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1 | AN ACT concerning regulation.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Insurance Code is amended by adding | |||||||||||||||||||||||
5 | Section 370b.2 as follows: | |||||||||||||||||||||||
6 | (215 ILCS 5/370b.2 new) | |||||||||||||||||||||||
7 | Sec. 370b.2. Deductibles and copayments. | |||||||||||||||||||||||
8 | (a) If an insured is required to pay a deductible or | |||||||||||||||||||||||
9 | copayment under a policy, an accident and health insurer must | |||||||||||||||||||||||
10 | disclose to the insured the total actual payments made by the | |||||||||||||||||||||||
11 | accident and health insurer to a health care provider and the | |||||||||||||||||||||||
12 | basis for the deductible or copayment the insured is required | |||||||||||||||||||||||
13 | to pay. | |||||||||||||||||||||||
14 | (b) If an accident and health insurer pays a claim to a | |||||||||||||||||||||||
15 | health care provider at an agreed-upon or discounted rate, then | |||||||||||||||||||||||
16 | the accident and health insurer must base the insured's | |||||||||||||||||||||||
17 | deductible or copayment upon the agreed-upon or discounted rate | |||||||||||||||||||||||
18 | rather than any other advertised or listed rate.
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19 | Section 10. The Health Maintenance Organization Act is | |||||||||||||||||||||||
20 | amended by adding Section 4-21 as follows: | |||||||||||||||||||||||
21 | (215 ILCS 125/4-21 new) |
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1 | Sec. 4-21. Calculation of deductible and copayments. If an | ||||||
2 | enrollee is required to pay a deductible or a copayment for a | ||||||
3 | health care service that is determined based upon the cost for | ||||||
4 | a health care service, then the deductible or copayment for | ||||||
5 | that health care service shall be based off the agreed-upon or | ||||||
6 | discounted rate paid to the provider. If the provider is not | ||||||
7 | paid per individual health care service, then the deductible or | ||||||
8 | copayment must be based upon the average net payment to a | ||||||
9 | specific provider for that health care service. | ||||||
10 | Section 15. The Illinois Public Aid Code is amended by | ||||||
11 | changing Section 5-16.8 as follows:
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12 | (305 ILCS 5/5-16.8)
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13 | Sec. 5-16.8. Required health benefits. The medical | ||||||
14 | assistance program
shall
(i) provide the post-mastectomy care | ||||||
15 | benefits required to be covered by a policy of
accident and | ||||||
16 | health insurance under Section 356t and the coverage required
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17 | under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, and | ||||||
18 | 356z.29 , and 356z.32 of the Illinois
Insurance Code and (ii) be | ||||||
19 | subject to the provisions of Sections 356z.19, 364.01, 370b.2, | ||||||
20 | 370c, and 370c.1 of the Illinois
Insurance Code.
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21 | On and after July 1, 2012, the Department shall reduce any | ||||||
22 | rate of reimbursement for services or other payments or alter | ||||||
23 | any methodologies authorized by this Code to reduce any rate of | ||||||
24 | reimbursement for services or other payments in accordance with |
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1 | Section 5-5e. | ||||||
2 | To ensure full access to the benefits set forth in this | ||||||
3 | Section, on and after January 1, 2016, the Department shall | ||||||
4 | ensure that provider and hospital reimbursement for | ||||||
5 | post-mastectomy care benefits required under this Section are | ||||||
6 | no lower than the Medicare reimbursement rate. | ||||||
7 | (Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15; | ||||||
8 | 99-642, eff. 7-28-16; 100-138, eff. 8-18-17; 100-863, eff. | ||||||
9 | 8-14-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised | ||||||
10 | 10-4-18.)
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