illinois Administrative Procedure
8Act and all rules and procedures of the Joint Committee on
9Administrative Rules; any purported rule not so adopted, for
10whatever reason, is unauthorized.
11(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
12102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
131-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
14eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
15102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
161-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
17eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
18103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
198-29-23.)
 
20    Section 15. The School Code is amended by changing Section
2110-22.3f as follows:
 
22    (105 ILCS 5/10-22.3f)
23    Sec. 10-22.3f. Required health benefits. Insurance
24protection and benefits for employees shall provide the

 

 

10300SB2639sam002- 5 -LRB103 35235 RPS 72174 a

1post-mastectomy care benefits required to be covered by a
2policy of accident and health insurance under Section 356t and
3the coverage required under Sections 356g, 356g.5, 356g.5-1,
4356m, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
5356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
6356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
7356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
8356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
9356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
10of the Illinois Insurance Code. Insurance policies shall
11comply with Section 356z.19 of the Illinois Insurance Code.
12The coverage shall comply with Sections 155.22a, 355b, and
13370c of the Illinois Insurance Code. The Department of
14Insurance shall enforce the requirements of this Section.
15    Rulemaking authority to implement Public Act 95-1045, if
16any, is conditioned on the rules being adopted in accordance
17with all provisions of the Illinois Administrative Procedure
18Act and all rules and procedures of the Joint Committee on
19Administrative Rules; any purported rule not so adopted, for
20whatever reason, is unauthorized.
21(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
22102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
231-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
24eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
25102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
261-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,

 

 

10300SB2639sam002- 6 -LRB103 35235 RPS 72174 a

1eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
2103-551, eff. 8-11-23; revised 8-29-23.)
 
3    Section 20. The Illinois Insurance Code is amended by
4changing Section 356m as follows:
 
5    (215 ILCS 5/356m)  (from Ch. 73, par. 968m)
6    Sec. 356m. Infertility coverage.
7    (a) No group policy of accident and health insurance
8providing coverage for more than 25 employees that provides
9pregnancy-related pregnancy related benefits may be issued,
10amended, delivered, or renewed in this State after the
11effective date of this amendatory Act of the 99th General
12Assembly unless the policy contains coverage for the diagnosis
13and treatment of infertility including, but not limited to, in
14vitro fertilization, uterine embryo lavage, embryo transfer,
15artificial insemination, gamete intrafallopian tube transfer,
16zygote intrafallopian tube transfer, and low tubal ovum
17transfer.
18    (b) The coverage required under subsection (a) is subject
19to the following conditions:
20        (1) Coverage for procedures for in vitro
21    fertilization, gamete intrafallopian tube transfer, or
22    zygote intrafallopian tube transfer shall be required only
23    if:
24            (A) the covered individual has been unable to

 

 

10300SB2639sam002- 7 -LRB103 35235 RPS 72174 a

1        attain a viable pregnancy, maintain a viable
2        pregnancy, or sustain a successful pregnancy through
3        reasonable, less costly medically appropriate
4        infertility treatments for which coverage is available
5        under the policy, plan, or contract;
6            (B) the covered individual has not undergone 4
7        completed oocyte retrievals, except that if a live
8        birth follows a completed oocyte retrieval, then 2
9        more completed oocyte retrievals shall be covered; and
10            (C) the procedures are performed at medical
11        facilities that conform to the American College of
12        Obstetric and Gynecology guidelines for in vitro
13        fertilization clinics or to the American Fertility
14        Society minimal standards for programs of in vitro
15        fertilization.
16        (1.5) For a group policy of accident and health
17    insurance that provides pregnancy-related benefits that is
18    issued, amended, delivered, or renewed in this State after
19    January 1, 2026, if the requirements of paragraph (1) are
20    met or if the covered individual obtains, from a physician
21    licensed to practice medicine in all its branches, a
22    recommendation approving the covered individual to seek in
23    vitro fertilization, gamete intrafallopian tube transfer,
24    or zygote intrafallopian tube transfer based on any of the
25    following: (i) the covered individual's medical, sexual,
26    and reproductive history; (ii) the covered individual's

 

 

10300SB2639sam002- 8 -LRB103 35235 RPS 72174 a

1    age; (iii) physical findings; or (iv) diagnostic testing,
2    then the procedure shall be covered without any other
3    restrictions or requirements.
4        (2) The procedures required to be covered under this
5    Section are not required to be contained in any policy or
6    plan issued to or by a religious institution or
7    organization or to or by an entity sponsored by a
8    religious institution or organization that finds the
9    procedures required to be covered under this Section to
10    violate its religious and moral teachings and beliefs.
11    (c) As used in this Section, "infertility" means a
12disease, condition, or status characterized by:
13        (1) a failure to establish a pregnancy or to carry a
14    pregnancy to live birth after 12 months of regular,
15    unprotected sexual intercourse if the woman is 35 years of
16    age or younger, or after 6 months of regular, unprotected
17    sexual intercourse if the woman is over 35 years of age;
18    conceiving but having a miscarriage does not restart the
19    12-month or 6-month term for determining infertility;
20        (2) a person's inability to reproduce either as a
21    single individual or with a partner without medical
22    intervention; or
23        (3) a licensed physician's findings based on a
24    patient's medical, sexual, and reproductive history, age,
25    physical findings, or diagnostic testing.
26    (d) A policy, contract, or certificate may not impose any

 

 

10300SB2639sam002- 9 -LRB103 35235 RPS 72174 a

1exclusions, limitations, or other restrictions on coverage of
2fertility medications that are different from those imposed on
3any other prescription medications, nor may it impose any
4exclusions, limitations, or other restrictions on coverage of
5any fertility services based on a covered individual's
6participation in fertility services provided by or to a third
7party, nor may it impose deductibles, copayments, coinsurance,
8benefit maximums, waiting periods, or any other limitations on
9coverage for the diagnosis of infertility, treatment for
10infertility, and standard fertility preservation services,
11except as provided in this Section, that are different from
12those imposed upon benefits for services not related to
13infertility.
14(Source: P.A. 102-170, eff. 1-1-22.)
 
15    Section 25. The Limited Health Service Organization Act is
16amended by changing Section 4003 as follows:
 
17    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
18    Sec. 4003. Illinois Insurance Code provisions. Limited
19health service organizations shall be subject to the
20provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
21141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
22154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2,
23355.3, 355b, 356m, 356q, 356v, 356z.4, 356z.4a, 356z.10,
24356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a,

 

 

10300SB2639sam002- 10 -LRB103 35235 RPS 72174 a

1356z.32, 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
2356z.54, 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68,
3364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
4444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
5XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
6Nothing in this Section shall require a limited health care
7plan to cover any service that is not a limited health service.
8For purposes of the Illinois Insurance Code, except for
9Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
10health service organizations in the following categories are
11deemed to be domestic companies:
12        (1) a corporation under the laws of this State; or
13        (2) a corporation organized under the laws of another
14    state, 30% or more of the enrollees of which are residents
15    of this State, except a corporation subject to
16    substantially the same requirements in its state of
17    organization as is a domestic company under Article VIII
18    1/2 of the Illinois Insurance Code.
19(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
20102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
211-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
22eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
23102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
241-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
25eff. 1-1-24; revised 8-29-23.)
 

 

 

10300SB2639sam002- 11 -LRB103 35235 RPS 72174 a

1    Section 30. The Voluntary Health Services Plans Act is
2amended by changing Section 10 as follows:
 
3    (215 ILCS 165/10)  (from Ch. 32, par. 604)
4    Sec. 10. Application of Insurance Code provisions. Health
5services plan corporations and all persons interested therein
6or dealing therewith shall be subject to the provisions of
7Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
8143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
9356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t, 356u, 356v,
10356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a,
11356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
12356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22,
13356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
14356z.33, 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
15356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62,
16356z.64, 356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401,
17401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
18and (15) of Section 367 of the Illinois Insurance Code.
19    Rulemaking authority to implement Public Act 95-1045, if
20any, is conditioned on the rules being adopted in accordance
21with all provisions of the Illinois Administrative Procedure
22Act and all rules and procedures of the Joint Committee on
23Administrative Rules; any purported rule not so adopted, for
24whatever reason, is unauthorized.
25(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;

 

 

10300SB2639sam002- 12 -LRB103 35235 RPS 72174 a

1102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
210-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
3eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
4102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
51-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
6eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
7103-551, eff. 8-11-23; revised 8-29-23.)
 
8    Section 35. The Illinois Public Aid Code is amended by
9changing Section 5-16.8 as follows:
 
10    (305 ILCS 5/5-16.8)
11    Sec. 5-16.8. Required health benefits. The medical
12assistance program shall (i) provide the post-mastectomy care
13benefits required to be covered by a policy of accident and
14health insurance under Section 356t and the coverage required
15under Sections 356g.5, 356m, 356q, 356u, 356w, 356x, 356z.6,
16356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
17356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and
18356z.61, 356z.64, and 356z.67 of the Illinois Insurance Code,
19(ii) be subject to the provisions of Sections 356z.19,
20356z.44, 356z.49, 364.01, 370c, and 370c.1 of the Illinois
21Insurance Code, and (iii) be subject to the provisions of
22subsection (d-5) of Section 10 of the Network Adequacy and
23Transparency Act.
24    The Department, by rule, shall adopt a model similar to

 

 

10300SB2639sam002- 13 -LRB103 35235 RPS 72174 a

1the requirements of Section 356z.39 of the Illinois Insurance
2Code.
3    On and after July 1, 2012, the Department shall reduce any
4rate of reimbursement for services or other payments or alter
5any methodologies authorized by this Code to reduce any rate
6of reimbursement for services or other payments in accordance
7with Section 5-5e.
8    To ensure full access to the benefits set forth in this
9Section, on and after January 1, 2016, the Department shall
10ensure that provider and hospital reimbursement for
11post-mastectomy care benefits required under this Section are
12no lower than the Medicare reimbursement rate.
13(Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
14102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
151-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
16eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
17102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
181-1-24; 103-420, eff. 1-1-24; revised 12-15-23.)
 
19    Section 99. Effective date. This Act takes effect January
201, 2026.".