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1 | AN ACT concerning regulation.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Insurance Code is amended by | ||||||
5 | changing Section 356m as follows:
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6 | (215 ILCS 5/356m) (from Ch. 73, par. 968m)
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7 | Sec. 356m. Infertility coverage.
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8 | (a) No group policy of accident and health insurance | ||||||
9 | providing coverage
for more than 25 employees that provides | ||||||
10 | pregnancy related benefits may be
issued, amended, delivered, | ||||||
11 | or
renewed in this State after the effective date of this | ||||||
12 | amendatory Act of the 99th General Assembly unless the policy | ||||||
13 | contains coverage for the diagnosis and treatment of
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14 | infertility including, but not limited to, in vitro | ||||||
15 | fertilization, uterine
embryo lavage, embryo transfer, | ||||||
16 | artificial insemination, gamete
intrafallopian tube transfer, | ||||||
17 | zygote intrafallopian tube transfer, and low
tubal ovum | ||||||
18 | transfer.
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19 | (b) The coverage required under subsection (a) is subject | ||||||
20 | to the following conditions:
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21 | (1) Coverage for procedures for in vitro | ||||||
22 | fertilization, gamete
intrafallopian tube transfer, or | ||||||
23 | zygote intrafallopian tube transfer shall
be required only |
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1 | if:
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2 | (A) the covered individual has been unable to | ||||||
3 | attain a viable pregnancy, maintain a viable | ||||||
4 | pregnancy, or sustain a
successful pregnancy through | ||||||
5 | reasonable, less costly medically appropriate
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6 | infertility treatments for which coverage is available | ||||||
7 | under the policy,
plan, or contract;
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8 | (B) the covered individual has not undergone 4 | ||||||
9 | completed oocyte
retrievals, except that if a live | ||||||
10 | birth follows a completed oocyte
retrieval, then 2 | ||||||
11 | more completed oocyte retrievals shall be covered; and
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12 | (C) the procedures are performed at medical | ||||||
13 | facilities that conform to
the American College of | ||||||
14 | Obstetric and Gynecology guidelines for in vitro
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15 | fertilization clinics or to the American Fertility | ||||||
16 | Society minimal
standards for programs of in vitro | ||||||
17 | fertilization.
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18 | (2) The procedures required to be covered under this | ||||||
19 | Section are not
required to be contained in any policy or | ||||||
20 | plan issued to or by a religious
institution or | ||||||
21 | organization or to or by an entity sponsored by a | ||||||
22 | religious
institution or organization that finds the | ||||||
23 | procedures required to be
covered under this Section to | ||||||
24 | violate its religious
and moral teachings and beliefs.
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25 | (c) As used in For purpose of this Section, "infertility" | ||||||
26 | means a disease, condition, or status characterized by: the |
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1 | inability to
conceive after one year of unprotected sexual | ||||||
2 | intercourse, the inability to conceive after one year of | ||||||
3 | attempts to produce conception, the inability to conceive | ||||||
4 | after an individual is diagnosed with a condition affecting | ||||||
5 | fertility, or the inability
to sustain a successful pregnancy.
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6 | (1) a failure to establish a pregnancy or to carry a | ||||||
7 | pregnancy to live birth after 12 months of regular, | ||||||
8 | unprotected sexual intercourse if the woman is 35 years of | ||||||
9 | age or younger, or after 6 months of regular, unprotected | ||||||
10 | sexual intercourse if the woman is over 35 years of age; | ||||||
11 | conceiving but having a miscarriage does not restart the | ||||||
12 | 12-month or 6-month term for determining infertility; | ||||||
13 | (2) a person's inability to reproduce either as a | ||||||
14 | single individual or with a partner without medical | ||||||
15 | intervention; or | ||||||
16 | (3) a licensed physician's findings based on a | ||||||
17 | patient's medical, sexual, and reproductive history, age, | ||||||
18 | physical findings, or diagnostic testing. | ||||||
19 | (d) A policy, contract, or certificate may not impose any | ||||||
20 | exclusions, limitations, or other restrictions on coverage of | ||||||
21 | fertility medications that are different from those imposed on | ||||||
22 | any other prescription medications, nor may it impose any | ||||||
23 | exclusions, limitations, or other restrictions on coverage of | ||||||
24 | any fertility services based on a covered individual's | ||||||
25 | participation in fertility services provided by or to a third | ||||||
26 | party, nor may it impose deductibles, copayments, coinsurance, |
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1 | benefit maximums, waiting periods, or any other limitations on | ||||||
2 | coverage for the diagnosis of infertility, treatment for | ||||||
3 | infertility, and standard fertility preservation services, | ||||||
4 | except as provided in this Section, that are different from | ||||||
5 | those imposed upon benefits for services not related to | ||||||
6 | infertility. | ||||||
7 | (Source: P.A. 99-421, eff. 1-1-16 .)
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