Chapter 215, INSURANCE

(215 ILCS 5/356t) Sec. 356t. Post-mastectomy care. An individual or group policy of accident and health insurance or managed care plan that provides surgical coverage and is amended, delivered, issued, or renewed after the effective date of this amendatory Act of 1997 shall provi…

(215 ILCS 5/356u) (Text of Section before amendment by P.A. 104-548) Sec. 356u. Pap tests and prostate cancer screenings. (a) A group policy of accident and health insurance that provides coverage for hospital or medical treatment or services for illness on an expense-incurred ba…

(215 ILCS 5/356u.10) Sec. 356u.10. Genetic testing and evidence-based screenings for an inherited gene mutation. (a) In this Section, "genetic testing for an inherited mutation" means germline multi-gene testing for an inherited mutation associated with an increased risk of cance…

(215 ILCS 5/356u.5) Sec. 356u.5. Coverage for genetic testing for breast and ovarian cancer susceptibility. A group or individual policy of accident and health insurance that is amended, delivered, issued, or renewed on or after January 1, 2024 shall provide coverage for the cost…

(215 ILCS 5/356v) Sec. 356v. Use of information derived from genetic testing. After the effective date of this amendatory Act of 1997, an insurer must comply with the provisions of the Genetic Information Privacy Act in connection with the amendment, delivery, issuance, or renewa…

(215 ILCS 5/356w) Sec. 356w. Diabetes self-management training and education. (a) A group policy of accident and health insurance that is amended, delivered, issued, or renewed after the effective date of this amendatory Act of 1998 shall provide coverage for outpatient self-mana…

(215 ILCS 5/356x) Sec. 356x. Coverage for colorectal cancer examination and screening. (a) An individual or group policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after the effective date of this amendatory Act of…

(215 ILCS 5/356z.1) Sec. 356z.1. Prenatal HIV testing. An individual or group policy of accident and health insurance that provides maternity coverage and is amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 92nd General Assembly must p…

(215 ILCS 5/356z.10) Sec. 356z.10. Amino acid-based elemental formulas. A group or individual major medical accident and health insurance policy or managed care plan amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 95th General Assembl…

(215 ILCS 5/356z.11) Sec. 356z.11. Dependent students; medical leave of absence. A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 95th General Assembly …

(215 ILCS 5/356z.12) Sec. 356z.12. Dependent coverage. (a) A group or individual policy of accident and health insurance or managed care plan that provides coverage for dependents and that is amended, delivered, issued, or renewed after the effective date of this amendatory Act o…

(215 ILCS 5/356z.13) Sec. 356z.13. Shingles vaccine. A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of the amendatory Act of this 95th General Assembly must provide coverage for a …

(215 ILCS 5/356z.14) (Text of Section before amendment by P.A. 104-561) Sec. 356z.14. Autism spectrum disorders. (a) A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after December 12, 2008 (the effective da…

(215 ILCS 5/356z.15) (Text of Section before amendment by P.A. 104-528) Sec. 356z.15. Habilitative services for children. (a) As used in this Section, "habilitative services" means occupational therapy, physical therapy, speech therapy, and other services prescribed by the insure…

(215 ILCS 5/356z.17) Sec. 356z.17. Wellness coverage. (a) A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after January 1, 2010 (the effective date of Public Act 96-639) that provides coverage for hospital …

(215 ILCS 5/356z.18) Sec. 356z.18. Prosthetic and customized orthotic devices. (a) For the purposes of this Section: "Customized orthotic device" means a supportive device for the body or a part of the body, the head, neck, or extremities, and includes the replacement or repair o…

(215 ILCS 5/356z.19) Sec. 356z.19. Cardiovascular disease. Because cardiovascular disease is a leading cause of death and disability, an insurer providing group or individual policies of accident and health insurance or a managed care plan shall develop and implement a process to…

(215 ILCS 5/356z.2) Sec. 356z.2. Coverage for adjunctive services in dental care. (a) An individual or group policy of accident and health insurance amended, delivered, issued, or renewed after January 1, 2003 (the effective date of Public Act 92-764) shall cover charges incurred…

(215 ILCS 5/356z.20) Sec. 356z.20. Cancer drug parity. (a) As used in this Section: "Financial requirement" means deductibles, copayments, coinsurance, out-of-pocket expenses, aggregate lifetime limits, and annual limits. "Treatment limitation" means limits on the frequency of tr…

(215 ILCS 5/356z.21) Sec. 356z.21. Tobacco use cessation programs; coverage offer. (a) Tobacco use is the number one cause of preventable disease and death in Illinois, costing $4.1 billion annually in direct health care costs and an additional $4.35 billion in lost productivity.…

(215 ILCS 5/356z.22) (Text of Section before amendment by P.A. 104-742) Sec. 356z.22. Coverage for telehealth services. (a) For purposes of this Section: "Asynchronous store and forward system" has the meaning given to that term in Section 5 of the Telehealth Act. "Distant site" …

(215 ILCS 5/356z.23) Sec. 356z.23. Coverage for opioid antagonists. (a) An individual or group policy of accident and health insurance amended, delivered, issued, or renewed in this State after the effective date of this amendatory Act of the 99th General Assembly that provides c…

(215 ILCS 5/356z.24) Sec. 356z.24. Immune gamma globulin therapy. (a) A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 99th General Assembly may not all…

(215 ILCS 5/356z.25) Sec. 356z.25. Coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome. A group or individual policy of accident and health insurance or managed care…

(215 ILCS 5/356z.26) Sec. 356z.26. Synchronization. (a) As used in this Section, "synchronization" means the coordination of medication refills for a patient taking 2 or more medications for one or more chronic conditions such that the patient's medications are refilled on the sa…

(215 ILCS 5/356z.28) Sec. 356z.28. Dry needling by a physical therapist. A group or individual policy of accident and health insurance or a qualified health plan offered through the health insurance market place is not required to provide coverage for dry needling performed by a …

(215 ILCS 5/356z.29) Sec. 356z.29. Stage 4 advanced, metastatic cancer. (a) As used in this Section, "stage 4 advanced, metastatic cancer" means cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph nodes, or other areas or parts of the b…

(215 ILCS 5/356z.3) Sec. 356z.3. Disclosure of limited benefit. An insurer that issues, delivers, amends, or renews an individual or group policy of accident and health insurance in this State after the effective date of this amendatory Act of the 92nd General Assembly and arrang…

(215 ILCS 5/356z.30) Sec. 356z.30. Coverage for hearing aids. (a) As used in this Section: "Hearing care professional" means a person who is a licensed hearing instrument dispenser, licensed audiologist, or licensed physician. "Hearing instrument" or "hearing aid" means any weara…

(215 ILCS 5/356z.31) (Text of Section before amendment by P.A. 104-742) Sec. 356z.31. Recovery housing for persons with substance use disorders. (a) Definitions. As used in this Section: "Substance use disorder" and "case management" have the meanings ascribed to those terms in S…

(215 ILCS 5/356z.32) Sec. 356z.32. Coverage for fertility preservation services. (a) As used in this Section: "Iatrogenic infertility" means an impairment of fertility by surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or processes. "May…

(215 ILCS 5/356z.33) (Text of Section before amendment by P.A. 104-762) Sec. 356z.33. Coverage for epinephrine injectors. (a) 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,…

(215 ILCS 5/356z.34) Sec. 356z.34. Coverage for cardiopulmonary monitors. A group or individual policy of accident and health insurance amended, delivered, issued, or renewed after January 1, 2020 (the effective date of Public Act 101-218) shall provide coverage for cardiopulmona…

(215 ILCS 5/356z.35) Sec. 356z.35. Long-term antibiotic therapy for tick-borne diseases. (a) As used in this Section: "Long-term antibiotic therapy" means the administration of oral, intramuscular, or intravenous antibiotics singly or in combination for periods of time in excess …

(215 ILCS 5/356z.36) (Text of Section before amendment by P.A. 104-742) Sec. 356z.36. Coverage of treatment models for early treatment of serious mental illnesses. (a) For purposes of early treatment of a serious mental illness in a child or young adult under age 26, a group or i…

(215 ILCS 5/356z.37) Sec. 356z.37. Whole body skin examination. An individual or group policy of accident and health insurance shall cover, without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement upon the insured patient, one annual office vis…

(215 ILCS 5/356z.38) Sec. 356z.38. Human breast milk coverage. (a) Notwithstanding any other provision of this Act, pasteurized donated human breast milk, which may include human milk fortifiers if indicated by a prescribing licensed medical practitioner, shall be covered under a…

(215 ILCS 5/356z.39) Sec. 356z.39. Coverage of the psychiatric Collaborative Care Model. (a) As used in this Section, "psychiatric Collaborative Care Model" means the evidence-based, integrated behavioral health service delivery method, which includes a formal collaborative arran…

(215 ILCS 5/356z.3a) (Text of Section before amendment by P.A. 104-732) Sec. 356z.3a. Billing; emergency services; nonparticipating providers. (a) As used in this Section: "Ancillary services" means: (1) items and services related to emergency medicine, anesthesiology, pathology,…

(215 ILCS 5/356z.4) Sec. 356z.4. Coverage for contraceptives. (a)(1) The General Assembly hereby finds and declares all of the following: (A) Illinois has a long history of expanding timely access to birth control to prevent unintended pregnancy. (B) The federal Patient Protectio…

(215 ILCS 5/356z.40) Sec. 356z.40. Pregnancy and postpartum coverage. (a) An individual or group policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after October 8, 2021 (the effective date of Public Act 102-665) shall provid…

(215 ILCS 5/356z.40a) Sec. 356z.40a. Pregnancy as a qualifying life event for qualified health plans. Beginning with the operation of a State-based exchange in plan year 2026, a pregnant individual has the right to enroll in a qualified health plan through a special enrollment pe…

(215 ILCS 5/356z.41) Sec. 356z.41. Cost sharing in prescription insulin drugs; limits; confidentiality of rebate information. (a) As used in this Section, "prescription insulin drug" means a prescription drug that contains insulin and is used to control blood glucose levels to tr…

(215 ILCS 5/356z.44) Sec. 356z.44. Vitamin D testing. (a) As used in this Section, "vitamin D testing" means vitamin D blood testing that measures the level of vitamin D in an individual's blood. (b) A group or individual policy of accident and health insurance or managed care pl…

(215 ILCS 5/356z.45) Sec. 356z.45. Coverage for patient care services provided by a pharmacist. 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, 2023 shall provide coverage f…

(215 ILCS 5/356z.46) (Text of Section before amendment by P.A. 104-731) Sec. 356z.46. Biomarker testing. (a) As used in this Section: "Biomarker" means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes…

(215 ILCS 5/356z.47) Sec. 356z.47. Coverage for pancreatic cancer screening. 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, 2022 shall provide coverage for medically necess…

(215 ILCS 5/356z.48) Sec. 356z.48. Colonoscopy coverage. (a) A group policy of accident and health insurance that is amended, delivered, issued, or renewed on or after January 1, 2022 shall provide coverage for a colonoscopy that is a follow-up exam based on an initial screen whe…

(215 ILCS 5/356z.49) Sec. 356z.49. A1C testing. (a) As used in this Section, "A1C testing" means blood sugar level testing used to diagnose prediabetes, type 1 diabetes, and type 2 diabetes and to monitor management of blood sugar levels. (b) A group or individual policy of accid…

(215 ILCS 5/356z.4a) Sec. 356z.4a. Coverage for abortion. (a) Except as otherwise provided in this Section, no individual or group policy of accident and health insurance that provides pregnancy-related benefits may be issued, amended, delivered, or renewed in this State after th…