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Employee Benefits

Significant Progress on Sweeping Health Insurance Reforms in Illinois


Gov. J.B. Pritzker

Gov. J.B. Pritzker's comprehensive health insurance reform proposal, introduced as House Bill 5395, has advanced out of committee and is poised for consideration by the full House. This proposal, known as the Health Care Protection Act, was initially outlined by Governor Pritzker in his State of the State address in February, where he emphasized its potential to "save lives and lower health care costs for millions of Illinoisans."

Key components of the proposal include provisions to address various aspects of health insurance practices. These include banning prior authorization requirements for in-patient mental health treatment and prohibiting the use of "step therapy" in prescription drug coverage. Step therapy, also known as "fail first" therapy, mandates patients to prove the ineffectiveness of cheaper treatment options before accessing prescribed medications or therapies.

Furthermore, the bill aims to regulate short-term, limited duration insurance policies that do not meet federal Affordable Care Act standards and mandates insurance companies to adhere to "generally accepted standards of care" in their utilization review programs. It also requires insurers to maintain updated lists of in-network providers and grants the Illinois Department of Insurance authority to approve or reject proposed rate changes in large-group insurance plans.

Governor Pritzker anticipates opposition from the insurance industry, but bill sponsor Rep. Anna Moeller, along with other advocates, have collaborated with industry stakeholders to develop language enabling companies to implement these changes effectively.

The bill cleared the House Human Services Committee with a technical amendment on a partisan 6-3 vote. Moeller intends to introduce an additional amendment before the full House vote.

In addition to health insurance reforms, the Illinois Senate is also considering legislation to restrict the marketing and sale of e-cigarettes and vaping devices. Senate Bill 2662, proposed by Sen. Julie Morrison, seeks to prohibit the marketing of vaping devices that could be mistaken as harmless objects, such as school supplies.


Senate Bill 3098, sponsored by Sen. Meg Loughran Cappel, aims to prohibit the online sale of e-cigarettes to individuals under 21 years old.

From: Insurance News Net

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