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90_HB3427
215 ILCS 5/356r
Amends the Illinois Insurance Code regarding women's
health care providers. Requires insurers to notify insureds
of the right to designate a woman's principal health care
provider and to provide a list of participating women's
health care providers within 30 days after a request for the
list is made. Effective immediately.
LRB9008922JSgcB
LRB9008922JSgcB
1 AN ACT to amend the Illinois Insurance Code by changing
2 Section 356r.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Illinois Insurance Code is amended by
6 changing Section 356r as follows:
7 (215 ILCS 5/356r)
8 Sec. 356r. Woman's principal health care provider.
9 (a) An individual or group policy of accident and health
10 insurance or a managed care plan amended, delivered, issued,
11 or renewed in this State after November 14, 1996 that
12 requires an insured or enrollee to designate an individual to
13 coordinate care or to control access to health care services
14 shall also permit a female insured or enrollee to designate a
15 participating woman's principal health care provider, and the
16 insurer or managed care plan shall inform all female insureds
17 or enrollees in writing of this right to designate a woman's
18 principal health care provider as part of the insurer's or
19 plan's regular notice of coverage to insureds or enrollees
20 and at any time a female insured designates or changes a
21 designation, or is given an opportunity to do either, of an
22 individual to coordinate care or to control access to health
23 care services. The insurer or managed care plan shall,
24 within 30 days after a request, provide a list of all
25 physicians licensed to practice medicine in all its branches
26 specializing in obstetrics or gynecology who have contracted
27 with the insurer or managed care plan from which the female
28 insured or enrollee may make this designation. No insurer or
29 plan formal or informal policy may restrict a female
30 insured's or enrollee's right to designate a woman's
31 principal health care provider. If the insurer or managed
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1 care plan fails to provide the list within 30 days after a
2 request, the female insured or enrollee may designate any
3 physician licensed to practice medicine in all its branches
4 specializing in obstetrics or gynecology as the woman's
5 principal health care provider.
6 (b) If a female insured or enrollee has designated a
7 woman's principal health care provider, then the insured or
8 enrollee must be given direct access to the woman's principal
9 health care provider for services covered by the policy or
10 plan without the need for a referral or prior approval.
11 Nothing shall prohibit the insurer or managed care plan from
12 requiring prior authorization or approval from either a
13 primary care provider or the woman's principal health care
14 provider for referrals for additional care or services.
15 (c) For the purposes of this Section the following terms
16 are defined:
17 (1) "Woman's principal health care provider" means
18 a physician licensed to practice medicine in all of its
19 branches specializing in obstetrics or gynecology.
20 (2) "Managed care entity" means any entity
21 including a licensed insurance company, hospital or
22 medical service plan, health maintenance organization,
23 limited health service organization, preferred provider
24 organization, third party administrator, an employer or
25 employee organization, or any person or entity that
26 establishes, operates, or maintains a network of
27 participating providers.
28 (3) "Managed care plan" means a plan operated by a
29 managed care entity that provides for the financing of
30 health care services to persons enrolled in the plan
31 through:
32 (A) organizational arrangements for ongoing
33 quality assurance, utilization review programs, or
34 dispute resolution; or
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1 (B) financial incentives for persons enrolled
2 in the plan to use the participating providers and
3 procedures covered by the plan.
4 (4) "Participating provider" means a physician who
5 has contracted with an insurer or managed care plan to
6 provide services to insureds or enrollees as defined by
7 the contract.
8 (d) The original provisions of this Section became law
9 on July 17, 1996 and took effect November 14, 1996, which is
10 120 days after becoming law.
11 (Source: P.A. 89-514; 90-14, eff. 7-1-97.)
12 Section 99. Effective date. This Act takes effect upon
13 becoming law.