Full Text of SB3538 103rd General Assembly
SB3538 103RD GENERAL ASSEMBLY | | | 103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024 SB3538 Introduced 2/9/2024, by Sen. Michael E. Hastings SYNOPSIS AS INTRODUCED: | | 55 ILCS 5/5-1069 | from Ch. 34, par. 5-1069 | 65 ILCS 5/10-4-2.4 new | |
| Amends the Counties Code and the Illinois Municipal Code. Provides that, if a municipality or county, including a home rule municipality or county, is a self-insurer for purposes of providing health insurance coverage for its employees, the insurance coverage shall include mental health counseling for any employee who is a first responder, including police and corrections officers, deputy sheriffs, firefighters, or emergency medical services personnel, without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided. Specifies that this requirement does not apply to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to the Internal Revenue Code. Preempts home rule. |
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| | | STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT MAY APPLY
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| | A BILL FOR |
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| 1 | | AN ACT concerning local government. | 2 | | Be it enacted by the People of the State of Illinois, | 3 | | represented in the General Assembly: | 4 | | Section 5. The Counties Code is amended by changing | 5 | | Section 5-1069 as follows: | 6 | | (55 ILCS 5/5-1069) (from Ch. 34, par. 5-1069) | 7 | | Sec. 5-1069. Group life, health, accident, hospital, and | 8 | | medical insurance. | 9 | | (a) The county board of any county may arrange to provide, | 10 | | for the benefit of employees of the county, group life, | 11 | | health, accident, hospital, and medical insurance, or any one | 12 | | or any combination of those types of insurance, or the county | 13 | | board may self-insure, for the benefit of its employees, all | 14 | | or a portion of the employees' group life, health, accident, | 15 | | hospital, and medical insurance, or any one or any combination | 16 | | of those types of insurance, including a combination of | 17 | | self-insurance and other types of insurance authorized by this | 18 | | Section, provided that the county board complies with all | 19 | | other requirements of this Section. The insurance may include | 20 | | provision for employees who rely on treatment by prayer or | 21 | | spiritual means alone for healing in accordance with the | 22 | | tenets and practice of a well recognized religious | 23 | | denomination. The county board may provide for payment by the |
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| 1 | | county of a portion or all of the premium or charge for the | 2 | | insurance with the employee paying the balance of the premium | 3 | | or charge, if any. If the county board undertakes a plan under | 4 | | which the county pays only a portion of the premium or charge, | 5 | | the county board shall provide for withholding and deducting | 6 | | from the compensation of those employees who consent to join | 7 | | the plan the balance of the premium or charge for the | 8 | | insurance. | 9 | | (b) If the county board does not provide for | 10 | | self-insurance or for a plan under which the county pays a | 11 | | portion or all of the premium or charge for a group insurance | 12 | | plan, the county board may provide for withholding and | 13 | | deducting from the compensation of those employees who consent | 14 | | thereto the total premium or charge for any group life, | 15 | | health, accident, hospital, and medical insurance. | 16 | | (c) The county board may exercise the powers granted in | 17 | | this Section only if it provides for self-insurance or, where | 18 | | it makes arrangements to provide group insurance through an | 19 | | insurance carrier, if the kinds of group insurance are | 20 | | obtained from an insurance company authorized to do business | 21 | | in the State of Illinois. The county board may enact an | 22 | | ordinance prescribing the method of operation of the insurance | 23 | | program. | 24 | | (d) If a county, including a home rule county, is a | 25 | | self-insurer for purposes of providing health insurance | 26 | | coverage for its employees, the insurance coverage shall |
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| 1 | | include screening by low-dose mammography for all women 35 | 2 | | years of age or older for the presence of occult breast cancer | 3 | | unless the county elects to provide mammograms itself under | 4 | | Section 5-1069.1. The coverage shall be as follows: | 5 | | (1) A baseline mammogram for women 35 to 39 years of | 6 | | age. | 7 | | (2) An annual mammogram for women 40 years of age or | 8 | | older. | 9 | | (3) A mammogram at the age and intervals considered | 10 | | medically necessary by the woman's health care provider | 11 | | for women under 40 years of age and having a family history | 12 | | of breast cancer, prior personal history of breast cancer, | 13 | | positive genetic testing, or other risk factors. | 14 | | (4) For a group policy of accident and health | 15 | | insurance that is amended, delivered, issued, or renewed | 16 | | on or after the effective date of this amendatory Act of | 17 | | the 101st General Assembly, a comprehensive ultrasound | 18 | | screening of an entire breast or breasts if a mammogram | 19 | | demonstrates heterogeneous or dense breast tissue or when | 20 | | medically necessary as determined by a physician licensed | 21 | | to practice medicine in all of its branches, advanced | 22 | | practice registered nurse, or physician assistant. | 23 | | (5) For a group policy of accident and health | 24 | | insurance that is amended, delivered, issued, or renewed | 25 | | on or after the effective date of this amendatory Act of | 26 | | the 101st General Assembly, a diagnostic mammogram when |
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| 1 | | medically necessary, as determined by a physician licensed | 2 | | to practice medicine in all its branches, advanced | 3 | | practice registered nurse, or physician assistant. | 4 | | A policy subject to this subsection shall not impose a | 5 | | deductible, coinsurance, copayment, or any other cost-sharing | 6 | | requirement on the coverage provided; except that this | 7 | | sentence does not apply to coverage of diagnostic mammograms | 8 | | to the extent such coverage would disqualify a high-deductible | 9 | | health plan from eligibility for a health savings account | 10 | | pursuant to Section 223 of the Internal Revenue Code (26 | 11 | | U.S.C. 223). | 12 | | For purposes of this subsection: | 13 | | "Diagnostic mammogram" means a mammogram obtained using | 14 | | diagnostic mammography. | 15 | | "Diagnostic mammography" means a method of screening that | 16 | | is designed to evaluate an abnormality in a breast, including | 17 | | an abnormality seen or suspected on a screening mammogram or a | 18 | | subjective or objective abnormality otherwise detected in the | 19 | | breast. | 20 | | "Low-dose mammography" means the x-ray examination of the | 21 | | breast using equipment dedicated specifically for mammography, | 22 | | including the x-ray tube, filter, compression device, and | 23 | | image receptor, with an average radiation exposure delivery of | 24 | | less than one rad per breast for 2 views of an average size | 25 | | breast. The term also includes digital mammography. | 26 | | (d-5) Coverage as described by subsection (d) shall be |
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| 1 | | provided at no cost to the insured and shall not be applied to | 2 | | an annual or lifetime maximum benefit. | 3 | | (d-10) When health care services are available through | 4 | | contracted providers and a person does not comply with plan | 5 | | provisions specific to the use of contracted providers, the | 6 | | requirements of subsection (d-5) are not applicable. When a | 7 | | person does not comply with plan provisions specific to the | 8 | | use of contracted providers, plan provisions specific to the | 9 | | use of non-contracted providers must be applied without | 10 | | distinction for coverage required by this Section and shall be | 11 | | at least as favorable as for other radiological examinations | 12 | | covered by the policy or contract. | 13 | | (d-15) If a county, including a home rule county, is a | 14 | | self-insurer for purposes of providing health insurance | 15 | | coverage for its employees, the insurance coverage shall | 16 | | include mastectomy coverage, which includes coverage for | 17 | | prosthetic devices or reconstructive surgery incident to the | 18 | | mastectomy. Coverage for breast reconstruction in connection | 19 | | with a mastectomy shall include: | 20 | | (1) reconstruction of the breast upon which the | 21 | | mastectomy has been performed; | 22 | | (2) surgery and reconstruction of the other breast to | 23 | | produce a symmetrical appearance; and | 24 | | (3) prostheses and treatment for physical | 25 | | complications at all stages of mastectomy, including | 26 | | lymphedemas. |
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| 1 | | Care shall be determined in consultation with the attending | 2 | | physician and the patient. The offered coverage for prosthetic | 3 | | devices and reconstructive surgery shall be subject to the | 4 | | deductible and coinsurance conditions applied to the | 5 | | mastectomy, and all other terms and conditions applicable to | 6 | | other benefits. When a mastectomy is performed and there is no | 7 | | evidence of malignancy then the offered coverage may be | 8 | | limited to the provision of prosthetic devices and | 9 | | reconstructive surgery to within 2 years after the date of the | 10 | | mastectomy. As used in this Section, "mastectomy" means the | 11 | | removal of all or part of the breast for medically necessary | 12 | | reasons, as determined by a licensed physician. | 13 | | A county, including a home rule county, that is a | 14 | | self-insurer for purposes of providing health insurance | 15 | | coverage for its employees, may not penalize or reduce or | 16 | | limit the reimbursement of an attending provider or provide | 17 | | incentives (monetary or otherwise) to an attending provider to | 18 | | induce the provider to provide care to an insured in a manner | 19 | | inconsistent with this Section. | 20 | | (d-20) The requirement that mammograms be included in | 21 | | health insurance coverage as provided in subsections (d) | 22 | | through (d-15) is an exclusive power and function of the State | 23 | | and is a denial and limitation under Article VII, Section 6, | 24 | | subsection (h) of the Illinois Constitution of home rule | 25 | | county powers. A home rule county to which subsections (d) | 26 | | through (d-15) apply must comply with every provision of those |
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| 1 | | subsections. | 2 | | (e) The term "employees" as used in this Section includes | 3 | | elected or appointed officials but does not include temporary | 4 | | employees. | 5 | | (f) The county board may, by ordinance, arrange to provide | 6 | | group life, health, accident, hospital, and medical insurance, | 7 | | or any one or a combination of those types of insurance, under | 8 | | this Section to retired former employees and retired former | 9 | | elected or appointed officials of the county. | 10 | | (g) Rulemaking authority to implement this amendatory Act | 11 | | of the 95th General Assembly, if any, is conditioned on the | 12 | | rules being adopted in accordance with all provisions of the | 13 | | Illinois Administrative Procedure Act and all rules and | 14 | | procedures of the Joint Committee on Administrative Rules; any | 15 | | purported rule not so adopted, for whatever reason, is | 16 | | unauthorized. | 17 | | (h) If a county, including a home rule county, is a | 18 | | self-insurer for purposes of providing health insurance | 19 | | coverage for its employees, the insurance coverage shall | 20 | | include mental health counseling for any employee who is a | 21 | | first responder, including police and corrections officers, | 22 | | deputy sheriffs, firefighters, or emergency medical services | 23 | | personnel, without imposing a deductible, coinsurance, | 24 | | copayment, or any other cost-sharing requirement on the | 25 | | coverage provided, except that this subsection does not apply | 26 | | to the extent such coverage would disqualify a high-deductible |
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| 1 | | health plan from eligibility for a health savings account | 2 | | pursuant to Section 223 of the Internal Revenue Code. | 3 | | The requirement that mental health counseling be included | 4 | | in health insurance coverage as provided in this subsection is | 5 | | an exclusive power and function of the State and is a denial | 6 | | and limitation under Article VII, Section 6, subsection (h) of | 7 | | the Illinois Constitution of home rule county powers. | 8 | | (Source: P.A. 100-513, eff. 1-1-18; 101-580, eff. 1-1-20 .) | 9 | | Section 10. The Illinois Municipal Code is amended by | 10 | | adding Section 10-4-2.4 as follows: | 11 | | (65 ILCS 5/10-4-2.4 new) | 12 | | Sec. 10-4-2.4. Mental health counseling. If a | 13 | | municipality, including a home rule municipality, is a | 14 | | self-insurer for purposes of providing health insurance | 15 | | coverage for its employees, the insurance coverage shall | 16 | | include mental health counseling for any employee who is a | 17 | | first responder, including police and corrections officers, | 18 | | deputy sheriffs, firefighters, or emergency medical services | 19 | | personnel, without imposing a deductible, coinsurance, | 20 | | copayment, or any other cost-sharing requirement on the | 21 | | coverage provided, except that this Section does not apply to | 22 | | the extent such coverage would disqualify a high-deductible | 23 | | health plan from eligibility for a health savings account | 24 | | pursuant to Section 223 of the Internal Revenue Code. |
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| 1 | | The requirement that mental health counseling be included | 2 | | in health insurance coverage as provided in this Section is an | 3 | | exclusive power and function of the State and is a denial and | 4 | | limitation under Article VII, Section 6, subsection (h) of the | 5 | | Illinois Constitution of home rule powers. |
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