Public Act 103-0951
 
SB3203 EnrolledLRB103 37942 CES 68074 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois, 
represented in the General Assembly:
 
    Section 5. The State Employees Group Insurance Act of 1971 
is amended by changing Section 6.11 as follows:
 
    (5 ILCS 375/6.11)
    Sec. 6.11. Required health benefits; Illinois Insurance 
Code requirements. The program of health benefits shall 
provide the post-mastectomy care benefits required to be 
covered by a policy of accident and health insurance under 
Section 356t of the Illinois Insurance Code. The program of 
health benefits shall provide the coverage required under 
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, 
356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 
356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 
356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, 
356z.60, and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 
and 356z.70 of the Illinois Insurance Code. The program of 
health benefits must comply with Sections 155.22a, 155.37, 
355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the 
Illinois Insurance Code. The program of health benefits shall 
provide the coverage required under Section 356m of the 
Illinois Insurance Code and, for the employees of the State 
Employee Group Insurance Program only, the coverage as also 
provided in Section 6.11B of this Act. The Department of 
Insurance shall enforce the requirements of this Section with 
respect to Sections 370c and 370c.1 of the Illinois Insurance 
Code; all other requirements of this Section shall be enforced 
by the Department of Central Management Services.
    Rulemaking authority to implement Public Act 95-1045, if 
any, is conditioned on the rules being adopted in accordance 
with all provisions of the Illinois Administrative Procedure 
Act and all rules and procedures of the Joint Committee on 
Administrative Rules; any purported rule not so adopted, for 
whatever reason, is unauthorized. 
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768, 
eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 
1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84, 
eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24; 
103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff. 
8-11-23; revised 8-29-23.)
 
    Section 10. The Illinois Insurance Code is amended by 
changing Section 356z.5 as follows:
 
    (215 ILCS 5/356z.5)
    Sec. 356z.5. Prescription inhalants. 
    (a) In this Section, "prescription inhaler" means a 
prescribed medical device that delivers inhaled medications 
used to treat breathing for persons suffering from asthma or 
other life-threatening bronchial ailments. "Prescription 
inhaler" includes metered-dose inhalers, nebulizers, and dry 
powder inhalers. "Prescription inhaler" does not include 
inhalers available over the counter without a prescription to 
provide temporary relief from respiratory symptoms. 
    (b) A group or individual policy of accident and health 
insurance or managed care plan amended, delivered, issued, or 
renewed through December 31, 2025 after the effective date of 
this amendatory Act of the 93rd General Assembly that provides 
coverage for prescription drugs may not deny or limit coverage 
for prescription inhalers inhalants to enable persons to 
breathe when suffering from asthma or other life-threatening 
bronchial ailments based upon any restriction on the number of 
days before an inhaler refill may be obtained if, contrary to 
those restrictions, the inhalants have been ordered or 
prescribed by the treating physician and are medically 
appropriate.
    (c) A group or individual policy of accident and health 
insurance or managed care plan amended, delivered, issued, or 
renewed on or after January 1, 2026 that provides coverage for 
prescription drugs may not deny or limit, except as otherwise 
provided in this subsection, coverage for prescription 
inhalers to enable persons to breathe when suffering from 
asthma or other life-threatening bronchial ailments based upon 
any restriction on the number of days before an inhaler refill 
may be obtained if, contrary to those restrictions, the 
inhalants have been ordered or prescribed by the treating 
physician and are medically appropriate. A group or individual 
policy of accident and health insurance or managed care plan 
subject to this subsection shall limit the total amount that a 
covered person is required to pay for a covered prescription 
inhaler to an amount not to exceed $25 per 30-day supply.
    (d) Nothing in this Section prevents a group or individual 
policy of accident and health insurance or managed care plan 
from reducing a covered person's cost sharing to an amount 
less than the amount specified in subsection (c).
    (e) Coverage for prescription inhalers shall not be 
subject to any deductible; except that this provision does not 
apply to the extent such coverage would disqualify a 
high-deductible health plan from eligibility for a health 
savings account pursuant to Section 223 of the Internal 
Revenue Code (26 U.S.C. 223).
    (f) The Department may adopt rules necessary to implement 
and administer this Section and to align with federal 
requirements. The Department may use any of its enforcement 
powers to obtain a group or individual policy of accident and 
health insurance's or managed care plan's compliance with this 
Section. 
(Source: P.A. 95-331, eff. 8-21-07.)