reglab/housing_qa huggingface dataset:
215 ILCS 5/356z.1
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 356z.1. Prenatal HIV testing. An individual or group policy of  accident and health insurance that provides maternity coverage and is amended,  delivered, issued, or renewed after the effective date of this amendatory Act  of the 92nd General Assembly must provide coverage for prenatal HIV testing  ordered by an attending physician licensed to practice medicine in all its  branches, or by a physician assistant or advanced practice registered nurse, including but not limited to orders consistent with  the recommendations of the American College of Obstetricians and Gynecologists  or the American Academy of Pediatrics.  (Source: P.A. 99-173, eff. 7-29-15.)
215 ILCS 5/356z.3
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 356z.3.  Disclosure of limited benefit. An insurer that  issues,  delivers,  amends, or  renews an individual or group policy of accident and health insurance in this  State after the  effective date of this amendatory Act of the 92nd General Assembly and  arranges, contracts  with, or administers contracts with a provider whereby beneficiaries are  provided an incentive to  use the services of such provider must include the following disclosure on its  contracts and  evidences of coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN  NON-PARTICIPATING PROVIDERS ARE USED. You should be aware that when you elect  to  utilize the services of a non-participating provider for a covered service in non-emergency  situations, benefit payments to such non-participating provider are not based upon the amount  billed. The basis of your benefit payment will be determined according to your policy's fee  schedule, usual and customary charge (which is determined by comparing charges for similar  services adjusted to the geographical area where the services are performed), or other method as  defined by the policy. YOU CAN EXPECT TO PAY MORE THAN THE COINSURANCE  AMOUNT DEFINED IN THE POLICY AFTER THE PLAN HAS PAID ITS REQUIRED  PORTION. Non-participating providers may bill members for any amount up to the  billed  charge after the plan has paid its portion of the bill as provided in Section 356z.3a of the Illinois Insurance Code. Participating providers  have agreed to accept  discounted payments for services with no additional billing to the member other  than co-insurance and deductible amounts. You may obtain further information  about the  participating  status of professional providers and information on out-of-pocket expenses by  calling the toll  free telephone number on your identification card.".(Source: P.A. 96-1523, eff. 6-1-11; 97-813, eff. 7-13-12.)
215 ILCS 5/356z.4a
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 356z.4a. Coverage for abortion.(a) Except as otherwise provided in this Section, no individual or group policy of accident and health insurance that provides pregnancy-related benefits may be issued, amended, delivered, or renewed in this State after the effective date of this amendatory Act of the 101st General Assembly unless the policy provides a covered person with coverage for abortion care.(b) Coverage for abortion care may not impose any deductible, coinsurance, waiting period, or other cost-sharing limitation that is greater than that required for other pregnancy-related benefits covered by the policy.(c) Except as otherwise authorized under this Section, a policy shall not impose any restrictions or delays on the coverage required under this Section.(d) This Section does not, pursuant to 42 U.S.C. 18054(a)(6), apply to a multistate plan that does not provide coverage for abortion.(e) If the Department concludes that enforcement of this Section may adversely affect the allocation of federal funds to this State, the Department may grant an exemption to the requirements, but only to the minimum extent necessary to ensure the continued receipt of federal funds.   (Source: P.A. 101-13, eff. 6-12-19.)
215 ILCS 5/356z.4b
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 356z.4b. Billing for long-acting reversible contraceptives.(a) In this Section, "long-acting reversible contraceptive device" means any intrauterine device or contraceptive implant.(b) Any individual or group policy of accident and health insurance or qualified health plan that is offered through the health insurance marketplace that is amended, delivered, issued, or renewed on or after the effective date of this amendatory Act of the 102nd General Assembly shall allow hospitals separate reimbursement for a long-acting reversible contraceptive device provided immediately postpartum in the inpatient hospital setting before hospital discharge. The payment shall be made in addition to a bundled or Diagnostic Related Group reimbursement for labor and delivery.   (Source: P.A. 102-665, eff. 10-8-21.)
215 ILCS 5/356z.5
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 356z.5.  Prescription inhalants. A group or individual  policy of  accident and health insurance or managed care plan amended, delivered, issued,  or renewed  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 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.       (Source: P.A. 95-331, eff. 8-21-07.)
215 ILCS 5/356z.6
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 356z.6. Bone mass measurement; osteoporosis.  A group or individual  policy of  accident and health insurance amended, delivered, issued,  or renewed after the effective date of this amendatory Act of the 93rd General  Assembly must  provide coverage for  medically necessary bone mass measurement and for the diagnosis and treatment  of osteoporosis on  the  same terms and conditions that are generally  applicable  to coverage for other  medical conditions.  (Source: P.A. 93-853, eff. 1-1-05.)
215 ILCS 5/356z.7
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

 (was 215 ILCS 5/370r)Sec. 356z.7. Prescription drugs; cancer treatment. No group policy of  accident or health insurance that provides coverage for prescribed  drugs approved by the federal Food and Drug Administration for the  treatment of certain types of cancer shall exclude coverage of any drug on  the basis that the drug has been prescribed for the treatment of a type of  cancer for which the drug has not been approved by the federal Food and  Drug Administration.  The drug, however, must be approved by the federal  Food and Drug Administration and must be recognized for the treatment of the  specific type of cancer for which the drug has been prescribed in any  one of the following established reference compendia:(a) the American Hospital Formulary Service Drug     Information;(b) National Comprehensive Cancer Network's Drugs &     Biologics Compendium;(c) Thomson Micromedex's Drug Dex;(d) Elsevier Gold Standard's Clinical Pharmacology; or(e) other authoritative compendia as identified from     time to time by the Federal Secretary of Health and Human Services; or if not in the compendia, recommended for that particular type of cancer  in formal clinical studies, the results of which have been published in at  least two peer reviewed professional medical journals published in the  United States or Great Britain.Any coverage required by this Section shall also include those medically  necessary services associated with the administration of a drug.Despite the provisions of this Section, coverage shall  not be required for any experimental or investigational drugs or any drug  that the federal Food and Drug Administration has determined to be  contraindicated for treatment of the specific type of cancer for which the  drug has been prescribed.  This Section shall apply only to cancer drugs.  Nothing in this Section shall be construed, expressly or by implication, to  create, impair, alter, limit, notify, enlarge, abrogate or prohibit  reimbursement for drugs used in the treatment of any other disease or  condition.  (Source: P.A. 95-331, eff. 8-21-07; 96-457, eff. 8-14-09.)
215 ILCS 5/356z.8
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 356z.8. Multiple sclerosis preventative physical therapy. A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 94th General Assembly must provide coverage for medically necessary preventative physical therapy for insureds diagnosed with multiple sclerosis. For the purposes of this Section, "preventative physical therapy" means physical therapy that is prescribed by a physician licensed to practice medicine in all of its branches for the purpose of treating parts of the body affected by multiple sclerosis, but only where the physical therapy includes reasonably defined goals, including, but not limited to, sustaining the level of function the person has achieved, with periodic evaluation of the efficacy of the physical therapy against those goals. The coverage required under this Section shall be subject to the same deductible, coinsurance, waiting period, cost sharing limitation, treatment limitation, calendar year maximum, or  other limitations as provided for  other physical or rehabilitative therapy benefits covered by the policy.  (Source: P.A. 94-1076, eff. 12-29-06.)
215 ILCS 5/356z.9
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 356z.9. Human papillomavirus vaccine. A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 95th General Assembly must provide coverage for a human papillomavirus vaccine (HPV) that is approved for marketing by the federal Food and Drug Administration.  (Source: P.A. 95-422, eff. 8-24-07; 95-876, eff. 8-21-08.)
215 ILCS 5/356z.10
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 356z.10. Amino acid-based elemental formulas. A group or individual major medical accident and health insurance policy or managed care plan amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 95th General Assembly must provide coverage and reimbursement for amino acid-based elemental formulas, regardless of delivery method, for the diagnosis and treatment of (i) eosinophilic disorders and (ii) short bowel syndrome when the prescribing physician has issued a written order stating that the amino acid-based elemental formula is medically necessary.  (Source: P.A. 95-520, eff. 8-28-07; 95-876, eff. 8-21-08.)
215 ILCS 5/356z.11
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 356z.11. Dependent students; medical leave of absence.  A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 95th General Assembly must continue to provide coverage for a dependent college student who takes a medical leave of absence or reduces his or her course load to part-time status because of a catastrophic illness or injury.Continuation of coverage under this Section is subject to all of the policy's terms and  conditions applicable to those forms of insurance. Continuation of insurance under the policy shall terminate  12 months after notice of the illness or injury or until the coverage would have otherwise lapsed pursuant to the terms and conditions of the policy, whichever comes first, provided the need for part-time status or medical leave of absence is supported by a clinical certification of need from a physician licensed to practice medicine in all its branches.The provisions of this Section do not apply to short-term travel, accident-only, limited, or specified disease policies or to policies or contracts designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare, or any other similar coverage under State or federal governmental plans.  (Source: P.A. 95-958, eff. 6-1-09; 96-328, eff. 8-11-09.)
215 ILCS 5/356z.13
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 356z.13. Shingles vaccine.  A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of the amendatory Act of this  95th General Assembly must provide coverage for a vaccine for shingles that is approved for marketing by the federal Food and Drug Administration if the vaccine is ordered by a physician licensed to practice medicine in all its branches and the enrollee is 60 years of age or older.  (Source: P.A. 95-978, eff. 1-1-09; 96-328, eff. 8-11-09.)
215 ILCS 5/356z.16
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 356z.16. (Repealed).        (Source: P.A. 100-386, eff. 1-1-18. Repealed by P.A. 101-456, eff. 8-23-19.)
215 ILCS 5/356z.19
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 356z.19. Cardiovascular disease. Because cardiovascular disease is a  leading cause of death and disability, an insurer providing group or individual policies of accident and health insurance or a managed care plan shall develop and implement a process to communicate with their adult enrollees on an annual basis regarding the importance and value of early detection and proactive management of cardiovascular disease. Nothing in this Section affects any change in the terms, conditions, or benefits of the policies and plans, nor the criteria, standards, and procedures related to the application for, enrollment in, or renewal of coverage or conditions of participation of enrollees in the health plans or policies subject to this Code.  (Source: P.A. 97-282, eff. 8-9-11; 97-813, eff. 7-13-12.)
215 ILCS 5/356z.20
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 356z.20. Cancer drug parity.(a) As used in this Section:"Financial requirement" means deductibles, copayments,  coinsurance, out-of-pocket expenses, aggregate lifetime  limits, and annual limits."Treatment limitation" means limits on the frequency of  treatment, days of coverage, or other similar limits on the  scope or duration of treatment.(b) On and after the effective date of this amendatory Act  of the 97th General Assembly, every insurer that amends,  delivers, issues, or renews an individual or group policy of  accident and health insurance amended, delivered, issued, or  renewed on or after the effective date of this amendatory Act  of the 97th General Assembly that provides coverage for  prescribed orally-administered cancer medications and  intravenously administered or injected cancer medications  shall ensure that:(1) the financial requirements applicable to such     prescribed orally-administered cancer medications are no more restrictive than the financial requirements applied to intravenously administered or injected cancer medications that are covered by the policy and that there are no separate cost-sharing requirements that are applicable only with respect to such prescribed orally-administered cancer medications; and(2) the treatment limitations applicable to such     prescribed orally-administered cancer medications are no more restrictive than the treatment limitations applied to intravenously administered or injected cancer medications that are covered by the policy and that there are no separate treatment limitations that are applicable only with respect to such prescribed orally-administered cancer medications.(c) An insurer cannot achieve compliance with this Section  by increasing financial requirements or imposing more  restrictive treatment limitations on prescribed orally-administered cancer medications or intravenously  administered or injected cancer medications covered under the  policy on the effective date of this amendatory Act of the 97th  General Assembly.   (Source: P.A. 97-198, eff. 1-1-12; 97-813, eff. 7-13-12.)
215 ILCS 5/356z.21
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 356z.21. Tobacco use cessation programs; coverage offer.(a) Tobacco use is the number one cause of preventable disease and death in Illinois, costing $4.1 billion annually in direct health care costs and an additional $4.35 billion in lost productivity. In Illinois, the smoking rates are highest among African Americans (25.8%). Smoking rates among lesbian, gay, and bisexual adults range from 25% to 44%. The U.S. Public Health Service Clinical Practice Guideline 2008 Update found that tobacco dependence treatments are both clinically effective and highly cost effective. A study in the Journal of Preventive Medicine concluded that comprehensive smoking cessation treatment is one of the 3 most important and cost effective preventive services that can be provided in medical practice. Greater efforts are needed to achieve more of this potential value by increasing current low  levels of performance.(b) In this Section, "tobacco use cessation program" means a program recommended by a physician that follows evidence-based treatment, such as is outlined in the United States Public Health Service guidelines for tobacco use cessation. "Tobacco use cessation program" includes education and medical treatment components designed to assist a person in ceasing the use of tobacco products.  "Tobacco use cessation program" includes education and counseling by physicians or associated medical personnel and all FDA approved medications for the treatment of tobacco dependence irrespective of whether they are available only over the counter, only by prescription, or both over the counter and by prescription.(c) On or after the effective date of this amendatory Act of the 97th General Assembly, every  insurer that amends, delivers, issues, or renews group accident and health policies providing coverage for hospital or medical treatment or services on an expense-incurred basis shall offer, for an additional premium and subject to the insurer's standard of insurability, optional coverage or optional reimbursement of up to $500 annually for a tobacco use cessation program for a person enrolled in the plan who is 18 years of age or older.(d) The coverage required by this Section shall be subject  to other general exclusions and limitations of the policy,  including coordination of benefits, participating provider  requirements, restrictions on services provided by family or household members, utilization review of health care services, including review of medical necessity, case management, experimental and investigational treatments, and other managed care provisions.(e) For the coverage provided under this Section, an insurer may not penalize or reduce or limit the reimbursement of an attending provider or provide incentives, monetary or otherwise, to an attending provider to induce the provider to provide care to an insured in a manner inconsistent with the coverage under this Section.  (Source: P.A. 97-592, eff. 1-1-12; 97-813, eff. 7-13-12.)
215 ILCS 5/356z.23
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 356z.23. Coverage for opioid antagonists.(a)  An individual or group policy of accident and health insurance amended, delivered, issued, or renewed in this State after the effective date of this amendatory Act of the 99th General Assembly that provides coverage for prescription drugs must provide coverage for at least one opioid antagonist, including the medication product, administration devices, and any pharmacy administration fees related to the dispensing of the opioid antagonist. This coverage must include refills for expired or utilized opioid antagonists.(b)  As used in this Section, "opioid antagonist"  means a drug that binds to opioid receptors and blocks or inhibits the effect of opioids acting on those receptors, including, but not limited to, naloxone hydrochloride or any other similarly acting drug approved by the U.S. Food and Drug Administration.  (Source: P.A. 99-480, eff. 9-9-15.)
215 ILCS 5/356z.24
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 356z.24. Immune gamma globulin therapy.(a) A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 99th General Assembly may not allow for the delay, discontinuation, or interruption of immune gamma globulin therapy for persons who are diagnosed with a primary immunodeficiency when prescribed as medically necessary by a physician licensed to practice medicine in all of its branches and if provided as a covered benefit under the plan. Nothing in this Section shall prevent an insurer from applying appropriate utilization review standards to the ongoing coverage of immune gamma globulin therapy for persons diagnosed with a primary immunodeficiency by a physician licensed to practice medicine in all of its branches.(b) Upon diagnosis of primary immunodeficiency by the prescribing physician, determination of an initial authorization for immune gamma globulin therapy shall be no less than 3 months.  Reauthorization for immune gamma globulin therapy for patients with a primary immunodeficiency diagnosis may occur every 6 months thereafter.  For patients with a diagnosis of primary immunodeficiency who have been receiving immune gamma globulin therapy for at least 2 years with sustained beneficial response based on the treatment notes or clinical narrative detailing progress to date, reauthorization shall be no less than 12 months unless a more frequent duration has been indicated by the prescribing physician.(c) If, at any time, the Secretary of the United States Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the Federal Register or publishes a comment in the Federal Register or issues an opinion, guidance, or other action that would  require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Public Law 111-148), including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any successor provision, to defray the cost of any coverage outlined in subsections (a) and (b), then subsections (a) and (b) are inoperative with respect to all coverage outlined in subsections (a) and (b) other than that authorized under Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and the State shall not assume any obligation for the cost of the coverage set forth in subsections (a) and (b).   (Source: P.A. 99-788, eff. 8-12-16.)