Bill Text: IL SB3739 | 2023-2024 | 103rd General Assembly | Introduced

---

Bill Title: Amends the Network Adequacy and Transparency Act. Adds definitions. Provides that the minimum ratio for each provider type shall be no less than any such ratio established for qualified health plans in Federally-Facilitated Exchanges by federal law or by the federal Centers for Medicare and Medicaid Services. Provides that the maximum travel time and distance standards and appointment wait time standards shall be no greater than any such standards established for qualified health plans in Federally-Facilitated Exchanges by federal law or by the federal Centers for Medicare and Medicaid Services. Makes changes to provisions concerning network adequacy, notice of nonrenewal or termination, transition of services, network transparency, administration and enforcement, provider requirements, and provider directory information. Amends the Managed Care Reform and Patient Rights Act. Makes changes to provisions concerning notice of nonrenewal or termination and transition of services. Amends the Illinois Administrative Procedure Act to authorize the Department of Insurance to adopt emergency rules implementing federal standards for provider ratios, time and distance, or appointment wait times when such standards apply to health insurance coverage regulated by the Department of Insurance and are more stringent than the State standards extant at the time the final federal standards are published. Amends the Illinois Administrative Procedure Act to make a conforming change. Effective immediately.

Spectrum: Partisan Bill (Democrat 11-0)

Status: (Introduced) 2024-05-13 - Added as Co-Sponsor Sen. Robert F. Martwick [SB3739 Detail]

Download: Illinois-2023-SB3739-Introduced.html

---

103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3739 Introduced 2/9/2024, by Sen. Robert Peters SYNOPSIS AS INTRODUCED:
5 ILCS 100/5-45.55 new
215 ILCS 124/3
215 ILCS 124/5
215 ILCS 124/10
215 ILCS 124/15
215 ILCS 124/20
215 ILCS 124/25
215 ILCS 124/30
215 ILCS 124/35 new
215 ILCS 124/40 new
215 ILCS 124/50 new
215 ILCS 134/20
215 ILCS 134/25
Amends the Network Adequacy and Transparency Act. Adds definitions. Provides that the minimum ratio for each provider type shall be no less than any such ratio established for qualified health plans in Federally-Facilitated Exchanges by federal law or by the federal Centers for Medicare and Medicaid Services. Provides that the maximum travel time and distance standards and appointment wait time standards shall be no greater than any such standards established for qualified health plans in Federally-Facilitated Exchanges by federal law or by the federal Centers for Medicare and Medicaid Services. Makes changes to provisions concerning network adequacy, notice of nonrenewal or termination, transition of services, network transparency, administration and enforcement, provider requirements, and provider directory information. Amends the Managed Care Reform and Patient Rights Act. Makes changes to provisions concerning notice of nonrenewal or termination and transition of services. Amends the Illinois Administrative Procedure Act to authorize the Department of Insurance to adopt emergency rules implementing federal standards for provider ratios, time and distance, or appointment wait times when such standards apply to health insurance coverage regulated by the Department of Insurance and are more stringent than the State standards extant at the time the final federal standards are published. Amends the Illinois Administrative Procedure Act to make a conforming change. Effective immediately.
LRB103 39496 RPS 69693 b
A BILL FOR
SB3739 LRB103 39496 RPS 69693 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Administrative Procedure Act is
amended by adding Section 5-45.55 as follows:
(5 ILCS 100/5-45.55 new)
Sec. 5-45.55. Emergency rulemaking; Network Adequacy and
Transparency Act. To provide for the expeditious and timely
implementation of the Network Adequacy and Transparency Act,
emergency rules implementing federal standards for provider
ratios, travel time and distance, and appointment wait times
if such standards apply to health insurance coverage regulated
by the Department of Insurance and are more stringent than the
State standards extant at the time the final federal standards
are published may be adopted in accordance with Section 5-45
by the Department of Insurance. The adoption of emergency
rules authorized by Section 5-45 and this Section is deemed to
be necessary for the public interest, safety, and welfare.
This Section is repealed one year after the effective date
of this amendatory Act of the 103rd General Assembly.
Section 15. The Network Adequacy and Transparency Act is
amended by changing Sections 3, 5, 10, 15, 20, 25, and 30 and

SB3739 - 2 - LRB103 39496 RPS 69693 b
by adding Sections 35, 40, and 50 as follows:
(215 ILCS 124/3)
Sec. 3. Applicability of Act. This Act applies to an
individual or group policy of accident and health insurance
coverage with a network plan amended, delivered, issued, or
renewed in this State on or after January 1, 2019. This Act
does not apply to an individual or group policy for excepted
benefits or short-term, limited-duration health insurance
coverage dental or vision insurance or a limited health
service organization with a network plan amended, delivered,
issued, or renewed in this State on or after January 1, 2019,
except to the extent that federal law establishes network
adequacy and transparency standards for stand-alone dental
plans, which the Department shall enforce.
(Source: P.A. 100-502, eff. 9-15-17; 100-601, eff. 6-29-18.)
(215 ILCS 124/5)
Sec. 5. Definitions. In this Act:
"Authorized representative" means a person to whom a
beneficiary has given express written consent to represent the
beneficiary; a person authorized by law to provide substituted
consent for a beneficiary; or the beneficiary's treating
provider only when the beneficiary or his or her family member
is unable to provide consent.
"Beneficiary" means an individual, an enrollee, an

SB3739 - 3 - LRB103 39496 RPS 69693 b
insured, a participant, or any other person entitled to
reimbursement for covered expenses of or the discounting of
provider fees for health care services under a program in
which the beneficiary has an incentive to utilize the services
of a provider that has entered into an agreement or
arrangement with an issuer insurer.
"Department" means the Department of Insurance.
"Essential community provider" has the meaning ascribed to
that term in 45 CFR 156.235.
"Excepted benefits" has the meaning ascribed to that term
in 42 U.S.C. 300gg-91(c).
"Exchange" has the meaning ascribed to that term in 45 CFR
155.20.
"Director" means the Director of Insurance.
"Family caregiver" means a relative, partner, friend, or
neighbor who has a significant relationship with the patient
and administers or assists the patient with activities of
daily living, instrumental activities of daily living, or
other medical or nursing tasks for the quality and welfare of
that patient.
"Group health plan" has the meaning ascribed to that term
in Section 5 of the Illinois Health Insurance Portability and
Accountability Act.
"Health insurance coverage" has the meaning ascribed to
that term in Section 5 of the Illinois Health Insurance
Portability and Accountability Act. "Health insurance

SB3739 - 4 - LRB103 39496 RPS 69693 b
coverage" does not include any coverage or benefits under
Medicare or under the medical assistance program established
under Article V of the Illinois Public Aid Code.
"Issuer" means a "health insurance issuer" as defined in
Section 5 of the Illinois Health Insurance Portability and
Accountability Act.
"Insurer" means any entity that offers individual or group
accident and health insurance, including, but not limited to,
health maintenance organizations, preferred provider
organizations, exclusive provider organizations, and other
plan structures requiring network participation, excluding the
medical assistance program under the Illinois Public Aid Code,
the State employees group health insurance program, workers
compensation insurance, and pharmacy benefit managers.
"Material change" means a significant reduction in the
number of providers available in a network plan, including,
but not limited to, a reduction of 10% or more in a specific
type of providers within any county, the removal of a major
health system that causes a network to be significantly
different within any county from the network when the
beneficiary purchased the network plan, or any change that
would cause the network to no longer satisfy the requirements
of this Act or the Department's rules for network adequacy and
transparency.
"Network" means the group or groups of preferred providers
providing services to a network plan.

SB3739 - 5 - LRB103 39496 RPS 69693 b
"Network plan" means an individual or group policy of
accident and health insurance coverage that either requires a
covered person to use or creates incentives, including
financial incentives, for a covered person to use providers
managed, owned, under contract with, or employed by the issuer
or by a third party contracted to arrange, contract for, or
administer such provider-related incentives for the issuer
insurer.
"Ongoing course of treatment" means (1) treatment for a
life-threatening condition, which is a disease or condition
for which likelihood of death is probable unless the course of
the disease or condition is interrupted; (2) treatment for a
serious acute condition, defined as a disease or condition
requiring complex ongoing care that the covered person is
currently receiving, such as chemotherapy, radiation therapy,
or post-operative visits, or a serious and complex condition
as defined under 42 U.S.C. 300gg-113(b)(2); (3) a course of
treatment for a health condition that a treating provider
attests that discontinuing care by that provider would worsen
the condition or interfere with anticipated outcomes; or (4)
the third trimester of pregnancy through the post-partum
period; (5) undergoing a course of institutional or inpatient
care from the provider within the meaning of 42 U.S.C.
300gg-113(b)(1)(B); (6) being scheduled to undergo nonelective
surgery from the provider, including receipt of preoperative
or postoperative care from such provider with respect to such

SB3739 - 6 - LRB103 39496 RPS 69693 b
a surgery; (7) being determined to be terminally ill, as
determined under 42 U.S.C. 1395x(dd)(3)(A), and receiving
treatment for such illness from such provider; or (8) any
other treatment of a condition or disease that requires
repeated health care services pursuant to a plan of treatment
by a provider because of the potential for changes in the
therapeutic regimen.
"Preferred provider" means any provider who has entered,
either directly or indirectly, into an agreement with an
employer or risk-bearing entity relating to health care
services that may be rendered to beneficiaries under a network
plan.
"Providers" means physicians licensed to practice medicine
in all its branches, other health care professionals,
hospitals, or other health care institutions or facilities
that provide health care services.
"Short-term, limited-duration health insurance coverage"
has the meaning ascribed to that term in Section 5 of the
Short-Term, Limited-Duration Health Insurance Coverage Act.
"Stand-alone dental plan" has the meaning ascribed to that
term in 45 CFR 156.400.
"Telehealth" has the meaning given to that term in Section
356z.22 of the Illinois Insurance Code.
"Telemedicine" has the meaning given to that term in
Section 49.5 of the Medical Practice Act of 1987.
"Tiered network" means a network that identifies and

SB3739 - 7 - LRB103 39496 RPS 69693 b
groups some or all types of provider and facilities into
specific groups to which different provider reimbursement,
covered person cost-sharing or provider access requirements,
or any combination thereof, apply for the same services.
"Woman's principal health care provider" means a physician
licensed to practice medicine in all of its branches
specializing in obstetrics, gynecology, or family practice.
(Source: P.A. 102-92, eff. 7-9-21; 102-813, eff. 5-13-22.)
(215 ILCS 124/10)
Sec. 10. Network adequacy.
(a) Before issuing, delivering, or renewing a network
plan, an issuer An insurer providing a network plan shall file
a description of all of the following with the Director:
(1) The written policies and procedures for adding
providers to meet patient needs based on increases in the
number of beneficiaries, changes in the
patient-to-provider ratio, changes in medical and health
care capabilities, and increased demand for services.
(2) The written policies and procedures for making
referrals within and outside the network.
(3) The written policies and procedures on how the
network plan will provide 24-hour, 7-day per week access
to network-affiliated primary care, emergency services,
and women's principal health care providers.
An issuer insurer shall not prohibit a preferred provider

SB3739 - 8 - LRB103 39496 RPS 69693 b
from discussing any specific or all treatment options with
beneficiaries irrespective of the insurer's position on those
treatment options or from advocating on behalf of
beneficiaries within the utilization review, grievance, or
appeals processes established by the issuer insurer in
accordance with any rights or remedies available under
applicable State or federal law.
(b) Before issuing, delivering, or renewing a network
plan, an issuer Insurers must file for review a description of
the services to be offered through a network plan. The
description shall include all of the following:
(1) A geographic map of the area proposed to be served
by the plan by county service area and zip code, including
marked locations for preferred providers.
(2) As deemed necessary by the Department, the names,
addresses, phone numbers, and specialties of the providers
who have entered into preferred provider agreements under
the network plan.
(3) The number of beneficiaries anticipated to be
covered by the network plan.
(4) An Internet website and toll-free telephone number
for beneficiaries and prospective beneficiaries to access
current and accurate lists of preferred providers in each
plan, additional information about the plan, as well as
any other information required by Department rule.
(5) A description of how health care services to be

SB3739 - 9 - LRB103 39496 RPS 69693 b
rendered under the network plan are reasonably accessible
and available to beneficiaries. The description shall
address all of the following:
(A) the type of health care services to be
provided by the network plan;
(B) the ratio of physicians and other providers to
beneficiaries, by specialty and including primary care
physicians and facility-based physicians when
applicable under the contract, necessary to meet the
health care needs and service demands of the currently
enrolled population;
(C) the travel and distance standards for plan
beneficiaries in county service areas; and
(D) a description of how the use of telemedicine,
telehealth, or mobile care services may be used to
partially meet the network adequacy standards, if
applicable.
(6) A provision ensuring that whenever a beneficiary
has made a good faith effort, as evidenced by accessing
the provider directory, calling the network plan, and
calling the provider, to utilize preferred providers for a
covered service and it is determined the insurer does not
have the appropriate preferred providers due to
insufficient number, type, unreasonable travel distance or
delay, or preferred providers refusing to provide a
covered service because it is contrary to the conscience

SB3739 - 10 - LRB103 39496 RPS 69693 b
of the preferred providers, as protected by the Health
Care Right of Conscience Act, the issuer insurer shall
ensure, directly or indirectly, by terms contained in the
payer contract, that the beneficiary will be provided the
covered service at no greater cost to the beneficiary than
if the service had been provided by a preferred provider.
This paragraph (6) does not apply to: (A) a beneficiary
who willfully chooses to access a non-preferred provider
for health care services available through the panel of
preferred providers, or (B) a beneficiary enrolled in a
health maintenance organization. In these circumstances,
the contractual requirements for non-preferred provider
reimbursements shall apply unless Section 356z.3a of the
Illinois Insurance Code requires otherwise. In no event
shall a beneficiary who receives care at a participating
health care facility be required to search for
participating providers under the circumstances described
in subsection (b) or (b-5) of Section 356z.3a of the
Illinois Insurance Code except under the circumstances
described in paragraph (2) of subsection (b-5).
(7) A provision that the beneficiary shall receive
emergency care coverage such that payment for this
coverage is not dependent upon whether the emergency
services are performed by a preferred or non-preferred
provider and the coverage shall be at the same benefit
level as if the service or treatment had been rendered by a

SB3739 - 11 - LRB103 39496 RPS 69693 b
preferred provider. For purposes of this paragraph (7),
"the same benefit level" means that the beneficiary is
provided the covered service at no greater cost to the
beneficiary than if the service had been provided by a
preferred provider. This provision shall be consistent
with Section 356z.3a of the Illinois Insurance Code.
(8) A limitation that, if the plan provides that the
beneficiary will incur a penalty for failing to
pre-certify inpatient hospital treatment, the penalty may
not exceed $1,000 per occurrence in addition to the plan
cost sharing provisions.
(9) For a network plan to be offered through the
Exchange in the individual or small group market, as well
as any off-Exchange mirror of such a network plan,
evidence that the network plan includes essential
community providers in accordance with rules established
by the Exchange that will operate in this State for the
applicable plan year.
(c) The issuer network plan shall demonstrate to the
Director a minimum ratio of providers to plan beneficiaries as
required by the Department for each network plan.
(1) The minimum ratio of physicians or other providers
to plan beneficiaries shall be established annually by the
Department in consultation with the Department of Public
Health based upon the guidance from the federal Centers
for Medicare and Medicaid Services. The Department shall

SB3739 - 12 - LRB103 39496 RPS 69693 b
not establish ratios for vision or dental providers who
provide services under dental-specific or vision-specific
benefits, except to the extent provided under federal law
for stand-alone dental plans. The Department shall
consider establishing ratios for the following physicians
or other providers:
(A) Primary Care;
(B) Pediatrics;
(C) Cardiology;
(D) Gastroenterology;
(E) General Surgery;
(F) Neurology;
(G) OB/GYN;
(H) Oncology/Radiation;
(I) Ophthalmology;
(J) Urology;
(K) Behavioral Health;
(L) Allergy/Immunology;
(M) Chiropractic;
(N) Dermatology;
(O) Endocrinology;
(P) Ears, Nose, and Throat (ENT)/Otolaryngology;
(Q) Infectious Disease;
(R) Nephrology;
(S) Neurosurgery;
(T) Orthopedic Surgery;

SB3739 - 13 - LRB103 39496 RPS 69693 b
(U) Physiatry/Rehabilitative;
(V) Plastic Surgery;
(W) Pulmonary;
(X) Rheumatology;
(Y) Anesthesiology;
(Z) Pain Medicine;
(AA) Pediatric Specialty Services;
(BB) Outpatient Dialysis; and
(CC) HIV.
(2) The Director shall establish a process for the
review of the adequacy of these standards, along with an
assessment of additional specialties to be included in the
list under this subsection (c).
(3) Notwithstanding any other law or rule, the minimum
ratio for each provider type shall be no less than any such
ratio established for qualified health plans in
Federally-Facilitated Exchanges by federal law or by the
federal Centers for Medicare and Medicaid Services, even
if the network plan is issued in the large group market or
is otherwise not issued through an exchange. Federal
standards for stand-alone dental plans shall only apply to
such network plans. In the absence of an applicable
Department rule, the federal standards shall apply for the
time period specified in the federal law, regulation, or
guidance. If the Centers for Medicare and Medicaid
Services establish standards that are more stringent than

SB3739 - 14 - LRB103 39496 RPS 69693 b
the standards in effect under any Department rule, the
Department may amend its rules to conform to the more
stringent federal standards.
(d) The network plan shall demonstrate to the Director
maximum travel and distance standards and appointment wait
time standards for plan beneficiaries, which shall be
established annually by the Department in consultation with
the Department of Public Health based upon the guidance from
the federal Centers for Medicare and Medicaid Services. These
standards shall consist of the maximum minutes or miles to be
traveled by a plan beneficiary for each county type, such as
large counties, metro counties, or rural counties as defined
by Department rule.
The maximum travel time and distance standards must
include standards for each physician and other provider
category listed for which ratios have been established.
The Director shall establish a process for the review of
the adequacy of these standards along with an assessment of
additional specialties to be included in the list under this
subsection (d).
Notwithstanding any other law or Department rule, the
maximum travel time and distance standards and appointment
wait time standards shall be no greater than any such
standards established for qualified health plans in
Federally-Facilitated Exchanges by federal law or by the
federal Centers for Medicare and Medicaid Services, even if

SB3739 - 15 - LRB103 39496 RPS 69693 b
the network plan is issued in the large group market or is
otherwise not issued through an exchange. Federal standards
for stand-alone dental plans shall only apply to such network
plans. In the absence of an applicable Department rule, the
federal standards shall apply for the time period specified in
the federal law, regulation, or guidance. If the Centers for
Medicare and Medicaid Services establish standards that are
more stringent than the standards in effect under any
Department rule, the Department may amend its rules to conform
to the more stringent federal standards.
If the federal area designations for the maximum time or
distance or appointment wait time standards required are
changed by the most recent Letter to Issuers in the
Federally-facilitated Marketplaces, the Department shall post
on its website notice of such changes and may amend its rules
to conform to those designations if the Director deems
appropriate.
(d-5)(1) Every issuer insurer shall ensure that
beneficiaries have timely and proximate access to treatment
for mental, emotional, nervous, or substance use disorders or
conditions in accordance with the provisions of paragraph (4)
of subsection (a) of Section 370c of the Illinois Insurance
Code. Issuers Insurers shall use a comparable process,
strategy, evidentiary standard, and other factors in the
development and application of the network adequacy standards
for timely and proximate access to treatment for mental,

SB3739 - 16 - LRB103 39496 RPS 69693 b
emotional, nervous, or substance use disorders or conditions
and those for the access to treatment for medical and surgical
conditions. As such, the network adequacy standards for timely
and proximate access shall equally be applied to treatment
facilities and providers for mental, emotional, nervous, or
substance use disorders or conditions and specialists
providing medical or surgical benefits pursuant to the parity
requirements of Section 370c.1 of the Illinois Insurance Code
and the federal Paul Wellstone and Pete Domenici Mental Health
Parity and Addiction Equity Act of 2008. Notwithstanding the
foregoing, the network adequacy standards for timely and
proximate access to treatment for mental, emotional, nervous,
or substance use disorders or conditions shall, at a minimum,
satisfy the following requirements:
(A) For beneficiaries residing in the metropolitan
counties of Cook, DuPage, Kane, Lake, McHenry, and Will,
network adequacy standards for timely and proximate access
to treatment for mental, emotional, nervous, or substance
use disorders or conditions means a beneficiary shall not
have to travel longer than 30 minutes or 30 miles from the
beneficiary's residence to receive outpatient treatment
for mental, emotional, nervous, or substance use disorders
or conditions. Beneficiaries shall not be required to wait
longer than 10 business days between requesting an initial
appointment and being seen by the facility or provider of
mental, emotional, nervous, or substance use disorders or

SB3739 - 17 - LRB103 39496 RPS 69693 b
conditions for outpatient treatment or to wait longer than
20 business days between requesting a repeat or follow-up
appointment and being seen by the facility or provider of
mental, emotional, nervous, or substance use disorders or
conditions for outpatient treatment; however, subject to
the protections of paragraph (3) of this subsection, a
network plan shall not be held responsible if the
beneficiary or provider voluntarily chooses to schedule an
appointment outside of these required time frames.
(B) For beneficiaries residing in Illinois counties
other than those counties listed in subparagraph (A) of
this paragraph, network adequacy standards for timely and
proximate access to treatment for mental, emotional,
nervous, or substance use disorders or conditions means a
beneficiary shall not have to travel longer than 60
minutes or 60 miles from the beneficiary's residence to
receive outpatient treatment for mental, emotional,
nervous, or substance use disorders or conditions.
Beneficiaries shall not be required to wait longer than 10
business days between requesting an initial appointment
and being seen by the facility or provider of mental,
emotional, nervous, or substance use disorders or
conditions for outpatient treatment or to wait longer than
20 business days between requesting a repeat or follow-up
appointment and being seen by the facility or provider of
mental, emotional, nervous, or substance use disorders or

SB3739 - 18 - LRB103 39496 RPS 69693 b
conditions for outpatient treatment; however, subject to
the protections of paragraph (3) of this subsection, a
network plan shall not be held responsible if the
beneficiary or provider voluntarily chooses to schedule an
appointment outside of these required time frames.
(2) For beneficiaries residing in all Illinois counties,
network adequacy standards for timely and proximate access to
treatment for mental, emotional, nervous, or substance use
disorders or conditions means a beneficiary shall not have to
travel longer than 60 minutes or 60 miles from the
beneficiary's residence to receive inpatient or residential
treatment for mental, emotional, nervous, or substance use
disorders or conditions.
(3) If there is no in-network facility or provider
available for a beneficiary to receive timely and proximate
access to treatment for mental, emotional, nervous, or
substance use disorders or conditions in accordance with the
network adequacy standards outlined in this subsection, the
issuer insurer shall provide necessary exceptions to its
network to ensure admission and treatment with a provider or
at a treatment facility in accordance with the network
adequacy standards in this subsection.
(4) If the federal Centers for Medicare and Medicaid
Services establishes or law requires more stringent standards
for qualified health plans in the Federally-Facilitated
Exchanges, the federal standards shall control for all network

SB3739 - 19 - LRB103 39496 RPS 69693 b
plans for the time period specified in the federal law,
regulation, or guidance, even if the network plan is issued in
the large group market, is issued through a different type of
Exchange, or is otherwise not issued through an Exchange.
(e) Except for network plans solely offered as a group
health plan, these ratio and time and distance standards apply
to the lowest cost-sharing tier of any tiered network.
(f) The network plan may consider use of other health care
service delivery options, such as telemedicine or telehealth,
mobile clinics, and centers of excellence, or other ways of
delivering care to partially meet the requirements set under
this Section.
(g) Except for the requirements set forth in subsection
(d-5), issuers insurers who are not able to comply with the
provider ratios and time and distance or appointment wait time
standards established under this Act or federal law by the
Department may request an exception to these requirements from
the Department. The Department may grant an exception in the
following circumstances:
(1) if no providers or facilities meet the specific
time and distance standard in a specific service area and
the issuer insurer (i) discloses information on the
distance and travel time points that beneficiaries would
have to travel beyond the required criterion to reach the
next closest contracted provider outside of the service
area and (ii) provides contact information, including

SB3739 - 20 - LRB103 39496 RPS 69693 b
names, addresses, and phone numbers for the next closest
contracted provider or facility;
(2) if patterns of care in the service area do not
support the need for the requested number of provider or
facility type and the issuer insurer provides data on
local patterns of care, such as claims data, referral
patterns, or local provider interviews, indicating where
the beneficiaries currently seek this type of care or
where the physicians currently refer beneficiaries, or
both; or
(3) other circumstances deemed appropriate by the
Department consistent with the requirements of this Act.
(h) Issuers Insurers are required to report to the
Director any material change to an approved network plan
within 15 days after the change occurs and any change that
would result in failure to meet the requirements of this Act.
The issuer shall submit a revised version of the portions of
the network adequacy filing affected by the material change,
as determined by the Director by rule, and the issuer shall
attach versions with the changes indicated for each document
that was revised from the previous version of the filing. Upon
notice from the issuer insurer, the Director shall reevaluate
the network plan's compliance with the network adequacy and
transparency standards of this Act. For every day past 15 days
that the issuer fails to submit a revised network adequacy
filing to the Director, the Director may order a fine of $1,000

SB3739 - 21 - LRB103 39496 RPS 69693 b
per day.
(i) If a network plan is inadequate under this Act with
respect to a provider type in a county, and if the network plan
does not have an approved exception for that provider type in
that county pursuant to subsection (g), an issuer shall
process out-of-network claims for covered health care services
received from that provider type within that county at the
in-network benefit level and shall retroactively adjudicate
and reimburse beneficiaries to achieve that objective if their
claims were processed at the out-of-network level contrary to
this subsection.
(j) If the Director determines that a network is
inadequate in any county and no exception has been granted
under subsection (g) and the issuer does not have a process in
place to comply with subsection (d-5), the Director may
prohibit the network plan from being issued or renewed within
that county until the Director determines that the network is
adequate apart from processes and exceptions described in
subsections (d-5) and (g). Nothing in this subsection shall be
construed to terminate any beneficiary's health insurance
coverage under a network plan before the expiration of the
beneficiary's policy period if the Director makes a
determination under this subsection after the issuance or
renewal of the beneficiary's policy or certificate because of
a material change. Policies or certificates issued or renewed
in violation of this subsection may subject the issuer to a

SB3739 - 22 - LRB103 39496 RPS 69693 b
civil penalty of $1,000 per policy.
(Source: P.A. 102-144, eff. 1-1-22; 102-901, eff. 7-1-22;
102-1117, eff. 1-13-23.)
(215 ILCS 124/15)
Sec. 15. Notice of nonrenewal or termination.
(a) A network plan must give at least 60 days' notice of
nonrenewal or termination of a provider to the provider and to
the beneficiaries served by the provider. The notice shall
include a name and address to which a beneficiary or provider
may direct comments and concerns regarding the nonrenewal or
termination and the telephone number maintained by the
Department for consumer complaints. Immediate written notice
may be provided without 60 days' notice when a provider's
license has been disciplined by a State licensing board or
when the network plan reasonably believes direct imminent
physical harm to patients under the provider's providers care
may occur. The notice to the beneficiary shall provide the
individual with an opportunity to notify the issuer of the
individual's need for transitional care.
(b) Primary care providers must notify active affected
patients of nonrenewal or termination of the provider from the
network plan, except in the case of incapacitation.
(Source: P.A. 100-502, eff. 9-15-17.)
(215 ILCS 124/20)

SB3739 - 23 - LRB103 39496 RPS 69693 b
Sec. 20. Transition of services.
(a) A network plan shall provide for continuity of care
for its beneficiaries as follows:
(1) If a beneficiary's physician or hospital provider
leaves the network plan's network of providers for reasons
other than termination of a contract in situations
involving imminent harm to a patient or a final
disciplinary action by a State licensing board and the
provider remains within the network plan's service area,
if benefits provided under such network plan with respect
to such provider or facility are terminated because of a
change in the terms of the participation of such provider
or facility in such plan, or if a contract between a group
health plan and a health insurance issuer offering a
network plan in connection with the group health plan is
terminated and results in a loss of benefits provided
under such plan with respect to such provider, then the
network plan shall permit the beneficiary to continue an
ongoing course of treatment with that provider during a
transitional period for the following duration:
(A) 90 days from the date of the notice to the
beneficiary of the provider's disaffiliation from the
network plan if the beneficiary has an ongoing course
of treatment; or
(B) if the beneficiary has entered the third
trimester of pregnancy at the time of the provider's

SB3739 - 24 - LRB103 39496 RPS 69693 b
disaffiliation, a period that includes the provision
of post-partum care directly related to the delivery.
(2) Notwithstanding the provisions of paragraph (1) of
this subsection (a), such care shall be authorized by the
network plan during the transitional period in accordance
with the following:
(A) the provider receives continued reimbursement
from the network plan at the rates and terms and
conditions applicable under the terminated contract
prior to the start of the transitional period;
(B) the provider adheres to the network plan's
quality assurance requirements, including provision to
the network plan of necessary medical information
related to such care; and
(C) the provider otherwise adheres to the network
plan's policies and procedures, including, but not
limited to, procedures regarding referrals and
obtaining preauthorizations for treatment.
(3) The provisions of this Section governing health
care provided during the transition period do not apply if
the beneficiary has successfully transitioned to another
provider participating in the network plan, if the
beneficiary has already met or exceeded the benefit
limitations of the plan, or if the care provided is not
medically necessary.
(b) A network plan shall provide for continuity of care

SB3739 - 25 - LRB103 39496 RPS 69693 b
for new beneficiaries as follows:
(1) If a new beneficiary whose provider is not a
member of the network plan's provider network, but is
within the network plan's service area, enrolls in the
network plan, the network plan shall permit the
beneficiary to continue an ongoing course of treatment
with the beneficiary's current physician during a
transitional period:
(A) of 90 days from the effective date of
enrollment if the beneficiary has an ongoing course of
treatment; or
(B) if the beneficiary has entered the third
trimester of pregnancy at the effective date of
enrollment, that includes the provision of post-partum
care directly related to the delivery.
(2) If a beneficiary, or a beneficiary's authorized
representative, elects in writing to continue to receive
care from such provider pursuant to paragraph (1) of this
subsection (b), such care shall be authorized by the
network plan for the transitional period in accordance
with the following:
(A) the provider receives reimbursement from the
network plan at rates established by the network plan;
(B) the provider adheres to the network plan's
quality assurance requirements, including provision to
the network plan of necessary medical information

SB3739 - 26 - LRB103 39496 RPS 69693 b
related to such care; and
(C) the provider otherwise adheres to the network
plan's policies and procedures, including, but not
limited to, procedures regarding referrals and
obtaining preauthorization for treatment.
(3) The provisions of this Section governing health
care provided during the transition period do not apply if
the beneficiary has successfully transitioned to another
provider participating in the network plan, if the
beneficiary has already met or exceeded the benefit
limitations of the plan, or if the care provided is not
medically necessary.
(c) In no event shall this Section be construed to require
a network plan to provide coverage for benefits not otherwise
covered or to diminish or impair preexisting condition
limitations contained in the beneficiary's contract.
(d) A provider shall comply with the requirements of 42
U.S.C. 300gg-138.
(Source: P.A. 100-502, eff. 9-15-17.)
(215 ILCS 124/25)
Sec. 25. Network transparency.
(a) A network plan shall post electronically an
up-to-date, accurate, and complete provider directory for each
of its network plans, with the information and search
functions, as described in this Section.

SB3739 - 27 - LRB103 39496 RPS 69693 b
(1) In making the directory available electronically,
the network plans shall ensure that the general public is
able to view all of the current providers for a plan
through a clearly identifiable link or tab and without
creating or accessing an account or entering a policy or
contract number.
(2) The network plan shall update the online provider
directory at least monthly. An issuer's failure to update
a network plan's directory shall subject the issuer to a
civil penalty of $5,000 per month. Providers shall notify
the network plan electronically or in writing of any
changes to their information as listed in the provider
directory, including the information required in
subparagraph (K) of paragraph (1) of subsection (b). If a
provider is no longer accepting new patients, the provider
must give notice to the issuer within 10 business days
after deciding to cease accepting new patients, or within
10 business days after the effective date of this
amendatory Act of the 103rd General Assembly, whichever is
later. The network plan shall update its online provider
directory in a manner consistent with the information
provided by the provider within 2 10 business days after
being notified of the change by the provider. Nothing in
this paragraph (2) shall void any contractual relationship
between the provider and the plan.
(3) At least once every 90 days, the The network plan

SB3739 - 28 - LRB103 39496 RPS 69693 b
shall audit each periodically at least 25% of its print
and online provider directories for accuracy, make any
corrections necessary, and retain documentation of the
audit. The network plan shall submit the audit to the
Director upon request. As part of these audits, the
network plan shall contact any provider in its network
that has not submitted a claim to the plan or otherwise
communicated his or her intent to continue participation
in the plan's network. The audits shall comply with 42
U.S.C. 300gg-115(a)(2), except that "provider directory
information" shall include all information required to be
included in a provider directory pursuant to this Act.
(4) A network plan shall provide a print copy of a
current provider directory or a print copy of the
requested directory information upon request of a
beneficiary or a prospective beneficiary. Print copies
must be updated quarterly and an errata that reflects
changes in the provider network must be updated quarterly.
(5) For each network plan, a network plan shall
include, in plain language in both the electronic and
print directory, the following general information:
(A) in plain language, a description of the
criteria the plan has used to build its provider
network;
(B) if applicable, in plain language, a
description of the criteria the issuer insurer or

SB3739 - 29 - LRB103 39496 RPS 69693 b
network plan has used to create tiered networks;
(C) if applicable, in plain language, how the
network plan designates the different provider tiers
or levels in the network and identifies for each
specific provider, hospital, or other type of facility
in the network which tier each is placed, for example,
by name, symbols, or grouping, in order for a
beneficiary-covered person or a prospective
beneficiary-covered person to be able to identify the
provider tier; and
(D) if applicable, a notation that authorization
or referral may be required to access some providers.
(6) A network plan shall make it clear for both its
electronic and print directories what provider directory
applies to which network plan, such as including the
specific name of the network plan as marketed and issued
in this State. The network plan shall include in both its
electronic and print directories a customer service email
address and telephone number or electronic link that
beneficiaries or the general public may use to notify the
network plan of inaccurate provider directory information
and contact information for the Department's Office of
Consumer Health Insurance.
(7) A provider directory, whether in electronic or
print format, shall accommodate the communication needs of
individuals with disabilities, and include a link to or

SB3739 - 30 - LRB103 39496 RPS 69693 b
information regarding available assistance for persons
with limited English proficiency.
(b) For each network plan, a network plan shall make
available through an electronic provider directory the
following information in a searchable format:
(1) for health care professionals:
(A) name;
(B) gender;
(C) participating office locations;
(D) specialty, if applicable;
(E) medical group affiliations, if applicable;
(F) facility affiliations, if applicable;
(G) participating facility affiliations, if
applicable;
(H) languages spoken other than English, if
applicable;
(I) whether accepting new patients;
(J) board certifications, if applicable; and
(K) use of telehealth or telemedicine, including,
but not limited to:
(i) whether the provider offers the use of
telehealth or telemedicine to deliver services to
patients for whom it would be clinically
appropriate;
(ii) what modalities are used and what types
of services may be provided via telehealth or

SB3739 - 31 - LRB103 39496 RPS 69693 b
telemedicine; and
(iii) whether the provider has the ability and
willingness to include in a telehealth or
telemedicine encounter a family caregiver who is
in a separate location than the patient if the
patient wishes and provides his or her consent;
and
(L) whether patients can make an appointment to
visit the health care professional.
(2) for hospitals:
(A) hospital name;
(B) hospital type (such as acute, rehabilitation,
children's, or cancer);
(C) participating hospital location; and
(D) hospital accreditation status; and
(3) for facilities, other than hospitals, by type:
(A) facility name;
(B) facility type;
(C) types of services performed; and
(D) participating facility location or locations.
(c) For the electronic provider directories, for each
network plan, a network plan shall make available all of the
following information in addition to the searchable
information required in this Section:
(1) for health care professionals:
(A) contact information, including both a

SB3739 - 32 - LRB103 39496 RPS 69693 b
telephone number and digital contact information if
the provider has supplied digital contact information;
and
(B) languages spoken other than English by
clinical staff, if applicable;
(2) for hospitals, telephone number and digital
contact information; and
(3) for facilities other than hospitals, telephone
number.
(d) The issuer insurer or network plan shall make
available in print, upon request, the following provider
directory information for the applicable network plan:
(1) for health care professionals:
(A) name;
(B) contact information, including a telephone
number and digital contact information if the provider
has supplied digital contact information;
(C) participating office location or locations;
(D) specialty, if applicable;
(E) languages spoken other than English, if
applicable;
(F) whether accepting new patients; and
(G) use of telehealth or telemedicine, including,
but not limited to:
(i) whether the provider offers the use of
telehealth or telemedicine to deliver services to

SB3739 - 33 - LRB103 39496 RPS 69693 b
patients for whom it would be clinically
appropriate;
(ii) what modalities are used and what types
of services may be provided via telehealth or
telemedicine; and
(iii) whether the provider has the ability and
willingness to include in a telehealth or
telemedicine encounter a family caregiver who is
in a separate location than the patient if the
patient wishes and provides his or her consent;
and
(H) whether patients can make an appointment to
visit the health care professional.
(2) for hospitals:
(A) hospital name;
(B) hospital type (such as acute, rehabilitation,
children's, or cancer); and
(C) participating hospital location, and telephone
number, and digital contact information; and
(3) for facilities, other than hospitals, by type:
(A) facility name;
(B) facility type;
(C) types of services performed; and
(D) participating facility location or locations,
and telephone numbers, and digital contact information
for each location.

SB3739 - 34 - LRB103 39496 RPS 69693 b
(e) The network plan shall include a disclosure in the
print format provider directory that the information included
in the directory is accurate as of the date of printing and
that beneficiaries or prospective beneficiaries should consult
the issuer's insurer's electronic provider directory on its
website and contact the provider. The network plan shall also
include a telephone number in the print format provider
directory for a customer service representative where the
beneficiary can obtain current provider directory information.
(f) The Director may conduct periodic audits of the
accuracy of provider directories. A network plan shall not be
subject to any fines or penalties for information required in
this Section that a provider submits that is inaccurate or
incomplete.
(g) To the extent not otherwise provided in this Act, an
issuer shall comply with the requirements of 42 U.S.C.
300gg-115, except that "provider directory information" shall
include all information required to be included in a provider
directory pursuant to this Section.
(h) This Section applies to network plans not otherwise
exempt under Section 3, including stand-alone dental plans.
(Source: P.A. 102-92, eff. 7-9-21; revised 9-26-23.)
(215 ILCS 124/30)
Sec. 30. Administration and enforcement.
(a) Issuers Insurers, as defined in this Act, have a

SB3739 - 35 - LRB103 39496 RPS 69693 b
continuing obligation to comply with the requirements of this
Act. Other than the duties specifically created in this Act,
nothing in this Act is intended to preclude, prevent, or
require the adoption, modification, or termination of any
utilization management, quality management, or claims
processing methodologies of an issuer insurer.
(b) Nothing in this Act precludes, prevents, or requires
the adoption, modification, or termination of any network plan
term, benefit, coverage or eligibility provision, or payment
methodology.
(c) The Director shall enforce the provisions of this Act
pursuant to the enforcement powers granted to it by law.
(d) The Department shall adopt rules to enforce compliance
with this Act to the extent necessary.
(e) In accordance with Section 5-45 of the Illinois
Administrative Procedure Act, the Department may adopt
emergency rules to implement federal standards for provider
ratios, travel time and distance, and appointment wait times
if such standards apply to health insurance coverage regulated
by the Department and are more stringent than the State
standards extant at the time the final federal standards are
published.
(Source: P.A. 100-502, eff. 9-15-17.)
(215 ILCS 124/35 new)
Sec. 35. Provider requirements. Providers shall comply

SB3739 - 36 - LRB103 39496 RPS 69693 b
with 42 U.S.C. 300gg-138 and 300gg-139 and the regulations
promulgated thereunder, as well as Section 20 and paragraph
(2) of subsection (a) of Section 25 of this Act, except that
"provider directory information" includes all information
required to be included in a provider directory pursuant to
Section 25 of this Act. To the extent a provider is licensed by
the Department of Financial and Professional Regulation or by
the Department of Public Health, that agency shall have the
authority to investigate, examine, process complaints, issue
subpoenas, examine witnesses under oath, issue a fine, or take
disciplinary action against the provider's license for
violations of these requirements in accordance with the
provider's applicable licensing statute.
(215 ILCS 124/40 new)
Sec. 40. Confidentiality.
(a) All records in the custody or possession of the
Department are presumed to be open to public inspection or
copying unless exempt from disclosure by Section 7 or 7.5 of
the Freedom of Information Act. Except as otherwise provided
in this Section or other applicable law, the filings required
under this Act shall be open to public inspection or copying.
(b) The following information shall not be deemed
confidential:
(1) actual or projected ratios of providers to
beneficiaries;

SB3739 - 37 - LRB103 39496 RPS 69693 b
(2) actual or projected time and distance between
network providers and beneficiaries or actual or projected
waiting times for a beneficiary to see a network provider;
(3) geographic maps of network providers;
(4) requests for exceptions under subsection (g) of
Section 10, except with respect to any discussion of
ongoing or planned contractual negotiations with providers
that the issuer requests to be treated as confidential;
(5) provider directories and provider lists; and
(6) insurer or Department statements of determination
as to whether a network plan has satisfied the Act's
requirements regarding the information described in this
subsection.
(c) An issuer's work papers and reports on the results of a
self-audit of its provider directories shall remain
confidential unless expressly waived by the insurer or unless
deemed public information under federal law.
(d) The filings required under Section 10 of this Act
shall be confidential while they remain under the Department's
review but shall become open to public inspection and copying
upon completion of the review, except as provided in this
Section or under other applicable law.
(e) Nothing in this Section shall supersede the statutory
requirement that work papers obtained during a market conduct
examination be deemed confidential.

SB3739 - 38 - LRB103 39496 RPS 69693 b
(215 ILCS 124/50 new)
Sec. 50. Funds for enforcement. Moneys from fines and
penalties collected from issuers for violations of this Act
shall be deposited into the Insurance Producer Administration
Fund for appropriation by the General Assembly to the
Department to be used for providing financial support of the
Department's enforcement of this Act.
Section 20. The Managed Care Reform and Patient Rights Act
is amended by changing Sections 20 and 25 as follows:
(215 ILCS 134/20)
Sec. 20. Notice of nonrenewal or termination. A health
care plan must give at least 60 days notice of nonrenewal or
termination of a health care provider to the health care
provider and to the enrollees served by the health care
provider. The notice shall include a name and address to which
an enrollee or health care provider may direct comments and
concerns regarding the nonrenewal or termination. Immediate
written notice may be provided without 60 days notice when a
health care provider's license has been disciplined by a State
licensing board. The notice to the enrollee shall provide the
individual with an opportunity to notify the health care plan
of the individual's need for transitional care.
(Source: P.A. 91-617, eff. 1-1-00.)

SB3739 - 39 - LRB103 39496 RPS 69693 b
(215 ILCS 134/25)
Sec. 25. Transition of services.
(a) A health care plan shall provide for continuity of
care for its enrollees as follows:
(1) If an enrollee's health care provider physician
leaves the health care plan's network of health care
providers for reasons other than termination of a contract
in situations involving imminent harm to a patient or a
final disciplinary action by a State licensing board and
the provider physician remains within the health care
plan's service area, or if benefits provided under such
health care plan with respect to such provider are
terminated because of a change in the terms of the
participation of such provider in such plan, or if a
contract between a group health plan, as defined in
Section 5 of the Illinois Health Insurance Portability and
Accountability Act, and a health care plan offered in
connection with the group health plan is terminated and
results in a loss of benefits provided under such plan
with respect to such provider, the health care plan shall
permit the enrollee to continue an ongoing course of
treatment with that provider physician during a
transitional period:
(A) of 90 days from the date of the notice of
provider's physician's termination from the health
care plan to the enrollee of the provider's

SB3739 - 40 - LRB103 39496 RPS 69693 b
physician's disaffiliation from the health care plan
if the enrollee has an ongoing course of treatment; or
(B) if the enrollee has entered the third
trimester of pregnancy at the time of the provider's
physician's disaffiliation, that includes the
provision of post-partum care directly related to the
delivery.
(2) Notwithstanding the provisions in item (1) of this
subsection, such care shall be authorized by the health
care plan during the transitional period only if the
provider physician agrees:
(A) to continue to accept reimbursement from the
health care plan at the rates applicable prior to the
start of the transitional period;
(B) to adhere to the health care plan's quality
assurance requirements and to provide to the health
care plan necessary medical information related to
such care; and
(C) to otherwise adhere to the health care plan's
policies and procedures, including but not limited to
procedures regarding referrals and obtaining
preauthorizations for treatment.
(3) During an enrollee's plan year, a health care plan
shall not remove a drug from its formulary or negatively
change its preferred or cost-tier sharing unless, at least
60 days before making the formulary change, the health

SB3739 - 41 - LRB103 39496 RPS 69693 b
care plan:
(A) provides general notification of the change in
its formulary to current and prospective enrollees;
(B) directly notifies enrollees currently
receiving coverage for the drug, including information
on the specific drugs involved and the steps they may
take to request coverage determinations and
exceptions, including a statement that a certification
of medical necessity by the enrollee's prescribing
provider will result in continuation of coverage at
the existing level; and
(C) directly notifies by first class mail and
through an electronic transmission, if available, the
prescribing provider of all health care plan enrollees
currently prescribed the drug affected by the proposed
change; the notice shall include a one-page form by
which the prescribing provider can notify the health
care plan by first class mail that coverage of the drug
for the enrollee is medically necessary.
The notification in paragraph (C) may direct the
prescribing provider to an electronic portal through which
the prescribing provider may electronically file a
certification to the health care plan that coverage of the
drug for the enrollee is medically necessary. The
prescribing provider may make a secure electronic
signature beside the words "certification of medical

SB3739 - 42 - LRB103 39496 RPS 69693 b
necessity", and this certification shall authorize
continuation of coverage for the drug.
If the prescribing provider certifies to the health
care plan either in writing or electronically that the
drug is medically necessary for the enrollee as provided
in paragraph (C), a health care plan shall authorize
coverage for the drug prescribed based solely on the
prescribing provider's assertion that coverage is
medically necessary, and the health care plan is
prohibited from making modifications to the coverage
related to the covered drug, including, but not limited
to:
(i) increasing the out-of-pocket costs for the
covered drug;
(ii) moving the covered drug to a more restrictive
tier; or
(iii) denying an enrollee coverage of the drug for
which the enrollee has been previously approved for
coverage by the health care plan.
Nothing in this item (3) prevents a health care plan
from removing a drug from its formulary or denying an
enrollee coverage if the United States Food and Drug
Administration has issued a statement about the drug that
calls into question the clinical safety of the drug, the
drug manufacturer has notified the United States Food and
Drug Administration of a manufacturing discontinuance or

SB3739 - 43 - LRB103 39496 RPS 69693 b
potential discontinuance of the drug as required by
Section 506C of the Federal Food, Drug, and Cosmetic Act,
as codified in 21 U.S.C. 356c, or the drug manufacturer
has removed the drug from the market.
Nothing in this item (3) prohibits a health care plan,
by contract, written policy or procedure, or any other
agreement or course of conduct, from requiring a
pharmacist to effect substitutions of prescription drugs
consistent with Section 19.5 of the Pharmacy Practice Act,
under which a pharmacist may substitute an interchangeable
biologic for a prescribed biologic product, and Section 25
of the Pharmacy Practice Act, under which a pharmacist may
select a generic drug determined to be therapeutically
equivalent by the United States Food and Drug
Administration and in accordance with the Illinois Food,
Drug and Cosmetic Act.
This item (3) applies to a policy or contract that is
amended, delivered, issued, or renewed on or after January
1, 2019. This item (3) does not apply to a health plan as
defined in the State Employees Group Insurance Act of 1971
or medical assistance under Article V of the Illinois
Public Aid Code.
(b) A health care plan shall provide for continuity of
care for new enrollees as follows:
(1) If a new enrollee whose physician is not a member
of the health care plan's provider network, but is within

SB3739 - 44 - LRB103 39496 RPS 69693 b
the health care plan's service area, enrolls in the health
care plan, the health care plan shall permit the enrollee
to continue an ongoing course of treatment with the
enrollee's current physician during a transitional period:
(A) of 90 days from the effective date of
enrollment if the enrollee has an ongoing course of
treatment; or
(B) if the enrollee has entered the third
trimester of pregnancy at the effective date of
enrollment, that includes the provision of post-partum
care directly related to the delivery.
(2) If an enrollee elects to continue to receive care
from such physician pursuant to item (1) of this
subsection, such care shall be authorized by the health
care plan for the transitional period only if the
physician agrees:
(A) to accept reimbursement from the health care
plan at rates established by the health care plan;
such rates shall be the level of reimbursement
applicable to similar physicians within the health
care plan for such services;
(B) to adhere to the health care plan's quality
assurance requirements and to provide to the health
care plan necessary medical information related to
such care; and
(C) to otherwise adhere to the health care plan's

SB3739 - 45 - LRB103 39496 RPS 69693 b
policies and procedures including, but not limited to
procedures regarding referrals and obtaining
preauthorization for treatment.
(c) In no event shall this Section be construed to require
a health care plan to provide coverage for benefits not
otherwise covered or to diminish or impair preexisting
condition limitations contained in the enrollee's contract. In
no event shall this Section be construed to prohibit the
addition of prescription drugs to a health care plan's list of
covered drugs during the coverage year.
(d) In this Section, "ongoing course of treatment" has the
meaning ascribed to that term in Section 5 of the Network
Adequacy and Transparency Act.
(Source: P.A. 100-1052, eff. 8-24-18.)
Section 95. No acceleration or delay. Where this Act makes
changes in a statute that is represented in this Act by text
that is not yet or no longer in effect (for example, a Section
represented by multiple versions), the use of that text does
not accelerate or delay the taking effect of (i) the changes
made by this Act or (ii) provisions derived from any other
Public Act.