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| Public Act 102-0170 | ||||
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Illinois Insurance Code is amended by | ||||
changing Section 356m as follows:
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(215 ILCS 5/356m) (from Ch. 73, par. 968m)
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Sec. 356m. Infertility coverage.
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(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
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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.
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(b) The coverage required under subsection (a) is subject | ||||
to the following conditions:
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(1) Coverage for procedures for in vitro | ||||
fertilization, gamete
intrafallopian tube transfer, or | ||||
zygote intrafallopian tube transfer shall
be required only | ||||
if:
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(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
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infertility treatments for which coverage is available | ||
under the policy,
plan, or contract;
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(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
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(C) the procedures are performed at medical | ||
facilities that conform to
the American College of | ||
Obstetric and Gynecology guidelines for in vitro
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fertilization clinics or to the American Fertility | ||
Society minimal
standards for programs of in vitro | ||
fertilization.
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(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.
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(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.
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(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.)
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