Full Text of HB2711 99th General Assembly
HB2711 99TH GENERAL ASSEMBLY |
| | 99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016 HB2711 Introduced , by Rep. Dan Brady SYNOPSIS AS INTRODUCED: |
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Amends the Illinois Insurance Code in relation to patient access to eye care. Provides that insurers may not set reimbursement rates in a manner that discriminates against a class of eye care providers. Provides that eye care coverage insurers may not preclude obtaining eye care directly from a licensed provider on a health care panel or promote a class of providers to the detriment of another class of providers. Requires that all providers on a provider panel be included in any publicly accessible list. Requires the inclusion of ophthalmologists and optometrists in provider panels. Imposes additional requirements.
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| | A BILL FOR |
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| | | HB2711 | | LRB099 04229 MLM 24251 b |
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| 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 Illinois Insurance Code is amended by adding | 5 | | Section 356z.23 as follows: | 6 | | (215 ILCS 5/356z.23 new) | 7 | | Sec. 356z.23. Patient access to eye care. | 8 | | (a) In this Section: | 9 | | "Covered person" means an individual enrolled in a health | 10 | | benefit plan or an eligible dependent thereof. | 11 | | "Covered services" means those health care services that a | 12 | | health care insurer is obligated to pay for or provide to a | 13 | | covered person under a health benefit plan. | 14 | | "Eye care" means those health care services and materials | 15 | | related to the care of the eye and related structures and | 16 | | vision care services that a health care insurer is obligated to | 17 | | pay for or provide to covered persons under the health benefit | 18 | | plan. | 19 | | "Health benefit plan" means any public or private health | 20 | | plan, program, policy, or agreement implemented in this State | 21 | | that provides health benefits to covered persons, including, | 22 | | but not limited to, payment and reimbursement for health care | 23 | | services. |
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| 1 | | "Health care insurer" means an entity, including, but not | 2 | | limited to, insurance companies, hospital service nonprofit | 3 | | corporations, nonprofit medical service corporations, health | 4 | | care corporations, health maintenance organizations, and | 5 | | preferred provider organizations authorized by the State to | 6 | | offer or provide health benefit plans, programs, policies, | 7 | | subscriber contracts, or any other agreements of a similar | 8 | | nature that compensate or indemnify health care providers for | 9 | | furnishing health care services. | 10 | | (b) A health care insurer providing a health benefit plan | 11 | | that includes eye care benefits shall: | 12 | | (1) not set professional fees or reimbursement for the | 13 | | same eye care services as defined by established current | 14 | | procedural terminology codes in a manner that | 15 | | discriminates against an individual eye care provider or a | 16 | | class of eye care providers; | 17 | | (2) not preclude a covered person who seeks eye care | 18 | | from obtaining such service directly from a provider on the | 19 | | health benefit plan provider panel who is licensed to | 20 | | provide eye care; | 21 | | (3) not promote or recommend any class of providers to | 22 | | the detriment of any other class of providers for the same | 23 | | eye care service; | 24 | | (4) ensure that all eye care providers on a health | 25 | | benefit plan provider panel are included on any publicly | 26 | | accessible list of participating providers for the plan; |
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| 1 | | (5) allow each eye care provider on a health benefit | 2 | | plan provider panel, without discrimination between | 3 | | classes of eye care providers, to furnish covered eye care | 4 | | services to covered persons to the extent permitted by the | 5 | | provider's licensure; | 6 | | (6) not require any eye care provider to hold hospital | 7 | | privileges or impose any other condition or restriction for | 8 | | initial admittance to a provider panel not necessary for | 9 | | the delivery of eye care upon the providers that would have | 10 | | the effect of excluding an individual eye care provider or | 11 | | class of eye care providers from participation on the | 12 | | health benefit plan; and | 13 | | (7) include optometrists and ophthalmologists on the | 14 | | health benefit plan provider panel in a manner that ensures | 15 | | plan enrollees timely access and geographic access. | 16 | | (c) Nothing in this Section shall preclude a covered person | 17 | | from receiving eye care or other covered services from the | 18 | | covered person's personal physician in accordance with the | 19 | | terms of the health benefit plan. | 20 | | (d) A person adversely affected by a violation of this | 21 | | Section by a health care insurer may bring an action in a court | 22 | | of competent jurisdiction for injunctive relief against the | 23 | | insurer and, upon prevailing, in addition to any injunctive | 24 | | relief that may be granted, shall recover from the insurer | 25 | | damages of not more than $100 and attorney's fees and costs. | 26 | | (e) Nothing in this Section requires a health benefit plan |
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| 1 | | to include eye care benefits. | 2 | | (f) The Director may adopt rules to enforce this Section.
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