Full Text of SB0174 101st General Assembly
SB0174enr 101ST GENERAL ASSEMBLY |
| | SB0174 Enrolled | | LRB101 04949 SMS 49958 b |
|
| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 1. Short title. This Act may be cited as the | 5 | | In-Office Membership Care Act. | 6 | | Section 5. Public policy. It is the policy of the State of | 7 | | Illinois to promote personal responsibility for health care and | 8 | | the cost-effective delivery of dental services by encouraging | 9 | | innovative use of in-office membership care practices for | 10 | | dental care. In-office membership care practices utilize a | 11 | | model of periodic fees for provider access and management over | 12 | | time, rather than simply a fee for visit or procedure service | 13 | | model. Some patients and individual dental care providers may | 14 | | wish to establish direct agreements with one another as an | 15 | | alternative to traditional fee-for-service care financed | 16 | | through health insurance. The purpose of this Act is to confirm | 17 | | that in-office membership care agreements that satisfy the | 18 | | provisions of this Act do not constitute insurance and as such | 19 | | are not subject to the Illinois Insurance Code. | 20 | | Section 10. Definitions. In this Act: | 21 | | "Dental care provider" means a natural person or persons | 22 | | licensed or otherwise legally authorized to provide health care |
| | | SB0174 Enrolled | - 2 - | LRB101 04949 SMS 49958 b |
|
| 1 | | services in the State of Illinois in the field of dentistry who | 2 | | provides such services either alone or with others at the same | 3 | | location or other location affiliated with the practice in a | 4 | | form and within a scope permitted by such licensure or legal | 5 | | authorization for the provision of such services and who enters | 6 | | into an in-office membership care agreement. | 7 | | "Direct fee" means an agreed-upon fee charged by a dental | 8 | | care provider as consideration for providing and being | 9 | | available to provide in-office membership care services | 10 | | described in an in-office membership care agreement. | 11 | | "In-office membership care agreement" means a written | 12 | | contract between a dental care provider or group of providers | 13 | | and an individual patient, the patient's family, or the | 14 | | patient's representative in which the dental care provider | 15 | | agrees to provide in-office membership care services to the | 16 | | patient over a specified period of time for payment of a direct | 17 | | fee. | 18 | | "In-office membership care services" means services that a | 19 | | dental care provider is licensed or otherwise legally | 20 | | authorized to provide, including, but not limited to, (i) | 21 | | dental screenings, assessments, diagnoses, and treatments for | 22 | | the purpose of promoting health; (ii) detection, management, | 23 | | and care of disease or injury; and (iii) routine preventive or | 24 | | diagnostic dental treatment. | 25 | | "Patient" means a person who is entitled to receive | 26 | | in-office membership care services under an in-office |
| | | SB0174 Enrolled | - 3 - | LRB101 04949 SMS 49958 b |
|
| 1 | | membership care agreement. | 2 | | Section 15. In-office membership care agreement | 3 | | provisions. | 4 | | (a) An in-office membership care agreement shall identify: | 5 | | (1) the dental care provider or providers and the | 6 | | patient or patients; | 7 | | (2) the general scope of services as well as the | 8 | | specific services to be provided by the dental care | 9 | | provider as part of the in-office membership care | 10 | | agreement; | 11 | | (3) the location or locations where services are to be | 12 | | provided; | 13 | | (4) the amount of the direct fee and the time interval | 14 | | at which it is to be paid; and | 15 | | (5) the term of the in-office membership care agreement | 16 | | and the conditions upon which it may be terminated by the | 17 | | dental care provider. | 18 | | (b) An in-office membership care agreement shall be | 19 | | terminable at will by written notice from the patient to the | 20 | | dental care provider. | 21 | | (c) If a party provides written notice of termination of | 22 | | the in-office membership care agreement, the dental care | 23 | | provider may refund to the patient all unearned direct fees | 24 | | associated with the covered services under the in-office | 25 | | membership care agreement. |
| | | SB0174 Enrolled | - 4 - | LRB101 04949 SMS 49958 b |
|
| 1 | | Section 20. Location of in-office membership care | 2 | | services. In-office membership care services may be provided in | 3 | | a dental care provider's office or another location in which a | 4 | | patient visit with the dental care provider needs to occur. | 5 | | Section 25. Insurance billing prohibited. Neither the | 6 | | patient nor the dental care provider shall submit a bill to an | 7 | | insurer for the services provided under an in-office membership | 8 | | care agreement. | 9 | | Section 30. In-office membership care agreements not | 10 | | classified as insurance. In-office membership care agreements | 11 | | are not subject to regulation as insurance under the Illinois | 12 | | Insurance Code. | 13 | | Section 35. Disclaimer. An in-office membership care | 14 | | agreement shall include the following disclaimer: "This | 15 | | agreement does not provide health insurance coverage, | 16 | | including the minimal essential coverage required by | 17 | | applicable federal law. It provides only the services described | 18 | | herein. It is recommended that health care insurance be | 19 | | obtained to cover dental services not provided for under this | 20 | | in-office membership care agreement.". | 21 | | Section 40. Restrictions on transfer. An in-office |
| | | SB0174 Enrolled | - 5 - | LRB101 04949 SMS 49958 b |
|
| 1 | | membership care agreement may not be sold or transferred by the | 2 | | dental care provider without the written consent of the patient | 3 | | and may be transferred only to another dental care provider. An | 4 | | in-office membership care agreement may not be sold to a group, | 5 | | employer or group of subscribers because it is an individual | 6 | | agreement between a dental care provider and a patient. These | 7 | | limitations do not prohibit the presentation of marketing | 8 | | materials to groups of potential patients or their | 9 | | representatives. | 10 | | Section 45. Effect of this Act. This Act does not prohibit | 11 | | dental care providers who are not dental care providers | 12 | | offering in-office membership care agreements from entering | 13 | | into agreements with patients to the extent such agreements do | 14 | | not violate the provisions of the Illinois Insurance Code. | 15 | | Section 80. The Illinois Insurance Code is amended by | 16 | | changing Section 352 as follows:
| 17 | | (215 ILCS 5/352) (from Ch. 73, par. 964)
| 18 | | Sec. 352. Scope of Article.
| 19 | | (a) Except as provided in subsections (b), (c), (d), and | 20 | | (e),
this Article shall
apply to all companies transacting in | 21 | | this State the kinds of business
enumerated in clause (b) of | 22 | | Class 1 and clause (a) of Class 2 of section 4.
Nothing in this | 23 | | Article shall apply to, or in any way affect policies or
|
| | | SB0174 Enrolled | - 6 - | LRB101 04949 SMS 49958 b |
|
| 1 | | contracts described in clause (a) of Class 1 of Section 4; | 2 | | however, this
Article shall apply to policies and contracts | 3 | | which contain benefits
providing reimbursement for the | 4 | | expenses of long term health care which are
certified or | 5 | | ordered by a physician including but not limited to
| 6 | | professional nursing care, custodial nursing care, and | 7 | | non-nursing
custodial care provided in a nursing home or at a | 8 | | residence of the insured.
| 9 | | (b) (Blank).
| 10 | | (c) A policy issued and delivered in this State
that | 11 | | provides coverage under that policy for
certificate holders who | 12 | | are neither residents of nor employed in this State
does not | 13 | | need to provide to those nonresident
certificate holders who | 14 | | are not employed in this State the coverages or
services | 15 | | mandated by this Article.
| 16 | | (d) Stop-loss insurance is exempt from all Sections
of this | 17 | | Article, except this Section and Sections 353a, 354, 357.30, | 18 | | and
370. For purposes of this exemption, stop-loss insurance is | 19 | | further defined as
follows:
| 20 | | (1) The policy must be issued to and insure an | 21 | | employer, trustee, or other
sponsor of the plan, or the | 22 | | plan itself, but not employees, members, or
participants.
| 23 | | (2) Payments by the insurer must be made to the | 24 | | employer, trustee, or
other sponsors of the plan, or the | 25 | | plan itself, but not to the employees,
members, | 26 | | participants, or health care providers.
|
| | | SB0174 Enrolled | - 7 - | LRB101 04949 SMS 49958 b |
|
| 1 | | (e) A policy issued or delivered in this State to the | 2 | | Department of Healthcare and Family Services (formerly
| 3 | | Illinois Department
of Public Aid) and providing coverage, | 4 | | under clause (b) of Class 1 or clause (a)
of Class 2 as | 5 | | described in Section 4, to persons who are enrolled under | 6 | | Article V of the Illinois
Public Aid Code or under the | 7 | | Children's Health Insurance Program Act is
exempt from all | 8 | | restrictions, limitations,
standards, rules, or regulations | 9 | | respecting benefits imposed by or under
authority of this Code, | 10 | | except those specified by subsection (1) of Section
143, | 11 | | Section 370c, and Section 370c.1. Nothing in this subsection, | 12 | | however, affects the total medical services
available to | 13 | | persons eligible for medical assistance under the Illinois | 14 | | Public
Aid Code.
| 15 | | (f) An in-office membership care agreement provided under | 16 | | the In-Office Membership Care Act is not insurance for the | 17 | | purposes of this Code. | 18 | | (Source: P.A. 99-480, eff. 9-9-15.)
| 19 | | Section 99. Effective date. This Act takes effect upon | 20 | | becoming law.
|
|