Bill Text: IL HB3188 | 2019-2020 | 101st General Assembly | Introduced

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Bill Title: Amends the Illinois Insurance Code. Provides that if an insured is required to pay a deductible or copayment under a policy, an accident and health insurer must disclose to the insured the total actual payments made by the accident and health insurer to a health care provider and the basis for the deductible or copayment the insured is required to pay. Provides that if an accident and health insurer pays a claim to a healthcare provider at an agreed-upon or discounted rate, then the accident and health insurer must base the insured's deductible or copayment upon the agreed-upon or discounted rate rather than any other advertised or listed rate. Amends the Health Maintenance Organization Act and the Illinois Public Aid Code. Provides the basis for calculation of a deductible or copayment.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2019-03-29 - Rule 19(a) / Re-referred to Rules Committee [HB3188 Detail]

Download: Illinois-2019-HB3188-Introduced.html

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101ST GENERAL ASSEMBLY State of Illinois 2019 and 2020 HB3188 Introduced , by Rep. Deanne M. Mazzochi SYNOPSIS AS INTRODUCED:
215 ILCS 5/370b.2 new
215 ILCS 125/4-21 new
305 ILCS 5/5-16.8
Amends the Illinois Insurance Code. Provides that if an insured is required to pay a deductible or copayment under a policy, an accident and health insurer must disclose to the insured the total actual payments made by the accident and health insurer to a health care provider and the basis for the deductible or copayment the insured is required to pay. Provides that if an accident and health insurer pays a claim to a healthcare provider at an agreed-upon or discounted rate, then the accident and health insurer must base the insured's deductible or copayment upon the agreed-upon or discounted rate rather than any other advertised or listed rate. Amends the Health Maintenance Organization Act and the Illinois Public Aid Code. Provides the basis for calculation of a deductible or copayment.
LRB101 10901 SMS 56048 b
A BILL FOR
HB3188 LRB101 10901 SMS 56048 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 Insurance Code is amended by adding
Section 370b.2 as follows:
(215 ILCS 5/370b.2 new)
Sec. 370b.2. Deductibles and copayments.
(a) If an insured is required to pay a deductible or
copayment under a policy, an accident and health insurer must
disclose to the insured the total actual payments made by the
accident and health insurer to a health care provider and the
basis for the deductible or copayment the insured is required
to pay.
(b) If an accident and health insurer pays a claim to a
health care provider at an agreed-upon or discounted rate, then
the accident and health insurer must base the insured's
deductible or copayment upon the agreed-upon or discounted rate
rather than any other advertised or listed rate.
Section 10. The Health Maintenance Organization Act is
amended by adding Section 4-21 as follows:
(215 ILCS 125/4-21 new)

HB3188 - 2 - LRB101 10901 SMS 56048 b
Sec. 4-21. Calculation of deductible and copayments. If an
enrollee is required to pay a deductible or a copayment for a
health care service that is determined based upon the cost for
a health care service, then the deductible or copayment for
that health care service shall be based off the agreed-upon or
discounted rate paid to the provider. If the provider is not
paid per individual health care service, then the deductible or
copayment must be based upon the average net payment to a
specific provider for that health care service.
Section 15. The Illinois Public Aid Code is amended by
changing Section 5-16.8 as follows:
(305 ILCS 5/5-16.8)
Sec. 5-16.8. Required health benefits. The medical
assistance program shall (i) provide the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, and
356z.29, and 356z.32 of the Illinois Insurance Code and (ii) be
subject to the provisions of Sections 356z.19, 364.01, 370b.2,
370c, and 370c.1 of the Illinois Insurance Code.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate of
reimbursement for services or other payments in accordance with

HB3188 - 3 - LRB101 10901 SMS 56048 b
Section 5-5e.
To ensure full access to the benefits set forth in this
Section, on and after January 1, 2016, the Department shall
ensure that provider and hospital reimbursement for
post-mastectomy care benefits required under this Section are
no lower than the Medicare reimbursement rate.
(Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15;
99-642, eff. 7-28-16; 100-138, eff. 8-18-17; 100-863, eff.
8-14-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
10-4-18.)