Full Text of SB0174 101st General Assembly
SB0174sam001 101ST GENERAL ASSEMBLY | Sen. John G. Mulroe Filed: 2/21/2019
| | 10100SB0174sam001 | | LRB101 04949 RAB 56113 a |
|
| 1 | | AMENDMENT TO SENATE BILL 174
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 174 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 1. Short title. This Act may be cited as the | 5 | | In-Office Membership Care Act. | 6 | | Section 5. Public policy. It is the policy of the State of | 7 | | Illinois to promote personal responsibility for health care and | 8 | | the cost-effective delivery of dental services by encouraging | 9 | | innovative use of in-office membership care practices for | 10 | | dental care. In-office membership care practices utilize a | 11 | | model of periodic fees for provider access and management over | 12 | | time, rather than simply a fee for visit or procedure service | 13 | | model. Some patients and individual dental care providers may | 14 | | wish to establish direct agreements with one another as an | 15 | | alternative to traditional fee-for-service care financed | 16 | | through health insurance. The purpose of this Act is to confirm |
| | | 10100SB0174sam001 | - 2 - | LRB101 04949 RAB 56113 a |
|
| 1 | | that in-office membership care agreements that satisfy the | 2 | | provisions of this Act do not constitute insurance and as such | 3 | | are not subject to the Illinois Insurance Code. | 4 | | Section 10. Definitions. In this Act: | 5 | | "Dental care provider" means a natural person or persons | 6 | | licensed or otherwise legally authorized to provide health care | 7 | | services in the State of Illinois in the field of dentistry who | 8 | | provides such services either alone or with others at the same | 9 | | location or other location affiliated with the practice in a | 10 | | form and within a scope permitted by such licensure or legal | 11 | | authorization for the provision of such services and who enters | 12 | | into an in-office membership care agreement. | 13 | | "Direct fee" means an agreed-upon fee charged by a dental | 14 | | care provider as consideration for providing and being | 15 | | available to provide in-office membership care services | 16 | | described in an in-office membership care agreement. | 17 | | "In-office membership care agreement" means a written | 18 | | contract between a dental care provider or group of providers | 19 | | and an individual patient, the patient's family, or the | 20 | | patient's representative in which the dental care provider | 21 | | agrees to provide in-office membership care services to the | 22 | | patient over a specified period of time for payment of a direct | 23 | | fee. | 24 | | "In-office membership care services" means services that a | 25 | | dental care provider is licensed or otherwise legally |
| | | 10100SB0174sam001 | - 3 - | LRB101 04949 RAB 56113 a |
|
| 1 | | authorized to provide, including, but not limited to, (i) | 2 | | dental screenings, assessments, diagnoses, and treatments for | 3 | | the purpose of promoting health; (ii) detection, management, | 4 | | and care of disease or injury; and (iii) routine preventive or | 5 | | diagnostic dental treatment. | 6 | | "Patient" means a person who is entitled to receive | 7 | | in-office membership care services under an in-office | 8 | | membership care agreement. | 9 | | Section 15. In-office membership care agreement | 10 | | provisions. | 11 | | (a) An in-office membership care agreement shall identify: | 12 | | (1) the dental care provider or providers and the | 13 | | patient or patients; | 14 | | (2) the general scope of services as well as the | 15 | | specific services to be provided by the dental care | 16 | | provider as part of the in-office membership care | 17 | | agreement; | 18 | | (3) the location or locations where services are to be | 19 | | provided; | 20 | | (4) the amount of the direct fee and the time interval | 21 | | at which it is to be paid; and | 22 | | (5) the term of the in-office membership care agreement | 23 | | and the conditions upon which it may be terminated by the | 24 | | dental care provider. | 25 | | (b) An in-office membership care agreement shall be |
| | | 10100SB0174sam001 | - 4 - | LRB101 04949 RAB 56113 a |
|
| 1 | | terminable at will by written notice from the patient to the | 2 | | dental care provider. | 3 | | (c) If a party provides written notice of termination of | 4 | | the in-office membership care agreement, the dental care | 5 | | provider may refund to the patient all unearned direct fees | 6 | | associated with the covered services under the in-office | 7 | | membership care agreement. | 8 | | Section 20. Location of in-office membership care | 9 | | services. In-office membership care services may be provided in | 10 | | a dental care provider's office or another location in which a | 11 | | patient visit with the dental care provider needs to occur. | 12 | | Section 25. Insurance billing prohibited. Neither the | 13 | | patient nor the dental care provider shall submit a bill to an | 14 | | insurer for the services provided under an in-office membership | 15 | | care agreement. | 16 | | Section 30. In-office membership care agreements not | 17 | | classified as insurance. In-office membership care agreements | 18 | | are not subject to regulation as insurance under the Illinois | 19 | | Insurance Code. | 20 | | Section 35. Disclaimer. An in-office membership care | 21 | | agreement shall include the following disclaimer: "This | 22 | | agreement does not provide health insurance coverage, |
| | | 10100SB0174sam001 | - 5 - | LRB101 04949 RAB 56113 a |
|
| 1 | | including the minimal essential coverage required by | 2 | | applicable federal law. It provides only the services described | 3 | | herein. It is recommended that health care insurance be | 4 | | obtained to cover dental services not provided for under this | 5 | | in-office membership care agreement.". | 6 | | Section 40. Restrictions on transfer. An in-office | 7 | | membership care agreement may not be sold or transferred by the | 8 | | dental care provider without the written consent of the patient | 9 | | and may be transferred only to another dental care provider. An | 10 | | in-office membership care agreement may not be sold to a group, | 11 | | employer or group of subscribers because it is an individual | 12 | | agreement between a dental care provider and a patient. These | 13 | | limitations do not prohibit the presentation of marketing | 14 | | materials to groups of potential patients or their | 15 | | representatives. | 16 | | Section 45. Effect of this Act. This Act does not prohibit | 17 | | dental care providers who are not dental care providers from | 18 | | entering into agreements with patients to the extent such | 19 | | agreements do not violate the provisions of the Illinois | 20 | | Insurance Code. | 21 | | Section 80. The Illinois Insurance Code is amended by | 22 | | changing Section 352 as follows:
|
| | | 10100SB0174sam001 | - 6 - | LRB101 04949 RAB 56113 a |
|
| 1 | | (215 ILCS 5/352) (from Ch. 73, par. 964)
| 2 | | Sec. 352. Scope of Article.
| 3 | | (a) Except as provided in subsections (b), (c), (d), and | 4 | | (e),
this Article shall
apply to all companies transacting in | 5 | | this State the kinds of business
enumerated in clause (b) of | 6 | | Class 1 and clause (a) of Class 2 of section 4.
Nothing in this | 7 | | Article shall apply to, or in any way affect policies or
| 8 | | contracts described in clause (a) of Class 1 of Section 4; | 9 | | however, this
Article shall apply to policies and contracts | 10 | | which contain benefits
providing reimbursement for the | 11 | | expenses of long term health care which are
certified or | 12 | | ordered by a physician including but not limited to
| 13 | | professional nursing care, custodial nursing care, and | 14 | | non-nursing
custodial care provided in a nursing home or at a | 15 | | residence of the insured.
| 16 | | (b) (Blank).
| 17 | | (c) A policy issued and delivered in this State
that | 18 | | provides coverage under that policy for
certificate holders who | 19 | | are neither residents of nor employed in this State
does not | 20 | | need to provide to those nonresident
certificate holders who | 21 | | are not employed in this State the coverages or
services | 22 | | mandated by this Article.
| 23 | | (d) Stop-loss insurance is exempt from all Sections
of this | 24 | | Article, except this Section and Sections 353a, 354, 357.30, | 25 | | and
370. For purposes of this exemption, stop-loss insurance is | 26 | | further defined as
follows:
|
| | | 10100SB0174sam001 | - 7 - | LRB101 04949 RAB 56113 a |
|
| 1 | | (1) The policy must be issued to and insure an | 2 | | employer, trustee, or other
sponsor of the plan, or the | 3 | | plan itself, but not employees, members, or
participants.
| 4 | | (2) Payments by the insurer must be made to the | 5 | | employer, trustee, or
other sponsors of the plan, or the | 6 | | plan itself, but not to the employees,
members, | 7 | | participants, or health care providers.
| 8 | | (e) A policy issued or delivered in this State to the | 9 | | Department of Healthcare and Family Services (formerly
| 10 | | Illinois Department
of Public Aid) and providing coverage, | 11 | | under clause (b) of Class 1 or clause (a)
of Class 2 as | 12 | | described in Section 4, to persons who are enrolled under | 13 | | Article V of the Illinois
Public Aid Code or under the | 14 | | Children's Health Insurance Program Act is
exempt from all | 15 | | restrictions, limitations,
standards, rules, or regulations | 16 | | respecting benefits imposed by or under
authority of this Code, | 17 | | except those specified by subsection (1) of Section
143, | 18 | | Section 370c, and Section 370c.1. Nothing in this subsection, | 19 | | however, affects the total medical services
available to | 20 | | persons eligible for medical assistance under the Illinois | 21 | | Public
Aid Code.
| 22 | | (f) An in-office membership care agreement provided under | 23 | | the In-Office Membership Care Act is not insurance for the | 24 | | purposes of this Code. | 25 | | (Source: P.A. 99-480, eff. 9-9-15.)
|
| | | 10100SB0174sam001 | - 8 - | LRB101 04949 RAB 56113 a |
|
| 1 | | Section 99. Effective date. This Act takes effect upon | 2 | | becoming law.".
|
|