Illinois General Assembly - Full Text of HB1191
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Full Text of HB1191  97th General Assembly


Rep. Greg Harris

Filed: 3/24/2011





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2    AMENDMENT NO. ______. Amend House Bill 1191 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Illinois Insurance Code is amended by
5changing Sections 356z.16 and 364.01 as follows:
6    (215 ILCS 5/356z.16)
7    Sec. 356z.16. Applicability of mandated benefits to
8supplemental policies. Unless specified otherwise, the
9following Sections of the Illinois Insurance Code do not apply
10to short-term travel, disability income, long-term care,
11accident only, or limited or specified disease policies: 356b,
12356c, 356d, 356g, 356k, 356m, 356n, 356p, 356q, 356r, 356t,
13356u, 356w, 356x, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6,
14356z.8, 356z.12, 364.01, 367.2-5, and 367e.
15(Source: P.A. 96-180, eff. 1-1-10; 96-1000, eff. 7-2-10;
1696-1034, eff. 1-1-11.)



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1    (215 ILCS 5/364.01)
2    Sec. 364.01. Qualified clinical cancer trials.
3    (a) No individual or group policy of accident and health
4insurance issued or renewed in this State may be cancelled or
5non-renewed for any individual based on that individual's
6participation in a qualified clinical cancer trial.
7    (b) Qualified clinical cancer trials must meet the
8following criteria:
9        (1) the effectiveness of the treatment has not been
10    determined relative to established therapies;
11        (2) the trial is under clinical investigation as part
12    of an approved cancer research trial in Phase II, Phase
13    III, or Phase IV of investigation;
14        (3) the trial is:
15            (A) approved by the Food and Drug Administration;
16        or
17            (B) approved and funded by the National Institutes
18        of Health, the Centers for Disease Control and
19        Prevention, the Agency for Healthcare Research and
20        Quality, the United States Department of Defense, the
21        United States Department of Veterans Affairs, or the
22        United States Department of Energy in the form of an
23        investigational new drug application, or a cooperative
24        group or center of any entity described in this
25        subdivision (B); and



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1        (4) the patient's primary care physician, if any, is
2    involved in the coordination of care.
3    (c) No group policy of accident and health insurance shall
4exclude coverage for any routine patient care administered to
5an insured who is a qualified individual participating in a
6qualified clinical cancer trial, if the policy covers that same
7routine patient care of insureds not enrolled in a qualified
8clinical cancer trial.
9    (d) The coverage that may not be excluded under subsection
10(c) of this Section is subject to all terms, conditions,
11restrictions, exclusions, and limitations that apply to the
12same routine patient care received by an insured not enrolled
13in a qualified clinical cancer trial, including the application
14of any authorization requirement, utilization review, or
15medical management practices. The insured or enrollee shall
16incur no greater out-of-pocket liability than had the insured
17or enrollee not enrolled in a qualified clinical cancer trial.
18    (e) If the group policy of accident and health insurance
19uses a preferred provider program and a preferred provider
20provides routine patient care in connection with a qualified
21clinical cancer trial, then the insurer may require the insured
22to use the preferred provider if the preferred provider agrees
23to provide to the insured that routine patient care.
24    (f) A qualified clinical cancer trial may not pay or refuse
25to pay for routine patient care of a individual participating
26in the trial, based in whole or in part on the person's having



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1or not having coverage for routine patient care under a group
2policy of accident and health insurance.
3    (g) Nothing in this Section shall be construed to limit an
4insurer's coverage with respect to clinical trials.
5    (h) Nothing in this Section shall require coverage for
6out-of-network services where the underlying health benefit
7plan does not provide coverage for out-of-network services.
8    (i) As used in this Section, "routine patient care" means
9all health care services provided in the qualified clinical
10cancer trial that are otherwise generally covered under the
11policy if those items or services were not provided in
12connection with a qualified clinical cancer trial consistent
13with the standard of care for the treatment of cancer,
14including the type and frequency of any diagnostic modality,
15that a provider typically provides to a cancer patient who is
16not enrolled in a qualified clinical cancer trial. "Routine
17patient care" does not include, and a group policy of accident
18and health insurance may exclude, coverage for:
19        (1) a health care service, item, or drug that is the
20    subject of the cancer clinical trial;
21        (2) a health care service, item, or drug provided
22    solely to satisfy data collection and analysis needs for
23    the qualified clinical cancer trial that is not used in the
24    direct clinical management of the patient;
25        (3) an investigational drug or device that has not been
26    approved for market by the United States Food and Drug



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1    Administration;
2        (4) transportation, lodging, food, or other expenses
3    for the patient or a family member or companion of the
4    patient that are associated with the travel to or from a
5    facility providing the qualified clinical cancer trial,
6    unless the policy covers these expenses for a cancer
7    patient who is not enrolled in a qualified clinical cancer
8    trial;
9        (5) a health care service, item, or drug customarily
10    provided by the qualified clinical cancer trial sponsors
11    free of charge for any patient;
12        (6) a health care service or item, which except for the
13    fact that it is being provided in a qualified clinical
14    cancer trial, is otherwise specifically excluded from
15    coverage under the insured's policy, including:
16            (A) costs of extra treatments, services,
17        procedures, tests, or drugs that would not be performed
18        or administered except for the fact that the insured is
19        participating in the cancer clinical trial; and
20            (B) costs of nonhealth care services that the
21        patient is required to receive as a result of
22        participation in the approved cancer clinical trial;
23        (7) costs for services, items, or drugs that are
24    eligible for reimbursement from a source other than a
25    patient's contract or policy providing for third-party
26    payment or prepayment of health or medical expenses,



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1    including the sponsor of the approved cancer clinical
2    trial; or
3        (8) costs associated with approved cancer clinical
4    trials designed exclusively to test toxicity or disease
5    pathophysiology, unless the policy covers these expenses
6    for a cancer patient who is not enrolled in a qualified
7    clinical cancer trial; or
8        (9) a health care service or item that is eligible for
9    reimbursement by a source other than the insured's policy,
10    including the sponsor of the qualified clinical cancer
11    trial.
12    The definitions of the terms "health care services",
13"Non-Preferred Provider", "Preferred Provider", and "Preferred
14Provider Program", stated in 50 IL Adm. Code Part 2051
15Preferred Provider Programs apply to these terms in this
17    (j) The external review procedures established under the
18Health Carrier External Review Act shall apply to the
19provisions under this Section.
20(Source: P.A. 93-1000, eff. 1-1-05.)
21    Section 99. Effective date. This Act takes effect January
221, 2012.".