|
| | 101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB2174 Introduced , by Rep. Kathleen Willis SYNOPSIS AS INTRODUCED:
|
| |
Amends the Managed Care Reform and Patient Rights Act. Provides that every health insurance carrier that provides coverage for prescription drugs shall ensure that no fewer than 25% of certain individual and group plans offered shall apply a pre-deductible, flat-dollar copayment structure to the entire drug benefit. Provides that the flat-dollar copayment structure for prescription drugs must be reasonably graduated and proportionately related in all tier levels such that the copayment structure as a whole does not discriminate against or discourage the enrollment of individuals with significant health care needs. Requires the health insurance carriers to clearly and appropriately name the plans to aid in consumer or plan-sponsor plan selection. Requires the health insurance carriers to market the plans in the same manner as their other plans. Provides that if a health insurance carrier offers fewer than 4 plans, the health insurance carrier shall ensure that one plan shall use the drug benefit structure, including cost-sharing requirements. Requires the Department of Insurance to adopt rules necessary to implement and enforce the provisions. Effective January 1, 2020.
|
| |
| | A BILL FOR |
|
|
| | HB2174 | | LRB101 07405 SMS 52445 b |
|
|
| 1 | | AN ACT concerning regulation.
|
| 2 | | Be it enacted by the People of the State of Illinois,
|
| 3 | | represented in the General Assembly:
|
| 4 | | Section 5. The Managed Care Reform and Patient Rights Act |
| 5 | | is amended by adding Section 45.3 as follows:
|
| 6 | | (215 ILCS 134/45.3 new) |
| 7 | | Sec. 45.3. Prescription drug benefits; plan choice. |
| 8 | | (a) Notwithstanding any other provision of law, on or after |
| 9 | | January 1, 2020, every health insurance carrier that provides |
| 10 | | coverage for prescription drugs shall ensure that no fewer than |
| 11 | | 25% of individual and group plans offered within each service |
| 12 | | area and at each level of coverage as defined in 42 U.S.C. |
| 13 | | 18022, if applicable, that are delivered, issued for delivery, |
| 14 | | renewed, amended, or continued by the health insurance carrier |
| 15 | | shall apply a pre-deductible, flat-dollar copayment structure |
| 16 | | to the entire drug benefit, including all tiers. A health |
| 17 | | insurance carrier shall not apply the deductible or any |
| 18 | | coinsurance amount to the entire drug benefit for these plans. |
| 19 | | The flat-dollar copayment structure for prescription drugs |
| 20 | | under this subsection (a) must be reasonably graduated and |
| 21 | | proportionately related in all tier levels such that the |
| 22 | | copayment structure as a whole does not discriminate against or |
| 23 | | discourage the enrollment of individuals with significant |