HB3861ham004 96TH GENERAL ASSEMBLY

Rep. Jack D. Franks

Filed: 4/2/2009

09600HB3861ham004 LRB096 06606 RPM 25077 a

AMENDMENT TO HOUSE BILL 3861

AMENDMENT NO. ______. Amend House Bill 3861 by replacing everything after the enacting clause with the following:

"Section 5. The Illinois Insurance Code is amended by adding Section 370u as follows:

(215 ILCS 5/370u new)

Sec. 370u. Out-of-network health care provider. Every health insurer and health plan that provides incentives for insureds, beneficiaries, or enrollees to seek services from a specific provider network must pay for out-of-network health care provided by out-of-network providers as provided in this Section. When an insured, beneficiary, or enrollee utilizes a network hospital and due to any reason services at that network hospital are provided by an out-of-network provider with whom the insured or enrollee does not have a provider-patient relationship, the health insurer or health plan shall ensure that the insured, beneficiary, or enrollee is provided the covered service at no greater cost to the insured, beneficiary, or enrollee than if the service had been provided by a network provider. The insurer or plan shall pay the out-of-network provider providing services in the network hospital the lesser of the actual charged amount or the amount the insurer or plan pays to their out-of-network providers pursuant to the health benefits plan providing the coverage for the services to the insured, beneficiary, or enrollee, less any cost sharing that is the responsibility of the insured, beneficiary, or enrollee for similar in-network services.

Except for applicable co-payments, deductibles, or co-insurance responsibilities of the insured or enrollee, a healthcare provider shall not bill or otherwise attempt to recover from the insured or enrollee the difference between the healthcare provider's charge and the amount paid by the insurer or plan.".