Insurance coverage

New Holmes Law requires insurance coverage for post-hysterectomy hormone therapy for women

SPRINGFIELD – When a woman needs a hysterectomy, the surgical removal of her uterus, ovaries and fallopian tubes causes a drop in estrogen and the onset of menopause. Insurance companies will soon be required to cover hormone therapy treatments under a plan spearheaded by State Sen. Linda Holmes.

“A lack of estrogen causes women to experience osteoporosis, weak bones, hot flashes and other symptoms,” Holmes (D-Aurora) said. “Hormone therapy replaces some or all of the estrogen that a woman’s ovaries would produce. Adding estrogen to a woman’s body reduces her risk of certain medical conditions.

Holmes’ new law requires insurance companies to cover the costs associated with medically necessary hormone therapy that induced menopause for patients undergoing hysterectomy. It applies to all plans issued or renewed on or after January 1, 2024 that are group or individual commercial health plans governed by the Insurance Code, as well as government employee plans, Medicaid plans, HMO plans and plans administered under the Municipal Code, counties. School Code, the School Code, the Limited Health Services Organizations Act and the Voluntary Health Services Plans Act.

“Hot flashes, weak bones, and osteoporosis dramatically decrease the quality of life for women who suffer from estrogen loss due to menopause,” Holmes said. “There is no reason for them to suffer when there is an effective treatment, and it will be more easily affordable and accessible under this new plan.”

Representative Keith Wheeler (R-North Aurora, 50and District) is the House sponsor of the bill; he recognizes that women who are scheduled for a hysterectomy need help so their bodies can re-regulate the many side effects of estrogen loss and the peace of mind of having the treatment covered by their insurance.

HB5254 was promulgated on Friday and is effective January 1, 2023.