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Public Act 104-0548
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| HB4203 Enrolled | LRB104 15932 BAB 29167 b |
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois, |
represented in the General Assembly:
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Section 5. The Illinois Insurance Code is amended by |
changing Section 356u as follows:
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(215 ILCS 5/356u) |
Sec. 356u. Pap tests and prostate cancer screenings. |
(a) A group policy of accident and health insurance that |
provides coverage for hospital or medical treatment or |
services for illness on an expense-incurred basis and is |
amended, delivered, issued, or renewed on or after January 1, |
2028 2024 shall provide coverage, without imposing a |
deductible, coinsurance, copayment, or any other cost-sharing |
requirement, for all of the following: |
(1) An annual cervical smear or Pap smear test for all |
insureds. |
(2) An annual prostate cancer screening for insureds |
upon the recommendation of a physician licensed to |
practice medicine in all its branches for: |
(A) asymptomatic individuals age 50 and over; |
(B) African-American individuals age 40 and over; |
and |
(C) individuals age 40 and over with a family |
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history of or genetic predisposition to prostate |
cancer. |
(3) An annual screening Surveillance tests for ovarian |
cancer for insureds who are at risk for ovarian cancer |
using (i) CA-125 serum tumor marker testing, (ii) |
transvaginal ultrasound, and (iii) pelvic examination. |
(a-5) A group policy of accident and health insurance that |
provides coverage for hospital or medical treatment or |
services for illness on an expense-incurred basis and is |
amended, delivered, issued, or renewed on or after January 1, |
2028 shall, in addition to the coverage required under |
paragraph (3) of subsection (a), provide coverage for all |
medically viable methods for the detection and diagnosis of |
ovarian cancer for insureds who are at risk for ovarian |
cancer, including, but not limited to, ultrasounds, magnetic |
resonance imagings (MRIs), x-rays, computed tomography (CT) |
scans, and CA-125 blood test screenings. The coverage required |
under this subsection may be subject to a deductible, |
coinsurance, or other cost sharing. |
(b) This Section shall not apply to agreements, contracts, |
or policies that provide coverage for a specified disease or |
other limited benefit coverage. |
(c) This Section does not apply to coverage of prostate |
cancer screenings to the extent such coverage would disqualify |
a high-deductible health plan from eligibility for a health |
savings account pursuant to Section 223 of the Internal |
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Revenue Code. |
(d) For the purposes of this Section: |
"At risk for ovarian cancer" means: |
(1) having a family history (i) with one or more |
first-degree relatives with ovarian cancer, (ii) of |
clusters of relatives with breast cancer, or (iii) of |
nonpolyposis colorectal cancer; or |
(2) testing positive for BRCA1 or BRCA2 mutations; or . |
(3) having a high level of CA-125, as indicated by a |
blood test screening. |
"Prostate cancer screening" means medically viable methods |
for the detection and diagnosis of prostate cancer, including |
a digital rectal exam and the prostate-specific antigen test |
and associated laboratory work. "Prostate cancer screening" |
includes medically necessary subsequent follow-up testing as |
directed by a health care provider, including, but not limited |
to: |
(1) urinary analysis; |
(2) serum biomarkers; and |
(3) medical imaging, including, but not limited to, |
magnetic resonance imaging. |
"Surveillance tests for ovarian cancer" means annual |
screening using (i) CA-125 serum tumor marker testing, (ii) |
transvaginal ultrasound, (iii) pelvic examination. |
(Source: P.A. 102-1073, eff. 1-1-23; 103-30, eff. 1-1-25.)
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Section 99. Effective date. This Act takes effect January |