On August 25, 2021, H.B. 2595 was passed, amending the Illinois Insurance Code to require insurers issuing or renewing group health plans (among other plans) in the state to provide coverage for medically necessary treatment of mental, emotional, nervous or substance use disorders or conditions. The new law applies to group health plans that are issued or renewed on or after January 1, 2022.
The law further provides that an insurer shall base any medical necessity determination or the utilization review criteria on current generally accepted standards of mental, emotional, nervous or substance use disorder or condition care, among other items. In addition, the law explains that for each violation, a civil penalty between $5,000 and $20,000 may be accessed in certain circumstances.
Employers should be aware of these developments and confirm with carriers (as applicable) that behavioral health coverage requirements comply with this new law effective January 1, 2022.
House Bill 2595 »
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