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Public Act 103-0703
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| HB5295 Enrolled | LRB103 38679 RPS 68816 b |
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois, |
represented in the General Assembly:
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Section 5. The Illinois Insurance Code is amended by |
changing Section 356z.56 as follows:
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(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 |
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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.)
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Section 10. The Illinois Public Aid Code is amended by |
changing Section 5-16.8 and by adding Section 5-52 as follows:
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(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 |
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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.)
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(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.
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Section 99. Effective date. This Act takes effect January |
1, 2026. |