HB4460 EnrolledLRB103 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 or police officer of an
11institution of higher education and any spouse or partner of
12the officer who resides with the officer.
13    (b) The joint mental health therapy services provided
14under subsection (a) shall be performed by a physician
15licensed to practice medicine in all of its branches, a
16licensed clinical psychologist, a licensed clinical social
17worker, a licensed clinical professional counselor, a licensed
18marriage and family therapist, a licensed social worker, or a
19licensed professional counselor.
 
20    Section 10. The Counties Code is amended by changing
21Section 5-1069 as follows:
 

 

 

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1    (55 ILCS 5/5-1069)  (from Ch. 34, par. 5-1069)
2    Sec. 5-1069. Group life, health, accident, hospital, and
3medical insurance.
4    (a) The county board of any county may arrange to provide,
5for the benefit of employees of the county, group life,
6health, accident, hospital, and medical insurance, or any one
7or any combination of those types of insurance, or the county
8board may self-insure, for the benefit of its employees, all
9or a portion of the employees' group life, health, accident,
10hospital, and medical insurance, or any one or any combination
11of those types of insurance, including a combination of
12self-insurance and other types of insurance authorized by this
13Section, provided that the county board complies with all
14other requirements of this Section. The insurance may include
15provision for employees who rely on treatment by prayer or
16spiritual means alone for healing in accordance with the
17tenets and practice of a well recognized religious
18denomination. The county board may provide for payment by the
19county of a portion or all of the premium or charge for the
20insurance with the employee paying the balance of the premium
21or charge, if any. If the county board undertakes a plan under
22which the county pays only a portion of the premium or charge,
23the county board shall provide for withholding and deducting
24from the compensation of those employees who consent to join
25the plan the balance of the premium or charge for the
26insurance.

 

 

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1    (b) If the county board does not provide for
2self-insurance or for a plan under which the county pays a
3portion or all of the premium or charge for a group insurance
4plan, the county board may provide for withholding and
5deducting from the compensation of those employees who consent
6thereto the total premium or charge for any group life,
7health, accident, hospital, and medical insurance.
8    (c) The county board may exercise the powers granted in
9this Section only if it provides for self-insurance or, where
10it makes arrangements to provide group insurance through an
11insurance carrier, if the kinds of group insurance are
12obtained from an insurance company authorized to do business
13in the State of Illinois. The county board may enact an
14ordinance prescribing the method of operation of the insurance
15program.
16    (d) If a county, including a home rule county, is a
17self-insurer for purposes of providing health insurance
18coverage for its employees, the insurance coverage shall
19include screening by low-dose mammography for all women 35
20years of age or older for the presence of occult breast cancer
21unless the county elects to provide mammograms itself under
22Section 5-1069.1. The coverage shall be as follows:
23        (1) A baseline mammogram for women 35 to 39 years of
24    age.
25        (2) An annual mammogram for women 40 years of age or
26    older.

 

 

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

 

 

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1health plan from eligibility for a health savings account
2pursuant to Section 223 of the Internal Revenue Code (26
3U.S.C. 223).
4    For purposes of this subsection:
5    "Diagnostic mammogram" means a mammogram obtained using
6diagnostic mammography.
7    "Diagnostic mammography" means a method of screening that
8is designed to evaluate an abnormality in a breast, including
9an abnormality seen or suspected on a screening mammogram or a
10subjective or objective abnormality otherwise detected in the
11breast.
12    "Low-dose mammography" means the x-ray examination of the
13breast using equipment dedicated specifically for mammography,
14including the x-ray tube, filter, compression device, and
15image receptor, with an average radiation exposure delivery of
16less than one rad per breast for 2 views of an average size
17breast. The term also includes digital mammography.
18    (d-5) Coverage as described by subsection (d) shall be
19provided at no cost to the insured and shall not be applied to
20an annual or lifetime maximum benefit.
21    (d-10) When health care services are available through
22contracted providers and a person does not comply with plan
23provisions specific to the use of contracted providers, the
24requirements of subsection (d-5) are not applicable. When a
25person does not comply with plan provisions specific to the
26use of contracted providers, plan provisions specific to the

 

 

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1use of non-contracted providers must be applied without
2distinction for coverage required by this Section and shall be
3at least as favorable as for other radiological examinations
4covered by the policy or contract.
5    (d-15) If a county, including a home rule county, is a
6self-insurer for purposes of providing health insurance
7coverage for its employees, the insurance coverage shall
8include mastectomy coverage, which includes coverage for
9prosthetic devices or reconstructive surgery incident to the
10mastectomy. Coverage for breast reconstruction in connection
11with a mastectomy shall include:
12        (1) reconstruction of the breast upon which the
13    mastectomy has been performed;
14        (2) surgery and reconstruction of the other breast to
15    produce a symmetrical appearance; and
16        (3) prostheses and treatment for physical
17    complications at all stages of mastectomy, including
18    lymphedemas.
19Care shall be determined in consultation with the attending
20physician and the patient. The offered coverage for prosthetic
21devices and reconstructive surgery shall be subject to the
22deductible and coinsurance conditions applied to the
23mastectomy, and all other terms and conditions applicable to
24other benefits. When a mastectomy is performed and there is no
25evidence of malignancy then the offered coverage may be
26limited to the provision of prosthetic devices and

 

 

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

 

 

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1this subsection shall be performed by a physician licensed to
2practice medicine in all of its branches, a licensed clinical
3psychologist, a licensed clinical social worker, a licensed
4clinical professional counselor, a licensed marriage and
5family therapist, a licensed social worker, or a licensed
6professional counselor.
7    This subsection is a limitation under subsection (i) of
8Section 6 of Article VII of the Illinois Constitution on the
9concurrent exercise by home rule units of powers and functions
10exercised by the State.
11    (e) The term "employees" as used in this Section includes
12elected or appointed officials but does not include temporary
13employees.
14    (f) The county board may, by ordinance, arrange to provide
15group life, health, accident, hospital, and medical insurance,
16or any one or a combination of those types of insurance, under
17this Section to retired former employees and retired former
18elected or appointed officials of the county.
19    (g) Rulemaking authority to implement this amendatory Act
20of the 95th General Assembly, if any, is conditioned on the
21rules being adopted in accordance with all provisions of the
22Illinois Administrative Procedure Act and all rules and
23procedures of the Joint Committee on Administrative Rules; any
24purported rule not so adopted, for whatever reason, is
25unauthorized.
26(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

 

 

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1under which the municipality pays a portion of the premium or
2charge for a group insurance plan, the corporate authorities
3may provide for withholding and deducting from the
4compensation of those employees who consent thereto the
5premium or charge for any group life, health, accident,
6hospital, and medical insurance.
7    (c) The corporate authorities may exercise the powers
8granted in this Section only if the kinds of group insurance
9are obtained from an insurance company authorized to do
10business in the State of Illinois, or are obtained through an
11intergovernmental joint self-insurance pool as authorized
12under the Intergovernmental Cooperation Act. The corporate
13authorities may enact an ordinance prescribing the method of
14operation of the insurance program.
15    (d) If a municipality, including a home rule municipality,
16is a self-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 municipality elects to provide mammograms itself
21under Section 10-4-2.1. 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.
13        (5) For a group policy of accident and health
14    insurance that is amended, delivered, issued, or renewed
15    on or after the effective date of this amendatory Act of
16    the 101st General Assembly, a diagnostic mammogram when
17    medically necessary, as determined by a physician licensed
18    to practice medicine in all its branches, advanced
19    practice registered nurse, or physician assistant.
20    A policy subject to this subsection shall not impose a
21deductible, coinsurance, copayment, or any other cost-sharing
22requirement on the coverage provided; except that this
23sentence does not apply to coverage of diagnostic mammograms
24to the extent such coverage would disqualify a high-deductible
25health plan from eligibility for a health savings account
26pursuant to Section 223 of the Internal Revenue Code (26

 

 

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

 

 

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

 

 

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1removal of all or part of the breast for medically necessary
2reasons, as determined by a licensed physician.
3    A municipality, including a home rule municipality, that
4is a self-insurer for purposes of providing health insurance
5coverage for its employees, may not penalize or reduce or
6limit the reimbursement of an attending provider or provide
7incentives (monetary or otherwise) to an attending provider to
8induce the provider to provide care to an insured in a manner
9inconsistent with this Section.
10    (d-20) The requirement that mammograms be included in
11health insurance coverage as provided in subsections (d)
12through (d-15) is an exclusive power and function of the State
13and is a denial and limitation under Article VII, Section 6,
14subsection (h) of the Illinois Constitution of home rule
15municipality powers. A home rule municipality to which
16subsections (d) through (d-15) apply must comply with every
17provision of those subsections.
18    (d-25) If a municipality, including a home rule
19municipality, is a self-insurer for purposes of providing
20health insurance coverage for its employees, the insurance
21coverage shall include joint mental health therapy services
22for any member of the municipality's police department or fire
23department and any spouse or partner of the member who resides
24with 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) Rulemaking authority to implement Public Act 95-1045,
11if any, is conditioned on the rules being adopted in
12accordance with all provisions of the Illinois Administrative
13Procedure Act and all rules and procedures of the Joint
14Committee on Administrative Rules; any purported rule not so
15adopted, for whatever reason, is unauthorized.
16(Source: P.A. 100-863, eff. 8-14-18; 101-580, eff. 1-1-20.)
 
17    Section 20. The Fire Protection District Act is amended by
18adding Section 6.3 as follows:
 
19    (70 ILCS 705/6.3 new)
20    Sec. 6.3. Health insurance; joint mental health therapy
21services. If a fire protection district is a self-insurer for
22purposes of providing health insurance coverage for officers
23and members of the fire department, the insurance coverage
24shall include joint mental health therapy services for any

 

 

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1officer or member of the fire department and any spouse or
2partner of the officer or member who resides with the officer
3or member. The joint mental health therapy services provided
4under this Section shall be performed by a physician licensed
5to practice medicine in all of its branches, a licensed
6clinical psychologist, a licensed clinical social worker, a
7licensed clinical professional counselor, a licensed marriage
8and family therapist, a licensed social worker, or a licensed
9professional counselor.
 
10    Section 99. Effective date. This Act takes effect January
111, 2025.