IL| The Illinois Department of Insurance Company Bulletin 2026-05 reminds Illinois health insurance issuers that any group or individual accident and health policy, HMO, limited health care plan, or voluntary health services plan covering laboratory services and issued, amended, delivered, or renewed on or after January 1, 2022, must cover biomarker testing as required by 215 ILCS 5/356z.46 and Public Act 102-0203. Biomarker testing—defined to include analysis of tissue, blood, or fluid biospecimens via single‑analyte tests, multiplex panels, and partial or whole genome sequencing—must be covered when supported by medical and scientific evidence for diagnosis, treatment, management, or ongoing monitoring of a disease or condition, and must be conducted efficiently to maximize results without unnecessary repeat biopsies or care delays.
If coverage is restricted, issuers must maintain a clear, readily accessible online exception process for patients and prescribing practitioners, keep medical policies and billing practices current with evidence‑based recommendations in the statute’s referenced sources, and may deny claims only on medical‑necessity grounds consistent with Section 356z.46. Issuers must use current statutory definitions and requirements, and issue biomarker coverage decisions in a timely manner in accordance with existing Illinois Insurance Code provisions and related regulations.