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Bill

HB 1331

NETWORK ADEQUACY-GENETIC MED

104th Regular Session Introduced by Sonya Harper and 3 co-sponsors

Illinois requires health insurers to maintain adequate in-network genetic medicine services starting January 2026, ensuring patient access to genetic specialists and testing without excessive delays or costs.

Public Act . . . . . . . . . 104-0175
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Bill Summary · HB 1331

Legislative bill overview

HB 1331 requires Illinois health insurers to ensure adequate network access to genetic medicine specialists and services. The bill establishes standards for network adequacy specific to genetic testing, counseling, and treatment, mandating that insurers maintain sufficient in-network providers to meet patient demand without unreasonable delays.

Why is this important

Genetic medicine is an increasingly critical field for diagnosing hereditary conditions, cancer risk assessment, and personalized treatment planning, yet many insurance networks lack adequate genetic counselor and specialist access. This bill ensures patients can access genetic services without prohibitive out-of-network costs or long wait times, reducing barriers to preventive care and early disease detection.

Potential points of contention

  • Provider scarcity: There is a limited supply of board-certified genetic counselors and specialists nationwide; mandated network adequacy may strain existing providers or force insurers to contract with less-qualified practitioners
  • Cost implications: Insurers may pass increased expenses to employers and consumers through higher premiums to maintain expanded genetic medicine networks
  • Vague standards: The bill's definition of "adequate network" for genetic services may lack specificity, creating disputes over compliance and enforcement between insurers and regulators

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

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