Healthcare (Insurance)

Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026, shall not impose any prior authorization or utilization management controls on covered behavioral health services. Makes conforming changes to the State Employees Group Insurance Act of 1971, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, and the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Insurance and the Department of Healthcare and Family Services to establish a process for receiving complaints from providers and covered individuals for violations of the mandate. Grants the Department of Insurance and the Department of Healthcare and Family Services the authority to issue cease and desist orders and administrative fines. Amends the Prior Authorization Reform Act. Provides that the Department of Healthcare and Family Services shall adopt rules consistent with the Act. Provisions amending the Prior Authorization Reform Act are effective immediately.

Amends the Illinois Insurance Code. Provides that, unless certain conditions are met, it is an unfair method of competition and an unfair and deceptive act or practice in the business of insurance to solicit an individual who is over the age of 65, as described in provisions concerning an individual who has executed a health care power of attorney or has a medical condition, such as dementia, that reduces the person's capacity to make informed decisions independently, (instead of to solicit an individual who is over the age of 65) to purchase accident or health insurance. Effective January 1, 2026.

Amends the Illinois Insurance Code. Makes changes to defined terms. Provides that a group policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after January 1, 2026 shall provide coverage for evidence-based cancer imaging for individuals with an increased risk of cancer as recommended by the current National Comprehensive Cancer Network clinical practice guidelines. Provides that this coverage shall be provided without cost-sharing, and the requirements of the Act shall not apply to the extent that providing coverage would disqualify a high-deductible health plan from eligibility for a health savings account.

Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2027 shall provide coverage for all medically necessary diagnostic testing and U.S. Food and Drug Administration-approved treatments or medications prescribed to slow the progression of Alzheimer's disease or another related dementia, in accordance with the U.S. Food and Drug Administration label, as determined by a physician licensed to practice medicine in all its branches. Provides that coverage of U.S. Food and Drug Administration-approved treatments or medications prescribed to slow the progression of Alzheimer's disease or another related dementia shall not be subject to step therapy. Amends the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, and the Voluntary Health Services Plans Act to require coverage under those provisions. Effective immediately.

Creates the Artificial Intelligence Systems Use in Health Insurance Act. Provides that the Department of Insurance's regulatory oversight of insurers includes oversight of an insurer's use of AI systems to make or support adverse determinations that affect consumers. Provides that any insurer authorized to operate in the State is subject to review by the Department in an investigation or market conduct action regarding the development, implementation, and use of AI systems or predictive models and the outcomes from the use of those AI systems or predictive models. Provides that an insurer authorized to do business in Illinois shall not issue an adverse consumer outcome with regard to the denial, reduction, or termination of insurance plans or benefits that result solely from the use or application of any AI system or predictive model. Provides that any decision-making process for the denial, reduction, or termination of insurance plans or benefits that results from the use of AI systems or predictive models shall be meaningfully reviewed, in accordance with review procedures determined by Department rules, by an individual with authority to override the AI systems and determinations. Authorizes the Department to adopt emergency rules to implement the Act and to adopt rules concerning standards for full and fair disclosure of an insurer's use of AI systems. Makes a conforming change in the Illinois Administrative Procedure Act.

Amends the Medical Patient Rights Act. Provides that a patient who is covered under a policy of accident and health insurance, dental plan, or vision care plan is entitled to receive medical, dental, or eye care services without being required to pay an amount in excess of the estimated cost share, copayment, or deductible before those services are provided if such services are typically covered under the policy of accident and health insurance, dental plan, or vision care plan.

Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for the cost of a karyotype test or related hormone testing to diagnose Klinefelter syndrome. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require coverage under those provisions.

Amends the Fair Patient Billing Act. Provides that medical creditors and debt collectors are prohibited from communicating with a patient regarding unpaid charges for the purpose of seeking to collect the charges and initiating a lawsuit or arbitration proceeding against the patient regarding the unpaid charges while an appeal of a health insurance decision is pending or was pending within 180 days. Sets forth provisions concerning medical debt interest under a reasonable payment plan, the applicable interest rate for judgments on medical debt, the effect of medical debt forgiveness on the contractual relationship between the medical creditor and the insurer or payor, and the applicability of the provisions.

Amends the Illinois Insurance Code. Provides that every insurer that amends, delivers, issues, or renews a group or individual policy or certificate of disability insurance or disability income insurance shall ensure parity for the payment of mental, emotional, nervous, or substance use disorders or conditions. Changes the definition of "treatment limitation" to include benefit payments under disability insurance or disability income insurance.

HB 1286 amends Illinois Insurance Code Section 367f to clarify requirements for maintaining group health insurance coverage for firefighters during retirement or disability periods. It requires municipalities and insurers to automatically allow firefighters to continue their group health coverage (including dependents' coverage) throughout their retirement or disability period at the same premium rate as active firefighters, without discrimination. The bill mandates specific written notices: municipalities must notify insurers within 15 days of a firefighter's retirement/disability period starting, and insurers must then notify firefighters of their continuation options within 15 days. This directly affects firefighters employed by Illinois municipalities who are covered under group health insurance policies.