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HB4203 Enrolled LRB104 15932 BAB 29167 b
1 AN ACT concerning regulation.
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 356u as follows:
6 (215 ILCS 5/356u)
7 Sec. 356u. Pap tests and prostate cancer screenings.
8 (a) A group policy of accident and health insurance that
9 provides coverage for hospital or medical treatment or
10 services for illness on an expense-incurred basis and is
11 amended, delivered, issued, or renewed on or after January 1,
12 2028 2024 shall provide coverage, without imposing a
13 deductible, coinsurance, copayment, or any other cost-sharing
14 requirement, for all of the following:
15 (1) An annual cervical smear or Pap smear test for all
16 insureds.
17 (2) An annual prostate cancer screening for insureds
18 upon the recommendation of a physician licensed to
19 practice medicine in all its branches for:
20 (A) asymptomatic individuals age 50 and over;
21 (B) African-American individuals age 40 and over;
22 and
23 (C) individuals age 40 and over with a family
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1 history of or genetic predisposition to prostate
2 cancer.
3 (3) An annual screening Surveillance tests for ovarian
4 cancer for insureds who are at risk for ovarian cancer
5 using (i) CA-125 serum tumor marker testing, (ii)
6 transvaginal ultrasound, and (iii) pelvic examination.
7 (a-5) A group policy of accident and health insurance that
8 provides coverage for hospital or medical treatment or
9 services for illness on an expense-incurred basis and is
10 amended, delivered, issued, or renewed on or after January 1,
11 2028 shall, in addition to the coverage required under
12 paragraph (3) of subsection (a), provide coverage for all
13 medically viable methods for the detection and diagnosis of
14 ovarian cancer for insureds who are at risk for ovarian
15 cancer, including, but not limited to, ultrasounds, magnetic
16 resonance imagings (MRIs), x-rays, computed tomography (CT)
17 scans, and CA-125 blood test screenings. The coverage required
18 under this subsection may be subject to a deductible,
19 coinsurance, or other cost sharing.
20 (b) This Section shall not apply to agreements, contracts,
21 or policies that provide coverage for a specified disease or
22 other limited benefit coverage.
23 (c) This Section does not apply to coverage of prostate
24 cancer screenings to the extent such coverage would disqualify
25 a high-deductible health plan from eligibility for a health
26 savings account pursuant to Section 223 of the Internal
HB4203 Enrolled -3- LRB104 15932 BAB 29167 b
1 Revenue Code.
2 (d) For the purposes of this Section:
3 "At risk for ovarian cancer" means:
4 (1) having a family history (i) with one or more
5 first-degree relatives with ovarian cancer, (ii) of
6 clusters of relatives with breast cancer, or (iii) of
7 nonpolyposis colorectal cancer; or
8 (2) testing positive for BRCA1 or BRCA2 mutations; or.
9 (3) having a high level of CA-125, as indicated by a
10 blood test screening.
11 "Prostate cancer screening" means medically viable methods
12 for the detection and diagnosis of prostate cancer, including
13 a digital rectal exam and the prostate-specific antigen test
14 and associated laboratory work. "Prostate cancer screening"
15 includes medically necessary subsequent follow-up testing as
16 directed by a health care provider, including, but not limited
17 to:
18 (1) urinary analysis;
19 (2) serum biomarkers; and
20 (3) medical imaging, including, but not limited to,
21 magnetic resonance imaging.
22 "Surveillance tests for ovarian cancer" means annual
23 screening using (i) CA-125 serum tumor marker testing, (ii)
24 transvaginal ultrasound, (iii) pelvic examination.
25 (Source: P.A. 102-1073, eff. 1-1-23; 103-30, eff. 1-1-25.)
26 Section 99. Effective date. This Act takes effect January
HB4203 Enrolled -4- LRB104 15932 BAB 29167 b
1 1, 2028.Every fact on this page links to its source, starting with the official bill record.