101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB3188

 

Introduced , by Rep. Deanne M. Mazzochi

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/370b.2 new
215 ILCS 125/4-21 new
305 ILCS 5/5-16.8

    Amends the Illinois Insurance Code. Provides that if an insured is required to pay a deductible or copayment under a policy, an accident and health insurer must disclose to the insured the total actual payments made by the accident and health insurer to a health care provider and the basis for the deductible or copayment the insured is required to pay. Provides that if an accident and health insurer pays a claim to a healthcare provider at an agreed-upon or discounted rate, then the accident and health insurer must base the insured's deductible or copayment upon the agreed-upon or discounted rate rather than any other advertised or listed rate. Amends the Health Maintenance Organization Act and the Illinois Public Aid Code. Provides the basis for calculation of a deductible or copayment.


LRB101 10901 SMS 56048 b

 

 

A BILL FOR

 

HB3188LRB101 10901 SMS 56048 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by adding
5Section 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
9copayment under a policy, an accident and health insurer must
10disclose to the insured the total actual payments made by the
11accident and health insurer to a health care provider and the
12basis for the deductible or copayment the insured is required
13to pay.
14    (b) If an accident and health insurer pays a claim to a
15health care provider at an agreed-upon or discounted rate, then
16the accident and health insurer must base the insured's
17deductible or copayment upon the agreed-upon or discounted rate
18rather than any other advertised or listed rate.
 
19    Section 10. The Health Maintenance Organization Act is
20amended by adding Section 4-21 as follows:
 
21    (215 ILCS 125/4-21 new)

 

 

HB3188- 2 -LRB101 10901 SMS 56048 b

1    Sec. 4-21. Calculation of deductible and copayments. If an
2enrollee is required to pay a deductible or a copayment for a
3health care service that is determined based upon the cost for
4a health care service, then the deductible or copayment for
5that health care service shall be based off the agreed-upon or
6discounted rate paid to the provider. If the provider is not
7paid per individual health care service, then the deductible or
8copayment must be based upon the average net payment to a
9specific provider for that health care service.
 
10    Section 15. The Illinois Public Aid Code is amended by
11changing Section 5-16.8 as follows:
 
12    (305 ILCS 5/5-16.8)
13    Sec. 5-16.8. Required health benefits. The medical
14assistance program shall (i) provide the post-mastectomy care
15benefits required to be covered by a policy of accident and
16health insurance under Section 356t and the coverage required
17under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, and
18356z.29, and 356z.32 of the Illinois Insurance Code and (ii) be
19subject to the provisions of Sections 356z.19, 364.01, 370b.2,
20370c, and 370c.1 of the Illinois Insurance Code.
21    On and after July 1, 2012, the Department shall reduce any
22rate of reimbursement for services or other payments or alter
23any methodologies authorized by this Code to reduce any rate of
24reimbursement for services or other payments in accordance with

 

 

HB3188- 3 -LRB101 10901 SMS 56048 b

1Section 5-5e.
2    To ensure full access to the benefits set forth in this
3Section, on and after January 1, 2016, the Department shall
4ensure that provider and hospital reimbursement for
5post-mastectomy care benefits required under this Section are
6no lower than the Medicare reimbursement rate.
7(Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15;
899-642, eff. 7-28-16; 100-138, eff. 8-18-17; 100-863, eff.
98-14-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
1010-4-18.)