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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 |
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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. |
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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 |
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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
|
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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