Chapter 215 — INSURANCE

(215 ILCS 5/356K) (from Ch. 73, par. 968K) Sec. 356K. Coverage for Organ Transplantation Procedures. No insurer providing individual accident and health insurance coverage under this Act for hospital or medical expenses shall deny reimbursement for an otherwise covered expense in…

(215 ILCS 5/356L) (from Ch. 73, par. 968L) Sec. 356L. No individual policy of accident or health insurance shall include any provision which shall have the effect of denying coverage to or on behalf of an insured under such policy on the basis of a failure by the insured to file …

(215 ILCS 5/356a) (from Ch. 73, par. 968a) Sec. 356a. Form of policy. (1) No individual policy of accident and health insurance shall be delivered or issued for delivery to any person in this State unless: (a) the entire money and other considerations therefor are expressed there…

(215 ILCS 5/356b) (from Ch. 73, par. 968b) Sec. 356b. (a) This Section applies to the hospital and medical expense provisions of an individual accident or health insurance policy. (b) If a policy provides that coverage of a dependent person terminates upon attainment of the limit…

(215 ILCS 5/356c) (from Ch. 73, par. 968c) Sec. 356c. (1) No policy of accident and health insurance providing coverage of hospital expenses or medical expenses or both on an expense incurred basis which in addition to covering the insured, also covers members of the insured's im…

(215 ILCS 5/356d) (from Ch. 73, par. 968d) Sec. 356d. Conversion privileges for insured former spouses. (1) No individual policy of accident and health insurance providing coverage of hospital and/or medical expense on either an expense incurred basis or other than an expense inc…

(215 ILCS 5/356e) (from Ch. 73, par. 968e) Sec. 356e. Victims of certain offenses. (1) No individual policy of accident and health insurance, which provides benefits for hospital or medical expenses based upon the actual expenses incurred, delivered or issued for delivery to any …

(215 ILCS 5/356f) (from Ch. 73, par. 968f) Sec. 356f. No individual policy of accident or health insurance or any renewal thereof shall be denied or cancelled by the insurer, nor shall any such policy contain any exception or exclusion of benefits, solely because the mother of th…

(215 ILCS 5/356g) (from Ch. 73, par. 968g) Sec. 356g. Mammograms; mastectomies. (a) Every insurer shall provide in each group or individual policy, contract, or certificate of insurance issued or renewed for persons who are residents of this State, coverage for screening by low-d…

(215 ILCS 5/356g.5) Sec. 356g.5. Clinical breast exam. (a) The General Assembly finds that clinical breast examinations are a critical tool in the early detection of breast cancer, while the disease is in its earlier and potentially more treatable stages. Insurer reimbursement of…

(215 ILCS 5/356g.5-1) Sec. 356g.5-1. Breast cancer pain medication and therapy. A group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 95th General As…

(215 ILCS 5/356h) (from Ch. 73, par. 968h) Sec. 356h. No individual or group policy of accident and health insurance which covers the insured's immediate family or children, as well as covering the insured, shall exclude a child from coverage or limit coverage for a child solely …

(215 ILCS 5/356i) (from Ch. 73, par. 968i) Sec. 356i. Medical assistance; coverage of child. (a) In this Section, "Medicaid" means medical assistance authorized under Section 1902 of the Social Security Act. (b) An individual or group policy of accident and health insurance that …

(215 ILCS 5/356j) (from Ch. 73, par. 968j) Sec. 356j. (Repealed). (Source: Repealed by P.A. 89-183, eff. 1-1-96.)

(215 ILCS 5/356m) (from Ch. 73, par. 968m) Sec. 356m. Infertility coverage. (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 afte…

(215 ILCS 5/356n) (from Ch. 73, par. 968n) Sec. 356n. Fibrocystic condition; denial of coverage. No group or individual policy of accident or health insurance or any renewal thereof shall be denied by the insurer, nor shall any policy contain any exception or exclusion of benefit…

(215 ILCS 5/356p) (from Ch. 73, par. 968p) Sec. 356p. Breast implant removal. No individual or group policy of accident and health insurance shall deny coverage for the removal of breast implants when the removal of the implants is medically necessary treatment for a sickness or …

(215 ILCS 5/356q) Sec. 356q. On or after the effective date of this Section, every insurer which delivers or issues for delivery in this State a group accident and health policy providing coverage for hospital, medical, or surgical treatment on an expense-incurred basis shall off…

(215 ILCS 5/356r) Sec. 356r. Access to obstetrical and gynecological care. (a) An individual or group policy of accident and health insurance or a managed care plan amended, delivered, issued, or renewed in this State must not require authorization or referral by the plan, issuer…

(215 ILCS 5/356s) Sec. 356s. Post-parturition care. 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 1996 shall provide coverage for the…

(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) 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 basis and is amended, delivered, issued, or renewed a…

(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 5/356y) Sec. 356y. (Repealed). (Source: P.A. 91-406, eff. 1-1-00. Repealed internally, eff. 1-1-03.)

(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) 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 date of Public Act 95-1005) must provide individuals …

(215 ILCS 5/356z.15) 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 insured's treating physician pursuant to a treatment plan…

(215 ILCS 5/356z.16) Sec. 356z.16. (Repealed). (Source: P.A. 100-386, eff. 1-1-18. Repealed by P.A. 101-456, eff. 8-23-19.)

(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) 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" has the meaning given to that term in Section 5 of …

(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.27) Sec. 356z.27. (Repealed). (Source: P.A. 100-863, eff. 8-14-18. Repealed by P.A. 102-775, eff. 5-13-22.)

(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…