(215 ILCS 5/370m) (from Ch. 73, par. 982m)
Sec. 370m.
Program Requirements.
Each
administrator shall provide to each beneficiary of any program subject to
this Article a document which (1) sets forth those providers with which
agreements or arrangements have been made to provide health care services
to such beneficiary, a source for the beneficiary to contact regarding
changes in such providers and a clear description of any incentives for the
beneficiary to utilize such providers, (2) discloses the extent of coverage
as well as any limitations or exclusions of health care services under the
program, (3) clearly sets out the circumstances under which reimbursement
will be made to a beneficiary unable to utilize the services of a provider
with which an arrangement or agreement has been made, (4) a description of
the process for addressing a beneficiary complaint under the program, and
(5) discloses deductible and coinsurance amounts charged to any person
receiving health care services from such a provider.
(Source: P.A. 84-618.)
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