101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB3226

 

Introduced 2/11/2020, by Sen. Laura Fine

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/356z.4

    Amends the Illinois Insurance Code to prohibit an organization that provides group policies of accident and health insurance which include coverage for contraceptive services from claiming an exemption from the requirement to cover contraceptive services based on a religious or moral objection. Allows an organization that provides group policies of accident and health insurance to request an accommodation from the requirement to cover contraceptive services based on a religious or moral objection, if the inculcation of religious values is the purpose of the organization, the organization primarily employs and serves persons who share the religious tenets of the organization, and the organization is a nonprofit religious entity under federal law. Effective immediately.


LRB101 17513 BMS 66924 b

 

 

A BILL FOR

 

SB3226LRB101 17513 BMS 66924 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by
5changing Section 356z.4 as follows:
 
6    (215 ILCS 5/356z.4)
7    Sec. 356z.4. Coverage for contraceptives.
8    (a)(1) The General Assembly hereby finds and declares all
9of the following:
10        (A) Illinois has a long history of expanding timely
11    access to birth control to prevent unintended pregnancy.
12        (B) The federal Patient Protection and Affordable Care
13    Act includes a contraceptive coverage guarantee as part of
14    a broader requirement for health insurance to cover key
15    preventive care services without out-of-pocket costs for
16    patients.
17        (C) The General Assembly intends to build on existing
18    State and federal law to promote gender equity and women's
19    health and to ensure greater contraceptive coverage equity
20    and timely access to all federal Food and Drug
21    Administration approved methods of birth control for all
22    individuals covered by an individual or group health
23    insurance policy in Illinois.

 

 

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1        (D) Medical management techniques such as denials,
2    step therapy, or prior authorization in public and private
3    health care coverage can impede access to the most
4    effective contraceptive methods.
5    (2) As used in this subsection (a):
6    "Contraceptive services" includes consultations,
7examinations, procedures, and medical services related to the
8use of contraceptive methods (including natural family
9planning) to prevent an unintended pregnancy.
10    "Medical necessity", for the purposes of this subsection
11(a), includes, but is not limited to, considerations such as
12severity of side effects, differences in permanence and
13reversibility of contraceptive, and ability to adhere to the
14appropriate use of the item or service, as determined by the
15attending provider.
16    "Therapeutic equivalent version" means drugs, devices, or
17products that can be expected to have the same clinical effect
18and safety profile when administered to patients under the
19conditions specified in the labeling and satisfy the following
20general criteria:
21        (i) they are approved as safe and effective;
22        (ii) they are pharmaceutical equivalents in that they
23    (A) contain identical amounts of the same active drug
24    ingredient in the same dosage form and route of
25    administration and (B) meet compendial or other applicable
26    standards of strength, quality, purity, and identity;

 

 

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1        (iii) they are bioequivalent in that (A) they do not
2    present a known or potential bioequivalence problem and
3    they meet an acceptable in vitro standard or (B) if they do
4    present such a known or potential problem, they are shown
5    to meet an appropriate bioequivalence standard;
6        (iv) they are adequately labeled; and
7        (v) they are manufactured in compliance with Current
8    Good Manufacturing Practice regulations.
9    (3) An individual or group policy of accident and health
10insurance amended, delivered, issued, or renewed in this State
11after the effective date of this amendatory Act of the 99th
12General Assembly shall provide coverage for all of the
13following services and contraceptive methods:
14        (A) All contraceptive drugs, devices, and other
15    products approved by the United States Food and Drug
16    Administration. This includes all over-the-counter
17    contraceptive drugs, devices, and products approved by the
18    United States Food and Drug Administration, excluding male
19    condoms. The following apply:
20            (i) If the United States Food and Drug
21        Administration has approved one or more therapeutic
22        equivalent versions of a contraceptive drug, device,
23        or product, a policy is not required to include all
24        such therapeutic equivalent versions in its formulary,
25        so long as at least one is included and covered without
26        cost-sharing and in accordance with this Section.

 

 

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1            (ii) If an individual's attending provider
2        recommends a particular service or item approved by the
3        United States Food and Drug Administration based on a
4        determination of medical necessity with respect to
5        that individual, the plan or issuer must cover that
6        service or item without cost sharing. The plan or
7        issuer must defer to the determination of the attending
8        provider.
9            (iii) If a drug, device, or product is not covered,
10        plans and issuers must have an easily accessible,
11        transparent, and sufficiently expedient process that
12        is not unduly burdensome on the individual or a
13        provider or other individual acting as a patient's
14        authorized representative to ensure coverage without
15        cost sharing.
16            (iv) This coverage must provide for the dispensing
17        of 12 months' worth of contraception at one time.
18        (B) Voluntary sterilization procedures.
19        (C) Contraceptive services, patient education, and
20    counseling on contraception.
21        (D) Follow-up services related to the drugs, devices,
22    products, and procedures covered under this Section,
23    including, but not limited to, management of side effects,
24    counseling for continued adherence, and device insertion
25    and removal.
26    (4) Except as otherwise provided in this subsection (a), a

 

 

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1policy subject to this subsection (a) shall not impose a
2deductible, coinsurance, copayment, or any other cost-sharing
3requirement on the coverage provided. The provisions of this
4paragraph do not apply to coverage of voluntary male
5sterilization procedures to the extent such coverage would
6disqualify a high-deductible health plan from eligibility for a
7health savings account pursuant to the federal Internal Revenue
8Code, 26 U.S.C. 223.
9    (5) Except as otherwise authorized under this subsection
10(a), a policy shall not impose any restrictions or delays on
11the coverage required under this subsection (a).
12    (6) If, at any time, the Secretary of the United States
13Department of Health and Human Services, or its successor
14agency, promulgates rules or regulations to be published in the
15Federal Register or publishes a comment in the Federal Register
16or issues an opinion, guidance, or other action that would
17require the State, pursuant to any provision of the Patient
18Protection and Affordable Care Act (Public Law 111-148),
19including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any
20successor provision, to defray the cost of any coverage
21outlined in this subsection (a), then this subsection (a) is
22inoperative with respect to all coverage outlined in this
23subsection (a) other than that authorized under Section 1902 of
24the Social Security Act, 42 U.S.C. 1396a, and the State shall
25not assume any obligation for the cost of the coverage set
26forth in this subsection (a).

 

 

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1    (7)(A) An organization that provides group policies of
2accident and health insurance may not claim an exemption from
3the requirement to cover contraceptive services based on a
4religious or moral objection.
5    (B) An organization that provides group policies of
6accident and health insurance may request an accommodation from
7the requirement to cover contraceptive services based on a
8religious or moral objection if it meets all of the following
9criteria:
10        (i) the inculcation of religious values is the purpose
11    of the organization;
12        (ii) the organization primarily employs persons who
13    share the religious tenets of the organization;
14        (iii) the organization primarily serves persons who
15    share the religious tenets of the organization; and
16        (iv) the organization is a nonprofit organization as
17    described in Section 6033(a)(1) and (a)(3)(A)(i) or (iii)
18    of the federal Internal Revenue Code, as amended.
19    (b) This subsection (b) shall become operative if and only
20if subsection (a) becomes inoperative.
21    An individual or group policy of accident and health
22insurance amended, delivered, issued, or renewed in this State
23after the date this subsection (b) becomes operative that
24provides coverage for outpatient services and outpatient
25prescription drugs or devices must provide coverage for the
26insured and any dependent of the insured covered by the policy

 

 

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1for all outpatient contraceptive services and all outpatient
2contraceptive drugs and devices approved by the Food and Drug
3Administration. Coverage required under this Section may not
4impose any deductible, coinsurance, waiting period, or other
5cost-sharing or limitation that is greater than that required
6for any outpatient service or outpatient prescription drug or
7device otherwise covered by the policy.
8    Nothing in this subsection (b) shall be construed to
9require an insurance company to cover services related to
10permanent sterilization that requires a surgical procedure.
11    As used in this subsection (b), "outpatient contraceptive
12service" means consultations, examinations, procedures, and
13medical services, provided on an outpatient basis and related
14to the use of contraceptive methods (including natural family
15planning) to prevent an unintended pregnancy.
16    (c) (Blank).
17    (d) If a plan or issuer utilizes a network of providers,
18nothing in this Section shall be construed to require coverage
19or to prohibit the plan or issuer from imposing cost-sharing
20for items or services described in this Section that are
21provided or delivered by an out-of-network provider, unless the
22plan or issuer does not have in its network a provider who is
23able to or is willing to provide the applicable items or
24services.
25(Source: P.A. 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19.)
 
26    Section 99. Effective date. This Act takes effect upon

 

 

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1becoming law.