IL HB5399

Amends the Illinois Insurance Code to require individual and group accident and health insurance policies amended, delivered, issued, or renewed on or after January 1, 2024 to cover medically necessary hypofractionated proton therapy at the same aggregate payment amount as standard intensity modulated radiation therapy (IMRT) for the same cancer indication.

Coverage applies only to eligible patients who are part of a clinical trial or registry, have a cancer type treatable with hypofractionated proton therapy, and are prescribed treatment by a board certified or board eligible radiation oncologist.

Proton therapy coverage cannot impose higher annual deductibles, coinsurance, or cost-sharing limitations than other radiation therapy benefits within the same insurance policy.

Limits patient out-of-pocket costs for in-network and out-of-network proton therapy providers to amounts not exceeding what would be charged for equivalent IMRT treatment, with out-of-network patients not responsible for amounts exceeding the allowable maximum charge.

Takes effect January 1, 2023, establishing definitions for key terms including biological effective dose, hypofractionated proton therapy protocol, IMRT, radiation therapy, and eligible patient.