[ Search ] [ Legislation ] [ Bill Summary ]
[ Home ] [ Back ] [ Bottom ]
|[ Introduced ]||[ Enrolled ]||[ House Amendment 001 ]|
|[ Senate Amendment 001 ]|
90_HB3427eng 215 ILCS 5/356r Amends the Illinois Insurance Code regarding women's health care providers. Requires insurers to notify insureds of the right to designate a woman's principal health care provider and to provide a list of participating women's health care providers within 30 days after a request for the list is made. Effective immediately. LRB9008922JSgcB HB3427 Engrossed LRB9008922JSgcB 1 AN ACT to amend the Illinois Insurance Code by changing 2 Section 356r. 3 Be it enacted by the People of the State of Illinois, 4 represented in the General Assembly: 5 Section 5. The Illinois Insurance Code is amended by 6 changing Section 356r as follows: 7 (215 ILCS 5/356r) 8 Sec. 356r. Woman's principal health care provider. 9 (a) An individual or group policy of accident and health 10 insurance or a managed care plan amended, delivered, issued, 11 or renewed in this State after November 14, 1996 that 12 requires an insured or enrollee to designate an individual to 13 coordinate care or to control access to health care services 14 shall also permit a female insured or enrollee to designate a 15 participating woman's principal health care provider, and the 16 insurer or managed care plan shall inform all female insureds 17 or enrollees in writing of this right to designate a woman's 18 principal health care provider as part of the insurer's or 19 plan's regular notice of coverage to insureds or enrollees 20 and at any time a female insured designates or changes a 21 designation, or is given an opportunity to do either, of an 22 individual to coordinate care or to control access to health 23 care services. The insurer or managed care plan shall, 24 within 30 days after a request, provide a list of all 25 physicians licensed to practice medicine in all its branches 26 specializing in obstetrics or gynecology who have contracted 27 with the insurer or managed care plan from which the female 28 insured or enrollee may make this designation. No insurer or 29 plan formal or informal policy may restrict a female 30 insured's or enrollee's right to designate a woman's 31 principal health care provider. If the insurer or managed HB3427 Engrossed -2- LRB9008922JSgcB 1 care plan fails to provide the list within 30 days after a 2 request, the female insured or enrollee may designate any 3 physician licensed to practice medicine in all its branches 4 specializing in obstetrics or gynecology as the woman's 5 principal health care provider. If the female enrollee is an 6 enrollee of a managed care plan under contract with the 7 Department of Public Aid, the physician chosen by the 8 enrollee as her woman's principal health care provider must 9 be a Medicaid-enrolled provider. 10 (b) If a female insured or enrollee has designated a 11 woman's principal health care provider, then the insured or 12 enrollee must be given direct access to the woman's principal 13 health care provider for services covered by the policy or 14 plan without the need for a referral or prior approval. 15 Nothing shall prohibit the insurer or managed care plan from 16 requiring prior authorization or approval from either a 17 primary care provider or the woman's principal health care 18 provider for referrals for additional care or services. 19 (c) For the purposes of this Section the following terms 20 are defined: 21 (1) "Woman's principal health care provider" means 22 a physician licensed to practice medicine in all of its 23 branches specializing in obstetrics or gynecology. 24 (2) "Managed care entity" means any entity 25 including a licensed insurance company, hospital or 26 medical service plan, health maintenance organization, 27 limited health service organization, preferred provider 28 organization, third party administrator, an employer or 29 employee organization, or any person or entity that 30 establishes, operates, or maintains a network of 31 participating providers. 32 (3) "Managed care plan" means a plan operated by a 33 managed care entity that provides for the financing of 34 health care services to persons enrolled in the plan HB3427 Engrossed -3- LRB9008922JSgcB 1 through: 2 (A) organizational arrangements for ongoing 3 quality assurance, utilization review programs, or 4 dispute resolution; or 5 (B) financial incentives for persons enrolled 6 in the plan to use the participating providers and 7 procedures covered by the plan. 8 (4) "Participating provider" means a physician who 9 has contracted with an insurer or managed care plan to 10 provide services to insureds or enrollees as defined by 11 the contract. 12 (d) The original provisions of this Section became law 13 on July 17, 1996 and took effect November 14, 1996, which is 14 120 days after becoming law. 15 (Source: P.A. 89-514; 90-14, eff. 7-1-97.) 16 Section 99. Effective date. This Act takes effect upon 17 becoming law.
[ Top ]