Section 2014.10  Purpose

 

The purpose of this Part is to clarify the requirements for health insurance coverage of over-the-counter contraceptive drugs, devices, and products.

 

Section 2014.20  Applicability

 

For policies, contracts, and certificates issued, delivered, amended, or renewed on or after January 1, 2025, except for excepted benefits, short-term, limited-duration health insurance coverage, Medicare Advantage plans, and coverage under the medical assistance program in the Illinois Public Aid Code [305 ILCS 5], this Part applies to all individual and group accident and health insurance, health care plans, limited health care plans, and voluntary health services plans, including pharmaceutical-only policies, contracts, and certificates.

 

Section 2014.30  Definitions

 

"Accident and health insurance" has the meaning ascribed in Section 4, Class 1(b) and 2(a) of the Code.

 

"Code" means the Illinois Insurance Code [215 ILCS 5].

 

"Excepted benefits" has the meaning ascribed in the following federal regulations:

 

For individual health insurance coverage, 45 CFR 148.220 (May 14, 2020) (no later editions or amendments); and

 

For group health insurance coverage, 45 CFR 146.145(b) (Oct. 31, 2016) (no later editions or amendments).

 

"Health care plan" has the meaning ascribed in Section 1-2(7) of the Health Maintenance Organization Act [215 ILCS 125].

 

"Health insurance issuer" has the meaning ascribed in Section 5 of the Health Insurance Portability and Accountability Act [215 ILCS 97].

 

"Limited health care plan" has the meaning ascribed in Section 1002 of the Limited Health Service Organization Act [215 ILCS 130]. 

 

"Short-term, limited-duration health insurance coverage" has the meaning ascribed in Section 5 of the Short-Term, Limited-Duration Health Insurance Coverage Act [215 ILCS 190].

 

"Voluntary health services plan" has the meaning ascribed in Section 2 of the Voluntary Health Services Plans Act [215 ILCS 165].

 

Section 2014.40  Contraceptive Coverage

 

a)         A covered individual must not be required to have a prescription for over-the-counter contraceptive drugs, devices, and products as a condition for coverage to apply.

 

b)         Health insurance issuers with any policy, contract, or certificate subject to Section 2014.20 are prohibited from requiring a prescription as a condition to cover over-the-counter contraceptives. Coverage as written and in operation must include over-the-counter contraceptive drugs, devices, and products in compliance with Section 356z.4(a) of the Code.