Bill Text: IL SB0764 | 2023-2024 | 103rd General Assembly | Engrossed

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Creates the Vision Care Plan Regulation Act. Provides that no vision care organization may issue a contract that requires an eye care provider, as a condition of participation in the vision care plan, to provide services or materials to an enrollee at a fee set by the vision care plan unless the services or materials are covered under the vision care plan. Provides that an eye care provider who chooses not to accept amounts set by a vision care plan for noncovered services or noncovered materials shall post a specified notice. Requires fees for covered services and materials to be reasonable and clearly listed on a fee schedule provided to the eye care provider. Prohibits a vision care organization from misrepresenting the benefits of a vision care plan as a means of selling coverage or communicating the benefit coverage to enrollees. Provides that the Act applies to any subcontractors used by a vision care organization to supply materials or services to an eye care provider or an enrollee under a vision care plan. Prohibits a vision care organization from restricting an eye care provider's freedom to choose suppliers, materials, or labs or from requiring an eye care provider to purchase materials from a source owned by the entity that issued the vision care plan. Provides that fees paid for materials supplied by a non-network lab are not required to be identical to fees paid for materials ordered through a network lab, but non-network lab fees shall be reasonable. Provides that a vision care organization and its officers, directors, agents, and employees are subject to specified laws. Provides that at the request of an enrollee, an eye care provider recommending an out-of-network source or supplier of vision care materials to an enrollee shall provide written notice to the enrollee stating that the source or supplier is an out-of-network laboratory or supplier of vision care materials, and any business interest the eye care provider has in the out-of-network source or supplier recommended to the enrollee. Provides that an eye care provider is required to offer an enrollee in-network sources or suppliers of vision care materials at the enrollee's request. Provides that the terms, fees, discounts, or reimbursement rates in a vision care plan may not be changed during the term of the contract unless mutually agreed to in writing by the eye care provider and the vision care organization. Provides that a change proposed to a vision care plan by the vision care organization shall become effective if the eye care provider fails to respond to the vision care organization within 60 days after receipt of notice of the proposed changes. Provides that the terms of a vision care plan contract that is amended, delivered, issued, or renewed after the effective date of the Act shall comply with the provisions. Provides that a vision care plan may enter into an agreement with a health care plan to deliver routine vision care services that are covered under the enrollee's plan. Provides that a vision care plan may act as a network regarding routine vision care services offered by a health care plan. Makes other changes. Amends the Consumer Fraud and Deceptive Business Practices Act to provide that any person who violates the Vision Care Plan Regulation Act commits an unlawful practice. Effective immediately.

Spectrum: Slight Partisan Bill (Democrat 8-5)

Status: (Passed) 2023-08-04 - Public Act . . . . . . . . . 103-0482 [SB0764 Detail]

Download: Illinois-2023-SB0764-Engrossed.html

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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 1. Short title. This Act may be cited as the Vision
Care Plan Regulation Act.
Section 5. Definitions. As used in this Act:
"Covered materials" means materials for which
reimbursement from the vision care plan is provided to an eye
care provider by an enrollee's plan contract or for which a
reimbursement would be available but for the application of
the enrollee's contractual limitation of deductibles,
copayments, or coinsurance. "Covered materials" includes lens
treatment or coatings added to a spectacle lens if the base
spectacle lens is a covered material.
"Covered services" means services for which reimbursement
from the vision care plan is provided to an eye care provider
by an enrollee's plan contract or for which a reimbursement
would be available but for the application of the enrollee's
contractual plan limitation of deductibles, copayments, or
coinsurance regardless of how the benefits are listed in an
enrollee's benefit plan's definition of benefits.
"Enrollee" means any individual enrolled in a vision care
plan provided by a group, employer, or other entity that

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purchases or supplies coverage for a vision care plan.
"Eye care provider" means a doctor of optometry licensed
pursuant to the Illinois Optometric Practice Act of 1987 or a
physician licensed to practice medicine in all of its branches
pursuant to the Medical Practice Act of 1987.
"Materials" means ophthalmic devices, including, but not
limited to:
(i) lenses, devices containing lenses, ophthalmic
frames, and other lens mounting apparatus, prisms, lens
treatments, and coatings;
(ii) contact lenses and prosthetic devices that
correct, relieve, or treat defects or abnormal conditions
of the human eye or adnexa; and
(iii) any devices that deliver medication or other
therapeutic treatment to the human eye or adnexa.
"Services" means the professional work performed by an eye
care provider.
"Subcontractor" means any company, group, or third-party
entity, including agents, servants, partially-owned or
wholly-owned subsidiaries and controlled organizations, that
the vision care plan contracts with to supply services or
materials for an eye care provider or enrollee to fulfill the
benefit plan of a vision care plan.
"Vision care organization" means an entity formed under
the laws of this State or another state that issues a vision
care plan.

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"Vision care plan" means a plan that creates, promotes,
sells, provides, advertises, or administers an integrated or
stand-alone plan that provides coverage for covered services
and covered materials.
Section 10. Noncovered services.
(a) No vision care organization that issues, delivers,
amends, or renews a vision care plan on or after the effective
date of this Act shall issue a contract that requires an eye
care provider, as a condition of participation in the vision
care plan, to provide services or materials to an enrollee at a
fee set by the vision care plan unless the services or
materials are covered services or covered materials under the
vision care plan. De minimis reimbursements shall not qualify
a service or material as a covered service or a covered
material under this Act.
(b) An eye care provider who chooses not to accept as
payment an amount set by a vision care plan for services or
materials that are not covered services or covered materials
shall post, in a conspicuous place, a notice stating the
following: "IMPORTANT: This eye care provider does not accept
the fee schedule set by your insurer for vision care services
and vision care materials that are not covered benefits under
your plan and instead charges his or her normal fee for those
services and materials. This eye care provider will provide
you with an estimated cost for each noncovered service or

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noncovered material upon your request."
Section 15. Fees for covered services and covered
materials. Fees paid under a vision care plan for covered
services and covered materials, regardless of the supplier or
optical lab used to obtain materials, shall be reasonable and
shall be clearly listed on a fee schedule that has been
provided to the eye care provider before entering into a
contract with the vision care organization. Fees paid for
materials supplied by a non-network lab are not required to be
identical to fees paid for materials ordered through a network
lab, but non-network lab fees shall be reasonable.
Section 20. Misrepresentation.
(a) A vision care organization and its officers,
directors, agents, and employees are subject to the provisions
of Sections 149 and 154.6 of the Illinois Insurance Code.
(b) Incorporation by reference in this Act to specific
laws of this State shall not be construed to exempt a vision
care organization or vision care plan from otherwise
applicable laws that are not specifically referenced in this
Act.
Section 25. Subcontractors. The provisions of this Act
apply to any subcontractors used by a vision care organization
to supply materials or services to an eye care provider or an

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enrollee under a vision care plan.
Section 30. Suppliers; optical labs.
(a) A vision care organization may not restrict or limit
an eye care provider's choice of suppliers of services,
covered materials, or the use of an optical lab.
(b) A vision care organization may not require an eye care
provider or patient to order or purchase covered materials,
including, but not limited to, ophthalmic lenses, from any
source owned by, controlled by, or in a common ownership
scheme with the entity that issued the vision care plan.
(c) At the request of an enrollee, an eye care provider
recommending an out-of-network source or supplier of vision
care materials to an enrollee shall provide written notice to
the enrollee stating:
(1) that the source or supplier is an out-of-network
laboratory or supplier of vision care materials; and
(2) any business interest that the eye care provider
has in the out-of-network source or supplier recommended
to the enrollee.
(d) An eye care provider is required to offer an enrollee
in-network sources or suppliers of vision care materials at
the enrollee's request.
Section 35. Modification of plan.
(a) The terms, fees, discounts, or reimbursement rates in

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a vision care plan may not be changed during the term of the
contract unless mutually agreed to in writing by the eye care
provider and the vision care organization that issued the
vision care plan. However, a change proposed to a vision care
plan by the vision care organization shall become effective if
the eye care provider fails to respond to the vision care
organization within 60 days after receipt of notice of the
proposed changes.
(b) The terms of a vision care plan contract that is
amended, delivered, issued, or renewed after the effective
date of this Act shall comply with the provisions of this Act.
Section 40. Prohibitions; medical plan preconditions.
(a) No vision care organization that issues, delivers,
amends, or renews a vision care plan on or after the effective
date of this Act shall issue a vision care plan contract that
requires:
(1) an eye care provider to contract with a plan that
offers supplemental or specialty health care services as a
condition of contracting with a plan that offers basic
health services; or
(2) an eye care provider to contract with a vision
care plan as a condition to participation in a medical
plan or in-network.
(b) A vision care plan may enter into an agreement with a
health care plan to deliver routine vision care services that

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are covered under the enrollee's plan.
(c) A vision care plan may act as a network regarding
routine vision care services offered by a health care plan.
Section 900. The Consumer Fraud and Deceptive Business
Practices Act is amended by adding Section 2BBBB as follows:
(815 ILCS 505/2BBBB new)
Sec. 2BBBB. Violations of the Vision Care Plan Regulation
Act. Any person who violates the Vision Care Plan Regulation
Act commits an unlawful practice within the meaning of this
Act.