Bill Text: IL HB4312 | 2019-2020 | 101st General Assembly | Introduced

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Bill Title: Amends the Illinois Insurance Code. Makes a technical change in a Section concerning accident and health insurance coverage for mammograms and mastectomies.

Sponsorship: Partisan Bill (Republican 1)

Status: (Introduced - Dead) 2020-01-28 - Referred to Rules Committee [HB4312 Detail]

Download: Illinois-2019-HB4312-Introduced.html

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101ST GENERAL ASSEMBLY State of Illinois 2019 and 2020 HB4312 Introduced , by Rep. Avery Bourne SYNOPSIS AS INTRODUCED:
215 ILCS 5/356g from Ch. 73, par. 968g
Amends the Illinois Insurance Code. Makes a technical change in a Section concerning accident and health insurance coverage for mammograms and mastectomies.
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A BILL FOR
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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 356g as follows:
(215 ILCS 5/356g) (from Ch. 73, par. 968g)
Sec. 356g. Mammograms; mastectomies.
(a) Every insurer shall provide in each group or individual
policy, contract, or certificate of insurance issued or renewed
for persons who are residents of this State, coverage for
screening by low-dose mammography for all women 35 years of age
or older for the the presence of occult breast cancer within
the provisions of the policy, contract, or certificate. The
coverage shall be as follows:
(1) A baseline mammogram for women 35 to 39 years of
age.
(2) An annual mammogram for women 40 years of age or
older.
(3) A mammogram at the age and intervals considered
medically necessary by the woman's health care provider for
women under 40 years of age and having a family history of
breast cancer, prior personal history of breast cancer,
positive genetic testing, or other risk factors.

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(4) For an individual or group policy of accident and
health insurance or a managed care plan that is amended,
delivered, issued, or renewed on or after the effective
date of this amendatory Act of the 101st General Assembly,
a comprehensive ultrasound screening and MRI of an entire
breast or breasts if a mammogram demonstrates
heterogeneous or dense breast tissue or when medically
necessary as determined by a physician licensed to practice
medicine in all of its branches.
(5) A screening MRI when medically necessary, as
determined by a physician licensed to practice medicine in
all of its branches.
(6) For an individual or group policy of accident and
health insurance or a managed care plan that is amended,
delivered, issued, or renewed on or after the effective
date of this amendatory Act of the 101st General Assembly,
a diagnostic mammogram when medically necessary, as
determined by a physician licensed to practice medicine in
all its branches, advanced practice registered nurse, or
physician assistant.
A policy subject to this subsection shall not impose a
deductible, coinsurance, copayment, or any other cost-sharing
requirement on the coverage provided; except that this sentence
does not apply to coverage of diagnostic mammograms to the
extent such coverage would disqualify a high-deductible health
plan from eligibility for a health savings account pursuant to

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Section 223 of the Internal Revenue Code (26 U.S.C. 223).
For purposes of this Section:
"Diagnostic mammogram" means a mammogram obtained using
diagnostic mammography.
"Diagnostic mammography" means a method of screening that
is designed to evaluate an abnormality in a breast, including
an abnormality seen or suspected on a screening mammogram or a
subjective or objective abnormality otherwise detected in the
breast.
"Low-dose mammography" means the x-ray examination of the
breast using equipment dedicated specifically for mammography,
including the x-ray tube, filter, compression device, and image
receptor, with radiation exposure delivery of less than 1 rad
per breast for 2 views of an average size breast. The term also
includes digital mammography and includes breast
tomosynthesis. As used in this Section, the term "breast
tomosynthesis" means a radiologic procedure that involves the
acquisition of projection images over the stationary breast to
produce cross-sectional digital three-dimensional images of
the breast.
If, at any time, the Secretary of the United States
Department of Health and Human Services, or its successor
agency, promulgates rules or regulations to be published in the
Federal Register or publishes a comment in the Federal Register
or issues an opinion, guidance, or other action that would
require the State, pursuant to any provision of the Patient

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Protection and Affordable Care Act (Public Law 111-148),
including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any
successor provision, to defray the cost of any coverage for
breast tomosynthesis outlined in this subsection, then the
requirement that an insurer cover breast tomosynthesis is
inoperative other than any such coverage authorized under
Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and
the State shall not assume any obligation for the cost of
coverage for breast tomosynthesis set forth in this subsection.
(a-5) Coverage as described by subsection (a) shall be
provided at no cost to the insured and shall not be applied to
an annual or lifetime maximum benefit.
(a-10) When health care services are available through
contracted providers and a person does not comply with plan
provisions specific to the use of contracted providers, the
requirements of subsection (a-5) are not applicable. When a
person does not comply with plan provisions specific to the use
of contracted providers, plan provisions specific to the use of
non-contracted providers must be applied without distinction
for coverage required by this Section and shall be at least as
favorable as for other radiological examinations covered by the
policy or contract.
(b) No policy of accident or health insurance that provides
for the surgical procedure known as a mastectomy shall be
issued, amended, delivered, or renewed in this State unless
that coverage also provides for prosthetic devices or

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reconstructive surgery incident to the mastectomy. Coverage
for breast reconstruction in connection with a mastectomy shall
include:
(1) reconstruction of the breast upon which the
mastectomy has been performed;
(2) surgery and reconstruction of the other breast to
produce a symmetrical appearance; and
(3) prostheses and treatment for physical
complications at all stages of mastectomy, including
lymphedemas.
Care shall be determined in consultation with the attending
physician and the patient. The offered coverage for prosthetic
devices and reconstructive surgery shall be subject to the
deductible and coinsurance conditions applied to the
mastectomy, and all other terms and conditions applicable to
other benefits. When a mastectomy is performed and there is no
evidence of malignancy then the offered coverage may be limited
to the provision of prosthetic devices and reconstructive
surgery to within 2 years after the date of the mastectomy. As
used in this Section, "mastectomy" means the removal of all or
part of the breast for medically necessary reasons, as
determined by a licensed physician.
Written notice of the availability of coverage under this
Section shall be delivered to the insured upon enrollment and
annually thereafter. An insurer may not deny to an insured
eligibility, or continued eligibility, to enroll or to renew

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coverage under the terms of the plan solely for the purpose of
avoiding the requirements of this Section. An insurer may not
penalize or reduce or limit the reimbursement of an attending
provider or provide incentives (monetary or otherwise) to an
attending provider to induce the provider to provide care to an
insured in a manner inconsistent with this Section.
(c) Rulemaking authority to implement Public Act 95-1045,
if any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 100-395, eff. 1-1-18; 101-580, eff. 1-1-20.)