IL HB5282

Requires individual and group accident and health insurance policies and managed care plans amended, delivered, issued, or renewed on or after the effective date to provide coverage for pregnancy and newborn care in accordance with federal essential health benefits requirements.

Mandates access to clinically appropriate case management programs for individuals identified as experiencing high-risk pregnancies by their treating provider, including coordination of health services, social services, and educational services.

Requires coverage for medically necessary mental health, emotional, nervous, and substance use disorder treatment related to pregnancy or postpartum complications, with first 48 hours of inpatient or detoxification services exempt from pre-service medical necessity review.

Establishes expedited internal appeal and external review processes for insurance denials of continued mental health and substance use treatment, with insurer responsible for benefits through the day following a denial determination.

Extends mental health and substance use disorder benefits to all individuals who have experienced a miscarriage or stillbirth, in addition to those with diagnosed mental health or substance use conditions during pregnancy or postpartum periods.