Public Act 102-0170
 
HB3709 EnrolledLRB102 04399 BMS 14417 b


  
    AN ACT concerning regulation.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  


 
    Section 5. The Illinois Insurance Code is amended  by 
changing Section 356m as follows:
 


    (215 ILCS 5/356m)  (from Ch. 73, par. 968m)




    Sec. 356m. Infertility coverage. 

    (a) No group policy of accident and health insurance 
providing coverage
for more than 25 employees that provides 
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 
        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.

        (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 
    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 For purpose of this Section, "infertility" 
means a disease, condition, or status characterized by: the 
inability to
conceive after one year of unprotected sexual 
intercourse, the inability to conceive after one year of 
attempts to produce conception, the inability to conceive 
after an individual is diagnosed with a condition affecting 
fertility, or the inability
to sustain a successful pregnancy.

        (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, 
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. 99-421, eff. 1-1-16.)