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90_HB0107ham002
LRB9000924JSccam
1 AMENDMENT TO HOUSE BILL 107
2 AMENDMENT NO. . Amend House Bill 107 on page 3 by
3 replacing lines 23 through 33 with the following:
4 "(c) An issuer of an individual or group policy of
5 accident and health insurance or managed care plan may not
6 (i) engage in any activities or provide incentives (monetary
7 or otherwise) to hospitals, insureds, enrollees, or
8 physicians to induce the provision of care to an individual
9 insured or enrollee in a manner inconsistent with this
10 Section or (ii) restrict benefits for any portions of a
11 period within a hospital length of stay required under
12 subsection (a) in a manner that is less favorable than the
13 benefits provided for any preceding portion of the stay.
14 Nothing in this subsection shall be construed as
15 preventing a plan or issuer from imposing deductibles,
16 coinsurance, or other cost-sharing in relation to benefits
17 for hospital lengths of stay in connection with surgical care
18 for a person under the policy or plan, except that the
19 coinsurance or other cost-sharing for any portion of a period
20 within a hospital length of stay required under subsection
21 (a) may not be greater than the coinsurance or cost-sharing
22 for any preceding portion of the stay.
23 (d) For the purposes of this Section the following terms
24 are defined:
-2- LRB9000924JSccam
1 (1) "Attending physician" means a physician
2 licensed to practice medicine in all its branches
3 providing care to the patient.
4 (2) "Managed care plan" means a plan that
5 establishes, operates, or maintains a network of health
6 care providers that have entered into agreements with the
7 plan to provide health care services to enrollees where
8 the plan has the ultimate and direct contractual
9 obligation to the enrollee to arrange for the provision
10 of or pay for services through:
11 (A) organizational arrangements for ongoing
12 quality assurance, utilization review programs, or
13 dispute resolution; or
14 (B) financial incentives for persons enrolled
15 in the plan to use the participating providers and
16 procedures covered by the plan.
17 A managed care plan may be established or operated
18 by any entity including a licensed insurance company,
19 hospital or medical service plan, health maintenance
20 organization, limited health service organization,
21 preferred provider organization, third party
22 administrator, or an employer or employee organization.
23 (e) The insurer or plan shall inform all insureds or
24 enrollees in writing of the right to this minimum coverage
25 under this Section as part of the insurer's or plan's regular
26 notice of coverage to insureds or enrollees and at the time
27 the insured or enrollee is admitted to a hospital for
28 procedures subject to this Section."; and
29 by deleting all of page 4; and
30 on page 5 by deleting lines 1 through 20; and
31 on page 6 by inserting immediately below line 2 the
32 following:
-3- LRB9000924JSccam
1 "Section 42. The Limited Health Service Organization Act
2 is amended by changing Section 4003 as follows:
3 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
4 Sec. 4003. Illinois Insurance Code provisions. Limited
5 health service organizations shall be subject to the
6 provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
7 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
8 154.6, 154.7, 154.8, 155.04, 355.2, 356t, 401, 401.1, 402,
9 403, 403A, 408, 408.2, and 412, and Articles VIII 1/2, XII,
10 XII 1/2, XIII, XIII 1/2, and XXVI of the Illinois Insurance
11 Code. For purposes of the Illinois Insurance Code, except
12 for Articles XIII and XIII 1/2, limited health service
13 organizations in the following categories are deemed to be
14 domestic companies:
15 (1) a corporation under the laws of this State; or
16 (2) a corporation organized under the laws of
17 another state, 30% of more of the enrollees of which are
18 residents of this State, except a corporation subject to
19 substantially the same requirements in its state of
20 organization as is a domestic company under Article VIII
21 1/2 of the Illinois Insurance Code.
22 (Source: P.A. 86-600; 87-587; 87-1090.)".