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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 Managed Care Reform and Patient Rights Act | ||||||
5 | is amended by adding Section 45.3 as follows: | ||||||
6 | (215 ILCS 134/45.3 new) | ||||||
7 | Sec. 45.3. Prescription drug benefits; plan choice. | ||||||
8 | (a) Notwithstanding any other provision of law, beginning | ||||||
9 | January 1, 2023, every health insurance carrier that offers an | ||||||
10 | individual health plan that provides coverage for prescription | ||||||
11 | drugs shall ensure that at least 10% of individual health care | ||||||
12 | plans offered in each applicable service area and at each | ||||||
13 | level of coverage as defined in 42 U.S.C. 18022 apply a | ||||||
14 | flat-dollar copayment structure to the entire drug benefit. | ||||||
15 | Beginning January 1, 2024, every health insurance carrier that | ||||||
16 | offers an individual health plan that provides coverage for | ||||||
17 | prescription drugs shall ensure that at least 25% of | ||||||
18 | individual health care plans offered in each applicable | ||||||
19 | service area and at each level of coverage as defined in 42 | ||||||
20 | U.S.C. 18022 apply a flat-dollar copayment structure to the | ||||||
21 | entire drug benefit. If a health insurance carrier offers | ||||||
22 | fewer than 4 plans in a service area, then the health insurance | ||||||
23 | carrier shall ensure that one plan applies a flat-dollar |
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1 | copayment structure to the entire drug benefit. | ||||||
2 | (b) Beginning January 1, 2023, every health insurance | ||||||
3 | carrier that offers a group health plan that provides coverage | ||||||
4 | for prescription drugs shall offer at least one group health | ||||||
5 | plan in each applicable service area and at each level of | ||||||
6 | coverage as defined in 42 U.S.C. 18022 that applies a | ||||||
7 | flat-dollar copayment structure to the entire drug benefit. | ||||||
8 | Beginning January 1, 2024, every health insurance carrier that | ||||||
9 | offers a group health plan that provides coverage for | ||||||
10 | prescription drugs shall offer at least 2 group health plans | ||||||
11 | in each applicable service area and at each level of coverage | ||||||
12 | as defined in 42 U.S.C. 18022 that apply a flat-dollar | ||||||
13 | copayment structure to the entire drug benefit. | ||||||
14 | (c) The flat-dollar copayment structure for prescription | ||||||
15 | drugs under subsections (a) and (b) must be applied | ||||||
16 | pre-deductible and be reasonably graduated and proportionately | ||||||
17 | related in all tier levels such that the copayment structure | ||||||
18 | as a whole does not discriminate against or discourage the | ||||||
19 | enrollment of individuals with significant health care needs. | ||||||
20 | (d) A health insurance carrier that offers individual or | ||||||
21 | group health care plans shall clearly and appropriately name | ||||||
22 | the plans described in subsections (a) and (b) to aid in the | ||||||
23 | individual or group plan selection process. | ||||||
24 | (e) A health insurance carrier shall market plans | ||||||
25 | described in subsections (a) and (b) in the same manner as | ||||||
26 | plans not described in subsections (a) and (b). |
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1 | (f) The Department shall adopt rules necessary to | ||||||
2 | implement and enforce the provisions of this Section.
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3 | Section 99. Effective date. This Act takes effect January | ||||||
4 | 1, 2023.
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