Bill Text: IL HB2251 | 2013-2014 | 98th General Assembly | Introduced

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Bill Title: Amends the Health Care Reimbursement Article of the Illinois Insurance Code to provide that all insurers and administrators shall comply with the provision of the Managed Care Reform and Patient Rights Act that establishes a patient's right to receive timely prior verification of his or her health plan benefits before obtaining health care services and amends the Managed Care Reform and Patient Rights Act to set forth that provision. Further amends the Managed Care Reform and Patient Rights Act to provide that a health care plan shall provide enrollees or their designated health care providers with timely Internet access to verification of benefits for specific health care services prior to the enrollee obtaining such services and that the verification shall be binding on the health care plan.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2014-12-03 - Session Sine Die [HB2251 Detail]

Download: Illinois-2013-HB2251-Introduced.html

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98TH GENERAL ASSEMBLY State of Illinois 2013 and 2014 HB2251 Introduced , by Rep. Timothy L. Schmitz SYNOPSIS AS INTRODUCED:
215 ILCS 5/370u new
215 ILCS 134/5
215 ILCS 134/15
Amends the Health Care Reimbursement Article of the Illinois Insurance Code to provide that all insurers and administrators shall comply with the provision of the Managed Care Reform and Patient Rights Act that establishes a patient's right to receive timely prior verification of his or her health plan benefits before obtaining health care services and amends the Managed Care Reform and Patient Rights Act to set forth that provision. Further amends the Managed Care Reform and Patient Rights Act to provide that a health care plan shall provide enrollees or their designated health care providers with timely Internet access to verification of benefits for specific health care services prior to the enrollee obtaining such services and that the verification shall be binding on the health care plan.
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A BILL FOR
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AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by adding
Section 370u as follows:
(215 ILCS 5/370u new)
Sec. 370u. Managed Care Reform and Patient Rights Act. All
insurers and administrators shall comply with item (2.5) of
subsection (a) of Section 5 of the Managed Care Reform and
Patient Rights Act.
Section 10. The Managed Care Reform and Patient Rights Act
is amended by changing Sections 5 and 15 as follows:
(215 ILCS 134/5)
Sec. 5. Health care patient rights.
(a) The General Assembly finds that:
(1) A patient has the right to care consistent with
professional standards of practice to assure quality
nursing and medical practices, to choose the participating
physician responsible for coordinating his or her care, to
receive information concerning his or her condition and
proposed treatment, to refuse any treatment to the extent

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permitted by law, and to privacy and confidentiality of
records except as otherwise provided by law.
(2) A patient has the right, regardless of source of
payment, to examine and to receive a reasonable explanation
of his or her total bill for health care services rendered
by his or her physician or other health care provider,
including the itemized charges for specific health care
services received. A physician or other health care
provider has responsibility only for a reasonable
explanation of those specific health care services
provided by the health care provider.
(2.5) A patient has the right to receive timely prior
verification of his or her health plan benefits before
obtaining health care services.
(3) A patient has the right to timely prior notice of
the termination whenever a health care plan cancels or
refuses to renew an enrollee's participation in the plan.
(4) A patient has the right to privacy and
confidentiality in health care. This right may be expressly
waived in writing by the patient or the patient's guardian.
(5) An individual has the right to purchase any health
care services with that individual's own funds.
(b) Nothing in this Section shall preclude the health care
plan from sharing information for plan quality assessment and
improvement purposes as required by Section 80.
(Source: P.A. 91-617, eff. 1-1-00.)

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(215 ILCS 134/15)
Sec. 15. Provision of information.
(a) A health care plan shall provide annually to enrollees
and prospective enrollees, upon request, a complete list of
participating health care providers in the health care plan's
service area and a description of the following terms of
coverage:
(1) the service area;
(2) the covered benefits and services with all
exclusions, exceptions, and limitations;
(3) the pre-certification and other utilization review
procedures and requirements;
(4) a description of the process for the selection of a
primary care physician, any limitation on access to
specialists, and the plan's standing referral policy;
(5) the emergency coverage and benefits, including any
restrictions on emergency care services;
(6) the out-of-area coverage and benefits, if any;
(7) the enrollee's financial responsibility for
copayments, deductibles, premiums, and any other
out-of-pocket expenses;
(8) the provisions for continuity of treatment in the
event a health care provider's participation terminates
during the course of an enrollee's treatment by that
provider;

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(9) the appeals process, forms, and time frames for
health care services appeals, complaints, and external
independent reviews, administrative complaints, and
utilization review complaints, including a phone number to
call to receive more information from the health care plan
concerning the appeals process; and
(10) a statement of all basic health care services and
all specific benefits and services mandated to be provided
to enrollees by any State law or administrative rule.
In the event of an inconsistency between any separate
written disclosure statement and the enrollee contract or
certificate, the terms of the enrollee contract or certificate
shall control.
(a-5) A health care plan shall provide enrollees or their
designated health care providers with timely Internet access to
verification of benefits for specific health care services
prior to the enrollee obtaining such services. The verification
shall be binding on the health care plan.
(b) Upon written request, a health care plan shall provide
to enrollees a description of the financial relationships
between the health care plan and any health care provider and,
if requested, the percentage of copayments, deductibles, and
total premiums spent on healthcare related expenses and the
percentage of copayments, deductibles, and total premiums
spent on other expenses, including administrative expenses,
except that no health care plan shall be required to disclose

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specific provider reimbursement.
(c) A participating health care provider shall provide all
of the following, where applicable, to enrollees upon request:
(1) Information related to the health care provider's
educational background, experience, training, specialty,
and board certification, if applicable.
(2) The names of licensed facilities on the provider
panel where the health care provider presently has
privileges for the treatment, illness, or procedure that is
the subject of the request.
(3) Information regarding the health care provider's
participation in continuing education programs and
compliance with any licensure, certification, or
registration requirements, if applicable.
(d) A health care plan shall provide the information
required to be disclosed under this Act upon enrollment and
annually thereafter in a legible and understandable format. The
Department shall promulgate rules to establish the format
based, to the extent practical, on the standards developed for
supplemental insurance coverage under Title XVIII of the
federal Social Security Act as a guide, so that a person can
compare the attributes of the various health care plans.
(e) The written disclosure requirements of this Section may
be met by disclosure to one enrollee in a household.
(Source: P.A. 91-617, eff. 1-1-00.)