Bill Text: IL SB3538 | 2023-2024 | 103rd General Assembly | Engrossed

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Bill Title: Amends the Counties Code and the Illinois Municipal Code. Provides that, if a municipality or county, including a home rule municipality or county, is a self-insurer for purposes of providing health insurance coverage for its employees, the insurance coverage shall include mental health counseling for any employee who is a first responder, including police and corrections officers, deputy sheriffs, firefighters, or emergency medical services personnel, without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided. Specifies that this requirement does not apply to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to the Internal Revenue Code. Preempts home rule.

Spectrum: Moderate Partisan Bill (Democrat 80-10)

Status: (Engrossed) 2024-04-24 - Assigned to Insurance Committee [SB3538 Detail]

Download: Illinois-2023-SB3538-Engrossed.html

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AN ACT concerning local government.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Counties Code is amended by changing
Section 5-1069 as follows:
(55 ILCS 5/5-1069) (from Ch. 34, par. 5-1069)
Sec. 5-1069. Group life, health, accident, hospital, and
medical insurance.
(a) The county board of any county may arrange to provide,
for the benefit of employees of the county, group life,
health, accident, hospital, and medical insurance, or any one
or any combination of those types of insurance, or the county
board may self-insure, for the benefit of its employees, all
or a portion of the employees' group life, health, accident,
hospital, and medical insurance, or any one or any combination
of those types of insurance, including a combination of
self-insurance and other types of insurance authorized by this
Section, provided that the county board complies with all
other requirements of this Section. The insurance may include
provision for employees who rely on treatment by prayer or
spiritual means alone for healing in accordance with the
tenets and practice of a well recognized religious
denomination. The county board may provide for payment by the

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county of a portion or all of the premium or charge for the
insurance with the employee paying the balance of the premium
or charge, if any. If the county board undertakes a plan under
which the county pays only a portion of the premium or charge,
the county board shall provide for withholding and deducting
from the compensation of those employees who consent to join
the plan the balance of the premium or charge for the
insurance.
(b) If the county board does not provide for
self-insurance or for a plan under which the county pays a
portion or all of the premium or charge for a group insurance
plan, the county board may provide for withholding and
deducting from the compensation of those employees who consent
thereto the total premium or charge for any group life,
health, accident, hospital, and medical insurance.
(c) The county board may exercise the powers granted in
this Section only if it provides for self-insurance or, where
it makes arrangements to provide group insurance through an
insurance carrier, if the kinds of group insurance are
obtained from an insurance company authorized to do business
in the State of Illinois. The county board may enact an
ordinance prescribing the method of operation of the insurance
program.
(d) If a county, including a home rule county, is a
self-insurer for purposes of providing health insurance
coverage for its employees, the insurance coverage shall

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include screening by low-dose mammography for all women 35
years of age or older for the presence of occult breast cancer
unless the county elects to provide mammograms itself under
Section 5-1069.1. The coverage shall be as follows:
(1) A baseline mammogram for women 35 to 39 years of
age.
(2) An annual mammogram for women 40 years of age or
older.
(3) A mammogram at the age and intervals considered
medically necessary by the woman's health care provider
for women under 40 years of age and having a family history
of breast cancer, prior personal history of breast cancer,
positive genetic testing, or other risk factors.
(4) For a group policy of accident and health
insurance that is amended, delivered, issued, or renewed
on or after the effective date of this amendatory Act of
the 101st General Assembly, a comprehensive ultrasound
screening of an entire breast or breasts if a mammogram
demonstrates heterogeneous or dense breast tissue or when
medically necessary as determined by a physician licensed
to practice medicine in all of its branches, advanced
practice registered nurse, or physician assistant.
(5) For a group policy of accident and health
insurance that is amended, delivered, issued, or renewed
on or after the effective date of this amendatory Act of
the 101st General Assembly, a diagnostic mammogram when

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medically necessary, as determined by a physician licensed
to practice medicine in all its branches, advanced
practice registered nurse, or physician assistant.
A policy subject to this subsection shall not impose a
deductible, coinsurance, copayment, or any other cost-sharing
requirement on the coverage provided; except that this
sentence does not apply to coverage of diagnostic mammograms
to the extent such coverage would disqualify a high-deductible
health plan from eligibility for a health savings account
pursuant to Section 223 of the Internal Revenue Code (26
U.S.C. 223).
For purposes of this subsection:
"Diagnostic mammogram" means a mammogram obtained using
diagnostic mammography.
"Diagnostic mammography" means a method of screening that
is designed to evaluate an abnormality in a breast, including
an abnormality seen or suspected on a screening mammogram or a
subjective or objective abnormality otherwise detected in the
breast.
"Low-dose mammography" means the x-ray examination of the
breast using equipment dedicated specifically for mammography,
including the x-ray tube, filter, compression device, and
image receptor, with an average radiation exposure delivery of
less than one rad per breast for 2 views of an average size
breast. The term also includes digital mammography.
(d-5) Coverage as described by subsection (d) shall be

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provided at no cost to the insured and shall not be applied to
an annual or lifetime maximum benefit.
(d-10) When health care services are available through
contracted providers and a person does not comply with plan
provisions specific to the use of contracted providers, the
requirements of subsection (d-5) are not applicable. When a
person does not comply with plan provisions specific to the
use of contracted providers, plan provisions specific to the
use of non-contracted providers must be applied without
distinction for coverage required by this Section and shall be
at least as favorable as for other radiological examinations
covered by the policy or contract.
(d-15) If a county, including a home rule county, is a
self-insurer for purposes of providing health insurance
coverage for its employees, the insurance coverage shall
include mastectomy coverage, which includes coverage for
prosthetic devices or reconstructive surgery incident to the
mastectomy. Coverage for breast reconstruction in connection
with a mastectomy shall include:
(1) reconstruction of the breast upon which the
mastectomy has been performed;
(2) surgery and reconstruction of the other breast to
produce a symmetrical appearance; and
(3) prostheses and treatment for physical
complications at all stages of mastectomy, including
lymphedemas.

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Care shall be determined in consultation with the attending
physician and the patient. The offered coverage for prosthetic
devices and reconstructive surgery shall be subject to the
deductible and coinsurance conditions applied to the
mastectomy, and all other terms and conditions applicable to
other benefits. When a mastectomy is performed and there is no
evidence of malignancy then the offered coverage may be
limited to the provision of prosthetic devices and
reconstructive surgery to within 2 years after the date of the
mastectomy. As used in this Section, "mastectomy" means the
removal of all or part of the breast for medically necessary
reasons, as determined by a licensed physician.
A county, including a home rule county, that is a
self-insurer for purposes of providing health insurance
coverage for its employees, may not penalize or reduce or
limit the reimbursement of an attending provider or provide
incentives (monetary or otherwise) to an attending provider to
induce the provider to provide care to an insured in a manner
inconsistent with this Section.
(d-20) The requirement that mammograms be included in
health insurance coverage as provided in subsections (d)
through (d-15) is an exclusive power and function of the State
and is a denial and limitation under Article VII, Section 6,
subsection (h) of the Illinois Constitution of home rule
county powers. A home rule county to which subsections (d)
through (d-15) apply must comply with every provision of those

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subsections.
(e) The term "employees" as used in this Section includes
elected or appointed officials but does not include temporary
employees.
(f) The county board may, by ordinance, arrange to provide
group life, health, accident, hospital, and medical insurance,
or any one or a combination of those types of insurance, under
this Section to retired former employees and retired former
elected or appointed officials of the county.
(g) Rulemaking authority to implement this amendatory Act
of the 95th General Assembly, if any, is conditioned on the
rules being adopted in accordance with all provisions of the
Illinois Administrative Procedure Act and all rules and
procedures of the Joint Committee on Administrative Rules; any
purported rule not so adopted, for whatever reason, is
unauthorized.
(h) If a county, including a home rule county, is a
self-insurer for purposes of providing health insurance
coverage for its employees, the insurance coverage shall
include mental health counseling for any employee who is a
first responder, including police and corrections officers,
deputy sheriffs, firefighters, or emergency medical services
personnel, without imposing a deductible, coinsurance,
copayment, or any other cost-sharing requirement on the
coverage provided, except that this subsection does not apply
to the extent such coverage would disqualify a high-deductible

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health plan from eligibility for a health savings account
pursuant to Section 223 of the Internal Revenue Code.
The requirement that mental health counseling be included
in health insurance coverage as provided in this subsection is
an exclusive power and function of the State and is a denial
and limitation under Article VII, Section 6, subsection (h) of
the Illinois Constitution of home rule county powers.
(Source: P.A. 100-513, eff. 1-1-18; 101-580, eff. 1-1-20.)
Section 10. The Illinois Municipal Code is amended by
adding Section 10-4-2.4 as follows:
(65 ILCS 5/10-4-2.4 new)
Sec. 10-4-2.4. Mental health counseling. If a
municipality, including a home rule municipality, is a
self-insurer for purposes of providing health insurance
coverage for its employees, the insurance coverage shall
include mental health counseling for any employee who is a
first responder, including police and corrections officers,
deputy sheriffs, firefighters, or emergency medical services
personnel, without imposing a deductible, coinsurance,
copayment, or any other cost-sharing requirement on the
coverage provided, except that this Section does not apply to
the extent such coverage would disqualify a high-deductible
health plan from eligibility for a health savings account
pursuant to Section 223 of the Internal Revenue Code.

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