(215 ILCS 5/356z.56) (Text of Section before amendment by P.A. 104-793)
Sec. 356z.56. Coverage for hormonal and non-hormonal therapy to treat menopause. A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed in this State shall provide coverage for medically necessary hormone therapy treatment to treat menopause that has been induced by a hysterectomy. This coverage applies only to coverage provided on or after January 1, 2024 and before January 1, 2026. A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for medically necessary hormonal and non-hormonal therapy to treat menopausal symptoms if the therapy is recommended by a qualified health care provider who is licensed, accredited, or certified under Illinois law and the therapy has been proven safe and effective in peer-reviewed scientific studies. Coverage for therapy to treat menopausal symptoms shall include all federal Food and Drug Administration-approved modalities of hormonal and non-hormonal administration, including, but not limited to, oral, transdermal, topical, and vaginal rings. (Source: P.A. 102-804, eff. 1-1-23; 103-154, eff. 6-30-23; 103-703, eff. 1-1-26.) (Text of Section after amendment by P.A. 104-793) Sec. 356z.56. Coverage for hormonal and non-hormonal therapy to treat menopause and perimenopause. A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed in this State shall provide coverage for medically necessary hormone therapy treatment to treat menopause that has been induced by a hysterectomy. This coverage applies only to coverage provided on or after January 1, 2024 and before January 1, 2026. A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for medically necessary hormonal and non-hormonal therapy to treat menopausal and perimenopausal symptoms or conditions if the therapy is recommended by a qualified health care provider who is licensed, accredited, or certified under Illinois law and the therapy has been proven safe and effective in peer-reviewed scientific studies and is prescribed in accordance with current evidence-based guidelines. Coverage for therapy to treat menopausal and perimenopausal symptoms or conditions shall include all federal Food and Drug Administration-approved modalities of hormonal and non-hormonal administration, including, but not limited to, oral, transdermal, topical, and vaginal rings. Coverage shall include medications for menopause-related osteoporosis and non-hormonal therapies for vasomotor symptoms. (Source: P.A. 103-154, eff. 6-30-23; 103-703, eff. 1-1-26; 104-793, eff. 1-1-28.)