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Public Act 101-0190 | ||||
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 1. Short title. This Act may be cited as the | ||||
In-Office Membership Care Act. | ||||
Section 5. Public policy. It is the policy of the State of | ||||
Illinois to promote personal responsibility for health care and | ||||
the cost-effective delivery of dental services by encouraging | ||||
innovative use of in-office membership care practices for | ||||
dental care. In-office membership care practices utilize a | ||||
model of periodic fees for provider access and management over | ||||
time, rather than simply a fee for visit or procedure service | ||||
model. Some patients and individual dental care providers may | ||||
wish to establish direct agreements with one another as an | ||||
alternative to traditional fee-for-service care financed | ||||
through health insurance. The purpose of this Act is to confirm | ||||
that in-office membership care agreements that satisfy the | ||||
provisions of this Act do not constitute insurance and as such | ||||
are not subject to the Illinois Insurance Code. | ||||
Section 10. Definitions. In this Act: | ||||
"Dental care provider" means a natural person or persons | ||||
licensed or otherwise legally authorized to provide health care |
services in the State of Illinois in the field of dentistry who | ||
provides such services either alone or with others at the same | ||
location or other location affiliated with the practice in a | ||
form and within a scope permitted by such licensure or legal | ||
authorization for the provision of such services and who enters | ||
into an in-office membership care agreement. | ||
"Direct fee" means an agreed-upon fee charged by a dental | ||
care provider as consideration for providing and being | ||
available to provide in-office membership care services | ||
described in an in-office membership care agreement. | ||
"In-office membership care agreement" means a written | ||
contract between a dental care provider or group of providers | ||
and an individual patient, the patient's family, or the | ||
patient's representative in which the dental care provider | ||
agrees to provide in-office membership care services to the | ||
patient over a specified period of time for payment of a direct | ||
fee. | ||
"In-office membership care services" means services that a | ||
dental care provider is licensed or otherwise legally | ||
authorized to provide, including, but not limited to, (i) | ||
dental screenings, assessments, diagnoses, and treatments for | ||
the purpose of promoting health; (ii) detection, management, | ||
and care of disease or injury; and (iii) routine preventive or | ||
diagnostic dental treatment. | ||
"Patient" means a person who is entitled to receive | ||
in-office membership care services under an in-office |
membership care agreement. | ||
Section 15. In-office membership care agreement | ||
provisions. | ||
(a) An in-office membership care agreement shall identify: | ||
(1) the dental care provider or providers and the | ||
patient or patients; | ||
(2) the general scope of services as well as the | ||
specific services to be provided by the dental care | ||
provider as part of the in-office membership care | ||
agreement; | ||
(3) the location or locations where services are to be | ||
provided; | ||
(4) the amount of the direct fee and the time interval | ||
at which it is to be paid; and | ||
(5) the term of the in-office membership care agreement | ||
and the conditions upon which it may be terminated by the | ||
dental care provider. | ||
(b) An in-office membership care agreement shall be | ||
terminable at will by written notice from the patient to the | ||
dental care provider. | ||
(c) If a party provides written notice of termination of | ||
the in-office membership care agreement, the dental care | ||
provider may refund to the patient all unearned direct fees | ||
associated with the covered services under the in-office | ||
membership care agreement. |
Section 20. Location of in-office membership care | ||
services. In-office membership care services may be provided in | ||
a dental care provider's office or another location in which a | ||
patient visit with the dental care provider needs to occur. | ||
Section 25. Insurance billing prohibited. Neither the | ||
patient nor the dental care provider shall submit a bill to an | ||
insurer for the services provided under an in-office membership | ||
care agreement. | ||
Section 30. In-office membership care agreements not | ||
classified as insurance. In-office membership care agreements | ||
are not subject to regulation as insurance under the Illinois | ||
Insurance Code. | ||
Section 35. Disclaimer. An in-office membership care | ||
agreement shall include the following disclaimer: "This | ||
agreement does not provide health insurance coverage, | ||
including the minimal essential coverage required by | ||
applicable federal law. It provides only the services described | ||
herein. It is recommended that health care insurance be | ||
obtained to cover dental services not provided for under this | ||
in-office membership care agreement.". | ||
Section 40. Restrictions on transfer. An in-office |
membership care agreement may not be sold or transferred by the | ||
dental care provider without the written consent of the patient | ||
and may be transferred only to another dental care provider. An | ||
in-office membership care agreement may not be sold to a group, | ||
employer or group of subscribers because it is an individual | ||
agreement between a dental care provider and a patient. These | ||
limitations do not prohibit the presentation of marketing | ||
materials to groups of potential patients or their | ||
representatives. | ||
Section 45. Effect of this Act. This Act does not prohibit | ||
dental care providers who are not dental care providers | ||
offering in-office membership care agreements from entering | ||
into agreements with patients to the extent such agreements do | ||
not violate the provisions of the Illinois Insurance Code. | ||
Section 80. The Illinois Insurance Code is amended by | ||
changing Section 352 as follows:
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(215 ILCS 5/352) (from Ch. 73, par. 964)
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Sec. 352. Scope of Article.
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(a) Except as provided in subsections (b), (c), (d), and | ||
(e),
this Article shall
apply to all companies transacting in | ||
this State the kinds of business
enumerated in clause (b) of | ||
Class 1 and clause (a) of Class 2 of section 4.
Nothing in this | ||
Article shall apply to, or in any way affect policies or
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contracts described in clause (a) of Class 1 of Section 4; | ||
however, this
Article shall apply to policies and contracts | ||
which contain benefits
providing reimbursement for the | ||
expenses of long term health care which are
certified or | ||
ordered by a physician including but not limited to
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professional nursing care, custodial nursing care, and | ||
non-nursing
custodial care provided in a nursing home or at a | ||
residence of the insured.
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(b) (Blank).
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(c) A policy issued and delivered in this State
that | ||
provides coverage under that policy for
certificate holders who | ||
are neither residents of nor employed in this State
does not | ||
need to provide to those nonresident
certificate holders who | ||
are not employed in this State the coverages or
services | ||
mandated by this Article.
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(d) Stop-loss insurance is exempt from all Sections
of this | ||
Article, except this Section and Sections 353a, 354, 357.30, | ||
and
370. For purposes of this exemption, stop-loss insurance is | ||
further defined as
follows:
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(1) The policy must be issued to and insure an | ||
employer, trustee, or other
sponsor of the plan, or the | ||
plan itself, but not employees, members, or
participants.
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(2) Payments by the insurer must be made to the | ||
employer, trustee, or
other sponsors of the plan, or the | ||
plan itself, but not to the employees,
members, | ||
participants, or health care providers.
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(e) A policy issued or delivered in this State to the | ||
Department of Healthcare and Family Services (formerly
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Illinois Department
of Public Aid) and providing coverage, | ||
under clause (b) of Class 1 or clause (a)
of Class 2 as | ||
described in Section 4, to persons who are enrolled under | ||
Article V of the Illinois
Public Aid Code or under the | ||
Children's Health Insurance Program Act is
exempt from all | ||
restrictions, limitations,
standards, rules, or regulations | ||
respecting benefits imposed by or under
authority of this Code, | ||
except those specified by subsection (1) of Section
143, | ||
Section 370c, and Section 370c.1. Nothing in this subsection, | ||
however, affects the total medical services
available to | ||
persons eligible for medical assistance under the Illinois | ||
Public
Aid Code.
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(f) An in-office membership care agreement provided under | ||
the In-Office Membership Care Act is not insurance for the | ||
purposes of this Code. | ||
(Source: P.A. 99-480, eff. 9-9-15.)
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Section 99. Effective date. This Act takes effect upon | ||
becoming law.
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