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SB2988 - 104th General Assembly

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB2988

Introduced 1/27/2026, by Sen. Laura Ellman

SYNOPSIS AS INTRODUCED:

215 ILCS 5/356z.62

Amends the Illinois Insurance Code. In provisions concerning coverage
of preventive health services, requires coverage of spinal examinations
for scoliosis.
LRB104 17962 BAB 31399 b

A BILL FOR

SB2988
LRB104 17962 BAB 31399 b
1

AN ACT concerning regulation.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 5.
The Illinois Insurance Code is amended by
5
changing Section 356z.62 as follows:

6

(215 ILCS 5/356z.62)
7

Sec. 356z.62.
Coverage of preventive health services.
8

(a) A policy of group health insurance coverage or
9
individual health insurance coverage as defined in Section 5
10
of the Illinois Health Insurance Portability and
11
Accountability Act shall, at a minimum, provide coverage for
12
and shall not impose any cost-sharing requirements, including
13
a copayment, coinsurance, or deductible, for:
14

(1) evidence-based items or services that have in
15

effect a rating of "A" or "B" in the current
16

recommendations of the United States Preventive Services
17

Task Force;
18

(2) immunizations that have in effect a recommendation
19

from the Advisory Committee on Immunization Practices of
20

the Centers for Disease Control and Prevention with
21

respect to the individual involved;
22

(3) with respect to infants, children, and
23

adolescents, evidence-informed preventive care and

SB2988
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LRB104 17962 BAB 31399 b
1

screenings provided for in the comprehensive guidelines
2

supported by the Health Resources and Services
3

Administration;
4

(4) with respect to women, such additional preventive
5

care and screenings not described in paragraph (1) of this
6

subsection (a) as provided for in comprehensive guidelines
7

supported by the Health Resources and Services
8

Administration for purposes of this paragraph;
and
9

(5) immunizations and medical countermeasures that
10

have in effect a recommendation within the State
11

Guidelines for Communicable Disease Prevention issued by
12

the Director of Public Health pursuant to Section 1.2 of
13

the Communicable Disease Prevention Act, with respect to
14

the individual involved. For this paragraph, the
15

prohibition on cost-sharing requirements does not apply if
16

and to the extent that the coverage would disqualify a
17

high-deductible health plan from eligibility for a health
18

savings account pursuant to Section 223 of the Internal
19

Revenue Code
; and

.

20

(6) spinal examinations for scoliosis.

21

(b) For purposes of this Section, and for purposes of any
22
other provision of State law, recommendations of the United
23
States Preventive Services Task Force regarding breast cancer
24
screening, mammography, and prevention issued in or around
25
November 2009 are not considered to be current.
26

(c) For office visits:

SB2988
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LRB104 17962 BAB 31399 b
1

(1) if an item or service described in subsection (a)
2

is billed separately or is tracked as individual encounter
3

data separately from an office visit, then a policy may
4

impose cost-sharing requirements with respect to the
5

office visit;
6

(2) if an item or service described in subsection (a)
7

is not billed separately or is not tracked as individual
8

encounter data separately from an office visit and the
9

primary purpose of the office visit is the delivery of
10

such an item or service, then a policy may not impose
11

cost-sharing requirements with respect to the office
12

visit; and
13

(3) if an item or service described in subsection (a)
14

is not billed separately or is not tracked as individual
15

encounter data separately from an office visit and the
16

primary purpose of the office visit is not the delivery of
17

such an item or service, then a policy may impose
18

cost-sharing requirements with respect to the office
19

visit.
20

(d) A policy must provide coverage pursuant to subsection
21
(a) for plan or policy years that begin on or after the date
22
that is one year after the date the recommendation or
23
guideline is issued. If a recommendation or guideline is in
24
effect on the first day of the plan or policy year, or if a
25
recommendation becomes effective for an in-force policy under
26
the circumstances described in subsection (d-5), the policy

SB2988
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LRB104 17962 BAB 31399 b
1
shall cover the items and services specified in the
2
recommendation or guideline through the last day of the plan
3
or policy year unless either:
4

(1) a recommendation under paragraph (1) of subsection
5

(a) is downgraded to a "D" rating; or
6

(2) the item or service is subject to a safety recall
7

or is otherwise determined to pose a significant safety
8

concern by a federal agency authorized to regulate the
9

item or service during the plan or policy year.
10

(d-5) Notwithstanding subsection (d), a policy, including
11
an in-force policy, must provide coverage pursuant to
12
paragraph (5) of subsection (a) within 15 business days after
13
the date the State Guidelines for Communicable Disease
14
Prevention are issued if the Guidelines reinstate any
15
recommendation or portion thereof under paragraph (2) of
16
subsection (a) that the Advisory Committee on Immunization
17
Practices has reduced or withdrawn.
18

(e) Network limitations.
19

(1) Subject to paragraph (3) of this subsection,
20

nothing in this Section requires coverage for items or
21

services described in subsection (a) that are delivered by
22

an out-of-network provider under a health maintenance
23

organization health care plan, other than a
24

point-of-service contract, or under a voluntary health
25

services plan that generally excludes coverage for
26

out-of-network services except as otherwise required by

SB2988
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LRB104 17962 BAB 31399 b
1

law.
2

(2) Subject to paragraph (3) of this subsection,
3

nothing in this Section precludes a policy with a
4

preferred provider program under Article XX-1/2 of this
5

Code, a health maintenance organization point-of-service
6

contract, or a similarly designed voluntary health
7

services plan from imposing cost-sharing requirements for
8

items or services described in subsection (a) that are
9

delivered by an out-of-network provider.
10

(3) If a policy does not have in its network a provider
11

who can provide an item or service described in subsection
12

(a), then the policy must cover the item or service when
13

performed by an out-of-network provider and it may not
14

impose cost-sharing with respect to the item or service.
15

(f) Nothing in this Section prevents a company from using
16
reasonable medical management techniques to determine the
17
frequency, method, treatment, or setting for an item or
18
service described in subsection (a) to the extent not
19
specified in the recommendation or guideline.
20

(g) Nothing in this Section shall be construed to prohibit
21
a policy from providing coverage for items or services in
22
addition to those required under subsection (a) or from
23
denying coverage for items or services that are not required
24
under subsection (a). Unless prohibited by other law, a policy
25
may impose cost-sharing requirements for a treatment not
26
described in subsection (a) even if the treatment results from

SB2988
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LRB104 17962 BAB 31399 b
1
an item or service described in subsection (a). Nothing in
2
this Section shall be construed to limit coverage requirements
3
provided under other law.
4

(h) The Director may develop guidelines to permit a
5
company to utilize value-based insurance designs. In the
6
absence of guidelines developed by the Director, any such
7
guidelines developed by the Secretary of the U.S. Department
8
of Health and Human Services that are in force under 42 U.S.C.
9
300gg-13 shall apply.
10

(i) For student health insurance coverage as defined at 45
11
CFR 147.145, student administrative health fees are not
12
considered cost-sharing requirements with respect to
13
preventive services specified under subsection (a). As used in
14
this subsection, "student administrative health fee" means a
15
fee charged by an institution of higher education on a
16
periodic basis to its students to offset the cost of providing
17
health care through health clinics regardless of whether the
18
students utilize the health clinics or enroll in student
19
health insurance coverage.
20

(j) For any recommendation or guideline specifically
21
referring to women or men, a company shall not deny or limit
22
the coverage required or a claim made under subsection (a)
23
based solely on the individual's recorded sex or actual or
24
perceived gender identity, or for the reason that the
25
individual is gender nonconforming, intersex, transgender, or
26
has undergone, or is in the process of undergoing, gender

SB2988
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LRB104 17962 BAB 31399 b
1
transition, if, notwithstanding the sex or gender assigned at
2
birth, the covered individual meets the conditions for the
3
recommendation or guideline at the time the item or service is
4
furnished.
5

(k) This Section does not apply to grandfathered health
6
plans, excepted benefits, or short-term, limited-duration
7
health insurance coverage.
8
(Source: P.A. 103-551, eff. 8-11-23; 104-439, eff. 12-2-25.)

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