SB 2697

Abstract

Amends the Illinois Insurance Code. Defines terms. Provides that 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 that is amended, delivered, issued, or renewed after January 1, 2025 shall provide coverage, without imposing any cost-sharing requirement, for clinical genetic testing for an inherited gene mutation for individuals with a personal or family history of cancer that is recommended by a health care professional; and evidence-based cancer imaging for individuals with an increased risk of cancer as recommended by National Comprehensive Cancer Network clinical practice guidelines. Provides that the requirements do not apply to coverage of genetic testing or evidence-based cancer imaging to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to the Internal Revenue Code. Senate Committee Amendment No. 1 Adds reference to: 5 ILCS 375/6.11 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 165/10 from Ch. 32, par. 604 Replaces everything after the enacting clause. Amends the Illinois Insurance Code. Provides that a group policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after January 1, 2026 shall provide coverage for clinical genetic testing for an inherited gene mutation for individuals with a personal or family history of cancer as recommended by a health care professional in accordance with current evidence-based clinical practice guidelines. Provides that the coverage shall limit the total amount that a covered person is required to pay for a clinical genetic test to an amount not to exceed $50. Provides that for individuals with a genetic test that is positive for an inherited mutation associated with an increased risk of cancer, coverage shall include any cancer risk management strategy as recommended by a health care professional in accordance with current evidence-based clinical practice guidelines to the extent that the management recommendation is not already covered by the policy. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act to make a conforming change. Senate Floor Amendment No. 2 Adds reference to: 305 ILCS 5/5-52 new Replaces everything after the enacting clause. Reinserts the provisions of the bill, as amended by Senate Amendment No. 1, with the following changes. Removes language concerning coverage for any cancer risk management strategy, as recommended by a health care professional. Requires, for individuals with a genetic test that is positive for an inherited mutation associated with an increased risk of cancer, coverage to include any evidence-based screenings, as recommended by a health care professional in accordance with current evidence-based clinical practice guidelines, to the extent that the management recommendation is not already covered by the policy, except that the coverage for the evidence-based screenings may be subject to a deductible, coinsurance, or other cost-sharing limitation. Defines "evidence-based screenings". Makes other changes. Amends the Illinois Public Aid Code. Subject to federal approval, requires the medical assistance program to provide coverage for clinical genetic testing for an inherited gene mutation for individuals with a personal or family history of cancer, as recommended by a health care professional in accordance with current evidence-based clinical practice guidelines. Requires, for individuals with a genetic test that is positive for an inherited mutation associated with an increased risk of cancer, coverage to include any evidence-based screenings, as recommended by a health care professional in accordance with current evidence-based clinical practice guidelines, to the extent that the management recommendation is not already covered by the medical assistance program. Changes to the Illinois Public Aid Code are effective January 1, 2025.