103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB3538

 

Introduced 2/9/2024, by Sen. Michael E. Hastings

 

SYNOPSIS AS INTRODUCED:
 
55 ILCS 5/5-1069  from Ch. 34, par. 5-1069
65 ILCS 5/10-4-2.4 new

    Amends the Counties Code and the Illinois Municipal Code. Provides that, if a municipality or county, including a home rule municipality or county, is a self-insurer for purposes of providing health insurance coverage for its employees, the insurance coverage shall include mental health counseling for any employee who is a first responder, including police and corrections officers, deputy sheriffs, firefighters, or emergency medical services personnel, without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided. Specifies that this requirement does not apply to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to the Internal Revenue Code. Preempts home rule.


LRB103 36871 AWJ 66983 b

STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT
MAY APPLY

 

 

A BILL FOR

 

SB3538LRB103 36871 AWJ 66983 b

1    AN ACT concerning local government.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Counties Code is amended by changing
5Section 5-1069 as follows:
 
6    (55 ILCS 5/5-1069)  (from Ch. 34, par. 5-1069)
7    Sec. 5-1069. Group life, health, accident, hospital, and
8medical insurance.
9    (a) The county board of any county may arrange to provide,
10for the benefit of employees of the county, group life,
11health, accident, hospital, and medical insurance, or any one
12or any combination of those types of insurance, or the county
13board may self-insure, for the benefit of its employees, all
14or a portion of the employees' group life, health, accident,
15hospital, and medical insurance, or any one or any combination
16of those types of insurance, including a combination of
17self-insurance and other types of insurance authorized by this
18Section, provided that the county board complies with all
19other requirements of this Section. The insurance may include
20provision for employees who rely on treatment by prayer or
21spiritual means alone for healing in accordance with the
22tenets and practice of a well recognized religious
23denomination. The county board may provide for payment by the

 

 

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1county of a portion or all of the premium or charge for the
2insurance with the employee paying the balance of the premium
3or charge, if any. If the county board undertakes a plan under
4which the county pays only a portion of the premium or charge,
5the county board shall provide for withholding and deducting
6from the compensation of those employees who consent to join
7the plan the balance of the premium or charge for the
8insurance.
9    (b) If the county board does not provide for
10self-insurance or for a plan under which the county pays a
11portion or all of the premium or charge for a group insurance
12plan, the county board may provide for withholding and
13deducting from the compensation of those employees who consent
14thereto the total premium or charge for any group life,
15health, accident, hospital, and medical insurance.
16    (c) The county board may exercise the powers granted in
17this Section only if it provides for self-insurance or, where
18it makes arrangements to provide group insurance through an
19insurance carrier, if the kinds of group insurance are
20obtained from an insurance company authorized to do business
21in the State of Illinois. The county board may enact an
22ordinance prescribing the method of operation of the insurance
23program.
24    (d) If a county, including a home rule county, is a
25self-insurer for purposes of providing health insurance
26coverage for its employees, the insurance coverage shall

 

 

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1include screening by low-dose mammography for all women 35
2years of age or older for the presence of occult breast cancer
3unless the county elects to provide mammograms itself under
4Section 5-1069.1. The coverage shall be as follows:
5        (1) A baseline mammogram for women 35 to 39 years of
6    age.
7        (2) An annual mammogram for women 40 years of age or
8    older.
9        (3) A mammogram at the age and intervals considered
10    medically necessary by the woman's health care provider
11    for women under 40 years of age and having a family history
12    of breast cancer, prior personal history of breast cancer,
13    positive genetic testing, or other risk factors.
14        (4) For a group policy of accident and health
15    insurance that is amended, delivered, issued, or renewed
16    on or after the effective date of this amendatory Act of
17    the 101st General Assembly, a comprehensive ultrasound
18    screening of an entire breast or breasts if a mammogram
19    demonstrates heterogeneous or dense breast tissue or when
20    medically necessary as determined by a physician licensed
21    to practice medicine in all of its branches, advanced
22    practice registered nurse, or physician assistant.
23        (5) For a group policy of accident and health
24    insurance that is amended, delivered, issued, or renewed
25    on or after the effective date of this amendatory Act of
26    the 101st General Assembly, a diagnostic mammogram when

 

 

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1    medically necessary, as determined by a physician licensed
2    to practice medicine in all its branches, advanced
3    practice registered nurse, or physician assistant.
4    A policy subject to this subsection shall not impose a
5deductible, coinsurance, copayment, or any other cost-sharing
6requirement on the coverage provided; except that this
7sentence does not apply to coverage of diagnostic mammograms
8to the extent such coverage would disqualify a high-deductible
9health plan from eligibility for a health savings account
10pursuant to Section 223 of the Internal Revenue Code (26
11U.S.C. 223).
12    For purposes of this subsection:
13    "Diagnostic mammogram" means a mammogram obtained using
14diagnostic mammography.
15    "Diagnostic mammography" means a method of screening that
16is designed to evaluate an abnormality in a breast, including
17an abnormality seen or suspected on a screening mammogram or a
18subjective or objective abnormality otherwise detected in the
19breast.
20    "Low-dose mammography" means the x-ray examination of the
21breast using equipment dedicated specifically for mammography,
22including the x-ray tube, filter, compression device, and
23image receptor, with an average radiation exposure delivery of
24less than one rad per breast for 2 views of an average size
25breast. The term also includes digital mammography.
26    (d-5) Coverage as described by subsection (d) shall be

 

 

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1provided at no cost to the insured and shall not be applied to
2an annual or lifetime maximum benefit.
3    (d-10) When health care services are available through
4contracted providers and a person does not comply with plan
5provisions specific to the use of contracted providers, the
6requirements of subsection (d-5) are not applicable. When a
7person does not comply with plan provisions specific to the
8use of contracted providers, plan provisions specific to the
9use of non-contracted providers must be applied without
10distinction for coverage required by this Section and shall be
11at least as favorable as for other radiological examinations
12covered by the policy or contract.
13    (d-15) If a county, including a home rule county, is a
14self-insurer for purposes of providing health insurance
15coverage for its employees, the insurance coverage shall
16include mastectomy coverage, which includes coverage for
17prosthetic devices or reconstructive surgery incident to the
18mastectomy. Coverage for breast reconstruction in connection
19with a mastectomy shall include:
20        (1) reconstruction of the breast upon which the
21    mastectomy has been performed;
22        (2) surgery and reconstruction of the other breast to
23    produce a symmetrical appearance; and
24        (3) prostheses and treatment for physical
25    complications at all stages of mastectomy, including
26    lymphedemas.

 

 

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1Care shall be determined in consultation with the attending
2physician and the patient. The offered coverage for prosthetic
3devices and reconstructive surgery shall be subject to the
4deductible and coinsurance conditions applied to the
5mastectomy, and all other terms and conditions applicable to
6other benefits. When a mastectomy is performed and there is no
7evidence of malignancy then the offered coverage may be
8limited to the provision of prosthetic devices and
9reconstructive surgery to within 2 years after the date of the
10mastectomy. As used in this Section, "mastectomy" means the
11removal of all or part of the breast for medically necessary
12reasons, as determined by a licensed physician.
13    A county, including a home rule county, that is a
14self-insurer for purposes of providing health insurance
15coverage for its employees, may not penalize or reduce or
16limit the reimbursement of an attending provider or provide
17incentives (monetary or otherwise) to an attending provider to
18induce the provider to provide care to an insured in a manner
19inconsistent with this Section.
20    (d-20) The requirement that mammograms be included in
21health insurance coverage as provided in subsections (d)
22through (d-15) is an exclusive power and function of the State
23and is a denial and limitation under Article VII, Section 6,
24subsection (h) of the Illinois Constitution of home rule
25county powers. A home rule county to which subsections (d)
26through (d-15) apply must comply with every provision of those

 

 

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1subsections.
2    (e) The term "employees" as used in this Section includes
3elected or appointed officials but does not include temporary
4employees.
5    (f) The county board may, by ordinance, arrange to provide
6group life, health, accident, hospital, and medical insurance,
7or any one or a combination of those types of insurance, under
8this Section to retired former employees and retired former
9elected or appointed officials of the county.
10    (g) Rulemaking authority to implement this amendatory Act
11of the 95th General Assembly, if any, is conditioned on the
12rules being adopted in accordance with all provisions of the
13Illinois Administrative Procedure Act and all rules and
14procedures of the Joint Committee on Administrative Rules; any
15purported rule not so adopted, for whatever reason, is
16unauthorized.
17    (h) If a county, including a home rule county, is a
18self-insurer for purposes of providing health insurance
19coverage for its employees, the insurance coverage shall
20include mental health counseling for any employee who is a
21first responder, including police and corrections officers,
22deputy sheriffs, firefighters, or emergency medical services
23personnel, without imposing a deductible, coinsurance,
24copayment, or any other cost-sharing requirement on the
25coverage provided, except that this subsection does not apply
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.
3    The requirement that mental health counseling be included
4in health insurance coverage as provided in this subsection is
5an exclusive power and function of the State and is a denial
6and limitation under Article VII, Section 6, subsection (h) of
7the Illinois Constitution of home rule county powers.
8(Source: P.A. 100-513, eff. 1-1-18; 101-580, eff. 1-1-20.)
 
9    Section 10. The Illinois Municipal Code is amended by
10adding Section 10-4-2.4 as follows:
 
11    (65 ILCS 5/10-4-2.4 new)
12    Sec. 10-4-2.4. Mental health counseling. If a
13municipality, including a home rule municipality, is a
14self-insurer for purposes of providing health insurance
15coverage for its employees, the insurance coverage shall
16include mental health counseling for any employee who is a
17first responder, including police and corrections officers,
18deputy sheriffs, firefighters, or emergency medical services
19personnel, without imposing a deductible, coinsurance,
20copayment, or any other cost-sharing requirement on the
21coverage provided, except that this Section does not apply to
22the extent such coverage would disqualify a high-deductible
23health plan from eligibility for a health savings account
24pursuant to Section 223 of the Internal Revenue Code.

 

 

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1    The requirement that mental health counseling be included
2in health insurance coverage as provided in this Section is an
3exclusive power and function of the State and is a denial and
4limitation under Article VII, Section 6, subsection (h) of the
5Illinois Constitution of home rule powers.