Public Act 103-0818
 
HB4460 EnrolledLRB103 36625 AWJ 66734 b

    AN ACT concerning government.
 
    Be it enacted by the People of the State of Illinois, 
represented in the General Assembly:
 
    Section 5. The State Employees Group Insurance Act of 1971 
is amended by adding Section 6.11D as follows:
 
    (5 ILCS 375/6.11D new)
    Sec. 6.11D. Joint mental health therapy services.
    (a) The State Employees Group Insurance Program shall 
provide coverage for joint mental health therapy services for 
any Illinois State Police officer or police officer of an 
institution of higher education and any spouse or partner of 
the officer who resides with the officer.
    (b) The joint mental health therapy services provided 
under subsection (a) shall be performed by a physician 
licensed to practice medicine in all of its branches, a 
licensed clinical psychologist, a licensed clinical social 
worker, a licensed clinical professional counselor, a licensed 
marriage and family therapist, a licensed social worker, or a 
licensed professional counselor. 
 
    Section 10. The Counties Code is amended by changing 
Section 5-1069 as follows:
 
    (55 ILCS 5/5-1069)  (from Ch. 34, par. 5-1069)
    Sec. 5-1069. Group life, health, accident, hospital, and 
medical insurance.
    (a) The county board of any county may arrange to provide, 
for the benefit of employees of the county, group life, 
health, accident, hospital, and medical insurance, or any one 
or any combination of those types of insurance, or the county 
board may self-insure, for the benefit of its employees, all 
or a portion of the employees' group life, health, accident, 
hospital, and medical insurance, or any one or any combination 
of those types of insurance, including a combination of 
self-insurance and other types of insurance authorized by this 
Section, provided that the county board complies with all 
other requirements of this Section. The insurance may include 
provision for employees who rely on treatment by prayer or 
spiritual means alone for healing in accordance with the 
tenets and practice of a well recognized religious 
denomination. The county board may provide for payment by the 
county of a portion or all of the premium or charge for the 
insurance with the employee paying the balance of the premium 
or charge, if any. If the county board undertakes a plan under 
which the county pays only a portion of the premium or charge, 
the county board shall provide for withholding and deducting 
from the compensation of those employees who consent to join 
the plan the balance of the premium or charge for the 
insurance.
    (b) If the county board does not provide for 
self-insurance or for a plan under which the county pays a 
portion or all of the premium or charge for a group insurance 
plan, the county board may provide for withholding and 
deducting from the compensation of those employees who consent 
thereto the total premium or charge for any group life, 
health, accident, hospital, and medical insurance.
    (c) The county board may exercise the powers granted in 
this Section only if it provides for self-insurance or, where 
it makes arrangements to provide group insurance through an 
insurance carrier, if the kinds of group insurance are 
obtained from an insurance company authorized to do business 
in the State of Illinois. The county board may enact an 
ordinance prescribing the method of operation of the insurance 
program.
    (d) If a county, including a home rule county, is a 
self-insurer for purposes of providing health insurance 
coverage for its employees, the insurance coverage shall 
include screening by low-dose mammography for all women 35 
years of age or older for the presence of occult breast cancer 
unless the county elects to provide mammograms itself under 
Section 5-1069.1. The coverage shall be as follows:
        (1) A baseline mammogram for women 35 to 39 years of 
    age.
        (2) An annual mammogram for women 40 years of age or 
    older.
        (3) A mammogram at the age and intervals considered 
    medically necessary by the woman's health care provider 
    for women under 40 years of age and having a family history 
    of breast cancer, prior personal history of breast cancer, 
    positive genetic testing, or other risk factors.
        (4) For a group policy of accident and health 
    insurance that is amended, delivered, issued, or renewed 
    on or after the effective date of this amendatory Act of 
    the 101st General Assembly, a comprehensive ultrasound 
    screening of an entire breast or breasts if a mammogram 
    demonstrates heterogeneous or dense breast tissue or when 
    medically necessary as determined by a physician licensed 
    to practice medicine in all of its branches, advanced 
    practice registered nurse, or physician assistant. 
        (5) For a group policy of accident and health 
    insurance that is amended, delivered, issued, or renewed 
    on or after the effective date of this amendatory Act of 
    the 101st General Assembly, a diagnostic mammogram when 
    medically necessary, as determined by a physician licensed 
    to practice medicine in all its branches, advanced 
    practice registered nurse, or physician assistant. 
    A policy subject to this subsection shall not impose a 
deductible, coinsurance, copayment, or any other cost-sharing 
requirement on the coverage provided; except that this 
sentence does not apply to coverage of diagnostic mammograms 
to the extent such coverage would disqualify a high-deductible 
health plan from eligibility for a health savings account 
pursuant to Section 223 of the Internal Revenue Code (26 
U.S.C. 223). 
    For purposes of this subsection:
    "Diagnostic mammogram" means a mammogram obtained using 
diagnostic mammography.
    "Diagnostic mammography" means a method of screening that 
is designed to evaluate an abnormality in a breast, including 
an abnormality seen or suspected on a screening mammogram or a 
subjective or objective abnormality otherwise detected in the 
breast.
    "Low-dose mammography" means the x-ray examination of the 
breast using equipment dedicated specifically for mammography, 
including the x-ray tube, filter, compression device, and 
image receptor, with an average radiation exposure delivery of 
less than one rad per breast for 2 views of an average size 
breast. The term also includes digital mammography.
    (d-5) Coverage as described by subsection (d) shall be 
provided at no cost to the insured and shall not be applied to 
an annual or lifetime maximum benefit.
    (d-10) When health care services are available through 
contracted providers and a person does not comply with plan 
provisions specific to the use of contracted providers, the 
requirements of subsection (d-5) are not applicable. When a 
person does not comply with plan provisions specific to the 
use of contracted providers, plan provisions specific to the 
use of non-contracted providers must be applied without 
distinction for coverage required by this Section and shall be 
at least as favorable as for other radiological examinations 
covered by the policy or contract.
    (d-15) If a county, including a home rule county, is a 
self-insurer for purposes of providing health insurance 
coverage for its employees, the insurance coverage shall 
include mastectomy coverage, which includes coverage for 
prosthetic devices or reconstructive surgery incident to the 
mastectomy. Coverage for breast reconstruction in connection 
with a mastectomy shall include:
        (1) reconstruction of the breast upon which the 
    mastectomy has been performed;
        (2) surgery and reconstruction of the other breast to 
    produce a symmetrical appearance; and
        (3) prostheses and treatment for physical 
    complications at all stages of mastectomy, including 
    lymphedemas.
Care shall be determined in consultation with the attending 
physician and the patient. The offered coverage for prosthetic 
devices and reconstructive surgery shall be subject to the 
deductible and coinsurance conditions applied to the 
mastectomy, and all other terms and conditions applicable to 
other benefits. When a mastectomy is performed and there is no 
evidence of malignancy then the offered coverage may be 
limited to the provision of prosthetic devices and 
reconstructive surgery to within 2 years after the date of the 
mastectomy. As used in this Section, "mastectomy" means the 
removal of all or part of the breast for medically necessary 
reasons, as determined by a licensed physician.
    A county, including a home rule county, that is a 
self-insurer for purposes of providing health insurance 
coverage for its employees, may not penalize or reduce or 
limit the reimbursement of an attending provider or provide 
incentives (monetary or otherwise) to an attending provider to 
induce the provider to provide care to an insured in a manner 
inconsistent with this Section. 
    (d-20) The requirement that mammograms be included in 
health insurance coverage as provided in subsections (d) 
through (d-15) is an exclusive power and function of the State 
and is a denial and limitation under Article VII, Section 6, 
subsection (h) of the Illinois Constitution of home rule 
county powers. A home rule county to which subsections (d) 
through (d-15) apply must comply with every provision of those 
subsections.
    (d-25) If a county, including a home rule county, is a 
self-insurer for purposes of providing health insurance 
coverage, the insurance coverage shall include joint mental 
health therapy services for any member of the Sheriff's 
office, including the sheriff, and any spouse or partner of 
the member who resides with the member. 
    The joint mental health therapy services provided under 
this subsection shall be performed by a physician licensed to 
practice medicine in all of its branches, a licensed clinical 
psychologist, a licensed clinical social worker, a licensed 
clinical professional counselor, a licensed marriage and 
family therapist, a licensed social worker, or a licensed 
professional counselor. 
    This subsection is a limitation under subsection (i) of 
Section 6 of Article VII of the Illinois Constitution on the 
concurrent exercise by home rule units of powers and functions 
exercised by the State. 
    (e) The term "employees" as used in this Section includes 
elected or appointed officials but does not include temporary 
employees.
    (f) The county board may, by ordinance, arrange to provide 
group life, health, accident, hospital, and medical insurance, 
or any one or a combination of those types of insurance, under 
this Section to retired former employees and retired former 
elected or appointed officials of the county.
    (g) Rulemaking authority to implement this amendatory Act 
of the 95th General Assembly, if any, is conditioned on the 
rules being adopted in accordance with all provisions of the 
Illinois Administrative Procedure Act and all rules and 
procedures of the Joint Committee on Administrative Rules; any 
purported rule not so adopted, for whatever reason, is 
unauthorized. 
(Source: P.A. 100-513, eff. 1-1-18; 101-580, eff. 1-1-20.)
 
    Section 15. The Illinois Municipal Code is amended by 
changing Section 10-4-2 as follows:
 
    (65 ILCS 5/10-4-2)  (from Ch. 24, par. 10-4-2)
    Sec. 10-4-2. Group insurance. 
    (a) The corporate authorities of any municipality may 
arrange to provide, for the benefit of employees of the 
municipality, group life, health, accident, hospital, and 
medical insurance, or any one or any combination of those 
types of insurance, and may arrange to provide that insurance 
for the benefit of the spouses or dependents of those 
employees. The insurance may include provision for employees 
or other insured persons who rely on treatment by prayer or 
spiritual means alone for healing in accordance with the 
tenets and practice of a well recognized religious 
denomination. The corporate authorities may provide for 
payment by the municipality of a portion of the premium or 
charge for the insurance with the employee paying the balance 
of the premium or charge. If the corporate authorities 
undertake a plan under which the municipality pays a portion 
of the premium or charge, the corporate authorities shall 
provide for withholding and deducting from the compensation of 
those municipal employees who consent to join the plan the 
balance of the premium or charge for the insurance.
    (b) If the corporate authorities do not provide for a plan 
under which the municipality pays a portion of the premium or 
charge for a group insurance plan, the corporate authorities 
may provide for withholding and deducting from the 
compensation of those employees who consent thereto the 
premium or charge for any group life, health, accident, 
hospital, and medical insurance.
    (c) The corporate authorities may exercise the powers 
granted in this Section only if the kinds of group insurance 
are obtained from an insurance company authorized to do 
business in the State of Illinois, or are obtained through an 
intergovernmental joint self-insurance pool as authorized 
under the Intergovernmental Cooperation Act. The corporate 
authorities may enact an ordinance prescribing the method of 
operation of the insurance program.
    (d) If a municipality, including a home rule municipality, 
is a self-insurer for purposes of providing health insurance 
coverage for its employees, the insurance coverage shall 
include screening by low-dose mammography for all women 35 
years of age or older for the presence of occult breast cancer 
unless the municipality elects to provide mammograms itself 
under Section 10-4-2.1. The coverage shall be as follows:
        (1) A baseline mammogram for women 35 to 39 years of 
    age.
        (2) An annual mammogram for women 40 years of age or 
    older.
        (3) A mammogram at the age and intervals considered 
    medically necessary by the woman's health care provider 
    for women under 40 years of age and having a family history 
    of breast cancer, prior personal history of breast cancer, 
    positive genetic testing, or other risk factors.
        (4) For a group policy of accident and health 
    insurance that is amended, delivered, issued, or renewed 
    on or after the effective date of this amendatory Act of 
    the 101st General Assembly, a comprehensive ultrasound 
    screening of an entire breast or breasts if a mammogram 
    demonstrates heterogeneous or dense breast tissue or when 
    medically necessary as determined by a physician licensed 
    to practice medicine in all of its branches. 
        (5) For a group policy of accident and health 
    insurance that is amended, delivered, issued, or renewed 
    on or after the effective date of this amendatory Act of 
    the 101st General Assembly, a diagnostic mammogram when 
    medically necessary, as determined by a physician licensed 
    to practice medicine in all its branches, advanced 
    practice registered nurse, or physician assistant. 
    A policy subject to this subsection shall not impose a 
deductible, coinsurance, copayment, or any other cost-sharing 
requirement on the coverage provided; except that this 
sentence does not apply to coverage of diagnostic mammograms 
to the extent such coverage would disqualify a high-deductible 
health plan from eligibility for a health savings account 
pursuant to Section 223 of the Internal Revenue Code (26 
U.S.C. 223). 
    For purposes of this subsection:
    "Diagnostic mammogram" means a mammogram obtained using 
diagnostic mammography.
    "Diagnostic mammography" means a method of screening that 
is designed to evaluate an abnormality in a breast, including 
an abnormality seen or suspected on a screening mammogram or a 
subjective or objective abnormality otherwise detected in the 
breast.
    "Low-dose mammography" means the x-ray examination of the 
breast using equipment dedicated specifically for mammography, 
including the x-ray tube, filter, compression device, and 
image receptor, with an average radiation exposure delivery of 
less than one rad per breast for 2 views of an average size 
breast. The term also includes digital mammography.
    (d-5) Coverage as described by subsection (d) shall be 
provided at no cost to the insured and shall not be applied to 
an annual or lifetime maximum benefit.
    (d-10) When health care services are available through 
contracted providers and a person does not comply with plan 
provisions specific to the use of contracted providers, the 
requirements of subsection (d-5) are not applicable. When a 
person does not comply with plan provisions specific to the 
use of contracted providers, plan provisions specific to the 
use of non-contracted providers must be applied without 
distinction for coverage required by this Section and shall be 
at least as favorable as for other radiological examinations 
covered by the policy or contract.
    (d-15) If a municipality, including a home rule 
municipality, is a self-insurer for purposes of providing 
health insurance coverage for its employees, the insurance 
coverage shall include mastectomy coverage, which includes 
coverage for prosthetic devices or reconstructive surgery 
incident to the mastectomy. Coverage for breast reconstruction 
in connection with a mastectomy shall include:
        (1) reconstruction of the breast upon which the 
    mastectomy has been performed;
        (2) surgery and reconstruction of the other breast to 
    produce a symmetrical appearance; and
        (3) prostheses and treatment for physical 
    complications at all stages of mastectomy, including 
    lymphedemas.
Care shall be determined in consultation with the attending 
physician and the patient. The offered coverage for prosthetic 
devices and reconstructive surgery shall be subject to the 
deductible and coinsurance conditions applied to the 
mastectomy, and all other terms and conditions applicable to 
other benefits. When a mastectomy is performed and there is no 
evidence of malignancy then the offered coverage may be 
limited to the provision of prosthetic devices and 
reconstructive surgery to within 2 years after the date of the 
mastectomy. As used in this Section, "mastectomy" means the 
removal of all or part of the breast for medically necessary 
reasons, as determined by a licensed physician.
    A municipality, including a home rule municipality, that 
is a self-insurer for purposes of providing health insurance 
coverage for its employees, may not penalize or reduce or 
limit the reimbursement of an attending provider or provide 
incentives (monetary or otherwise) to an attending provider to 
induce the provider to provide care to an insured in a manner 
inconsistent with this Section. 
    (d-20) The requirement that mammograms be included in 
health insurance coverage as provided in subsections (d) 
through (d-15) is an exclusive power and function of the State 
and is a denial and limitation under Article VII, Section 6, 
subsection (h) of the Illinois Constitution of home rule 
municipality powers. A home rule municipality to which 
subsections (d) through (d-15) apply must comply with every 
provision of those subsections.
    (d-25) If a municipality, including a home rule 
municipality, is a self-insurer for purposes of providing 
health insurance coverage for its employees, the insurance 
coverage shall include joint mental health therapy services 
for any member of the municipality's police department or fire 
department and any spouse or partner of the member who resides 
with the member.
    The joint mental health therapy services provided under 
this subsection shall be performed by a physician licensed to 
practice medicine in all of its branches, a licensed clinical 
psychologist, a licensed clinical social worker, a licensed 
clinical professional counselor, a licensed marriage and 
family therapist, a licensed social worker, or a licensed 
professional counselor.
    This subsection is a limitation under subsection (i) of 
Section 6 of Article VII of the Illinois Constitution on the 
concurrent exercise by home rule units of powers and functions 
exercised by the State. 
    (e) Rulemaking authority to implement Public Act 95-1045, 
if any, is conditioned on the rules being adopted in 
accordance with all provisions of the Illinois Administrative 
Procedure Act and all rules and procedures of the Joint 
Committee on Administrative Rules; any purported rule not so 
adopted, for whatever reason, is unauthorized. 
(Source: P.A. 100-863, eff. 8-14-18; 101-580, eff. 1-1-20.)
 
    Section 20. The Fire Protection District Act is amended by 
adding Section 6.3 as follows:
 
    (70 ILCS 705/6.3 new)
    Sec. 6.3. Health insurance; joint mental health therapy 
services. If a fire protection district is a self-insurer for 
purposes of providing health insurance coverage for officers 
and members of the fire department, the insurance coverage 
shall include joint mental health therapy services for any 
officer or member of the fire department and any spouse or 
partner of the officer or member who resides with the officer 
or member. The joint mental health therapy services provided 
under this Section shall be performed by a physician licensed 
to practice medicine in all of its branches, a licensed 
clinical psychologist, a licensed clinical social worker, a 
licensed clinical professional counselor, a licensed marriage 
and family therapist, a licensed social worker, or a licensed 
professional counselor.
 
    Section 99. Effective date. This Act takes effect January 
1, 2025.

Effective Date:  1/1/2025