Bill Text: IL HB0468 | 2009-2010 | 96th General Assembly | Introduced

---

Bill Title: Amends the Illinois Insurance Code. Provides that when a person presents a benefits information card, if the health care professional or health care provider has a participation contract with the insurer, health maintenance organization, or other entity identified on the card, then the health care professional or health care provider shall submit its claim for services covered under the policy within the time frame specified by the insurer or other entity, but not later than one year after the last date that services have been provided to the insured person. Provides that the health care professional or health care provider may not discriminate against the insured person based upon the cause of that person's sickness or accidental injury. If the health care professional or health care provider fails to submit its claim within the time frame provided for under the Act, the health care professional or health care provider may not seek remittance from the insured person. Effective immediately.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2009-03-13 - Rule 19(a) / Re-referred to Rules Committee [HB0468 Detail]

Download: Illinois-2009-HB0468-Introduced.html

---

96TH GENERAL ASSEMBLY State of Illinois 2009 and 2010 HB0468 Introduced 2/4/2009, by Rep. Jay C. Hoffman SYNOPSIS AS INTRODUCED:
215 ILCS 5/368c
Amends the Illinois Insurance Code. Provides that when a person presents a benefits information card, if the health care professional or health care provider has a participation contract with the insurer, health maintenance organization, or other entity identified on the card, then the health care professional or health care provider shall submit its claim for services covered under the policy within the time frame specified by the insurer or other entity, but not later than one year after the last date that services have been provided to the insured person. Provides that the health care professional or health care provider may not discriminate against the insured person based upon the cause of that person's sickness or accidental injury. If the health care professional or health care provider fails to submit its claim within the time frame provided for under the Act, the health care professional or health care provider may not seek remittance from the insured person. Effective immediately.
LRB096 06839 RPM 16925 b
A BILL FOR
HB0468 LRB096 06839 RPM 16925 b
AN ACT concerning insurance.
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
changing Section 368c as follows:
(215 ILCS 5/368c)
Sec. 368c. Remittance advice and procedures.
(a) A remittance advice shall be furnished to a health care
professional or health care provider that identifies the
disposition of each claim. The remittance advice shall identify
the services billed; the patient responsibility, if any; the
actual payment, if any, for the services billed; and the reason
for any reduction to the amount for which the claim was
submitted. For any reductions to the amount for which the claim
was submitted, the remittance shall identify any withholds and
the reason for any denial or reduction.
A remittance advice for capitation or prospective payment
arrangements shall be furnished to a health care professional
or health care provider pursuant to a contract with an insurer,
health maintenance organization, independent practice
association, or physician hospital organization in accordance
with the terms of the contract.
(b) When health care services are provided by a

HB0468 - 2 - LRB096 06839 RPM 16925 b
non-participating health care professional or health care
provider, an insurer, health maintenance organization,
independent practice association, or physician hospital
organization may pay for covered services either to a patient
directly or to the non-participating health care professional
or health care provider.
(c) When a person presents a benefits information card, a
health care professional or health care provider shall make a
good faith effort to inform the person if the health care
professional or health care provider has a participation
contract with the insurer, health maintenance organization, or
other entity identified on the card. If the health care
professional or health care provider has a participation
contract, then the health care professional or health care
provider shall submit its claim for services covered under the
policy within the time frame specified by the insurer, health
maintenance organization, or other entity, but not later than
one year after the last date that services have been provided
to the insured person. The health care professional or health
care provider may not discriminate against the insured person
based upon the cause of that person's sickness or accidental
injury. If the health care professional or health care provider
fails to submit its claim within the time frame provided for
under this subsection (c), the health care professional or
health care provider may not seek remittance from the insured
person.

HB0468 - 3 - LRB096 06839 RPM 16925 b
(Source: P.A. 93-261, eff. 1-1-04.)
Section 99. Effective date. This Act takes effect upon
becoming law.