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92_HB2112eng HB2112 Engrossed LRB9203373JSpcA 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 Section 356x as follows: 6 (215 ILCS 5/356x) 7 Sec. 356x. Coverage for colorectal cancer examinations 8screening. 9 (a) An individual or group policy of accident and health 10 insurance providing coverage on an expense incurred basis, a 11 self-insured group arrangement to the extent not preempted by 12 federal law, and a managed health care delivery plan of any 13 type or description, that is amended, delivered, issued, or 14 renewed on or after the effective date of this amendatory Act 15 of the 92nd General Assembly that provides coverage to a 16 resident of this State must provide benefits or coverage for 17 colorectal cancer examinations and laboratory tests for 18 cancer for any nonsymptomatic covered individual, in 19 accordance with the most recently published American Cancer 20 Society guidelines for colorectal cancer screening for a 21 covered individual who is: 22 (1) at least 50 years of age; or 23 (2) less than 50 years of age and at high risk for 24 colorectal cancer according to the most recently 25 published colorectal cancer screening guidelines of the 26 American Cancer Society. 27 The coverage required under this Section must meet the 28 requirements set forth in subsection (b). 29 (b) To encourage colorectal cancer screenings, patients 30 and health care providers must not be required to meet 31 burdensome criteria or overcome obstacles to secure the HB2112 Engrossed -2- LRB9203373JSpcA 1 coverage. An individual may not be required to pay an 2 additional deductible or coinsurance for testing that is 3 greater than an annual deductible or coinsurance established 4 for similar benefits. If the program or contract does not 5 cover a similar benefit, a deductible or coinsurance may not 6 be set at a level that materially diminishes the value of the 7 colorectal cancer benefit required. 8 (c) An entity subject to this Section is not required 9 under this Section to provide for a referral to a 10 non-participating health care provider, unless the entity 11 does not have an appropriate health care provider that is 12 available and accessible to administer the screening exam and 13 that is a participating health care provider with respect to 14 the treatment. 15 (d) If an entity subject to this Section refers an 16 individual to a non-participating health care provider 17 pursuant to this Section, services provided pursuant to the 18 approved screening exam or resulting treatment (if any) shall 19 be provided at no additional cost to the insured beyond what 20 the insured would otherwise pay for services provided by a 21 participating health care provider.An insurer shall provide22in each group policy, contract, or certificate of accident23and health insurance amended, delivered, issued, or renewed24covering persons who are residents of this State coverage for25colorectal cancer screening with sigmoidoscopy or fecal26occult blood testing once every 3 years for persons who are27at least 50 years old.28(b) For persons who may be classified as high risk for29colorectal cancer because the person or a first degree family30member of the person has a history of colorectal cancer, the31coverage required under subsection (a) shall apply to persons32who have attained at least 30 years of age.33(c) This Section does not apply to agreements,34contracts, or policies that provide coverage for a specifiedHB2112 Engrossed -3- LRB9203373JSpcA 1disease or other limited benefit coverage.2 (Source: P.A. 90-741, eff. 1-1-99.) 3 Section 99. Effective date. This Act takes effect upon 4 becoming law.