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(215 ILCS 5/356u)
(Text of Section before amendment by P.A. 103-30)
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 after January 1, 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 |
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(2) An annual prostate cancer screening for male
|
| insureds upon the recommendation of a physician licensed to practice medicine in all its branches for:
|
|
(A) asymptomatic men age 50 and over;
(B) African-American men age 40 and over; and
(C) men age 40 and over with a family history of
|
|
(3) Surveillance tests for ovarian cancer for female
|
| insureds who are at risk for ovarian cancer.
|
|
(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 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 women relatives with breast cancer, or (iii) of nonpolyposis colorectal cancer; or
|
|
(2) testing positive for BRCA1 or BRCA2 mutations.
"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.)
(Text of Section after amendment by P.A. 103-30)
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 after January 1, 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
|
|
(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;
|
|
(C) individuals age 40 and over with a family
|
| history of or genetic predisposition to prostate cancer.
|
|
(3) Surveillance tests for ovarian cancer for
|
| insureds who are at risk for ovarian cancer.
|
|
(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 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.
"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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