Public Act 103-1011
 
SB3538 EnrolledLRB103 36871 AWJ 66983 b

    AN ACT concerning local government.
 
    Be it enacted by the People of the State of Illinois, 
represented in the General Assembly:
 
    Section 5. 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.
    (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. 
    (h) 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, on and after June 1, 2025, mental health counseling 
for any county employee who is a first responder without 
imposing a deductible, coinsurance, copayment, or any other 
cost-sharing requirement on the coverage provided, except that 
this subsection does not apply 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.
    The requirement that mental health counseling be included 
in health insurance coverage as provided in this subsection 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. 
    As used in this subsection: 
    "First responders" means police and corrections officers, 
deputy sheriffs, firefighters, emergency medical services 
personnel, as that term is defined in Section 3.5 of the 
Emergency Medical Services (EMS) Systems Act, dispatched 
pursuant to a 9-1-1 call, emergency medical dispatchers, as 
that term is defined in Section 3.70 of the Emergency Medical 
Services (EMS) Systems Act, public safety telecommunicators, 
as that term is defined in Section 2 of the Emergency Telephone 
System Act, and mental health professionals employed and 
dispatched by any unit of local government in response to 
emergency crisis calls received on public emergency service 
lines instead of or in conjunction with law enforcement. 
    "Mental health counseling" means counseling therapy 
sessions provided by a clinical social worker, professional 
counselor, or licensed psychologist. 
(Source: P.A. 100-513, eff. 1-1-18; 101-580, eff. 1-1-20.)
 
    Section 10. The Illinois Municipal Code is amended by 
adding Section 10-4-2.4 as follows:
 
    (65 ILCS 5/10-4-2.4 new)
    Sec. 10-4-2.4. Mental health counseling.
    (a) As used in this Section:
    "First responders" means police and corrections officers, 
deputy sheriffs, firefighters, emergency medical services 
personnel, as that term is defined in Section 3.5 of the 
Emergency Medical Services (EMS) Systems Act, dispatched 
pursuant to a 9-1-1 call, emergency medical dispatchers, as 
that term is defined in Section 3.70 of the Emergency Medical 
Services (EMS) Systems Act, public safety telecommunicators, 
as that term is defined in Section 2 of the Emergency Telephone 
System Act, and mental health professionals employed and 
dispatched by any unit of local government in response to 
emergency crisis calls received on public emergency service 
lines instead of or in conjunction with law enforcement. 
    "Mental health counseling" means counseling therapy 
sessions provided by a clinical social worker, professional 
counselor, or licensed psychologist. 
    (b) 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, on and after June 1, 2025, mental health counseling 
for any employee who is a first responder without imposing a 
deductible, coinsurance, copayment, or any other cost-sharing 
requirement on the coverage provided, except that this Section 
does not apply 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.
    (c) The requirement that mental health counseling be 
included in health insurance coverage as provided in this 
Section 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 
powers.
 
    Section 15. The Fire Protection District Act is amended by 
adding Section 6.3 as follows:
 
    (70 ILCS 705/6.3 new)
    Sec. 6.3. Mental health counseling. 
    (a) As used in this Section: 
    "First responders" means firefighters, emergency medical 
services personnel, as that term is defined in Section 3.5 of 
the Emergency Medical Services (EMS) Systems Act, dispatched 
pursuant to a 9-1-1 call, emergency medical dispatchers, as 
that term is defined in Section 3.70 of the Emergency Medical 
Services (EMS) Systems Act, and public safety 
telecommunicators, as that term is defined in Section 2 of the 
Emergency Telephone System Act. 
    "Mental health counseling" means counseling therapy 
sessions provided by a clinical social worker, professional 
counselor, or licensed psychologist. 
    (b) If a fire protection district is a self-insurer for 
purposes of providing health insurance coverage for its 
employees, the insurance coverage shall include, on and after 
June 1, 2025, mental health counseling for any employee who is 
a first responder without imposing a deductible, coinsurance, 
copayment, or any other cost-sharing requirement on the 
coverage provided, except that this Section does not apply 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.

Effective Date:  1/1/2025