Bill Text: IL HB4504 | 2023-2024 | 103rd General Assembly | Engrossed

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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: Partisan Bill (Democrat 24-0)

Status: (Introduced) 2024-04-19 - Rule 19(a) / Re-referred to Rules Committee [HB4504 Detail]

Download: Illinois-2023-HB4504-Engrossed.html

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HB4504 Engrossed LRB103 36828 RPS 66939 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The State Employees Group Insurance Act of 1971
is amended by changing Section 6.11 as follows:
(5 ILCS 375/6.11)
Sec. 6.11. Required health benefits; Illinois Insurance
Code requirements. The program of health benefits shall
provide the post-mastectomy care benefits required to be
covered by a policy of accident and health insurance under
Section 356t of the Illinois Insurance Code. The program of
health benefits shall provide the coverage required under
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
356z.60, and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68,
and 356z.70 of the Illinois Insurance Code. The program of
health benefits must comply with Sections 155.22a, 155.37,
355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the
Illinois Insurance Code. The program of health benefits shall

HB4504 Engrossed - 2 - LRB103 36828 RPS 66939 b
provide the coverage required under Section 356m of the
Illinois Insurance Code and, for the employees of the State
Employee Group Insurance Program only, the coverage as also
provided in Section 6.11B of this Act. The Department of
Insurance shall enforce the requirements of this Section with
respect to Sections 370c and 370c.1 of the Illinois Insurance
Code; all other requirements of this Section shall be enforced
by the Department of Central Management Services.
Rulemaking authority to implement Public Act 95-1045, 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.
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
8-11-23; revised 8-29-23.)
Section 10. The Illinois Insurance Code is amended by
changing Section 356z.5 as follows:

HB4504 Engrossed - 3 - LRB103 36828 RPS 66939 b
(215 ILCS 5/356z.5)
Sec. 356z.5. Prescription inhalants.
(a) In this Section, "prescription inhaler" means a
prescribed medical device that delivers inhaled medications
used to treat breathing for persons suffering from asthma or
other life-threatening bronchial ailments. "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 group or individual policy of accident and health
insurance or managed care plan amended, delivered, issued, or
renewed through December 31, 2025 after the effective date of
this amendatory Act of the 93rd General Assembly that provides
coverage for prescription drugs may not deny or limit coverage
for prescription inhalers inhalants to enable persons to
breathe when suffering from asthma or other life-threatening
bronchial ailments 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.
(c) 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

HB4504 Engrossed - 4 - LRB103 36828 RPS 66939 b
prescription drugs may not deny or limit, except as otherwise
provided in this subsection, coverage for prescription
inhalers to enable persons to breathe when suffering from
asthma or other life-threatening bronchial ailments 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. A group or individual
policy of accident and health insurance or managed care plan
subject to this subsection 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 dollars per 30-day
supply.
(d) Nothing in this Section 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 amount specified in subsection (c).
(e) Coverage for prescription inhalers shall not be
subject to any deductible; except that this provision 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 (26 U.S.C. 223).
(f) 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

HB4504 Engrossed - 5 - LRB103 36828 RPS 66939 b