Full Text of SB0764 103rd General Assembly
SB0764enr 103RD GENERAL ASSEMBLY |
| | SB0764 Enrolled | | LRB103 03219 BMS 48225 b |
|
| 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 1. Short title. This Act may be cited as the Vision | 5 | | Care Plan Regulation Act. | 6 | | Section 5. Definitions. As used in this Act:
| 7 | | "Covered materials" means materials for which | 8 | | reimbursement from the vision care plan is provided to an eye | 9 | | care provider by an enrollee's plan contract or for which a | 10 | | reimbursement would be available but for the application of | 11 | | the enrollee's contractual limitation of deductibles, | 12 | | copayments, or coinsurance.
"Covered materials" includes lens | 13 | | treatment or coatings added to a spectacle lens if the base | 14 | | spectacle lens is a covered material. | 15 | | "Covered services" means services for which reimbursement | 16 | | from the vision care plan is provided to an eye care provider | 17 | | by an enrollee's plan contract or for which a reimbursement | 18 | | would be available but for the application of the enrollee's | 19 | | contractual plan limitation of deductibles, copayments, or | 20 | | coinsurance regardless of how the benefits are listed in an | 21 | | enrollee's benefit plan's definition of benefits.
| 22 | | "Enrollee" means any individual enrolled in a vision care | 23 | | plan provided by a group, employer, or other entity that |
| | | SB0764 Enrolled | - 2 - | LRB103 03219 BMS 48225 b |
|
| 1 | | purchases or supplies coverage for a vision care plan.
| 2 | | "Eye care provider" means a doctor of optometry licensed | 3 | | pursuant to the Illinois Optometric Practice Act of 1987 or a | 4 | | physician licensed to practice medicine in all of its branches | 5 | | pursuant to the Medical Practice Act of 1987.
| 6 | | "Materials" means ophthalmic devices, including, but not | 7 | | limited to:
| 8 | | (i) lenses, devices containing lenses, ophthalmic | 9 | | frames, and other lens mounting apparatus, prisms, lens | 10 | | treatments, and coatings;
| 11 | | (ii) contact lenses and prosthetic devices that | 12 | | correct, relieve, or treat defects or abnormal conditions | 13 | | of the human eye or adnexa; and
| 14 | | (iii) any devices that deliver medication or other | 15 | | therapeutic treatment to the human eye or adnexa.
| 16 | | "Services" means the professional work performed by an eye | 17 | | care provider.
| 18 | | "Subcontractor" means any company, group, or third-party | 19 | | entity, including agents, servants, partially-owned or | 20 | | wholly-owned subsidiaries and controlled organizations, that | 21 | | the vision care plan contracts with to supply services or | 22 | | materials for an eye care provider or enrollee to fulfill the | 23 | | benefit plan of a vision care plan.
| 24 | | "Vision care organization" means an entity formed under | 25 | | the laws of this State or another state that issues a vision | 26 | | care plan.
|
| | | SB0764 Enrolled | - 3 - | LRB103 03219 BMS 48225 b |
|
| 1 | | "Vision care plan" means a plan that creates, promotes, | 2 | | sells, provides, advertises, or administers an integrated or | 3 | | stand-alone plan that provides coverage for covered services | 4 | | and covered materials. | 5 | | Section 10. Noncovered services. | 6 | | (a) No vision care organization that issues, delivers, | 7 | | amends, or renews a vision care plan on or after the effective | 8 | | date of this Act shall issue a contract that requires an eye | 9 | | care provider, as a condition of participation in the vision | 10 | | care plan, to provide services or materials to an enrollee at a | 11 | | fee set by the vision care plan unless the services or | 12 | | materials are covered services or covered materials under the | 13 | | vision care plan. De minimis reimbursements shall not qualify | 14 | | a service or material as a covered service or a covered | 15 | | material under this Act. | 16 | | (b) An eye care provider who chooses not to accept as | 17 | | payment an amount set by a vision care plan for services or | 18 | | materials that are not covered services or covered materials | 19 | | shall post, in a conspicuous place, a notice stating the | 20 | | following: "IMPORTANT: This eye care provider does not accept | 21 | | the fee schedule set by your insurer for vision care services | 22 | | and vision care materials that are not covered benefits under | 23 | | your plan and instead charges his or her normal fee for those | 24 | | services and materials. This eye care provider will provide | 25 | | you with an estimated cost for each noncovered service or |
| | | SB0764 Enrolled | - 4 - | LRB103 03219 BMS 48225 b |
|
| 1 | | noncovered material upon your request." | 2 | | Section 15. Fees for covered services and covered | 3 | | materials. Fees paid under a vision care plan for covered | 4 | | services and covered materials, regardless of the supplier or | 5 | | optical lab used to obtain materials, shall be reasonable and | 6 | | shall be clearly listed on a fee schedule that has been | 7 | | provided to the eye care provider before entering into a | 8 | | contract with the vision care organization. Fees paid for | 9 | | materials supplied by a non-network lab are not required to be | 10 | | identical to fees paid for materials ordered through a network | 11 | | lab, but non-network lab fees shall be reasonable. | 12 | | Section 20. Misrepresentation. | 13 | | (a) A vision care organization and its officers, | 14 | | directors, agents, and employees are subject to the provisions | 15 | | of Sections 149 and 154.6 of the Illinois Insurance Code. | 16 | | (b) Incorporation by reference in this Act to specific | 17 | | laws of this State shall not be construed to exempt a vision | 18 | | care organization or vision care plan from otherwise | 19 | | applicable laws that are not specifically referenced in this | 20 | | Act. | 21 | | Section 25. Subcontractors. The provisions of this Act | 22 | | apply to any subcontractors used by a vision care organization | 23 | | to supply materials or services to an eye care provider or an |
| | | SB0764 Enrolled | - 5 - | LRB103 03219 BMS 48225 b |
|
| 1 | | enrollee under a vision care plan. | 2 | | Section 30. Suppliers; optical labs.
| 3 | | (a) A vision care organization may not restrict or limit | 4 | | an eye care provider's choice of suppliers of services, | 5 | | covered materials, or the use of an optical lab.
| 6 | | (b) A vision care organization may not require an eye care | 7 | | provider or patient to order or purchase covered materials, | 8 | | including, but not limited to, ophthalmic lenses, from any | 9 | | source owned by, controlled by, or in a common ownership | 10 | | scheme with the entity that issued the vision care plan. | 11 | | (c)
At the request of an enrollee, an eye care provider | 12 | | recommending an out-of-network source or supplier of vision | 13 | | care materials to an enrollee shall provide written notice to | 14 | | the enrollee stating: | 15 | | (1) that the source or supplier is an out-of-network | 16 | | laboratory or supplier of vision care materials; and | 17 | | (2) any business interest that the eye care provider | 18 | | has in the out-of-network source or supplier recommended | 19 | | to the enrollee. | 20 | | (d) An eye care provider is required to offer an enrollee | 21 | | in-network sources or suppliers of vision care materials at | 22 | | the enrollee's request. | 23 | | Section 35. Modification of plan. | 24 | | (a) The terms, fees, discounts, or reimbursement rates in |
| | | SB0764 Enrolled | - 6 - | LRB103 03219 BMS 48225 b |
|
| 1 | | a vision care plan may not be changed during the term of the | 2 | | contract unless mutually agreed to in writing by the eye care | 3 | | provider and the vision care organization that issued the | 4 | | vision care plan. However, a change proposed to a vision care | 5 | | plan by the vision care organization shall become effective if | 6 | | the eye care provider fails to respond to the vision care | 7 | | organization within 60 days after receipt of notice of the | 8 | | proposed changes. | 9 | | (b) The terms of a vision care plan contract that is | 10 | | amended, delivered, issued, or renewed after the effective | 11 | | date of this Act shall comply with the provisions of this Act. | 12 | | Section 40. Prohibitions; medical plan preconditions. | 13 | | (a) No vision care organization that issues, delivers, | 14 | | amends, or renews a vision care plan on or after the effective | 15 | | date of this Act shall issue a vision care plan contract that | 16 | | requires: | 17 | | (1) an eye care provider to contract with a plan that | 18 | | offers supplemental or specialty health care services as a | 19 | | condition of contracting with a plan that offers basic | 20 | | health services; or | 21 | | (2) an eye care provider to contract with a vision | 22 | | care plan as a condition to participation in a medical | 23 | | plan or in-network. | 24 | | (b) A vision care plan may enter into an agreement with a | 25 | | health care plan to deliver routine vision care services that |
| | | SB0764 Enrolled | - 7 - | LRB103 03219 BMS 48225 b |
|
| 1 | | are covered under the enrollee's plan. | 2 | | (c) A vision care plan may act as a network regarding | 3 | | routine vision care services offered by a health care plan. | 4 | | Section 900. The Consumer Fraud and Deceptive Business | 5 | | Practices Act is amended by adding Section 2BBBB as follows: | 6 | | (815 ILCS 505/2BBBB new) | 7 | | Sec. 2BBBB. Violations of the Vision Care Plan Regulation | 8 | | Act. Any person who violates the Vision Care Plan Regulation | 9 | | Act commits an unlawful practice within the meaning of this | 10 | | Act.
| 11 | | Section 999. Effective date. This Act takes effect upon | 12 | | becoming law. |
|