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Public Act 103-0703 Public Act 0703 103RD GENERAL ASSEMBLY | Public Act 103-0703 | HB5295 Enrolled | LRB103 38679 RPS 68816 b |
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| AN ACT concerning regulation. | Be it enacted by the People of the State of Illinois, | represented in the General Assembly: | Section 5. The Illinois Insurance Code is amended by | changing Section 356z.56 as follows: | (215 ILCS 5/356z.56) | Sec. 356z.56. Coverage for hormonal and non-hormonal | hormone therapy to treat menopause. A group or individual | policy of accident and health insurance or a managed care plan | that is amended, delivered, issued, or renewed in this State | on or after January 1, 2024 shall provide coverage for | medically necessary hormone therapy treatment to treat | menopause that has been induced by a hysterectomy. This | coverage applies only to coverage provided on or after January | 1, 2024 and before January 1, 2026. | 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 medically necessary hormonal and non-hormonal | therapy to treat menopausal symptoms if the therapy is | recommended by a qualified health care provider who is | licensed, accredited, or certified under Illinois law and the | therapy has been proven safe and effective in peer-reviewed |
| scientific studies. Coverage for therapy to treat menopausal | symptoms shall include all federal Food and Drug | Administration-approved modalities of hormonal and | non-hormonal administration, including, but not limited to, | oral, transdermal, topical, and vaginal rings. | (Source: P.A. 102-804, eff. 1-1-23; 103-154, eff. 6-30-23.) | Section 10. The Illinois Public Aid Code is amended by | changing Section 5-16.8 and by adding Section 5-52 as follows: | (305 ILCS 5/5-16.8) | Sec. 5-16.8. Required health benefits. The medical | assistance program shall (i) 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.5, 356q, 356u, 356w, 356x, 356z.6, | 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46, | 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and | 356z.61 , 356z.64, and 356z.67 of the Illinois Insurance Code, | (ii) be subject to the provisions of Sections 356z.19, | 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the Illinois | Insurance Code, and (iii) be subject to the provisions of | subsection (d-5) of Section 10 of the Network Adequacy and | Transparency Act. | The Department, by rule, shall adopt a model similar to | the requirements of Section 356z.39 of the Illinois Insurance |
| Code. | On and after July 1, 2012, the Department shall reduce any | rate of reimbursement for services or other payments or alter | any methodologies authorized by this Code to reduce any rate | of reimbursement for services or other payments in accordance | with Section 5-5e. | To ensure full access to the benefits set forth in this | Section, on and after January 1, 2016, the Department shall | ensure that provider and hospital reimbursement for | post-mastectomy care benefits required under this Section are | no lower than the Medicare reimbursement rate. | (Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22; | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff. | 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813, | eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23; | 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. | 1-1-24; 103-420, eff. 1-1-24; revised 12-15-23.) | (305 ILCS 5/5-52 new) | Sec. 5-52. Coverage for hormonal therapy to treat | menopause. The medical assistance program shall provide | coverage for medically necessary hormone therapy treatment to | treat menopause that has been induced by a hysterectomy. | Section 99. Effective date. This Act takes effect January | 1, 2026. |
Effective Date: 1/1/2026
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