SB0162 Summary

• Requires health insurance plans, including county and municipal self-insured plans, to cover diagnostic mammograms when medically necessary with no cost-sharing for qualifying policies.

• Expands breast cancer screening coverage to include comprehensive ultrasound screening and MRI when mammograms show dense or heterogeneous breast tissue, effective for policies amended or renewed on or after January 1, 2020.

• Defines "diagnostic mammogram" and "diagnostic mammography" to clarify coverage for evaluating breast abnormalities detected on screening or clinical exams.

• Applies mandatory coverage requirements to Illinois Insurance Code (accident and health insurance), Health Maintenance Organization Act contracts, county employee health plans, and municipal employee health plans.

• Allows high-deductible health plans to impose cost-sharing on diagnostic mammograms only to the extent necessary to maintain health savings account eligibility under federal tax law.