Synopsis As Introduced Amends the Illinois Insurance Code, Health Maintenance Organization Act, Limited Health Service Organization Act, and Voluntary Health Services Plans Act. Provides that no insurer may issue a service provider contract that requires an optometrist or ophthalmologist to provide services or materials to the insurer's policyholders at a fee set by the insurer unless the services or materials are covered services or materials under the applicable policyholder agreement. Effective January 1, 2014.
Replaces everything after the enacting clause. Amends the Illinois Insurance Code. Provides that an insurer that is licensed to write accident and health insurance under the provisions of the Code shall be authorized to issue policies for exclusive provider organization plans (EPOs) for either group or individual policies, provided such policies otherwise conform to certain provisions. Sets forth provisions concerning enrollment, compliance, applicability, contracts, disclosure, restrictions on primary care physicians, and claims and appeals processes. Provides that any insurer that issues, delivers, amends, or renews an individual or group EPO in this State after the effective date of the amendatory Act shall not be obligated to comply with the provision concerning noninstitutional providers solely with respect to the EPO product. Provides that an administrator, or an insurer as applicable under the Code, may offer an EPO, provided that the administrator meets the requirements of the Code and the Director makes certain determinations. Makes other changes.