HB5464 Summary

• Amends the Illinois Insurance Code to require group health insurance policies, individual health policies, qualified health plans, and employer group health plans amended, delivered, issued, or renewed on or after the effective date to provide unlimited benefits for inpatient and outpatient treatment of mental, emotional, nervous, or substance use disorders at in-network facilities.

• Requires coverage for serious mental illnesses and substance use disorders (as defined by the DSM) to be consistent with mental health parity requirements, including schizophrenia, bipolar disorder, major depression, PTSD, eating disorders, and substance abuse or dependence disorders.

• Mandates that the first 180 days per plan year of inpatient and outpatient treatment be provided without prior authorization or prospective utilization review when medically necessary, with concurrent review permitted for days 29 and beyond.

• Specifies that the first 28 days of inpatient care, detoxification, partial hospitalization, and outpatient treatment shall not be subject to retrospective or concurrent review, with medical necessity determined solely by the treating provider.

• Requires insurers to provide emergency network exceptions within 24 hours when no in-network facility is immediately available and establishes timelines for internal appeals (24 hours) and expedited external appeals (24 hours) for coverage denials.