Public Act 099-0672
 
HB5576 EnrolledLRB099 20488 EGJ 45009 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.4 as follows:
 



    (215 ILCS 5/356z.4)



    Sec. 356z.4. Coverage for contraceptives.  
    (a)(1)      The General Assembly hereby finds and declares all 
of the following:
        (A)    Illinois has a long history of expanding timely 
    access to birth control to prevent unintended pregnancy.
        (B)   The federal Patient Protection and Affordable Care 
    Act includes a contraceptive coverage guarantee as part of 
    a broader requirement for health insurance to cover key 
    preventive care services without out-of-pocket costs for 
    patients.
        (C)   The General Assembly intends to build on existing 
    State and federal law to promote gender equity and women's 
    health and to ensure greater contraceptive coverage equity 
    and timely access to all federal Food and Drug 
    Administration approved methods of birth control for all 
    individuals covered by an individual or group health 
    insurance policy in Illinois.
        (D)   Medical management techniques such as denials, 
    step therapy, or prior authorization in public and private 
    health care coverage can impede access to the most 
    effective contraceptive methods.
    (2) As used in this subsection (a): 
    "Contraceptive services" includes consultations, 
examinations, procedures, and medical services related to the 
use of contraceptive methods (including natural family 
planning) to prevent an unintended pregnancy.
    "Medical necessity", for the purposes of this subsection 
(a),  includes, but is not limited to, considerations such as 
severity of side effects, differences in permanence and 
reversibility of contraceptive, and ability to adhere to the 
appropriate use of the item or service, as determined by the 
attending provider.
    "Therapeutic equivalent version" means drugs, devices, or 
products that can be expected to have the same clinical effect 
and safety profile when administered to patients under the 
conditions specified in the labeling and satisfy the following 
general criteria:
        (i) they are approved as safe and effective;
        (ii) they are pharmaceutical equivalents in that they 
    (A) contain identical amounts of the same active drug 
    ingredient in the same dosage form and route of 
    administration and (B) meet compendial or other applicable 
    standards of strength, quality, purity, and identity;
        (iii) they are bioequivalent in that (A) they do not 
    present a known or potential bioequivalence problem and 
    they meet an acceptable in vitro standard or (B) if they do 
    present such a known or potential problem, they are shown 
    to meet an appropriate bioequivalence standard;
        (iv) they are adequately labeled; and
        (v) they are manufactured in compliance with Current 
    Good Manufacturing Practice regulations. 
    (3) An individual or group policy of accident and health 
insurance amended,
delivered, issued, or renewed in this State 
after the effective date of this amendatory Act of the 99th 
General Assembly shall provide coverage for all of the 
following services and contraceptive methods: 
        (A)   All contraceptive drugs, devices, and other 
    products approved by the United States Food and Drug 
    Administration. This includes all over-the-counter 
    contraceptive drugs, devices, and products approved by the 
    United States Food and Drug Administration, excluding male 
    condoms. The following apply:
            (i)      If the United States Food and Drug 
        Administration has approved one or more therapeutic 
        equivalent versions of a contraceptive drug, device, 
        or product, a policy is not required to include all 
        such therapeutic equivalent versions in its formulary, 
        so long as at least one is included and covered without 
        cost-sharing and in accordance with this Section.
            (ii)      If an individual's attending provider 
        recommends a particular service or item approved by the 
        United States Food and Drug Administration based on a 
        determination of medical necessity with respect to 
        that individual, the plan or issuer must cover that 
        service or item without cost sharing. The plan or 
        issuer must defer to the determination of the attending 
        provider.
            (iii)     If a drug, device, or product is not covered, 
        plans and issuers must have an easily accessible, 
        transparent, and sufficiently expedient process that 
        is not unduly burdensome on the individual or a 
        provider or other individual acting as a patient's 
        authorized representative to ensure coverage without 
        cost sharing.
            (iv)     This coverage must provide for the dispensing 
        of 12 months' worth of contraception at one time.
        (B)    Voluntary sterilization procedures.
        (C)   Contraceptive services, patient education, and 
    counseling on contraception.
        (D)   Follow-up services related to the drugs, devices, 
    products, and procedures covered under this Section, 
    including, but not limited to, management of side effects, 
    counseling for continued adherence, and device insertion 
    and removal.
    (4) Except as otherwise provided in this subsection (a), a 
policy subject to this subsection (a) shall not impose a 
deductible, coinsurance, copayment, or any other cost-sharing 
requirement on the coverage provided. 
    (5) Except as otherwise authorized under this subsection 
(a), a policy shall not impose any restrictions or delays on 
the coverage required under this subsection (a). 
    (6) If, at any time, the Secretary of the United States 
Department of Health and Human Services, or its successor 
agency, promulgates rules or regulations to be published in the 
Federal Register or publishes a comment in the Federal Register 
or issues an opinion, guidance, or other action that would 
require the State, pursuant to any provision of the Patient 
Protection and Affordable Care Act (Public Law 111–148), 
including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any 
successor provision, to defray the cost of any coverage 
outlined in this subsection (a), then this subsection (a) is 
inoperative with respect to all coverage outlined in this 
subsection (a) other than that authorized under Section 1902 of 
the Social Security Act, 42 U.S.C. 1396a, and the State shall 
not assume any obligation for the cost of the coverage set 
forth in this subsection (a). 
    (b) This subsection (b) shall become operative if and only 
if subsection (a) becomes inoperative. 
    (a) An individual or group policy of accident and health 
insurance amended,
delivered, issued, or renewed in this State 
after the date this subsection (b) becomes operative effective 
date of this
amendatory Act of the 93rd General Assembly that 
provides coverage for
outpatient services and outpatient 
prescription drugs or devices must provide
coverage for the 
insured and any
dependent of the
insured covered by the policy 
for all outpatient contraceptive services and
all outpatient 
contraceptive drugs and devices approved by the Food and
Drug 
Administration.  Coverage required under this Section may not 
impose any
deductible, coinsurance, waiting period, or other 
cost-sharing or limitation
that is greater than that required 
for any outpatient service or outpatient
prescription drug or 
device otherwise covered by the policy.

    Nothing in this subsection (b) shall be construed to 
require an insurance
company to cover services related to 
permanent sterilization that requires a
surgical procedure. 
    (b) As used in this subsection (b) Section, "outpatient 
contraceptive service" means
consultations, examinations, 
procedures, and medical services, provided on an
outpatient 
basis and related to the use of contraceptive methods 
(including
natural family planning) to prevent an unintended 
pregnancy.

    (c) Nothing in this Section shall be construed to require 
an insurance
company to cover services related to an abortion 
as the term "abortion" is
defined in the Illinois Abortion Law 
of 1975.

    (d) If a plan or issuer utilizes a network of providers, 
nothing in this Section shall be construed to require coverage 
or to prohibit the plan or issuer from imposing cost-sharing 
for items or services described in this Section that are 
provided or delivered by an out-of-network provider, unless the 
plan or issuer does not have in its network a provider who is 
able to or is willing to provide the applicable items or 
services. 
    (d) Nothing in this Section shall be construed to require 
an insurance
company to cover services related to permanent 
sterilization that requires a
surgical procedure.

(Source: P.A. 95-331, eff. 8-21-07.)