Illinois General Assembly - Bill Status for SB3233

Amends the Department of Insurance Law of the Civil Administrative Code of Illinois. Provides that the Department of Insurance shall study the frequency and economic impact of nonparticipating facility-based physician and provider claims concerning the issue of when a beneficiary, insured, or enrollee utilizes a participating network hospital or a participating network ambulatory surgery center and, due to any reason, in-network services for radiology, anesthesiology, pathology, emergency physician, or neonatology are unavailable and are provided by a nonparticipating facility-based physician or provider and the insurer's or health plan's responsibility to ensure that the beneficiary, insured, or enrollee incurs no greater out-of-pocket costs than the beneficiary, insured, or enrollee would have incurred with a participating physician or provider for covered services. Provides that the Department shall report its findings and recommendations to the General Assembly no later than October 1, 2012. Amends the Illinois Insurance Code to provide that nothing in the provision concerning nonparticipating facility-based physicians and providers shall be interpreted to change the prudent layperson provisions with respect to emergency services under the Managed Care Reform and Patient Rights Act. Effective immediately.

Replaces everything after the enacting clause with the introduced bill with the following change. Deletes the provision amending the Department of Insurance Law of the Civil Administrative Code of Illinois concerning the study of out-of-network facility-based physician and provider claims. Effective immediately.

Replaces everything after the enacting clause. Amends the Health Maintenance Organization Act. Makes changes to the definitions of "basic health care services" and "health care plan". Makes changes to the provision concerning evidence of coverage. Provides that a Health Maintenance Organization may require deductibles and copayments of enrollees as a condition for the receipt of specific health care services, including basic health care services. Provides that deductibles and copayments shall be the only allowable charge, other than premiums, assessed enrollees. Provides that deductibles and copayments shall be for specific dollar amounts or for specific percentages of the cost of the health care services. Provides that no deductible and copayment paid for the receipt of basic health care services may exceed the annual out-of-pocket expenses as defined in the federal Internal Revenue Code. Provides that no combination of deductibles and copayments for basic health care services may exceed the annual maximums as specified by the federal Affordable Care Act. Provides that deductibles and copayments applicable to supplemental health care services, catastrophic-only plans as defined under the federal Affordable Care Act, or pre-existing conditions are not subject to the annual limitations described in the provision concerning deductibles and copayments. Effective immediately.

Provides that the provision concerning deductibles and copayments applies to enrollees and does not limit the health care plan payment for services provided by non-participating providers.

Deletes language that provides that no deductible and copayment paid for the receipt of basic health care services may exceed the annual out-of-pocket expenses as defined in the federal Internal Revenue Code and that no combination of deductibles and copayments for basic health care services may exceed the annual maximums as specified by the federal Affordable Care Act. Provides instead that no combination of deductibles and copayments paid for the receipt of basic health care services may exceed the annual maximum out-of-pocket expenses of a high deductible health plan as defined in the provision of the United States Code concerning health savings accounts. Provides that the provision concerning deductibles and copayments applies to enrollees and does not limit the health care plan payment for services provided by non-participating providers.

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