Public Act 103-0703
 
HB5295 EnrolledLRB103 38679 RPS 68816 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 356z.56 as follows:
 
    (215 ILCS 5/356z.56)
    Sec. 356z.56. Coverage for hormonal and non-hormonal 
hormone therapy to treat menopause. A group or individual 
policy of accident and health insurance or a managed care plan 
that is amended, delivered, issued, or renewed in this State 
on or after January 1, 2024 shall provide coverage for 
medically necessary hormone therapy treatment to treat 
menopause that has been induced by a hysterectomy. This 
coverage applies only to coverage provided on or after January 
1, 2024 and before January 1, 2026. 
    A group or individual policy of accident and health 
insurance or a managed care plan that is amended, delivered, 
issued, or renewed on or after January 1, 2026 shall provide 
coverage for medically necessary hormonal and non-hormonal 
therapy to treat menopausal symptoms if the therapy is 
recommended by a qualified health care provider who is 
licensed, accredited, or certified under Illinois law and the 
therapy has been proven safe and effective in peer-reviewed 
scientific studies. Coverage for therapy to treat menopausal 
symptoms shall include all federal Food and Drug 
Administration-approved modalities of hormonal and 
non-hormonal administration, including, but not limited to, 
oral, transdermal, topical, and vaginal rings. 
(Source: P.A. 102-804, eff. 1-1-23; 103-154, eff. 6-30-23.)
 
    Section 10. The Illinois Public Aid Code is amended by 
changing Section 5-16.8 and by adding Section 5-52 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, 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. 
    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.)
 
    (305 ILCS 5/5-52 new)
    Sec. 5-52. Coverage for hormonal therapy to treat 
menopause. The medical assistance program shall provide 
coverage for medically necessary hormone therapy treatment to 
treat menopause that has been induced by a hysterectomy.
 
    Section 99. Effective date. This Act takes effect January 
1, 2026.