HMO OFFER POINT OF SERVICE
Synopsis of Bill as introduced:
Amends the Health Maintenance Organization Act. Authorizes health
maintenance organizations to offer point-of-service benefits.
Establishes reinsurance and capital requirements. Authorizes health
maintenance organizations to establish annual maximum benefit
allowances for point-of-service products.
HOUSE AMENDMENT NO. 1.
Deletes reference to:
215 ILCS 125/5-3.7 new
Adds reference to:
215 ILCS 125/2-6 from Ch. 111 1/2, par. 1406.2
215 ILCS 125/Art. 4.5, heading new
215 ILCS 125/4.5-1 new
Replaces everything after the enacting clause. Amends the Health
Maintenance Organization Act. Authorizes health maintenance
organizations to offer point-of-service benefits. Provides that net
worth must be at least 300% of the "authorized control level" as
determined in the manner provided under Article IIA of the Illinois
Insurance Code or a specified greater amount based upon the projected
out-of-plan claims. Requires health maintenance organizations that
offer point-of-service products to file quarterly reports with the
Department of Insurance and to maintain reinsurance for catastrophic
losses. Limits expenditures for out-of-plan services. Restricts the
offer of point-of-service products when expenditures exceed the
statutory limit. Allows a health maintenance organization to treat as
out-of-plan services those services an enrollee obtains from a
participating provider, but for which proper authorization was not
given by the organization.
FISCAL NOTE (Department of Insurance)
HB 1040 would have no fiscal impact on the Department.
HOUSE AMENDMENT NO. 2.
Makes a technical correction.
Last action on Bill: PUBLIC ACT.............................. 92-0135
Last action date: JUL-24-2001
Amendments to Bill: AMENDMENTS ADOPTED: HOUSE - 2 SENATE - 0
END OF INQUIRY
Full Text Bill Status