Illinois General Assembly - Full Text of HB1191
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Full Text of HB1191  97th General Assembly



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1    AN ACT concerning insurance.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Illinois Insurance Code is amended by
5changing Sections 356z.16 and 364.01 as follows:
6    (215 ILCS 5/356z.16)
7    Sec. 356z.16. Applicability of mandated benefits to
8supplemental policies. Unless specified otherwise, the
9following Sections of the Illinois Insurance Code do not apply
10to short-term travel, disability income, long-term care,
11accident only, or limited or specified disease policies: 356b,
12356c, 356d, 356g, 356k, 356m, 356n, 356p, 356q, 356r, 356t,
13356u, 356w, 356x, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6,
14356z.8, 356z.12, 364.01, 367.2-5, and 367e.
15(Source: P.A. 96-180, eff. 1-1-10; 96-1000, eff. 7-2-10;
1696-1034, eff. 1-1-11.)
17    (215 ILCS 5/364.01)
18    Sec. 364.01. Qualified clinical cancer trials.
19    (a) No individual or group policy of accident and health
20insurance issued or renewed in this State may be cancelled or
21non-renewed for any individual based on that individual's
22participation in a qualified clinical cancer trial.



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1    (b) Qualified clinical cancer trials must meet the
2following criteria:
3        (1) the effectiveness of the treatment has not been
4    determined relative to established therapies;
5        (2) the trial is under clinical investigation as part
6    of an approved cancer research trial in Phase II, Phase
7    III, or Phase IV of investigation;
8        (3) the trial is:
9            (A) approved by the Food and Drug Administration;
10        or
11            (B) approved and funded by the National Institutes
12        of Health, the Centers for Disease Control and
13        Prevention, the Agency for Healthcare Research and
14        Quality, the United States Department of Defense, the
15        United States Department of Veterans Affairs, or the
16        United States Department of Energy in the form of an
17        investigational new drug application, or a cooperative
18        group or center of any entity described in this
19        subdivision (B); and
20        (4) the patient's primary care physician, if any, is
21    involved in the coordination of care.
22    (c) No group policy of accident and health insurance shall
23exclude coverage for any routine patient care administered to
24an insured who is a qualified individual participating in a
25qualified clinical cancer trial, if the policy covers that same
26routine patient care of insureds not enrolled in a qualified



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1clinical cancer trial.
2    (d) The coverage that may not be excluded under subsection
3(c) of this Section is subject to all terms, conditions,
4restrictions, exclusions, and limitations that apply to the
5same routine patient care received by an insured not enrolled
6in a qualified clinical cancer trial, including the application
7of any authorization requirement, utilization review, or
8medical management practices. The insured or enrollee shall
9incur no greater out-of-pocket liability than had the insured
10or enrollee not enrolled in a qualified clinical cancer trial.
11    (e) If the group policy of accident and health insurance
12uses a preferred provider program and a preferred provider
13provides routine patient care in connection with a qualified
14clinical cancer trial, then the insurer may require the insured
15to use the preferred provider if the preferred provider agrees
16to provide to the insured that routine patient care.
17    (f) A qualified clinical cancer trial may not pay or refuse
18to pay for routine patient care of an individual participating
19in the trial, based in whole or in part on the person's having
20or not having coverage for routine patient care under a group
21policy of accident and health insurance.
22    (g) Nothing in this Section shall be construed to limit an
23insurer's coverage with respect to clinical trials.
24    (h) Nothing in this Section shall require coverage for
25out-of-network services where the underlying health benefit
26plan does not provide coverage for out-of-network services.



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1    (i) As used in this Section, "routine patient care" means
2all health care services provided in the qualified clinical
3cancer trial that are otherwise generally covered under the
4policy if those items or services were not provided in
5connection with a qualified clinical cancer trial consistent
6with the standard of care for the treatment of cancer,
7including the type and frequency of any diagnostic modality,
8that a provider typically provides to a cancer patient who is
9not enrolled in a qualified clinical cancer trial. "Routine
10patient care" does not include, and a group policy of accident
11and health insurance may exclude, coverage for:
12        (1) a health care service, item, or drug that is the
13    subject of the cancer clinical trial;
14        (2) a health care service, item, or drug provided
15    solely to satisfy data collection and analysis needs for
16    the qualified clinical cancer trial that is not used in the
17    direct clinical management of the patient;
18        (3) an investigational drug or device that has not been
19    approved for market by the United States Food and Drug
20    Administration;
21        (4) transportation, lodging, food, or other expenses
22    for the patient or a family member or companion of the
23    patient that are associated with the travel to or from a
24    facility providing the qualified clinical cancer trial,
25    unless the policy covers these expenses for a cancer
26    patient who is not enrolled in a qualified clinical cancer



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1    trial;
2        (5) a health care service, item, or drug customarily
3    provided by the qualified clinical cancer trial sponsors
4    free of charge for any patient;
5        (6) a health care service or item, which except for the
6    fact that it is being provided in a qualified clinical
7    cancer trial, is otherwise specifically excluded from
8    coverage under the insured's policy, including:
9            (A) costs of extra treatments, services,
10        procedures, tests, or drugs that would not be performed
11        or administered except for the fact that the insured is
12        participating in the cancer clinical trial; and
13            (B) costs of nonhealth care services that the
14        patient is required to receive as a result of
15        participation in the approved cancer clinical trial;
16        (7) costs for services, items, or drugs that are
17    eligible for reimbursement from a source other than a
18    patient's contract or policy providing for third-party
19    payment or prepayment of health or medical expenses,
20    including the sponsor of the approved cancer clinical
21    trial; or
22        (8) costs associated with approved cancer clinical
23    trials designed exclusively to test toxicity or disease
24    pathophysiology, unless the policy covers these expenses
25    for a cancer patient who is not enrolled in a qualified
26    clinical cancer trial; or



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1        (9) a health care service or item that is eligible for
2    reimbursement by a source other than the insured's policy,
3    including the sponsor of the qualified clinical cancer
4    trial.
5    The definitions of the terms "health care services",
6"Non-Preferred Provider", "Preferred Provider", and "Preferred
7Provider Program", stated in 50 IL Adm. Code Part 2051
8Preferred Provider Programs apply to these terms in this
10    (j) The external review procedures established under the
11Health Carrier External Review Act shall apply to the
12provisions under this Section.
13(Source: P.A. 93-1000, eff. 1-1-05.)
14    Section 99. Effective date. This Act takes effect January
151, 2012.