Illinois Administrative Code › Title 50 - INSURANCE › Part 2001 - CONSTRUCTION AND FILING OF ACCIDENT AND HEALTH INSURANCE POLICY FORMS › Subpart A - PROVISIONS APPLICABLE TO INDIVIDUAL AND GROUP POLICIES › Section 2001.8 - Coverage of Preventive Health Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) Services
1) In General
Beginning at the time described in subsection (b), and
				  subject to
				  45
				  CFR 147.131, a group health plan, or a health
				  insurance issuer offering group or individual health insurance coverage, must
				  provide coverage stated both in the policy and certificate (for group coverage)
				  for all of the following items and services, and may not impose any
				  cost-sharing requirements (such as a copayment, coinsurance or deductible) with
				  respect to those items or services:
A)
				Evidence-based items or services that have in effect a rating of A or B in the
				current recommendations of the United States Preventive Services Task Force
				with respect to the individual involved (except as otherwise provided in
				subsection (c));
B) Immunizations
				for routine use in children, adolescents and adults that have in effect a
				recommendation from the Advisory Committee on Immunization Practices of the
				Centers for Disease Control and Prevention with respect to the individual
				involved (for this purpose, a recommendation from the Advisory Committee on
				Immunization Practices of the Centers for Disease Control and Prevention is
				considered in effect after it has been adopted by the Director of the Centers
				for Disease Control and Prevention, and a recommendation is considered to be
				for routine use if it is listed on the Immunization Schedules of the Centers
				for Disease Control and Prevention);
C) With respect to infants, children and
				adolescents, evidence-informed preventive care and screenings provided for in
				comprehensive guidelines supported by the Health Resources and Services
				Administration; and
D) With respect
				to women, to the extent not described in subsection (a)(1)(A), preventive care
				and screenings provided for in binding comprehensive health plan coverage
				guidelines supported by the Health Resources and Services Administration.
i) In developing the binding health plan
				coverage guidelines specified in this subsection (a)(1)(D), the Health
				Resources and Services Administration shall be informed by evidence and may
				establish exemptions from those guidelines allowed with respect to group health
				plans established or maintained by religious employers and health insurance
				coverage provided in connection with group health plans established or
				maintained by religious employers with respect to any requirement to cover
				contraceptive services under such guidelines.
ii) For purposes of this subsection
				(a)(1)(D), a "religious employer" is an organization that meets all of the
				following criteria: The inculcation of religious values is the purpose of the
				organization; the organization primarily employs persons who share the
				religious tenets of the organization; the organization serves primarily persons
				who share the religious tenets of the organization; the organization is a
				nonprofit organization as described in section 6033(a)(1) and (a)(3)(A)(i) or
				(iii) of the Internal Revenue Code of 1986, as amended (
				26 USC
				6033 ).