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(215 ILCS 125/4-4)
(from Ch. 111 1/2, par. 1408.4)
Sexual assault or abuse victims; coverage of expenses;
recovery of State funds; reimbursement of Department of Public Health.
(1) Contracts or evidences of coverage issued by a health maintenance
organization, which provide benefits for health care services, shall to the
full extent of coverage provided for any other emergency or accident care,
provide for the payment of actual expenses incurred, without offset or
reduction for benefit deductibles or co-insurance amounts, in the examination
and testing of a victim of an offense defined in Sections 11-1.20 through 11-1.60 or 12-13 through 12-16
of the Criminal Code of 1961 or the Criminal Code of 2012, or an attempt to
commit such offense, to establish that sexual contact did occur or did not
occur, and to establish the presence or absence of sexually transmitted disease
or infection, and examination and treatment of injuries and trauma sustained by
a victim of such offense.
(2) For purposes of enabling the recovery of State funds, any health
maintenance organization subject to this Section shall upon reasonable demand
by the Department of Public Health disclose the names and identities of its
enrollees entitled to benefits under this provision to the Department of Public
Health whenever the Department of Public Health has determined that it has
paid, or is about to pay for, health care services for which a health
maintenance organization is liable under this Section. All information
received by the Department of Public Health under this provision shall be held
on a confidential basis and shall not be subject to subpoena and shall not be
made public by the Department of Public Health or used for any
purpose other than that authorized by this Section.
(3) Whenever the Department of Public Health finds that it has paid
for all or part of any health care services for which a health maintenance
organization is obligated to pay under this Section, the Department of Public
Health shall be entitled to receive reimbursement for its payments from
such organization provided that the Department of Public Health has notified
the organization of its claims before the organization has paid such benefits
to its enrollees or in behalf of its enrollees.
(Source: P.A. 96-1551, eff. 7-1-11; 97-1150, eff. 1-25-13.)