Bill Text: IL HB5103 | 2023-2024 | 103rd General Assembly | Introduced

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Bill Title: Amends the Illinois Insurance Code. In a provision concerning coverage of certain cancer screenings, adds having a high level of CA-125, as indicated by a blood test screening, to the definition of "at risk for ovarian cancer". Provides that "surveillance tests for ovarian cancer" means all medically viable methods for the detection and diagnosis of ovarian cancer, including, but not limited to, ultrasounds, magnetic resonance imagings (MRIs), x-rays, computed tomography (CT) scans, and CA-125 blood test screenings (instead of an annual screening using (i) CA-125 serum tumor marker testing, (ii) transvaginal ultrasound, (iii) pelvic examination).

Spectrum: Bipartisan Bill

Status: (Introduced) 2024-04-05 - House Committee Amendment No. 1 Rule 19(c) / Re-referred to Rules Committee [HB5103 Detail]

Download: Illinois-2023-HB5103-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB5103 Introduced , by Rep. Jed Davis SYNOPSIS AS INTRODUCED:
215 ILCS 5/356u
Amends the Illinois Insurance Code. In a provision concerning coverage of certain cancer screenings, adds having a high level of CA-125, as indicated by a blood test screening, to the definition of "at risk for ovarian cancer". Provides that "surveillance tests for ovarian cancer" means all medically viable methods for the detection and diagnosis of ovarian cancer, including, but not limited to, ultrasounds, magnetic resonance imagings (MRIs), x-rays, computed tomography (CT) scans, and CA-125 blood test screenings (instead of an annual screening using (i) CA-125 serum tumor marker testing, (ii) transvaginal ultrasound, (iii) pelvic examination).
LRB103 37231 RPS 67350 b
A BILL FOR
HB5103 LRB103 37231 RPS 67350 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by
changing Section 356u as follows:
(215 ILCS 5/356u)
(Text of Section before amendment by P.A. 103-30)
Sec. 356u. Pap tests and prostate cancer screenings.
(a) A group policy of accident and health insurance that
provides coverage for hospital or medical treatment or
services for illness on an expense-incurred basis and is
amended, delivered, issued, or renewed after January 1, 2024
shall provide coverage, without imposing a deductible,
coinsurance, copayment, or any other cost-sharing requirement,
for all of the following:
(1) An annual cervical smear or Pap smear test for
female insureds.
(2) An annual prostate cancer screening for male
insureds upon the recommendation of a physician licensed
to practice medicine in all its branches for:
(A) asymptomatic men age 50 and over;
(B) African-American men age 40 and over; and
(C) men age 40 and over with a family history of

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prostate cancer.
(3) Surveillance tests for ovarian cancer for female
insureds who are at risk for ovarian cancer.
(b) This Section shall not apply to agreements, contracts,
or policies that provide coverage for a specified disease or
other limited benefit coverage.
(c) This Section does not apply to coverage of prostate
cancer screenings to the extent such coverage would disqualify
a high-deductible health plan from eligibility for a health
savings account pursuant to Section 223 of the Internal
Revenue Code.
(d) For the purposes of this Section:
"At risk for ovarian cancer" means:
(1) having a family history (i) with one or more
first-degree relatives with ovarian cancer, (ii) of
clusters of women relatives with breast cancer, or (iii)
of nonpolyposis colorectal cancer; or
(2) testing positive for BRCA1 or BRCA2 mutations; or .
(3) having a high level of CA-125, as indicated by a
blood test screening.
"Prostate cancer screening" means medically viable methods
for the detection and diagnosis of prostate cancer, including
a digital rectal exam and the prostate-specific antigen test
and associated laboratory work. "Prostate cancer screening"
includes medically necessary subsequent follow-up testing as
directed by a health care provider, including, but not limited

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to:
(1) urinary analysis;
(2) serum biomarkers; and
(3) medical imaging, including, but not limited to,
magnetic resonance imaging.
"Surveillance tests for ovarian cancer" means all
medically viable methods for the detection and diagnosis of
ovarian cancer, including, but not limited to, ultrasounds,
magnetic resonance imagings (MRIs), x-rays, computed
tomography (CT) scans, and CA-125 blood test screenings.
annual screening using (i) CA-125 serum tumor marker testing,
(ii) transvaginal ultrasound, (iii) pelvic examination.
(Source: P.A. 102-1073, eff. 1-1-23.)
(Text of Section after amendment by P.A. 103-30)
Sec. 356u. Pap tests and prostate cancer screenings.
(a) A group policy of accident and health insurance that
provides coverage for hospital or medical treatment or
services for illness on an expense-incurred basis and is
amended, delivered, issued, or renewed after January 1, 2024
shall provide coverage, without imposing a deductible,
coinsurance, copayment, or any other cost-sharing requirement,
for all of the following:
(1) An annual cervical smear or Pap smear test for all
insureds.
(2) An annual prostate cancer screening for insureds

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upon the recommendation of a physician licensed to
practice medicine in all its branches for:
(A) asymptomatic individuals age 50 and over;
(B) African-American individuals age 40 and over;
and
(C) individuals age 40 and over with a family
history of or genetic predisposition to prostate
cancer.
(3) Surveillance tests for ovarian cancer for insureds
who are at risk for ovarian cancer.
(b) This Section shall not apply to agreements, contracts,
or policies that provide coverage for a specified disease or
other limited benefit coverage.
(c) This Section does not apply to coverage of prostate
cancer screenings to the extent such coverage would disqualify
a high-deductible health plan from eligibility for a health
savings account pursuant to Section 223 of the Internal
Revenue Code.
(d) For the purposes of this Section:
"At risk for ovarian cancer" means:
(1) having a family history (i) with one or more
first-degree relatives with ovarian cancer, (ii) of
clusters of relatives with breast cancer, or (iii) of
nonpolyposis colorectal cancer; or
(2) testing positive for BRCA1 or BRCA2 mutations; or .
(3) having a high level of CA-125, as indicated by a

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blood test screening.
"Prostate cancer screening" means medically viable methods
for the detection and diagnosis of prostate cancer, including
a digital rectal exam and the prostate-specific antigen test
and associated laboratory work. "Prostate cancer screening"
includes medically necessary subsequent follow-up testing as
directed by a health care provider, including, but not limited
to:
(1) urinary analysis;
(2) serum biomarkers; and
(3) medical imaging, including, but not limited to,
magnetic resonance imaging.
"Surveillance tests for ovarian cancer" means all
medically viable methods for the detection and diagnosis of
ovarian cancer, including, but not limited to, ultrasounds,
magnetic resonance imagings (MRIs), x-rays, computed
tomography (CT) scans, and CA-125 blood test screenings.
annual screening using (i) CA-125 serum tumor marker testing,
(ii) transvaginal ultrasound, (iii) pelvic examination.
(Source: P.A. 102-1073, eff. 1-1-23; 103-30, eff. 1-1-25.)
Section 95. No acceleration or delay. Where this Act makes
changes in a statute that is represented in this Act by text
that is not yet or no longer in effect (for example, a Section
represented by multiple versions), the use of that text does
not accelerate or delay the taking effect of (i) the changes

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