Illinois writes a large body of coverage duties into group accident and health policies, and the useful answer to “what does state law require my plan to cover” is not a list. It is a shape. Illinois’ mandates include duties on prescription drug coverage for cancer treatment, infertility diagnosis and treatment, preventive services, telehealth, autism spectrum disorders, hearing aids, biomarker testing, epinephrine injectors, continuous glucose monitors, anesthesia services and a great deal more — but those duties sit in at least four separate bodies of law, every one of them passes through a scope gate before it reaches any particular contract, a single section number can conceal several unrelated requirements, and the set is not stable between the day you are quoted and the day you renew.
That shape is the story, and it does not need a total attached to it. This page explains it with the sections that demonstrate each part.
The gate every Illinois mandate passes through first
Before any individual mandate matters, read 215 ILCS 5/352, the scope section of Article XX, because it decides which contracts the Article reaches at all.
Subsection (d) exempts stop-loss insurance from the entire Article but for a short list of named sections. Subsection (e) exempts policies issued to Healthcare and Family Services for Medicaid and CHIP enrollees from essentially all benefit requirements, with three named exceptions. Subsection (c) provides that a policy issued in Illinois covering certificate holders “who are neither residents of nor employed in this State” need not give those nonresidents the Article’s mandated coverages. Subsection (g) keeps a band of sections away from reinsurance and from life and annuity contracts with incidental accident-and-sickness provisions.
Beside it, 215 ILCS 5/352b removes excepted benefits from the Article’s reach: references to a policy of individual or group accident and health insurance “do not include any coverage or policy that provides an excepted benefit, as that term is defined in Section 2791(c) of the federal Public Health Service Act.”
And 215 ILCS 5/352c prohibits short-term, limited-duration insurance, with the corresponding Act in Chapter 215 marked repealed.
The takeaway for anyone comparing an Illinois proposal: “Illinois requires X” is almost never true without qualification. Stop-loss, excepted benefits, Medicaid and CHIP contracts, and out-of-state certificate holders each have their own door.
A section number is not always an identifier
215 ILCS 5/356z.80 is the clearest illustration in the entire Illinois Insurance Code. Seven separate Public Acts of the 104th General Assembly all assigned that number to unrelated subjects, and the compiled statute prints all seven concurrently, each under its own Text of Section from P.A. … marker. Alzheimer’s treatments, anesthesia services, hippotherapy, testing for Klinefelter syndrome, laser hair removal, complex wheelchair service and repair, and a peripheral artery disease screening test all answer to 356z.80.
So a bare reference to that number identifies nothing. The anesthesia mandate — the one with an operative coverage duty today — is 215 ILCS 5/356z.80 (P.A. 104-42), and it reads:
“(a) A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for medically necessary anesthesia services, regardless of the duration, for any procedure covered by the policy. (b) An individual or group policy of accident and health insurance is prohibited from denying payment or reimbursement for anesthesia services solely because the duration of care exceeded a preset time limit.”
Other sections in the series carry multiple printed versions of the same subject, and there the bare number is unambiguous. The rule that survives contact with Illinois practice: where a section number carries more than one distinct subject at the source, the enacting Public Act travels with the citation.
The Illinois fact most summaries still get wrong
215 ILCS 5/356m, the infertility mandate, is the section to check any Illinois summary against — including the ones that sound authoritative.
Subsection (a) applied to a group policy “providing coverage for more than 25 employees”
that provides pregnancy-related benefits, and by its own terms ran “after January 1, 2016 and through December 31, 2025.”
That window has closed.
Subsection (a-5) is the operative text now, and it opens differently:
“No group policy of accident and health insurance that provides pregnancy-related benefits may be issued, amended, delivered, or renewed in this State on or after January 1, 2026 unless the policy contains coverage for the diagnosis and treatment of infertility, including, but not limited to, in vitro fertilization, uterine embryo lavage, embryo transfer, artificial insemination, gamete intrafallopian tube transfer, zygote intrafallopian tube transfer, surgical sperm extraction procedures, and low tubal ovum transfer…”
The employee threshold is simply gone. The employee threshold quoted above — the one every summary of this mandate still repeats — became false on January 1, 2026 and is false today. The mandate now reaches any group policy providing pregnancy-related benefits, without regard to group size. Subsection (e) retains a carve-out for a policy issued to or by a religious institution or organization that finds the procedures to violate its religious and moral teachings and beliefs.
There is one loose thread worth naming rather than papering over: subsection (b) still opens “the coverage required under subsection (a)…,” keying its in-vitro fertilization preconditions to the subsection whose window has closed. That seam is reported here and resolved nowhere.
An effective date is not the date coverage starts
This trips up careful readers, because the mistake comes from reading the statute correctly.
215 ILCS 5/356z.89 requires coverage for preeclampsia biomarker testing. Its source line is P.A. 104-710, effective 7-31-26, so the section is live Illinois law right now. But the operative sentence reads that a policy “amended, delivered, issued, or renewed on or after January 1, 2028 shall cover, without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement upon the insured, preeclampsia biomarker testing.”
Two different dates, and only one of them describes when a plan has to pay for anything. An employer told “Illinois now covers this” on the strength of the source line would be reading a duty that has not yet reached any policy. Several sections in the series carry a before-and-after amendment pair with a future switch date, which is the same trap in a different arrangement.
Some Illinois sections require an offer, not coverage
A heading that says a benefit is covered does not always mean the policy must contain it.
215 ILCS 5/356z.21, on tobacco use cessation programs, is the cleanest example in the Article. Subsection (c) provides that every insurer amending, delivering, issuing or renewing group accident and health policies providing coverage for hospital or medical treatment “shall offer, for an additional premium and subject to the insurer’s standard of insurability, optional coverage or optional reimbursement of up to $500 annually for a tobacco use cessation program for a person enrolled in the plan who is 18 years of age or older.”
The duty attaches to group policies, and it is a duty to make the offer. The group may decline it. An employer reading a summary that lists this among covered benefits would expect something the policy need not contain unless the offer was accepted.
Some Illinois sections bite only if the policy already covers something
215 ILCS 5/356z.7 — printed with its renumbering tail, “(was 215 ILCS 5/370r)”
— is the contingent form. It provides that “no group policy of accident or health insurance that provides coverage for prescribed drugs approved by the federal Food and Drug Administration for the treatment of certain types of cancer shall exclude coverage of any drug on the basis that the drug has been prescribed for the treatment of a type of cancer for which the drug has not been approved by the federal Food and Drug Administration.”
Read the conditional. The section does not create prescription drug coverage. It bars an off-label exclusion inside a policy that already covers prescribed drugs, and it conditions the protection further on the drug being recognized in one of the named reference compendia the section lists. Group policies only.
Preventive services at 215 ILCS 5/356z.62 show the same pattern from the other direction — a broad requirement to cover specified evidence-based items and immunizations without cost-sharing, narrowed by its own subsection (k): “this Section does not apply to grandfathered health plans, excepted benefits, or short-term, limited-duration health insurance coverage.” A recent amending layer added a state backstop that reinstates immunization coverage within 15 business days if a federal recommendation is reduced or withdrawn — a genuinely unusual structural feature, and one that only reaches the plans subsection (k) leaves inside the section.
Why nobody can hand you the complete list
Illinois does not publish a consolidated list of the coverage duties it imposes. The only consolidated enumeration located anywhere is federal — a CMS list of Illinois state-required benefits — and its own file metadata shows a last-modified date in November 2015. Every row on it carries an enactment cell reading “Before 2012,” which on the document’s face means none of them triggers the federal defrayal rule described below. Illinois has enacted a great many coverage sections since.
The Illinois Department of Insurance publishes a set of recurring reports — on consumer complaints, market share, medical malpractice, insulin pricing, health care rate review and more. A term sweep of that reports index returned zero occurrences of “mandate,” “mandated benefit,” “cost impact,” “essential health benefit” and “defray.” That sweep covers the index page rather than the whole department site, so the accurate sentence is that no mandate publication was located among the Department’s listed reports.
The federal rule in the background is 45 CFR 155.170, and it is the sharpest thing in this area. A benefit required by state action taking place on or after January 1, 2012, other than for compliance with federal requirements, and not covered in the state’s benchmark plan, “is considered in addition to the essential health benefits” — and “a State must make payments … to defray the cost of any State-required benefits in addition to the EHB.” The rule also requires that “the State will identify which State-required benefits are in addition to the EHB.” A May 2026 amendment restructures this for plan years beginning on or after January 1, 2028, adding an express four-part test that includes whether the requirement is applicable to the small group or individual markets.
The scope limit matters: that rule governs qualified health plans, and the defrayal obligation does not reach large-group or self-funded plans. So it is not the case that every Illinois mandate triggers a state payment. What can be said is that the cut line is December 31, 2011, that Illinois’ mandate set has grown substantially since then, and that no Illinois identification under that rule was located.
What this means for an Illinois employer buying or renewing
For an employer, the operational conclusion is short. The list you can check is not the contract you bought. Illinois’ benefit duties reach fully insured group policies through a gate, at dates that differ from the dates on the statutes, under numbers that sometimes carry more than one meaning — and the benchmark the state compares against is itself a small-group PPO product rather than a statute. Read the policy, and read it against the written benefit comparison your own employees are entitled to receive.
The bottom line
Illinois’ mandates include a long and growing set of coverage duties, but they sit in at least four separate bodies of law, every one of them passes through a scope gate first, and the set changes between the day you are quoted and the day you renew. Ask what your policy covers, not what the statute list says.
Frequently asked questions
How many benefit mandates does Illinois have?
No count is establishable, and this page prints none. The reason is structural rather than evasive. The entire text of 215 ILCS 5, Article XX was pulled and parsed rather than sampled, and counting it still would not produce an answer: not every section in the Article is a coverage duty — some are standard policy provisions, some are payment and billing rules, some are scope and form — and Illinois mandates also live outside the Insurance Code entirely, in the HMO Act at 215 ILCS 125, in the Voluntary Health Services Plans Act at 215 ILCS 165, and in the administrative rules at 50 Ill. Adm. Code. The numbering is also non-contiguous, so inferring a total from the highest section number gives a wrong answer. The honest formulation is that Illinois’ mandates include the duties below, not that they number anything in particular.
Does the Illinois infertility mandate only apply to groups with more than 25 employees?
Not any more, and this is the single most repeated error about Illinois group coverage. Subsection (a) of 215 ILCS 5/356m applied to a group policy “providing coverage for more than 25 employees” and ran through December 31, 2025. Subsection (a-5), operative from January 1, 2026, reads instead that “no group policy of accident and health insurance that provides pregnancy-related benefits may be issued, amended, delivered, or renewed in this State on or after January 1, 2026 unless the policy contains coverage for the diagnosis and treatment of infertility.” The employee threshold is gone from the operative subsection. The mandate now reaches any group policy providing pregnancy-related benefits regardless of group size. A religious carve-out at subsection (e) is retained.
Why does a citation to 215 ILCS 5/356z.80 need a Public Act with it?
Because seven different Public Acts of the 104th General Assembly all assigned the number 356z.80 to unrelated subjects, and the compiled statute prints all seven concurrently, each under its own “Text of Section from P.A. …” marker. The subjects have nothing to do with one another — they run from treatments for Alzheimer’s disease and related dementias to anesthesia services to complex wheelchair service and repair. A bare reference to 356z.80 therefore identifies no particular duty. The anesthesia mandate, for example, is cited as 215 ILCS 5/356z.80 (P.A. 104-42), and the Public Act is part of the citation rather than a decoration on it. Several other sections in the series carry multiple concurrent versions of the same subject, where the bare number is unambiguous and no Public Act is appended.
If a mandate is in force, does that mean my plan covers it now?
Not necessarily, and two separate things can make the answer no. The first is timing: a Public Act’s effective date and the date its coverage duty begins are different dates. The preeclampsia biomarker testing mandate at 215 ILCS 5/356z.89 sits under a Public Act effective 7-31-26 — live law today — while the coverage duty itself reaches policies “amended, delivered, issued, or renewed on or after January 1, 2028.” The second is scope. Article XX runs through 215 ILCS 5/352, which carves out stop-loss insurance from almost the whole Article, and 215 ILCS 5/352b removes excepted benefits from the Article’s references to group accident and health policies. A duty that is in force is not thereby a duty on your contract.
Does Illinois publish a list of everything a group plan has to cover?
Nothing current was located. The only consolidated enumeration found anywhere is a federal document, a CMS list of Illinois state-required benefits, and its own file header shows it was last modified in November 2015 — every row on it carries an enactment cell reading “Before 2012,” and Illinois has enacted a large number of coverage sections since. The Illinois Department of Insurance publishes a set of recurring reports; a term sweep of its reports index returned zero occurrences of “mandate,” “mandated benefit,” “cost impact,” “essential health benefit” and “defray.” That sweep covers the reports index page, not the whole department site, so the accurate statement is that no such publication was located rather than that none exists.
About the author
Nate Jones, CPCU, is the founder of Wexford Insurance and Wexford Health Insurance, an independent agency placing small-business group benefits in 9 states. He reads Illinois benefit mandates section by section against the policy in front of him, because a section number alone does not tell an Illinois employer which duty applies to their plan. Start with the Wexford Health Insurance quote form.