Illinois General Assembly - Illinois Compiled Statutes

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215 ILCS 125/4-20

    (215 ILCS 125/4-20)
    Sec. 4-20. Deductibles and copayments.

(a) 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. Deductibles and copayments shall be the only
allowable charges, other than premiums, assessed enrollees. Nothing within
this subsection (a) shall preclude the provider from charging reasonable
administrative fees, such as service fees for checks returned for non-sufficient
funds and missed appointments.

(b) Deductibles and copayments shall be for specific dollar amounts or for
specific percentages of the cost of the health care services.

(c) 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 26 U.S.C. 223.

(d) 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 this Section.

(e) This Section applies to enrollees and does not limit the health care plan payment for services provided by non-participating providers.

(f) This Section applies to enrollees and does not limit the health care plan payment for services provided by non-participating providers.

(Source: P.A. 97-1148, eff. 1-24-13.)