Insurance Coverage: Illinois
For more information about insurance coverage of clinical trial costs, see this feature's main page: States That Require Health Plans to Cover Patient Care Costs in Clinical Trials.
Legislation: House Bill 1191
Effective: January 1, 2012
What clinical trials are covered?
Qualified clinical cancer trials wherein:
- The effectiveness of the treatment has not been determined relative to established therapies and the patient's primary care physician is involved with the coordination of care
- The trial is a Phase II, III, or IV investigation
- The trial is:
- Approved by the U.S. Food and Drug Administration, or
- Approved and funded by one of the following:
- National Institutes of Health
- Centers for Disease Control and Prevention
- Agency for Healthcare Research and Quality
- U.S. Department of Defense
- U.S. Department of Veterans Affairs
- U.S. Department of Energy
Who is required to pay?
Private individual and group insurers.
Other key provisions:
- Insurance may not be cancelled or non-renewed based on an individual's participation in a qualified clinical cancer trial.
- Coverage for routine patient care cannot be excluded for an individual participating in a qualified clinical cancer trial if the policy otherwise covers the same routine patient care.
- The coverage under this law must be subject to all terms, conditions, restrictions, exclusions, and limitations that apply to the same routine patient care received by an insured not enrolled in a trial.
- The insurer is allowed to require the insured to use the preferred provider if the preferred provider agrees to provide to the insured that routine patient care, if the insurer uses a preferred provider program and a preferred provider provides routine patient care in connection with a trial.
- A trial is prohibited from paying or refusing to pay for routine patient care of an individual participating in the trial, based in whole or in part on the person's having or not having coverage for routine patient care under a group policy of accident and health insurance.