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1 | AN ACT concerning regulation. | ||||||
2 | Be it enacted by the People of the State of Illinois, | ||||||
3 | represented in the General Assembly: | ||||||
4 | Section 5. The State Employees Group Insurance Act of 1971 | ||||||
5 | is amended by changing Section 6.11 as follows: | ||||||
6 | (5 ILCS 375/6.11) | ||||||
7 | Sec. 6.11. Required health benefits; Illinois Insurance | ||||||
8 | Code requirements. The program of health benefits shall | ||||||
9 | provide the post-mastectomy care benefits required to be | ||||||
10 | covered by a policy of accident and health insurance under | ||||||
11 | Section 356t of the Illinois Insurance Code. The program of | ||||||
12 | health benefits shall provide the coverage required under | ||||||
13 | Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, | ||||||
14 | 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, | ||||||
15 | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, | ||||||
16 | 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, | ||||||
17 | 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, | ||||||
18 | 356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, | ||||||
19 | 356z.60, and 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, | ||||||
20 | and 356z.70 of the Illinois Insurance Code. The program of | ||||||
21 | health benefits must comply with Sections 155.22a, 155.37, | ||||||
22 | 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the | ||||||
23 | Illinois Insurance Code. The program of health benefits shall |
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1 | provide the coverage required under Section 356m of the | ||||||
2 | Illinois Insurance Code and, for the employees of the State | ||||||
3 | Employee Group Insurance Program only, the coverage as also | ||||||
4 | provided in Section 6.11B of this Act. The Department of | ||||||
5 | Insurance shall enforce the requirements of this Section with | ||||||
6 | respect to Sections 370c and 370c.1 of the Illinois Insurance | ||||||
7 | Code; all other requirements of this Section shall be enforced | ||||||
8 | by the Department of Central Management Services. | ||||||
9 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
10 | any, is conditioned on the rules being adopted in accordance | ||||||
11 | with all provisions of the Illinois Administrative Procedure | ||||||
12 | Act and all rules and procedures of the Joint Committee on | ||||||
13 | Administrative Rules; any purported rule not so adopted, for | ||||||
14 | whatever reason, is unauthorized. | ||||||
15 | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||||||
16 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. | ||||||
17 | 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768, | ||||||
18 | eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | ||||||
19 | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | ||||||
20 | 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84, | ||||||
21 | eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24; | ||||||
22 | 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff. | ||||||
23 | 8-11-23; revised 8-29-23.) | ||||||
24 | Section 10. The Illinois Insurance Code is amended by | ||||||
25 | changing Section 356z.5 as follows: |
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1 | (215 ILCS 5/356z.5) | ||||||
2 | Sec. 356z.5. Prescription inhalants. | ||||||
3 | (a) In this Section, "prescription inhaler" means a | ||||||
4 | prescribed medical device that delivers inhaled medications | ||||||
5 | used to treat breathing for persons suffering from asthma or | ||||||
6 | other life-threatening bronchial ailments. "Prescription | ||||||
7 | inhaler" includes metered-dose inhalers, nebulizers, and dry | ||||||
8 | powder inhalers. "Prescription inhaler" does not include | ||||||
9 | inhalers available over the counter without a prescription to | ||||||
10 | provide temporary relief from respiratory symptoms. | ||||||
11 | (b) A group or individual policy of accident and health | ||||||
12 | insurance or managed care plan amended, delivered, issued, or | ||||||
13 | renewed through December 31, 2025 after the effective date of | ||||||
14 | this amendatory Act of the 93rd General Assembly that provides | ||||||
15 | coverage for prescription drugs may not deny or limit coverage | ||||||
16 | for prescription inhalers inhalants to enable persons to | ||||||
17 | breathe when suffering from asthma or other life-threatening | ||||||
18 | bronchial ailments based upon any restriction on the number of | ||||||
19 | days before an inhaler refill may be obtained if, contrary to | ||||||
20 | those restrictions, the inhalants have been ordered or | ||||||
21 | prescribed by the treating physician and are medically | ||||||
22 | appropriate. | ||||||
23 | (c) A group or individual policy of accident and health | ||||||
24 | insurance or managed care plan amended, delivered, issued, or | ||||||
25 | renewed on or after January 1, 2026 that provides coverage for |
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1 | prescription drugs may not deny or limit, except as otherwise | ||||||
2 | provided in this subsection, coverage for prescription | ||||||
3 | inhalers to enable persons to breathe when suffering from | ||||||
4 | asthma or other life-threatening bronchial ailments based upon | ||||||
5 | any restriction on the number of days before an inhaler refill | ||||||
6 | may be obtained if, contrary to those restrictions, the | ||||||
7 | inhalants have been ordered or prescribed by the treating | ||||||
8 | physician and are medically appropriate. A group or individual | ||||||
9 | policy of accident and health insurance or managed care plan | ||||||
10 | subject to this subsection shall limit the total amount that a | ||||||
11 | covered person is required to pay for a covered prescription | ||||||
12 | inhaler to an amount not to exceed $25 dollars per 30-day | ||||||
13 | supply. | ||||||
14 | (d) Nothing in this Section prevents a group or individual | ||||||
15 | policy of accident and health insurance or managed care plan | ||||||
16 | from reducing a covered person's cost sharing to an amount | ||||||
17 | less than the amount specified in subsection (c). | ||||||
18 | (e) Coverage for prescription inhalers shall not be | ||||||
19 | subject to any deductible; except that this provision does not | ||||||
20 | apply to the extent such coverage would disqualify a | ||||||
21 | high-deductible health plan from eligibility for a health | ||||||
22 | savings account pursuant to Section 223 of the Internal | ||||||
23 | Revenue Code (26 U.S.C. 223). | ||||||
24 | (f) The Department may adopt rules necessary to implement | ||||||
25 | and administer this Section and to align with federal | ||||||
26 | requirements. The Department may use any of its enforcement |
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1 | powers to obtain a group or individual policy of accident and | ||||||
2 | health insurance's or managed care plan's compliance with this | ||||||
3 | Section. | ||||||
4 | (Source: P.A. 95-331, eff. 8-21-07.) |