Illinois General Assembly - Full Text of SB1358

LRB104 09465 BAB 19526 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB1358

Introduced 1/28/2025, by Sen. Adriane Johnson

SYNOPSIS AS INTRODUCED:

215 ILCS 5/356z.80 new

Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after July 1, 2025 shall provide coverage for the full cost of an annual PET scan for insureds age 35 or older who elect to get a PET scan, regardless of whether the PET scan was ordered by a physician licensed to practice medicine in all its branches and regardless of whether the insured displays symptoms. Sets forth findings and definitions. Effective immediately.

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Findings; purpose.

(a) The General Assembly finds the following:

(1) Positron emission tomography (PET) scans have been proven as the most effective form of medical imaging for detecting both tumors and cancer. Studies show that PET scans have an almost 92.5% chance to successfully diagnose malignancies.

(2) The risk of cancer and cancer diagnoses starts to exponentially increase beginning at the age of 45 in both men and women.

(3) PET scans are not covered as screening tests unless the individual has Medicare or a physician orders a PET scan. Because a person must be at least age 65 to be eligible for Medicare and because many cancers are hard to detect based on symptoms, thousands of cases of cancer are undetected.

(4) By the time an individual is eligible to receive a PET scan, the cancer is often too far progressed and difficult to treat.

(b) The purposes of this Act are to:

(1) mandate insurance companies to cover the full cost of an annual PET scan to better public health; and

(2) protect the health and welfare of older constituents who are at a higher risk of cancer.

Section 5. The Illinois Insurance Code is amended by adding Section 356z.80 as follows:

(215 ILCS 5/356z.80 new)

Sec. 356z.80. Coverage of positron emission tomography.

(a) In this Section:

"Positron emission" means a subtype of radioactive decay, also referred to as beta decay, that can be used to detect or reveal metabolic or biochemical functions of tissues.

"Positron emission tomography" or "PET scan" means an imaging technique that uses radiotracers to analyze and measure differences in metabolic processes and other physiological processes.

"Radiotracer" means a chemical compound where one or more atoms have been replaced by a radioisotope, helping in monitoring chemical reactions in the body.

(b) A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after July 1, 2025 shall provide coverage for the full cost of an annual PET scan for insureds age 35 or older who elect to get a PET scan, regardless of whether the PET scan was ordered by a physician licensed to practice medicine in all its branches and regardless of whether the insured displays symptoms.

Section 99. Effective date. This Act takes effect upon becoming law.