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1 | AN ACT concerning regulation.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Insurance Code is amended by | ||||||
5 | changing Section 355.4 and by adding Section 355.5 as follows: | ||||||
6 | (215 ILCS 5/355.4) | ||||||
7 | Sec. 355.4. Provider notification of network plan changes. | ||||||
8 | (a) As used in this Section: | ||||||
9 | "Contracting entity" means any person or company that | ||||||
10 | enters into direct contracts with providers for the delivery | ||||||
11 | of dental services in the ordinary course of business, | ||||||
12 | including a third-party administrator and a dental carrier. | ||||||
13 | "Dental carrier" means a dental insurance company, dental | ||||||
14 | service corporation, dental plan organization authorized to | ||||||
15 | provide dental benefits, or a health insurance plan that | ||||||
16 | includes coverage for dental services. | ||||||
17 | (b) No dental carrier may automatically enroll a provider | ||||||
18 | in a leased network without allowing any provider that is part | ||||||
19 | of the dental carrier's provider network to choose to not | ||||||
20 | participate by opting out. | ||||||
21 | (c) Any contract entered into or renewed on or after the | ||||||
22 | effective date of this amendatory Act of the 103rd General | ||||||
23 | Assembly this amendatory Act of the 99th General Assembly that |
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1 | allows the rights and obligations of the contract to be | ||||||
2 | assigned or leased to another insurer shall provide for notice | ||||||
3 | that informs each provider in writing via certified mail 60 | ||||||
4 | days before any scheduled assignment or lease of the network | ||||||
5 | to which the provider is a contracted provider. To be in | ||||||
6 | compliance with this Section, the notification must include | ||||||
7 | all contract terms, a policy manual, a fee schedule, and a | ||||||
8 | statement that the provider has the right to choose not to | ||||||
9 | participate in third-party access of that assignment or lease | ||||||
10 | within 30 days after the assignment or lease to the | ||||||
11 | contracting dentist . | ||||||
12 | (d) A dental carrier that leases or assigns its network | ||||||
13 | shall not cancel a network participating dentist's contractual | ||||||
14 | relationship or otherwise penalize a network participating | ||||||
15 | dentist in any way based on whether or not the dentist accepts | ||||||
16 | the terms of the assignment or lease. Before accepting the | ||||||
17 | terms of an assignment or lease agreement as described in this | ||||||
18 | Section, any provider who receives notification of an | ||||||
19 | impending assignment or lease must be given the option to | ||||||
20 | contract directly with the entities proposing to gain access | ||||||
21 | to the provider's network. | ||||||
22 | (e) The provisions of this Section do not apply: | ||||||
23 | (1) if access to a provider network contract is | ||||||
24 | granted to a dental carrier or an entity operating in | ||||||
25 | accordance with the same brand licensee program as the | ||||||
26 | contracting entity; or |
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1 | (2) to a provider network contract for dental services | ||||||
2 | provided to beneficiaries of the State employee group | ||||||
3 | health insurance program or the medical assistance program | ||||||
4 | under the Illinois Public Aid Code.
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5 | (Source: P.A. 99-568, eff. 7-15-16.) | ||||||
6 | (215 ILCS 5/355.5 new) | ||||||
7 | Sec. 355.5. Dental coverage reimbursement; prohibitions. | ||||||
8 | No insurer, dental service plan corporation, professional | ||||||
9 | service corporation, insurance network leasing company, or any | ||||||
10 | company that amends, delivers, issues, or renews an individual | ||||||
11 | or group policy of accident and health insurance on or after | ||||||
12 | the effective date of this amendatory Act of the 103rd General | ||||||
13 | Assembly shall require a dental care provider to incur a fee to | ||||||
14 | access and obtain payment or reimbursement for services | ||||||
15 | provided. A dental plan carrier shall provide a dental care | ||||||
16 | provider with 100% of the contracted amount of the payment or | ||||||
17 | reimbursement. Fees incurred directly by a dental care | ||||||
18 | provider from third parties related to transmitting an | ||||||
19 | automated clearing house network claim, transaction | ||||||
20 | management, data management, or portal services and other fees | ||||||
21 | charged by third parties that are not in the control of the | ||||||
22 | dental plan carrier shall not be prohibited by this Section.
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