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| 1 | AN ACT concerning regulation. | ||||||
| 2 | Be it enacted by the People of the State of Illinois, | ||||||
| 3 | represented in the General Assembly: | ||||||
| 4 | Section 5. The Illinois Insurance Code is amended by | ||||||
| 5 | changing Section 356u as follows: | ||||||
| 6 | (215 ILCS 5/356u) | ||||||
| 7 | Sec. 356u. Pap tests and prostate cancer screenings. | ||||||
| 8 | (a) A group policy of accident and health insurance that | ||||||
| 9 | provides coverage for hospital or medical treatment or | ||||||
| 10 | services for illness on an expense-incurred basis and is | ||||||
| 11 | amended, delivered, issued, or renewed after January 1, 2024 | ||||||
| 12 | shall provide coverage, without imposing a deductible, | ||||||
| 13 | coinsurance, copayment, or any other cost-sharing requirement, | ||||||
| 14 | for all of the following: | ||||||
| 15 | (1) An annual cervical smear or Pap smear test for all | ||||||
| 16 | insureds. | ||||||
| 17 | (2) An annual prostate cancer screening for insureds | ||||||
| 18 | upon the recommendation of a physician licensed to | ||||||
| 19 | practice medicine in all its branches for: | ||||||
| 20 | (A) asymptomatic individuals age 50 and over; | ||||||
| 21 | (B) African-American individuals age 40 and over; | ||||||
| 22 | and | ||||||
| 23 | (C) individuals age 40 and over with a family | ||||||
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| 1 | history of or genetic predisposition to prostate | ||||||
| 2 | cancer. | ||||||
| 3 | (3) Surveillance tests for ovarian cancer for insureds | ||||||
| 4 | who are at risk for ovarian cancer. | ||||||
| 5 | (b) This Section shall not apply to agreements, contracts, | ||||||
| 6 | or policies that provide coverage for a specified disease or | ||||||
| 7 | other limited benefit coverage. | ||||||
| 8 | (c) This Section does not apply to coverage of prostate | ||||||
| 9 | cancer screenings to the extent such coverage would disqualify | ||||||
| 10 | a high-deductible health plan from eligibility for a health | ||||||
| 11 | savings account pursuant to Section 223 of the Internal | ||||||
| 12 | Revenue Code. | ||||||
| 13 | (d) For the purposes of this Section: | ||||||
| 14 | "At risk for ovarian cancer" means: | ||||||
| 15 | (1) having a family history (i) with one or more | ||||||
| 16 | first-degree relatives with ovarian cancer, (ii) of | ||||||
| 17 | clusters of relatives with breast cancer, or (iii) of | ||||||
| 18 | nonpolyposis colorectal cancer; or | ||||||
| 19 | (2) testing positive for BRCA1 or BRCA2 mutations; or . | ||||||
| 20 | (3) having a high level of CA-125, as indicated by a | ||||||
| 21 | blood test screening. | ||||||
| 22 | "Prostate cancer screening" means medically viable methods | ||||||
| 23 | for the detection and diagnosis of prostate cancer, including | ||||||
| 24 | a digital rectal exam and the prostate-specific antigen test | ||||||
| 25 | and associated laboratory work. "Prostate cancer screening" | ||||||
| 26 | includes medically necessary subsequent follow-up testing as | ||||||
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| 1 | directed by a health care provider, including, but not limited | ||||||
| 2 | to: | ||||||
| 3 | (1) urinary analysis; | ||||||
| 4 | (2) serum biomarkers; and | ||||||
| 5 | (3) medical imaging, including, but not limited to, | ||||||
| 6 | magnetic resonance imaging. | ||||||
| 7 | "Surveillance tests for ovarian cancer" means all | ||||||
| 8 | medically viable methods for the detection and diagnosis of | ||||||
| 9 | ovarian cancer, including, but not limited to, ultrasounds, | ||||||
| 10 | magnetic resonance imagings (MRIs), x-rays, computed | ||||||
| 11 | tomography (CT) scans, and CA-125 blood test screenings. | ||||||
| 12 | annual screening using (i) CA-125 serum tumor marker testing, | ||||||
| 13 | (ii) transvaginal ultrasound, (iii) pelvic examination. | ||||||
| 14 | (Source: P.A. 102-1073, eff. 1-1-23; 103-30, eff. 1-1-25.) | ||||||
| 15 | Section 99. Effective date. This Act takes effect January | ||||||
| 16 | 1, 2028. | ||||||