HB 4335

Abstract

Amends the Illinois Insurance Code. Provides that 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, 2024 and that provides coverage for prescription drugs shall provide coverage for vaginal estrogen, and that coverage for vaginal estrogen shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code. House Committee Amendment No. 1 Replaces everything after the enacting clause with the provisions of the introduced bill with the following changes. Provides that 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, 2024 and that provides coverage for prescription drugs shall include coverage for one or more therapeutic equivalent versions of vaginal estrogen in its formulary (rather than provide coverage for vaginal estrogen), and that a policy is not required to include all therapeutic equivalent versions of vaginal estrogen in its formulary so long as at least one is included and covered without cost sharing and in accordance with the provisions. Provides that if an individual's attending provider recommends a particular vaginal estrogen product or its therapeutic equivalent version approved by the United States Food and Drug Administration based on the provider's determination, the issuer must cover that service or item without cost sharing. Provides that coverage for vaginal estrogen shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided, except to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to specified federal law. Defines "therapeutic equivalent version".