Changes in Law for Coverage of Mammograms and Breast Cancer Pain Medication and Therapy

Effective March 27, 2009, legislation was signed into law (P.A. 95-1045) that requires fully insured group and individual health insurance plans and self-funded, public health insurance plans (i.e., those offered by cities, counties and school districts) to cover all medically necessary pain medication and pain therapy related to the treatment of breast cancer. This new law also requires insurers to cover low-dose preventive mammography screening, including digital mammography, at no cost to the insured and without application to any annual or lifetime maximum benefits when contracted providers are used or at a cost at least as favorable as coverage for other radiological examinations when out-of-network providers are used.

For more information regarding this new law, please use the link below to access the General Assembly website and to review the specific Public Act or contact your Compliance Department with questions or concerns.

http://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=095-1045&GA=095

On February 17, 2009, President Barack Obama signed the American Recovery and Reinvestment Act (ARRA), commonly called the Stimulus Plan. ARRA provides a subsidy that may reduce by 65% the cost of COBRA and other state group continuation coverage for workers who lose their jobs.

Pursuant to the American Recovery and Reinvestment Act of 2009 (ARRA) and a related State law signed by the Governor on June 18, 2009 (P.A. 96-0013), insurers and HMOs are required to notify certain individuals about the availability of premium reductions for group continuation coverage provided for under ARRA. For more detailed information about these laws, please see the Department’s fact sheet entitled “Federal Stimulus – Premium Reduction for Group Continuation Coverage.”

The U.S. Department of Labor published model notices to help employers and insurers comply with ARRA’s notification requirements. The Illinois Department of Insurance has modified these notices to account for features unique to Illinois continuation law.
http://www.idfpr.com/doi/pressRelease/pr09/ModelNotices.asp

ARRA itself does not change the length of time that group continuation coverage must be provided to eligible individuals: COBRA typically provides for up to 18 months of coverage, while mini-COBRA had provided for up to 9 months of coverage.

The period of coverage required under the state mini-COBRA law, however, was recently increased from 9 months to 12 months by Public Act 096-0013. All group plans subject to the law that are issued, delivered, amended or renewed after June 18, 2009, must provide for up to 12 months of continuation coverage. If an individual is currently receiving mini-COBRA coverage and the employer’s policy is renewed after June 18, 2009, the individual would be entitled to the additional 3 months of coverage, regardless of the date the individual first elected mini-COBRA coverage.   For complete details see:  http://www.idfpr.com/DOI/General/COBRASubsidyFactSheet06182009.pdf