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| Public Act 103-0951 | ||||
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AN ACT concerning regulation. | ||||
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 changing Section 6.11 as follows: | ||||
(5 ILCS 375/6.11) | ||||
Sec. 6.11. Required health benefits; Illinois Insurance | ||||
Code requirements. The program of health benefits shall | ||||
provide the post-mastectomy care benefits required to be | ||||
covered by a policy of accident and health insurance under | ||||
Section 356t of the Illinois Insurance Code. The program of | ||||
health benefits shall provide the coverage required under | ||||
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, | ||||
356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, | ||||
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, | ||||
356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, | ||||
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, | ||||
356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, | ||||
356z.60, and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, | ||||
and 356z.70 of the Illinois Insurance Code. The program of | ||||
health benefits must comply with Sections 155.22a, 155.37, | ||||
355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the | ||||
Illinois Insurance Code. The program of health benefits shall | ||||
provide the coverage required under Section 356m of the | ||
Illinois Insurance Code and, for the employees of the State | ||
Employee Group Insurance Program only, the coverage as also | ||
provided in Section 6.11B of this Act. The Department of | ||
Insurance shall enforce the requirements of this Section with | ||
respect to Sections 370c and 370c.1 of the Illinois Insurance | ||
Code; all other requirements of this Section shall be enforced | ||
by the Department of Central Management Services. | ||
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. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. | ||
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768, | ||
eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | ||
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | ||
1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84, | ||
eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24; | ||
103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff. | ||
8-11-23; revised 8-29-23.) | ||
Section 10. The Illinois Insurance Code is amended by | ||
changing Section 356z.5 as follows: | ||
(215 ILCS 5/356z.5) | ||
Sec. 356z.5. Prescription inhalants. | ||
(a) In this Section, "prescription inhaler" means a | ||
prescribed medical device that delivers inhaled medications | ||
used to treat breathing for persons suffering from asthma or | ||
other life-threatening bronchial ailments. "Prescription | ||
inhaler" includes metered-dose inhalers, nebulizers, and dry | ||
powder inhalers. "Prescription inhaler" does not include | ||
inhalers available over the counter without a prescription to | ||
provide temporary relief from respiratory symptoms. | ||
(b) A group or individual policy of accident and health | ||
insurance or managed care plan amended, delivered, issued, or | ||
renewed through December 31, 2025 after the effective date of | ||
this amendatory Act of the 93rd General Assembly that provides | ||
coverage for prescription drugs may not deny or limit coverage | ||
for prescription inhalers inhalants to enable persons to | ||
breathe when suffering from asthma or other life-threatening | ||
bronchial ailments based upon any restriction on the number of | ||
days before an inhaler refill may be obtained if, contrary to | ||
those restrictions, the inhalants have been ordered or | ||
prescribed by the treating physician and are medically | ||
appropriate. | ||
(c) A group or individual policy of accident and health | ||
insurance or managed care plan amended, delivered, issued, or | ||
renewed on or after January 1, 2026 that provides coverage for | ||
prescription drugs may not deny or limit, except as otherwise | ||
provided in this subsection, coverage for prescription | ||
inhalers to enable persons to breathe when suffering from | ||
asthma or other life-threatening bronchial ailments based upon | ||
any restriction on the number of days before an inhaler refill | ||
may be obtained if, contrary to those restrictions, the | ||
inhalants have been ordered or prescribed by the treating | ||
physician and are medically appropriate. A group or individual | ||
policy of accident and health insurance or managed care plan | ||
subject to this subsection shall limit the total amount that a | ||
covered person is required to pay for a covered prescription | ||
inhaler to an amount not to exceed $25 per 30-day supply. | ||
(d) Nothing in this Section prevents a group or individual | ||
policy of accident and health insurance or managed care plan | ||
from reducing a covered person's cost sharing to an amount | ||
less than the amount specified in subsection (c). | ||
(e) Coverage for prescription inhalers shall not be | ||
subject to any deductible; except that this provision does not | ||
apply 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). | ||
(f) The Department may adopt rules necessary to implement | ||
and administer this Section and to align with federal | ||
requirements. The Department may use any of its enforcement | ||
powers to obtain a group or individual policy of accident and | ||
health insurance's or managed care plan's compliance with this | ||
Section. | ||
(Source: P.A. 95-331, eff. 8-21-07.) | ||