Full Text of SB3735 101st General Assembly
SB3735 101ST GENERAL ASSEMBLY |
| | 101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020 SB3735 Introduced 2/14/2020, by Sen. Andy Manar SYNOPSIS AS INTRODUCED: |
| 215 ILCS 5/370i | from Ch. 73, par. 982i |
|
Amends the Illinois Insurance Code. Provides that an insurer shall apply any third-party payment, financial assistance, discount, patient voucher, or other reduction in out-of-pocket expenses made by or on behalf of an insured for prescription drugs toward the insured's deductible, copay, cost-sharing responsibility, or out-of-pocket maximum associated with the insured's policy. Effective January 1, 2021.
|
| |
| | A BILL FOR |
|
| | | SB3735 | | LRB101 19649 BMS 69137 b |
|
| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Insurance Code is amended by | 5 | | changing Section 370i as follows:
| 6 | | (215 ILCS 5/370i) (from Ch. 73, par. 982i)
| 7 | | Sec. 370i.
Policies, agreements or arrangements with | 8 | | incentives or
limits on reimbursement authorized.
| 9 | | (a) Policies, agreements or arrangements issued under this | 10 | | Article may
not contain terms or conditions that would operate | 11 | | unreasonably to restrict
the access and availability of health | 12 | | care services for the insured.
| 13 | | (b) An insurer or administrator may:
| 14 | | (1) enter into agreements with certain providers of its | 15 | | choice relating
to health care services which may be | 16 | | rendered to insureds or beneficiaries
of the insurer or | 17 | | administrator, including
agreements relating to the | 18 | | amounts to be charged the insureds or
beneficiaries for | 19 | | services rendered;
| 20 | | (2) issue or administer programs, policies or | 21 | | subscriber contracts in
this State that include incentives | 22 | | for the insured or beneficiary to
utilize the services of a | 23 | | provider which has entered into an agreement with
the |
| | | SB3735 | - 2 - | LRB101 19649 BMS 69137 b |
|
| 1 | | insurer or administrator pursuant to paragraph (1) above.
| 2 | | (c) After the effective date of this amendatory Act of the | 3 | | 92nd General
Assembly, any insurer
that arranges, contracts | 4 | | with, or administers contracts with a provider whereby
| 5 | | beneficiaries are
provided an incentive to use the services of | 6 | | such provider must include the
following disclosure
on its | 7 | | contracts and evidences of coverage: "WARNING, LIMITED | 8 | | BENEFITS WILL
BE
PAID WHEN NON-PARTICIPATING PROVIDERS ARE | 9 | | USED. You should be aware that
when you elect to utilize the | 10 | | services of a non-participating provider for a
covered service | 11 | | in
non-emergency situations, benefit payments to such | 12 | | non-participating provider
are not based
upon the amount | 13 | | billed. The basis of your benefit payment will be determined
| 14 | | according to your
policy's fee schedule, usual and customary | 15 | | charge (which is determined by
comparing charges
for similar | 16 | | services adjusted to the geographical area where the services | 17 | | are
performed), or other
method as defined by the policy. YOU | 18 | | CAN EXPECT TO PAY MORE THAN THE
COINSURANCE AMOUNT DEFINED IN | 19 | | THE POLICY AFTER THE PLAN HAS PAID ITS
REQUIRED PORTION. | 20 | | Non-participating providers may bill members for any amount
up | 21 | | to
the billed charge after the plan has paid its portion of the | 22 | | bill.
Participating providers have
agreed to accept discounted | 23 | | payments for services with no additional billing to
the member | 24 | | other
than co-insurance and deductible amounts. You may obtain | 25 | | further information
about the
participating status of | 26 | | professional providers and information on out-of-pocket
|
| | | SB3735 | - 3 - | LRB101 19649 BMS 69137 b |
|
| 1 | | expenses by
calling the toll free telephone number on your | 2 | | identification card.".
| 3 | | (d) Notwithstanding any other provision in this Article, an | 4 | | insurer shall apply any third-party payment, financial | 5 | | assistance, discount, patient voucher, or other reduction in | 6 | | out-of-pocket expenses made by or on behalf of an insured for | 7 | | prescription drugs toward the insured's deductible, copay, | 8 | | cost-sharing responsibility, or out-of-pocket maximum | 9 | | associated with the insured's policy. | 10 | | (Source: P.A. 92-579, eff. 1-1-03.)
| 11 | | Section 99. Effective date. This Act takes effect January | 12 | | 1, 2021.
|
|