Bill > HB1770

This bill amends the Illinois Insurance Code to require insurance policies to provide coverage for medically necessary treatments for genetic, rare, unknown, or unique conditions, specifically mentioning Ehlers-Danlos syndrome and altered drug metabolism. For policies that cover prescription drugs, the bill mandates coverage for opioid alternatives, medicines from the World Health Organization's Model List of Essential Medicines, and custom-made medications and medical food. The bill also stipulates that insurance policies that limit medication quantities in compliance with state and federal laws cannot require pre-approval for treating patients with rare metabolism conditions who may need higher medication doses. Additionally, the bill shifts the burden of proof away from the insured, meaning that in cases of claim rejections, preauthorization requests, and appeals related to the required coverage, the insurance company must demonstrate why a treatment is not medically necessary. This legislation aims to improve access to medical treatment for individuals with rare and complex health conditions by reducing insurance barriers and ensuring more comprehensive coverage.

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https://www.ilga.gov/legislation/BillStatus.asp?DocNum=1770&GAID=18&DocTypeID=HB&SessionID=114&GA=104