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90_HB1330eng
215 ILCS 5/356g from Ch. 73, par. 968g
215 ILCS 130/4003 from Ch. 73, par. 1504-3
215 ILCS 165/10 from Ch. 32, par. 604
Amends the Illinois Insurance Code. Provides that the
mammogram coverage requirements apply to managed care plans.
Amends the Limited Health Service Organization Act and the
Voluntary Health Services Plans Act to require coverage for
mammograms under those Acts.
LRB9004656JScc
HB1330 Engrossed LRB9004656JScc
1 AN ACT concerning mammograms, amending named Acts.
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 356g as follows:
6 (215 ILCS 5/356g) (from Ch. 73, par. 968g)
7 Sec. 356g. Mammogram coverage.
8 (a) Every insurer and every managed care entity shall
9 provide in each group or individual policy, contract, or
10 certificate of insurance, or managed care plan issued or
11 renewed for persons who are residents of this State, coverage
12 for screening by low-dose mammography for all women 35 years
13 of age or older for the presence of occult breast cancer
14 within the provisions of the policy, contract, or
15 certificate. The coverage shall be as follows:
16 (1) A baseline mammogram for women 35 to 39 years
17 of age.
18 (2) An mammogram every 1 to 2 years, even if no
19 symptoms are present, for women 40 to 49 years of age.
20 (3) An annual mammogram for women 50 years of age
21 or older.
22 These benefits shall be at least as favorable as for
23 other radiological examinations and subject to the same
24 dollar limits, deductibles, and co-insurance factors. For
25 purposes of this Section, "low-dose mammography" means the
26 x-ray examination of the breast using equipment dedicated
27 specifically for mammography, including the x-ray tube,
28 filter, compression device, and image receptor, with
29 radiation exposure delivery of less than 1 rad per breast for
30 2 views of an average size breast.
31 (b) No policy of accident or health insurance that
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1 provides for the surgical procedure known as a mastectomy
2 shall be issued, amended, delivered or renewed in this State
3 on or after July 1, 1981, unless coverage is also offered for
4 prosthetic devices or reconstructive surgery incident to the
5 mastectomy, providing that the mastectomy is performed after
6 July 1, 1981. The offered coverage for prosthetic devices and
7 reconstructive surgery shall be subject to the deductible and
8 coinsurance conditions applied to the mastectomy, and all
9 other terms and conditions applicable to other benefits.
10 When a mastectomy is performed and there is no evidence of
11 malignancy then the offered coverage may be limited to the
12 provision of prosthetic devices and reconstructive surgery to
13 within 2 years after the date of the mastectomy. As used in
14 this Section, "mastectomy" means the removal of all or part
15 of the breast for medically necessary reasons, as determined
16 by a licensed physician. As used in this Section, the terms
17 "managed care entity" and "managed care plan" have the
18 meanings given them in Section 356r of this Code.
19 (Source: P.A. 86-899; 87-518.)
20 Section 10. The Limited Health Service Organization Act
21 is amended by changing Section 4003 as follows:
22 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
23 Sec. 4003. Illinois Insurance Code provisions. Limited
24 health service organizations shall be subject to the
25 provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
26 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
27 154.6, 154.7, 154.8, 155.04, 355.2, 356g, 401, 401.1, 402,
28 403, 403A, 408, 408.2, and 412, and Articles VIII 1/2, XII,
29 XII 1/2, XIII, XIII 1/2, and XXVI of the Illinois Insurance
30 Code. For purposes of the Illinois Insurance Code, except
31 for Articles XIII and XIII 1/2, limited health service
32 organizations in the following categories are deemed to be
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1 domestic companies:
2 (1) a corporation under the laws of this State; or
3 (2) a corporation organized under the laws of
4 another state, 30% of more of the enrollees of which are
5 residents of this State, except a corporation subject to
6 substantially the same requirements in its state of
7 organization as is a domestic company under Article VIII
8 1/2 of the Illinois Insurance Code.
9 (Source: P.A. 86-600; 87-587; 87-1090.)
10 Section 15. The Voluntary Health Services Plans Act is
11 amended by changing Section 10 as follows:
12 (215 ILCS 165/10) (from Ch. 32, par. 604)
13 Sec. 10. Application of Insurance Code provisions.
14 Health services plan corporations and all persons interested
15 therein or dealing therewith shall be subject to the
16 provisions of Article XII 1/2 and Sections 3.1, 133, 140,
17 143, 143c, 149, 354, 355.2, 356g, 356r, 367.2, 401, 401.1,
18 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7) and
19 (15) of Section 367 of the Illinois Insurance Code.
20 (Source: P.A. 89-514, eff. 7-17-96.)