State of Illinois
92nd General Assembly
Legislation

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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
 8    screening.
 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  provide
22    in  each  group  policy, contract, or certificate of accident
23    and health insurance amended, delivered, issued,  or  renewed
24    covering persons who are residents of this State coverage for
25    colorectal  cancer  screening  with  sigmoidoscopy  or  fecal
26    occult  blood  testing once every 3 years for persons who are
27    at least 50 years old.
28        (b)  For persons who may be classified as high  risk  for
29    colorectal cancer because the person or a first degree family
30    member  of the person has a history of colorectal cancer, the
31    coverage required under subsection (a) shall apply to persons
32    who have attained at least 30 years of age.
33        (c)  This  Section  does   not   apply   to   agreements,
34    contracts,  or policies that provide coverage for a specified
 
HB2112 Engrossed            -3-               LRB9203373JSpcA
 1    disease 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.

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