SB 2639

Abstract

Amends the Illinois Insurance Code. Provides that, for a group policy of accident and health insurance providing coverage for more than 25 employees that provides pregnancy related benefits that is issued, amended, delivered, or renewed in this State after the effective date of the amendatory Act, if a covered individual obtains, from a physician licensed to practice medicine in all its branches, a recommendation approving the covered individual to seek in vitro fertilization, gamete intrafallopian tube transfer, or zygote intrafallopian tube transfer based on any of the following: the covered individual's medical, sexual, and reproductive history; the covered individual's age; physical findings; or diagnostic testing, then the procedure shall be covered without any other restrictions or requirements. Senate Floor Amendment No. 1 Adds reference to: 5 ILCS 375/6.11B 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 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. Amends the State Employees Group Insurance Act of 1971. Provides that the infertility insurance provision added by Public Act 103-8 (effective January 1, 2024) applies only to coverage provided on or after July 1, 2024 and before July 1, 2026. Repeals the provision regarding infertility coverage on July 1, 2026. Amends the Illinois Insurance Code. Provides that 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 after January 1, 2016 through December 31, 2025 unless the policy contains coverage for the diagnosis and treatment of infertility. Provides that no group policy of accident and health insurance that provides pregnancy related benefits may be issued, amended, delivered, or renewed in this State on or after January 1, 2026 unless the policy contains coverage for the diagnosis and treatment of infertility; specifies what shall be covered. Provides that coverage shall be required only if the procedures: (1) are considered medically appropriate based on clinical guidelines or standards developed by the American Society for Reproductive Medicine, the American College of Obstetricians and Gynecologists, or the Society for Assisted Reproductive Technology; and (2) are performed at medical facilities or clinics that conform to the American College of Obstetricians and Gynecologists guidelines for in vitro fertilization or the American Society for Reproductive Medicine minimum standards for practices offering assisted reproductive technologies. Provides that if those requirements are met, then the procedure shall be covered without any other restrictions or requirements. Makes changes in the Counties Code, the Illinois Municipal Code, the School Code, the Limited Health Service Organization Act, and the Voluntary Health Services Plans Act to provide that infertility insurance must be included in health insurance coverage for employees. Effective December 31, 2025. Senate Floor Amendment No. 2 Adds reference to: 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 130/4003 from Ch. 73, par. 1504-3 215 ILCS 165/10 from Ch. 32, par. 604 305 ILCS 5/5-16.8 Replaces everything after the enacting clause. Reinserts the provisions of the introduced bill with the following changes. Provides that, for a group policy of accident and health insurance that provides pregnancy related benefits (rather than providing coverage for more than 25 employees that provides pregnancy-related benefits) that is issued, amended, delivered, or renewed in this State after January 1, 2026 (rather than the effective date of the amendatory Act), if a covered individual obtains, from a physician licensed to practice medicine in all its branches, a recommendation approving the covered individual to seek in vitro fertilization, gamete intrafallopian tube transfer, or zygote intrafallopian tube transfer based on any of the following: the covered individual's medical, sexual, and reproductive history; the covered individual's age; physical findings; or diagnostic testing, then the procedure shall be covered without any other restrictions or requirements. Amends the Counties Code, the Illinois Municipal Code, the School Code, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require plans under those Acts to comply with provisions of the Illinois Insurance Code requiring coverage for the diagnosis and treatment of infertility. Adds a January 1, 2026 effective date.