Rep. Margaret Croke

Filed: 2/20/2024

 

 


 

 


 
10300HB4112ham001LRB103 33223 MXP 69304 a

1
AMENDMENT TO HOUSE BILL 4112

2    AMENDMENT NO. ______. Amend House Bill 4112 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The State Employees Group Insurance Act of
51971 is amended by changing Section 6.11B as follows:
 
6    (5 ILCS 375/6.11B)
7    Sec. 6.11B. Infertility coverage.
8    (a) Beginning on January 1, 2024, the State Employees
9Group Insurance Program shall provide coverage for the
10diagnosis and treatment of infertility, including, but not
11limited to, in vitro fertilization, uterine embryo lavage,
12embryo transfer, artificial insemination, gamete
13intrafallopian tube transfer, zygote intrafallopian tube
14transfer, and low tubal ovum transfer. The coverage required
15shall include procedures necessary to screen or diagnose a
16fertilized egg before implantation, including, but not limited

 

 

10300HB4112ham001- 2 -LRB103 33223 MXP 69304 a

1to, preimplantation genetic diagnosis, preimplantation genetic
2screening, and prenatal genetic diagnosis.
3    (b) Beginning on January 1, 2024, coverage under this
4Section for procedures for in vitro fertilization, gamete
5intrafallopian tube transfer, or zygote intrafallopian tube
6transfer shall be required only if the procedures:
7        (1) are considered medically appropriate based on
8    clinical guidelines or standards developed by the American
9    Society for Reproductive Medicine, the American College of
10    Obstetricians and Gynecologists, or the Society for
11    Assisted Reproductive Technology; and
12        (2) are performed at medical facilities or clinics
13    that conform to the American College of Obstetricians and
14    Gynecologists guidelines for in vitro fertilization or the
15    American Society for Reproductive Medicine minimum
16    standards for practices offering assisted reproductive
17    technologies.
18    (c) As used in this Section, "infertility" means a
19disease, condition, or status characterized by:
20        (1) a failure to establish a pregnancy or to carry a
21    pregnancy to live birth after 12 months of regular,
22    unprotected sexual intercourse if the woman is 35 years of
23    age or younger, or after 6 months of regular, unprotected
24    sexual intercourse if the woman is over 35 years of age;
25    conceiving but having a miscarriage does not restart the
26    12-month or 6-month term for determining infertility;

 

 

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1        (2) a person's inability to reproduce either as a
2    single individual or with a partner without medical
3    intervention; or
4        (3) a licensed physician's findings based on a
5    patient's medical, sexual, and reproductive history, age,
6    physical findings, or diagnostic testing.
7    (d) The State Employees Group Insurance Program may not
8impose any exclusions, limitations, or other restrictions on
9coverage of fertility medications that are different from
10those imposed on any other prescription medications, nor may
11it impose any exclusions, limitations, or other restrictions
12on coverage of any fertility services based on a covered
13individual's participation in fertility services provided by
14or to a third party, nor may it impose deductibles,
15copayments, coinsurance, benefit maximums, waiting periods, or
16any other limitations on coverage for the diagnosis of
17infertility, treatment for infertility, and standard fertility
18preservation services, except as provided in this Section,
19that are different from those imposed upon benefits for
20services not related to infertility.
21    (e) This Section applies only to coverage provided on or
22after January 1, 2024 and before January 1, 2026.
23    (f) This Section is repealed on January 1, 2026.
24(Source: P.A. 103-8, eff. 1-1-24.)
 
25    Section 10. The Counties Code is amended by changing

 

 

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1Section 5-1069.3 as follows:
 
2    (55 ILCS 5/5-1069.3)
3    Sec. 5-1069.3. Required health benefits. If a county,
4including a home rule county, is a self-insurer for purposes
5of providing health insurance coverage for its employees, the
6coverage shall include coverage for the post-mastectomy care
7benefits required to be covered by a policy of accident and
8health insurance under Section 356t and the coverage required
9under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w,
10356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
11356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
12356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36,
13356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
14356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
15356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
16of the Illinois Insurance Code. The coverage shall comply with
17Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
18Insurance Code. The Department of Insurance shall enforce the
19requirements of this Section. The requirement that health
20benefits be covered as provided in this Section is an
21exclusive power and function of the State and is a denial and
22limitation under Article VII, Section 6, subsection (h) of the
23Illinois Constitution. A home rule county to which this
24Section applies must comply with every provision of this
25Section.

 

 

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1    Rulemaking authority to implement Public Act 95-1045, if
2any, is conditioned on the rules being adopted in accordance
3with all provisions of the Illinois Administrative Procedure
4Act and all rules and procedures of the Joint Committee on
5Administrative Rules; any purported rule not so adopted, for
6whatever reason, is unauthorized.
7(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
8102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
91-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
10eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
11102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
121-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
13eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
14103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
158-29-23.)
 
16    Section 15. The Illinois Municipal Code is amended by
17changing Section 10-4-2.3 as follows:
 
18    (65 ILCS 5/10-4-2.3)
19    Sec. 10-4-2.3. Required health benefits. If a
20municipality, including a home rule municipality, is a
21self-insurer for purposes of providing health insurance
22coverage for its employees, the coverage shall include
23coverage for the post-mastectomy care benefits required to be
24covered by a policy of accident and health insurance under

 

 

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1Section 356t and the coverage required under Sections 356g,
2356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, 356z.4,
3356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
4356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
5356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
6356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
7356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
8356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois
9Insurance Code. The coverage shall comply with Sections
10155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
11Code. The Department of Insurance shall enforce the
12requirements of this Section. The requirement that health
13benefits be covered as provided in this is an exclusive power
14and function of the State and is a denial and limitation under
15Article VII, Section 6, subsection (h) of the Illinois
16Constitution. A home rule municipality to which this Section
17applies must comply with every provision of this Section.
18    Rulemaking authority to implement Public Act 95-1045, if
19any, is conditioned on the rules being adopted in accordance
20with all provisions of the Illinois Administrative Procedure
21Act and all rules and procedures of the Joint Committee on
22Administrative Rules; any purported rule not so adopted, for
23whatever reason, is unauthorized.
24(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
25102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
261-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,

 

 

10300HB4112ham001- 7 -LRB103 33223 MXP 69304 a

1eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
2102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
31-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
4eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
5103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
68-29-23.)
 
7    Section 20. The School Code is amended by changing Section
810-22.3f as follows:
 
9    (105 ILCS 5/10-22.3f)
10    Sec. 10-22.3f. Required health benefits. Insurance
11protection and benefits for employees shall provide the
12post-mastectomy care benefits required to be covered by a
13policy of accident and health insurance under Section 356t and
14the coverage required under Sections 356g, 356g.5, 356g.5-1,
15356m, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
16356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
17356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
18356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
19356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
20356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
21of the Illinois Insurance Code. Insurance policies shall
22comply with Section 356z.19 of the Illinois Insurance Code.
23The coverage shall comply with Sections 155.22a, 355b, and
24370c of the Illinois Insurance Code. The Department of

 

 

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1Insurance shall enforce the requirements of this Section.
2    Rulemaking authority to implement Public Act 95-1045, if
3any, is conditioned on the rules being adopted in accordance
4with all provisions of the Illinois Administrative Procedure
5Act and all rules and procedures of the Joint Committee on
6Administrative Rules; any purported rule not so adopted, for
7whatever reason, is unauthorized.
8(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
9102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
101-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
11eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
12102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
131-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
14eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
15103-551, eff. 8-11-23; revised 8-29-23.)
 
16    Section 25. The Illinois Insurance Code is amended by
17changing Section 356m as follows:
 
18    (215 ILCS 5/356m)  (from Ch. 73, par. 968m)
19    Sec. 356m. Infertility coverage.
20    (a) No group policy of accident and health insurance
21providing coverage for more than 25 employees that provides
22pregnancy related benefits may be issued, amended, delivered,
23or renewed in this State after January 1, 2016 through
24December 31, 2025 the effective date of this amendatory Act of

 

 

10300HB4112ham001- 9 -LRB103 33223 MXP 69304 a

1the 99th General Assembly unless the policy contains coverage
2for the diagnosis and treatment of infertility including, but
3not limited to, in vitro fertilization, uterine embryo lavage,
4embryo transfer, artificial insemination, gamete
5intrafallopian tube transfer, zygote intrafallopian tube
6transfer, and low tubal ovum transfer.
7    (a-5) No group policy of accident and health insurance
8that provides pregnancy related benefits may be issued,
9amended, delivered, or renewed in this State on or after
10January 1, 2026 unless the policy contains coverage for the
11diagnosis and treatment of infertility, including, but not
12limited to, in vitro fertilization, uterine embryo lavage,
13embryo transfer, artificial insemination, gamete
14intrafallopian tube transfer, zygote intrafallopian tube
15transfer, and low tubal ovum transfer and procedures necessary
16to screen or diagnose a fertilized egg before implantation,
17including, but not limited to, preimplantation genetic
18diagnosis, preimplantation genetic screening, and prenatal
19genetic diagnosis. Coverage under this subsection for the
20diagnosis and treatment of infertility shall be required only
21if the procedures:
22        (1) are considered medically appropriate by the
23    patient's medical provider based on clinical guidelines or
24    standards developed by the American Society for
25    Reproductive Medicine, the American College of
26    Obstetricians and Gynecologists, or the Society for

 

 

10300HB4112ham001- 10 -LRB103 33223 MXP 69304 a

1    Assisted Reproductive Technology; and
2        (2) are performed at medical facilities or clinics
3    that conform to the American College of Obstetricians and
4    Gynecologists guidelines for in vitro fertilization or the
5    American Society for Reproductive Medicine minimum
6    standards for practices offering assisted reproductive
7    technologies.
8    (b) The coverage required under subsection (a) for
9procedures for in vitro fertilization, gamete intrafallopian
10tube transfer, or zygote intrafallopian tube transfer shall be
11required only if: is subject to the following conditions:
12        (1) Coverage for procedures for in vitro
13    fertilization, gamete intrafallopian tube transfer, or
14    zygote intrafallopian tube transfer shall be required only
15    if:
16        (1) (A) the covered individual has been unable to
17    attain a viable pregnancy, maintain a viable pregnancy, or
18    sustain a successful pregnancy through reasonable, less
19    costly medically appropriate infertility treatments for
20    which coverage is available under the policy, plan, or
21    contract;
22        (2) (B) the covered individual has not undergone 4
23    completed oocyte retrievals, except that if a live birth
24    follows a completed oocyte retrieval, then 2 more
25    completed oocyte retrievals shall be covered; and
26        (3) (C) the procedures are performed at medical

 

 

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1    facilities that conform to the American College of
2    Obstetric and Gynecology guidelines for in vitro
3    fertilization clinics or to the American Fertility Society
4    minimal standards for programs of in vitro fertilization.
5        (2) The procedures required to be covered under this
6    Section are not required to be contained in any policy or
7    plan issued to or by a religious institution or
8    organization or to or by an entity sponsored by a
9    religious institution or organization that finds the
10    procedures required to be covered under this Section to
11    violate its religious and moral teachings and beliefs.
12    (c) As used in this Section, "infertility" means a
13disease, condition, or status characterized by:
14        (1) a failure to establish a pregnancy or to carry a
15    pregnancy to live birth after 12 months of regular,
16    unprotected sexual intercourse if the woman is 35 years of
17    age or younger, or after 6 months of regular, unprotected
18    sexual intercourse if the woman is over 35 years of age;
19    conceiving but having a miscarriage does not restart the
20    12-month or 6-month term for determining infertility;
21        (2) a person's inability to reproduce either as a
22    single individual or with a partner without medical
23    intervention; or
24        (3) a licensed physician's findings based on a
25    patient's medical, sexual, and reproductive history, age,
26    physical findings, or diagnostic testing.

 

 

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1    (d) A policy, contract, or certificate may not impose any
2exclusions, limitations, or other restrictions on coverage of
3fertility medications that are different from those imposed on
4any other prescription medications, nor may it impose any
5exclusions, limitations, or other restrictions on coverage of
6any fertility services based on a covered individual's
7participation in fertility services provided by or to a third
8party, nor may it impose deductibles, copayments, coinsurance,
9benefit maximums, waiting periods, or any other limitations on
10coverage for the diagnosis of infertility, treatment for
11infertility, and standard fertility preservation services,
12except as provided in this Section, that are different from
13those imposed upon benefits for services not related to
14infertility.
15    (e) The procedures required to be covered under this
16Section are not required to be contained in any policy or plan
17issued to or by a religious institution or organization or to
18or by an entity sponsored by a religious institution or
19organization that finds the procedures required to be covered
20under this Section to violate its religious and moral
21teachings and beliefs.
22(Source: P.A. 102-170, eff. 1-1-22.)
 
23    Section 30. The Limited Health Service Organization Act is
24amended by changing Section 4003 as follows:
 

 

 

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1    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
2    Sec. 4003. Illinois Insurance Code provisions. Limited
3health service organizations shall be subject to the
4provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
5141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
6154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2,
7355.3, 355b, 356m, 356q, 356v, 356z.4, 356z.4a, 356z.10,
8356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a,
9356z.32, 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
10356z.54, 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68,
11364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
12444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
13XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
14Nothing in this Section shall require a limited health care
15plan to cover any service that is not a limited health service.
16For purposes of the Illinois Insurance Code, except for
17Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
18health service organizations in the following categories are
19deemed to be domestic companies:
20        (1) a corporation under the laws of this State; or
21        (2) a corporation organized under the laws of another
22    state, 30% or more of the enrollees of which are residents
23    of this State, except a corporation subject to
24    substantially the same requirements in its state of
25    organization as is a domestic company under Article VIII
26    1/2 of the Illinois Insurance Code.

 

 

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1(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
2102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
31-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
4eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
5102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
61-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
7eff. 1-1-24; revised 8-29-23.)
 
8    Section 35. The Voluntary Health Services Plans Act is
9amended by changing Section 10 as follows:
 
10    (215 ILCS 165/10)  (from Ch. 32, par. 604)
11    Sec. 10. Application of Insurance Code provisions. Health
12services plan corporations and all persons interested therein
13or dealing therewith shall be subject to the provisions of
14Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
15143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
16356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t, 356u, 356v,
17356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a,
18356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
19356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22,
20356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
21356z.33, 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
22356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62,
23356z.64, 356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401,
24401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)

 

 

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1and (15) of Section 367 of the Illinois Insurance Code.
2    Rulemaking authority to implement Public Act 95-1045, if
3any, is conditioned on the rules being adopted in accordance
4with all provisions of the Illinois Administrative Procedure
5Act and all rules and procedures of the Joint Committee on
6Administrative Rules; any purported rule not so adopted, for
7whatever reason, is unauthorized.
8(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
9102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
1010-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
11eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
12102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
131-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
14eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
15103-551, eff. 8-11-23; revised 8-29-23.)
 
16    Section 40. The Illinois Public Aid Code is amended by
17changing Section 5-16.8 as follows:
 
18    (305 ILCS 5/5-16.8)
19    Sec. 5-16.8. Required health benefits. The medical
20assistance program shall (i) provide the post-mastectomy care
21benefits required to be covered by a policy of accident and
22health insurance under Section 356t and the coverage required
23under Sections 356g.5, 356m, 356q, 356u, 356w, 356x, 356z.6,
24356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,

 

 

10300HB4112ham001- 16 -LRB103 33223 MXP 69304 a

1356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and
2356z.61, 356z.64, and 356z.67 of the Illinois Insurance Code,
3(ii) be subject to the provisions of Sections 356z.19,
4356z.44, 356z.49, 364.01, 370c, and 370c.1 of the Illinois
5Insurance Code, and (iii) be subject to the provisions of
6subsection (d-5) of Section 10 of the Network Adequacy and
7Transparency Act.
8    The Department, by rule, shall adopt a model similar to
9the requirements of Section 356z.39 of the Illinois Insurance
10Code.
11    On and after July 1, 2012, the Department shall reduce any
12rate of reimbursement for services or other payments or alter
13any methodologies authorized by this Code to reduce any rate
14of reimbursement for services or other payments in accordance
15with Section 5-5e.
16    To ensure full access to the benefits set forth in this
17Section, on and after January 1, 2016, the Department shall
18ensure that provider and hospital reimbursement for
19post-mastectomy care benefits required under this Section are
20no lower than the Medicare reimbursement rate.
21(Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
22102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
231-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
24eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
25102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
261-1-24; 103-420, eff. 1-1-24; revised 12-15-23.)
 

 

 

10300HB4112ham001- 17 -LRB103 33223 MXP 69304 a

1    Section 99. Effective date. This Act takes effect December
231, 2025.".