SB2639 103RD GENERAL ASSEMBLY

LRB103 35235 RPS 65226 b

103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB2639

Introduced 11/7/2023, by Sen. Michael E. Hastings

SYNOPSIS AS INTRODUCED:

215 ILCS 5/356m

from Ch. 73, par. 968m

Amends the Illinois Insurance Code. Provides that, for a group policy of accident and health insurance providing coverage for more than 25 employees that provides pregnancy related benefits that is issued, amended, delivered, or renewed in this State after the effective date of the amendatory Act, if a covered individual obtains, from a physician licensed to practice medicine in all its branches, a recommendation approving the covered individual to seek in vitro fertilization, gamete intrafallopian tube transfer, or zygote intrafallopian tube transfer based on any of the following: the covered individual's medical, sexual, and reproductive history; the covered individual's age; physical findings; or diagnostic testing, then the procedure shall be covered without any other restrictions or requirements.

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Insurance Code is amended by changing Section 356m as follows:

(215 ILCS 5/356m) (from Ch. 73, par. 968m)

Sec. 356m. Infertility coverage.

(a) No group policy of accident and health insurance providing coverage for more than 25 employees that provides pregnancy related benefits may be issued, amended, delivered, or renewed in this State after the effective date of this amendatory Act of the 99th General Assembly unless the policy contains coverage for the diagnosis and treatment of infertility including, but not limited to, in vitro fertilization, uterine embryo lavage, embryo transfer, artificial insemination, gamete intrafallopian tube transfer, zygote intrafallopian tube transfer, and low tubal ovum transfer.

(b) The coverage required under subsection (a) is subject to the following conditions:

(1) Coverage for procedures for in vitro fertilization, gamete intrafallopian tube transfer, or zygote intrafallopian tube transfer shall be required only if:

(A) the covered individual has been unable to attain a viable pregnancy, maintain a viable pregnancy, or sustain a successful pregnancy through reasonable, less costly medically appropriate infertility treatments for which coverage is available under the policy, plan, or contract;

(B) the covered individual has not undergone 4 completed oocyte retrievals, except that if a live birth follows a completed oocyte retrieval, then 2 more completed oocyte retrievals shall be covered; and

(C) the procedures are performed at medical facilities that conform to the American College of Obstetric and Gynecology guidelines for in vitro fertilization clinics or to the American Fertility Society minimal standards for programs of in vitro fertilization.

(1.5) For a group policy of accident and health insurance providing coverage for more than 25 employees that provides pregnancy related benefits that is issued, amended, delivered, or renewed in this State after the effective date of this amendatory Act of the 103rd General Assembly, if the requirements of paragraph (1) are met or if the covered individual obtains, from a physician licensed to practice medicine in all its branches, a recommendation approving the covered individual to seek in vitro fertilization, gamete intrafallopian tube transfer, or zygote intrafallopian tube transfer based on any of the following: (i) the covered individual's medical, sexual, and reproductive history; (ii) the covered individual's age; (iii) physical findings; or (iv) diagnostic testing, then the procedure shall be covered without any other restrictions or requirements.

(2) The procedures required to be covered under this Section are not required to be contained in any policy or plan issued to or by a religious institution or organization or to or by an entity sponsored by a religious institution or organization that finds the procedures required to be covered under this Section to violate its religious and moral teachings and beliefs.

(c) As used in this Section, "infertility" means a disease, condition, or status characterized by:

(1) a failure to establish a pregnancy or to carry a pregnancy to live birth after 12 months of regular, unprotected sexual intercourse if the woman is 35 years of age or younger, or after 6 months of regular, unprotected sexual intercourse if the woman is over 35 years of age; conceiving but having a miscarriage does not restart the 12-month or 6-month term for determining infertility;

(2) a person's inability to reproduce either as a single individual or with a partner without medical intervention; or

(3) a licensed physician's findings based on a patient's medical, sexual, and reproductive history, age, physical findings, or diagnostic testing.

(d) A policy, contract, or certificate may not impose any exclusions, limitations, or other restrictions on coverage of fertility medications that are different from those imposed on any other prescription medications, nor may it impose any exclusions, limitations, or other restrictions on coverage of any fertility services based on a covered individual's participation in fertility services provided by or to a third party, nor may it impose deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any other limitations on coverage for the diagnosis of infertility, treatment for infertility, and standard fertility preservation services, except as provided in this Section, that are different from those imposed upon benefits for services not related to infertility.

(Source: P.A. 102-170, eff. 1-1-22.)