Illinois General Assembly - Bill Status for HB5576

Amends the Illinois Insurance Code. Makes changes to a Section concerning coverage for contraceptives. Provides that an individual or group health policy shall provide coverage for all contraceptive drugs, devices, and other products approved by the United States Food and Drug Administration, including over-the-counter contraceptive drugs, devices, and products; voluntary sterilization procedures; contraceptive services, patient education, and counseling on contraception; and follow-up services related to their use. Provides that if the United States Food and Drug Administration has approved one or more therapeutic equivalent versions of a contraceptive drug, device, or product, a policy is not required to include all therapeutic equivalent versions in its formulary, so long as at least one is included and covered without cost-sharing; if an individual's attending provider recommends a particular service or item approved by the United States Food and Drug Administration based on a determination of medical necessity with respect to that individual, the plan or issuer must cover that service or item without cost sharing and the plan or issuer must defer to the determination of the attending provider; if a drug, device or product is not covered, plans and issuers must have an easily accessible, transparent, and sufficiently expedient process that is not unduly burdensome on the individual or a provider or person acting as a patient's authorized representative to ensure coverage without cost sharing; and that coverage must provide for the dispensing of 12 months' worth of contraception at one time. Defines "contraceptive services", "medical necessity", and "therapeutic equivalent version". Removes language prohibiting the provisions from being construed to require an insurance company cover services related to permanent sterilization requiring a surgical procedure.

Replaces everything after the enacting clause with the introduced bill with the following changes: Provides that the changes in the introduced bill are inoperative with respect to all outlined coverage other than that authorized under Section 1902 of the Social Security Act and the State shall not assume any obligation for the cost of the coverage set forth if, at any time, the Secretary of the United States Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the Federal Register or publishes a comment in the Federal Register or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act to defray the cost of the outlined coverage; in which case, the coverage requirements in existing law shall apply. Makes changes to the definitions of "contraceptive services" and "medical necessity". Excludes male condoms from the coverage requirement. Makes other changes.

Provides that if a plan or issuer utilizes a network of providers, nothing in the provision concerning coverage for contraceptives shall be construed to require coverage or to prohibit the plan or issuer from imposing cost-sharing for certain items or services that are provided or delivered by an out-of-network provider, unless the plan or issuer does not have in its network a provider who is able to or is willing to provide the applicable items or services.

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