99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
HB2711

 

Introduced , by Rep. Dan Brady

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/356z.23 new

    Amends the Illinois Insurance Code in relation to patient access to eye care. Provides that insurers may not set reimbursement rates in a manner that discriminates against a class of eye care providers. Provides that eye care coverage insurers may not preclude obtaining eye care directly from a licensed provider on a health care panel or promote a class of providers to the detriment of another class of providers. Requires that all providers on a provider panel be included in any publicly accessible list. Requires the inclusion of ophthalmologists and optometrists in provider panels. Imposes additional requirements.


LRB099 04229 MLM 24251 b

 

 

A BILL FOR

 

HB2711LRB099 04229 MLM 24251 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by adding
5Section 356z.23 as follows:
 
6    (215 ILCS 5/356z.23 new)
7    Sec. 356z.23. Patient access to eye care.
8    (a) In this Section:
9    "Covered person" means an individual enrolled in a health
10benefit plan or an eligible dependent thereof.
11    "Covered services" means those health care services that a
12health care insurer is obligated to pay for or provide to a
13covered person under a health benefit plan.
14    "Eye care" means those health care services and materials
15related to the care of the eye and related structures and
16vision care services that a health care insurer is obligated to
17pay for or provide to covered persons under the health benefit
18plan.
19    "Health benefit plan" means any public or private health
20plan, program, policy, or agreement implemented in this State
21that provides health benefits to covered persons, including,
22but not limited to, payment and reimbursement for health care
23services.

 

 

HB2711- 2 -LRB099 04229 MLM 24251 b

1    "Health care insurer" means an entity, including, but not
2limited to, insurance companies, hospital service nonprofit
3corporations, nonprofit medical service corporations, health
4care corporations, health maintenance organizations, and
5preferred provider organizations authorized by the State to
6offer or provide health benefit plans, programs, policies,
7subscriber contracts, or any other agreements of a similar
8nature that compensate or indemnify health care providers for
9furnishing health care services.
10    (b) A health care insurer providing a health benefit plan
11that includes eye care benefits shall:
12        (1) not set professional fees or reimbursement for the
13    same eye care services as defined by established current
14    procedural terminology codes in a manner that
15    discriminates against an individual eye care provider or a
16    class of eye care providers;
17        (2) not preclude a covered person who seeks eye care
18    from obtaining such service directly from a provider on the
19    health benefit plan provider panel who is licensed to
20    provide eye care;
21        (3) not promote or recommend any class of providers to
22    the detriment of any other class of providers for the same
23    eye care service;
24        (4) ensure that all eye care providers on a health
25    benefit plan provider panel are included on any publicly
26    accessible list of participating providers for the plan;

 

 

HB2711- 3 -LRB099 04229 MLM 24251 b

1        (5) allow each eye care provider on a health benefit
2    plan provider panel, without discrimination between
3    classes of eye care providers, to furnish covered eye care
4    services to covered persons to the extent permitted by the
5    provider's licensure;
6        (6) not require any eye care provider to hold hospital
7    privileges or impose any other condition or restriction for
8    initial admittance to a provider panel not necessary for
9    the delivery of eye care upon the providers that would have
10    the effect of excluding an individual eye care provider or
11    class of eye care providers from participation on the
12    health benefit plan; and
13        (7) include optometrists and ophthalmologists on the
14    health benefit plan provider panel in a manner that ensures
15    plan enrollees timely access and geographic access.
16    (c) Nothing in this Section shall preclude a covered person
17from receiving eye care or other covered services from the
18covered person's personal physician in accordance with the
19terms of the health benefit plan.
20    (d) A person adversely affected by a violation of this
21Section by a health care insurer may bring an action in a court
22of competent jurisdiction for injunctive relief against the
23insurer and, upon prevailing, in addition to any injunctive
24relief that may be granted, shall recover from the insurer
25damages of not more than $100 and attorney's fees and costs.
26    (e) Nothing in this Section requires a health benefit plan

 

 

HB2711- 4 -LRB099 04229 MLM 24251 b

1to include eye care benefits.
2    (f) The Director may adopt rules to enforce this Section.