HB4460 EngrossedLRB103 36625 AWJ 66734 b

1    AN ACT concerning government.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The State Employees Group Insurance Act of 1971
5is amended by adding Section 6.11D as follows:
 
6    (5 ILCS 375/6.11D new)
7    Sec. 6.11D. Joint mental health therapy services.
8    (a) The State Employees Group Insurance Program shall
9provide coverage for joint mental health therapy services for
10any Illinois State Police officer and any spouse or partner of
11the officer who resides with the officer.
12    (b) The joint mental health therapy services provided
13under subsection (a) shall be performed by a physician
14licensed to practice medicine in all of its branches, a
15licensed clinical psychologist, a licensed clinical social
16worker, a licensed clinical professional counselor, a licensed
17marriage and family therapist, a licensed social worker, or a
18licensed professional counselor.
 
19    Section 10. The Counties Code is amended by changing
20Section 5-1069 as follows:
 
21    (55 ILCS 5/5-1069)  (from Ch. 34, par. 5-1069)

 

 

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1    Sec. 5-1069. Group life, health, accident, hospital, and
2medical insurance.
3    (a) The county board of any county may arrange to provide,
4for the benefit of employees of the county, group life,
5health, accident, hospital, and medical insurance, or any one
6or any combination of those types of insurance, or the county
7board may self-insure, for the benefit of its employees, all
8or a portion of the employees' group life, health, accident,
9hospital, and medical insurance, or any one or any combination
10of those types of insurance, including a combination of
11self-insurance and other types of insurance authorized by this
12Section, provided that the county board complies with all
13other requirements of this Section. The insurance may include
14provision for employees who rely on treatment by prayer or
15spiritual means alone for healing in accordance with the
16tenets and practice of a well recognized religious
17denomination. The county board may provide for payment by the
18county of a portion or all of the premium or charge for the
19insurance with the employee paying the balance of the premium
20or charge, if any. If the county board undertakes a plan under
21which the county pays only a portion of the premium or charge,
22the county board shall provide for withholding and deducting
23from the compensation of those employees who consent to join
24the plan the balance of the premium or charge for the
25insurance.
26    (b) If the county board does not provide for

 

 

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1self-insurance or for a plan under which the county pays a
2portion or all of the premium or charge for a group insurance
3plan, the county board may provide for withholding and
4deducting from the compensation of those employees who consent
5thereto the total premium or charge for any group life,
6health, accident, hospital, and medical insurance.
7    (c) The county board may exercise the powers granted in
8this Section only if it provides for self-insurance or, where
9it makes arrangements to provide group insurance through an
10insurance carrier, if the kinds of group insurance are
11obtained from an insurance company authorized to do business
12in the State of Illinois. The county board may enact an
13ordinance prescribing the method of operation of the insurance
14program.
15    (d) If a county, including a home rule county, is a
16self-insurer for purposes of providing health insurance
17coverage for its employees, the insurance coverage shall
18include screening by low-dose mammography for all women 35
19years of age or older for the presence of occult breast cancer
20unless the county elects to provide mammograms itself under
21Section 5-1069.1. The coverage shall be as follows:
22        (1) A baseline mammogram for women 35 to 39 years of
23    age.
24        (2) An annual mammogram for women 40 years of age or
25    older.
26        (3) A mammogram at the age and intervals considered

 

 

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1    medically necessary by the woman's health care provider
2    for women under 40 years of age and having a family history
3    of breast cancer, prior personal history of breast cancer,
4    positive genetic testing, or other risk factors.
5        (4) For a group policy of accident and health
6    insurance that is amended, delivered, issued, or renewed
7    on or after the effective date of this amendatory Act of
8    the 101st General Assembly, a comprehensive ultrasound
9    screening of an entire breast or breasts if a mammogram
10    demonstrates heterogeneous or dense breast tissue or when
11    medically necessary as determined by a physician licensed
12    to practice medicine in all of its branches, advanced
13    practice registered nurse, or physician assistant.
14        (5) For a group policy of accident and health
15    insurance that is amended, delivered, issued, or renewed
16    on or after the effective date of this amendatory Act of
17    the 101st General Assembly, a diagnostic mammogram when
18    medically necessary, as determined by a physician licensed
19    to practice medicine in all its branches, advanced
20    practice registered nurse, or physician assistant.
21    A policy subject to this subsection shall not impose a
22deductible, coinsurance, copayment, or any other cost-sharing
23requirement on the coverage provided; except that this
24sentence does not apply to coverage of diagnostic mammograms
25to the extent such coverage would disqualify a high-deductible
26health plan from eligibility for a health savings account

 

 

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1pursuant to Section 223 of the Internal Revenue Code (26
2U.S.C. 223).
3    For purposes of this subsection:
4    "Diagnostic mammogram" means a mammogram obtained using
5diagnostic mammography.
6    "Diagnostic mammography" means a method of screening that
7is designed to evaluate an abnormality in a breast, including
8an abnormality seen or suspected on a screening mammogram or a
9subjective or objective abnormality otherwise detected in the
10breast.
11    "Low-dose mammography" means the x-ray examination of the
12breast using equipment dedicated specifically for mammography,
13including the x-ray tube, filter, compression device, and
14image receptor, with an average radiation exposure delivery of
15less than one rad per breast for 2 views of an average size
16breast. The term also includes digital mammography.
17    (d-5) Coverage as described by subsection (d) shall be
18provided at no cost to the insured and shall not be applied to
19an annual or lifetime maximum benefit.
20    (d-10) When health care services are available through
21contracted providers and a person does not comply with plan
22provisions specific to the use of contracted providers, the
23requirements of subsection (d-5) are not applicable. When a
24person does not comply with plan provisions specific to the
25use of contracted providers, plan provisions specific to the
26use of non-contracted providers must be applied without

 

 

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1distinction for coverage required by this Section and shall be
2at least as favorable as for other radiological examinations
3covered by the policy or contract.
4    (d-15) If a county, including a home rule county, is a
5self-insurer for purposes of providing health insurance
6coverage for its employees, the insurance coverage shall
7include mastectomy coverage, which includes coverage for
8prosthetic devices or reconstructive surgery incident to the
9mastectomy. Coverage for breast reconstruction in connection
10with a mastectomy shall include:
11        (1) reconstruction of the breast upon which the
12    mastectomy has been performed;
13        (2) surgery and reconstruction of the other breast to
14    produce a symmetrical appearance; and
15        (3) prostheses and treatment for physical
16    complications at all stages of mastectomy, including
17    lymphedemas.
18Care shall be determined in consultation with the attending
19physician and the patient. The offered coverage for prosthetic
20devices and reconstructive surgery shall be subject to the
21deductible and coinsurance conditions applied to the
22mastectomy, and all other terms and conditions applicable to
23other benefits. When a mastectomy is performed and there is no
24evidence of malignancy then the offered coverage may be
25limited to the provision of prosthetic devices and
26reconstructive surgery to within 2 years after the date of the

 

 

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1mastectomy. As used in this Section, "mastectomy" means the
2removal of all or part of the breast for medically necessary
3reasons, as determined by a licensed physician.
4    A county, including a home rule county, that is a
5self-insurer for purposes of providing health insurance
6coverage for its employees, may not penalize or reduce or
7limit the reimbursement of an attending provider or provide
8incentives (monetary or otherwise) to an attending provider to
9induce the provider to provide care to an insured in a manner
10inconsistent with this Section.
11    (d-20) The requirement that mammograms be included in
12health insurance coverage as provided in subsections (d)
13through (d-15) is an exclusive power and function of the State
14and is a denial and limitation under Article VII, Section 6,
15subsection (h) of the Illinois Constitution of home rule
16county powers. A home rule county to which subsections (d)
17through (d-15) apply must comply with every provision of those
18subsections.
19    (d-25) If a county, including a home rule county, is a
20self-insurer for purposes of providing health insurance
21coverage, the insurance coverage shall include joint mental
22health therapy services for any member of the Sheriff's
23office, including the sheriff, and any spouse or partner of
24the member who resides with the member.
25    The joint mental health therapy services provided under
26this subsection shall be performed by a physician licensed to

 

 

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1practice medicine in all of its branches, a licensed clinical
2psychologist, a licensed clinical social worker, a licensed
3clinical professional counselor, a licensed marriage and
4family therapist, a licensed social worker, or a licensed
5professional counselor.
6    This subsection is a limitation under subsection (i) of
7Section 6 of Article VII of the Illinois Constitution on the
8concurrent exercise by home rule units of powers and functions
9exercised by the State.
10    (e) The term "employees" as used in this Section includes
11elected or appointed officials but does not include temporary
12employees.
13    (f) The county board may, by ordinance, arrange to provide
14group life, health, accident, hospital, and medical insurance,
15or any one or a combination of those types of insurance, under
16this Section to retired former employees and retired former
17elected or appointed officials of the county.
18    (g) Rulemaking authority to implement this amendatory Act
19of the 95th General Assembly, if any, is conditioned on the
20rules being adopted in accordance with all provisions of the
21Illinois Administrative Procedure Act and all rules and
22procedures of the Joint Committee on Administrative Rules; any
23purported rule not so adopted, for whatever reason, is
24unauthorized.
25(Source: P.A. 100-513, eff. 1-1-18; 101-580, eff. 1-1-20.)
 

 

 

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1    Section 15. The Illinois Municipal Code is amended by
2changing Section 10-4-2 as follows:
 
3    (65 ILCS 5/10-4-2)  (from Ch. 24, par. 10-4-2)
4    Sec. 10-4-2. Group insurance.
5    (a) The corporate authorities of any municipality may
6arrange to provide, for the benefit of employees of the
7municipality, group life, health, accident, hospital, and
8medical insurance, or any one or any combination of those
9types of insurance, and may arrange to provide that insurance
10for the benefit of the spouses or dependents of those
11employees. The insurance may include provision for employees
12or other insured persons who rely on treatment by prayer or
13spiritual means alone for healing in accordance with the
14tenets and practice of a well recognized religious
15denomination. The corporate authorities may provide for
16payment by the municipality of a portion of the premium or
17charge for the insurance with the employee paying the balance
18of the premium or charge. If the corporate authorities
19undertake a plan under which the municipality pays a portion
20of the premium or charge, the corporate authorities shall
21provide for withholding and deducting from the compensation of
22those municipal employees who consent to join the plan the
23balance of the premium or charge for the insurance.
24    (b) If the corporate authorities do not provide for a plan
25under which the municipality pays a portion of the premium or

 

 

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1charge for a group insurance plan, the corporate authorities
2may provide for withholding and deducting from the
3compensation of those employees who consent thereto the
4premium or charge for any group life, health, accident,
5hospital, and medical insurance.
6    (c) The corporate authorities may exercise the powers
7granted in this Section only if the kinds of group insurance
8are obtained from an insurance company authorized to do
9business in the State of Illinois, or are obtained through an
10intergovernmental joint self-insurance pool as authorized
11under the Intergovernmental Cooperation Act. The corporate
12authorities may enact an ordinance prescribing the method of
13operation of the insurance program.
14    (d) If a municipality, including a home rule municipality,
15is a self-insurer for purposes of providing health insurance
16coverage for its employees, the insurance coverage shall
17include screening by low-dose mammography for all women 35
18years of age or older for the presence of occult breast cancer
19unless the municipality elects to provide mammograms itself
20under Section 10-4-2.1. The coverage shall be as follows:
21        (1) A baseline mammogram for women 35 to 39 years of
22    age.
23        (2) An annual mammogram for women 40 years of age or
24    older.
25        (3) A mammogram at the age and intervals considered
26    medically necessary by the woman's health care provider

 

 

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1    for women under 40 years of age and having a family history
2    of breast cancer, prior personal history of breast cancer,
3    positive genetic testing, or other risk factors.
4        (4) For a group policy of accident and health
5    insurance that is amended, delivered, issued, or renewed
6    on or after the effective date of this amendatory Act of
7    the 101st General Assembly, a comprehensive ultrasound
8    screening of an entire breast or breasts if a mammogram
9    demonstrates heterogeneous or dense breast tissue or when
10    medically necessary as determined by a physician licensed
11    to practice medicine in all of its branches.
12        (5) For a group policy of accident and health
13    insurance that is amended, delivered, issued, or renewed
14    on or after the effective date of this amendatory Act of
15    the 101st General Assembly, a diagnostic mammogram when
16    medically necessary, as determined by a physician licensed
17    to practice medicine in all its branches, advanced
18    practice registered nurse, or physician assistant.
19    A policy subject to this subsection shall not impose a
20deductible, coinsurance, copayment, or any other cost-sharing
21requirement on the coverage provided; except that this
22sentence does not apply to coverage of diagnostic mammograms
23to the extent such coverage would disqualify a high-deductible
24health plan from eligibility for a health savings account
25pursuant to Section 223 of the Internal Revenue Code (26
26U.S.C. 223).

 

 

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1    For purposes of this subsection:
2    "Diagnostic mammogram" means a mammogram obtained using
3diagnostic mammography.
4    "Diagnostic mammography" means a method of screening that
5is designed to evaluate an abnormality in a breast, including
6an abnormality seen or suspected on a screening mammogram or a
7subjective or objective abnormality otherwise detected in the
8breast.
9    "Low-dose mammography" means the x-ray examination of the
10breast using equipment dedicated specifically for mammography,
11including the x-ray tube, filter, compression device, and
12image receptor, with an average radiation exposure delivery of
13less than one rad per breast for 2 views of an average size
14breast. The term also includes digital mammography.
15    (d-5) Coverage as described by subsection (d) shall be
16provided at no cost to the insured and shall not be applied to
17an annual or lifetime maximum benefit.
18    (d-10) When health care services are available through
19contracted providers and a person does not comply with plan
20provisions specific to the use of contracted providers, the
21requirements of subsection (d-5) are not applicable. When a
22person does not comply with plan provisions specific to the
23use of contracted providers, plan provisions specific to the
24use of non-contracted providers must be applied without
25distinction for coverage required by this Section and shall be
26at least as favorable as for other radiological examinations

 

 

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1covered by the policy or contract.
2    (d-15) If a municipality, including a home rule
3municipality, is a self-insurer for purposes of providing
4health insurance coverage for its employees, the insurance
5coverage shall include mastectomy coverage, which includes
6coverage for prosthetic devices or reconstructive surgery
7incident to the mastectomy. Coverage for breast reconstruction
8in connection with a mastectomy shall include:
9        (1) reconstruction of the breast upon which the
10    mastectomy has been performed;
11        (2) surgery and reconstruction of the other breast to
12    produce a symmetrical appearance; and
13        (3) prostheses and treatment for physical
14    complications at all stages of mastectomy, including
15    lymphedemas.
16Care shall be determined in consultation with the attending
17physician and the patient. The offered coverage for prosthetic
18devices and reconstructive surgery shall be subject to the
19deductible and coinsurance conditions applied to the
20mastectomy, and all other terms and conditions applicable to
21other benefits. When a mastectomy is performed and there is no
22evidence of malignancy then the offered coverage may be
23limited to the provision of prosthetic devices and
24reconstructive surgery to within 2 years after the date of the
25mastectomy. As used in this Section, "mastectomy" means the
26removal of all or part of the breast for medically necessary

 

 

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1reasons, as determined by a licensed physician.
2    A municipality, including a home rule municipality, that
3is a self-insurer for purposes of providing health insurance
4coverage for its employees, may not penalize or reduce or
5limit the reimbursement of an attending provider or provide
6incentives (monetary or otherwise) to an attending provider to
7induce the provider to provide care to an insured in a manner
8inconsistent with this Section.
9    (d-20) The requirement that mammograms be included in
10health insurance coverage as provided in subsections (d)
11through (d-15) is an exclusive power and function of the State
12and is a denial and limitation under Article VII, Section 6,
13subsection (h) of the Illinois Constitution of home rule
14municipality powers. A home rule municipality to which
15subsections (d) through (d-15) apply must comply with every
16provision of those subsections.
17    (d-25) If a municipality, including a home rule
18municipality, is a self-insurer for purposes of providing
19health insurance coverage for its employees, the insurance
20coverage shall include joint mental health therapy services
21for any member of the municipality's police department or fire
22department and any spouse or partner of the member who resides
23with the member.
24    The joint mental health therapy services provided under
25this subsection shall be performed by a physician licensed to
26practice medicine in all of its branches, a licensed clinical

 

 

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1psychologist, a licensed clinical social worker, a licensed
2clinical professional counselor, a licensed marriage and
3family therapist, a licensed social worker, or a licensed
4professional counselor.
5    This subsection is a limitation under subsection (i) of
6Section 6 of Article VII of the Illinois Constitution on the
7concurrent exercise by home rule units of powers and functions
8exercised by the State.
9    (e) Rulemaking authority to implement Public Act 95-1045,
10if any, is conditioned on the rules being adopted in
11accordance with all provisions of the Illinois Administrative
12Procedure Act and all rules and procedures of the Joint
13Committee on Administrative Rules; any purported rule not so
14adopted, for whatever reason, is unauthorized.
15(Source: P.A. 100-863, eff. 8-14-18; 101-580, eff. 1-1-20.)
 
16    Section 99. Effective date. This Act takes effect January
171, 2025.