Bill Text: IL HB4203 | 2025-2026 | 104th General Assembly | Enrolled

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Bill Title: Amends the Illinois Insurance Code. Makes changes to defined terms. Includes an annual screening (rather than surveillance tests) for ovarian cancer for insureds who are at risk for ovarian cancer using (i) CA-125 serum tumor marker testing, (ii) transvaginal ultrasound, and (iii) pelvic examination (rather than only for insureds who are at risk for ovarian cancer) in provisions requiring coverage without cost sharing. 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 is amended, delivered, issued, or renewed on or after January 1, 2028 shall, in addition to specified coverage, provide coverage for all medically viable methods for the detection and diagnosis of ovarian cancer for insureds who are at risk for ovarian cancer. Provides that the coverage may be subject to a deductible, coinsurance, or other cost sharing. Effective January 1, 2028.

Sponsorship: Slight Partisan Bill (Republican 6-2)

Status: (Passed) 2026-07-10 - Public Act . . . . . . . . . 104-0548 [HB4203 Detail]

Download: Illinois-2025-HB4203-Enrolled.html

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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)
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 on or after January 1,
2028 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
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

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history of or genetic predisposition to prostate
cancer.
(3) An annual screening Surveillance tests for ovarian
cancer for insureds who are at risk for ovarian cancer
using (i) CA-125 serum tumor marker testing, (ii)
transvaginal ultrasound, and (iii) pelvic examination.
(a-5) 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 on or after January 1,
2028 shall, in addition to the coverage required under
paragraph (3) of subsection (a), provide coverage for all
medically viable methods for the detection and diagnosis of
ovarian cancer for insureds who are at risk for ovarian
cancer, including, but not limited to, ultrasounds, magnetic
resonance imagings (MRIs), x-rays, computed tomography (CT)
scans, and CA-125 blood test screenings. The coverage required
under this subsection may be subject to a deductible,
coinsurance, or other cost sharing.
(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

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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
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 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 99. Effective date. This Act takes effect January

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1, 2028.