Reproductive Health Care Services, including Abortion and Contraceptives
FAQ for Insurance Coverage
Note: This FAQ is intended to provide general information. Please call the number on the back of your insurance card or go to your health plan's website for specific information about your coverage.
Is my insurance required to cover my abortion?
That depends on your type of insurance. The Reproductive Health Act requires state-regulated private health insurance plans that offer pregnancy-related benefits to cover abortion. This includes plans that you or your family purchase directly from a carrier such as plans purchased on the ACA (Affordable Care Act) Health Insurance Marketplace, and coverage that you have through an employer that is “fully insured". However, this requirement does not apply to Medicare or other federally managed plans, and it does not apply to private employers that provide “self-funded” group health plans, which are preempted from state regulation.
Additionally, for state-regulated private insurance plans, abortion care coverage must include medication abortion (“abortion pills”) obtained through a prescription, regardless of whether the plan otherwise provides prescription drug benefits.
Beginning January 1, 2024, state-regulated private insurance plans must also provide coverage for follow-up services related to coverage for medication abortion (“abortion pills”), such as management of side effects, medication self-management or adherence counseling, risk reduction strategies, and mental health strategies.
If you have questions about your plan’s abortion coverage, contact your insurer. To find out what type of insurance plan you have, contact your insurer or your employer’s human resource department, or call the Illinois Department of Insurance - Office of Consumer Health Insurance at 877-527-9431.
Is my Illinois Medicaid plan required to cover abortion?
Yes. Please see this information from the Illinois Department of Healthcare and Family Services and visit the HFS website.
Is my private insurance required to cover medication abortion (“abortion pills”) via telehealth?
For state-regulated private insurance, yes. Self-funded private employer plans are not required to cover medication abortion (“abortion pills”) via telehealth by state law but some plans still do.
Is my private insurance required to cover contraceptives or medication abortion (“abortion pills”) via mail?
The delivery method does not impact the coverage of contraceptives or abortion pills. The Illinois Insurance Code requires state-regulated health insurance plans that provide pregnancy related benefits to cover abortion, including via medication abortion (“abortion pills”). Illinois law and the ACA require coverage for contraceptive counseling and the full range of contraceptive products approved, cleared, or granted by the FDA without cost-sharing.
What do I do if I am unable to find an in-network abortion provider?
The Illinois Network Adequacy and Transparency Act protects individuals enrolled in PPO plans who, after making a good faith effort, are unable to find an in-network provider without “unreasonable travel distance or delay” when accessing health care, including abortion services, or because an in-network provider refuses to provide a service contrary to their conscience. In those circumstances, the insurer is required to cover the out-of-network care at the in-network benefit level.
Additionally, effective January 1, 2022, the federal No Surprises Act (“NSA”) provides protection for covered individuals who inadvertently obtain out-of-network care, including covered abortion services, based on a good faith belief that the provider was in-network because their insurer’s current provider directory listed the provider as in-network. State law also prohibits balance billing and requires both HMOs and PPOs to cover you at the in-network benefit level if you need to go out-of-network because no in-network provider will provide you a health care service due to their conscience objections. “Balance billing” is when a health care provider bills you for more than your cost-sharing because the insurer refuses to pay as much as the provider charges for the service.
For more information, contact your insurer or call the Illinois Department of Insurance - Office of Consumer Health Insurance at 877-527-9431.
Can my private insurer require a referral for an abortion?
If you have a state-regulated PPO plan, referrals are not required.
If you have a state-regulated HMO plan, a referral is not necessary to obtain abortion services from a participating provider. If you need abortion services from a provider who is not part of the HMO network, referral requirements still apply.
Can my private insurer require prior authorization for an abortion?
For state-regulated plans no, but for self-funded private employer plans yes.
Is my private insurance required to cover contraception?
Can my private insurer discriminate against me for accessing reproductive health services, such as abortion or contraceptives?
Illinois and federal insurance laws prohibit discrimination by an insurer based on an insured’s receipt of health care, medical condition, claims history, medical history, and other health status-related factors. Additionally, Illinois insurance regulations prohibit discrimination based on sex, actual or perceived gender identity, or sexual orientation.
Grandfathered health plans, excepted benefits, and short-term, limited-duration health insurance coverage are exempt from the Illinois insurance regulation prohibiting gender identity discrimination. However, consumers with one of these types of coverage who have experienced discrimination still may file a complaint with the Illinois Department of Human Rights by completing the IDHR Complainant Information Sheet and submitting it using one of the following methods:
• emailing it to IDHR.Intake@illinois.gov,
• faxing it to 312-814-6251, Attn: Intake Unit,
• mailing it to IDHR, Attn: Intake Unit, 555 W. Monroe Street, Suite 700, Chicago, IL 60661.
For more information about the Illinois Department of Human Rights, visit www.dhr.illinois.gov.