Full Text of HB1191 97th General Assembly
HB1191enr 97TH GENERAL ASSEMBLY |
| | HB1191 Enrolled | | LRB097 06572 RPM 46657 b |
|
| 1 | | AN ACT concerning insurance.
| 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 Sections 356z.16 and 364.01 as follows: | 6 | | (215 ILCS 5/356z.16) | 7 | | Sec. 356z.16. Applicability of mandated benefits to | 8 | | supplemental policies. Unless specified otherwise, the | 9 | | following Sections of the Illinois Insurance Code do not apply | 10 | | to short-term travel, disability income, long-term care, | 11 | | accident only, or limited or specified disease policies: 356b, | 12 | | 356c, 356d, 356g, 356k, 356m, 356n, 356p, 356q, 356r, 356t, | 13 | | 356u, 356w, 356x, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, | 14 | | 356z.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; | 16 | | 96-1034, 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 | 20 | | insurance issued or renewed in this State may be cancelled or | 21 | | non-renewed for any individual based on that individual's | 22 | | participation in a qualified clinical cancer trial. |
| | | HB1191 Enrolled | - 2 - | LRB097 06572 RPM 46657 b |
|
| 1 | | (b) Qualified clinical cancer trials must meet the | 2 | | following 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 | 23 | | exclude coverage for any routine patient care administered to | 24 | | an insured who is a qualified individual participating in a | 25 | | qualified clinical cancer trial, if the policy covers that same | 26 | | routine patient care of insureds not enrolled in a qualified |
| | | HB1191 Enrolled | - 3 - | LRB097 06572 RPM 46657 b |
|
| 1 | | clinical cancer trial. | 2 | | (d) The coverage that may not be excluded under subsection | 3 | | (c) of this Section is subject to all terms, conditions, | 4 | | restrictions, exclusions, and limitations that apply to the | 5 | | same routine patient care received by an insured not enrolled | 6 | | in a qualified clinical cancer trial, including the application | 7 | | of any authorization requirement, utilization review, or | 8 | | medical management practices. The insured or enrollee shall | 9 | | incur no greater out-of-pocket liability than had the insured | 10 | | or enrollee not enrolled in a qualified clinical cancer trial. | 11 | | (e) If the group policy of accident and health insurance | 12 | | uses a preferred provider program and a preferred provider | 13 | | provides routine patient care in connection with a qualified | 14 | | clinical cancer trial, then the insurer may require the insured | 15 | | to use the preferred provider if the preferred provider agrees | 16 | | to provide to the insured that routine patient care. | 17 | | (f) A qualified clinical cancer trial may not pay or refuse | 18 | | to pay for routine patient care of an individual participating | 19 | | in the trial, based in whole or in part on the person's having | 20 | | or not having coverage for routine patient care under a group | 21 | | policy of accident and health insurance. | 22 | | (g) Nothing in this Section shall be construed to limit an | 23 | | insurer's coverage with respect to clinical trials. | 24 | | (h) Nothing in this Section shall require coverage for | 25 | | out-of-network services where the underlying health benefit | 26 | | plan does not provide coverage for out-of-network services. |
| | | HB1191 Enrolled | - 4 - | LRB097 06572 RPM 46657 b |
|
| 1 | | (i) As used in this Section, "routine patient care" means | 2 | | all health care services provided in the qualified clinical | 3 | | cancer trial that are otherwise generally covered under the | 4 | | policy if those items or services were not provided in | 5 | | connection with a qualified clinical cancer trial consistent | 6 | | with the standard of care for the treatment of cancer, | 7 | | including the type and frequency of any diagnostic modality, | 8 | | that a provider typically provides to a cancer patient who is | 9 | | not enrolled in a qualified clinical cancer trial. "Routine | 10 | | patient care" does not include, and a group policy of accident | 11 | | and 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 |
| | | HB1191 Enrolled | - 5 - | LRB097 06572 RPM 46657 b |
|
| 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 |
| | | HB1191 Enrolled | - 6 - | LRB097 06572 RPM 46657 b |
|
| 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 | 7 | | Provider Program", stated in 50 IL Adm. Code Part 2051 | 8 | | Preferred Provider Programs apply to these terms in this | 9 | | Section. | 10 | | (j) The external review procedures established under the | 11 | | Health Carrier External Review Act shall apply to the | 12 | | provisions under this Section. | 13 | | (Source: P.A. 93-1000, eff. 1-1-05.)
| 14 | | Section 99. Effective date. This Act takes effect January | 15 | | 1, 2012.
|
|