HB2072enr 103RD GENERAL ASSEMBLY

HB2072 Enrolled LRB103 04625 BMS 51012 b

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 355.4 and by adding Section 355.5 as follows:

(215 ILCS 5/355.4)

Sec. 355.4. Provider notification of network plan changes.

(a) As used in this Section:

"Contracting entity" means any person or company that enters into direct contracts with providers for the delivery of dental services in the ordinary course of business, including a third-party administrator and a dental carrier.

"Dental carrier" means a dental insurance company, dental service corporation, dental plan organization authorized to provide dental benefits, or a health insurance plan that includes coverage for dental services.

(b) No dental carrier may automatically enroll a provider in a leased network without allowing any provider that is part of the dental carrier's provider network to choose to not participate by opting out.

(c) Any contract entered into or renewed on or after the effective date of this amendatory Act of the 103rd General Assembly this amendatory Act of the 99th General Assembly that allows the rights and obligations of the contract to be assigned or leased to another insurer shall provide for notice that informs each provider in writing via certified mail 60 days before any scheduled assignment or lease of the network to which the provider is a contracted provider. To be in compliance with this Section, the notification must include all contract terms, a policy manual, a fee schedule, and a statement that the provider has the right to choose not to participate in third-party access of that assignment or lease within 30 days after the assignment or lease to the contracting dentist.

(d) A dental carrier that leases or assigns its network shall not cancel a network participating dentist's contractual relationship or otherwise penalize a network participating dentist in any way based on whether or not the dentist accepts the terms of the assignment or lease. Before accepting the terms of an assignment or lease agreement as described in this Section, any provider who receives notification of an impending assignment or lease must be given the option to contract directly with the entities proposing to gain access to the provider's network.

(e) The provisions of this Section do not apply:

(1) if access to a provider network contract is granted to a dental carrier or an entity operating in accordance with the same brand licensee program as the contracting entity; or

(2) to a provider network contract for dental services provided to beneficiaries of the State employee group health insurance program or the medical assistance program under the Illinois Public Aid Code.

(Source: P.A. 99-568, eff. 7-15-16.)

(215 ILCS 5/355.5 new)

Sec. 355.5. Dental coverage reimbursement; prohibitions. No insurer, dental service plan corporation, professional service corporation, insurance network leasing company, or any company that amends, delivers, issues, or renews an individual or group policy of accident and health insurance on or after the effective date of this amendatory Act of the 103rd General Assembly shall require a dental care provider to incur a fee to access and obtain payment or reimbursement for services provided. A dental plan carrier shall provide a dental care provider with 100% of the contracted amount of the payment or reimbursement. Fees incurred directly by a dental care provider from third parties related to transmitting an automated clearing house network claim, transaction management, data management, or portal services and other fees charged by third parties that are not in the control of the dental plan carrier shall not be prohibited by this Section.