Illinois General Assembly - Bill Status for HB5302

Amends the State Employees Group Insurance Act of 1971, the Illinois Insurance Code, and the Health Maintenance Organization Act. Provides that a health insurer that bases payment for benefits upon a usual or customary charge or other similar reimbursement methodology must disclose certain information. Replaces references to "customary fee" with "customary charge or other similar methodology" throughout the provision. Provides that under no circumstances shall rates paid by Medicaid or Medicare, or rates negotiated or set by the insurer or any other insurer in conjunction with their contracted providers, be used to determine usual and customary charges. Provides that no health insurer shall deny reimbursement for an otherwise covered expense incurred for any drug, device, medical treatment, or procedure, including organ transplantation, solely on the basis that such procedure is deemed experimental or investigational unless certain conditions are present. Makes a corresponding change in the Health Maintenance Organization Act. Adds a new provision requiring a system of health claims appeals and external independent review. Adds a new provision authorizing coverage for wellness coverage. Requires wellness coverage under the State Employees Group Insurance Act of 1971. Repeals a provision concerning the coverage of organ transplantation procedures. In a provision concerning the continuation coverage of health benefits after termination of employment or membership, provides that in the event the employer fails or refuses to provide notice of continuation rights to the employee or member, the insurer is required to mail notice of the continuation rights to the employee or member at the last known address of the employee. Makes other changes.

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