(215 ILCS 5/356z.3) (Text of Section before amendment by P.A. 103-718) Sec. 356z.3. Disclosure of limited benefit. An insurer that
issues,
delivers,
amends, or
renews an individual or group policy of accident and health insurance in this
State after the
effective date of this amendatory Act of the 92nd General Assembly and
arranges, contracts
with, or administers contracts with a provider whereby beneficiaries are
provided an incentive to
use the services of such provider must include the following disclosure on its
contracts and
evidences of coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN
NON-PARTICIPATING PROVIDERS ARE USED. You should be aware that when you elect
to
utilize the services of a non-participating provider for a covered service in non-emergency
situations, benefit payments to such non-participating provider are not based upon the amount
billed. The basis of your benefit payment will be determined according to your policy's fee
schedule, usual and customary charge (which is determined by comparing charges for similar
services adjusted to the geographical area where the services are performed), or other method as
defined by the policy. YOU CAN EXPECT TO PAY MORE THAN THE COINSURANCE
AMOUNT DEFINED IN THE POLICY AFTER THE PLAN HAS PAID ITS REQUIRED
PORTION. Non-participating providers may bill members for any amount up to the
billed
charge after the plan has paid its portion of the bill, except as provided in Section 356z.3a of the Illinois Insurance Code for covered services received at a participating health care facility from a nonparticipating provider that are: (a) ancillary services, (b) items or services furnished as a result of unforeseen, urgent medical needs that arise at the time the item or service is furnished, or (c) items or services received when the facility or the non-participating provider fails to satisfy the notice and consent criteria specified under Section 356z.3a. Participating providers
have agreed to accept
discounted payments for services with no additional billing to the member other
than co-insurance and deductible amounts. You may obtain further information
about the
participating
status of professional providers and information on out-of-pocket expenses by
calling the toll
free telephone number on your identification card.".(Source: P.A. 102-901, eff. 1-1-23.) (Text of Section after amendment by P.A. 103-718) Sec. 356z.3. Disclosure of limited benefit. An insurer that issues, delivers, amends, or renews an individual or group policy of accident and health insurance in this State after the effective date of this amendatory Act of the 92nd General Assembly and arranges, contracts with, or administers contracts with a provider whereby beneficiaries are provided an incentive to use the services of such provider must include the following disclosure on its contracts and evidences of coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN NON-PARTICIPATING PROVIDERS ARE USED. YOU CAN EXPECT TO PAY MORE THAN THE COST-SHARING AMOUNT DEFINED IN THE POLICY IN NON-EMERGENCY SITUATIONS. Except in limited situations governed by the federal No Surprises Act or Section 356z.3a of the Illinois Insurance Code (215 ILCS 5/356z.3a), non-participating providers furnishing non-emergency services may bill members for any amount up to the billed charge after the plan has paid its portion of the bill. If you elect to use a non-participating provider, plan benefit payments will be determined according to your policy's fee schedule, usual and customary charge (which is determined by comparing charges for similar services adjusted to the geographical area where the services are performed), or other method as defined by the policy. Participating providers have agreed to ONLY bill members the cost-sharing amounts. You may obtain further information about the participating status of professional providers and information on out-of-pocket expenses by calling the toll-free telephone number on your identification card.".(Source: P.A. 102-901, eff. 1-1-23; 103-718, eff. 1-1-25.) |