Full Text of HB1525 094th General Assembly
HB1525 94TH GENERAL ASSEMBLY
|
|
|
94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006 HB1525
Introduced 2/10/2005, by Rep. Linda Chapa LaVia - Marlow H. Colvin - Michael P. McAuliffe - Jack McGuire - Elaine Nekritz SYNOPSIS AS INTRODUCED: |
|
|
Amends the Consumer Fraud and Deceptive Business Practices Act. Provides that it is an unlawful practice if an entity which sells health-related cash discount cards fails to register as an administrator of a preferred provider organization with the Illinois Division of Insurance. Prohibits a health-related discount card organization from engaging in specific activities. Provides that it is an unlawful practice if certain disclosures are not made in writing to a prospective member before purchase. Provides that it is an unlawful practice if the health-related cash discount card organization does not provide the customer a right to cancel, with full reimbursement of all membership and enrollment fees, within 30 days after the date of purchase. Provides that it is an unlawful practice if a health-related cash discount card does not safeguard protected health information.
|
| |
|
|
A BILL FOR
|
|
|
|
|
HB1525 |
|
LRB094 07965 RXD 38146 b |
|
| 1 |
| AN ACT concerning health.
| 2 |
| Be it enacted by the People of the State of Illinois,
| 3 |
| represented in the General Assembly:
| 4 |
| Section 5. The Consumer Fraud and Deceptive Business | 5 |
| Practices Act is amended by changing Section 2B.3 as follows:
| 6 |
| (815 ILCS 505/2B.3)
| 7 |
| Sec. 2B.3. Health-related cash discount cards.
| 8 |
| (a) Deceptive sale or promotion of health-related cash | 9 |
| discount
cards. It is an unlawful
practice for any person to | 10 |
| sell, market, promote, advertise, or otherwise
distribute any | 11 |
| card or
other purchasing mechanism or device that purports to
| 12 |
| offer discounts or access to discounts from health care | 13 |
| providers in health
related purchases if:
| 14 |
| (1) the card or other purchasing mechanism or device | 15 |
| does not
expressly provide in bold and prominent type that | 16 |
| the discounts are not
insurance;
| 17 |
| (2) the discounts are not specifically authorized by a
| 18 |
| contract with each health care provider listed in | 19 |
| conjunction with
the card or other purchasing mechanism or | 20 |
| device as outlined in subsection (e) of this Section ; or
| 21 |
| (3) the discounts or access to discounts offered or the | 22 |
| range of
discounts or access to the range of discounts | 23 |
| offered are misleading,
deceptive or fraudulent, | 24 |
| regardless of the literal wording used.
| 25 |
| (b) Registration. It is an unlawful practice if an entity | 26 |
| which sells health-related cash discount cards fails to | 27 |
| register as an administrator of a preferred provider | 28 |
| organization with the Illinois Division of Insurance as | 29 |
| required by Article XX 1/2 of the Illinois Insurance Code.
| 30 |
| (c) Prohibited activities of a health-related cash | 31 |
| discount card organization.
| 32 |
| (1) It is unlawful practice for a health-related cash |
|
|
|
HB1525 |
- 2 - |
LRB094 07965 RXD 38146 b |
|
| 1 |
| discount card organization to:
| 2 |
| (A) Use in its advertisements, marketing material, | 3 |
| brochures, and discount cards the term "insurance" | 4 |
| except as otherwise provided in this Section; | 5 |
| (B) Use in its advertisements, marketing material, | 6 |
| brochures, and discount cards the terms "health plan", | 7 |
| "coverage", "copay", "copayments", "preexisting | 8 |
| conditions", "guaranteed issue", "premium", | 9 |
| "enrollment", "PPO", "preferred provider | 10 |
| organization", or other terms that could reasonably | 11 |
| mislead a person into believing the health-related | 12 |
| cash discount card was health insurance;
| 13 |
| (C) Have restrictions on free access to plan | 14 |
| providers, including, but not limited to, waiting | 15 |
| periods and notification periods; or
| 16 |
| (D) Pay providers any fees for medical services.
| 17 |
| (2) It is an unlawful practice for a health-related | 18 |
| cash discount card organization to collect or accept money | 19 |
| from a member for payment to a provider for specific | 20 |
| medical services furnished or to be furnished to the | 21 |
| member.
| 22 |
| (3) It is an unlawful practice if a health-related cash | 23 |
| discount card organization offers for sale a type of | 24 |
| service without having a provider available within a | 25 |
| prospective customer's service area (area defined by | 26 |
| consumer's zip code, or within 50 miles thereof) that is | 27 |
| contractually bound to honor the discount card.
| 28 |
| (d) Prepayment disclosures.
| 29 |
| (1) It is an unlawful practice if the following | 30 |
| disclosures are not made in writing to any prospective | 31 |
| member before purchase and are not on the first page of any | 32 |
| advertisements, marketing materials, or brochures relating | 33 |
| to a health-related cash discount card:
| 34 |
| (A) That the plan provides discounts at certain | 35 |
| health care providers for medical services.
| 36 |
| (B) That the plan does not make payments directly |
|
|
|
HB1525 |
- 3 - |
LRB094 07965 RXD 38146 b |
|
| 1 |
| to the providers of medical services.
| 2 |
| (C) That the plan member is obligated to pay for | 3 |
| all health care services but will receive a discount | 4 |
| from those health care providers who have contracted | 5 |
| with the discount plan organization.
| 6 |
| (D) The corporate name, locations, and toll-free | 7 |
| customer service number of the licensed health-related | 8 |
| cash discount card organization.
| 9 |
| The disclosures must be printed in not less than 12-point | 10 |
| font or no smaller than the largest font on the page if larger | 11 |
| than 12-point font.
| 12 |
| (2) It is an unlawful practice if a health-related cash | 13 |
| discount card organization does not provide each | 14 |
| prospective customer before purchase:
| 15 |
| (A) A written list for each type of service offered | 16 |
| in conjunction with the health-related cash discount | 17 |
| card containing the name, address, and phone number of | 18 |
| the closest 25 health care providers in the prospective | 19 |
| customer's service area (area defined by consumer's | 20 |
| zip code, or within 50 miles thereof) that are | 21 |
| contractually bound to honor the discount card. The | 22 |
| written list of providers may be provided | 23 |
| electronically if requested in that format by the | 24 |
| prospective customer.
| 25 |
| (B) For each provider disclosed in subparagraph | 26 |
| (A) of paragraph (2) of this subsection, the | 27 |
| health-related cash discount card organization must | 28 |
| provide the prospective member with the negotiated fee | 29 |
| schedule for the most common health care procedures, | 30 |
| and other comparable rate information which supports | 31 |
| the discount claims of the discount plan organization. | 32 |
| The fee schedules may be provided electronically if | 33 |
| requested in that format by the prospective customer.
| 34 |
| (e) Right to cancel. It is an unlawful practice if the | 35 |
| health-related cash discount card organization does not | 36 |
| provide the customer a right to cancel, with full reimbursement |
|
|
|
HB1525 |
- 4 - |
LRB094 07965 RXD 38146 b |
|
| 1 |
| of all membership and enrollment fees, within 30 days after the | 2 |
| date of purchase.
| 3 |
| (f) Provider agreements.
| 4 |
| (1) The contract required in paragraph (2) of | 5 |
| subsection (a) of this Section may be entered into directly | 6 |
| by the provider or by a provider network to which the | 7 |
| provider belongs.
| 8 |
| (2) It is an unlawful practice if a provider agreement | 9 |
| does not include the following:
| 10 |
| (A) A list of the services and products to be | 11 |
| provided at a discount.
| 12 |
| (B) The amount or amounts of the discounts or, | 13 |
| alternatively, a fee schedule which reflects the | 14 |
| provider's discounted rates.
| 15 |
| (C) That the provider will not charge members more | 16 |
| than the discounted rates.
| 17 |
| (3) It is an unlawful practice if a provider agreement | 18 |
| between a health-related cash discount card organization | 19 |
| and a provider network does not require that the provider | 20 |
| network have written agreements with its providers which:
| 21 |
| (A) Contain the terms described in paragraph (2) of | 22 |
| this subsection.
| 23 |
| (B) Authorize the provider network to contract | 24 |
| with the health-related cash discount card | 25 |
| organization on behalf of the provider.
| 26 |
| (C) Require the network to maintain an up-to-date | 27 |
| list of its contracted providers and to provide that | 28 |
| list on a monthly basis to the health-related cash | 29 |
| discount card organization.
| 30 |
| (4) It is an unlawful practice if the health-related | 31 |
| cash discount card organization does not maintain a copy of | 32 |
| each active provider agreement.
| 33 |
| (g) Provider name listing. It is an unlawful practice if | 34 |
| each health-related cash discount card organization does not | 35 |
| maintain an up-to-date list of the names and addresses of the | 36 |
| providers with which it has contracted, available to consumers |
|
|
|
HB1525 |
- 5 - |
LRB094 07965 RXD 38146 b |
|
| 1 |
| by a toll-free customer service number and on an Internet | 2 |
| website page, and the web address and phone number shall be | 3 |
| prominently displayed on all its advertisements, marketing | 4 |
| materials, brochures, and discount cards. This subsection | 5 |
| applies to those providers with whom the health-related cash | 6 |
| discount card organization has contracted directly, as well as | 7 |
| those who are members of a provider network with which the | 8 |
| health-related cash discount card organization has contracted.
| 9 |
| (h) Bundling health-related cash discount cards with other | 10 |
| products. It is an unlawful practice if a marketer or | 11 |
| health-related cash discount card organization sells a | 12 |
| health-related cash discount card together with any other | 13 |
| product and the fees for each individual product are not | 14 |
| provided in writing to the member and itemized. If any of the | 15 |
| additional products are insurance products, they must be | 16 |
| itemized as such.
| 17 |
| (i) Protection of personal health information. It is an | 18 |
| unlawful practice if a health-related cash discount card does | 19 |
| not safeguard protected health information as defined in the | 20 |
| Health Insurance Portability and Accountability Act of 1996, in | 21 |
| a manner consistent with the intent of the rule with regard to | 22 |
| consent, authorization, notice, public policy, permissible | 23 |
| uses and disclosures, and by limiting disclosure to the minimum | 24 |
| necessary.
| 25 |
| (j) Insurance products or services.
| 26 |
| (1) It is an unlawful practice if a health-related cash | 27 |
| discount card organization provides a product or service | 28 |
| which would be classified as insurance under the Illinois | 29 |
| Insurance Code to its members and does not comply with all | 30 |
| applicable provisions under State law.
| 31 |
| (2) It is an unlawful practice if a health-related cash | 32 |
| discount card organization provides an insurance product | 33 |
| or service as outlined in paragraph (1) of this subsection, | 34 |
| and the company does not disclose in writing to a | 35 |
| prospective member before purchase the name, address, and | 36 |
| toll-free customer service number of the insurance company |
|
|
|
HB1525 |
- 6 - |
LRB094 07965 RXD 38146 b |
|
| 1 |
| providing the insurance product or service.
| 2 |
| (k) Discount claims. It is an unlawful practice if a | 3 |
| health-related cash discount card organization does not adhere | 4 |
| to all of the Retail Advertising provisions in Title 14, Part | 5 |
| 470 of the Illinois Administrative Code. It is an unlawful | 6 |
| practice for a health-related discount card organization to | 7 |
| state or imply that any products or services are being offered | 8 |
| for sale at a range of prices or at a range of percentage or | 9 |
| fractional discounts unless the highest price or lowest | 10 |
| discount in the range is clearly and conspicuously disclosed in | 11 |
| the advertisement and a reasonable number of these products or | 12 |
| services in the advertisement are offered with at least the | 13 |
| largest advertised discount. If a discount card organization | 14 |
| advertises a range of discounts, at least one provider within a | 15 |
| prospective member's geographic area must provide services at | 16 |
| the highest end of the range advertised.
| 17 |
| (l) Fiduciary and bonding requirements. It is an unlawful | 18 |
| practice for a licensed health-related cash discount card | 19 |
| organization not to: (1) establish and maintain a fiduciary | 20 |
| account, separate and apart from any and all other accounts, | 21 |
| for use in protecting plan members; or (2) post or cause to be | 22 |
| posted a bond of indemnity in an amount equal to not less that | 23 |
| $50,000. If a bond of indemnity is posted, it shall be held by | 24 |
| the Director of Insurance for the benefit of plan members under | 25 |
| the programs subject to this Section. An administrator who | 26 |
| operates more than one such program may establish and maintain | 27 |
| a separate fiduciary account or bond of indemnity for each such | 28 |
| program or may operate and maintain a consolidated fiduciary | 29 |
| account or bond of indemnity for all such programs.
| 30 |
| (Source: P.A. 92-296, eff. 1-1-02.)
|
|