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.
SENATE AMENDMENT NO. 1.
Deletes reference to:
215 ILCS 125/5-3.7 new
Adds reference to:
215 ILCS 125/2-3 from Ch. 111 1/2, par. 1405
215 ILCS 125/2-4 from Ch. 111 1/2, par. 1406
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.
SENATE AMENDMENT NO. 2.
Changes "$500,0000" to "$500,000".
Last action on Bill: SESSION SINE DIE
Last action date: JAN-07-2003
Amendments to Bill: AMENDMENTS ADOPTED: HOUSE - 0 SENATE - 2
END OF INQUIRY
Full Text Bill Status