Full Text of SB2901 99th General Assembly
SB2901ham002 99TH GENERAL ASSEMBLY | Rep. Elaine Nekritz Filed: 11/14/2016
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| 1 | | AMENDMENT TO SENATE BILL 2901
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 2901, AS AMENDED, | 3 | | by replacing everything after the enacting clause with the | 4 | | following:
| 5 | | "Section 5. The Illinois Insurance Code is amended by | 6 | | changing Section 356z.4 as follows:
| 7 | | (215 ILCS 5/356z.4)
| 8 | | (Text of Section before amendment by P.A. 99-672 )
| 9 | | Sec. 356z.4. Coverage for contraceptives.
| 10 | | (a) An individual or group policy of accident and health | 11 | | insurance amended,
delivered, issued, or renewed in this State | 12 | | after the effective date of this
amendatory Act of the 93rd | 13 | | General Assembly that provides coverage for
outpatient | 14 | | services and outpatient prescription drugs or devices must | 15 | | provide
coverage for the insured and any
dependent of the
| 16 | | insured covered by the policy for all outpatient contraceptive |
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| 1 | | services and
all outpatient contraceptive drugs and devices | 2 | | approved by the Food and
Drug Administration. Coverage required | 3 | | under this Section may not impose any
deductible, coinsurance, | 4 | | waiting period, or other cost-sharing or limitation
that is | 5 | | greater than that required for any outpatient service or | 6 | | outpatient
prescription drug or device otherwise covered by the | 7 | | policy.
| 8 | | (b) As used in this Section, "outpatient contraceptive | 9 | | service" means
consultations, examinations, procedures, and | 10 | | medical services, provided on an
outpatient basis and related | 11 | | to the use of contraceptive methods (including
natural family | 12 | | planning) to prevent an unintended pregnancy.
| 13 | | (c) Nothing in this Section shall be construed to require | 14 | | an insurance
company to cover services related to an abortion | 15 | | as the term "abortion" is
defined in the Illinois Abortion Law | 16 | | of 1975.
| 17 | | (d) Nothing in this Section shall be construed to require | 18 | | an insurance
company to cover services related to permanent | 19 | | sterilization that requires a
surgical procedure.
| 20 | | (Source: P.A. 95-331, eff. 8-21-07.)
| 21 | | (Text of Section after amendment by P.A. 99-672 )
| 22 | | Sec. 356z.4. Coverage for contraceptives. | 23 | | (a)(1) The General Assembly hereby finds and declares all | 24 | | of the following: | 25 | | (A) Illinois has a long history of expanding timely |
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| 1 | | access to birth control to prevent unintended pregnancy. | 2 | | (B) The federal Patient Protection and Affordable Care | 3 | | Act includes a contraceptive coverage guarantee as part of | 4 | | a broader requirement for health insurance to cover key | 5 | | preventive care services without out-of-pocket costs for | 6 | | patients. | 7 | | (C) The General Assembly intends to build on existing | 8 | | State and federal law to promote gender equity and women's | 9 | | health and to ensure greater contraceptive coverage equity | 10 | | and timely access to all federal Food and Drug | 11 | | Administration approved methods of birth control for all | 12 | | individuals covered by an individual or group health | 13 | | insurance policy in Illinois. | 14 | | (D) Medical management techniques such as denials, | 15 | | step therapy, or prior authorization in public and private | 16 | | health care coverage can impede access to the most | 17 | | effective contraceptive methods. | 18 | | (2) As used in this subsection (a): | 19 | | "Contraceptive services" includes consultations, | 20 | | examinations, procedures, and medical services related to the | 21 | | use of contraceptive methods (including natural family | 22 | | planning) to prevent an unintended pregnancy. | 23 | | "Medical necessity", for the purposes of this subsection | 24 | | (a), includes, but is not limited to, considerations such as | 25 | | severity of side effects, differences in permanence and | 26 | | reversibility of contraceptive, and ability to adhere to the |
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| 1 | | appropriate use of the item or service, as determined by the | 2 | | attending provider. | 3 | | "Therapeutic equivalent version" means drugs, devices, or | 4 | | products that can be expected to have the same clinical effect | 5 | | and safety profile when administered to patients under the | 6 | | conditions specified in the labeling and satisfy the following | 7 | | general criteria: | 8 | | (i) they are approved as safe and effective; | 9 | | (ii) they are pharmaceutical equivalents in that they | 10 | | (A) contain identical amounts of the same active drug | 11 | | ingredient in the same dosage form and route of | 12 | | administration and (B) meet compendial or other applicable | 13 | | standards of strength, quality, purity, and identity; | 14 | | (iii) they are bioequivalent in that (A) they do not | 15 | | present a known or potential bioequivalence problem and | 16 | | they meet an acceptable in vitro standard or (B) if they do | 17 | | present such a known or potential problem, they are shown | 18 | | to meet an appropriate bioequivalence standard; | 19 | | (iv) they are adequately labeled; and | 20 | | (v) they are manufactured in compliance with Current | 21 | | Good Manufacturing Practice regulations. | 22 | | (3) An individual or group policy of accident and health | 23 | | insurance amended,
delivered, issued, or renewed in this State | 24 | | on or after January 1, 2017 ( the effective date of Public Act | 25 | | 99-672) this amendatory Act of the 99th General Assembly shall | 26 | | provide coverage for all of the following services and |
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| 1 | | contraceptive methods: | 2 | | (A) All contraceptive drugs, devices, and other | 3 | | products approved by the United States Food and Drug | 4 | | Administration. This includes all over-the-counter | 5 | | contraceptive drugs, devices, and products approved by the | 6 | | United States Food and Drug Administration, excluding male | 7 | | condoms. The following apply: | 8 | | (i) If the United States Food and Drug | 9 | | Administration has approved one or more therapeutic | 10 | | equivalent versions of a contraceptive drug, device, | 11 | | or product, a policy is not required to include all | 12 | | such therapeutic equivalent versions in its formulary, | 13 | | so long as at least one is included and covered without | 14 | | cost-sharing and in accordance with this Section. | 15 | | (ii) If an individual's attending provider | 16 | | recommends a particular service or item approved by the | 17 | | United States Food and Drug Administration based on a | 18 | | determination of medical necessity with respect to | 19 | | that individual, the plan or issuer must cover that | 20 | | service or item without cost sharing. The plan or | 21 | | issuer must defer to the determination of the attending | 22 | | provider. | 23 | | (iii) If a drug, device, or product is not covered, | 24 | | plans and issuers must have an easily accessible, | 25 | | transparent, and sufficiently expedient process that | 26 | | is not unduly burdensome on the individual or a |
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| 1 | | provider or other individual acting as a patient's | 2 | | authorized representative to ensure coverage without | 3 | | cost sharing. | 4 | | (iv) This coverage must provide for the dispensing | 5 | | of 12 months' worth of contraception at one time. | 6 | | (B) Voluntary sterilization procedures. | 7 | | (C) Contraceptive services, patient education, and | 8 | | counseling on contraception. | 9 | | (D) Follow-up services related to the drugs, devices, | 10 | | products, and procedures covered under this Section, | 11 | | including, but not limited to, management of side effects, | 12 | | counseling for continued adherence, and device insertion | 13 | | and removal. | 14 | | (4) Except as otherwise provided in this subsection (a), a | 15 | | policy subject to this subsection (a) shall not impose a | 16 | | deductible, coinsurance, copayment, or any other cost-sharing | 17 | | requirement on the coverage provided. | 18 | | (5) Except as otherwise authorized under this subsection | 19 | | (a), a policy shall not impose any restrictions or delays on | 20 | | the coverage required under this subsection (a). | 21 | | (6) If, at any time, the Secretary of the United States | 22 | | Department of Health and Human Services, or its successor | 23 | | agency, promulgates rules or regulations to be published in the | 24 | | Federal Register or publishes a comment in the Federal Register | 25 | | or issues an opinion, guidance, or other action that would | 26 | | require the State, pursuant to any provision of the Patient |
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| 1 | | Protection and Affordable Care Act (Public Law 111-148), | 2 | | including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any | 3 | | successor provision, to defray the cost of any coverage | 4 | | outlined in this subsection (a), then this subsection (a) is | 5 | | inoperative with respect to all coverage outlined in this | 6 | | subsection (a) other than that authorized under Section 1902 of | 7 | | the Social Security Act, 42 U.S.C. 1396a, and the State shall | 8 | | not assume any obligation for the cost of the coverage set | 9 | | forth in this subsection (a). | 10 | | (b) This subsection (b) shall become operative if and only | 11 | | if subsection (a) becomes inoperative. | 12 | | An individual or group policy of accident and health | 13 | | insurance amended,
delivered, issued, or renewed in this State | 14 | | after the date this subsection (b) becomes operative that | 15 | | provides coverage for
outpatient services and outpatient | 16 | | prescription drugs or devices must provide
coverage for the | 17 | | insured and any
dependent of the
insured covered by the policy | 18 | | for all outpatient contraceptive services and
all outpatient | 19 | | contraceptive drugs and devices approved by the Food and
Drug | 20 | | Administration. Coverage required under this Section may not | 21 | | impose any
deductible, coinsurance, waiting period, or other | 22 | | cost-sharing or limitation
that is greater than that required | 23 | | for any outpatient service or outpatient
prescription drug or | 24 | | device otherwise covered by the policy.
| 25 | | Nothing in this subsection (b) shall be construed to | 26 | | require an insurance
company to cover services related to |
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| 1 | | permanent sterilization that requires a
surgical procedure. | 2 | | As used in this subsection (b), "outpatient contraceptive | 3 | | service" means
consultations, examinations, procedures, and | 4 | | medical services, provided on an
outpatient basis and related | 5 | | to the use of contraceptive methods (including
natural family | 6 | | planning) to prevent an unintended pregnancy.
| 7 | | (c) Nothing in this Section shall be construed to require | 8 | | an insurance
company to cover services related to an abortion | 9 | | as the term "abortion" is
defined in the Illinois Abortion Law | 10 | | of 1975.
| 11 | | (d) If a plan or issuer utilizes a network of providers, | 12 | | nothing in this Section shall be construed to require coverage | 13 | | or to prohibit the plan or issuer from imposing cost-sharing | 14 | | for items or services described in this Section that are | 15 | | provided or delivered by an out-of-network provider, unless the | 16 | | plan or issuer does not have in its network a provider who is | 17 | | able to or is willing to provide the applicable items or | 18 | | services.
| 19 | | (Source: P.A. 99-672, eff. 1-1-17.)
| 20 | | Section 95. No acceleration or delay. Where this Act makes | 21 | | changes in a statute that is represented in this Act by text | 22 | | that is not yet or no longer in effect (for example, a Section | 23 | | represented by multiple versions), the use of that text does | 24 | | not accelerate or delay the taking effect of (i) the changes | 25 | | made by this Act or (ii) provisions derived from any other |
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| 1 | | Public Act.
| 2 | | Section 99. Effective date. This Act takes effect upon | 3 | | becoming law.".
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