Full Text of HB3709 102nd General Assembly
HB3709ham001 102ND GENERAL ASSEMBLY | Rep. Margaret Croke Filed: 3/18/2021
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| 1 | | AMENDMENT TO HOUSE BILL 3709
| 2 | | AMENDMENT NO. ______. Amend House Bill 3709 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Insurance Code is amended by | 5 | | changing Section 356m as follows:
| 6 | | (215 ILCS 5/356m) (from Ch. 73, par. 968m)
| 7 | | Sec. 356m. Infertility coverage.
| 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
| 14 | | infertility including, but not limited to, in vitro | 15 | | fertilization, uterine
embryo lavage, embryo transfer, | 16 | | artificial insemination, gamete
intrafallopian tube transfer, |
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| 1 | | zygote intrafallopian tube transfer, and low
tubal ovum | 2 | | transfer.
| 3 | | (b) The coverage required under subsection (a) is subject | 4 | | to the following conditions:
| 5 | | (1) Coverage for procedures for in vitro | 6 | | fertilization, gamete
intrafallopian tube transfer, or | 7 | | zygote intrafallopian tube transfer shall
be required only | 8 | | if:
| 9 | | (A) the covered individual has been unable to | 10 | | attain a viable pregnancy, maintain a viable | 11 | | pregnancy, or sustain a
successful pregnancy through | 12 | | reasonable, less costly medically appropriate
| 13 | | infertility treatments for which coverage is available | 14 | | under the policy,
plan, or contract;
| 15 | | (B) the covered individual has not undergone 4 | 16 | | completed oocyte
retrievals, except that if a live | 17 | | birth follows a completed oocyte
retrieval, then 2 | 18 | | more completed oocyte retrievals shall be covered; and
| 19 | | (C) the procedures are performed at medical | 20 | | facilities that conform to
the American College of | 21 | | Obstetric and Gynecology guidelines for in vitro
| 22 | | fertilization clinics or to the American Fertility | 23 | | Society minimal
standards for programs of in vitro | 24 | | fertilization.
| 25 | | (2) The procedures required to be covered under this | 26 | | Section are not
required to be contained in any policy or |
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| 1 | | plan issued to or by a religious
institution or | 2 | | organization or to or by an entity sponsored by a | 3 | | religious
institution or organization that finds the | 4 | | procedures required to be
covered under this Section to | 5 | | violate its religious
and moral teachings and beliefs.
| 6 | | (c) As used in For purpose of this Section, "infertility" | 7 | | means a disease, condition, or status characterized by: the | 8 | | inability to
conceive after one year of unprotected sexual | 9 | | intercourse, the inability to conceive after one year of | 10 | | attempts to produce conception, the inability to conceive | 11 | | after an individual is diagnosed with a condition affecting | 12 | | fertility, or the inability
to sustain a successful pregnancy.
| 13 | | (1) a failure to establish a pregnancy or to carry a | 14 | | pregnancy to live birth after 12 months of regular, | 15 | | unprotected sexual intercourse if the woman is 35 years of | 16 | | age or younger, or after 6 months of regular, unprotected | 17 | | sexual intercourse if the woman is over 35 years of age; | 18 | | conceiving but having a miscarriage does not restart the | 19 | | 12-month or 6-month term for determining infertility; | 20 | | (2) a person's inability to reproduce either as a | 21 | | single individual or with a partner without medical | 22 | | intervention; or | 23 | | (3) a licensed physician's findings based on a | 24 | | patient's medical, sexual, and reproductive history, age, | 25 | | physical findings, or diagnostic testing. | 26 | | (d) A policy, contract, or certificate may not impose any |
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| 1 | | exclusions, limitations, or other restrictions on coverage of | 2 | | fertility medications that are different from those imposed on | 3 | | any other prescription medications, nor may it impose any | 4 | | exclusions, limitations, or other restrictions on coverage of | 5 | | any fertility services based on a covered individual's | 6 | | participation in fertility services provided by or to a third | 7 | | party, nor may it impose deductibles, copayments, coinsurance, | 8 | | benefit maximums, waiting periods, or any other limitations on | 9 | | coverage for the diagnosis of infertility, treatment for | 10 | | infertility, and standard fertility preservation services, | 11 | | except as provided in this Section, that are different from | 12 | | those imposed upon benefits for services not related to | 13 | | infertility. | 14 | | (Source: P.A. 99-421, eff. 1-1-16 .)".
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