Insurance coverage

Senate passes Crowe’s plan to require insurance coverage for genetic test kits for at-risk women

SPRINGFIELD — To streamline the detection process and determine the hereditary risks of breast and ovarian cancers in women, the Illinois Senate has approved a plan championed by State Senator Rachelle Crowe (D-Glen Carbon ) to force insurance companies to cover the cost of genetic test kits.

“Early detection through genetic testing is critical for women with a family history of breast or ovarian cancer,” Crowe said. “By offering genetic testing at no cost, Illinois could provide comfort and stability to those most at risk.”

According to Centers for Disaster Control and Prevention, the genes most frequently affected in hereditary breast and ovarian cancers are the BRCA1 and BRCA2 genes. About 3% of breast cancers, about 7,500 women per year, and 10% of ovarian cancers, about 2,000 women per year, result from inherited mutations.

Once a test is recommended by a health care provider, Crowe’s proposal requires insurance coverage for costs associated with genetic testing for BRCA1 and 2 genes. The measure applies to residents of the Illinois with individual or group insurance policies issued on or after January 1, 2024.

In current law, the Illinois Insurance Code requires individual and group health insurance plans to cover annual cancer screenings for women who test positive for BRCA1 or 2 mutations. However, the code does not require health insurance plans to cover genetic mutation testing. Some insurance companies have specific genetic testing criteria or do not cover genetic testing in certain situations, even when considered medically appropriate.

“By codifying coverage into law, Illinois would create a consistent and reliable process for genetic mutation testing for at-risk women,” Crowe said. “Hereditary breast and ovarian cancers pose significant threats to women’s health, and preventive medical treatment can be implemented once the risks are determined.”

House Bill 5334 moves for final consideration by the Governor.