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90_SB1692
5 ILCS 375/6.12 new
55 ILCS 5/5-1069.6 new
65 ILCS 5/10-4-2.6 new
105 ILCS 5/10-22.3g new
215 ILCS 5/364.2 new
215 ILCS 125/5-3.7 new
215 ILCS 130/4002.2 new
215 ILCS 165/15.10-1 new
Amends the Illinois Insurance Code, the State Employees
Group Insurance Act of 1971, the Counties Code, the Illinois
Municipal Code, and various insurance regulatory Acts.
Provides that the coverage for eye care benefits under those
Acts may not discriminate against optometrists with respect
to the provision of services or payment for services.
LRB9009785JSmg
LRB9009785JSmg
1 AN ACT concerning patient access to eye care, amending
2 named Acts.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The State Employees Group Insurance Act of
6 1971 is amended by adding Section 6.12 as follows:
7 (5 ILCS 375/6.12 new)
8 Sec. 6.12. Eye care benefits. The program of health
9 benefits is subject to the provisions of Section 364.2 of the
10 Illinois Insurance Code.
11 Section 10. The Counties Code is amended by adding
12 Section 5-1069.6 as follows:
13 (55 ILCS 5/5-1069.6 new)
14 Sec. 5-1069.6. Eye care benefits. All counties,
15 including home rule counties are subject to the provisions of
16 Section 364.2 of the Illinois Insurance Code. The
17 requirement under this Section that health care benefits
18 provided by counties comply with Section 364.2 of the
19 Illinois Insurance Code is an exclusive power and function of
20 the State and is denial and limitation of home rule county
21 powers under Article VII, Section 6, subsection (h) of the
22 Illinois Constitution.
23 Section 15. The Illinois Municipal Code is amended by
24 adding Section 10-4-2.6 as follows:
25 (65 ILCS 5/10-4-2.6 new)
26 Sec. 10-4-2.6. Eye care benefits. The corporate
27 authorities of all municipalities are subject to the
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1 provisions of Section 364.2 of the Illinois Insurance Code.
2 The requirement under this Section that health care benefits
3 provided by municipalities comply with Section 364.2 of the
4 Illinois Insurance Code is an exclusive power and function of
5 the State and is a denial and limitation of home rule
6 municipality powers under Article VII, Section 6, subsection
7 (h) of the Illinois Constitution.
8 Section 20. The School Code is amended by adding Section
9 10-22.3g as follows:
10 (105 ILCS 5/10-22.3g new)
11 Sec. 10-22.3g. Eye care benefits. Insurance protection
12 and benefits for employees are subject to the provisions of
13 Section 364.2 of the Illinois Insurance Code.
14 Section 25. The Illinois Insurance Code is amended by
15 adding Section 364.2 as follows:
16 (215 ILCS 5/364.2 new)
17 Sec. 364.2. Eye care benefits.
18 (a) As used in this Section:
19 "Covered person" means an insured, an individual enrolled
20 in a health benefit plan, or an eligible dependent thereof.
21 "Covered services" means those health care services that
22 a health care insurer is obligated to pay for or provide to a
23 covered person under a health benefit plan.
24 "Eye care" means those health care services and materials
25 related to the care of the eye and related structures and
26 vision care services that a health care insurer is obligated
27 to pay for or provide to covered persons under the health
28 benefit plan.
29 "Eye care provider" means a therapeutically certified
30 optometrist licensed under the Illinois Optometric Practice
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1 Act of 1987 or an Ophthalmologist licensed to practice
2 medicine in all its branches.
3 (b) A group or individual policy of accident and health
4 insurance or a managed care plan, as defined in Section 356r,
5 that provides eye care benefits and is amended, delivered,
6 issued or renewed after the effective date of this amendatory
7 Act of 1998 shall:
8 (1) not set professional fees or reimbursement for
9 the same eye care services as defined by Current
10 Procedural Terminology codes established by the American
11 Medical Association in a manner that discriminates
12 against an individual eye care provider or a class of eye
13 care providers;
14 (2) not preclude a covered person who seeks eye
15 care from obtaining the service directly from a provider
16 on the health benefit plan provider panel who is licensed
17 to provide eye care;
18 (3) not promote or recommend any class of providers
19 to the detriment of any other class of providers for the
20 same eye care service;
21 (4) ensure that all eye care providers on a health
22 benefit plan provider panel are included on any publicly
23 accessible list of participating providers for the plan;
24 (5) allow each eye care provider on a health
25 benefit plan provider panel, without discrimination
26 between classes of eye care providers, to furnish covered
27 eye care services to covered persons to the extent
28 permitted by the provider's license;
29 (6) not require any eye care provider to hold
30 hospital privileges or impose any other condition or
31 restriction for initial admittance to a provider panel
32 not necessary for the delivery of eye care upon the
33 providers that would have the effect of excluding an
34 individual eye care provider or class of eye care
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1 providers from participation on the health benefit plan;
2 (7) include eye care providers on the health
3 benefit plan provider panel in a manner that ensures plan
4 enrollees timely access and geographic access;
5 (8) not restrict the patient from seeking emergency
6 treatment from any eye care provider for a condition of
7 the eye that would lead an ordinary person to believe
8 that such an injury could result in loss of sight. The
9 health benefit plan shall provide coverage at the same
10 level in this instance for both participating and
11 non-participating eye care providers.
12 (c) Nothing in this Section shall preclude a covered
13 person from receiving eye care or other covered services from
14 the covered person's personal physician in accordance with
15 the terms of the health benefit plan if the patient so
16 desires.
17 (d) A person adversely affected by a violation of this
18 Section by a health care insurer may bring an action in a
19 court of competent jurisdiction for injunctive relief against
20 the insurer and, upon prevailing, in addition to any
21 injunctive relief that may be granted, shall recover from the
22 insurer damages of not more than $5,000 and attorney's fees
23 and costs.
24 (e) Nothing in this Section requires a health benefit
25 plan to include eye care benefits.
26 Section 30. The Health Maintenance Organization Act is
27 amended by adding Section 5-3.7 as follows:
28 (215 ILCS 125/5-3.7 new)
29 Sec. 5-3.7. Eye care benefits. Health maintenance
30 organizations are subject to the provisions of Section 364.2
31 of the Illinois Insurance Code.
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1 Section 35. The Limited Health Service Organization Act
2 is amended by adding Section 4002.2 as follows:
3 (215 ILCS 130/4002.2 new)
4 Sec. 4002.2. Eye care benefits. Limited health service
5 organizations are subject to Section 364.2 of the Illinois
6 Insurance Code.
7 Section 40. The Voluntary Health Services Plans Act is
8 amended by adding Section 15.10-1 as follows:
9 (215 ILCS 165/15.10-1 new)
10 Sec. 15.10-1. Eye care benefits. A health service plan
11 corporation is subject to the provisions of Section 364.2 of
12 the Illinois Insurance Code.