92nd General Assembly
Summary of SB0452
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Senate Sponsors:
JACOBS-MADIGAN,R-SIEBEN.

House Sponsors:
BRUNSVOLD-PARKE

Short description: 
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

           Location: Senate

 Amendments to Bill: AMENDMENTS ADOPTED: HOUSE -   0     SENATE -   2


   END OF INQUIRY 



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