Full Text of SB1365 95th General Assembly
SB1365enr 95TH GENERAL ASSEMBLY
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SB1365 Enrolled |
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LRB095 04641 KBJ 24699 b |
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| AN ACT concerning insurance.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Illinois Insurance Code is amended by | 5 |
| changing Section 356g as follows:
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| (215 ILCS 5/356g) (from Ch. 73, par. 968g)
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| Sec. 356g. Mammograms; mastectomies.
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| (a) Every insurer shall provide in each group or individual
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| policy, contract, or certificate of insurance issued or renewed | 10 |
| for persons
who are residents of this State, coverage for | 11 |
| screening by low-dose
mammography for all women 35 years of age | 12 |
| or older for the presence of
occult breast cancer within the | 13 |
| provisions of the policy, contract, or
certificate. The | 14 |
| coverage shall be as follows:
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| (1) A baseline mammogram for women 35 to 39 years of | 16 |
| age.
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| (2) An annual mammogram for women 40 years of age or | 18 |
| older.
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| (3) A mammogram at the age and intervals considered | 20 |
| medically necessary by the woman's health care provider for | 21 |
| women under 40 years of age and having a family history of | 22 |
| breast cancer , prior personal history of breast cancer, | 23 |
| positive genetic testing, or other risk factors.
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SB1365 Enrolled |
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LRB095 04641 KBJ 24699 b |
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| (4) A comprehensive ultrasound screening of an entire | 2 |
| breast or breasts if a mammogram demonstrates | 3 |
| heterogeneous or dense breast tissue, when medically | 4 |
| necessary as determined by a physician licensed to practice | 5 |
| medicine in all of its branches.
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| These benefits shall be at least as favorable as for other | 7 |
| radiological
examinations and subject to the same dollar | 8 |
| limits, deductibles, and
co-insurance factors. For purposes of | 9 |
| this Section, "low-dose mammography"
means the x-ray | 10 |
| examination of the breast using equipment dedicated
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| specifically for mammography, including the x-ray tube, | 12 |
| filter, compression
device, and image receptor, with radiation | 13 |
| exposure delivery of less than
1 rad per breast for 2 views of | 14 |
| an average size breast.
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| (b) No policy of accident or health insurance that provides | 16 |
| for
the surgical procedure known as a mastectomy shall be | 17 |
| issued, amended,
delivered, or renewed in this State unless
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| that coverage also provides for prosthetic devices
or | 19 |
| reconstructive surgery
incident to the mastectomy.
Coverage | 20 |
| for breast reconstruction in connection with a mastectomy shall
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| include:
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| (1) reconstruction of the breast upon which the | 23 |
| mastectomy has been
performed;
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| (2) surgery and reconstruction of the other breast to | 25 |
| produce a
symmetrical appearance; and
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| (3) prostheses and treatment for physical |
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SB1365 Enrolled |
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LRB095 04641 KBJ 24699 b |
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| complications at all stages of
mastectomy, including | 2 |
| lymphedemas.
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| Care shall be determined in consultation with the attending | 4 |
| physician and the
patient.
The offered coverage for prosthetic | 5 |
| devices and
reconstructive surgery shall be subject to the | 6 |
| deductible and coinsurance
conditions applied to the | 7 |
| mastectomy, and all other terms and conditions
applicable to | 8 |
| other benefits. When a mastectomy is performed and there is
no | 9 |
| evidence of malignancy then the offered coverage may be limited | 10 |
| to the
provision of prosthetic devices and reconstructive | 11 |
| surgery to within 2
years after the date of the mastectomy. As | 12 |
| used in this Section,
"mastectomy" means the removal of all or | 13 |
| part of the breast for medically
necessary reasons, as | 14 |
| determined by a licensed physician.
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| Written notice of the availability of coverage under this | 16 |
| Section shall be
delivered to the insured upon enrollment and | 17 |
| annually thereafter. An insurer
may not deny to an insured | 18 |
| eligibility, or continued eligibility, to enroll or
to renew | 19 |
| coverage under the terms of the plan solely for the purpose of
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| avoiding the requirements of this Section. An insurer may not | 21 |
| penalize or
reduce or
limit the reimbursement of an attending | 22 |
| provider or provide incentives
(monetary or otherwise) to an | 23 |
| attending provider to induce the provider to
provide care to an | 24 |
| insured in a manner inconsistent with this Section.
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| (Source: P.A. 94-121, eff. 7-6-05.)
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SB1365 Enrolled |
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LRB095 04641 KBJ 24699 b |
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| Section 10. The Health Maintenance Organization Act is | 2 |
| amended by changing Section 4-6.1 as follows:
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| (215 ILCS 125/4-6.1) (from Ch. 111 1/2, par. 1408.7)
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| Sec. 4-6.1. Mammograms; mastectomies.
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| (a) Every contract or evidence of coverage
issued by a | 6 |
| Health Maintenance Organization for persons who are residents | 7 |
| of
this State shall contain coverage for screening by low-dose | 8 |
| mammography
for all women 35 years of age or older for the | 9 |
| presence of occult breast
cancer. The coverage shall be as | 10 |
| follows:
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| (1) A baseline mammogram for women 35 to 39 years of | 12 |
| age.
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| (2) An annual mammogram for women 40 years of age or | 14 |
| older.
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| (3) A mammogram at the age and intervals considered | 16 |
| medically necessary by the woman's health care provider for | 17 |
| women under 40 years of age and having a family history of | 18 |
| breast cancer , prior personal history of breast cancer, | 19 |
| positive genetic testing, or other risk factors. | 20 |
| (4) A comprehensive ultrasound screening of an entire | 21 |
| breast or breasts if a mammogram demonstrates | 22 |
| heterogeneous or dense breast tissue, when medically | 23 |
| necessary as determined by a physician licensed to practice | 24 |
| medicine in all of its branches.
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| These benefits shall be at least as favorable as for other |
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SB1365 Enrolled |
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LRB095 04641 KBJ 24699 b |
|
| 1 |
| radiological
examinations and subject to the same dollar | 2 |
| limits, deductibles, and
co-insurance factors. For purposes of | 3 |
| this Section, "low-dose mammography"
means the x-ray | 4 |
| examination of the breast using equipment dedicated
| 5 |
| specifically for mammography, including the x-ray tube, | 6 |
| filter, compression
device, and image receptor, with radiation | 7 |
| exposure delivery of less than 1
rad per breast for 2 views of | 8 |
| an average size breast.
| 9 |
| (b) No contract or evidence of coverage issued by a health | 10 |
| maintenance
organization that provides for the
surgical | 11 |
| procedure known as a mastectomy shall be issued, amended, | 12 |
| delivered,
or renewed in this State on or after the effective | 13 |
| date of this amendatory Act
of the 92nd General Assembly unless | 14 |
| that coverage also provides for prosthetic
devices or | 15 |
| reconstructive surgery incident to the mastectomy, providing | 16 |
| that
the mastectomy is performed after the effective date of | 17 |
| this amendatory Act.
Coverage for breast reconstruction in | 18 |
| connection
with a mastectomy shall
include:
| 19 |
| (1) reconstruction of the breast upon which the | 20 |
| mastectomy has been
performed;
| 21 |
| (2) surgery and reconstruction of the other breast to | 22 |
| produce a
symmetrical appearance; and
| 23 |
| (3) prostheses and treatment for physical | 24 |
| complications at all stages of
mastectomy, including | 25 |
| lymphedemas.
| 26 |
| Care shall be determined in consultation with the attending |
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SB1365 Enrolled |
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LRB095 04641 KBJ 24699 b |
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| physician and the
patient.
The offered coverage for prosthetic | 2 |
| devices and
reconstructive surgery shall be subject to the | 3 |
| deductible and coinsurance
conditions applied to the | 4 |
| mastectomy and all other terms and conditions
applicable to | 5 |
| other benefits. When a mastectomy is performed and there is
no | 6 |
| evidence of malignancy, then the offered coverage may be | 7 |
| limited to the
provision of prosthetic devices and | 8 |
| reconstructive surgery to within 2
years after the date of the | 9 |
| mastectomy. As used in this Section,
"mastectomy" means the | 10 |
| removal of all or part of the breast for medically
necessary | 11 |
| reasons, as determined by a licensed physician.
| 12 |
| Written notice of the availability of coverage under this | 13 |
| Section shall be
delivered to the enrollee upon enrollment and | 14 |
| annually thereafter. A
health maintenance organization may not | 15 |
| deny to an enrollee eligibility, or
continued eligibility, to | 16 |
| enroll or
to renew coverage under the terms of the plan solely | 17 |
| for the purpose of
avoiding the requirements of this Section. A | 18 |
| health maintenance organization
may not penalize or
reduce or
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| limit the reimbursement of an attending provider or provide | 20 |
| incentives
(monetary or otherwise) to an attending provider to | 21 |
| induce the provider to
provide care to an insured in a manner | 22 |
| inconsistent with this Section.
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| (Source: P.A. 94-121, eff. 7-6-05.)
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| Section 99. Effective date. This Act takes effect upon | 25 |
| becoming law.
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