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90_HB3738
215 ILCS 5/370g from Ch. 73, par. 982g
Amends the Health Care Reimbursement Reform Act of 1985
in the Illinois Insurance Code. Changes the definition of
"emergency" to a medical condition of recent onset and
severity that would lead a prudent layperson to believe that
urgent, immediate, or unscheduled medical care is required
(instead of an accidental bodily injury or emergency
condition that reasonably requires the beneficiary or insured
to seek immediate medical care under circumstances or at
locations that reasonably preclude the person from obtaining
needed medical care from a preferred provider). Provides
that determination of the patient's need for emergency care
shall be based upon the symptoms and condition at the time
the patient is initially examined by the physician.
LRB9010768NTsb
LRB9010768NTsb
1 AN ACT to amend the Illinois Insurance Code by changing
2 Section 370g.
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 370g as follows:
7 (215 ILCS 5/370g) (from Ch. 73, par. 982g)
8 Sec. 370g. Definitions. As used in this Article, the
9 following definitions apply:
10 (a) "Health care services" means health care services or
11 products rendered or sold by a provider within the scope of
12 the provider's license or legal authorization. The term
13 includes, but is not limited to, hospital, medical, surgical,
14 dental, vision and pharmaceutical services or products.
15 (b) "Insurer" means an insurance company or a health
16 service corporation authorized in this State to issue
17 policies or subscriber contracts which reimburse for expenses
18 of health care services.
19 (c) "Insured" means an individual entitled to
20 reimbursement for expenses of health care services under a
21 policy or subscriber contract issued or administered by an
22 insurer.
23 (d) "Provider" means an individual or entity duly
24 licensed or legally authorized to provide health care
25 services.
26 (e) "Noninstitutional provider" means any person
27 licensed under the Medical Practice Act of 1987, as now or
28 hereafter amended.
29 (f) "Beneficiary" means an individual entitled to
30 reimbursement for expenses of or the discount of provider
31 fees for health care services under a program where the
-2- LRB9010768NTsb
1 beneficiary has an incentive to utilize the services of a
2 provider which has entered into an agreement or arrangement
3 with an administrator.
4 (g) "Administrator" means any person, partnership or
5 corporation, other than an insurer or health maintenance
6 organization holding a certificate of authority under the
7 "Health Maintenance Organization Act", as now or hereafter
8 amended, that arranges, contracts with, or administers
9 contracts with a provider whereby beneficiaries are provided
10 an incentive to use the services of such provider.
11 (h) "Emergency" means a medical condition of recent
12 onset and severity that would lead a prudent layperson,
13 possessing an average knowledge of medicine and health, to
14 believe that urgent, immediate, or unscheduled medical care
15 is required. Determination of the patient's need for
16 emergency care shall be based upon the symptoms and condition
17 at the time the patient is initially examined by the
18 physician and not upon the final determination of the
19 patient's actual medical condition an accidental bodily
20 injury or emergency medical condition which reasonably
21 requires the beneficiary or insured to seek immediate medical
22 care under circumstances or at locations which reasonably
23 preclude the beneficiary or insured from obtaining needed
24 medical care from a preferred provider.
25 (Source: P.A. 88-400.)