215 ILCS 5/356z.71

(215 ILCS 5/356z.71)

(Text of Section from P.A. 103-700)

(This Section may contain text from a Public Act with a delayed effective date)

Sec. 356z.71. Insurance coverage for dependent parents.

(a) A group or individual policy of accident and health insurance issued, amended, delivered, or renewed after January 1, 2026 that provides dependent coverage shall make that dependent coverage available to the parent or stepparent of the insured if the parent or stepparent meets the definition of a qualifying relative under 26 U.S.C. 152(d) and lives or resides within the accident and health insurance policy's service area.

(b) This Section does not apply to specialized health care service plans, Medicare supplement insurance, hospital-only policies, accident-only policies, or specified disease insurance policies that reimburse for hospital, medical, or surgical expenses.

(Source: P.A. 103-700, eff. 1-1-25.)

(Text of Section from P.A. 103-751)

Sec. 356z.71. Coverage for annual menopause health visit. A group or individual policy of accident and health insurance providing coverage for more than 25 employees that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide, for individuals 45 years of age and older, coverage for an annual menopause health visit. A policy subject to this Section shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided; except that this Section does not apply to this coverage 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.

(Source: P.A. 103-751, eff. 8-2-24.)

(Text of Section from P.A. 103-758)

(This Section may contain text from a Public Act with a delayed effective date)

Sec. 356z.71. Coverage during a generic drug shortage.

(a) As used in this Section:

"Eligible prescription drug" means a prescription drug approved under 21 U.S.C. 355(c) that is not under patent.

"Generic drug" means a drug that is approved pursuant to an application referencing an eligible prescription drug that is submitted under subsection (j) of Section 505 of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. 355(j).

"Unavailable" means being listed as Currently in Shortage or as a Discontinuation in the United States Food and Drug Administration's Drug Shortages Database. "Unavailable" does not include being listed as a Resolved Shortage in the United States Food and Drug Administration's Drug Shortages Database.

(b) If a generic drug or a therapeutic equivalent is unavailable due to a supply issue and dosage cannot be adjusted, a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed after January 1, 2026 shall provide coverage for a brand name eligible prescription drug until supply of the generic drug or a therapeutic equivalent is available.

(Source: P.A. 103-758, eff. 1-1-25.)

(Text of Section from P.A. 103-870)

(This Section may contain text from a Public Act with a delayed effective date)

Sec. 356z.71. Coverage for at-home pregnancy tests. A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for at-home, urine-based pregnancy tests that are prescribed to the covered person, regardless of whether the tests are otherwise available over-the-counter. The coverage required under this Section is limited to 2 at-home, urine-based pregnancy tests every 30 days.

(Source: P.A. 103-870, eff. 1-1-25.)

(Text of Section from P.A. 103-918)

(This Section may contain text from a Public Act with a delayed effective date)

Sec. 356z.71. Coverage of vaccination administration fees.

(a) A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for vaccinations for COVID-19, influenza, and respiratory syncytial virus, including the administration of the vaccine by a pharmacist or health care provider authorized to administer such a vaccine, without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement, if the following conditions are met:

(1) the vaccine is authorized or licensed by the United States Food and Drug Administration; and

(2) the vaccine is ordered and administered according to the Advisory Committee on Immunization Practices standard immunization schedule.

(b) If the vaccinations provided for in subsection (a) are not otherwise available to be administered by a contracted pharmacist or health care provider, the group or individual policy of accident and health insurance or a managed care plan shall cover the vaccination, including administration fees, without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement.

(c) The coverage required in this Section does not apply to the extent that the coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to Section 223 of the Internal Revenue Code of 1986.

(Source: P.A. 103-918, eff. 1-1-25.)

(Text of Section from P.A. 103-972)

(This Section may contain text from a Public Act with a delayed effective date)

Sec. 356z.71. Coverage for medically necessary care and treatment to address a major injury to the jaw either through an accident or disease.

(a) In this Section, "medically necessary care and treatment to address a major injury to the jaw either through an accident or disease" includes:

(1) oral and facial surgery, including reconstructive services and procedures necessary to improve, restore, or maintain vital functions;

(2) dental implants, crowns, or bridges;

(3) prosthetic treatment such as obturators, speech appliances, and feeding appliances;

(4) orthodontic treatment and management;

(5) prosthodontic treatment and management; and

(6) otolaryngology treatment and management.

(b) An individual or group policy of accident and health insurance amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for medically necessary care and treatment to address a major injury to the jaw either through an accident or disease. Coverage under this Section may impose the same deductibles, coinsurance, or other cost-sharing limitations that are imposed on other related benefits under the policy.

(Source: P.A. 103-972, eff. 1-1-25.)

(Text of Section from P.A. 103-1024)

(This Section may contain text from a Public Act with a delayed effective date)

Sec. 356z.71. Coverage for mobile integrated health care services.

(a) In this Section:

"Eligible recipient" means an individual who has received hospital emergency department services 3 or more times in a period of 4 consecutive months in the past 12 months or an individual who has been identified by a health care provider as an individual for whom mobile integrated health care services would likely prevent admission or readmission to or would allow discharge from a hospital, behavioral health facility, acute care facility, or nursing facility.

"Mobile integrated health care services" means medically necessary health services provided on-site by emergency medical services personnel, as defined in Section 5 of the Emergency Medical Services (EMS) Systems Act.

"Mobile integrated health care services" includes health assessment, chronic disease monitoring and education, medication compliance, immunizations and vaccinations, laboratory specimen collection, hospital discharge follow-up care, and minor medical procedures as approved by the applicable EMS Medical Director.

"Mobile integrated health care services" does not include nonemergency ambulance transport.

(b) A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026, shall provide coverage to an eligible recipient for medically necessary mobile integrated health care services.

(Source: P.A. 103-1024, eff. 1-1-25.)