Illinois General Assembly - Full Text of HB3709
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Full Text of HB3709  102nd General Assembly




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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 356m as follows:
6    (215 ILCS 5/356m)  (from Ch. 73, par. 968m)
7    Sec. 356m. Infertility coverage.
8    (a) No group policy of accident and health insurance
9providing coverage for more than 25 employees that provides
10pregnancy related benefits may be issued, amended, delivered,
11or renewed in this State after the effective date of this
12amendatory Act of the 99th General Assembly unless the policy
13contains coverage for the diagnosis and treatment of
14infertility including, but not limited to, in vitro
15fertilization, uterine embryo lavage, embryo transfer,
16artificial insemination, gamete intrafallopian tube transfer,
17zygote intrafallopian tube transfer, and low tubal ovum
19    (b) The coverage required under subsection (a) is subject
20to the following conditions:
21        (1) Coverage for procedures for in vitro
22    fertilization, gamete intrafallopian tube transfer, or
23    zygote intrafallopian tube transfer shall be required only



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1    if:
2            (A) the covered individual has been unable to
3        attain a viable pregnancy, maintain a viable
4        pregnancy, or sustain a successful pregnancy through
5        reasonable, less costly medically appropriate
6        infertility treatments for which coverage is available
7        under the policy, plan, or contract;
8            (B) the covered individual has not undergone 4
9        completed oocyte retrievals, except that if a live
10        birth follows a completed oocyte retrieval, then 2
11        more completed oocyte retrievals shall be covered; and
12            (C) the procedures are performed at medical
13        facilities that conform to the American College of
14        Obstetric and Gynecology guidelines for in vitro
15        fertilization clinics or to the American Fertility
16        Society minimal standards for programs of in vitro
17        fertilization.
18        (2) The procedures required to be covered under this
19    Section are not required to be contained in any policy or
20    plan issued to or by a religious institution or
21    organization or to or by an entity sponsored by a
22    religious institution or organization that finds the
23    procedures required to be covered under this Section to
24    violate its religious and moral teachings and beliefs.
25    (c) As used in For purpose of this Section, "infertility"
26means a disease, condition, or status characterized by: the



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1inability to conceive after one year of unprotected sexual
2intercourse, the inability to conceive after one year of
3attempts to produce conception, the inability to conceive
4after an individual is diagnosed with a condition affecting
5fertility, or the inability to sustain a successful pregnancy.
6        (1) a failure to establish a pregnancy or to carry a
7    pregnancy to live birth after 12 months of regular,
8    unprotected sexual intercourse if the woman is 35 years of
9    age or younger, or after 6 months of regular, unprotected
10    sexual intercourse if the woman is over 35 years of age;
11    conceiving but having a miscarriage does not restart the
12    12-month or 6-month term for determining infertility;
13        (2) a person's inability to reproduce either as a
14    single individual or with a partner without medical
15    intervention; or
16        (3) a licensed physician's findings based on a
17    patient's medical, sexual, and reproductive history, age,
18    physical findings, or diagnostic testing.
19    (d) A policy, contract, or certificate may not impose any
20exclusions, limitations, or other restrictions on coverage of
21fertility medications that are different from those imposed on
22any other prescription medications, nor may it impose any
23exclusions, limitations, or other restrictions on coverage of
24any fertility services based on a covered individual's
25participation in fertility services provided by or to a third
26party, nor may it impose deductibles, copayments, coinsurance,



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1benefit maximums, waiting periods, or any other limitations on
2coverage for the diagnosis of infertility, treatment for
3infertility, and standard fertility preservation services,
4except as provided in this Section, that are different from
5those imposed upon benefits for services not related to
7(Source: P.A. 99-421, eff. 1-1-16.)