Amends the Fair Patient Billing Act. Makes changes to findings and defined terms provisions. Provides that a hospital shall not deny any protection or benefit of the Act on the basis of a patient's citizenship or immigration status or assets or prospective assets. Provides that a patient who inquires about a denial of financial assistance in whole or in part must be permitted to appeal the decision within at least 90 days. Requires a hospital to use only a uniform financial assistance form developed and provided by the Attorney General no later than December 31, 2026. Provides that every hospital bill and every collection notice must notify the patient, in the patient's preferred language, of the availability of hospital financial assistance and charity care. Establishes further provisions concerning hospitals pursuing collection actions; outsourced health care services; patient responsibilities; and applicability of the Act. Amends the Hospital Uninsured Patient Discount Act. Sets forth provisions concerning uninsured patient discounts for specified income levels. Prohibits hospitals from making the availability of a discount under the Act contingent upon the uninsured patient first applying for coverage under public health insurance programs. Provides that patients may not be denied a discount under the Act on the basis of citizenship or immigration status or assets or prospective assets. Makes other changes concerning uninsured patient discounts, outsourcing health care services, and patient responsibilities. Effective immediately.
Amends the Illinois Insurance Code. Provides that, on and after the effective date of the amendatory Act, coverage for all abortifacients, hormonal therapy medication, human immunodeficiency virus pre-exposure prophylaxis, and post-exposure prophylaxis drugs approved by the United States Food and Drug Administration, and follow-up services related to that coverage, shall include screenings for pre-PrEP HIV and sexually transmitted infections. Provides that the coverage shall also include kidney function analysis, routine laboratory testing, and routine provider visits associated with those screenings. Amends the Prior Authorization Reform Act. Prohibits a health insurance issuer from requiring prior authorization for the following prescription drug types and their therapeutic equivalents approved by the United States Food and Drug Administration: human immunodeficiency virus pre-exposure prophylaxis and post-exposure prophylaxis medication or human immunodeficiency virus treatment medication. Effective January 1, 2028.
Creates the Illinois Menopause Equity and Care Act. Amends the Department of Public Health Powers and Duties Law. Requires the Department of Public Health to create educational materials regarding menopause, including symptoms, treatment options, and patient rights for distribution to the public online. Amends the Illinois Insurance Code. Provides that on or after January 1, 2028, all individual and group health insurance policies issued, renewed, or amended must provide coverage for medically necessary evaluation and treatment of perimenopause and menopause as determined by a licensed health care provider using evidence-based guidelines. Amends the Medical Practice Act of 1987. Provides if a licensee treats or evaluates patients suffering from menopause-related conditions, 5 hours of the required 50 hours must include continuing education on menopause care, including management of symptoms, hormonal and non-hormonal therapies, and bone health. Amends the Illinois Human Rights Act. Defines "menopause-related condition" includes perimenopause, menopause, and associated medical or symptomatic conditions, including, but not limited to, vasomotor symptoms, sleep disruption, cognitive or mood changes, and osteoporosis-related changes. Provides that it is a civil rights violation to unlawfully discriminate because of a menopause-related condition or fail or refuse to provide reasonable accommodations.
Amends the Illinois Insurance Code. Requires the Department of Insurance to establish and maintain a dedicated, publicly accessible webpage on its official website that compiles and provides direct hyperlinks to the provider search directories or tools maintained by each health insurance issuer regulated by the Department. Provides that each regulated health insurance issuer shall submit to the Department, upon request and at least annually, the current URL for its provider search directory and notify the Department of any changes within 30 days after the changes. Provides that failure to comply may result in penalties. Establishes maintenance requirements of the webpage by the Department.
Amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Requires the Department of Public Health to establish the Abortion Access Fund Grant Program to award grants from the Abortion Access Fund to support access to abortion care services throughout the State. Provides that grants awarded under the Program shall only be used to fund abortion services for which the use of federal funds is prohibited for patients who are uninsured or underinsured with respect to those services. Allows the Department to establish rules necessary to implement the Abortion Access Fund Grant Program, including eligibility criteria, grant limits, application standards, requirements for the distribution and obligation of grant funds, accounting for the use of the funds, and standards for monitoring compliance with the requirements of the Program. Amends the State Finance Act to create the Abortion Access Fund as a special fund in the State treasury. Amends the Illinois Health Benefits Exchange Law. Requires specified health insurance issuers that have offered one or more qualified health plans through the Illinois Health Benefits Exchange to report to the Department of Insurance an accounting of receipts, disbursements, transfers of funds between accounts, total dollar claims paid, accrued interest, and the year-end balance for each reporting year for the separate allocation accounts that the issuer has established under specified provisions of federal law for abortion services for which federal funding is prohibited. Establishes further reporting requirements for health insurance issuers. Provides that, if the amount of premiums collected during the plan year for abortion services for which federal funding is prohibited exceeds total claims paid for such services rendered during the plan year, the Director of Insurance shall order the health insurance issuer to transfer funds, and the issuer shall complete the transfer, to the Abortion Access Fund. Makes other changes. Effective immediately.
Creates the Transparency in Downcoding Act. Provides that the Act applies to certain policies of health insurance amended, delivered, issued, or renewed on or after the effective date of the Act, except for employee or employer self-insured health benefit plans under the federal Employee Retirement Income Security Act of 1974 and health care provided pursuant to the Workers' Compensation Act or the Workers' Occupational Diseases Act. Prohibits a health insurance issuer from using an automated process, system, or tool to downcode a claim; from downcoding a claim based solely on the reported diagnosis codes; and from using downcoding practices in a targeted or discriminatory manner against physicians who routinely treat patients with complex or chronic conditions. Requires downcoding decisions to be made by a physician licensed to practice medicine in all its branches in any United States jurisdiction and of the same or similar specialty as a physician who typically manages the medical condition or disease. Sets forth provisions concerning notification requirements for downcoded claims; the appeal process for downcoded claims; enforcement by the Department of Insurance; and penalties. Provides that any pattern or practice of discriminatory downcoding identified by the Director of Insurance or another regulatory authority shall be subject to enforcement actions, including fines, restitution, or suspension of the health insurance issuer's license in this State. Effective immediately.
Amends the Hospital Licensing Act. Provides that a hospital licensed under the Act shall not charge a covered hospital employee more than 10% of the total health insurance premium cost. Provides that any agreement permitting a charge to a covered hospital employee in excess of 10% of the total health insurance premium cost shall be deemed invalid, void, and unenforceable. Provides that a hospital in violation of those provisions shall pay a civil penalty of $500 to the Department of Public Health for each impacted covered hospital employee.
Amends the Illinois Insurance Code. Sets forth provisions requiring an individual or group policy of accident and health insurance amended, delivered, issued, or renewed in this State on or after the effective date of the amendatory Act to provide coverage for up to a 12-month supply of prescription hormone therapy, and the necessary supplies for self-administration, that is prescribed by a network provider within the provider's scope of practice and dispensed at one time for an enrollee by a provider or pharmacist, or at a location licensed or otherwise authorized to dispense drugs or supplies. Amends the Pharmacy Practice Act. Provides that, notwithstanding any other provision of law, a dispensing provider or pharmacist shall dispense, at a patient's request, up to a 12-month supply of a prescription hormone therapy and the necessary supplies for self-administration pursuant to a valid prescription that specifies an initial quantity followed by periodic refills, except as specified. 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 the provisions of those Acts.
Amends the Fair Patient Billing Act. Makes changes to findings and defined terms provisions. Provides that a hospital shall not deny any protection or benefit of the Act on the basis of a patient's citizenship or immigration status or assets or prospective assets. Provides that a patient who inquires about a denial of financial assistance in whole or in part must be permitted to appeal the decision within at least 90 days. Requires a hospital to use only a uniform financial assistance form developed and provided by the Attorney General no later than December 31, 2026. Provides that every hospital bill and every collection notice must notify the patient, in the patient's preferred language, of the availability of hospital financial assistance and charity care. Establishes further provisions concerning hospitals pursuing collection actions; outsourced health care services; patient responsibilities; and applicability of the Act. Amends the Hospital Uninsured Patient Discount Act. Sets forth provisions concerning uninsured patient discounts for specified income levels. Prohibits hospitals from making the availability of a discount under the Act contingent upon the uninsured patient first applying for coverage under public health insurance programs. Provides that patients may not be denied a discount under the Act on the basis of citizenship or immigration status or assets or prospective assets. Makes other changes concerning uninsured patient discounts, outsourcing health care services, and patient responsibilities. Effective immediately.
Amends the Illinois Insurance Code. Requires every insurer to provide in each group or individual policy, contract, or certificate of insurance issued or renewed for persons who are residents of the State, coverage for screening by low-dose mammography for all patients 30 (instead of 35) years of age or older for the presence of occult breast cancer within the provisions of the policy, contract, or certificate. Requires coverage for a baseline mammogram for patients 30 to 34 (instead of 35 to 39) years of age and an annual mammogram for patients 35 (instead of 40) years of age or older. Effective January 1, 2027.
