103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2078 Introduced , by Rep. Laura Faver Dias SYNOPSIS AS INTRODUCED: 215 ILCS 5/356g from Ch. 73, par. 968g Amends the Accident and Health Article of the Illinois Insurance Code. Provides that coverage for screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer shall include a screening MRI or ultrasound (rather than a screening MRI when medically necessary, as determined by a physician licensed to practice medicine in all of its branches). LRB103 25679 BMS 52028 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2078 Introduced , by Rep. Laura Faver Dias SYNOPSIS AS INTRODUCED: 215 ILCS 5/356g from Ch. 73, par. 968g 215 ILCS 5/356g from Ch. 73, par. 968g Amends the Accident and Health Article of the Illinois Insurance Code. Provides that coverage for screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer shall include a screening MRI or ultrasound (rather than a screening MRI when medically necessary, as determined by a physician licensed to practice medicine in all of its branches). LRB103 25679 BMS 52028 b LRB103 25679 BMS 52028 b A BILL FOR
103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2078 Introduced , by Rep. Laura Faver Dias SYNOPSIS AS INTRODUCED:
215 ILCS 5/356g from Ch. 73, par. 968g 215 ILCS 5/356g from Ch. 73, par. 968g
215 ILCS 5/356g from Ch. 73, par. 968g
Amends the Accident and Health Article of the Illinois Insurance Code. Provides that coverage for screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer shall include a screening MRI or ultrasound (rather than a screening MRI when medically necessary, as determined by a physician licensed to practice medicine in all of its branches).
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LRB103 25679 BMS 52028 b
A BILL FOR
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HB2078 LRB103 25679 BMS 52028 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 356g as follows:
6 (215 ILCS 5/356g) (from Ch. 73, par. 968g)
7 Sec. 356g. Mammograms; mastectomies.
8 (a) Every insurer shall provide in each group or
9 individual policy, contract, or certificate of insurance
10 issued or renewed for persons who are residents of this State,
11 coverage for screening by low-dose mammography for all women
12 35 years of age or older for the presence of occult breast
13 cancer within the provisions of the policy, contract, or
14 certificate. The coverage shall be as follows:
15 (1) A baseline mammogram for women 35 to 39 years of
16 age.
17 (2) An annual mammogram for women 40 years of age or
18 older.
19 (3) A mammogram at the age and intervals considered
20 medically necessary by the woman's health care provider
21 for women under 40 years of age and having a family history
22 of breast cancer, prior personal history of breast cancer,
23 positive genetic testing, or other risk factors.
103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2078 Introduced , by Rep. Laura Faver Dias SYNOPSIS AS INTRODUCED:
215 ILCS 5/356g from Ch. 73, par. 968g 215 ILCS 5/356g from Ch. 73, par. 968g
215 ILCS 5/356g from Ch. 73, par. 968g
Amends the Accident and Health Article of the Illinois Insurance Code. Provides that coverage for screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer shall include a screening MRI or ultrasound (rather than a screening MRI when medically necessary, as determined by a physician licensed to practice medicine in all of its branches).
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LRB103 25679 BMS 52028 b
A BILL FOR
215 ILCS 5/356g from Ch. 73, par. 968g
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1 (4) For an individual or group policy of accident and
2 health insurance or a managed care plan that is amended,
3 delivered, issued, or renewed on or after the effective
4 date of this amendatory Act of the 101st General Assembly,
5 a comprehensive ultrasound screening and MRI of an entire
6 breast or breasts if a mammogram demonstrates
7 heterogeneous or dense breast tissue or when medically
8 necessary as determined by a physician licensed to
9 practice medicine in all of its branches.
10 (5) A screening MRI or ultrasound when medically
11 necessary, as determined by a physician licensed to
12 practice medicine in all of its branches.
13 (6) For an individual or group policy of accident and
14 health insurance or a managed care plan that is amended,
15 delivered, issued, or renewed on or after the effective
16 date of this amendatory Act of the 101st General Assembly,
17 a diagnostic mammogram when medically necessary, as
18 determined by a physician licensed to practice medicine in
19 all its branches, advanced practice registered nurse, or
20 physician assistant.
21 A policy subject to this subsection shall not impose a
22 deductible, coinsurance, copayment, or any other cost-sharing
23 requirement on the coverage provided; except that this
24 sentence does not apply to coverage of diagnostic mammograms
25 to the extent such coverage would disqualify a high-deductible
26 health plan from eligibility for a health savings account
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1 pursuant to Section 223 of the Internal Revenue Code (26
2 U.S.C. 223).
3 For purposes of this Section:
4 "Diagnostic mammogram" means a mammogram obtained using
5 diagnostic mammography.
6 "Diagnostic mammography" means a method of screening that
7 is designed to evaluate an abnormality in a breast, including
8 an abnormality seen or suspected on a screening mammogram or a
9 subjective or objective abnormality otherwise detected in the
10 breast.
11 "Low-dose mammography" means the x-ray examination of the
12 breast using equipment dedicated specifically for mammography,
13 including the x-ray tube, filter, compression device, and
14 image receptor, with radiation exposure delivery of less than
15 1 rad per breast for 2 views of an average size breast. The
16 term also includes digital mammography and includes breast
17 tomosynthesis. As used in this Section, the term "breast
18 tomosynthesis" means a radiologic procedure that involves the
19 acquisition of projection images over the stationary breast to
20 produce cross-sectional digital three-dimensional images of
21 the breast.
22 If, at any time, the Secretary of the United States
23 Department of Health and Human Services, or its successor
24 agency, promulgates rules or regulations to be published in
25 the Federal Register or publishes a comment in the Federal
26 Register or issues an opinion, guidance, or other action that
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1 would require the State, pursuant to any provision of the
2 Patient Protection and Affordable Care Act (Public Law
3 111-148), including, but not limited to, 42 U.S.C.
4 18031(d)(3)(B) or any successor provision, to defray the cost
5 of any coverage for breast tomosynthesis outlined in this
6 subsection, then the requirement that an insurer cover breast
7 tomosynthesis is inoperative other than any such coverage
8 authorized under Section 1902 of the Social Security Act, 42
9 U.S.C. 1396a, and the State shall not assume any obligation
10 for the cost of coverage for breast tomosynthesis set forth in
11 this subsection.
12 (a-5) Coverage as described by subsection (a) shall be
13 provided at no cost to the insured and shall not be applied to
14 an annual or lifetime maximum benefit.
15 (a-10) When health care services are available through
16 contracted providers and a person does not comply with plan
17 provisions specific to the use of contracted providers, the
18 requirements of subsection (a-5) are not applicable. When a
19 person does not comply with plan provisions specific to the
20 use of contracted providers, plan provisions specific to the
21 use of non-contracted providers must be applied without
22 distinction for coverage required by this Section and shall be
23 at least as favorable as for other radiological examinations
24 covered by the policy or contract.
25 (b) No policy of accident or health insurance that
26 provides for the surgical procedure known as a mastectomy
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1 shall be issued, amended, delivered, or renewed in this State
2 unless that coverage also provides for prosthetic devices or
3 reconstructive surgery incident to the mastectomy. Coverage
4 for breast reconstruction in connection with a mastectomy
5 shall include:
6 (1) reconstruction of the breast upon which the
7 mastectomy has been performed;
8 (2) surgery and reconstruction of the other breast to
9 produce a symmetrical appearance; and
10 (3) prostheses and treatment for physical
11 complications at all stages of mastectomy, including
12 lymphedemas.
13 Care shall be determined in consultation with the attending
14 physician and the patient. The offered coverage for prosthetic
15 devices and reconstructive surgery shall be subject to the
16 deductible and coinsurance conditions applied to the
17 mastectomy, and all other terms and conditions applicable to
18 other benefits. When a mastectomy is performed and there is no
19 evidence of malignancy then the offered coverage may be
20 limited to the provision of prosthetic devices and
21 reconstructive surgery to within 2 years after the date of the
22 mastectomy. As used in this Section, "mastectomy" means the
23 removal of all or part of the breast for medically necessary
24 reasons, as determined by a licensed physician.
25 Written notice of the availability of coverage under this
26 Section shall be delivered to the insured upon enrollment and
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1 annually thereafter. An insurer may not deny to an insured
2 eligibility, or continued eligibility, to enroll or to renew
3 coverage under the terms of the plan solely for the purpose of
4 avoiding the requirements of this Section. An insurer may not
5 penalize or reduce or limit the reimbursement of an attending
6 provider or provide incentives (monetary or otherwise) to an
7 attending provider to induce the provider to provide care to
8 an insured in a manner inconsistent with this Section.
9 (c) Rulemaking authority to implement Public Act 95-1045,
10 if any, is conditioned on the rules being adopted in
11 accordance with all provisions of the Illinois Administrative
12 Procedure Act and all rules and procedures of the Joint
13 Committee on Administrative Rules; any purported rule not so
14 adopted, for whatever reason, is unauthorized.
15 (Source: P.A. 100-395, eff. 1-1-18; 101-580, eff. 1-1-20.)
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