HB5295 EnrolledLRB103 38679 RPS 68816 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.56 as follows:
 
6    (215 ILCS 5/356z.56)
7    Sec. 356z.56. Coverage for hormonal and non-hormonal
8hormone therapy to treat menopause. A group or individual
9policy of accident and health insurance or a managed care plan
10that is amended, delivered, issued, or renewed in this State
11on or after January 1, 2024 shall provide coverage for
12medically necessary hormone therapy treatment to treat
13menopause that has been induced by a hysterectomy. This
14coverage applies only to coverage provided on or after January
151, 2024 and before January 1, 2026.
16    A group or individual policy of accident and health
17insurance or a managed care plan that is amended, delivered,
18issued, or renewed on or after January 1, 2026 shall provide
19coverage for medically necessary hormonal and non-hormonal
20therapy to treat menopausal symptoms if the therapy is
21recommended by a qualified health care provider who is
22licensed, accredited, or certified under Illinois law and the
23therapy has been proven safe and effective in peer-reviewed

 

 

HB5295 Enrolled- 2 -LRB103 38679 RPS 68816 b

1scientific studies. Coverage for therapy to treat menopausal
2symptoms shall include all federal Food and Drug
3Administration-approved modalities of hormonal and
4non-hormonal administration, including, but not limited to,
5oral, transdermal, topical, and vaginal rings.
6(Source: P.A. 102-804, eff. 1-1-23; 103-154, eff. 6-30-23.)
 
7    Section 10. The Illinois Public Aid Code is amended by
8changing Section 5-16.8 and by adding Section 5-52 as follows:
 
9    (305 ILCS 5/5-16.8)
10    Sec. 5-16.8. Required health benefits. The medical
11assistance program shall (i) provide the post-mastectomy care
12benefits required to be covered by a policy of accident and
13health insurance under Section 356t and the coverage required
14under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
15356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
16356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and
17356z.61, 356z.64, and 356z.67 of the Illinois Insurance Code,
18(ii) be subject to the provisions of Sections 356z.19,
19356z.44, 356z.49, 364.01, 370c, and 370c.1 of the Illinois
20Insurance Code, and (iii) be subject to the provisions of
21subsection (d-5) of Section 10 of the Network Adequacy and
22Transparency Act.
23    The Department, by rule, shall adopt a model similar to
24the requirements of Section 356z.39 of the Illinois Insurance

 

 

HB5295 Enrolled- 3 -LRB103 38679 RPS 68816 b

1Code.
2    On and after July 1, 2012, the Department shall reduce any
3rate of reimbursement for services or other payments or alter
4any methodologies authorized by this Code to reduce any rate
5of reimbursement for services or other payments in accordance
6with Section 5-5e.
7    To ensure full access to the benefits set forth in this
8Section, on and after January 1, 2016, the Department shall
9ensure that provider and hospital reimbursement for
10post-mastectomy care benefits required under this Section are
11no lower than the Medicare reimbursement rate.
12(Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
13102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
141-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
15eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
16102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
171-1-24; 103-420, eff. 1-1-24; revised 12-15-23.)
 
18    (305 ILCS 5/5-52 new)
19    Sec. 5-52. Coverage for hormonal therapy to treat
20menopause. The medical assistance program shall provide
21coverage for medically necessary hormone therapy treatment to
22treat menopause that has been induced by a hysterectomy.
 
23    Section 99. Effective date. This Act takes effect January
241, 2026.