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Public Act 103-0818 Public Act 0818 103RD GENERAL ASSEMBLY | Public Act 103-0818 | HB4460 Enrolled | LRB103 36625 AWJ 66734 b |
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| AN ACT concerning government. | Be it enacted by the People of the State of Illinois, | represented in the General Assembly: | Section 5. The State Employees Group Insurance Act of 1971 | is amended by adding Section 6.11D as follows: | (5 ILCS 375/6.11D new) | Sec. 6.11D. Joint mental health therapy services. | (a) The State Employees Group Insurance Program shall | provide coverage for joint mental health therapy services for | any Illinois State Police officer or police officer of an | institution of higher education and any spouse or partner of | the officer who resides with the officer. | (b) The joint mental health therapy services provided | under subsection (a) shall be performed by a physician | licensed to practice medicine in all of its branches, a | licensed clinical psychologist, a licensed clinical social | worker, a licensed clinical professional counselor, a licensed | marriage and family therapist, a licensed social worker, or a | licensed professional counselor. | Section 10. The Counties Code is amended by changing | Section 5-1069 as follows: |
| (55 ILCS 5/5-1069) (from Ch. 34, par. 5-1069) | Sec. 5-1069. Group life, health, accident, hospital, and | medical insurance. | (a) The county board of any county may arrange to provide, | for the benefit of employees of the county, group life, | health, accident, hospital, and medical insurance, or any one | or any combination of those types of insurance, or the county | board may self-insure, for the benefit of its employees, all | or a portion of the employees' group life, health, accident, | hospital, and medical insurance, or any one or any combination | of those types of insurance, including a combination of | self-insurance and other types of insurance authorized by this | Section, provided that the county board complies with all | other requirements of this Section. The insurance may include | provision for employees who rely on treatment by prayer or | spiritual means alone for healing in accordance with the | tenets and practice of a well recognized religious | denomination. The county board may provide for payment by the | county of a portion or all of the premium or charge for the | insurance with the employee paying the balance of the premium | or charge, if any. If the county board undertakes a plan under | which the county pays only a portion of the premium or charge, | the county board shall provide for withholding and deducting | from the compensation of those employees who consent to join | the plan the balance of the premium or charge for the | insurance. |
| (b) If the county board does not provide for | self-insurance or for a plan under which the county pays a | portion or all of the premium or charge for a group insurance | plan, the county board may provide for withholding and | deducting from the compensation of those employees who consent | thereto the total premium or charge for any group life, | health, accident, hospital, and medical insurance. | (c) The county board may exercise the powers granted in | this Section only if it provides for self-insurance or, where | it makes arrangements to provide group insurance through an | insurance carrier, if the kinds of group insurance are | obtained from an insurance company authorized to do business | in the State of Illinois. The county board may enact an | ordinance prescribing the method of operation of the insurance | program. | (d) If a county, including a home rule county, is a | self-insurer for purposes of providing health insurance | coverage for its employees, the insurance coverage shall | include screening by low-dose mammography for all women 35 | years of age or older for the presence of occult breast cancer | unless the county elects to provide mammograms itself under | Section 5-1069.1. The coverage shall be as follows: | (1) A baseline mammogram for women 35 to 39 years of | age. | (2) An annual mammogram for women 40 years of age or | older. |
| (3) A mammogram at the age and intervals considered | medically necessary by the woman's health care provider | for women under 40 years of age and having a family history | of breast cancer, prior personal history of breast cancer, | positive genetic testing, or other risk factors. | (4) For a group policy of accident and health | insurance that is amended, delivered, issued, or renewed | on or after the effective date of this amendatory Act of | the 101st General Assembly, a comprehensive ultrasound | screening of an entire breast or breasts if a mammogram | demonstrates heterogeneous or dense breast tissue or when | medically necessary as determined by a physician licensed | to practice medicine in all of its branches, advanced | practice registered nurse, or physician assistant. | (5) For a group policy of accident and health | insurance that is amended, delivered, issued, or renewed | on or after the effective date of this amendatory Act of | the 101st General Assembly, a diagnostic mammogram when | medically necessary, as determined by a physician licensed | to practice medicine in all its branches, advanced | practice registered nurse, or physician assistant. | A policy subject to this subsection shall not impose a | deductible, coinsurance, copayment, or any other cost-sharing | requirement on the coverage provided; except that this | sentence does not apply to coverage of diagnostic mammograms | 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 (26 | U.S.C. 223). | For purposes of this subsection: | "Diagnostic mammogram" means a mammogram obtained using | diagnostic mammography. | "Diagnostic mammography" means a method of screening that | is designed to evaluate an abnormality in a breast, including | an abnormality seen or suspected on a screening mammogram or a | subjective or objective abnormality otherwise detected in the | breast. | "Low-dose mammography" means the x-ray examination of the | breast using equipment dedicated specifically for mammography, | including the x-ray tube, filter, compression device, and | image receptor, with an average radiation exposure delivery of | less than one rad per breast for 2 views of an average size | breast. The term also includes digital mammography. | (d-5) Coverage as described by subsection (d) shall be | provided at no cost to the insured and shall not be applied to | an annual or lifetime maximum benefit. | (d-10) When health care services are available through | contracted providers and a person does not comply with plan | provisions specific to the use of contracted providers, the | requirements of subsection (d-5) are not applicable. When a | person does not comply with plan provisions specific to the | use of contracted providers, plan provisions specific to the |
| use of non-contracted providers must be applied without | distinction for coverage required by this Section and shall be | at least as favorable as for other radiological examinations | covered by the policy or contract. | (d-15) If a county, including a home rule county, is a | self-insurer for purposes of providing health insurance | coverage for its employees, the insurance coverage shall | include mastectomy coverage, which includes coverage for | prosthetic devices or reconstructive surgery incident to the | mastectomy. Coverage for breast reconstruction in connection | with a mastectomy shall include: | (1) reconstruction of the breast upon which the | mastectomy has been performed; | (2) surgery and reconstruction of the other breast to | produce a symmetrical appearance; and | (3) prostheses and treatment for physical | complications at all stages of mastectomy, including | lymphedemas. | Care shall be determined in consultation with the attending | physician and the patient. The offered coverage for prosthetic | devices and reconstructive surgery shall be subject to the | deductible and coinsurance conditions applied to the | mastectomy, and all other terms and conditions applicable to | other benefits. When a mastectomy is performed and there is no | evidence of malignancy then the offered coverage may be | limited to the provision of prosthetic devices and |
| reconstructive surgery to within 2 years after the date of the | mastectomy. As used in this Section, "mastectomy" means the | removal of all or part of the breast for medically necessary | reasons, as determined by a licensed physician. | A county, including a home rule county, that is a | self-insurer for purposes of providing health insurance | coverage for its employees, may not penalize or reduce or | limit the reimbursement of an attending provider or provide | incentives (monetary or otherwise) to an attending provider to | induce the provider to provide care to an insured in a manner | inconsistent with this Section. | (d-20) The requirement that mammograms be included in | health insurance coverage as provided in subsections (d) | through (d-15) is an exclusive power and function of the State | and is a denial and limitation under Article VII, Section 6, | subsection (h) of the Illinois Constitution of home rule | county powers. A home rule county to which subsections (d) | through (d-15) apply must comply with every provision of those | subsections. | (d-25) If a county, including a home rule county, is a | self-insurer for purposes of providing health insurance | coverage, the insurance coverage shall include joint mental | health therapy services for any member of the Sheriff's | office, including the sheriff, and any spouse or partner of | the member who resides with the member. | The joint mental health therapy services provided under |
| this subsection shall be performed by a physician licensed to | practice medicine in all of its branches, a licensed clinical | psychologist, a licensed clinical social worker, a licensed | clinical professional counselor, a licensed marriage and | family therapist, a licensed social worker, or a licensed | professional counselor. | This subsection is a limitation under subsection (i) of | Section 6 of Article VII of the Illinois Constitution on the | concurrent exercise by home rule units of powers and functions | exercised by the State. | (e) The term "employees" as used in this Section includes | elected or appointed officials but does not include temporary | employees. | (f) The county board may, by ordinance, arrange to provide | group life, health, accident, hospital, and medical insurance, | or any one or a combination of those types of insurance, under | this Section to retired former employees and retired former | elected or appointed officials of the county. | (g) Rulemaking authority to implement this amendatory Act | of the 95th General Assembly, if any, is conditioned on the | rules being adopted in accordance with all provisions of the | Illinois Administrative Procedure Act and all rules and | procedures of the Joint Committee on Administrative Rules; any | purported rule not so adopted, for whatever reason, is | unauthorized. | (Source: P.A. 100-513, eff. 1-1-18; 101-580, eff. 1-1-20 .) |
| Section 15. The Illinois Municipal Code is amended by | changing Section 10-4-2 as follows: | (65 ILCS 5/10-4-2) (from Ch. 24, par. 10-4-2) | Sec. 10-4-2. Group insurance. | (a) The corporate authorities of any municipality may | arrange to provide, for the benefit of employees of the | municipality, group life, health, accident, hospital, and | medical insurance, or any one or any combination of those | types of insurance, and may arrange to provide that insurance | for the benefit of the spouses or dependents of those | employees. The insurance may include provision for employees | or other insured persons who rely on treatment by prayer or | spiritual means alone for healing in accordance with the | tenets and practice of a well recognized religious | denomination. The corporate authorities may provide for | payment by the municipality of a portion of the premium or | charge for the insurance with the employee paying the balance | of the premium or charge. If the corporate authorities | undertake a plan under which the municipality pays a portion | of the premium or charge, the corporate authorities shall | provide for withholding and deducting from the compensation of | those municipal employees who consent to join the plan the | balance of the premium or charge for the insurance. | (b) If the corporate authorities do not provide for a plan |
| under which the municipality pays a portion of the premium or | charge for a group insurance plan, the corporate authorities | may provide for withholding and deducting from the | compensation of those employees who consent thereto the | premium or charge for any group life, health, accident, | hospital, and medical insurance. | (c) The corporate authorities may exercise the powers | granted in this Section only if the kinds of group insurance | are obtained from an insurance company authorized to do | business in the State of Illinois, or are obtained through an | intergovernmental joint self-insurance pool as authorized | under the Intergovernmental Cooperation Act. The corporate | authorities may enact an ordinance prescribing the method of | operation of the insurance program. | (d) If a municipality, including a home rule municipality, | is a self-insurer for purposes of providing health insurance | coverage for its employees, the insurance coverage shall | include screening by low-dose mammography for all women 35 | years of age or older for the presence of occult breast cancer | unless the municipality elects to provide mammograms itself | under Section 10-4-2.1. The coverage shall be as follows: | (1) A baseline mammogram for women 35 to 39 years of | age. | (2) An annual mammogram for women 40 years of age or | older. | (3) A mammogram at the age and intervals considered |
| medically necessary by the woman's health care provider | for women under 40 years of age and having a family history | of breast cancer, prior personal history of breast cancer, | positive genetic testing, or other risk factors. | (4) For a group policy of accident and health | insurance that is amended, delivered, issued, or renewed | on or after the effective date of this amendatory Act of | the 101st General Assembly, a comprehensive ultrasound | screening of an entire breast or breasts if a mammogram | demonstrates heterogeneous or dense breast tissue or when | medically necessary as determined by a physician licensed | to practice medicine in all of its branches. | (5) For a group policy of accident and health | insurance that is amended, delivered, issued, or renewed | on or after the effective date of this amendatory Act of | the 101st General Assembly, a diagnostic mammogram when | medically necessary, as determined by a physician licensed | to practice medicine in all its branches, advanced | practice registered nurse, or physician assistant. | A policy subject to this subsection shall not impose a | deductible, coinsurance, copayment, or any other cost-sharing | requirement on the coverage provided; except that this | sentence does not apply to coverage of diagnostic mammograms | 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 (26 |
| U.S.C. 223). | For purposes of this subsection: | "Diagnostic mammogram" means a mammogram obtained using | diagnostic mammography. | "Diagnostic mammography" means a method of screening that | is designed to evaluate an abnormality in a breast, including | an abnormality seen or suspected on a screening mammogram or a | subjective or objective abnormality otherwise detected in the | breast. | "Low-dose mammography" means the x-ray examination of the | breast using equipment dedicated specifically for mammography, | including the x-ray tube, filter, compression device, and | image receptor, with an average radiation exposure delivery of | less than one rad per breast for 2 views of an average size | breast. The term also includes digital mammography. | (d-5) Coverage as described by subsection (d) shall be | provided at no cost to the insured and shall not be applied to | an annual or lifetime maximum benefit. | (d-10) When health care services are available through | contracted providers and a person does not comply with plan | provisions specific to the use of contracted providers, the | requirements of subsection (d-5) are not applicable. When a | person does not comply with plan provisions specific to the | use of contracted providers, plan provisions specific to the | use of non-contracted providers must be applied without | distinction for coverage required by this Section and shall be |
| at least as favorable as for other radiological examinations | covered by the policy or contract. | (d-15) If a municipality, including a home rule | municipality, is a self-insurer for purposes of providing | health insurance coverage for its employees, the insurance | coverage shall include mastectomy coverage, which includes | coverage for prosthetic devices or reconstructive surgery | incident to the mastectomy. Coverage for breast reconstruction | in connection with a mastectomy shall include: | (1) reconstruction of the breast upon which the | mastectomy has been performed; | (2) surgery and reconstruction of the other breast to | produce a symmetrical appearance; and | (3) prostheses and treatment for physical | complications at all stages of mastectomy, including | lymphedemas. | Care shall be determined in consultation with the attending | physician and the patient. The offered coverage for prosthetic | devices and reconstructive surgery shall be subject to the | deductible and coinsurance conditions applied to the | mastectomy, and all other terms and conditions applicable to | other benefits. When a mastectomy is performed and there is no | evidence of malignancy then the offered coverage may be | limited to the provision of prosthetic devices and | reconstructive surgery to within 2 years after the date of the | mastectomy. As used in this Section, "mastectomy" means the |
| removal of all or part of the breast for medically necessary | reasons, as determined by a licensed physician. | A municipality, including a home rule municipality, that | is a self-insurer for purposes of providing health insurance | coverage for its employees, may not penalize or reduce or | limit the reimbursement of an attending provider or provide | incentives (monetary or otherwise) to an attending provider to | induce the provider to provide care to an insured in a manner | inconsistent with this Section. | (d-20) The requirement that mammograms be included in | health insurance coverage as provided in subsections (d) | through (d-15) is an exclusive power and function of the State | and is a denial and limitation under Article VII, Section 6, | subsection (h) of the Illinois Constitution of home rule | municipality powers. A home rule municipality to which | subsections (d) through (d-15) apply must comply with every | provision of those subsections. | (d-25) If a municipality, including a home rule | municipality, is a self-insurer for purposes of providing | health insurance coverage for its employees, the insurance | coverage shall include joint mental health therapy services | for any member of the municipality's police department or fire | department and any spouse or partner of the member who resides | with the member. | The joint mental health therapy services provided under | this subsection shall be performed by a physician licensed to |
| practice medicine in all of its branches, a licensed clinical | psychologist, a licensed clinical social worker, a licensed | clinical professional counselor, a licensed marriage and | family therapist, a licensed social worker, or a licensed | professional counselor. | This subsection is a limitation under subsection (i) of | Section 6 of Article VII of the Illinois Constitution on the | concurrent exercise by home rule units of powers and functions | exercised by the State. | (e) Rulemaking authority to implement Public Act 95-1045, | if any, is conditioned on the rules being adopted in | accordance with all provisions of the Illinois Administrative | Procedure Act and all rules and procedures of the Joint | Committee on Administrative Rules; any purported rule not so | adopted, for whatever reason, is unauthorized. | (Source: P.A. 100-863, eff. 8-14-18; 101-580, eff. 1-1-20 .) | Section 20. The Fire Protection District Act is amended by | adding Section 6.3 as follows: | (70 ILCS 705/6.3 new) | Sec. 6.3. Health insurance; joint mental health therapy | services. If a fire protection district is a self-insurer for | purposes of providing health insurance coverage for officers | and members of the fire department, the insurance coverage | shall include joint mental health therapy services for any |
| officer or member of the fire department and any spouse or | partner of the officer or member who resides with the officer | or member. The joint mental health therapy services provided | under this Section shall be performed by a physician licensed | to practice medicine in all of its branches, a licensed | clinical psychologist, a licensed clinical social worker, a | licensed clinical professional counselor, a licensed marriage | and family therapist, a licensed social worker, or a licensed | professional counselor. | Section 99. Effective date. This Act takes effect January | 1, 2025. |
Effective Date: 1/1/2025
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