103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB3148

 

Introduced 2/17/2023, by Rep. Dagmara Avelar

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/356z.60

    Amends the Accident and Health Article of the Illinois Insurance Code. Provides that an individual or group policy of accident and health insurance amended, delivered, issued, or renewed in the State after January 1, 2024 shall provide coverage for emergency contraceptives. Effective immediately.


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A BILL FOR

 

HB3148LRB103 28272 BMS 54651 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 Illinois Insurance Code is amended by
5changing Section 356z.60 as follows:
 
6    (215 ILCS 5/356z.60)
7    Sec. 356z.60. Coverage for abortifacients, emergency
8contraceptives, hormonal therapy, and human immunodeficiency
9virus pre-exposure prophylaxis and post-exposure prophylaxis.
10    (a) As used in this Section:
11    "Abortifacients" means any medication administered to
12terminate a pregnancy by a health care professional.
13    "Emergency contraceptives" means medication used to
14prevent pregnancy after unprotected or inadequately protected
15sexual intercourse or contraceptive failure.
16    "Health care professional" means a physician licensed to
17practice medicine in all of its branches, licensed advanced
18practice registered nurse, or physician assistant.
19    "Hormonal therapy medication" means hormonal treatment
20administered to treat gender dysphoria.
21    "Therapeutic equivalent version" means drugs, devices, or
22products that can be expected to have the same clinical effect
23and safety profile when administered to patients under the

 

 

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1conditions specified in the labeling and that satisfy the
2following general criteria:
3        (1) it is approved as safe and effective;
4        (2) it is a pharmaceutical equivalent in that it:
5            (A) contains identical amounts of the same active
6        drug ingredient in the same dosage form and route of
7        administration; and
8            (B) meets compendial or other applicable standards
9        of strength, quality, purity, and identity;
10        (3) it is bioequivalent in that:
11            (A) it does not present a known or potential
12        bioequivalence problem and it meets an acceptable in
13        vitro standard; or
14            (B) if it does present such a known or potential
15        problem, it is shown to meet an appropriate
16        bioequivalence standard;
17        (4) it is adequately labeled; and
18        (5) it is manufactured in compliance with Current Good
19    Manufacturing Practice regulations adopted by the United
20    States Food and Drug Administration.
21    (b) An individual or group policy of accident and health
22insurance amended, delivered, issued, or renewed in this State
23after January 1, 2024 shall provide coverage for all
24abortifacients, emergency contraceptives, hormonal therapy
25medication, human immunodeficiency virus pre-exposure
26prophylaxis and post-exposure prophylaxis drugs approved by

 

 

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1the United States Food and Drug Administration, and follow-up
2services related to that coverage, including, but not limited
3to, management of side effects, medication self-management or
4adherence counseling, risk reduction strategies, and mental
5health counseling.
6    (c) The coverage required under subsection (b) is subject
7to the following conditions:
8        (1) If the United States Food and Drug Administration
9    has approved one or more therapeutic equivalent versions
10    of an abortifacient drug, a policy is not required to
11    include all such therapeutic equivalent versions in its
12    formulary so long as at least one is included and covered
13    without cost sharing and in accordance with this Section.
14        (2) If an individual's attending provider recommends a
15    particular drug approved by the United States Food and
16    Drug Administration based on a determination of medical
17    necessity with respect to that individual, the plan or
18    issuer must defer to the determination of the attending
19    provider and must cover that service or item without cost
20    sharing.
21        (3) If a drug is not covered, plans and issuers must
22    have an easily accessible, transparent, and sufficiently
23    expedient process that is not unduly burdensome on the
24    individual or a provider or other individual acting as a
25    patient's authorized representative to ensure coverage
26    without cost sharing.

 

 

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1    (d) Except as otherwise provided in this Section, a policy
2subject to this Section shall not impose a deductible,
3coinsurance, copayment, or any other cost-sharing requirement
4on the coverage provided. The provisions of this subsection do
5not apply to coverage of procedures to the extent such
6coverage would disqualify a high-deductible health plan from
7eligibility for a health savings account pursuant to the
8federal Internal Revenue Code, 26 U.S.C. 223.
9    (e) Except as otherwise authorized under this Section, a
10policy shall not impose any restrictions or delays on the
11coverage required under this Section.
12    (f) The coverage requirements in this Section for
13abortifacients do not, pursuant to 42 U.S.C. 18054(a)(6),
14apply to a multistate plan that does not provide coverage for
15abortion.
16    (g) If the Department concludes that enforcement of any
17coverage requirement of this Section for abortifacients may
18adversely affect the allocation of federal funds to this
19State, the Department may grant an exemption to that
20requirement, but only to the minimum extent necessary to
21ensure the continued receipt of federal funds.
22(Source: P.A. 102-1117, eff. 1-13-23.)
 
23    Section 99. Effective date. This Act takes effect upon
24becoming law.