Bill Text: IL HB4112 | 2023-2024 | 103rd General Assembly | Engrossed


Bill Title: 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 on or after January 1, 2025 unless the policy contains coverage for the diagnosis and treatment of infertility. Requires such coverage to include procedures necessary to screen or diagnose a fertilized egg before implantation. Provides that coverage for in vitro fertilization, gamete intrafallopian tube transfer, or zygote intrafallopian tube transfer 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. Makes changes in 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 provide that infertility insurance must be included in health insurance coverage for employees. Effective immediately.

Spectrum: Strong Partisan Bill (Democrat 35-3)

Status: (Introduced) 2024-05-16 - Added Co-Sponsor Rep. Debbie Meyers-Martin [HB4112 Detail]

Download: Illinois-2023-HB4112-Engrossed.html

HB4112 EngrossedLRB103 33223 LNS 63031 b
1 AN ACT concerning regulation.
2 Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4 Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Section 6.11B as follows:
6 (5 ILCS 375/6.11B)
7 Sec. 6.11B. Infertility coverage.
8 (a) Beginning on January 1, 2024, the State Employees
9Group Insurance Program shall provide coverage for the
10diagnosis and treatment of infertility, including, but not
11limited to, in vitro fertilization, uterine embryo lavage,
12embryo transfer, artificial insemination, gamete
13intrafallopian tube transfer, zygote intrafallopian tube
14transfer, and low tubal ovum transfer. The coverage required
15shall include procedures necessary to screen or diagnose a
16fertilized egg before implantation, including, but not limited
17to, preimplantation genetic diagnosis, preimplantation genetic
18screening, and prenatal genetic diagnosis.
19 (b) Beginning on January 1, 2024, coverage under this
20Section for procedures for in vitro fertilization, gamete
21intrafallopian tube transfer, or zygote intrafallopian tube
22transfer shall be required only if the procedures:
23 (1) are considered medically appropriate based on

HB4112 Engrossed- 2 -LRB103 33223 LNS 63031 b
1 clinical guidelines or standards developed by the American
2 Society for Reproductive Medicine, the American College of
3 Obstetricians and Gynecologists, or the Society for
4 Assisted Reproductive Technology; and
5 (2) are performed at medical facilities or clinics
6 that conform to the American College of Obstetricians and
7 Gynecologists guidelines for in vitro fertilization or the
8 American Society for Reproductive Medicine minimum
9 standards for practices offering assisted reproductive
10 technologies.
11 (c) As used in this Section, "infertility" means a
12disease, condition, or status characterized by:
13 (1) a failure to establish a pregnancy or to carry a
14 pregnancy to live birth after 12 months of regular,
15 unprotected sexual intercourse if the woman is 35 years of
16 age or younger, or after 6 months of regular, unprotected
17 sexual intercourse if the woman is over 35 years of age;
18 conceiving but having a miscarriage does not restart the
19 12-month or 6-month term for determining infertility;
20 (2) a person's inability to reproduce either as a
21 single individual or with a partner without medical
22 intervention; or
23 (3) a licensed physician's findings based on a
24 patient's medical, sexual, and reproductive history, age,
25 physical findings, or diagnostic testing.
26 (d) The State Employees Group Insurance Program may not

HB4112 Engrossed- 3 -LRB103 33223 LNS 63031 b
1impose any exclusions, limitations, or other restrictions on
2coverage of fertility medications that are different from
3those imposed on any other prescription medications, nor may
4it impose any exclusions, limitations, or other restrictions
5on coverage of any fertility services based on a covered
6individual's participation in fertility services provided by
7or to a third party, nor may it impose deductibles,
8copayments, coinsurance, benefit maximums, waiting periods, or
9any other limitations on coverage for the diagnosis of
10infertility, treatment for infertility, and standard fertility
11preservation services, except as provided in this Section,
12that are different from those imposed upon benefits for
13services not related to infertility.
14 (e) This Section applies only to coverage provided on or
15after January 1, 2024 and before July 1, 2026.
16 (f) This Section is repealed on July 1, 2026.
17(Source: P.A. 103-8, eff. 1-1-24.)
18 Section 10. The Counties Code is amended by changing
19Section 5-1069.3 as follows:
20 (55 ILCS 5/5-1069.3)
21 Sec. 5-1069.3. Required health benefits. If a county,
22including a home rule county, is a self-insurer for purposes
23of providing health insurance coverage for its employees, the
24coverage shall include coverage for the post-mastectomy care

HB4112 Engrossed- 4 -LRB103 33223 LNS 63031 b
1benefits required to be covered by a policy of accident and
2health insurance under Section 356t and the coverage required
3under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w,
4356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
5356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
6356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36,
7356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
8356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
9356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
10of the Illinois Insurance Code. The coverage shall comply with
11Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
12Insurance Code. The Department of Insurance shall enforce the
13requirements of this Section. The requirement that health
14benefits be covered as provided in this Section is an
15exclusive power and function of the State and is a denial and
16limitation under Article VII, Section 6, subsection (h) of the
17Illinois Constitution. A home rule county to which this
18Section applies must comply with every provision of this
19Section.
20 Rulemaking authority to implement Public Act 95-1045, if
21any, is conditioned on the rules being adopted in accordance
22with all provisions of the Illinois Administrative Procedure
23Act and all rules and procedures of the Joint Committee on
24Administrative Rules; any purported rule not so adopted, for
25whatever reason, is unauthorized.
26(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;

HB4112 Engrossed- 5 -LRB103 33223 LNS 63031 b
1102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
21-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
3eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
4102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
51-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
6eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
7103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
88-29-23.)
9 Section 15. The Illinois Municipal Code is amended by
10changing Section 10-4-2.3 as follows:
11 (65 ILCS 5/10-4-2.3)
12 Sec. 10-4-2.3. Required health benefits. If a
13municipality, including a home rule municipality, is a
14self-insurer for purposes of providing health insurance
15coverage for its employees, the coverage shall include
16coverage for the post-mastectomy care benefits required to be
17covered by a policy of accident and health insurance under
18Section 356t and the coverage required under Sections 356g,
19356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, 356z.4,
20356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
21356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
22356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
23356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
24356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,

HB4112 Engrossed- 6 -LRB103 33223 LNS 63031 b
1356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois
2Insurance Code. The coverage shall comply with Sections
3155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
4Code. The Department of Insurance shall enforce the
5requirements of this Section. The requirement that health
6benefits be covered as provided in this is an exclusive power
7and function of the State and is a denial and limitation under
8Article VII, Section 6, subsection (h) of the Illinois
9Constitution. A home rule municipality to which this Section
10applies must comply with every provision of this Section.
11 Rulemaking authority to implement Public Act 95-1045, if
12any, is conditioned on the rules being adopted in accordance
13with all provisions of the Illinois Administrative Procedure
14Act and all rules and procedures of the Joint Committee on
15Administrative Rules; any purported rule not so adopted, for
16whatever reason, is unauthorized.
17(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
18102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
191-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
20eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
21102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
221-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
23eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
24103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
258-29-23.)

HB4112 Engrossed- 7 -LRB103 33223 LNS 63031 b
1 Section 20. The School Code is amended by changing Section
210-22.3f as follows:
3 (105 ILCS 5/10-22.3f)
4 Sec. 10-22.3f. Required health benefits. Insurance
5protection and benefits for employees shall provide the
6post-mastectomy care benefits required to be covered by a
7policy of accident and health insurance under Section 356t and
8the coverage required under Sections 356g, 356g.5, 356g.5-1,
9356m, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
10356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
11356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
12356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
13356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
14356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
15of the Illinois Insurance Code. Insurance policies shall
16comply with Section 356z.19 of the Illinois Insurance Code.
17The coverage shall comply with Sections 155.22a, 355b, and
18370c of the Illinois Insurance Code. The Department of
19Insurance shall enforce the requirements of this Section.
20 Rulemaking authority to implement Public Act 95-1045, if
21any, is conditioned on the rules being adopted in accordance
22with all provisions of the Illinois Administrative Procedure
23Act and all rules and procedures of the Joint Committee on
24Administrative Rules; any purported rule not so adopted, for
25whatever reason, is unauthorized.

HB4112 Engrossed- 8 -LRB103 33223 LNS 63031 b
1(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
2102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
31-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
4eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
5102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
61-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
7eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
8103-551, eff. 8-11-23; revised 8-29-23.)
9 Section 25. The Illinois Insurance Code is amended by
10changing Section 356m as follows:
11 (215 ILCS 5/356m) (from Ch. 73, par. 968m)
12 Sec. 356m. Infertility coverage.
13 (a) No group policy of accident and health insurance
14providing coverage for more than 25 employees that provides
15pregnancy related benefits may be issued, amended, delivered,
16or renewed in this State after January 1, 2016 through
17December 31, 2025 the effective date of this amendatory Act of
18the 99th General Assembly unless the policy contains coverage
19for the diagnosis and treatment of infertility including, but
20not limited to, in vitro fertilization, uterine embryo lavage,
21embryo transfer, artificial insemination, gamete
22intrafallopian tube transfer, zygote intrafallopian tube
23transfer, and low tubal ovum transfer.
24 (b) The coverage required under subsection (a) for

HB4112 Engrossed- 9 -LRB103 33223 LNS 63031 b
1procedures for in vitro fertilization, gamete intrafallopian
2tube transfer, or zygote intrafallopian tube transfer shall be
3required only if: is subject to the following conditions:
4 (1) Coverage for procedures for in vitro
5 fertilization, gamete intrafallopian tube transfer, or
6 zygote intrafallopian tube transfer shall be required only
7 if:
8 (1) (A) the covered individual has been unable to
9 attain a viable pregnancy, maintain a viable pregnancy, or
10 sustain a successful pregnancy through reasonable, less
11 costly medically appropriate infertility treatments for
12 which coverage is available under the policy, plan, or
13 contract;
14 (2) (B) the covered individual has not undergone 4
15 completed oocyte retrievals, except that if a live birth
16 follows a completed oocyte retrieval, then 2 more
17 completed oocyte retrievals shall be covered; and
18 (3) (C) the procedures are performed at medical
19 facilities that conform to the American College of
20 Obstetric and Gynecology guidelines for in vitro
21 fertilization clinics or to the American Fertility Society
22 minimal standards for programs of in vitro fertilization.
23 (2) The procedures required to be covered under this
24 Section are not required to be contained in any policy or
25 plan issued to or by a religious institution or
26 organization or to or by an entity sponsored by a

HB4112 Engrossed- 10 -LRB103 33223 LNS 63031 b
1 religious institution or organization that finds the
2 procedures required to be covered under this Section to
3 violate its religious and moral teachings and beliefs.
4 (c) No group policy of accident and health insurance that
5provides pregnancy related benefits may be issued, amended,
6delivered, or renewed in this State on or after January 1, 2026
7unless the policy contains coverage for the diagnosis and
8treatment of infertility, including, but not limited to, in
9vitro fertilization, uterine embryo lavage, embryo transfer,
10artificial insemination, gamete intrafallopian tube transfer,
11zygote intrafallopian tube transfer, and low tubal ovum
12transfer and procedures necessary to screen or diagnose a
13fertilized egg before implantation, including, but not limited
14to, preimplantation genetic diagnosis, preimplantation genetic
15screening, and prenatal genetic diagnosis. Coverage under this
16subsection for the diagnosis and treatment of infertility
17shall be required only if the procedures:
18 (1) are considered medically appropriate by the
19 patient's medical provider based on clinical guidelines or
20 standards developed by the American Society for
21 Reproductive Medicine, the American College of
22 Obstetricians and Gynecologists, or the Society for
23 Assisted Reproductive Technology; and
24 (2) are performed at medical facilities or clinics
25 that conform to the American College of Obstetricians and
26 Gynecologists guidelines for in vitro fertilization or the

HB4112 Engrossed- 11 -LRB103 33223 LNS 63031 b
1 American Society for Reproductive Medicine minimum
2 standards for practices offering assisted reproductive
3 technologies.
4 (d) (c) As used in this Section, "infertility" means a
5disease, condition, or status characterized by:
6 (1) a failure to establish a pregnancy or to carry a
7 pregnancy to live birth after 12 months of regular,
8 unprotected sexual intercourse if the woman is 35 years of
9 age or younger, or after 6 months of regular, unprotected
10 sexual intercourse if the woman is over 35 years of age;
11 conceiving but having a miscarriage does not restart the
12 12-month or 6-month term for determining infertility;
13 (2) a person's inability to reproduce either as a
14 single individual or with a partner without medical
15 intervention; or
16 (3) a licensed physician's findings based on a
17 patient's medical, sexual, and reproductive history, age,
18 physical findings, or diagnostic testing.
19 (e) (d) A policy, contract, or certificate may not impose
20any exclusions, limitations, or other restrictions on coverage
21of fertility medications that are different from those imposed
22on any other prescription medications, nor may it impose any
23exclusions, limitations, or other restrictions on coverage of
24any fertility services based on a covered individual's
25participation in fertility services provided by or to a third
26party, nor may it impose deductibles, copayments, coinsurance,

HB4112 Engrossed- 12 -LRB103 33223 LNS 63031 b
1benefit maximums, waiting periods, or any other limitations on
2coverage for the diagnosis of infertility, treatment for
3infertility, and standard fertility preservation services,
4except as provided in this Section, that are different from
5those imposed upon benefits for services not related to
6infertility.
7 (f) The procedures required to be covered under this
8Section are not required to be contained in any policy or plan
9issued to or by a religious institution or organization or to
10or by an entity sponsored by a religious institution or
11organization that finds the procedures required to be covered
12under this Section to violate its religious and moral
13teachings and beliefs.
14(Source: P.A. 102-170, eff. 1-1-22.)
15 Section 30. The Limited Health Service Organization Act is
16amended by changing Section 4003 as follows:
17 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
18 Sec. 4003. Illinois Insurance Code provisions. Limited
19health service organizations shall be subject to the
20provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
21141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
22154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2,
23355.3, 355b, 356m, 356q, 356v, 356z.4, 356z.4a, 356z.10,
24356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a,

HB4112 Engrossed- 13 -LRB103 33223 LNS 63031 b
1356z.32, 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
2356z.54, 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68,
3364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
4444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
5XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
6Nothing in this Section shall require a limited health care
7plan to cover any service that is not a limited health service.
8For purposes of the Illinois Insurance Code, except for
9Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
10health service organizations in the following categories are
11deemed to be domestic companies:
12 (1) a corporation under the laws of this State; or
13 (2) a corporation organized under the laws of another
14 state, 30% or more of the enrollees of which are residents
15 of this State, except a corporation subject to
16 substantially the same requirements in its state of
17 organization as is a domestic company under Article VIII
18 1/2 of the Illinois Insurance Code.
19(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
20102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
211-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
22eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
23102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
241-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
25eff. 1-1-24; revised 8-29-23.)

HB4112 Engrossed- 14 -LRB103 33223 LNS 63031 b
1 Section 35. The Voluntary Health Services Plans Act is
2amended by changing Section 10 as follows:
3 (215 ILCS 165/10) (from Ch. 32, par. 604)
4 Sec. 10. Application of Insurance Code provisions. Health
5services plan corporations and all persons interested therein
6or dealing therewith shall be subject to the provisions of
7Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
8143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
9356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t, 356u, 356v,
10356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a,
11356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
12356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22,
13356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
14356z.33, 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
15356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62,
16356z.64, 356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401,
17401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
18and (15) of Section 367 of the Illinois Insurance Code.
19 Rulemaking authority to implement Public Act 95-1045, if
20any, is conditioned on the rules being adopted in accordance
21with all provisions of the Illinois Administrative Procedure
22Act and all rules and procedures of the Joint Committee on
23Administrative Rules; any purported rule not so adopted, for
24whatever reason, is unauthorized.
25(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;

HB4112 Engrossed- 15 -LRB103 33223 LNS 63031 b
1102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
210-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
3eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
4102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
51-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
6eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
7103-551, eff. 8-11-23; revised 8-29-23.)
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