Sen. Cristina Castro

Filed: 5/3/2023





10300SB0764sam001LRB103 03219 BMS 61411 a


2    AMENDMENT NO. ______. Amend Senate Bill 764 by replacing
3everything after the enacting clause with the following:
4    "Section 1. Short title. This Act may be cited as the
5Vision Care Plan Regulation Act.
6    Section 5. Definitions. As used in this Act:
7    "Covered materials" means materials for which
8reimbursement from the vision care plan is provided to an eye
9care provider by an enrollee's plan contract or for which a
10reimbursement would be available but for the application of
11the enrollee's contractual limitation of deductibles,
12copayments, or coinsurance. "Covered materials" includes lens
13treatment or coatings added to a spectacle lens if the base
14spectacle lens is a covered material.
15    "Covered services" means services for which reimbursement
16from the vision care plan is provided to an eye care provider



10300SB0764sam001- 2 -LRB103 03219 BMS 61411 a

1by an enrollee's plan contract or for which a reimbursement
2would be available but for the application of the enrollee's
3contractual plan limitation of deductibles, copayments, or
4coinsurance regardless of how the benefits are listed in an
5enrollee's benefit plan's definition of benefits.
6    "Enrollee" means any individual enrolled in a vision care
7plan provided by a group, employer, or other entity that
8purchases or supplies coverage for a vision care plan.
9    "Eye care provider" means a doctor of optometry licensed
10pursuant to the Illinois Optometric Practice Act of 1987 or a
11physician licensed to practice medicine in all of its branches
12pursuant to the Medical Practice Act of 1987.
13    "Materials" means ophthalmic devices, including, but not
14limited to:
15        (i) lenses, devices containing lenses, ophthalmic
16    frames, and other lens mounting apparatus, prisms, lens
17    treatments, and coatings;
18        (ii) contact lenses and prosthetic devices that
19    correct, relieve, or treat defects or abnormal conditions
20    of the human eye or adnexa; and
21        (iii) any devices that deliver medication or other
22    therapeutic treatment to the human eye or adnexa.
23    "Services" means the professional work performed by an eye
24care provider.
25    "Subcontractor" means any company, group, or third-party
26entity, including agents, servants, partially-owned or



10300SB0764sam001- 3 -LRB103 03219 BMS 61411 a

1wholly-owned subsidiaries and controlled organizations, that
2the vision care plan contracts with to supply services or
3materials for an eye care provider or enrollee to fulfill the
4benefit plan of a vision care plan.
5    "Vision care organization" means an entity formed under
6the laws of this State or another state that issues a vision
7care plan.
8    "Vision care plan" means a plan that creates, promotes,
9sells, provides, advertises, or administers an integrated or
10stand-alone plan that provides coverage for covered services
11and covered materials.
12    Section 10. Noncovered services.
13    (a) No vision care organization that issues, delivers,
14amends, or renews a vision care plan on or after the effective
15date of this Act shall issue a contract that requires an eye
16care provider, as a condition of participation in the vision
17care plan, to provide services or materials to an enrollee at a
18fee set by the vision care plan unless the services or
19materials are covered services or covered materials under the
20vision care plan. De minimis reimbursements shall not qualify
21a service or material as a covered service or a covered
22material under this Act.
23    (b) An eye care provider who chooses not to accept as
24payment an amount set by a vision care plan for services or
25materials that are not covered services or covered materials



10300SB0764sam001- 4 -LRB103 03219 BMS 61411 a

1shall post, in a conspicuous place, a notice stating the
2following: "IMPORTANT: This eye care provider does not accept
3the fee schedule set by your insurer for vision care services
4and vision care materials that are not covered benefits under
5your plan and instead charges his or her normal fee for those
6services and materials. This eye care provider will provide
7you with an estimated cost for each noncovered service or
8noncovered material upon your request."
9    Section 15. Fees for covered services and covered
10materials. Fees paid under a vision care plan for covered
11services and covered materials, regardless of the supplier or
12optical lab used to obtain materials, shall be reasonable and
13shall be clearly listed on a fee schedule that has been
14provided to the eye care provider before entering into a
15contract with the vision care organization. Fees paid for
16materials supplied by a non-network lab are not required to be
17identical to fees paid for materials ordered through a network
18lab, but non-network lab fees shall be reasonable.
19    Section 20. Misrepresentation.
20    (a) A vision care organization and its officers,
21directors, agents, and employees are subject to the provisions
22of Sections 149 and 154.6 of the Illinois Insurance Code.
23    (b) Incorporation by reference in this Act to specific
24laws of this State shall not be construed to exempt a vision



10300SB0764sam001- 5 -LRB103 03219 BMS 61411 a

1care organization or vision care plan from otherwise
2applicable laws that are not specifically referenced in this
4    Section 25. Subcontractors. The provisions of this Act
5apply to any subcontractors used by a vision care organization
6to supply materials or services to an eye care provider or an
7enrollee under a vision care plan.
8    Section 30. Suppliers; optical labs.
9    (a) A vision care organization may not restrict or limit
10an eye care provider's choice of suppliers of services,
11covered materials, or the use of an optical lab.
12    (b) A vision care organization may not require an eye care
13provider or patient to order or purchase covered materials,
14including, but not limited to, ophthalmic lenses, from any
15source owned by, controlled by, or in a common ownership
16scheme with the entity that issued the vision care plan.
17    (c) At the request of an enrollee, an eye care provider
18recommending an out-of-network source or supplier of vision
19care materials to an enrollee shall provide written notice to
20the enrollee stating:
21        (1) that the source or supplier is an out-of-network
22    laboratory or supplier of vision care materials; and
23        (2) any business interest that the eye care provider
24    has in the out-of-network source or supplier recommended



10300SB0764sam001- 6 -LRB103 03219 BMS 61411 a

1    to the enrollee.
2    (d) An eye care provider is required to offer an enrollee
3in-network sources or suppliers of vision care materials at
4the enrollee's request.
5    Section 35. Modification of plan.
6    (a) The terms, fees, discounts, or reimbursement rates in
7a vision care plan may not be changed during the term of the
8contract unless mutually agreed to in writing by the eye care
9provider and the vision care organization that issued the
10vision care plan. However, a change proposed to a vision care
11plan by the vision care organization shall become effective if
12the eye care provider fails to respond to the vision care
13organization within 60 days after receipt of notice of the
14proposed changes.
15    (b) The terms of a vision care plan contract that is
16amended, delivered, issued, or renewed after the effective
17date of this Act shall comply with the provisions of this Act.
18    Section 40. Prohibitions; medical plan preconditions.
19    (a) No vision care organization that issues, delivers,
20amends, or renews a vision care plan on or after the effective
21date of this Act shall issue a vision care plan contract that
23        (1) an eye care provider to contract with a plan that
24    offers supplemental or specialty health care services as a



10300SB0764sam001- 7 -LRB103 03219 BMS 61411 a

1    condition of contracting with a plan that offers basic
2    health services; or
3        (2) an eye care provider to contract with a vision
4    care plan as a condition to participation in a medical
5    plan or in-network.
6    (b) A vision care plan may enter into an agreement with a
7health care plan to deliver routine vision care services that
8are covered under the enrollee's plan.
9    (c) A vision care plan may act as a network regarding
10routine vision care services offered by a health care plan.
11    Section 900. The Consumer Fraud and Deceptive Business
12Practices Act is amended by adding Section 2BBBB as follows:
13    (815 ILCS 505/2BBBB new)
14    Sec. 2BBBB. Violations of the Vision Care Plan Regulation
15Act. Any person who violates the Vision Care Plan Regulation
16Act commits an unlawful practice within the meaning of this
18    Section 999. Effective date. This Act takes effect upon
19becoming law.".