Bill Text: IL HB3749 | 2009-2010 | 96th General Assembly | Introduced
Bill Title: Amends the Illinois Insurance Code. Provides that an insured may be entitled to interest at the rate of 10% (instead of 9%) if an insurer fails to pay a claim within a specified time frame. Provides that an insurer may not (1) reduce the amount of a claim or (2) recoup or offset any amount of a claim unless that reduction or recoupment or offset results from an arbitration process that has been authorized by the Director of Insurance. Provides that no policy or plan may deny, discontinue, or alter coverage of a treatment method that follows a prescribed standard of care for any illness, condition, injury, disease, or disability during a benefit period if the illness, condition, injury, disease, or disability was covered at any time during the benefit period or if a claim regarding the treatment method is paid during the benefit period. Provides that insurers may not change certain fee calculations more frequently than once each year. Grants the Director of Insurance specific authority to issue a cease and desist order against, fine, or otherwise penalize any company that violates the provisions concerning coverage and rates. Makes other changes. Effective immediately.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2009-04-03 - Rule 19(a) / Re-referred to Rules Committee [HB3749 Detail]
Download: Illinois-2009-HB3749-Introduced.html
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1 | AN ACT concerning insurance.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Insurance Code is amended by | ||||||||||||||||||||||||||||||||
5 | changing Sections 357.9, 357.9a, 368c and 368d and by adding | ||||||||||||||||||||||||||||||||
6 | Section 368g as follows:
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7 | (215 ILCS 5/357.9) (from Ch. 73, par. 969.9)
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8 | Sec. 357.9. "TIME OF PAYMENT OF CLAIMS: Indemnities
payable | ||||||||||||||||||||||||||||||||
9 | under
this policy for any loss other than loss for which this | ||||||||||||||||||||||||||||||||
10 | policy provides
any periodic payment will be paid immediately | ||||||||||||||||||||||||||||||||
11 | upon receipt of due
written proof of such loss.
Subject
to due | ||||||||||||||||||||||||||||||||
12 | written proof of loss, all
accrued indemnities for loss for | ||||||||||||||||||||||||||||||||
13 | which this policy provides periodic
payment will be paid ....
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14 | (insert period for payment which must not be
less frequently | ||||||||||||||||||||||||||||||||
15 | than monthly) and any balance remaining unpaid upon the
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16 | termination of liability, will be paid immediately upon receipt | ||||||||||||||||||||||||||||||||
17 | of due
written proof."
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18 | All claims and indemnities payable under the terms of
a | ||||||||||||||||||||||||||||||||
19 | policy of accident and health insurance shall be paid within 30 | ||||||||||||||||||||||||||||||||
20 | days
following receipt by the insurer of due proof of loss.
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21 | Failure to pay
within such period shall entitle the insured
to | ||||||||||||||||||||||||||||||||
22 | interest at the rate of 10% 9
per cent per annum from the 30th | ||||||||||||||||||||||||||||||||
23 | day after receipt of such proof of loss to
the date of late |
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1 | payment, provided that interest amounting to less than one
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2 | dollar need not be paid.
An insured or an insured's assignee | ||||||
3 | shall be
notified by the insurer, health maintenance | ||||||
4 | organization, managed care plan,
health care plan, preferred | ||||||
5 | provider organization, or third party administrator
of any | ||||||
6 | known failure to provide sufficient documentation for a
due | ||||||
7 | proof of
loss within 30 days after receipt of the claim.
Any
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8 | required interest payments shall be made within 30 days after | ||||||
9 | the payment.
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10 | The requirements of this Section shall apply to any policy | ||||||
11 | of accident
and health insurance delivered, issued for | ||||||
12 | delivery, renewed or amended on
or after 180 days following the | ||||||
13 | effective date of this amendatory Act of 1985.
The requirements | ||||||
14 | of this Section also shall specifically apply to
any group | ||||||
15 | policy of dental insurance only, delivered, issued for
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16 | delivery, renewed or amended on or after 180 days following the | ||||||
17 | effective
date of this amendatory Act of 1987.
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18 | (Source: P.A. 91-605, eff. 12-14-99.)
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19 | (215 ILCS 5/357.9a) (from Ch. 73, par. 969.9a)
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20 | Sec. 357.9a. Delay in payment of claims. Periodic payments
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21 | of accrued indemnities for loss-of-time coverage under | ||||||
22 | accident
and health policies shall commence not later than 30 | ||||||
23 | days after
the receipt by the company of the required written | ||||||
24 | proofs of loss.
An insurer which violates this Section if | ||||||
25 | liable under said policy, shall
pay to the insured, in addition |
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1 | to any other penalty provided for in this Code,
interest at the | ||||||
2 | rate of 10% 9% per annum from the 30th day after
receipt of | ||||||
3 | such proofs of loss to the date of late payment of the
accrued | ||||||
4 | indemnities, provided that interest amounting to less than
one | ||||||
5 | dollar need not be paid.
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6 | (Source: P.A. 92-139, eff. 7-24-01.)
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7 | (215 ILCS 5/368c)
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8 | Sec. 368c. Remittance advice and procedures.
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9 | (a) A remittance advice shall be furnished to a health care | ||||||
10 | professional or
health
care provider that identifies the | ||||||
11 | disposition of each claim. The remittance
advice shall identify | ||||||
12 | the services billed; the patient responsibility, if any;
the | ||||||
13 | actual payment, if any, for the services billed ; and the | ||||||
14 | reason for any
reduction to the amount for
which the claim was | ||||||
15 | submitted. For any reductions to the amount for which the
claim | ||||||
16 | was submitted, the remittance shall identify any withholds and | ||||||
17 | the reason
for any denial or reduction. An insurer, health | ||||||
18 | maintenance
organization,
independent practice association, or | ||||||
19 | physician hospital organization may not reduce the amount of a | ||||||
20 | claim unless that reduction results from an arbitration process | ||||||
21 | that has been authorized by the Director.
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22 | A remittance advice for capitation or prospective payment | ||||||
23 | arrangements shall
be
furnished to a health care professional | ||||||
24 | or health care provider pursuant to a
contract with
an insurer, | ||||||
25 | health maintenance organization,
independent practice |
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1 | association,
or
physician hospital organization in accordance | ||||||
2 | with the terms of the contract.
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3 | (b) When health care services are provided by a | ||||||
4 | non-participating
health care
professional or health care | ||||||
5 | provider, an insurer, health maintenance
organization,
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6 | independent practice association, or physician hospital | ||||||
7 | organization may pay
for covered
services either to a patient | ||||||
8 | directly or to the non-participating health care
professional | ||||||
9 | or
health care provider.
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10 | (c) When a person presents a
benefits information card,
a | ||||||
11 | health care professional or health care provider shall make a | ||||||
12 | good faith
effort
to inform the
person if the
health care | ||||||
13 | professional or health care provider has a participation | ||||||
14 | contract
with the
insurer,
health maintenance organization, or | ||||||
15 | other
entity identified on the card.
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16 | (Source: P.A. 93-261, eff. 1-1-04.)
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17 | (215 ILCS 5/368d)
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18 | Sec. 368d. Recoupments.
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19 | (a) A health care professional or health care provider | ||||||
20 | shall be provided a
remittance advice, which must include an | ||||||
21 | explanation of a
recoupment or
offset taken by an insurer, | ||||||
22 | health maintenance organization,
independent practice | ||||||
23 | association, or physician hospital
organization, if any. The | ||||||
24 | recoupment explanation shall, at a minimum, include
the name
of | ||||||
25 | the patient; the date of service; the service code or if no |
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1 | service code is
available a service description;
the recoupment | ||||||
2 | amount; and the reason for the recoupment or offset. In
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3 | addition,
an insurer,
health maintenance organization, | ||||||
4 | independent
practice association, or physician
hospital | ||||||
5 | organization shall provide with the remittance advice a | ||||||
6 | telephone
number or mailing address to initiate an appeal of | ||||||
7 | the recoupment or offset. An insurer, health maintenance
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8 | organization,
independent practice association, or physician | ||||||
9 | hospital organization may not recoup or offset any amount | ||||||
10 | unless that recoupment or offset results from an arbitration | ||||||
11 | process that has been authorized by the Director.
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12 | (b) It is not a recoupment when a health care professional | ||||||
13 | or health care
provider
is paid an amount prospectively or | ||||||
14 | concurrently under a contract with an
insurer, health
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15 | maintenance organization, independent practice
association, or | ||||||
16 | physician
hospital
organization that requires a retrospective | ||||||
17 | reconciliation based upon specific
conditions
outlined in the | ||||||
18 | contract.
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19 | (Source: P.A. 93-261, eff. 1-1-04.)
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20 | (215 ILCS 5/368g new) | ||||||
21 | Sec. 368g. Coverage and rates. | ||||||
22 | (a) No policy of accident and health or managed care plan | ||||||
23 | amended, delivered, issued, or renewed in this State may deny, | ||||||
24 | discontinue, or alter coverage of a treatment method that | ||||||
25 | follows a prescribed standard of care for any illness, |
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1 | condition, injury, disease, or disability during a benefit | ||||||
2 | period if the illness, condition, injury, disease, or | ||||||
3 | disability was covered at any time during the benefit period or | ||||||
4 | if a claim regarding the treatment method is paid during the | ||||||
5 | benefit period. If a treatment method is covered by the policy | ||||||
6 | or plan during the benefit period or if a claim regarding the | ||||||
7 | treatment method is paid, then the policy or plan must continue | ||||||
8 | coverage of the treatment method at the usual and customary fee | ||||||
9 | rate for the remainder of the benefit period. | ||||||
10 | (b) No company that issues, delivers, amends, or renews an | ||||||
11 | individual or group policy of accident and health or managed | ||||||
12 | care plan in this State may do any of the following: | ||||||
13 | (1) alter its definition of "eligible expense" or | ||||||
14 | "maximum allowable expense" for a policy or plan after the | ||||||
15 | policy's or plan's benefit period has started; | ||||||
16 | (2) increase its stated usual and customary fee rate | ||||||
17 | for services covered by the policy or plan more frequently | ||||||
18 | than once each calendar year; or | ||||||
19 | (3) alter any fee schedules, fee methodologies, or | ||||||
20 | other methods used to calculate payment more frequently | ||||||
21 | than once each calendar year. | ||||||
22 | (c) The Director is hereby granted specific authority to | ||||||
23 | issue a cease and desist order against, fine, or otherwise | ||||||
24 | penalize any company doing business in this State that violates | ||||||
25 | the provisions of this Section.
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26 | Section 99. Effective date. This Act takes effect upon |
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1 | becoming law.
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