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HB 3605

INS-GENETIC TESTING & SCREEN

104th Regular Session Introduced by Cristina Castro and 14 co-sponsors

Requires group health plans (post-1/1/2026) to cover genetic testing for inherited cancer-risk mutations and NCCN-based cancer screenings, with a $50 max out-of-pocket for tests.

Added as Alternate Chief Co-Sponsor Sen. Bill Cunningham
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Bill Summary · HB 3605

HB 3605 — Summary (INS — Genetic Testing & Screening)

Status: Introduced 02/18/2025; House Amendment 001 filed 03/25/2025; multiple committee actions (reported favorably as substituted 05/07/2025). Added co-sponsors include Reps. Stephanie A. Kifowit, Anne Stava, Janet Yang Rohr, Marcus C. Evans, Jr., and William "Will" Davis.

Main purpose

Require most group accident & health insurance policies and managed care plans delivered, issued, amended, or renewed after January 1, 2026 to cover: (1) clinical genetic testing for inherited gene mutations associated with increased cancer risk, and (2) evidence‑based cancer screenings recommended for people at increased risk—both per current evidence‑based clinical practice guidelines (explicitly the National Comprehensive Cancer Network, NCCN).

Key provisions

  • Definitions: The bill updates defined terms to refer to "genetic testing for an inherited mutation" (germline, multi‑gene testing tied to increased cancer risk) and to "evidence‑based cancer screenings" (as reflected in current clinical practice guidelines). House Amendment 001 replaces the word “imaging” with “screening” throughout the bill.
  • Coverage requirement: Group policies and managed care plans amended, delivered, issued, or renewed after 1/1/2026 must cover:
    • Clinical genetic testing for inherited mutations when recommended by a health care professional in accordance with current evidence‑based guidelines (including NCCN), for individuals with a personal or family history of cancer.
    • Evidence‑based cancer screenings for individuals at increased risk as recommended by current NCCN or similar guidelines.
  • Cost-sharing and limits:
    • The bill contains a provision limiting the total out‑of‑pocket amount a covered person must pay for a clinical genetic test to no more than $50 (text references an exception where federal law prohibits cost‑sharing).
    • Coverage for evidence‑based screenings required after a positive genetic test is to be provided; such screenings may be subject to deductible/coinsurance only to the extent those cost‑sharing levels are no greater than those applied to comparable cancer risk management benefits under the policy.
  • HDHP/HSA exemption: The requirements do not apply to the extent that providing the coverage would cause a plan to lose its status as a high‑deductible health plan eligible for a Health Savings Account under Internal Revenue Code §223.

Who is affected

  • Insurers and managed care plans offering group accident & health coverage in Illinois (policies amended, issued, delivered, or renewed after 1/1/2026).
  • Individuals with a personal or family history of cancer, people identified as having increased cancer risk, and those with positive germline genetic tests—who would gain access to covered genetic testing and guideline‑recommended screenings, often with limited cost‑sharing.
  • Employers offering group coverage may be affected by changes in benefit design and cost‑sharing.

Procedural/timeline notes

  • Effective application is tied to policy actions on or after January 1, 2026.
  • House Amendment 001 (03/25/2025) clarifies terminology by replacing “imaging” with “screening.”
  • The bill has progressed through the Insurance Committee and been reported favorably as substituted (05/07/2025); further floor and Rules Committee actions occurred in March–May 2025.

Note: The bill text contains some overlapping and partially redrafted language; the summary reflects the bill’s apparent intent as clarified by the House amendment and committee substitute (coverage tied to current evidence‑based clinical practice guidelines, notably NCCN).

Compiled from official sources — confirm details with the bill’s official record.

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