Full Text of SB2086 102nd General Assembly
SB2086 102ND GENERAL ASSEMBLY
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
Introduced 2/26/2021, by Sen. Cristina Castro
SYNOPSIS AS INTRODUCED:
815 ILCS 505/2WWW new
Creates the Vision Care Plan Regulation Act. Provides that no vision
care organization may issue a contract that requires an eye care provider
to provide services or materials to an enrollee at a fee set by the vision
care plan unless the services or materials are covered under the vision
care plan. Requires fees for covered services and materials to be
reasonable and clearly listed on a fee schedule provided to the eye care
provider. Prohibits a vision care organization from misrepresenting the
benefits of a vision care plan as a means of selling coverage or
communicating the benefit coverage to enrollees. Provides that the Act
applies to any subcontractors used by a vision care organization to supply
materials or services to an eye care provider or an enrollee under a vision
care plan. Prohibits a vision care organization from restricting an eye
care provider's freedom to choose suppliers, materials, or labs or from
requiring an eye care provider to purchase materials from a source owned by
the entity that issued the vision care plan. Provides that the terms, fees,
discounts, or reimbursement rates in a vision care plan may not be changed
unless mutually agreed to in writing by the eye care provider and the
vision care organization. Provides that a person or entity adversely
affected by a violation of the Act by the vision care organization may seek
injunctive relief and shall recover attorney's fees and costs from the
vision care organization upon prevailing. Amends the Consumer Fraud and
Deceptive Business Practices Act to provide that any person who violates
the Vision Care Plan Regulation Act commits an unlawful practice.
A BILL FOR
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AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
This Act may be cited as the
Care Plan Regulation Act.
As used in this Act:
"Covered materials" means materials for which
reimbursement from the vision care plan is provided to an eye
care provider by an enrollee's plan contract or for which a
reimbursement would be available but for the application of
the enrollee's contractual limitation of deductibles,
copayments, or coinsurance.
"Covered services" means services for which reimbursement
from the vision care plan is provided to an eye care provider
by an enrollee's plan contract or for which a reimbursement
would be available but for the application of the enrollee's
contractual plan limitation of deductibles, copayments, or
coinsurance regardless of how the benefits are listed in an
enrollee's benefit plan's definition of benefits.
"Enrollee" means any individual enrolled in a vision care
plan provided by a group, employer, or other entity that
purchases or supplies coverage for a vision care plan.
"Eye care provider" means a doctor of optometry licensed
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pursuant to the Illinois Optometric Practice Act of 1987 or a
physician licensed to practice medicine in all of its branches
pursuant to the Medical Practice Act of 1987.
"Materials" means ophthalmic devices, including, but not
(i) lenses, devices containing lenses, artificial
intraocular lenses, ophthalmic frames, and other lens
mounting apparatus, prisms, lens treatments, and coatings;
(ii) contact lenses and prosthetic devices that
correct, relieve, or treat defects or abnormal conditions
of the human eye or adnexa; and
(iii) any devices that deliver medication or other
therapeutic treatment to the human eye or adnexa.
"Services" means the professional work performed by an eye
"Subcontractor" means any company, group, or third-party
entity, including agents, servants, partially-owned or
wholly-owned subsidiaries and controlled organizations, that
the vision care plan contracts with to supply services or
materials for an eye care provider or enrollee to fulfill the
benefit plan of a vision care plan.
"Vision care organization" means an entity formed under
the laws of this State or another state that issues a vision
"Vision care plan" means a plan that creates, promotes,
sells, provides, advertises, or administers an integrated or
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stand-alone plan that provides coverage for covered services
and covered materials.
No vision care
organization that issues, delivers, amends, or renews a vision
care plan on or after the effective date of this amendatory Act
of the 102nd General Assembly shall issue a contract that
requires an eye care provider to provide services or materials
to an enrollee at a fee set by the vision care plan unless the
services or materials are covered services or covered
materials under the vision care plan. De minimis
reimbursements shall not qualify a service or material as a
covered service or a covered material under this Act.
Fees for covered services and covered
Fees paid under a vision care plan for covered
services and covered materials, regardless of the supplier or
optical lab used to obtain materials, shall be reasonable and
shall be clearly listed on a fee schedule that has been
provided to the eye care provider before entering into a
contract with the vision care organization.
A vision care organization
shall not misrepresent the benefits of a vision care plan to
groups, employers, or enrollees as a means of selling coverage
or communicating the benefit coverage to enrollees.
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The provisions of this Act
apply to any subcontractors used by a vision care organization
to supply materials or services to an eye care provider or an
enrollee under a vision care plan.
Suppliers; optical labs.
(a) A vision care organization may not restrict, limit, or
disincentivize, either directly or indirectly, an eye care
provider's freedom to choose suppliers of services or
materials or the use of an optical lab.
(b) A vision care organization may not require an eye care
provider or patient to order or purchase covered materials,
including, but not limited to, ophthalmic lenses, from any
source owned by, controlled by, or in a common ownership
scheme with the entity that issued the vision care plan.
Modification of plan.
The terms, fees,
discounts, or reimbursement rates in a vision care plan may
not be changed unless mutually agreed to in writing by the eye
care provider and the vision care organization that issued the
vision care plan.
A person or entity
adversely affected by a violation of this Act by the vision
care organization that issued a vision care plan may bring an
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action in a court of competent jurisdiction for injunctive
relief and, upon prevailing, in addition to any injunctive
relief that may be granted, shall recover attorney's fees and
costs from the vision care organization.
The Consumer Fraud and Deceptive Business
Practices Act is amended by adding Section 2WWW as follows:
(815 ILCS 505/2WWW new)
Violations of the Vision Care Plan Regulation
Any person who violates the Vision Care Plan Regulation
Act commits an unlawful practice within the meaning of this