Synopsis As Introduced Amends the State Employees Group Insurance Act of 1971, Counties Code, Illinois Municipal Code, School Code, Illinois Insurance Code, Health Maintenance Organization Act, and Voluntary Health Services Plans Act. Provides that accident and health insurance policies that provide coverage for prescription drugs or cancer chemotherapy treatment must provide coverage for prescribed orally-administered cancer medication used to kill or slow the growth of cancerous cells. Provides that an insurer shall ensure that the financial requirements and treatment limitations for orally-administered cancer medication coverage are no more restrictive than the requirements and limitations applied to intravenously administered cancer medications. Provides that accident and health insurance policies shall provide coverage to a qualified individual for participation in a qualified clinical cancer trial. Provides that an insurer shall not deny, limit, or impose additional conditions on the coverage of routine patient costs. Provides that the payment rate shall be at the agreed rate for covered items and services provided by a participating provider and at the usual and customary rate for covered items and services provided by a nonparticipating provider. Makes other changes. Contains a nonacceleration clause. Effective immediately.
Replaces everything after the enacting clause. Amends the Illinois Insurance Code. Makes changes in the provision concerning disclosure of limited benefit. Sets forth a provision concerning nonparticipating facility-based physicians and providers. Provides that 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, the insurer or health plan shall ensure that the beneficiary, insured, or enrollee shall incur no greater out-of-pocket costs than the beneficiary, insured, or enrollee would have incurred with a participating physician or provider for covered services. Sets forth provisions concerning written explanation of benefits, billing, assignment, negotiated reimbursement, and arbitration. Makes other changes.