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HB 4207

Illinois House•Engrossed

Summary

HB 4207, “INS-HEALTH/CORONARY SCAN”, was introduced in the House on Nov 20, 2025 by Rep. Yolanda Morris (D) with 15 co-sponsors. It was referred to Assignments, and last saw action on May 19, 2026: Added as Alternate Co-Sponsor Sen. Laura M. Murphy.

Record

Text

HB 4207 has 15 co-sponsors and 2 roll calls.

hb4207/engrossed.txt
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Full Text of HB4207
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	HB4207 - 104th General Assembly
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			House Amendment 001
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		Engrossed
		House Amendment 001
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		HB4207 Engrossed		LRB104 15812 BAB 29011 b
    AN ACT concerning regulation.
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
    Section 5. The Illinois Insurance Code is amended by
adding Section 356z.88 as follows:
    (215 ILCS 5/356z.88 new)
    Sec. 356z.88. Coronary calcium scan and scoring.
    (a) 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 this 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.
    (b) 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.
		HB4207 Engrossed	- 2 -	LRB104 15812 BAB 29011 b
    (c) For policies subject to cost-sharing requirements, the 
cost sharing for a coronary calcium scan and scoring shall not 
exceed the cost sharing applied to comparable diagnostic 
imaging services.
    (d) Nothing in this Section shall be construed to require 
coverage in a manner inconsistent with federal law.
    Section 10. The Health Maintenance Organization Act is
amended by changing Section 5-3 as follows:
    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
    Sec. 5-3. Illinois Insurance Code provisions.
    (a) Health Maintenance Organizations shall be subject to
the provisions of Sections 133, 134, 136, 137, 139, 140,
141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
155.49, 352c, 355.2, 355.3, 355.6, 355.7, 355b, 355c, 356f,
356g, 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,
356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
		HB4207 Engrossed	- 3 -	LRB104 15812 BAB 29011 b
356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,
356z.76, 356z.77, 356z.78, 356z.79, 356z.80, 356z.81, 356z.82, 
356z.83, 356z.84, 356z.85, 356z.88, 364, 364.01, 364.3, 367.2,
367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370a, 370c,
370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444,
and 444.1, paragraph (c) of subsection (2) of Section 367, and
Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
XXVI, and XXXIIB of the Illinois Insurance Code.
    (b) For purposes of the Illinois Insurance Code, except
for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
Health Maintenance Organizations in the following categories
are deemed to be "domestic companies":
        (1) a corporation authorized under the Dental Service
    Plan Act or the Voluntary Health Services Plans Act;
        (2) a corporation organized under the laws of this
    State; or
        (3) a corporation organized under the laws of another
    state, 30% or more of the enrollees of which are residents
    of this State, except a corporation subject to
    substantially the same requirements in its state of
    organization as is a "domestic company" under Article VIII
    1/2 of the Illinois Insurance Code.
    (c) In considering the merger, consolidation, or other
acquisition of control of a Health Maintenance Organization
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
		HB4207 Engrossed	- 4 -	LRB104 15812 BAB 29011 b
        (1) the Director shall give primary consideration to
    the continuation of benefits to enrollees and the
    financial conditions of the acquired Health Maintenance
    Organization after the merger, consolidation, or other
    acquisition of control takes effect;
        (2)(i) the criteria specified in subsection (1)(b) of
    Section 131.8 of the Illinois Insurance Code shall not
    apply and (ii) the Director, in making his determination
    with respect to the merger, consolidation, or other
    acquisition of control, need not take into account the
    effect on competition of the merger, consolidation, or
    other acquisition of control;
        (3) the Director shall have the power to require the
    following information:
            (A) certification by an independent actuary of the
        adequacy of the reserves of the Health Maintenance
        Organization sought to be acquired;
            (B) pro forma financial statements reflecting the
        combined balance sheets of the acquiring company and
        the Health Maintenance Organization sought to be
        acquired as of the end of the preceding year and as of
        a date 90 days prior to the acquisition, as well as pro
        forma financial statements reflecting projected
        combined operation for a period of 2 years;
            (C) a pro forma business plan detailing an
        acquiring party's plans with respect to the operation
		HB4207 Engrossed	- 5 -	LRB104 15812 BAB 29011 b
        of the Health Maintenance Organization sought to be
        acquired for a period of not less than 3 years; and
            (D) such other information as the Director shall
        require.
    (d) The provisions of Article VIII 1/2 of the Illinois
Insurance Code and this Section 5-3 shall apply to the sale by
any health maintenance organization of greater than 10% of its
enrollee population (including, without limitation, the health
maintenance organization's right, title, and interest in and
to its health care certificates).
    (e) In considering any management contract or service
agreement subject to Section 141.1 of the Illinois Insurance
Code, the Director (i) shall, in addition to the criteria
specified in Section 141.2 of the Illinois Insurance Code,
take into account the effect of the management contract or
service agreement on the continuation of benefits to enrollees
and the financial condition of the health maintenance
organization to be managed or serviced, and (ii) need not take
into account the effect of the management contract or service
agreement on competition.
    (f) Except for small employer groups as defined in the
Small Employer Rating, Renewability and Portability Health
Insurance Act and except for medicare supplement policies as
defined in Section 363 of the Illinois Insurance Code, a
Health Maintenance Organization may by contract agree with a
group or other enrollment unit to effect refunds or charge
		HB4207 Engrossed	- 6 -	LRB104 15812 BAB 29011 b
additional premiums under the following terms and conditions:
        (i) the amount of, and other terms and conditions with
    respect to, the refund or additional premium are set forth
    in the group or enrollment unit contract agreed in advance
    of the period for which a refund is to be paid or
    additional premium is to be charged (which period shall
    not be less than one year); and
        (ii) the amount of the refund or additional premium
    shall not exceed 20% of the Health Maintenance
    Organization's profitable or unprofitable experience with
    respect to the group or other enrollment unit for the
    period (and, for purposes of a refund or additional
    premium, the profitable or unprofitable experience shall
    be calculated taking into account a pro rata share of the
    Health Maintenance Organization's administrative and
    marketing expenses, but shall not include any refund to be
    made or additional premium to be paid pursuant to this
    subsection (f)). The Health Maintenance Organization and
    the group or enrollment unit may agree that the profitable
    or unprofitable experience may be calculated taking into
    account the refund period and the immediately preceding 2
    plan years.
    The Health Maintenance Organization shall include a
statement in the evidence of coverage issued to each enrollee
describing the possibility of a refund or additional premium,
and upon request of any group or enrollment unit, provide to
		HB4207 Engrossed	- 7 -	LRB104 15812 BAB 29011 b
the group or enrollment unit a description of the method used
to calculate (1) the Health Maintenance Organization's
profitable experience with respect to the group or enrollment
unit and the resulting refund to the group or enrollment unit
or (2) the Health Maintenance Organization's unprofitable
experience with respect to the group or enrollment unit and
the resulting additional premium to be paid by the group or
enrollment unit.
    In no event shall the Illinois Health Maintenance
Organization Guaranty Association be liable to pay any
contractual obligation of an insolvent organization to pay any
refund authorized under this Section.
    (g) Rulemaking authority to implement Public Act 95-1045,
if any, is conditioned on the rules being adopted in
accordance with all provisions of the Illinois Administrative
Procedure Act and all rules and procedures of the Joint
Committee on Administrative Rules; any purported rule not so
adopted, for whatever reason, is unauthorized.
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
103-123, eff. 1-1-24; 103-154, eff. 6-30-23; 103-420, eff.
1-1-24; 103-426, eff. 8-4-23; 103-445, eff. 1-1-24; 103-551,
eff. 8-11-23; 103-605, eff. 7-1-24; 103-618, eff. 1-1-25;
103-649, eff. 1-1-25; 103-656, eff. 1-1-25; 103-700, eff.
1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
eff. 8-2-24; 103-758, eff. 1-1-25; 103-777, eff. 8-2-24;
103-808, eff. 1-1-26; 103-914, eff. 1-1-25; 103-918, eff.
		HB4207 Engrossed	- 8 -	LRB104 15812 BAB 29011 b
1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-28,
eff. 1-1-26; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73,
eff. 1-1-26; 104-98, eff. 1-1-26; 104-289, eff. 1-1-26;
104-324, eff. 1-1-26; 104-334, eff. 8-15-25; 104-379, eff.
1-1-26; 104-417, eff. 8-15-25; revised 11-21-25.)
    Section 15. The Illinois Public Aid Code is amended by
changing Section 5-16.8 as follows:
    (305 ILCS 5/5-16.8)
    Sec. 5-16.8. Required health benefits.
    (a) The medical assistance program shall (i) provide the
post-mastectomy care benefits required to be covered by a
policy of accident and health insurance under Section 356t and
the coverage required under Sections 356g.5, 356q, 356u, 356w,
356x, 356z.6, 356z.26, 356z.29, 356z.32, 356z.33, 356z.34,
356z.35, 356z.46, 356z.47, 356z.51, 356z.53, 356z.59, 356z.60,
356z.61, 356z.64, 356z.67, 356z.71, [and] 356z.75, [and] 356z.80, 
356z.84, and 356z.85 of the Illinois Insurance Code, (ii) be
subject to the provisions of Sections 356z.19, 356z.44,
356z.49, 364.01, 370c, and 370c.1 of the Illinois Insurance
Code, and (iii) be subject to the provisions of subsection
(d-5) of Section 10 of the Network Adequacy and Transparency
Act.
    The Department, by rule, shall adopt a model similar to
the requirements of Section 356z.39 of the Illinois Insurance
		HB4207 Engrossed	- 9 -	LRB104 15812 BAB 29011 b
Code.
    On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate
of reimbursement for services or other payments in accordance
with Section 5-5e.
    To ensure full access to the benefits set forth in this
Section, on and after January 1, 2016, the Department shall
ensure that provider and hospital reimbursement for
post-mastectomy care benefits required under this Section are
no lower than the Medicare reimbursement rate.
    (b)(1) Subject to appropriation and federal approval, the 
Department shall provide coverage under the medical assistance 
program for a medically necessary coronary artery 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.
		HB4207 Engrossed	- 10 -	LRB104 15812 BAB 29011 b
    (2) Coverage under this subsection shall be provided 
without cost sharing to the beneficiary.
    (3) The Department may adopt reasonable utilization 
controls consistent with other diagnostic imaging services 
covered under the medical assistance program.
    (4) Implementation of coverage under this subsection shall 
occur only to the extent that federal financial participation 
is available and approved by the federal Centers for Medicare 
and Medicaid Services.
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24;
103-420, eff. 1-1-24; 103-605, eff. 7-1-24; 103-703, eff.
1-1-25; 103-758, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-73,
eff. 1-1-26; 104-324, eff. 1-1-26; 104-379, eff. 1-1-26;
104-417, eff. 8-15-25; revised 11-21-25.)

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.

Sponsors

Rep. Yolanda Morris (D) sponsors HB 4207, and 15 members have co-sponsored it.

Committees

HB 4207 went before 3 committees: Rules, Insurance and Assignments.

Rules
Rules
Referred to · Jan 14, 2026 · 5,290 Bills
Insurance
Insurance
Referred to · Feb 11, 2026
Assignments
Assignments
Referred to · Apr 15, 2026

History

HB 4207 has taken 38 actions since Nov 20, 2025, the latest on May 19, 2026.

ChamberAction
May 19, 2026
Senate
Added as Alternate Co-Sponsor Sen. Laura M. Murphy
May 15, 2026
Senate
Rule 3-9(a) / Re-referred to Assignments
May 8, 2026
Senate
Rule 2-10 Committee Deadline Established As May 15, 2026
Apr 28, 2026
Senate
Assigned to Insurance
Apr 15, 2026
Senate
Arrive in Senate

Votes

HB 4207 went to 2 roll calls in the House, the latest on Apr 14, 2026 at 110–0.

ChamberQuestion
Yea
Nay
Apr 14, 2026
House
House Third Reading
110
0
Mar 18, 2026
House
House Insurance Committee
14
0

Source: ilga.gov · legiscan.com