HB 5493

Abstract

Amends the Illinois Insurance Code. Provides that certain coverage requirements apply to an individual policy of accident and health insurance (currently, a policy of accident and health insurance). Provides that an individual or group policy of accident and health insurance or a managed care plan must not require authorization or referral by the plan, issuer, or any person, including a primary care provider, for any covered individual who seeks coverage for certain obstetrical or gynecological care. Provides that if a policy, contract, or certificate requires or allows a covered individual to designate a primary care provider and provides coverage for any obstetrical or gynecological care, the insurer shall provide the notice required under specified federal regulations in all circumstances required under those regulations. Makes changes in provisions concerning post-parturition care. Changes the language required in the disclosure of a limited benefit. Increases the fee for filing a plan of division of a domestic stock company and for filing an insurance business transfer plan. Makes changes in provisions concerning fraud reporting; coverage for epinephrine injectors; blanket accident and health insurance; authorization of policies, agreements, or arrangements with incentives or limits on reimbursement; and refunds and penalties. Repeals a provision concerning the application of certain provisions. Amends the Network Adequacy and Transparency Act. Changes references from "woman's principal health care provider" to "obstetrical and gynecological health care professional". Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Limited Health Service Organization Act, and the Illinois Public Aid Code to make conforming changes. Amends the Health Maintenance Organization Act. Makes changes to the required disclosures. Provides that health maintenance organizations are subject to certain coverage requirements for pharmacy testing, screening, vaccinations, and treatment; for proton beam therapy; for children with neuromuscular, neurological, or cognitive impairment; and for no-cost mental health prevention and wellness visits. Effective immediately, except that certain provisions are effective January 1, 2025. House Committee Amendment No. 2 Deletes reference to: 215 ILCS 5/155.23 Adds reference to: 5 ILCS 375/6.11 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 65 ILCS 5/10-4-2.4 new 105 ILCS 5/10-22.3f 215 ILCS 5/356z.30a rep. 215 ILCS 130/4003 from Ch. 73, par. 1504-3 215 ILCS 165/10 from Ch. 32, par. 604 Replaces everything after the enacting clause. Reinserts the provisions of the introduced bill with the following changes. Further amends the Illinois Insurance Code. Repeals a provision requiring certain policies to offer, for an additional premium and subject to the insurer's standard of insurability, optional coverage or optional reimbursement for hearing instruments and related services for all individuals when a hearing care professional prescribes a hearing instrument to augment communication. Makes conforming changes. In a provision concerning the scope of the Casualty Insurance, Fidelity Bonds and Surety Contracts Article, includes certain policies that are not otherwise excluded under the Unauthorized Companies Article. Removes changes to a provision concerning fraud reporting. Further amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, and the School Code. Requires coverage or reimbursement for hearing aids. Makes other changes. Amends the Voluntary Health Services Plans Act to make a conforming change. Effective immediately, except that certain provisions are effective January 1, 2025. House Committee Amendment No. 3 Provides that "tax due" means the full amount due for the applicable tax period (rather than that year) under specified provisions.