Illinois General Assembly - Full Text of HB2617
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Full Text of HB2617  100th General Assembly


Rep. Laura Fine

Filed: 4/23/2018





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2    AMENDMENT NO. ______. Amend House Bill 2617, AS AMENDED,
3with reference to page and line numbers of House Amendment No.
41, on page 5, by replacing line 18 with the following:
5"changing Section 356z.4 and adding Section 356z.29 as follows:
6    (215 ILCS 5/356z.4)
7    Sec. 356z.4. Coverage for contraceptives.
8    (a)(1) The General Assembly hereby finds and declares all
9of the following:
10        (A) Illinois has a long history of expanding timely
11    access to birth control to prevent unintended pregnancy.
12        (B) The federal Patient Protection and Affordable Care
13    Act includes a contraceptive coverage guarantee as part of
14    a broader requirement for health insurance to cover key
15    preventive care services without out-of-pocket costs for
16    patients.



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1        (C) The General Assembly intends to build on existing
2    State and federal law to promote gender equity and women's
3    health and to ensure greater contraceptive coverage equity
4    and timely access to all federal Food and Drug
5    Administration approved methods of birth control for all
6    individuals covered by an individual or group health
7    insurance policy in Illinois.
8        (D) Medical management techniques such as denials,
9    step therapy, or prior authorization in public and private
10    health care coverage can impede access to the most
11    effective contraceptive methods.
12    (2) As used in this subsection (a):
13    "Contraceptive services" includes consultations,
14examinations, procedures, and medical services related to the
15use of contraceptive methods (including natural family
16planning) to prevent an unintended pregnancy.
17    "Medical necessity", for the purposes of this subsection
18(a), includes, but is not limited to, considerations such as
19severity of side effects, differences in permanence and
20reversibility of contraceptive, and ability to adhere to the
21appropriate use of the item or service, as determined by the
22attending provider.
23    "Therapeutic equivalent version" means drugs, devices, or
24products that can be expected to have the same clinical effect
25and safety profile when administered to patients under the
26conditions specified in the labeling and satisfy the following



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1general criteria:
2        (i) they are approved as safe and effective;
3        (ii) they are pharmaceutical equivalents in that they
4    (A) contain identical amounts of the same active drug
5    ingredient in the same dosage form and route of
6    administration and (B) meet compendial or other applicable
7    standards of strength, quality, purity, and identity;
8        (iii) they are bioequivalent in that (A) they do not
9    present a known or potential bioequivalence problem and
10    they meet an acceptable in vitro standard or (B) if they do
11    present such a known or potential problem, they are shown
12    to meet an appropriate bioequivalence standard;
13        (iv) they are adequately labeled; and
14        (v) they are manufactured in compliance with Current
15    Good Manufacturing Practice regulations.
16    (3) An individual or group policy of accident and health
17insurance amended, delivered, issued, or renewed in this State
18after the effective date of this amendatory Act of the 99th
19General Assembly shall provide coverage for all of the
20following services and contraceptive methods:
21        (A) All contraceptive drugs, devices, and other
22    products approved by the United States Food and Drug
23    Administration. This includes all over-the-counter
24    contraceptive drugs, devices, and products approved by the
25    United States Food and Drug Administration, excluding male
26    condoms. The following apply:



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1            (i) If the United States Food and Drug
2        Administration has approved one or more therapeutic
3        equivalent versions of a contraceptive drug, device,
4        or product, a policy is not required to include all
5        such therapeutic equivalent versions in its formulary,
6        so long as at least one is included and covered without
7        cost-sharing and in accordance with this Section.
8            (ii) If an individual's attending provider
9        recommends a particular service or item approved by the
10        United States Food and Drug Administration based on a
11        determination of medical necessity with respect to
12        that individual, the plan or issuer must cover that
13        service or item without cost sharing. The plan or
14        issuer must defer to the determination of the attending
15        provider.
16            (iii) If a drug, device, or product is not covered,
17        plans and issuers must have an easily accessible,
18        transparent, and sufficiently expedient process that
19        is not unduly burdensome on the individual or a
20        provider or other individual acting as a patient's
21        authorized representative to ensure coverage without
22        cost sharing.
23            (iv) This coverage must provide for the dispensing
24        of 12 months' worth of contraception at one time.
25        (B) Voluntary sterilization procedures.
26        (C) Contraceptive services, patient education, and



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1    counseling on contraception.
2        (D) Follow-up services related to the drugs, devices,
3    products, and procedures covered under this Section,
4    including, but not limited to, management of side effects,
5    counseling for continued adherence, and device insertion
6    and removal.
7    (4) Except as otherwise provided in this subsection (a), a
8policy subject to this subsection (a) shall not impose a
9deductible, coinsurance, copayment, or any other cost-sharing
10requirement on the coverage provided. The provisions of this
11paragraph do not apply to coverage of voluntary male
12sterilization procedures to the extent such coverage would
13disqualify a high-deductible health plan from eligibility for a
14health savings account pursuant to the federal Internal Revenue
15Code, 26 U.S.C. 223.
16    (5) Except as otherwise authorized under this subsection
17(a), a policy shall not impose any restrictions or delays on
18the coverage required under this subsection (a).
19    (6) If, at any time, the Secretary of the United States
20Department of Health and Human Services, or its successor
21agency, promulgates rules or regulations to be published in the
22Federal Register or publishes a comment in the Federal Register
23or issues an opinion, guidance, or other action that would
24require the State, pursuant to any provision of the Patient
25Protection and Affordable Care Act (Public Law 111-148),
26including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any



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1successor provision, to defray the cost of any coverage
2outlined in this subsection (a), then this subsection (a) is
3inoperative with respect to all coverage outlined in this
4subsection (a) other than that authorized under Section 1902 of
5the Social Security Act, 42 U.S.C. 1396a, and the State shall
6not assume any obligation for the cost of the coverage set
7forth in this subsection (a).
8    (b) This subsection (b) shall become operative if and only
9if subsection (a) becomes inoperative.
10    An individual or group policy of accident and health
11insurance amended, delivered, issued, or renewed in this State
12after the date this subsection (b) becomes operative that
13provides coverage for outpatient services and outpatient
14prescription drugs or devices must provide coverage for the
15insured and any dependent of the insured covered by the policy
16for all outpatient contraceptive services and all outpatient
17contraceptive drugs and devices approved by the Food and Drug
18Administration. Coverage required under this Section may not
19impose any deductible, coinsurance, waiting period, or other
20cost-sharing or limitation that is greater than that required
21for any outpatient service or outpatient prescription drug or
22device otherwise covered by the policy.
23    Nothing in this subsection (b) shall be construed to
24require an insurance company to cover services related to
25permanent sterilization that requires a surgical procedure.
26    As used in this subsection (b), "outpatient contraceptive



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1service" means consultations, examinations, procedures, and
2medical services, provided on an outpatient basis and related
3to the use of contraceptive methods (including natural family
4planning) to prevent an unintended pregnancy.
5    (c) Nothing in this Section shall be construed to require
6an insurance company to cover services related to an abortion
7as the term "abortion" is defined in the Illinois Abortion Law
8of 1975.
9    (d) If a plan or issuer utilizes a network of providers,
10nothing in this Section shall be construed to require coverage
11or to prohibit the plan or issuer from imposing cost-sharing
12for items or services described in this Section that are
13provided or delivered by an out-of-network provider, unless the
14plan or issuer does not have in its network a provider who is
15able to or is willing to provide the applicable items or
17(Source: P.A. 99-672, eff. 1-1-17.)".