Bill
HB 3001
The bill expands insurance coverage for ovarian cancer surveillance to more at‑risk individuals by broadening definitions and allowing various imaging and CA-125 tests.
Status and procedural history
- Bill number: HB 3001 (introduced in the 104th General Assembly). Primary sponsor: Rep. Norine K. Hammond.
- Filed: February 2025; Read first time March 20, 2025. Referred to the Insurance Committee (with subsequent referrals to Rules). As of June 28, 2025: in committee upon adjournment.
- Amends: 215 ILCS 5/356u (section of the Illinois Insurance Code concerning Pap tests and prostate/ovarian cancer screening coverage).
- Effective date if enacted: January 1, 2027.
Purpose / intent
- To revise mandated health-insurance coverage language regarding surveillance (screening and diagnostic) testing for ovarian cancer, and to add an elevated CA-125 blood test level as a criterion identifying a person "at risk for ovarian cancer." The changes broaden the defined set of covered surveillance modalities and clarify definitions of covered prostate and ovarian cancer screening services.
Key substantive provisions
- Definition update — "At risk for ovarian cancer": expands the statutory definition to include persons who (1) have a family history (one or more first‑degree relatives with ovarian cancer; clusters of breast cancer; or nonpolyposis colorectal cancer), (2) test positive for BRCA1 or BRCA2 mutations, or (3) have a high level of CA-125 as indicated by a blood test screening.
- Definition update — "Surveillance tests for ovarian cancer": replaces language that specified an annual screening using (i) CA-125 serum testing, (ii) transvaginal ultrasound, and (iii) pelvic examination with broader language that surveillance tests "means all medically viable methods" for detection/diagnosis, and explicitly lists (but is not limited to) ultrasounds, MRIs, x‑rays, CT scans, and CA‑125 blood test screenings.
- Prostate screening: retains definition that includes digital rectal exam and PSA testing, and explicitly includes medically necessary follow‑up testing (e.g., urinalysis, serum biomarkers, medical imaging including MRI).
- Applicability and exclusions:
- Applies to group accident and health policies that provide hospital coverage or services for illness on an expense‑incurred basis and meet the timing/renewal criteria in the statute.
- Does not apply to specified disease/limited benefit policies.
- Does not require coverage that would disqualify a high‑deductible health plan from HSA eligibility under IRC §223.
Who would be affected
- Group health insurers and third‑party administrators offering covered plans in Illinois: they would be required to cover the broader set of medically viable ovarian surveillance methods for persons meeting the "at risk" definition once the law takes effect.
- Insured individuals: particularly people identified as at risk for ovarian cancer (including those with high CA‑125 levels), who may gain clearer access to a wider range of covered diagnostic and surveillance modalities.
- Health care providers: would have more flexibility to order and obtain coverage for varied imaging and diagnostic tests for at‑risk patients.
Potential impacts
- Clinical: broadens recognized risk criteria (adding elevated CA‑125) and allows clinicians to use a wider array of diagnostic modalities for surveillance.
- Insurer/utilization: could increase utilization of imaging and blood test surveillance for at‑risk individuals; potential premium or cost‑implications are not specified in the bill.
- Legal/administrative: clarifies definitions and insurer obligations in statute; effective date is January 1, 2027.
Compiled from official sources — confirm details with the bill’s official record.
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