Illinois General Assembly - Full Text of HB3845
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Full Text of HB3845  102nd General Assembly

HB3845 102ND GENERAL ASSEMBLY

  
  

 


 
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB3845

 

Introduced 2/22/2021, by Rep. Lindsey LaPointe

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/356z.43 new

    Amends the Illinois Insurance Code to require an insurance policy to provide coverage for medically necessary treatments for genetic, rare, unknown or unnamed, and unique conditions, including Ehlers-Danlos syndrome and altered drug metabolism. Provides that an insurance policy that provides coverage for prescription drugs shall include coverage for opioid alternatives, coverage for medicines included in the Model List of Essential Medicines published by the World Health Organization, and coverage for custom-made medications and medical food. Provides that an insurance policy that limits the quantity of a medication in accordance with applicable State and federal law shall not require pre-approval for the treatment of patients with rare metabolism conditions that may need a higher dose of medication than what is otherwise allowed within a time frame or prescription schedule. Provides that the burden of proving that treatment is medically necessary shall not lie with the insured in cases of rejections for filing claims, preauthorization requests, and appeals related to coverage required under the Section.


LRB102 14127 BMS 19479 b

 

 

A BILL FOR

 

HB3845LRB102 14127 BMS 19479 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. Genetic, rare, and unique conditions;
8medically necessary treatment.
9    (a) An insurance policy amended, delivered, issued, or
10renewed in this State on or after the effective date of this
11amendatory Act of the 102nd General Assembly shall provide
12coverage for medically necessary treatments for genetic, rare,
13unknown or unnamed, and unique conditions, including
14Ehlers-Danlos syndrome and altered drug metabolism.
15    (b) For an insurance policy that provides coverage for
16prescription drugs, the coverage required under subsection (a)
17shall include coverage for opioid alternatives, coverage for
18medicines included in the most recent Model List of Essential
19Medicines published by the World Health Organization, and
20coverage for custom-made medications and medical food.
21    (c) An insurance policy that limits the quantity of a
22medication in accordance with applicable State and federal law
23shall not require pre-approval for the treatment of patients

 

 

HB3845- 2 -LRB102 14127 BMS 19479 b

1with rare metabolism conditions that may need a higher dose of
2medication than what is otherwise allowed within a time frame
3or prescription schedule.
4    (d) The burden of proving that treatment is medically
5necessary shall not lie with the insured in cases of
6rejections for filing claims, preauthorization requests, and
7appeals related to coverage required under this Section.