Full Text of SB3378 96th General Assembly
SB3378 96TH GENERAL ASSEMBLY
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96TH GENERAL ASSEMBLY
State of Illinois
2009 and 2010 SB3378
Introduced 2/10/2010, by Sen. William R. Haine SYNOPSIS AS INTRODUCED: |
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215 ILCS 5/370u new |
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215 ILCS 5/370v new |
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Amends the Illinois Insurance Code. Provides that every health insurer and health plan that provides incentives for insureds to seek services from a specific provider network must pay for out-of-network health care provided by out-of-network providers pursuant to the provisions concerning out-of-network providers. Sets forth the conditions under which an insured who utilizes an out-of-network provider shall not be charged a greater cost than if the service had been provided by a network provider. Provides that prior to the provision of any medical services by an out-of-network provider, the out-of-network provider shall give a written notice to the patient. Sets forth the circumstances under which a network hospital may enter into an exclusive arrangement with a provider or a group of providers with regard to the provision of certain medical services provided at a network hospital. Makes other changes.
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A BILL FOR
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SB3378 |
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LRB096 18501 RPM 33882 b |
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| AN ACT concerning insurance.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Illinois Insurance Code is amended by adding | 5 |
| Sections 370u and 370v as follows: | 6 |
| (215 ILCS 5/370u new) | 7 |
| Sec. 370u. Out-of-network health care provider. | 8 |
| (a) Every health insurer and health plan that provides | 9 |
| incentives for insureds, beneficiaries, or enrollees to seek | 10 |
| services from a specific provider network must pay for | 11 |
| out-of-network health care provided by out-of-network | 12 |
| providers pursuant to this Section. | 13 |
| (b) An insured, beneficiary, or enrollee who utilizes an | 14 |
| out-of-network provider with whom the insured, beneficiary, or | 15 |
| enrollee does not have a provider-patient relationship shall be | 16 |
| provided a covered service at no greater cost to the insured, | 17 |
| beneficiary, or enrollee than if the service had been provided | 18 |
| by a network provider if: | 19 |
| (1) a network hospital is utilized; | 20 |
| (2) the insurer or health plan has been contacted in | 21 |
| advance by the network hospital or the patient, | 22 |
| beneficiary, or enrollee regarding the services to be | 23 |
| provided; and |
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SB3378 |
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LRB096 18501 RPM 33882 b |
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| (3) due to any reason, in-network services are | 2 |
| unavailable. | 3 |
| (c) The insurer or plan shall pay the out-of-network | 4 |
| provider providing services in the network hospital the lesser | 5 |
| of the actual charged amount or usual and customary amount, | 6 |
| less any cost sharing that is the responsibility of the | 7 |
| insured, beneficiary, or enrollee for similar in-network | 8 |
| services. | 9 |
| (d) Prior to the provision of any medical services by an | 10 |
| out-of-network provider, a notice from the out-of-network | 11 |
| provider to the patient or prospective patient shall be given | 12 |
| and shall include: | 13 |
| (1) a written good faith estimate of the provider's | 14 |
| reasonably anticipated charges; | 15 |
| (2) a written statement of the provider's billing | 16 |
| policies and practices; and | 17 |
| (3) a written statement of the business names of all | 18 |
| insurers and health plans with which the provider | 19 |
| participates and is under contract and from whom the | 20 |
| provider accepts reimbursements as payment in full after | 21 |
| payment by the insured, beneficiary, or enrollee of any | 22 |
| deductibles, copayments, or coinsurance pursuant to the | 23 |
| insured's, beneficiary's, or enrollee's contract with the | 24 |
| insurer or health plan. | 25 |
| A network hospital shall require the out-of-network | 26 |
| provider to obtain the patient's or a prospective patient's |
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SB3378 |
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LRB096 18501 RPM 33882 b |
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| signature acknowledging receipt of the notice prior to the | 2 |
| provision of medical services. A copy of the signed | 3 |
| acknowledgement shall be kept in the patient's file. | 4 |
| (e) Except for applicable copayments, deductibles, or | 5 |
| coinsurance responsibilities of the insured or enrollee, a | 6 |
| healthcare provider shall not bill or otherwise attempt to | 7 |
| recover from the insured or enrollee the difference between the | 8 |
| healthcare provider's charge and the amount paid by the insurer | 9 |
| or plan as provided in this Section. | 10 |
| (f) This Section shall apply only to nonemergency services. | 11 |
| (215 ILCS 5/370v new) | 12 |
| Sec. 370v. Exclusive provider agreements. A network | 13 |
| hospital shall not enter into an exclusive arrangement with a | 14 |
| provider or a group of providers with regard to the provision | 15 |
| of certain medical services provided at the network hospital | 16 |
| unless: | 17 |
| (1) the provider or group of providers agrees to | 18 |
| contract with an insurer or health plan that has contracted | 19 |
| with the network hospital; or | 20 |
| (2) the provider or group of providers accepts as | 21 |
| payment in full, after payment by the insured, beneficiary, | 22 |
| or enrollee of any deductibles, copayments, or coinsurance | 23 |
| pursuant to the insured's, beneficiary's, or enrollee's | 24 |
| contract with the insurer or health plan, the usual and | 25 |
| customary amount from the insurer or health plan.
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