State of Illinois
90th General Assembly
Legislation

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90_HB1330

      215 ILCS 5/356g           from Ch. 73, par. 968g
      215 ILCS 130/4003         from Ch. 73, par. 1504-3
      215 ILCS 165/10           from Ch. 32, par. 604
          Amends the Illinois Insurance  Code.  Provides  that  the
      mammogram  coverage requirements apply to managed care plans.
      Amends the Limited Health Service Organization  Act  and  the
      Voluntary  Health  Services Plans Act to require coverage for
      mammograms under those Acts.
                                                     LRB9004656JScc
                                               LRB9004656JScc
 1        AN ACT concerning mammograms, amending named Acts.
 2        Be it enacted by the People of  the  State  of  Illinois,
 3    represented in the General Assembly:
 4        Section  5.   The  Illinois  Insurance Code is amended by
 5    changing Section 356g as follows:
 6        (215 ILCS 5/356g) (from Ch. 73, par. 968g)
 7        Sec. 356g. Mammogram coverage.
 8        (a)  Every insurer and every managed  care  entity  shall
 9    provide  in  each  group  or  individual policy, contract, or
10    certificate of insurance, or  managed  care  plan  issued  or
11    renewed for persons who are residents of this State, coverage
12    for  screening by low-dose mammography for all women 35 years
13    of age or older for the  presence  of  occult  breast  cancer
14    within   the   provisions   of   the   policy,  contract,  or
15    certificate. The coverage shall be as follows:
16             (1)  A baseline mammogram for women 35 to  39  years
17        of age.
18             (2)  An  mammogram  every  1  to 2 years, even if no
19        symptoms are present, for women 40 to 49 years of age.
20             (3)  An annual mammogram for women 50 years  of  age
21        or older.
22        These  benefits  shall  be  at  least as favorable as for
23    other radiological  examinations  and  subject  to  the  same
24    dollar  limits,  deductibles,  and  co-insurance factors. For
25    purposes of this Section, "low-dose  mammography"  means  the
26    x-ray  examination  of  the  breast using equipment dedicated
27    specifically  for  mammography,  including  the  x-ray  tube,
28    filter,  compression  device,  and   image   receptor,   with
29    radiation exposure delivery of less than 1 rad per breast for
30    2 views of an average size breast.
31        (b)  No  policy  of  accident  or  health  insurance that
                            -2-                LRB9004656JScc
 1    provides for the surgical procedure  known  as  a  mastectomy
 2    shall  be issued, amended, delivered or renewed in this State
 3    on or after July 1, 1981, unless coverage is also offered for
 4    prosthetic devices or reconstructive surgery incident to  the
 5    mastectomy,  providing that the mastectomy is performed after
 6    July 1, 1981. The offered coverage for prosthetic devices and
 7    reconstructive surgery shall be subject to the deductible and
 8    coinsurance conditions applied to  the  mastectomy,  and  all
 9    other  terms  and  conditions  applicable  to other benefits.
10    When a mastectomy is performed and there is  no  evidence  of
11    malignancy  then  the  offered coverage may be limited to the
12    provision of prosthetic devices and reconstructive surgery to
13    within 2 years after the date of the mastectomy. As  used  in
14    this  Section,  "mastectomy" means the removal of all or part
15    of the breast for medically necessary reasons, as  determined
16    by  a  licensed physician. As used in this Section, the terms
17    "managed care  entity"  and  "managed  care  plan"  have  the
18    meanings given them in Section 356r of this Code.
19    (Source: P.A. 86-899; 87-518.)
20        Section  10.  The Limited Health Service Organization Act
21    is amended by changing Section 4003 as follows:
22        (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
23        Sec. 4003.  Illinois Insurance Code provisions.   Limited
24    health   service   organizations  shall  be  subject  to  the
25    provisions of Sections 133,  134,  137,  140,  141.1,  141.2,
26    141.3,  143,  143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
27    154.6, 154.7, 154.8, 155.04, 355.2, 356g,  401,  401.1,  402,
28    403,  403A,  408, 408.2, and 412, and Articles VIII 1/2, XII,
29    XII 1/2, XIII, XIII 1/2, and XXVI of the  Illinois  Insurance
30    Code.   For  purposes  of the Illinois Insurance Code, except
31    for Articles  XIII  and  XIII  1/2,  limited  health  service
32    organizations  in  the  following categories are deemed to be
                            -3-                LRB9004656JScc
 1    domestic companies:
 2             (1)  a corporation under the laws of this State; or
 3             (2)  a  corporation  organized  under  the  laws  of
 4        another state, 30% of more of the enrollees of which  are
 5        residents  of this State, except a corporation subject to
 6        substantially the  same  requirements  in  its  state  of
 7        organization  as is a domestic company under Article VIII
 8        1/2 of the Illinois Insurance Code.
 9    (Source: P.A. 86-600; 87-587; 87-1090.)
10        Section 15. The Voluntary Health Services  Plans  Act  is
11    amended by changing Section 10 as follows:
12        (215 ILCS 165/10) (from Ch. 32, par. 604)
13        Sec.   10.  Application  of  Insurance  Code  provisions.
14    Health services plan corporations and all persons  interested
15    therein   or  dealing  therewith  shall  be  subject  to  the
16    provisions of Article XII 1/2 and  Sections  3.1,  133,  140,
17    143,  143c,  149,  354, 355.2, 356g, 356r, 367.2, 401, 401.1,
18    402, 403, 403A, 408, 408.2, and 412, and paragraphs  (7)  and
19    (15) of Section 367 of the Illinois Insurance Code.
20    (Source: P.A. 89-514, eff. 7-17-96.)

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