Bill Text: IL SB3203 | 2023-2024 | 103rd General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or before December 31, 2025 that provides coverage for prescription drugs may not deny or limit coverage for prescription inhalers (instead of prescription inhalants) based upon any restriction on the number of days before an inhaler refill may be obtained if, contrary to those restrictions, the inhalants have been ordered or prescribed by the treating physician and are medically appropriate. Provides that a group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after January 1, 2026 that provides coverage for prescription drugs shall limit the total amount that a covered person is required to pay for a covered prescription inhaler to an amount not to exceed $25 per 30-day supply, and provides that nothing in the provisions prevents a group or individual policy of accident and health insurance or managed care plan from reducing a covered person's cost sharing to an amount less than the cap. Makes a conforming change. Provides that coverage for prescription inhalers shall not be subject to any deductible, except to the extent that the coverage would disqualify a high-deductible health plan from eligibility for a health savings account. Authorizes rulemaking and enforcement by the Department of Insurance. Amends the State Employees Group Insurance Act of 1971. Provides that the program of health benefits shall provide coverage for prescription inhalers under the Illinois Insurance Code.

Spectrum: Strong Partisan Bill (Democrat 53-3)

Status: (Passed) 2024-08-09 - Public Act . . . . . . . . . 103-0951 [SB3203 Detail]

Download: Illinois-2023-SB3203-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3203 Introduced 2/6/2024, by Sen. Mattie Hunter SYNOPSIS AS INTRODUCED:
215 ILCS 5/356z.71 new
Amends the Illinois Insurance Code. Provides that a health plan shall limit the total amount that a covered person is required to pay for a covered prescription inhaler at an amount not to exceed $25 per 30-day supply and shall limit the total amount that a covered person is required to pay for all covered prescription inhalers at an amount not to exceed $50 in total per 30 days. Provides that coverage for prescription inhalers shall not be subject to any deductible. Provides that nothing in the provisions prevents a health plan from reducing a covered person's cost sharing to an amount less than the cap. Authorizes rulemaking and enforcement by the Department of Insurance. Effective January 1, 2025.
LRB103 37942 CES 68074 b
A BILL FOR
SB3203 LRB103 37942 CES 68074 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by
adding Section 356z.71 as follows:
(215 ILCS 5/356z.71 new)
Sec. 356z.71. Prescription inhalers.
(a) In this Section:
"Health plan" means a policy of accident and health
insurance or managed care plan that is amended, delivered,
issued, or renewed on or after the effective date of this
amendatory Act of the 103rd General Assembly that provides
coverage for prescription inhalers.
"Prescription inhaler" means a prescribed medical device
that delivers inhaled medications used to treat respiratory
conditions and the prescribed inhaled medication.
"Prescription inhaler" includes metered-dose inhalers,
nebulizers, and dry powder inhalers. "Prescription inhaler"
does not include inhalers available over the counter without a
prescription to provide temporary relief from respiratory
symptoms.
(b) A health plan shall limit the total amount that a
covered person is required to pay for a covered prescription

SB3203 - 2 - LRB103 37942 CES 68074 b
inhaler to an amount not to exceed $25 per 30-day supply and
shall limit the total amount that a covered person is required
to pay for all covered prescription inhalers to an amount not
to exceed $50 in total per 30 days. Coverage for prescription
inhalers shall not be subject to any deductible.
(c) Nothing in this Section prevents a health plan from
reducing a covered person's cost sharing to an amount less
than the amount specified in subsection (b).
(d) The Department may adopt rules necessary to implement
and administer this Section and to align with federal
requirements. The Department may use any of its enforcement
powers to obtain a health plan's compliance with this Section.