INS-GENETIC TESTING & SCREEN

Illinois General Assembly - Full Text of HB3605

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Full Text of HB3605

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HB3605 - 104th General Assembly

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HB3605 Engrossed
LRB104 09298 BAB 19356 b
1

AN ACT concerning regulation.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 5.
The State Employees Group Insurance Act of 1971
5
is amended by changing Section 6.11 and by adding Section
6
6.11F as follows:

7

(5 ILCS 375/6.11)
8

(Text of Section before amendment by P.A. 104-1
)
9

Sec. 6.11.
Required health benefits; Illinois Insurance
10
Code requirements.
The program of health benefits shall
11
provide the post-mastectomy care benefits required to be
12
covered by a policy of accident and health insurance under
13
Section 356t of the Illinois Insurance Code. The program of
14
health benefits shall provide the coverage required under
15
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
356u.10,

16
356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
17
356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
18
356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
19
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
20
356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
21
356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70,
22
356z.71, 356z.74, 356z.76,
and
356z.77,
and
356z.80
, 356z.81,
23
356z.82, 356z.83, 356z.84, and 356z.85
of the Illinois

HB3605 Engrossed
- 2 -
LRB104 09298 BAB 19356 b
1
Insurance Code. The program of health benefits must comply
2
with Sections 155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1
3
and Article XXXIIB of the Illinois Insurance Code. The program
4
of health benefits shall provide the coverage required under
5
Section 356m of the Illinois Insurance Code and, for the
6
employees of the State Employee Group Insurance Program only,
7
the coverage as also provided in Section 6.11B of this Act. The
8
Department of Insurance shall enforce the requirements of this
9
Section with respect to Sections 370c and 370c.1 and Article
10
XXXIIB of the Illinois Insurance Code; all other requirements
11
of this Section shall be enforced by the Department of Central
12
Management Services.
13

Rulemaking authority to implement Public Act 95-1045, if
14
any, is conditioned on the rules being adopted in accordance
15
with all provisions of the Illinois Administrative Procedure
16
Act and all rules and procedures of the Joint Committee on
17
Administrative Rules; any purported rule not so adopted, for
18
whatever reason, is unauthorized.
19
(Source: P.A. 103-8, eff. 1-1-24; 103-84, eff. 1-1-24; 103-91,
20
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
21
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
22
7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-870,
23
eff. 1-1-25; 103-914, eff. 1-1-25; 103-918, eff. 1-1-25;
24
103-951, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-27, eff.
25
1-1-26, 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff.
26
1-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379,

HB3605 Engrossed
- 3 -
LRB104 09298 BAB 19356 b
1
eff. 1-1-26; 104-417, eff. 8-15-25; revised 11-19-25.)

2

(Text of Section after amendment by P.A. 104-1
)
3

Sec. 6.11.
Required health benefits; Illinois Insurance
4
Code requirements.
The program of health benefits shall
5
provide the post-mastectomy care benefits required to be
6
covered by a policy of accident and health insurance under
7
Section 356t of the Illinois Insurance Code. The program of
8
health benefits shall provide the coverage required under
9
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
356u.10,

10
356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
11
356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
12
356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
13
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
14
356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
15
356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70,
16
356z.71, 356z.74, 356z.76,
and
356z.77,
356z.79,

and
356z.80
,
17
356z.81, 356z.82, 356z.83, 356z.84, and 356z.85
of the
18
Illinois Insurance Code. The program of health benefits must
19
comply with Sections 155.22a, 155.37, 355b, 356z.19, 370c, and
20
370c.1 and Article XXXIIB of the Illinois Insurance Code. The
21
program of health benefits shall provide the coverage required
22
under Section 356m of the Illinois Insurance Code and, for the
23
employees of the State Employee Group Insurance Program only,
24
the coverage as also provided in Section 6.11B of this Act. The
25
Department of Insurance shall enforce the requirements of this

HB3605 Engrossed
- 4 -
LRB104 09298 BAB 19356 b
1
Section with respect to Sections 370c and 370c.1 and Article
2
XXXIIB of the Illinois Insurance Code; all other requirements
3
of this Section shall be enforced by the Department of Central
4
Management Services.
5

Rulemaking authority to implement Public Act 95-1045, if
6
any, is conditioned on the rules being adopted in accordance
7
with all provisions of the Illinois Administrative Procedure
8
Act and all rules and procedures of the Joint Committee on
9
Administrative Rules; any purported rule not so adopted, for
10
whatever reason, is unauthorized.
11
(Source: P.A. 103-8, eff. 1-1-24; 103-84, eff. 1-1-24; 103-91,
12
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
13
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
14
7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-870,
15
eff. 1-1-25; 103-914, eff. 1-1-25; 103-918, eff. 1-1-25;
16
103-951, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff.
17
7-1-27; 104-27, eff. 1-1-26, 104-42, eff. 8-1-25; 104-68, eff.
18
1-1-26; 104-73, eff. 1-1-26; 104-289, eff. 1-1-26; 104-324,
19
eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25;
20
revised 11-19-25.)

21

(5 ILCS 375/6.11F new)
22

Sec. 6.11F.
Genetic testing and evidence-based screenings
23
for an inherited gene mutation.
24

(a) In this Section, "genetic testing for an inherited
25
mutation" means germline multi-gene testing for an inherited

HB3605 Engrossed
- 5 -
LRB104 09298 BAB 19356 b
1
mutation associated with an increased risk of cancer in
2
accordance with evidence-based, clinical practice guidelines.
3

(b) The State Employees Group Insurance Program shall
4
provide coverage for clinical genetic testing for an inherited
5
gene mutation for individuals with a personal or family
6
history of cancer, as recommended by a health care
7
professional in accordance with current evidence-based
8
clinical practice guidelines, including, but not limited to,
9
the current version of the National Comprehensive Cancer
10
Network clinical practice guidelines. The coverage shall limit
11
the total amount that a covered person is required to pay for a
12
clinical genetic test under this subsection to an amount not
13
to exceed $50, except for services for which cost sharing is
14
prohibited under 42 U.S.C. 300gg-13. This subsection (b) shall
15
not apply to coverage of genetic testing to the extent such
16
coverage would disqualify a high-deductible health plan from
17
eligibility for a health savings account pursuant to Section
18
223 of the Internal Revenue Code.
19

(c) For individuals with a genetic test that is positive
20
for an inherited mutation associated with an increased risk of
21
cancer, coverage required under this Section shall include any
22
evidence-based screenings, as recommended by a health care
23
professional in accordance with current evidence-based
24
clinical practice guidelines, to the extent that the
25
management recommendation is not already covered by the
26
policy, except that coverage for evidence-based screenings

HB3605 Engrossed
- 6 -
LRB104 09298 BAB 19356 b
1
under this subsection (c) may be subject to a deductible,
2
coinsurance, or other cost-sharing limitation so long as the
3
limitation is not greater than that required for other related
4
cancer risk management benefits covered under the policy. In
5
this subsection, "evidence-based cancer screenings" means
6
medically recommended evidence-based screening modalities in
7
accordance with current clinical practice guidelines.

8

Section 10.
The Illinois Insurance Code is amended by
9
changing Section 356u.10 as follows:

10

(215 ILCS 5/356u.10)
11

Sec. 356u.10.
Genetic testing and evidence-based
12
screenings for an inherited gene mutation.
13

(a)
As used in

In
this Section
:

,

14

"Cost sharing" means a deductible, coinsurance, copayment,
15
or any similar out-of-pocket expense.
16

"Evidence-based screening" means evidence-based cancer
17
screening modalities in accordance with the most recent
18
version of the National Comprehensive Cancer Network clinical
19
practice guidelines.

20

"
Genetic

genetic
testing for an inherited mutation" means
21
germline multi-gene testing for an inherited mutation
22
associated with an increased risk of cancer in accordance with
23
evidence-based, clinical practice guidelines.
24

(b)
An individual or

A
group policy of accident and health

HB3605 Engrossed
- 7 -
LRB104 09298 BAB 19356 b
1
insurance or managed care plan that is amended, delivered,
2
issued, or renewed after January 1,
2028

2026
shall provide
3
coverage for clinical genetic testing for an inherited gene
4
mutation for individuals with a personal or family history of
5
cancer, as recommended by a health care professional in
6
accordance with current evidence-based clinical practice
7
guidelines, including, but not limited to, the current version
8
of the National Comprehensive Cancer Network clinical practice
9
guidelines.
The coverage shall limit the total amount that a
10
covered person is required to pay for a clinical genetic test
11
under this subsection to an amount not to exceed $50, except
12
for services for which cost sharing is prohibited under 42
13
U.S.C. 300gg-13. This subsection (b) shall not apply to
14
coverage of genetic testing to the extent such coverage would
15
disqualify a high-deductible health plan from eligibility for
16
a health savings account pursuant to Section 223 of the
17
Internal Revenue Code.
18

(c) For individuals with a genetic test that is positive
19
for an inherited mutation associated with an increased risk of
20
cancer, coverage required under this Section shall include any
21
evidence-based screenings, as recommended by a health care
22
professional in accordance with current evidence-based
23
clinical practice guidelines
, including, but not limited to,
24
the current version of the National Comprehensive Cancer
25
Network clinical practice guidelines
, to the extent that the
26
management recommendation is not already covered by the

HB3605 Engrossed
- 8 -
LRB104 09298 BAB 19356 b
1
policy
.

, except that coverage for evidence-based screenings
2
under this subsection (c) may be subject to a deductible,
3
coinsurance, or other cost-sharing limitation so long as the
4
limitation is not greater than that required for other related
5
cancer risk management benefits covered under the policy. In
6
this subsection, "evidence-based cancer screenings" means
7
medically recommended evidence-based screening modalities in
8
accordance with current clinical practice guidelines.
9

(d) The coverage provided in subsections (b) and (c) shall
10
be provided without cost sharing, except for services for
11
which cost sharing is prohibited under 42 U.S.C. 300gg-13.
12
Subsections (b) and (c) do not apply to the extent that
13
providing such coverage would disqualify a high-deductible
14
health plan from eligibility for a health savings account
15
pursuant to Section 223 of the Internal Revenue Code.
16

(e) This Section does not apply to the State Employees
17
Group Insurance Program or any health care plan established or
18
maintained under the State Employees Group Insurance Act of
19
1971.
20
(Source: P.A. 103-914, eff. 1-1-25
.)

21

Section 95.
No acceleration or delay.
Where this Act makes
22
changes in a statute that is represented in this Act by text
23
that is not yet or no longer in effect (for example, a Section
24
represented by multiple versions), the use of that text does
25
not accelerate or delay the taking effect of (i) the changes

HB3605 Engrossed
- 9 -
LRB104 09298 BAB 19356 b
1
made by this Act or (ii) provisions derived from any other
2
Public Act.

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