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Public Act 92-0745
SB2245 Enrolled LRB9211443JSpcB
AN ACT concerning insurance.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by
changing Section 368a as follows:
(215 ILCS 5/368a)
Sec. 368a. Timely payment for health care services.
(a) This Section applies to insurers, health maintenance
organizations, managed care plans, health care plans,
preferred provider organizations, third party administrators,
independent practice associations, and physician-hospital
organizations (hereinafter referred to as "payors") that
provide periodic payments, which are payments not requiring a
claim, bill, capitation encounter data, or capitation
reconciliation reports, such as prospective capitation
payments, to health care professionals and health care
facilities to provide medical or health care services for
insureds or enrollees.
(1) A payor shall make periodic payments in
accordance with item (3). Failure to make periodic
payments within the period of time specified in item (3)
shall entitle the health care professional or health care
facility to interest at the rate of 9% per year from the
date payment was required to be made to the date of the
late payment, provided that interest amounting to less
than $1 need not be paid. Any required interest payments
shall be made within 30 days after the payment.
(2) When a payor requires selection of a health
care professional or health care facility, the selection
shall be completed by the insured or enrollee no later
than 30 days after enrollment. The payor shall provide
written notice of this requirement to all insureds and
enrollees. Nothing in this Section shall be construed to
require a payor to select a health care professional or
health care facility for an insured or enrollee.
(3) A payor shall provide the health care
professional or health care facility with notice of the
selection as a health care professional or health care
facility by an insured or enrollee and the effective date
of the selection within 60 calendar days after the
selection. No later than the 60th day following the date
an insured or enrollee has selected a health care
professional or health care facility or the date that
selection becomes effective, whichever is later, or in
cases of retrospective enrollment only, 30 days after
notice by an employer to the payor of the selection, a
payor shall begin periodic payment of the required
amounts to the insured's or enrollee's health care
professional or health care facility, or the designee of
either, calculated from the date of selection or the date
the selection becomes effective, whichever is later. All
subsequent payments shall be made in accordance with a
monthly periodic cycle.
(b) Notwithstanding any other provision of this Section,
independent practice associations and physician-hospital
organizations shall make begin making periodic payment of the
required amounts in accordance with a monthly periodic
schedule within 60 days after an insured or enrollee has
selected a health care professional or health care facility
or after the date that selection becomes effective, whichever
is later. Before January 1, 2001, subsequent periodic
payments shall be made in accordance with a 60-day periodic
schedule, and after December 31, 2000, subsequent periodic
payments shall be made in accordance with a monthly periodic
schedule.
Notwithstanding any other provision of this Section,
independent practice associations and physician-hospital
organizations shall make all other payments for health
services within 30 60 days after receipt of due proof of loss
received before January 1, 2001 and within 30 days after
receipt of due proof of loss received after December 31,
2000. Independent practice associations and
physician-hospital organizations shall notify the insured,
insured's assignee, health care professional, or health care
facility of any failure to provide sufficient documentation
for a due proof of loss within 30 days after receipt of the
claim for health services.
Failure to pay within the required time period shall
entitle the payee to interest at the rate of 9% per year from
the date the payment is due to the date of the late payment,
provided that interest amounting to less that $1 need not be
paid. Any required interest payments shall be made within 30
days after the payment.
(c) All insurers, health maintenance organizations,
managed care plans, health care plans, preferred provider
organizations, and third party administrators shall ensure
that all claims and indemnities concerning health care
services other than for any periodic payment shall be paid
within 30 days after receipt of due written proof of such
loss. An insured, insured's assignee, health care
professional, or health care facility shall be notified of
any known failure to provide sufficient documentation for a
due proof of loss within 30 days after receipt of the claim
for health care services. Failure to pay within such period
shall entitle the payee to interest at the rate of 9% per
year from the 30th day after receipt of such proof of loss to
the date of late payment, provided that interest amounting to
less than one dollar need not be paid. Any required interest
payments shall be made within 30 days after the payment.
(d) The Department shall enforce the provisions of this
Section pursuant to the enforcement powers granted to it by
law.
(e) The Department is hereby granted specific authority
to issue a cease and desist order, fine, or otherwise
penalize independent practice associations and
physician-hospital organizations that violate this Section.
The Department shall adopt reasonable rules to enforce
compliance with this Section by independent practice
associations and physician-hospital organizations.
(Source: P.A. 91-605, eff. 12-14-99; 91-788, eff. 6-9-00.)
Passed in the General Assembly May 29, 2002.
Approved July 25, 2002.
Effective January 01, 2003.
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