HB 4504

Abstract

Amends the Illinois Insurance Code. Provides that a health plan shall limit the total amount that a covered person is required to pay for a covered prescription inhaler at an amount not to exceed $25 per 30-day supply and shall limit the total amount that a covered person is required to pay for all covered prescription inhalers at an amount not to exceed $50 in total per 30 days. Provides that coverage for prescription inhalers shall not be subject to any deductible. Provides that nothing in the provisions prevents a health plan from reducing a covered person's cost sharing to an amount less than the cap. Authorizes rulemaking and enforcement by the Department of Insurance. Effective January 1, 2025. House Committee Amendment No. 1 Deletes reference to: 215 ILCS 5/356z.71 new Adds reference to: 5 ILCS 375/6.11 215 ILCS 5/356z.5 Replaces everything after the enacting clause. Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or before December 31, 2025 that provides coverage for prescription drugs may not deny or limit coverage for prescription inhalers (instead of prescription inhalants) 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. Provides that 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 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, and provides that nothing in the provisions 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 cap. Makes a conforming change. Provides that coverage for prescription inhalers shall not be subject to any deductible, except to the extent that the coverage would disqualify a high-deductible health plan from eligibility for a health savings account. Authorizes rulemaking and enforcement by the Department of Insurance. Amends the State Employees Group Insurance Act of 1971. Provides that the program of health benefits shall provide coverage for prescription inhalers under the Illinois Insurance Code.