Illinois General Assembly - Full Text of Public Act 094-0866
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Public Act 094-0866




Public Act 094-0866
HB5339 Enrolled LRB094 16810 LJB 52086 b

    AN ACT concerning insurance.
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
    Section 5. The Managed Care Reform and Patient Rights Act
is amended by changing Section 30 as follows:
    (215 ILCS 134/30)
    Sec. 30. Prohibitions.
    (a) No health care plan or its subcontractors may prohibit
or discourage health care providers by contract or policy from
discussing any health care services and health care providers,
utilization review and quality assurance policies, terms and
conditions of plans and plan policy with enrollees, prospective
enrollees, providers, or the public.
    (b) No health care plan by contract, written policy, or
procedure may permit or allow an individual or entity to
dispense a different drug in place of the drug or brand of drug
ordered or prescribed without the express permission of the
person ordering or prescribing the drug, except as provided
under Section 3.14 of the Illinois Food, Drug and Cosmetic Act.
    (c) No health care plan or its subcontractors may by
contract, written policy, procedure, or otherwise mandate or
require an enrollee to substitute his or her participating
primary care physician under the plan during inpatient
hospitalization, such as with a hospitalist physician licensed
to practice medicine in all its branches, without the agreement
of that enrollee's participating primary care physician.
"Participating primary care physician" for health care plans
and subcontractors that do not require coordination of care by
a primary care physician means the participating physician
treating the patient. All health care plans shall inform
enrollees of any policies, recommendations, or guidelines
concerning the substitution of the enrollee's primary care
physician when hospitalization is necessary in the manner set
forth in subsections (d) and (e) of Section 15.
    (d) Any violation of this Section shall be subject to the
penalties under this Act.
(Source: P.A. 91-617, eff. 1-1-00; 92-770, eff. 1-1-03.)
    Section 99. Effective date. This Act takes effect upon
becoming law.

Effective Date: 6/16/2006