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Public Act 102-0170


 

Public Act 0170 102ND GENERAL ASSEMBLY

  
  
  

 


 
Public Act 102-0170
 
HB3709 EnrolledLRB102 04399 BMS 14417 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Illinois Insurance Code is amended by
changing Section 356m as follows:
 
    (215 ILCS 5/356m)  (from Ch. 73, par. 968m)
    Sec. 356m. Infertility coverage.
    (a) No group policy of accident and health insurance
providing coverage for more than 25 employees that provides
pregnancy related benefits may be issued, amended, delivered,
or renewed in this State after the effective date of this
amendatory Act of the 99th General Assembly unless the policy
contains coverage for the diagnosis and treatment of
infertility including, but not limited to, in vitro
fertilization, uterine embryo lavage, embryo transfer,
artificial insemination, gamete intrafallopian tube transfer,
zygote intrafallopian tube transfer, and low tubal ovum
transfer.
    (b) The coverage required under subsection (a) is subject
to the following conditions:
        (1) Coverage for procedures for in vitro
    fertilization, gamete intrafallopian tube transfer, or
    zygote intrafallopian tube transfer shall be required only
    if:
            (A) the covered individual has been unable to
        attain a viable pregnancy, maintain a viable
        pregnancy, or sustain a successful pregnancy through
        reasonable, less costly medically appropriate
        infertility treatments for which coverage is available
        under the policy, plan, or contract;
            (B) the covered individual has not undergone 4
        completed oocyte retrievals, except that if a live
        birth follows a completed oocyte retrieval, then 2
        more completed oocyte retrievals shall be covered; and
            (C) the procedures are performed at medical
        facilities that conform to the American College of
        Obstetric and Gynecology guidelines for in vitro
        fertilization clinics or to the American Fertility
        Society minimal standards for programs of in vitro
        fertilization.
        (2) The procedures required to be covered under this
    Section are not required to be contained in any policy or
    plan issued to or by a religious institution or
    organization or to or by an entity sponsored by a
    religious institution or organization that finds the
    procedures required to be covered under this Section to
    violate its religious and moral teachings and beliefs.
    (c) As used in For purpose of this Section, "infertility"
means a disease, condition, or status characterized by: the
inability to conceive after one year of unprotected sexual
intercourse, the inability to conceive after one year of
attempts to produce conception, the inability to conceive
after an individual is diagnosed with a condition affecting
fertility, or the inability to sustain a successful pregnancy.
        (1) a failure to establish a pregnancy or to carry a
    pregnancy to live birth after 12 months of regular,
    unprotected sexual intercourse if the woman is 35 years of
    age or younger, or after 6 months of regular, unprotected
    sexual intercourse if the woman is over 35 years of age;
    conceiving but having a miscarriage does not restart the
    12-month or 6-month term for determining infertility;
        (2) a person's inability to reproduce either as a
    single individual or with a partner without medical
    intervention; or
        (3) a licensed physician's findings based on a
    patient's medical, sexual, and reproductive history, age,
    physical findings, or diagnostic testing.
    (d) A policy, contract, or certificate may not impose any
exclusions, limitations, or other restrictions on coverage of
fertility medications that are different from those imposed on
any other prescription medications, nor may it impose any
exclusions, limitations, or other restrictions on coverage of
any fertility services based on a covered individual's
participation in fertility services provided by or to a third
party, nor may it impose deductibles, copayments, coinsurance,
benefit maximums, waiting periods, or any other limitations on
coverage for the diagnosis of infertility, treatment for
infertility, and standard fertility preservation services,
except as provided in this Section, that are different from
those imposed upon benefits for services not related to
infertility.
(Source: P.A. 99-421, eff. 1-1-16.)

Effective Date: 1/1/2022