Illinois General Assembly - Full Text of SB1788
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Full Text of SB1788  102nd General Assembly




State of Illinois
2021 and 2022


Introduced 2/26/2021, by Sen. Laura M. Murphy


215 ILCS 5/356z.43 new
305 ILCS 5/5-16.8

    Amends the Illinois Insurance Code. Provides that no individual or group policy of accident and health insurance or managed care organization shall change an insured's eligibility or coverage during a contract period. Provides that during a contract period, insureds shall have the protection and continuity of their providers, medication, covered benefits, and formulary during the contract period. Amends the Illinois Public Aid Code making conforming changes.

LRB102 11326 BMS 16659 b





SB1788LRB102 11326 BMS 16659 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
5adding Section 356z.43 as follows:
6    (215 ILCS 5/356z.43 new)
7    Sec. 356z.43. Contract terms; coverage. No individual or
8group policy of accident and health insurance or managed care
9organization shall amend, deliver, issue, or renew a policy in
10a way that changes an insured's eligibility or coverage during
11a contract period. During a contract period, an insured shall
12have the protection and continuity of his or her providers,
13his or her medication, his or her covered benefits, and the
14formulary during the contract period.
15    Section 10. The Illinois Public Aid Code is amended by
16changing Section 5-16.8 as follows:
17    (305 ILCS 5/5-16.8)
18    Sec. 5-16.8. Required health benefits. The medical
19assistance program shall (i) provide the post-mastectomy care
20benefits required to be covered by a policy of accident and
21health insurance under Section 356t and the coverage required



SB1788- 2 -LRB102 11326 BMS 16659 b

1under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26,
2356z.29, 356z.32, 356z.33, 356z.34, and 356z.35, and 356z.43
3of the Illinois Insurance Code and (ii) be subject to the
4provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of
5the Illinois Insurance Code.
6    The Department, by rule, shall adopt a model similar to
7the requirements of Section 356z.39 of the Illinois Insurance
9    On and after July 1, 2012, the Department shall reduce any
10rate of reimbursement for services or other payments or alter
11any methodologies authorized by this Code to reduce any rate
12of reimbursement for services or other payments in accordance
13with Section 5-5e.
14    To ensure full access to the benefits set forth in this
15Section, on and after January 1, 2016, the Department shall
16ensure that provider and hospital reimbursement for
17post-mastectomy care benefits required under this Section are
18no lower than the Medicare reimbursement rate.
19(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
20100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
217-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
22eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)