IL HB5230

Requires individual and group accident and health insurance policies amended, delivered, issued, or renewed on or after January 1, 2021 to cover medically necessary hypofractionated proton therapy for eligible cancer patients.

Insurance must pay the same aggregate amount for hypofractionated proton therapy as would be paid for standard intensity modulated radiation therapy (IMRT) delivering the same biological effective dose.

Coverage requires the patient to be treated as part of a clinical trial or registry, have a cancer type treatable with hypofractionated proton therapy, and be prescribed treatment by a board-certified or board-eligible radiation oncologist.

Patient cost-sharing (deductibles, coinsurance, other limitations) for proton therapy cannot exceed what would be required for comparable IMRT treatment under the same policy.

Patient out-of-pocket costs for both in-network and out-of-network proton therapy providers cannot exceed what the patient would pay for equivalent IMRT treatment.