SB0314 Summary

• Requires all insurers and health maintenance organizations to cover low-dose mammography screening for women 35 and older, including baseline mammograms for ages 35-39, annual mammograms for age 40+, and supplemental ultrasound or MRI screening when mammograms show dense breast tissue.

• Mandates coverage for comprehensive ultrasound and MRI screening when medically necessary for women with dense breast tissue, and standalone screening MRI when medically necessary as determined by a physician.

• Requires all mastectomy insurance coverage to include reconstruction of the affected breast, surgery on the other breast for symmetrical appearance, and prostheses and treatment for complications including lymphedemas, with coverage available at no cost to the insured and not subject to annual or lifetime maximums.

• Extends identical mammography and mastectomy coverage requirements to the Illinois Medicaid program for eligible women, and establishes performance goals and quality improvement programs for breast cancer screening and treatment providers.

• Prohibits insurers and HMOs from denying enrollment or penalizing providers to avoid these coverage requirements, and makes coverage available with no patient cost-sharing when using contracted providers.