HB5142ham002 103RD GENERAL ASSEMBLY

Rep. Robyn Gabel

Filed: 3/7/2024

10300HB5142ham002 LRB103 38742 RPS 70706 a

AMENDMENT TO HOUSE BILL 5142

AMENDMENT NO. ______. Amend House Bill 5142, AS AMENDED, with reference to page and line numbers of House Amendment No. 1, on page 1, line 5, by replacing "Section" with "Sections 356z.4a and"; and

on page 1, immediately below line 5, by inserting the following:

"(215 ILCS 5/356z.4a)

Sec. 356z.4a. Coverage for abortion.

(a) Except as otherwise provided in this Section, no individual or group policy of accident and health insurance that provides pregnancy-related benefits may be issued, amended, delivered, or renewed in this State after the effective date of this amendatory Act of the 101st General Assembly unless the policy provides a covered person with coverage for abortion care. Regardless of whether the policy otherwise provides prescription drug benefits, abortion care coverage must include medications that are obtained through a prescription and used to terminate a pregnancy, regardless of whether there is proof of a pregnancy.

(b) Coverage for abortion care may not impose any deductible, coinsurance, waiting period, or other cost-sharing limitation that is greater than that required for other pregnancy-related benefits covered by the policy. This subsection does not apply to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to Section 223 of the Internal Revenue Code.

(c) Except as otherwise authorized under this Section, a policy shall not impose any restrictions or delays on the coverage required under this Section.

(d) This Section does not, pursuant to 42 U.S.C. 18054(a)(6), apply to a multistate plan that does not provide coverage for abortion.

(e) If the Department concludes that enforcement of this Section may adversely affect the allocation of federal funds to this State, the Department may grant an exemption to the requirements, but only to the minimum extent necessary to ensure the continued receipt of federal funds.

(Source: P.A. 101-13, eff. 6-12-19; 102-1117, eff. 1-13-23.)"; and

on page 3, line 3, after "Code.", by inserting "All outpatient coverage required under this subsection (b) must be provided without cost sharing, except that, for treatment of substance use disorders, the prohibition on cost-sharing applies to the levels of treatment below and not including 3.1 (Clinically Managed Low-Intensity Residential) established by the American Society of Addiction Medicine."; and

on page 6, line 10, after the period, by inserting "All outpatient coverage required by paragraphs (2) through (6) of this subsection (b) must be provided without cost sharing, except that, for treatment of substance use disorders, the prohibition on cost-sharing applies to the levels of treatment below and not including 3.1 (Clinically Managed Low-Intensity Residential) established by the American Society of Addiction Medicine."; and

on page 7, by replacing lines 7 through 11 with the following:

"(c) The cost-sharing prohibitions in this Section do not apply to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to Section 223 of the Internal Revenue Code.".