HB2072enr 103RD GENERAL ASSEMBLY

  
  
  

 


 
HB2072 EnrolledLRB103 04625 BMS 51012 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by
5changing Section 355.4 and by adding Section 355.5 as follows:
 
6    (215 ILCS 5/355.4)
7    Sec. 355.4. Provider notification of network plan changes.
8    (a) As used in this Section:
9    "Contracting entity" means any person or company that
10enters into direct contracts with providers for the delivery
11of dental services in the ordinary course of business,
12including a third-party administrator and a dental carrier.
13    "Dental carrier" means a dental insurance company, dental
14service corporation, dental plan organization authorized to
15provide dental benefits, or a health insurance plan that
16includes coverage for dental services.
17    (b) No dental carrier may automatically enroll a provider
18in a leased network without allowing any provider that is part
19of the dental carrier's provider network to choose to not
20participate by opting out.
21    (c) Any contract entered into or renewed on or after the
22effective date of this amendatory Act of the 103rd General
23Assembly this amendatory Act of the 99th General Assembly that

 

 

HB2072 Enrolled- 2 -LRB103 04625 BMS 51012 b

1allows the rights and obligations of the contract to be
2assigned or leased to another insurer shall provide for notice
3that informs each provider in writing via certified mail 60
4days before any scheduled assignment or lease of the network
5to which the provider is a contracted provider. To be in
6compliance with this Section, the notification must include
7all contract terms, a policy manual, a fee schedule, and a
8statement that the provider has the right to choose not to
9participate in third-party access of that assignment or lease
10within 30 days after the assignment or lease to the
11contracting dentist.
12    (d) A dental carrier that leases or assigns its network
13shall not cancel a network participating dentist's contractual
14relationship or otherwise penalize a network participating
15dentist in any way based on whether or not the dentist accepts
16the terms of the assignment or lease. Before accepting the
17terms of an assignment or lease agreement as described in this
18Section, any provider who receives notification of an
19impending assignment or lease must be given the option to
20contract directly with the entities proposing to gain access
21to the provider's network.
22    (e) The provisions of this Section do not apply:
23        (1) if access to a provider network contract is
24    granted to a dental carrier or an entity operating in
25    accordance with the same brand licensee program as the
26    contracting entity; or

 

 

HB2072 Enrolled- 3 -LRB103 04625 BMS 51012 b

1        (2) to a provider network contract for dental services
2    provided to beneficiaries of the State employee group
3    health insurance program or the medical assistance program
4    under the Illinois Public Aid Code.
5(Source: P.A. 99-568, eff. 7-15-16.)
 
6    (215 ILCS 5/355.5 new)
7    Sec. 355.5. Dental coverage reimbursement; prohibitions.
8No insurer, dental service plan corporation, professional
9service corporation, insurance network leasing company, or any
10company that amends, delivers, issues, or renews an individual
11or group policy of accident and health insurance on or after
12the effective date of this amendatory Act of the 103rd General
13Assembly shall require a dental care provider to incur a fee to
14access and obtain payment or reimbursement for services
15provided. A dental plan carrier shall provide a dental care
16provider with 100% of the contracted amount of the payment or
17reimbursement. Fees incurred directly by a dental care
18provider from third parties related to transmitting an
19automated clearing house network claim, transaction
20management, data management, or portal services and other fees
21charged by third parties that are not in the control of the
22dental plan carrier shall not be prohibited by this Section.