Bill Text: IL SB1422 | 2023-2024 | 103rd General Assembly | Introduced
Bill Title: Amends the Illinois Insurance Code. Provides that if the policies, agreements, or arrangements of an insurer operate unreasonably in restricting an insured individual's ability to obtain home medical equipment, then an insurer is required to reasonably reimburse its insured for expenses incurred due to the unreasonable restriction. Defines "arrangement".
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2023-02-07 - Referred to Assignments [SB1422 Detail]
Download: Illinois-2023-SB1422-Introduced.html
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1 | AN ACT concerning regulation.
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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 Section 370g and by adding Section 370u as follows:
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6 | (215 ILCS 5/370g) (from Ch. 73, par. 982g)
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7 | Sec. 370g. Definitions. As used in this Article, the | |||||||||||||||||||||
8 | following definitions
apply:
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9 | (a) "Health care services" means health care services or | |||||||||||||||||||||
10 | products
rendered or sold by a provider within the scope of the | |||||||||||||||||||||
11 | provider's license
or legal authorization. The term includes, | |||||||||||||||||||||
12 | but is not limited to, hospital,
medical, surgical, dental, | |||||||||||||||||||||
13 | vision and pharmaceutical services or products.
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14 | (b) "Insurer" means an insurance company or a health | |||||||||||||||||||||
15 | service corporation
authorized in this State to issue policies | |||||||||||||||||||||
16 | or subscriber contracts which
reimburse for expenses of health | |||||||||||||||||||||
17 | care services.
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18 | (c) "Insured" means an individual entitled to | |||||||||||||||||||||
19 | reimbursement for expenses
of health care services under a | |||||||||||||||||||||
20 | policy or subscriber contract issued or
administered by an | |||||||||||||||||||||
21 | insurer.
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22 | (d) "Provider" means an individual or entity duly licensed | |||||||||||||||||||||
23 | or legally
authorized to provide health care services.
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1 | (e) "Noninstitutional provider" means any person licensed | ||||||
2 | under the Medical
Practice Act of 1987, as now or hereafter | ||||||
3 | amended.
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4 | (f) "Beneficiary" means an individual entitled to | ||||||
5 | reimbursement for
expenses of or the discount of provider fees | ||||||
6 | for health care services under
a program where the beneficiary | ||||||
7 | has an incentive to utilize the services of a
provider which | ||||||
8 | has entered into an agreement or arrangement with an
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9 | administrator.
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10 | (g) "Administrator" means any person, partnership or | ||||||
11 | corporation, other
than an insurer or health maintenance | ||||||
12 | organization holding a certificate of
authority under the | ||||||
13 | "Health Maintenance Organization Act", as now or hereafter
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14 | amended, that arranges, contracts with, or administers | ||||||
15 | contracts with a
provider whereby beneficiaries are provided | ||||||
16 | an incentive to use the services of
such provider.
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17 | (h) "Emergency medical condition" has the meaning given to | ||||||
18 | that term in Section 10 of the Managed Care Reform and Patient | ||||||
19 | Rights Act. | ||||||
20 | (i) "Arrangement" means a scheme between insurers and | ||||||
21 | health care service providers to supply health care products, | ||||||
22 | including, but not limited to, a provider's maintenance of | ||||||
23 | supplies to adequately fulfill its obligations under the | ||||||
24 | scheme.
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25 | (Source: P.A. 102-409, eff. 1-1-22 .)
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1 | (215 ILCS 5/370u new) | ||||||
2 | Sec. 370u. Reimbursement; home medical equipment. If the | ||||||
3 | policies, agreements, or arrangements of an insurer operate | ||||||
4 | unreasonably in restricting an insured individual's ability to | ||||||
5 | obtain home medical equipment, as defined in Section 10 of the | ||||||
6 | Home Medical Equipment and Services Provider License Act, then | ||||||
7 | the insurer is required to reasonably reimburse its insured | ||||||
8 | for expenses incurred due to the unreasonable restriction.
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