INS-HEALTH/CORONARY SCAN

Amends the Illinois Insurance Code. Provides that an individual or group policy of accident and health insurance that is amended, delivered, issued, or renewed on or after January 1, 2028 and is subject to the Code shall provide coverage for a medically necessary coronary calcium scan and scoring if: (1) the individual is between 40 and 75 years of age; (2) the scan is ordered by a licensed health care provider; and (3) the provider has conducted and documented a cardiovascular risk assessment demonstrating clinical appropriateness consistent with evidence-based guidelines. Provides that coverage shall be provided at intervals consistent with evidence-based clinical guidelines and shall not be subject to more restrictive limitations than other diagnostic imaging services covered under the policy. Sets forth provisions concerning cost-sharing. Amends the Health Maintenance Organization Act to require the same coverage under the provisions of that Act. Amends the Illinois Public Aid Code to require coverage for a medically necessary coronary calcium scan and scoring for an eligible individual who: (A) is between 40 and 75 years of age; (B) is assessed by a licensed health care provider as having moderate or greater risk of atherosclerotic cardiovascular disease based on a documented cardiovascular risk assessment consistent with nationally recognized evidence-based clinical guidelines; (C) does not have a prior diagnosis of coronary artery disease; and (D) has not received a covered coronary artery calcium scan within the previous 5 years, unless medically necessary as determined by the Department of Healthcare and Family Services. Requires coverage without cost sharing and provides that the Department may adopt reasonable utilization controls consistent with other diagnostic imaging services covered under the medical assistance program. Provides that implementation of the coverage shall occur only to the extent that federal financial participation is available and approved by the federal Centers for Medicare and Medicaid Services.

Status

Engrossed

Passed its first chamber

Status date

Apr 14, 2026

212 days ago

Current chamber

Senate

Session

2025-2026 Regular Session