SB0174 EnrolledLRB101 04949 SMS 49958 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 1. Short title. This Act may be cited as the
5In-Office Membership Care Act.
 
6    Section 5. Public policy. It is the policy of the State of
7Illinois to promote personal responsibility for health care and
8the cost-effective delivery of dental services by encouraging
9innovative use of in-office membership care practices for
10dental care. In-office membership care practices utilize a
11model of periodic fees for provider access and management over
12time, rather than simply a fee for visit or procedure service
13model. Some patients and individual dental care providers may
14wish to establish direct agreements with one another as an
15alternative to traditional fee-for-service care financed
16through health insurance. The purpose of this Act is to confirm
17that in-office membership care agreements that satisfy the
18provisions of this Act do not constitute insurance and as such
19are not subject to the Illinois Insurance Code.
 
20    Section 10. Definitions. In this Act:
21    "Dental care provider" means a natural person or persons
22licensed or otherwise legally authorized to provide health care

 

 

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1services in the State of Illinois in the field of dentistry who
2provides such services either alone or with others at the same
3location or other location affiliated with the practice in a
4form and within a scope permitted by such licensure or legal
5authorization for the provision of such services and who enters
6into an in-office membership care agreement.
7    "Direct fee" means an agreed-upon fee charged by a dental
8care provider as consideration for providing and being
9available to provide in-office membership care services
10described in an in-office membership care agreement.
11    "In-office membership care agreement" means a written
12contract between a dental care provider or group of providers
13and an individual patient, the patient's family, or the
14patient's representative in which the dental care provider
15agrees to provide in-office membership care services to the
16patient over a specified period of time for payment of a direct
17fee.
18    "In-office membership care services" means services that a
19dental care provider is licensed or otherwise legally
20authorized to provide, including, but not limited to, (i)
21dental screenings, assessments, diagnoses, and treatments for
22the purpose of promoting health; (ii) detection, management,
23and care of disease or injury; and (iii) routine preventive or
24diagnostic dental treatment.
25    "Patient" means a person who is entitled to receive
26in-office membership care services under an in-office

 

 

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1membership care agreement.
 
2    Section 15. In-office membership care agreement
3provisions.
4    (a) An in-office membership care agreement shall identify:
5        (1) the dental care provider or providers and the
6    patient or patients;
7        (2) the general scope of services as well as the
8    specific services to be provided by the dental care
9    provider as part of the in-office membership care
10    agreement;
11        (3) the location or locations where services are to be
12    provided;
13        (4) the amount of the direct fee and the time interval
14    at which it is to be paid; and
15        (5) the term of the in-office membership care agreement
16    and the conditions upon which it may be terminated by the
17    dental care provider.
18    (b) An in-office membership care agreement shall be
19terminable at will by written notice from the patient to the
20dental care provider.
21    (c) If a party provides written notice of termination of
22the in-office membership care agreement, the dental care
23provider may refund to the patient all unearned direct fees
24associated with the covered services under the in-office
25membership care agreement.
 

 

 

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1    Section 20. Location of in-office membership care
2services. In-office membership care services may be provided in
3a dental care provider's office or another location in which a
4patient visit with the dental care provider needs to occur.
 
5    Section 25. Insurance billing prohibited. Neither the
6patient nor the dental care provider shall submit a bill to an
7insurer for the services provided under an in-office membership
8care agreement.
 
9    Section 30. In-office membership care agreements not
10classified as insurance. In-office membership care agreements
11are not subject to regulation as insurance under the Illinois
12Insurance Code.
 
13    Section 35. Disclaimer. An in-office membership care
14agreement shall include the following disclaimer: "This
15agreement does not provide health insurance coverage,
16including the minimal essential coverage required by
17applicable federal law. It provides only the services described
18herein. It is recommended that health care insurance be
19obtained to cover dental services not provided for under this
20in-office membership care agreement.".
 
21    Section 40. Restrictions on transfer. An in-office

 

 

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1membership care agreement may not be sold or transferred by the
2dental care provider without the written consent of the patient
3and may be transferred only to another dental care provider. An
4in-office membership care agreement may not be sold to a group,
5employer or group of subscribers because it is an individual
6agreement between a dental care provider and a patient. These
7limitations do not prohibit the presentation of marketing
8materials to groups of potential patients or their
9representatives.
 
10    Section 45. Effect of this Act. This Act does not prohibit
11dental care providers who are not dental care providers
12offering in-office membership care agreements from entering
13into agreements with patients to the extent such agreements do
14not violate the provisions of the Illinois Insurance Code.
 
15    Section 80. The Illinois Insurance Code is amended by
16changing Section 352 as follows:
 
17    (215 ILCS 5/352)  (from Ch. 73, par. 964)
18    Sec. 352. Scope of Article.
19    (a) Except as provided in subsections (b), (c), (d), and
20(e), this Article shall apply to all companies transacting in
21this State the kinds of business enumerated in clause (b) of
22Class 1 and clause (a) of Class 2 of section 4. Nothing in this
23Article shall apply to, or in any way affect policies or

 

 

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1contracts described in clause (a) of Class 1 of Section 4;
2however, this Article shall apply to policies and contracts
3which contain benefits providing reimbursement for the
4expenses of long term health care which are certified or
5ordered by a physician including but not limited to
6professional nursing care, custodial nursing care, and
7non-nursing custodial care provided in a nursing home or at a
8residence of the insured.
9    (b) (Blank).
10    (c) A policy issued and delivered in this State that
11provides coverage under that policy for certificate holders who
12are neither residents of nor employed in this State does not
13need to provide to those nonresident certificate holders who
14are not employed in this State the coverages or services
15mandated by this Article.
16    (d) Stop-loss insurance is exempt from all Sections of this
17Article, except this Section and Sections 353a, 354, 357.30,
18and 370. For purposes of this exemption, stop-loss insurance is
19further defined as follows:
20        (1) The policy must be issued to and insure an
21    employer, trustee, or other sponsor of the plan, or the
22    plan itself, but not employees, members, or participants.
23        (2) Payments by the insurer must be made to the
24    employer, trustee, or other sponsors of the plan, or the
25    plan itself, but not to the employees, members,
26    participants, or health care providers.

 

 

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1    (e) A policy issued or delivered in this State to the
2Department of Healthcare and Family Services (formerly
3Illinois Department of Public Aid) and providing coverage,
4under clause (b) of Class 1 or clause (a) of Class 2 as
5described in Section 4, to persons who are enrolled under
6Article V of the Illinois Public Aid Code or under the
7Children's Health Insurance Program Act is exempt from all
8restrictions, limitations, standards, rules, or regulations
9respecting benefits imposed by or under authority of this Code,
10except those specified by subsection (1) of Section 143,
11Section 370c, and Section 370c.1. Nothing in this subsection,
12however, affects the total medical services available to
13persons eligible for medical assistance under the Illinois
14Public Aid Code.
15    (f) An in-office membership care agreement provided under
16the In-Office Membership Care Act is not insurance for the
17purposes of this Code.
18(Source: P.A. 99-480, eff. 9-9-15.)
 
19    Section 99. Effective date. This Act takes effect upon
20becoming law.