SB1422 103RD GENERAL ASSEMBLY

LRB103 27645 BMS 54021 b

103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB1422

Introduced 2/7/2023, by Sen. Patrick J. Joyce

SYNOPSIS AS INTRODUCED:

215 ILCS 5/370g	from Ch. 73, par. 982g
215 ILCS 5/370u new

Amends the Illinois Insurance Code. Provides that if the policies, agreements, or arrangements of an insurer operate unreasonably in restricting an insured individual's ability to obtain home medical equipment, then an insurer is required to reasonably reimburse its insured for expenses incurred due to the unreasonable restriction. Defines "arrangement".

A BILL FOR

AN ACT concerning regulation.

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 370g and by adding Section 370u as follows:

(215 ILCS 5/370g) (from Ch. 73, par. 982g)

Sec. 370g. Definitions. As used in this Article, the following definitions apply:

(a) "Health care services" means health care services or products rendered or sold by a provider within the scope of the provider's license or legal authorization. The term includes, but is not limited to, hospital, medical, surgical, dental, vision and pharmaceutical services or products.

(b) "Insurer" means an insurance company or a health service corporation authorized in this State to issue policies or subscriber contracts which reimburse for expenses of health care services.

(c) "Insured" means an individual entitled to reimbursement for expenses of health care services under a policy or subscriber contract issued or administered by an insurer.

(d) "Provider" means an individual or entity duly licensed or legally authorized to provide health care services.

(e) "Noninstitutional provider" means any person licensed under the Medical Practice Act of 1987, as now or hereafter amended.

(f) "Beneficiary" means an individual entitled to reimbursement for expenses of or the discount of provider fees for health care services under a program where the beneficiary has an incentive to utilize the services of a provider which has entered into an agreement or arrangement with an administrator.

(g) "Administrator" means any person, partnership or corporation, other than an insurer or health maintenance organization holding a certificate of authority under the "Health Maintenance Organization Act", as now or hereafter amended, that arranges, contracts with, or administers contracts with a provider whereby beneficiaries are provided an incentive to use the services of such provider.

(h) "Emergency medical condition" has the meaning given to that term in Section 10 of the Managed Care Reform and Patient Rights Act.

(i) "Arrangement" means a scheme between insurers and health care service providers to supply health care products, including, but not limited to, a provider's maintenance of supplies to adequately fulfill its obligations under the scheme.

(Source: P.A. 102-409, eff. 1-1-22.)

(215 ILCS 5/370u new)

Sec. 370u. Reimbursement; home medical equipment. If the policies, agreements, or arrangements of an insurer operate unreasonably in restricting an insured individual's ability to obtain home medical equipment, as defined in Section 10 of the Home Medical Equipment and Services Provider License Act, then the insurer is required to reasonably reimburse its insured for expenses incurred due to the unreasonable restriction.