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| | HB5318 Enrolled | | LRB102 25274 BMS 34547 b |
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| 1 | | AN ACT concerning regulation.
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| 2 | | Be it enacted by the People of the State of Illinois,
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| 3 | | represented in the General Assembly:
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| 4 | | Section 5. The Illinois Insurance Code is amended by |
| 5 | | changing Section 356u as follows:
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| 6 | | (215 ILCS 5/356u)
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| 7 | | Sec. 356u. Pap tests and prostate cancer screenings |
| 8 | | prostate-specific antigen tests.
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| 9 | | (a) A group policy of accident and health insurance that |
| 10 | | provides coverage
for hospital or medical treatment or |
| 11 | | services for illness on an
expense-incurred basis and is |
| 12 | | amended, delivered, issued, or renewed after January 1, 2024 |
| 13 | | the
effective date of this amendatory Act of 1997 shall |
| 14 | | provide coverage, without imposing a deductible, coinsurance, |
| 15 | | copayment, or any other cost-sharing requirement, for all of
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| 16 | | the
following:
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| 17 | | (1) An annual cervical smear or Pap smear test for |
| 18 | | female insureds.
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| 19 | | (2) An annual prostate cancer screening digital rectal |
| 20 | | examination and a prostate-specific
antigen test, for male |
| 21 | | insureds upon the recommendation of a physician licensed
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| 22 | | to practice medicine in all its branches for:
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| 23 | | (A) asymptomatic men age 50 and over;
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| | HB5318 Enrolled | - 2 - | LRB102 25274 BMS 34547 b |
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| 1 | | (B) African-American men age 40 and over; and
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| 2 | | (C) men age 40 and over with a family history of |
| 3 | | prostate cancer.
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| 4 | | (3) Surveillance tests for ovarian cancer for female |
| 5 | | insureds who are at risk for ovarian cancer. |
| 6 | | (b) This Section shall not apply to agreements, contracts, |
| 7 | | or policies that
provide coverage for a specified disease or |
| 8 | | other limited benefit coverage.
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| 9 | | (c) This Section does not apply to coverage of prostate |
| 10 | | cancer screenings to the extent such coverage would disqualify |
| 11 | | a high-deductible health plan from eligibility for a health |
| 12 | | savings account pursuant to Section 223 of the Internal |
| 13 | | Revenue Code. |
| 14 | | (d) (c) For the purposes of this Section: |
| 15 | | "At risk for ovarian cancer" means: |
| 16 | | (1) having a family history (i) with one or more |
| 17 | | first-degree relatives with ovarian cancer, (ii) of |
| 18 | | clusters of women relatives with breast cancer, or (iii) |
| 19 | | of nonpolyposis colorectal cancer; or |
| 20 | | (2) testing positive for BRCA1 or BRCA2 mutations. |
| 21 | | "Prostate cancer screening" means medically viable methods |
| 22 | | for the detection and diagnosis of prostate cancer, including |
| 23 | | a digital rectal exam and the prostate-specific antigen test |
| 24 | | and associated laboratory work. "Prostate cancer screening" |
| 25 | | includes medically necessary subsequent follow-up testing as |
| 26 | | directed by a health care provider, including, but not limited |
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| 1 | | to: |
| 2 | | (1) urinary analysis; |
| 3 | | (2) serum biomarkers; and |
| 4 | | (3) medical imaging, including, but not limited to, |
| 5 | | magnetic resonance imaging. |
| 6 | | "Surveillance tests for ovarian cancer" means annual |
| 7 | | screening using (i) CA-125 serum tumor marker testing, (ii) |
| 8 | | transvaginal ultrasound, (iii) pelvic examination.
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| 9 | | (Source: P.A. 94-122, eff. 1-1-06.)
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