SB2639 EngrossedLRB103 35235 RPS 65226 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Counties Code is amended by changing
5Section 5-1069.3 as follows:
 
6    (55 ILCS 5/5-1069.3)
7    Sec. 5-1069.3. Required health benefits. If a county,
8including a home rule county, is a self-insurer for purposes
9of providing health insurance coverage for its employees, the
10coverage shall include coverage for the post-mastectomy care
11benefits required to be covered by a policy of accident and
12health insurance under Section 356t and the coverage required
13under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w,
14356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
16356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36,
17356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
18356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
19356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
20of the Illinois Insurance Code. The coverage shall comply with
21Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
22Insurance Code. The Department of Insurance shall enforce the
23requirements of this Section. The requirement that health

 

 

SB2639 Engrossed- 2 -LRB103 35235 RPS 65226 b

1benefits be covered as provided in this Section is an
2exclusive power and function of the State and is a denial and
3limitation under Article VII, Section 6, subsection (h) of the
4Illinois Constitution. A home rule county to which this
5Section applies must comply with every provision of this
6Section.
7    Rulemaking authority to implement Public Act 95-1045, if
8any, is conditioned on the rules being adopted in accordance
9with all provisions of the Illinois Administrative Procedure
10Act and all rules and procedures of the Joint Committee on
11Administrative Rules; any purported rule not so adopted, for
12whatever reason, is unauthorized.
13(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
14102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
151-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
16eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
17102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
181-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
19eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
20103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
218-29-23.)
 
22    Section 10. The Illinois Municipal Code is amended by
23changing Section 10-4-2.3 as follows:
 
24    (65 ILCS 5/10-4-2.3)

 

 

SB2639 Engrossed- 3 -LRB103 35235 RPS 65226 b

1    Sec. 10-4-2.3. Required health benefits. If a
2municipality, including a home rule municipality, is a
3self-insurer for purposes of providing health insurance
4coverage for its employees, the coverage shall include
5coverage for the post-mastectomy care benefits required to be
6covered by a policy of accident and health insurance under
7Section 356t and the coverage required under Sections 356g,
8356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, 356z.4,
9356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
10356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
11356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
12356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
13356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
14356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois
15Insurance Code. The coverage shall comply with Sections
16155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
17Code. The Department of Insurance shall enforce the
18requirements of this Section. The requirement that health
19benefits be covered as provided in this is an exclusive power
20and function of the State and is a denial and limitation under
21Article VII, Section 6, subsection (h) of the Illinois
22Constitution. A home rule municipality to which this Section
23applies must comply with every provision of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if
25any, is conditioned on the rules being adopted in accordance
26with all provisions of the Illinois Administrative Procedure

 

 

SB2639 Engrossed- 4 -LRB103 35235 RPS 65226 b

1Act and all rules and procedures of the Joint Committee on
2Administrative Rules; any purported rule not so adopted, for
3whatever reason, is unauthorized.
4(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
5102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
61-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
7eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
8102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
91-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
10eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
11103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
128-29-23.)
 
13    Section 15. The School Code is amended by changing Section
1410-22.3f as follows:
 
15    (105 ILCS 5/10-22.3f)
16    Sec. 10-22.3f. Required health benefits. Insurance
17protection and benefits for employees shall provide the
18post-mastectomy care benefits required to be covered by a
19policy of accident and health insurance under Section 356t and
20the coverage required under Sections 356g, 356g.5, 356g.5-1,
21356m, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
22356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
23356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
24356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,

 

 

SB2639 Engrossed- 5 -LRB103 35235 RPS 65226 b

1356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
2356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
3of the Illinois Insurance Code. Insurance policies shall
4comply with Section 356z.19 of the Illinois Insurance Code.
5The coverage shall comply with Sections 155.22a, 355b, and
6370c of the Illinois Insurance Code. The Department of
7Insurance shall enforce the requirements of this Section.
8    Rulemaking authority to implement Public Act 95-1045, if
9any, is conditioned on the rules being adopted in accordance
10with all provisions of the Illinois Administrative Procedure
11Act and all rules and procedures of the Joint Committee on
12Administrative Rules; any purported rule not so adopted, for
13whatever reason, is unauthorized.
14(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
15102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
161-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
17eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
18102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
191-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
20eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
21103-551, eff. 8-11-23; revised 8-29-23.)
 
22    Section 20. The Illinois Insurance Code is amended by
23changing Section 356m as follows:
 
24    (215 ILCS 5/356m)  (from Ch. 73, par. 968m)

 

 

SB2639 Engrossed- 6 -LRB103 35235 RPS 65226 b

1    Sec. 356m. Infertility coverage.
2    (a) No group policy of accident and health insurance
3providing coverage for more than 25 employees that provides
4pregnancy-related pregnancy related benefits may be issued,
5amended, delivered, or renewed in this State after the
6effective date of this amendatory Act of the 99th General
7Assembly unless the policy contains coverage for the diagnosis
8and treatment of infertility including, but not limited to, in
9vitro fertilization, uterine embryo lavage, embryo transfer,
10artificial insemination, gamete intrafallopian tube transfer,
11zygote intrafallopian tube transfer, and low tubal ovum
12transfer.
13    (b) The coverage required under subsection (a) is subject
14to the following conditions:
15        (1) Coverage for procedures for in vitro
16    fertilization, gamete intrafallopian tube transfer, or
17    zygote intrafallopian tube transfer shall be required only
18    if:
19            (A) the covered individual has been unable to
20        attain a viable pregnancy, maintain a viable
21        pregnancy, or sustain a successful pregnancy through
22        reasonable, less costly medically appropriate
23        infertility treatments for which coverage is available
24        under the policy, plan, or contract;
25            (B) the covered individual has not undergone 4
26        completed oocyte retrievals, except that if a live

 

 

SB2639 Engrossed- 7 -LRB103 35235 RPS 65226 b

1        birth follows a completed oocyte retrieval, then 2
2        more completed oocyte retrievals shall be covered; and
3            (C) the procedures are performed at medical
4        facilities that conform to the American College of
5        Obstetric and Gynecology guidelines for in vitro
6        fertilization clinics or to the American Fertility
7        Society minimal standards for programs of in vitro
8        fertilization.
9        (1.5) For a group policy of accident and health
10    insurance that provides pregnancy-related benefits that is
11    issued, amended, delivered, or renewed in this State after
12    January 1, 2026, if the requirements of paragraph (1) are
13    met or if the covered individual obtains, from a physician
14    licensed to practice medicine in all its branches, a
15    recommendation approving the covered individual to seek in
16    vitro fertilization, gamete intrafallopian tube transfer,
17    or zygote intrafallopian tube transfer based on any of the
18    following: (i) the covered individual's medical, sexual,
19    and reproductive history; (ii) the covered individual's
20    age; (iii) physical findings; or (iv) diagnostic testing,
21    then the procedure shall be covered without any other
22    restrictions or requirements.
23        (2) The procedures required to be covered under this
24    Section are not required to be contained in any policy or
25    plan issued to or by a religious institution or
26    organization or to or by an entity sponsored by a

 

 

SB2639 Engrossed- 8 -LRB103 35235 RPS 65226 b

1    religious institution or organization that finds the
2    procedures required to be covered under this Section to
3    violate its religious and moral teachings and beliefs.
4    (c) As used in this Section, "infertility" means a
5disease, condition, or status characterized by:
6        (1) a failure to establish a pregnancy or to carry a
7    pregnancy to live birth after 12 months of regular,
8    unprotected sexual intercourse if the woman is 35 years of
9    age or younger, or after 6 months of regular, unprotected
10    sexual intercourse if the woman is over 35 years of age;
11    conceiving but having a miscarriage does not restart the
12    12-month or 6-month term for determining infertility;
13        (2) a person's inability to reproduce either as a
14    single individual or with a partner without medical
15    intervention; or
16        (3) a licensed physician's findings based on a
17    patient's medical, sexual, and reproductive history, age,
18    physical findings, or diagnostic testing.
19    (d) A policy, contract, or certificate may not impose any
20exclusions, limitations, or other restrictions on coverage of
21fertility medications that are different from those imposed on
22any other prescription medications, nor may it impose any
23exclusions, limitations, or other restrictions on coverage of
24any fertility services based on a covered individual's
25participation in fertility services provided by or to a third
26party, nor may it impose deductibles, copayments, coinsurance,

 

 

SB2639 Engrossed- 9 -LRB103 35235 RPS 65226 b

1benefit maximums, waiting periods, or any other limitations on
2coverage for the diagnosis of infertility, treatment for
3infertility, and standard fertility preservation services,
4except as provided in this Section, that are different from
5those imposed upon benefits for services not related to
6infertility.
7(Source: P.A. 102-170, eff. 1-1-22.)
 
8    Section 25. The Limited Health Service Organization Act is
9amended by changing Section 4003 as follows:
 
10    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
11    Sec. 4003. Illinois Insurance Code provisions. Limited
12health service organizations shall be subject to the
13provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
14141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
15154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2,
16355.3, 355b, 356m, 356q, 356v, 356z.4, 356z.4a, 356z.10,
17356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a,
18356z.32, 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
19356z.54, 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68,
20364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
21444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
22XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
23Nothing in this Section shall require a limited health care
24plan to cover any service that is not a limited health service.

 

 

SB2639 Engrossed- 10 -LRB103 35235 RPS 65226 b

1For purposes of the Illinois Insurance Code, except for
2Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
3health service organizations in the following categories are
4deemed to be domestic companies:
5        (1) a corporation under the laws of this State; or
6        (2) a corporation organized under the laws of another
7    state, 30% or more of the enrollees of which are residents
8    of this State, except a corporation subject to
9    substantially the same requirements in its state of
10    organization as is a domestic company under Article VIII
11    1/2 of the Illinois Insurance Code.
12(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
13102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
141-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
15eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
16102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
171-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
18eff. 1-1-24; revised 8-29-23.)
 
19    Section 30. The Voluntary Health Services Plans Act is
20amended by changing Section 10 as follows:
 
21    (215 ILCS 165/10)  (from Ch. 32, par. 604)
22    Sec. 10. Application of Insurance Code provisions. Health
23services plan corporations and all persons interested therein
24or dealing therewith shall be subject to the provisions of

 

 

SB2639 Engrossed- 11 -LRB103 35235 RPS 65226 b

1Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
2143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
3356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t, 356u, 356v,
4356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a,
5356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
6356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22,
7356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
8356z.33, 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
9356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62,
10356z.64, 356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401,
11401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
12and (15) of Section 367 of the Illinois Insurance Code.
13    Rulemaking authority to implement Public Act 95-1045, if
14any, is conditioned on the rules being adopted in accordance
15with all provisions of the Illinois Administrative Procedure
16Act and all rules and procedures of the Joint Committee on
17Administrative Rules; any purported rule not so adopted, for
18whatever reason, is unauthorized.
19(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
20102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
2110-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
22eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
23102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
241-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
25eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
26103-551, eff. 8-11-23; revised 8-29-23.)
 

 

 

SB2639 Engrossed- 12 -LRB103 35235 RPS 65226 b

1    Section 35. The Illinois Public Aid Code is amended by
2changing Section 5-16.8 as follows:
 
3    (305 ILCS 5/5-16.8)
4    Sec. 5-16.8. Required health benefits. The medical
5assistance program shall (i) provide the post-mastectomy care
6benefits required to be covered by a policy of accident and
7health insurance under Section 356t and the coverage required
8under Sections 356g.5, 356m, 356q, 356u, 356w, 356x, 356z.6,
9356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
10356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and
11356z.61, 356z.64, and 356z.67 of the Illinois Insurance Code,
12(ii) be subject to the provisions of Sections 356z.19,
13356z.44, 356z.49, 364.01, 370c, and 370c.1 of the Illinois
14Insurance Code, and (iii) be subject to the provisions of
15subsection (d-5) of Section 10 of the Network Adequacy and
16Transparency Act.
17    The Department, by rule, shall adopt a model similar to
18the requirements of Section 356z.39 of the Illinois Insurance
19Code.
20    On and after July 1, 2012, the Department shall reduce any
21rate of reimbursement for services or other payments or alter
22any methodologies authorized by this Code to reduce any rate
23of reimbursement for services or other payments in accordance
24with Section 5-5e.

 

 

SB2639 Engrossed- 13 -LRB103 35235 RPS 65226 b

1    To ensure full access to the benefits set forth in this
2Section, on and after January 1, 2016, the Department shall
3ensure that provider and hospital reimbursement for
4post-mastectomy care benefits required under this Section are
5no lower than the Medicare reimbursement rate.
6(Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
7102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
81-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
9eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
10102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
111-1-24; 103-420, eff. 1-1-24; revised 12-15-23.)
 
12    Section 99. Effective date. This Act takes effect January
131, 2026.