Section 2019.10  Purpose

 

The purpose of this Part is to establish minimum benefit standards for diabetic pharmaceuticals, supplies and durable medical equipment coverage to be provided in this State.

 

Section 2019.20  Applicability and Scope

 

This Part applies to all group accident and health insurance policies and health maintenance organization group contracts that are amended, delivered, issued or renewed in this State after the effective date of this Part.  This Part also applies to group point-of-service contracts offered by a limited health service organization and group voluntary health services plans.  This Part does not apply to agreements, contracts or policies that provide coverage for a specified diagnosis or other limited benefit coverage.

 

(Source:  Amended at 45 Ill. Reg. 7141, effective May 28, 2021)

 

Section 2019.30  Definitions

 

Durable Medical Equipment means blood glucose monitors, blood glucose monitors for the legally blind, cartridges for the legally blind and lancets and lancing devices.

 

Pharmaceuticals and Supplies means insulin, syringes, needles, test strips for glucose monitors, FDA approved oral agents used to control blood sugar and glucagon emergency kits.

 

Section 2019.40  Minimum Benefit Standards

 

a)         Coverage for durable medical equipment shall be subject to the same deductible, copayment, and coinsurance provisions provided for other durable medical equipment, depending on whether the coverage is provided under the policy or a durable medical equipment rider to the policy.  The minimum benefit shall not apply to a group policy of accident and health insurance that does not provide durable medical equipment.

 

b)         Except as otherwise provided in Section 356z.41 of the Illinois Insurance Code [215 ILCS 5], coverage for pharmaceuticals and supplies shall be subject to the same coverage, deductible, co-payment, and co-insurance provisions provided for other pharmaceuticals, depending on whether that coverage is provided under the policy or a drug rider to the policy.  The minimum benefit shall not apply to a group policy of accident and health insurance that does not provide drug coverage.

 

(Source:  Amended at 45 Ill. Reg. 7141, effective May 28, 2021)