|
Sections 356g, 356g.5, 356g.5-1, 356m, 356q,
356u, 356w, 356x, |
356z.2, 356z.4, 356z.4a, 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.56, 356z.57, 356z.59, and 356z.60, and |
356z.62 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 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. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20; |
101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. |
1-1-20; 101-625, eff. 1-1-21; 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; 102-804, 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; |
revised 12-13-22.)
|
(Text of Section after amendment by P.A. 102-768) |
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.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, and |
356z.60, and 356z.62 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 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. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20; |
101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. |
1-1-20; 101-625, eff. 1-1-21; 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.)
|
Section 15. The Criminal Identification Act is amended by |
changing Section 3.2 as follows:
|
(20 ILCS 2630/3.2) (from Ch. 38, par. 206-3.2)
|
Sec. 3.2.
(a) It is the duty of any person conducting or |
operating a medical facility,
or any physician or nurse as |
soon as treatment permits to notify the local
law enforcement |
agency of that jurisdiction upon the application for
treatment |
of a person who is not accompanied by a law enforcement |
officer,
when it reasonably appears that the person requesting |
treatment has
received:
|
(1) any injury resulting from the discharge of a |
firearm; or
|
|
(2) any injury sustained in the commission of or as a |
victim of a
criminal offense.
|
Any hospital, physician or nurse shall be forever held |
harmless from
any civil liability for their reasonable |
compliance with the provisions of
this Section. |
(b) Notwithstanding subsection (a), nothing in this
|
Section shall be construed to require the reporting of lawful
|
health care activity, whether such activity may constitute a
|
violation of another state's law. |
(c) As used in this Section: |
"Lawful health care" means: |
(1) reproductive health care that is not unlawful |
under the laws of this State or was not unlawful under the |
laws of this State as of January 13, 2023 (the effective |
date of Public Act 102-1117), including on any theory of |
vicarious, joint, several, or conspiracy liability; or |
(2) the treatment of gender dysphoria or the |
affirmation of an individual's gender identity or gender |
expression, including but not limited to, all supplies, |
care, and services of a medical, behavioral health, mental |
health, surgical, psychiatric, therapeutic, diagnostic, |
preventative, rehabilitative, or supportive nature that is |
not unlawful under the laws of this State or was not |
unlawful under the laws of this State as of January 13, |
2023 (the effective date of Public Act 102-1117), |
including on any theory of vicarious, joint, several, or |
|
conspiracy liability.
|
"Lawful health care activity" means seeking, providing,
|
receiving, assisting in seeking, providing, or receiving,
|
providing material support for, or traveling to obtain lawful
|
health care. |
(Source: P.A. 102-1117, eff. 1-13-23.)
|
Section 20. The Counties Code is amended by changing |
Section 5-1069.3 as follows:
|
(55 ILCS 5/5-1069.3)
|
Sec. 5-1069.3. Required health benefits. If a county, |
including a home
rule
county, is a self-insurer for purposes |
of providing health insurance coverage
for its employees, the |
coverage shall include coverage for the post-mastectomy
care |
benefits required to be covered by a policy of accident and |
health
insurance under Section 356t and the coverage required |
under Sections 356g, 356g.5, 356g.5-1, 356q, 356u,
356w, 356x, |
356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, |
356z.12, 356z.13, 356z.14, 356z.15, 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.48, 356z.51, 356z.53, |
356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and 356z.62 |
of
the Illinois Insurance Code. The coverage shall comply with |
Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois |
Insurance Code. The Department of Insurance shall enforce the |
|
requirements of this Section. The requirement that health |
benefits be covered
as provided in this Section is an
|
exclusive power and function of the State and is a denial and |
limitation under
Article VII, Section 6, subsection (h) of the |
Illinois Constitution. A home
rule county to which this |
Section applies must comply with every provision of
this |
Section.
|
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. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; |
101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. |
1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, |
eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22; |
102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. |
1-1-23; 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.)
|
Section 25. The Illinois Municipal Code is amended by |
changing Section 10-4-2.3 as follows:
|
(65 ILCS 5/10-4-2.3)
|
|
Sec. 10-4-2.3. Required health benefits. If a |
municipality, including a
home rule municipality, is a |
self-insurer for purposes of providing health
insurance |
coverage for its employees, the coverage shall include |
coverage for
the post-mastectomy care benefits required to be |
covered by a policy of
accident and health insurance under |
Section 356t and the coverage required
under Sections 356g, |
356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, |
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, |
356z.14, 356z.15, 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.48, 356z.51, 356z.53, 356z.54, |
356z.56, 356z.57, 356z.59, and 356z.60, and 356z.62 of the |
Illinois
Insurance
Code. The coverage shall comply with |
Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois |
Insurance Code. The Department of Insurance shall enforce the |
requirements of this Section. The requirement that health
|
benefits be covered as provided in this is an exclusive power |
and function of
the State and is a denial and limitation under |
Article VII, Section 6,
subsection (h) of the Illinois |
Constitution. A home rule municipality to which
this Section |
applies must comply with every provision of this Section.
|
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. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; |
101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. |
1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, |
eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22; |
102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. |
1-1-23; 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.)
|
Section 30. The School Code is amended by changing Section |
10-22.3f as follows:
|
(105 ILCS 5/10-22.3f)
|
Sec. 10-22.3f. Required health benefits. Insurance |
protection and
benefits
for employees shall provide the |
post-mastectomy care benefits required to be
covered by a |
policy of accident and health insurance under Section 356t and |
the
coverage required under Sections 356g, 356g.5, 356g.5-1, |
356q, 356u, 356w, 356x, 356z.4, 356z.4a,
356z.6, 356z.8, |
356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 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.56, 356z.57, 356z.59, and 356z.60, and |
356z.62 of
the
Illinois Insurance Code.
Insurance policies |
|
shall comply with Section 356z.19 of the Illinois Insurance |
Code. The coverage shall comply with Sections 155.22a, 355b, |
and 370c of
the Illinois Insurance Code. The Department of |
Insurance shall enforce the requirements of this Section.
|
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. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; |
101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. |
1-1-21; 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; 102-804, 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.)
|
Section 35. The Illinois Insurance Code is amended by |
changing Section 356z.4 and by adding Section 356z.62 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, except as provided in the current comprehensive |
guidelines supported by the Health Resources and Services |
Administration. 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. The provisions of this |
paragraph do not apply to coverage of voluntary male |
sterilization procedures to the extent such coverage would |
disqualify a high-deductible health plan from eligibility for |
a health savings account pursuant to the federal Internal |
Revenue Code, 26 U.S.C. 223. |
(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. |
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 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. |
As used in this subsection (b), "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) (Blank).
|
(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.
|
(Source: P.A. 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19.)
|
(215 ILCS 5/356z.62 new) |
Sec. 356z.62. Coverage of preventive health services. |
|
(a) A policy of group health insurance coverage or |
individual health insurance coverage as defined in Section 5 |
of the Illinois Health Insurance Portability and |
Accountability Act shall, at a minimum, provide coverage for |
and shall not impose any cost-sharing requirements, including |
a copayment, coinsurance, or deductible, for: |
(1) evidence-based items or services that have in |
effect a rating of "A" or "B" in the current |
recommendations of the United States Preventive Services |
Task Force; |
(2) immunizations that have in effect a recommendation |
from the Advisory Committee on Immunization Practices of |
the Centers for Disease Control and Prevention with |
respect to the individual involved; |
(3) with respect to infants, children, and |
adolescents, evidence-informed preventive care and |
screenings provided for in the comprehensive guidelines |
supported by the Health Resources and Services |
Administration; and |
(4) with respect to women, such additional preventive |
care and screenings not described in paragraph (1) of this |
subsection (a) as provided for in comprehensive guidelines |
supported by the Health Resources and Services |
Administration for purposes of this paragraph. |
(b) For purposes of this Section, and for purposes of any |
other provision of State law, recommendations of the United |
|
States Preventive Services Task Force regarding breast cancer |
screening, mammography, and prevention issued in or around |
November 2009 are not considered to be current. |
(c) For office visits: |
(1) if an item or service described in subsection (a) |
is billed separately or is tracked as individual encounter |
data separately from an office visit, then a policy may |
impose cost-sharing requirements with respect to the |
office visit; |
(2) if an item or service described in subsection (a) |
is not billed separately or is not tracked as individual |
encounter data separately from an office visit and the |
primary purpose of the office visit is the delivery of |
such an item or service, then a policy may not impose |
cost-sharing requirements with respect to the office |
visit; and |
(3) if an item or service described in subsection (a) |
is not billed separately or is not tracked as individual |
encounter data separately from an office visit and the |
primary purpose of the office visit is not the delivery of |
such an item or service, then a policy may impose |
cost-sharing requirements with respect to the office |
visit. |
(d) A policy must provide coverage pursuant to subsection |
(a) for plan or policy years that begin on or after the date |
that is one year after the date the recommendation or |
|
guideline is issued. If a recommendation or guideline is in |
effect on the first day of the plan or policy year, the policy |
shall cover the items and services specified in the |
recommendation or guideline through the last day of the plan |
or policy year unless either: |
(1) a recommendation under paragraph (1) of subsection |
(a) is downgraded to a "D" rating; or |
(2) the item or service is subject to a safety recall |
or is otherwise determined to pose a significant safety |
concern by a federal agency authorized to regulate the |
item or service during the plan or policy year. |
(e) Network limitations. |
(1) Subject to paragraph (3) of this subsection, |
nothing in this Section requires coverage for items or |
services described in subsection (a) that are delivered by |
an out-of-network provider under a health maintenance |
organization health care plan, other than a |
point-of-service contract, or under a voluntary health |
services plan that generally excludes coverage for |
out-of-network services except as otherwise required by |
law. |
(2) Subject to paragraph (3) of this subsection, |
nothing in this Section precludes a policy with a |
preferred provider program under Article XX-1/2 of this |
Code, a health maintenance organization point-of-service |
contract, or a similarly designed voluntary health |
|
services plan from imposing cost-sharing requirements for |
items or services described in subsection (a) that are |
delivered by an out-of-network provider. |
(3) If a policy does not have in its network a provider |
who can provide an item or service described in subsection |
(a), then the policy must cover the item or service when |
performed by an out-of-network provider and it may not |
impose cost-sharing with respect to the item or service. |
(f) Nothing in this Section prevents a company from using |
reasonable medical management techniques to determine the |
frequency, method, treatment, or setting for an item or |
service described in subsection (a) to the extent not |
specified in the recommendation or guideline. |
(g) Nothing in this Section shall be construed to prohibit |
a policy from providing coverage for items or services in |
addition to those required under subsection (a) or from |
denying coverage for items or services that are not required |
under subsection (a). Unless prohibited by other law, a policy |
may impose cost-sharing requirements for a treatment not |
described in subsection (a) even if the treatment results from |
an item or service described in subsection (a). Nothing in |
this Section shall be construed to limit coverage requirements |
provided under other law. |
(h) The Director may develop guidelines to permit a |
company to utilize value-based insurance designs. In the |
absence of guidelines developed by the Director, any such |
|
guidelines developed by the Secretary of the U.S. Department |
of Health and Human Services that are in force under 42 U.S.C. |
300gg-13 shall apply. |
(i) For student health insurance coverage as defined at 45 |
CFR 147.145, student administrative health fees are not |
considered cost-sharing requirements with respect to |
preventive services specified under subsection (a). As used in |
this subsection, "student administrative health fee" means a |
fee charged by an institution of higher education on a |
periodic basis to its students to offset the cost of providing |
health care through health clinics regardless of whether the |
students utilize the health clinics or enroll in student |
health insurance coverage. |
(j) For any recommendation or guideline specifically |
referring to women or men, a company shall not deny or limit |
the coverage required or a claim made under subsection (a) |
based solely on the individual's recorded sex or actual or |
perceived gender identity, or for the reason that the |
individual is gender nonconforming, intersex, transgender, or |
has undergone, or is in the process of undergoing, gender |
transition, if, notwithstanding the sex or gender assigned at |
birth, the covered individual meets the conditions for the |
recommendation or guideline at the time the item or service is |
furnished. |
(k) This Section does not apply to grandfathered health |
plans, excepted benefits, or short-term, limited-duration |
|
health insurance coverage.
|
Section 40. The Health Maintenance Organization Act is |
amended by changing Section 5-3 as follows:
|
(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
|
Sec. 5-3. Insurance Code provisions.
|
(a) Health Maintenance Organizations
shall be subject to |
the provisions of Sections 133, 134, 136, 137, 139, 140, |
141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, |
154, 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, |
355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x, |
356y,
356z.2, 356z.3a, 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.18, 356z.19, 356z.21, 356z.22, 356z.25, |
356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, |
356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48, |
356z.50, 356z.51, 356z.53 256z.53, 356z.54, 356z.56, 356z.57, |
356z.59, 356z.60, 356z.62, 364, 364.01, 364.3, 367.2, 367.2-5, |
367i, 368a, 368b, 368c, 368d, 368e, 370c,
370c.1, 401, 401.1, |
402, 403, 403A,
408, 408.2, 409, 412, 444,
and
444.1,
|
paragraph (c) of subsection (2) of Section 367, and Articles |
IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, XXVI, and |
XXXIIB of the Illinois Insurance Code.
|
(b) For purposes of the Illinois Insurance Code, except |
for Sections 444
and 444.1 and Articles XIII and XIII 1/2, |
|
Health Maintenance Organizations in
the following categories |
are deemed to be "domestic companies":
|
(1) a corporation authorized under the
Dental Service |
Plan Act or the Voluntary Health Services Plans Act;
|
(2) a corporation organized under the laws of this |
State; or
|
(3) a corporation organized under the laws of another |
state, 30% or more
of the enrollees of which are residents |
of this State, except a
corporation subject to |
substantially the same requirements in its state of
|
organization as is a "domestic company" under Article VIII |
1/2 of the
Illinois Insurance Code.
|
(c) In considering the merger, consolidation, or other |
acquisition of
control of a Health Maintenance Organization |
pursuant to Article VIII 1/2
of the Illinois Insurance Code,
|
(1) the Director shall give primary consideration to |
the continuation of
benefits to enrollees and the |
financial conditions of the acquired Health
Maintenance |
Organization after the merger, consolidation, or other
|
acquisition of control takes effect;
|
(2)(i) the criteria specified in subsection (1)(b) of |
Section 131.8 of
the Illinois Insurance Code shall not |
apply and (ii) the Director, in making
his determination |
with respect to the merger, consolidation, or other
|
acquisition of control, need not take into account the |
effect on
competition of the merger, consolidation, or |
|
other acquisition of control;
|
(3) the Director shall have the power to require the |
following
information:
|
(A) certification by an independent actuary of the |
adequacy
of the reserves of the Health Maintenance |
Organization sought to be acquired;
|
(B) pro forma financial statements reflecting the |
combined balance
sheets of the acquiring company and |
the Health Maintenance Organization sought
to be |
acquired as of the end of the preceding year and as of |
a date 90 days
prior to the acquisition, as well as pro |
forma financial statements
reflecting projected |
combined operation for a period of 2 years;
|
(C) a pro forma business plan detailing an |
acquiring party's plans with
respect to the operation |
of the Health Maintenance Organization sought to
be |
acquired for a period of not less than 3 years; and
|
(D) such other information as the Director shall |
require.
|
(d) The provisions of Article VIII 1/2 of the Illinois |
Insurance Code
and this Section 5-3 shall apply to the sale by |
any health maintenance
organization of greater than 10% of its
|
enrollee population (including without limitation the health |
maintenance
organization's right, title, and interest in and |
to its health care
certificates).
|
(e) In considering any management contract or service |
|
agreement subject
to Section 141.1 of the Illinois Insurance |
Code, the Director (i) shall, in
addition to the criteria |
specified in Section 141.2 of the Illinois
Insurance Code, |
take into account the effect of the management contract or
|
service agreement on the continuation of benefits to enrollees |
and the
financial condition of the health maintenance |
organization to be managed or
serviced, and (ii) need not take |
into account the effect of the management
contract or service |
agreement on competition.
|
(f) Except for small employer groups as defined in the |
Small Employer
Rating, Renewability and Portability Health |
Insurance Act and except for
medicare supplement policies as |
defined in Section 363 of the Illinois
Insurance Code, a |
Health Maintenance Organization may by contract agree with a
|
group or other enrollment unit to effect refunds or charge |
additional premiums
under the following terms and conditions:
|
(i) the amount of, and other terms and conditions with |
respect to, the
refund or additional premium are set forth |
in the group or enrollment unit
contract agreed in advance |
of the period for which a refund is to be paid or
|
additional premium is to be charged (which period shall |
not be less than one
year); and
|
(ii) the amount of the refund or additional premium |
shall not exceed 20%
of the Health Maintenance |
Organization's profitable or unprofitable experience
with |
respect to the group or other enrollment unit for the |
|
period (and, for
purposes of a refund or additional |
premium, the profitable or unprofitable
experience shall |
be calculated taking into account a pro rata share of the
|
Health Maintenance Organization's administrative and |
marketing expenses, but
shall not include any refund to be |
made or additional premium to be paid
pursuant to this |
subsection (f)). The Health Maintenance Organization and |
the
group or enrollment unit may agree that the profitable |
or unprofitable
experience may be calculated taking into |
account the refund period and the
immediately preceding 2 |
plan years.
|
The Health Maintenance Organization shall include a |
statement in the
evidence of coverage issued to each enrollee |
describing the possibility of a
refund or additional premium, |
and upon request of any group or enrollment unit,
provide to |
the group or enrollment unit a description of the method used |
to
calculate (1) the Health Maintenance Organization's |
profitable experience with
respect to the group or enrollment |
unit and the resulting refund to the group
or enrollment unit |
or (2) the Health Maintenance Organization's unprofitable
|
experience with respect to the group or enrollment unit and |
the resulting
additional premium to be paid by the group or |
enrollment unit.
|
In no event shall the Illinois Health Maintenance |
Organization
Guaranty Association be liable to pay any |
contractual obligation of an
insolvent organization to pay any |
|
refund authorized under this Section.
|
(g) 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. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; |
101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff. |
1-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, |
eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; |
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. |
1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, |
eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; |
102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. |
1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, |
eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.)
|
Section 45. The Voluntary Health Services Plans Act is |
amended by changing Section 10 as follows:
|
(215 ILCS 165/10) (from Ch. 32, par. 604)
|
Sec. 10. Application of Insurance Code provisions. Health |
services
plan corporations and all persons interested therein |
or dealing therewith
shall be subject to the provisions of |
Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, |
|
143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, |
356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v,
356w, |
356x, 356y, 356z.1, 356z.2, 356z.3a, 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.18, 356z.19, 356z.21, 356z.22, 356z.25, |
356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, |
356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, |
356z.56, 356z.57, 356z.59, 356z.60, 356z.62, 364.01, 364.3, |
367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, |
and paragraphs (7) and (15) of Section 367 of the Illinois
|
Insurance Code.
|
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. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; |
101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. |
1-1-21; 102-30, 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; 102-775, eff. 5-13-22; 102-804, eff. |
1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, |
eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23; |
102-1117, eff. 1-13-23.)
|
|
Section 50. The Medical Practice Act of 1987 is amended by |
changing Section 18 as follows:
|
(225 ILCS 60/18) (from Ch. 111, par. 4400-18)
|
(Section scheduled to be repealed on January 1, 2027)
|
Sec. 18. Visiting professor, physician, or resident |
permits.
|
(A) Visiting professor permit.
|
(1) A visiting professor permit shall
entitle a person |
to practice medicine in all of its branches
or to practice |
the treatment of human ailments without the
use of drugs |
and without operative surgery provided:
|
(a) the person maintains an equivalent |
authorization
to practice medicine in all of its |
branches or to practice
the treatment of human |
ailments without the use of drugs
and without |
operative surgery in good standing in his or her
|
native licensing jurisdiction during the period of the
|
visiting professor permit;
|
(b) the person has received a faculty appointment |
to
teach in a medical, osteopathic or chiropractic |
school in
Illinois; and
|
(c) the Department may prescribe the information |
necessary to
establish
an applicant's eligibility for |
a permit. This information shall include
without |
limitation (i) a statement from the dean of the |
|
medical school at which
the
applicant will be employed |
describing the applicant's qualifications and (ii)
a |
statement from the dean of the medical school listing |
every affiliated
institution in which the applicant |
will be providing instruction as part of the
medical |
school's education program and justifying any clinical |
activities at
each of the institutions listed by the |
dean.
|
(2) Application for visiting professor permits shall
|
be made to the Department, in writing, on forms prescribed
|
by the Department and shall be accompanied by the required
|
fee established by rule, which shall not be refundable. |
Any application
shall require the information as, in the |
judgment of the Department, will
enable the Department to |
pass on the qualifications of the applicant.
|
(3) A visiting professor permit shall be valid for no |
longer than 2
years from the date of issuance or until the |
time the
faculty appointment is terminated, whichever |
occurs first,
and may be renewed only in accordance with |
subdivision (A)(6) of this
Section.
|
(4) The applicant may be required to appear before the |
Medical Board for an interview prior to, and as a
|
requirement for, the issuance of the original permit and |
the
renewal.
|
(5) Persons holding a permit under this Section shall
|
only practice medicine in all of its branches or practice
|
|
the treatment of human ailments without the use of drugs
|
and without operative surgery in the State of Illinois in
|
their official capacity under their contract
within the |
medical school itself and any affiliated institution in |
which the
permit holder is providing instruction as part |
of the medical school's
educational program and for which |
the medical school has assumed direct
responsibility.
|
(6) After the initial renewal of a visiting professor |
permit, a visiting professor permit shall be valid until |
the last day of the
next physician license renewal period, |
as set by rule, and may only be
renewed for applicants who |
meet the following requirements:
|
(i) have obtained the required continuing |
education hours as set by
rule; and
|
(ii) have paid the fee prescribed for a license |
under Section 21 of this
Act.
|
For initial renewal, the visiting professor must |
successfully pass a
general competency examination authorized |
by the Department by rule, unless he or she was issued an |
initial visiting professor permit on or after January 1, 2007, |
but prior to July 1, 2007.
|
(B) Visiting physician permit.
|
(1) The Department may, in its discretion, issue a |
temporary visiting
physician permit, without examination, |
provided:
|
|
(a) (blank);
|
(b) that the person maintains an equivalent |
authorization to practice
medicine in all of its |
branches or to practice the treatment of human
|
ailments without the use of drugs and without |
operative surgery in good
standing in his or her |
native licensing jurisdiction during the period of the
|
temporary visiting physician permit;
|
(c) that the person has received an invitation or |
appointment to study,
demonstrate, or perform a
|
specific medical, osteopathic, chiropractic or |
clinical subject or
technique in a medical, |
osteopathic, or chiropractic school, a state or |
national medical, osteopathic, or chiropractic |
professional association or society conference or |
meeting, a hospital
licensed under the Hospital |
Licensing Act, a hospital organized
under the |
University of Illinois Hospital Act, or a facility |
operated
pursuant to the Ambulatory Surgical Treatment |
Center Act; and
|
(d) that the temporary visiting physician permit |
shall only permit the
holder to practice medicine in |
all of its branches or practice the
treatment of human |
ailments without the use of drugs and without |
operative
surgery within the scope of the medical, |
osteopathic, chiropractic, or
clinical studies, or in |
|
conjunction with the state or national medical, |
osteopathic, or chiropractic professional association |
or society conference or meeting, for which the holder |
was invited or appointed.
|
(2) The application for the temporary visiting |
physician permit shall be
made to the Department, in |
writing, on forms prescribed by the
Department, and shall |
be accompanied by the required fee established by
rule, |
which shall not be refundable. The application shall |
require
information that, in the judgment of the |
Department, will enable the
Department to pass on the |
qualification of the applicant, and the necessity
for the |
granting of a temporary visiting physician permit.
|
(3) A temporary visiting physician permit shall be |
valid for no longer than (i) 180
days
from the date of |
issuance or (ii) until the time the medical, osteopathic,
|
chiropractic, or clinical studies are completed, or the |
state or national medical, osteopathic, or chiropractic |
professional association or society conference or meeting |
has concluded, whichever occurs first. The temporary |
visiting physician permit may be issued multiple times to |
a visiting physician under this paragraph (3) as long as |
the total number of days it is active do not exceed 180 |
days within a 365-day period.
|
(4) The applicant for a temporary visiting physician |
permit may be
required to appear before the Medical Board |
|
for an interview
prior to, and as a requirement for, the |
issuance of a temporary visiting
physician permit.
|
(5) A limited temporary visiting physician permit |
shall be issued to a
physician licensed in another state |
who has been requested to perform emergency
procedures in |
Illinois if he or she meets the requirements as |
established by
rule.
|
(C) Visiting resident permit.
|
(1) The Department may, in its discretion, issue a |
temporary visiting
resident permit, without examination, |
provided:
|
(a) (blank);
|
(b) that the person maintains an equivalent |
authorization to practice
medicine in all of its |
branches or to practice the treatment of human
|
ailments without the use of drugs and without |
operative surgery in good
standing in his or her |
native licensing jurisdiction during the period of
the |
temporary visiting resident permit;
|
(c) that the applicant is enrolled in a |
postgraduate clinical training
program outside the |
State of Illinois that is approved by the Department;
|
(d) that the individual has been invited or |
appointed for a specific
period of time to perform a |
portion of that post graduate clinical training
|
|
program under the supervision of an Illinois licensed |
physician in an
Illinois patient care clinic or |
facility that is affiliated with the
out-of-State post |
graduate training program; and
|
(e) that the temporary visiting resident permit |
shall only permit the
holder to practice medicine in |
all of its branches or practice the
treatment of human |
ailments without the use of drugs and without |
operative
surgery within the scope of the medical, |
osteopathic, chiropractic or
clinical studies for |
which the holder was invited or appointed.
|
(2) The application for the temporary visiting |
resident permit shall be
made to the Department, in |
writing, on forms prescribed by the Department,
and shall |
be accompanied by the required fee established by rule. |
The
application shall require information that, in the |
judgment of the
Department, will enable the Department to |
pass on the qualifications of
the applicant.
|
(3) A temporary visiting resident permit shall be |
valid for 180 days from
the date of issuance or until the |
time the medical, osteopathic,
chiropractic, or clinical |
studies are completed, whichever occurs first.
|
(4) The applicant for a temporary visiting resident |
permit may be
required to appear before the Medical Board |
for an interview
prior to, and as a requirement for, the |
issuance of a temporary visiting
resident permit.
|
|
(D) Postgraduate training exemption period; visiting |
rotations. A person may participate in visiting rotations in |
an approved postgraduate training program, not to exceed a |
total of 90 days for all rotations, if the following |
information is submitted in writing or electronically to the |
Department by the patient care clinics or facilities where the |
person will be performing the training or by an affiliated |
program: |
(1) The person who has been invited or appointed to |
perform a portion of their postgraduate clinical training |
program in Illinois. |
(2) The name and address of the primary patient care |
clinic or facility, the date the training is to begin, and |
the length of time of the invitation or appointment. |
(3) The name and license number of the Illinois |
physician who will be responsible for supervising the |
trainee and the medical director or division director of |
the department or facility. |
(4) Certification from the postgraduate training |
program that the person is approved and enrolled in an |
graduate training program approved by the Department in |
their home state.
|
(Source: P.A. 102-20, eff. 1-1-22.)
|
Section 95. No acceleration or delay. Where this Act makes |