Sen. John G. Mulroe

Filed: 2/26/2019

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 174

2    AMENDMENT NO. ______. Amend Senate Bill 174 by replacing
3everything after the enacting clause with the following:
 
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

 

 

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1that in-office membership care agreements that satisfy the
2provisions of this Act do not constitute insurance and as such
3are not subject to the Illinois Insurance Code.
 
4    Section 10. Definitions. In this Act:
5    "Dental care provider" means a natural person or persons
6licensed or otherwise legally authorized to provide health care
7services in the State of Illinois in the field of dentistry who
8provides such services either alone or with others at the same
9location or other location affiliated with the practice in a
10form and within a scope permitted by such licensure or legal
11authorization for the provision of such services and who enters
12into an in-office membership care agreement.
13    "Direct fee" means an agreed-upon fee charged by a dental
14care provider as consideration for providing and being
15available to provide in-office membership care services
16described in an in-office membership care agreement.
17    "In-office membership care agreement" means a written
18contract between a dental care provider or group of providers
19and an individual patient, the patient's family, or the
20patient's representative in which the dental care provider
21agrees to provide in-office membership care services to the
22patient over a specified period of time for payment of a direct
23fee.
24    "In-office membership care services" means services that a
25dental care provider is licensed or otherwise legally

 

 

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1authorized to provide, including, but not limited to, (i)
2dental screenings, assessments, diagnoses, and treatments for
3the purpose of promoting health; (ii) detection, management,
4and care of disease or injury; and (iii) routine preventive or
5diagnostic dental treatment.
6    "Patient" means a person who is entitled to receive
7in-office membership care services under an in-office
8membership care agreement.
 
9    Section 15. In-office membership care agreement
10provisions.
11    (a) An in-office membership care agreement shall identify:
12        (1) the dental care provider or providers and the
13    patient or patients;
14        (2) the general scope of services as well as the
15    specific services to be provided by the dental care
16    provider as part of the in-office membership care
17    agreement;
18        (3) the location or locations where services are to be
19    provided;
20        (4) the amount of the direct fee and the time interval
21    at which it is to be paid; and
22        (5) the term of the in-office membership care agreement
23    and the conditions upon which it may be terminated by the
24    dental care provider.
25    (b) An in-office membership care agreement shall be

 

 

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1terminable at will by written notice from the patient to the
2dental care provider.
3    (c) If a party provides written notice of termination of
4the in-office membership care agreement, the dental care
5provider may refund to the patient all unearned direct fees
6associated with the covered services under the in-office
7membership care agreement.
 
8    Section 20. Location of in-office membership care
9services. In-office membership care services may be provided in
10a dental care provider's office or another location in which a
11patient visit with the dental care provider needs to occur.
 
12    Section 25. Insurance billing prohibited. Neither the
13patient nor the dental care provider shall submit a bill to an
14insurer for the services provided under an in-office membership
15care agreement.
 
16    Section 30. In-office membership care agreements not
17classified as insurance. In-office membership care agreements
18are not subject to regulation as insurance under the Illinois
19Insurance Code.
 
20    Section 35. Disclaimer. An in-office membership care
21agreement shall include the following disclaimer: "This
22agreement does not provide health insurance coverage,

 

 

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1including the minimal essential coverage required by
2applicable federal law. It provides only the services described
3herein. It is recommended that health care insurance be
4obtained to cover dental services not provided for under this
5in-office membership care agreement.".
 
6    Section 40. Restrictions on transfer. An in-office
7membership care agreement may not be sold or transferred by the
8dental care provider without the written consent of the patient
9and may be transferred only to another dental care provider. An
10in-office membership care agreement may not be sold to a group,
11employer or group of subscribers because it is an individual
12agreement between a dental care provider and a patient. These
13limitations do not prohibit the presentation of marketing
14materials to groups of potential patients or their
15representatives.
 
16    Section 45. Effect of this Act. This Act does not prohibit
17dental care providers who are not dental care providers
18offering in-office membership care agreements from entering
19into agreements with patients to the extent such agreements do
20not violate the provisions of the Illinois Insurance Code.
 
21    Section 80. The Illinois Insurance Code is amended by
22changing Section 352 as follows:
 

 

 

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1    (215 ILCS 5/352)  (from Ch. 73, par. 964)
2    Sec. 352. Scope of Article.
3    (a) Except as provided in subsections (b), (c), (d), and
4(e), this Article shall apply to all companies transacting in
5this State the kinds of business enumerated in clause (b) of
6Class 1 and clause (a) of Class 2 of section 4. Nothing in this
7Article shall apply to, or in any way affect policies or
8contracts described in clause (a) of Class 1 of Section 4;
9however, this Article shall apply to policies and contracts
10which contain benefits providing reimbursement for the
11expenses of long term health care which are certified or
12ordered by a physician including but not limited to
13professional nursing care, custodial nursing care, and
14non-nursing custodial care provided in a nursing home or at a
15residence of the insured.
16    (b) (Blank).
17    (c) A policy issued and delivered in this State that
18provides coverage under that policy for certificate holders who
19are neither residents of nor employed in this State does not
20need to provide to those nonresident certificate holders who
21are not employed in this State the coverages or services
22mandated by this Article.
23    (d) Stop-loss insurance is exempt from all Sections of this
24Article, except this Section and Sections 353a, 354, 357.30,
25and 370. For purposes of this exemption, stop-loss insurance is
26further defined as follows:

 

 

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1        (1) The policy must be issued to and insure an
2    employer, trustee, or other sponsor of the plan, or the
3    plan itself, but not employees, members, or participants.
4        (2) Payments by the insurer must be made to the
5    employer, trustee, or other sponsors of the plan, or the
6    plan itself, but not to the employees, members,
7    participants, or health care providers.
8    (e) A policy issued or delivered in this State to the
9Department of Healthcare and Family Services (formerly
10Illinois Department of Public Aid) and providing coverage,
11under clause (b) of Class 1 or clause (a) of Class 2 as
12described in Section 4, to persons who are enrolled under
13Article V of the Illinois Public Aid Code or under the
14Children's Health Insurance Program Act is exempt from all
15restrictions, limitations, standards, rules, or regulations
16respecting benefits imposed by or under authority of this Code,
17except those specified by subsection (1) of Section 143,
18Section 370c, and Section 370c.1. Nothing in this subsection,
19however, affects the total medical services available to
20persons eligible for medical assistance under the Illinois
21Public Aid Code.
22    (f) An in-office membership care agreement provided under
23the In-Office Membership Care Act is not insurance for the
24purposes of this Code.
25(Source: P.A. 99-480, eff. 9-9-15.)
 

 

 

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1    Section 99. Effective date. This Act takes effect upon
2becoming law.".