Illinois General Assembly - Full Text of SB2086
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Full Text of SB2086  102nd General Assembly

SB2086 102ND GENERAL ASSEMBLY

  
  

 


 
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
SB2086

 

Introduced 2/26/2021, by Sen. Cristina Castro

 

SYNOPSIS AS INTRODUCED:
 
New Act
815 ILCS 505/2WWW new

    Creates the Vision Care Plan Regulation Act. Provides that no vision care organization may issue a contract that requires an eye care provider to provide services or materials to an enrollee at a fee set by the vision care plan unless the services or materials are covered under the vision care plan. Requires fees for covered services and materials to be reasonable and clearly listed on a fee schedule provided to the eye care provider. Prohibits a vision care organization from misrepresenting the benefits of a vision care plan as a means of selling coverage or communicating the benefit coverage to enrollees. Provides that the Act applies to any subcontractors used by a vision care organization to supply materials or services to an eye care provider or an enrollee under a vision care plan. Prohibits a vision care organization from restricting an eye care provider's freedom to choose suppliers, materials, or labs or from requiring an eye care provider to purchase materials from a source owned by the entity that issued the vision care plan. Provides that the terms, fees, discounts, or reimbursement rates in a vision care plan may not be changed unless mutually agreed to in writing by the eye care provider and the vision care organization. Provides that a person or entity adversely affected by a violation of the Act by the vision care organization may seek injunctive relief and shall recover attorney's fees and costs from the vision care organization upon prevailing. Amends the Consumer Fraud and Deceptive Business Practices Act to provide that any person who violates the Vision Care Plan Regulation Act commits an unlawful practice.


LRB102 16322 BMS 21709 b

 

 

A BILL FOR

 

SB2086LRB102 16322 BMS 21709 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. Short title. This Act may be cited as the Vision
5Care 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.
13    "Covered services" means services for which reimbursement
14from the vision care plan is provided to an eye care provider
15by an enrollee's plan contract or for which a reimbursement
16would be available but for the application of the enrollee's
17contractual plan limitation of deductibles, copayments, or
18coinsurance regardless of how the benefits are listed in an
19enrollee's benefit plan's definition of benefits.
20    "Enrollee" means any individual enrolled in a vision care
21plan provided by a group, employer, or other entity that
22purchases or supplies coverage for a vision care plan.
23    "Eye care provider" means a doctor of optometry licensed

 

 

SB2086- 2 -LRB102 16322 BMS 21709 b

1pursuant to the Illinois Optometric Practice Act of 1987 or a
2physician licensed to practice medicine in all of its branches
3pursuant to the Medical Practice Act of 1987.
4    "Materials" means ophthalmic devices, including, but not
5limited to:
6        (i) lenses, devices containing lenses, artificial
7    intraocular lenses, ophthalmic frames, and other lens
8    mounting apparatus, prisms, lens treatments, and coatings;
9        (ii) contact lenses and prosthetic devices that
10    correct, relieve, or treat defects or abnormal conditions
11    of the human eye or adnexa; and
12        (iii) any devices that deliver medication or other
13    therapeutic treatment to the human eye or adnexa.
14    "Services" means the professional work performed by an eye
15care provider.
16    "Subcontractor" means any company, group, or third-party
17entity, including agents, servants, partially-owned or
18wholly-owned subsidiaries and controlled organizations, that
19the vision care plan contracts with to supply services or
20materials for an eye care provider or enrollee to fulfill the
21benefit plan of a vision care plan.
22    "Vision care organization" means an entity formed under
23the laws of this State or another state that issues a vision
24care plan.
25    "Vision care plan" means a plan that creates, promotes,
26sells, provides, advertises, or administers an integrated or

 

 

SB2086- 3 -LRB102 16322 BMS 21709 b

1stand-alone plan that provides coverage for covered services
2and covered materials.
 
3    Section 10. Noncovered services. No vision care
4organization that issues, delivers, amends, or renews a vision
5care plan on or after the effective date of this amendatory Act
6of the 102nd General Assembly shall issue a contract that
7requires an eye care provider to provide services or materials
8to an enrollee at a fee set by the vision care plan unless the
9services or materials are covered services or covered
10materials under the vision care plan. De minimis
11reimbursements shall not qualify a service or material as a
12covered service or a covered material under this Act.
 
13    Section 15. Fees for covered services and covered
14materials. Fees paid under a vision care plan for covered
15services and covered materials, regardless of the supplier or
16optical lab used to obtain materials, shall be reasonable and
17shall be clearly listed on a fee schedule that has been
18provided to the eye care provider before entering into a
19contract with the vision care organization.
 
20    Section 20. Misrepresentation. A vision care organization
21shall not misrepresent the benefits of a vision care plan to
22groups, employers, or enrollees as a means of selling coverage
23or communicating the benefit coverage to enrollees.
 

 

 

SB2086- 4 -LRB102 16322 BMS 21709 b

1    Section 25. Subcontractors. The provisions of this Act
2apply to any subcontractors used by a vision care organization
3to supply materials or services to an eye care provider or an
4enrollee under a vision care plan.
 
5    Section 30. Suppliers; optical labs.
6    (a) A vision care organization may not restrict, limit, or
7disincentivize, either directly or indirectly, an eye care
8provider's freedom to choose suppliers of services or
9materials or the use of an optical lab.
10    (b) A vision care organization may not require an eye care
11provider or patient to order or purchase covered materials,
12including, but not limited to, ophthalmic lenses, from any
13source owned by, controlled by, or in a common ownership
14scheme with the entity that issued the vision care plan.
 
15    Section 35. Modification of plan. The terms, fees,
16discounts, or reimbursement rates in a vision care plan may
17not be changed unless mutually agreed to in writing by the eye
18care provider and the vision care organization that issued the
19vision care plan.
 
20    Section 40. Injunctive relief. A person or entity
21adversely affected by a violation of this Act by the vision
22care organization that issued a vision care plan may bring an

 

 

SB2086- 5 -LRB102 16322 BMS 21709 b

1action in a court of competent jurisdiction for injunctive
2relief and, upon prevailing, in addition to any injunctive
3relief that may be granted, shall recover attorney's fees and
4costs from the vision care organization.
 
5    Section 900. The Consumer Fraud and Deceptive Business
6Practices Act is amended by adding Section 2WWW as follows:
 
7    (815 ILCS 505/2WWW new)
8    Sec. 2WWW. Violations of the Vision Care Plan Regulation
9Act. Any person who violates the Vision Care Plan Regulation
10Act commits an unlawful practice within the meaning of this
11Act.