March 16, 2022

Benefit Updates Based on New Illinois Laws

Blue Cross and Blue Shield of Illinois (BCBSIL) is updating several benefits due to new laws in Illinois.

Definition of Infertility for Coverage of Infertility Benefits
As a result of House Bill 3709, BCBSIL is updating the definition of infertility in our benefit booklets based on the updated definition in the statute. Specifically, infertility is defined as any of the following:

1. Failure to establish a pregnancy or to carry a pregnancy to live birth.
• After 12 months of regular, unprotected sexual intercourse if the woman is 35 or younger
• After 6 months of regular, unprotected sexual intercourse if the woman is over 35
• Conceiving but having a miscarriage does not restart the 12-month or 6-month term for determining infertility
2. Inability to reproduce either as a single individual or with a partner without medical intervention
3. A licensed physician's findings based on a patient's medical, sexual and reproductive history, age, physical findings or diagnostic testing
   

• Applies to: Retail plans, Custom and Standard Fully Insured plans, Grandfathered and Transitional plans, PPO, HMO and POS plans, Student Health plans and ASO plans for State Employees.
• Effective date: For all policies issued, amended, delivered or renewed on or after Jan. 1, 2022.

Colonoscopy Coverage
As a result of House Bill 2653, BCBSIL will cover colonoscopies without cost sharing when they are follow-up exams to initial screening and determined medically necessary.

• Applies to: All HMO plans, including those that are Retail, Custom and Standard Fully Insured, Grandfathered and Transitional, Student Health and ASO. This change will not apply to high deductible health plans (HDHPs) where zero cost-sharing coverage conflicts with federal Internal Revenue Service (IRS) requirements.
• Effective date: For all policies issued, amended, delivered or renewed on or after Jan. 1, 2022.

Port Wine Stains Coverage
As a result of Senate Bill 2158, BCBSIL will cover medically necessary treatment of port wine stains.

• Applies to: Retail plans, Custom and Standard Fully Insured plans, Grandfathered and Transitional PPO and HMO plans, Student Health plans, and ASO plans for State Employees, County Employees, Municipal Employees or School Districts.
• Effective date: For all policies issued, amended, delivered or renewed on or after Jan. 1, 2022.

Coverage for Temporomandibular Joint Disorder (TMJ)
As a result of Senate Bill 499 the current benefit for the requirement for PPO plans to cover treatment for TMJ is being extended to the plan types listed below.

• Applies to: HMO, Medicaid and plans, including ASO plans, for State, Municipality and County employees.
• Effective date: For all policies issued, amended, delivered or renewed on or after Jan. 1, 2022.

Coverage for Biomarker Testing
As a result of House Bill 1779, BCBSIL will cover evidence-based biomarker testing when performed to diagnose, treat, manage or monitor a disease or condition.

• Applies to: PPO and HMO plans that are Retail, Custom and Standard Fully Insured, Grandfathered and Transitional, Student Health, and ASO plans for State Employees, County Employees, Municipal Employees or School Districts.
• Effective date: For all policies issued, amended, delivered or renewed on or after Jan. 1, 2022.

Coverage for A1c and Vitamin D Testing
As a result of Senate Bill 1854, BCBSIL will cover A1c tests for prediabetes, Type 1 and Type 2 diabetes when deemed medically necessary and Vitamin D testing for a vitamin D deficiency when deemed medically necessary.

• Applies to: PPO and HMO plans that are Retail, Custom and Standard Fully Insured, Grandfathered and Transitional, and Student Health.
• Effective date: For all policies issued, amended, delivered or renewed on or after Jan. 1, 2022.

Coverage for Cancer Screening
As a result of House Bill 2109, which has also been called “Cal’s Law,” in covering medically necessary cancer screenings, BCBSIL will not apply utilization management to cancer screenings that the provider determines is medically necessary.

• Applies to: PPO and HMO plans that are Retail, Custom and Standard Fully Insured, Grandfathered and Transitional, Student Health, and ASO plans for State Employees, County Employees, Municipal Employees or School Districts.
• Effective date: For all policies issued, amended, delivered or renewed on or after Jan. 1, 2022.

Coverage of Pancreatic Cancer Screening
Senate Bill 968 requires coverage for medically necessary pancreatic cancer screenings, but BCBSIL is not making any changes as pancreatic cancer screenings will continue to be covered, subject to medical necessity and applicable cost sharing.