HB 5142

Abstract

Amends the Illinois Insurance Code. Provides that insurers shall cover all services for pregnancy, postpartum, and newborn care that are rendered by perinatal doulas or licensed certified professional midwives, including home births, home visits, and support during labor, abortion, or miscarriage. Provides that the required coverage includes the necessary equipment and medical supplies for a home birth. Provides that coverage for pregnancy, postpartum, and newborn care shall include home visits by lactation consultants and the purchase of breast pumps and breast pump supplies, including such breast pumps, breast pump supplies, breastfeeding supplies, and feeding aids as recommended by the lactation consultant. Provides that coverage for postpartum services shall apply for at least one year after birth. Provides that certain pregnancy and postpartum coverage shall be provided without cost-sharing requirements. Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that post-parturition care benefits shall not be subject to any cost-sharing requirement. Provides that the medical assistance program shall cover home visits for lactation counseling and support services. Provides that the medical assistance program shall cover counselor-recommended or provider-recommended breast pumps as well as breast pump supplies, breastfeeding supplies, and feeding aids. Provides that nothing in the provisions shall limit the number of lactation encounters, visits, or services; breast pumps; breast pump supplies; breastfeeding supplies; or feeding aids a beneficiary is entitled to receive under the program. Makes other changes. Effective January 1, 2026. House Committee Amendment No. 1 Deletes reference to: 305 ILCS 5/5-18.10 Replaces everything after the enacting clause. Reinserts the provisions of the introduced bill with the following changes. Removes language providing that post-parturition care benefits shall not be subject to any cost-sharing requirement. Provides that coverage for postpartum services shall apply for at least one year after the end of the pregnancy (rather than one year after birth). Provides that beginning January 1, 2025, certified professional midwife services (instead of licensed certified professional midwife services) shall be covered under the medical assistance program. Removes language providing that midwifery services covered under the provisions shall include home births and home prenatal, labor and delivery, and postnatal care. Removes changes to a provision of the Illinois Public Aid Code concerning reimbursement for postpartum visits. Effective January 1, 2026, except that certain changes to the Illinois Public Aid Code are effective January 1, 2025. House Committee Amendment No. 2 Adds reference to: 215 ILCS 5/356z.4a Provides that all outpatient coverage required under a provision concerning coverage for pregnancy, postpartum, and newborn care must be provided without cost sharing, except to the extent that such coverage would disqualify a high-deductible health plan from eligibility for a health savings account and except that, for treatment of substance use disorders, the prohibition on cost-sharing applies to the levels of treatment below and not including 3.1 (Clinically Managed Low-Intensity Residential) established by the American Society of Addiction Medicine. Makes a conforming change. Further amends the Illinois Insurance Code. Provides that coverage for abortion care may not impose any deductible, coinsurance, waiting period, or other cost-sharing (instead of other cost-sharing limitation that is greater than that required for other pregnancy-related benefits covered by the policy). Provides that the provision does not apply to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account. Fiscal Note (Dept. on Insurance) To ensure the expanded pregnancy, postpartum, and newborn care benefits are included and ensure the expanded providers able to deliver these services are included in policy forms, would require personnel to review the additional form filing review requirements. The potential for increased complaints received by DOI resulting from this legislation would require personnel to field such calls (complaints). Two additional employees under the title of Insurance Analyst will be needed. Fiscal Impact: $260,000 House Floor Amendment No. 5 Replaces everything after the enacting clause. Reinserts the provisions of the bill as amended by House Amendment No. 1 with changes. Further amends the Illinois Insurance Code. Provides that coverage for abortion care may not impose any deductible, coinsurance, waiting period, or other cost-sharing limitation, except to the extent that the coverage would disqualify a high-deductible health plan from eligibility for a health savings account (rather than coverage for abortion care may not impose any deductible, coinsurance, waiting period, or other cost-sharing limitation that is greater than that required for other pregnancy-related benefits covered by the policy). Defines "perinatal doula" and "lactation consultant". Provides that coverage for postpartum services shall apply for all covered services rendered within the first 12 months after the end of pregnancy (rather than the coverage shall apply for at least one year after the end of pregnancy), except that a policy is not required to cover more than $8,000 for doula visits for each pregnancy and subsequent postpartum period. Provides that all outpatient coverage, other than health care services for home births, required under a provision concerning coverage for pregnancy, postpartum, and newborn care must be provided without cost sharing, except that, for mental health services, the cost-sharing prohibition does not apply to inpatient or residential services, and, for treatment of substance use disorders, the prohibition on cost-sharing applies to the levels of treatment below and not including Level 3.1 (Clinically Managed Low-Intensity Residential) established by the American Society of Addiction Medicine. Makes other changes. Effective January 1, 2026, except that certain changes to the Illinois Public Aid Code are effective January 1, 2025. Senate Committee Amendment No. 1 Provides that beginning January 1, 2025, certified professional midwife services (in addition to licensed certified professional midwife services) shall be covered under the medical assistance program.