Illinois General Assembly - Full Text of SB0764
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Full Text of SB0764  103rd General Assembly



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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 Vision
5Care Plan Regulation Act.
6    Section 5. Definitions. As used in this Act:
7    "Covered materials" means materials for which
8reimbursement from the vision care plan is provided to an eye
9care provider by an enrollee's plan contract or for which a
10reimbursement would be available but for the application of
11the enrollee's contractual limitation of deductibles,
12copayments, or coinsurance. "Covered materials" includes lens
13treatment or coatings added to a spectacle lens if the base
14spectacle lens is a covered material.
15    "Covered services" means services for which reimbursement
16from the vision care plan is provided to an eye care provider
17by an enrollee's plan contract or for which a reimbursement
18would be available but for the application of the enrollee's
19contractual plan limitation of deductibles, copayments, or
20coinsurance regardless of how the benefits are listed in an
21enrollee's benefit plan's definition of benefits.
22    "Enrollee" means any individual enrolled in a vision care
23plan provided by a group, employer, or other entity that



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1purchases or supplies coverage for a vision care plan.
2    "Eye care provider" means a doctor of optometry licensed
3pursuant to the Illinois Optometric Practice Act of 1987 or a
4physician licensed to practice medicine in all of its branches
5pursuant to the Medical Practice Act of 1987.
6    "Materials" means ophthalmic devices, including, but not
7limited to:
8        (i) lenses, devices containing lenses, ophthalmic
9    frames, and other lens mounting apparatus, prisms, lens
10    treatments, and coatings;
11        (ii) contact lenses and prosthetic devices that
12    correct, relieve, or treat defects or abnormal conditions
13    of the human eye or adnexa; and
14        (iii) any devices that deliver medication or other
15    therapeutic treatment to the human eye or adnexa.
16    "Services" means the professional work performed by an eye
17care provider.
18    "Subcontractor" means any company, group, or third-party
19entity, including agents, servants, partially-owned or
20wholly-owned subsidiaries and controlled organizations, that
21the vision care plan contracts with to supply services or
22materials for an eye care provider or enrollee to fulfill the
23benefit plan of a vision care plan.
24    "Vision care organization" means an entity formed under
25the laws of this State or another state that issues a vision
26care plan.



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1    "Vision care plan" means a plan that creates, promotes,
2sells, provides, advertises, or administers an integrated or
3stand-alone plan that provides coverage for covered services
4and covered materials.
5    Section 10. Noncovered services.
6    (a) No vision care organization that issues, delivers,
7amends, or renews a vision care plan on or after the effective
8date of this Act shall issue a contract that requires an eye
9care provider, as a condition of participation in the vision
10care plan, to provide services or materials to an enrollee at a
11fee set by the vision care plan unless the services or
12materials are covered services or covered materials under the
13vision care plan. De minimis reimbursements shall not qualify
14a service or material as a covered service or a covered
15material under this Act.
16    (b) An eye care provider who chooses not to accept as
17payment an amount set by a vision care plan for services or
18materials that are not covered services or covered materials
19shall post, in a conspicuous place, a notice stating the
20following: "IMPORTANT: This eye care provider does not accept
21the fee schedule set by your insurer for vision care services
22and vision care materials that are not covered benefits under
23your plan and instead charges his or her normal fee for those
24services and materials. This eye care provider will provide
25you with an estimated cost for each noncovered service or



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1noncovered material upon your request."
2    Section 15. Fees for covered services and covered
3materials. Fees paid under a vision care plan for covered
4services and covered materials, regardless of the supplier or
5optical lab used to obtain materials, shall be reasonable and
6shall be clearly listed on a fee schedule that has been
7provided to the eye care provider before entering into a
8contract with the vision care organization. Fees paid for
9materials supplied by a non-network lab are not required to be
10identical to fees paid for materials ordered through a network
11lab, but non-network lab fees shall be reasonable.
12    Section 20. Misrepresentation.
13    (a) A vision care organization and its officers,
14directors, agents, and employees are subject to the provisions
15of Sections 149 and 154.6 of the Illinois Insurance Code.
16    (b) Incorporation by reference in this Act to specific
17laws of this State shall not be construed to exempt a vision
18care organization or vision care plan from otherwise
19applicable laws that are not specifically referenced in this
21    Section 25. Subcontractors. The provisions of this Act
22apply to any subcontractors used by a vision care organization
23to supply materials or services to an eye care provider or an



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1enrollee under a vision care plan.
2    Section 30. Suppliers; optical labs.
3    (a) A vision care organization may not restrict or limit
4an eye care provider's choice of suppliers of services,
5covered materials, or the use of an optical lab.
6    (b) A vision care organization may not require an eye care
7provider or patient to order or purchase covered materials,
8including, but not limited to, ophthalmic lenses, from any
9source owned by, controlled by, or in a common ownership
10scheme with the entity that issued the vision care plan.
11    (c) At the request of an enrollee, an eye care provider
12recommending an out-of-network source or supplier of vision
13care materials to an enrollee shall provide written notice to
14the enrollee stating:
15        (1) that the source or supplier is an out-of-network
16    laboratory or supplier of vision care materials; and
17        (2) any business interest that the eye care provider
18    has in the out-of-network source or supplier recommended
19    to the enrollee.
20    (d) An eye care provider is required to offer an enrollee
21in-network sources or suppliers of vision care materials at
22the enrollee's request.
23    Section 35. Modification of plan.
24    (a) The terms, fees, discounts, or reimbursement rates in



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1a vision care plan may not be changed during the term of the
2contract unless mutually agreed to in writing by the eye care
3provider and the vision care organization that issued the
4vision care plan. However, a change proposed to a vision care
5plan by the vision care organization shall become effective if
6the eye care provider fails to respond to the vision care
7organization within 60 days after receipt of notice of the
8proposed changes.
9    (b) The terms of a vision care plan contract that is
10amended, delivered, issued, or renewed after the effective
11date of this Act shall comply with the provisions of this Act.
12    Section 40. Prohibitions; medical plan preconditions.
13    (a) No vision care organization that issues, delivers,
14amends, or renews a vision care plan on or after the effective
15date of this Act shall issue a vision care plan contract that
17        (1) an eye care provider to contract with a plan that
18    offers supplemental or specialty health care services as a
19    condition of contracting with a plan that offers basic
20    health services; or
21        (2) an eye care provider to contract with a vision
22    care plan as a condition to participation in a medical
23    plan or in-network.
24    (b) A vision care plan may enter into an agreement with a
25health care plan to deliver routine vision care services that



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1are covered under the enrollee's plan.
2    (c) A vision care plan may act as a network regarding
3routine vision care services offered by a health care plan.
4    Section 900. The Consumer Fraud and Deceptive Business
5Practices Act is amended by adding Section 2BBBB as follows:
6    (815 ILCS 505/2BBBB new)
7    Sec. 2BBBB. Violations of the Vision Care Plan Regulation
8Act. Any person who violates the Vision Care Plan Regulation
9Act commits an unlawful practice within the meaning of this
11    Section 999. Effective date. This Act takes effect upon
12becoming law.