Illinois General Assembly - Full Text of HB4433
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Full Text of HB4433  102nd General Assembly




HB4433 EnrolledLRB102 23892 BMS 33089 b

1    AN ACT concerning regulation.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Managed Care Reform and Patient Rights Act
5is amended by changing Section 30 as follows:
6    (215 ILCS 134/30)
7    Sec. 30. Prohibitions.
8    (a) No health care plan or its subcontractors may prohibit
9or discourage health care providers by contract or policy from
10discussing any health care services and health care providers,
11utilization review and quality assurance policies, terms and
12conditions of plans and plan policy with enrollees,
13prospective enrollees, providers, or the public.
14    (b) No health care plan by contract, written policy, or
15procedure may permit or allow an individual or entity to
16dispense a different drug in place of the drug or brand of drug
17ordered or prescribed without the express permission of the
18person ordering or prescribing the drug, except as provided
19under Section 3.14 of the Illinois Food, Drug and Cosmetic
21    (c) No health care plan or its subcontractors may by
22contract, written policy, procedure, or otherwise mandate or
23require an enrollee to substitute his or her participating



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1primary care physician under the plan during inpatient
2hospitalization, such as with a hospitalist physician licensed
3to practice medicine in all its branches, without the
4agreement of that enrollee's participating primary care
5physician. "Participating primary care physician" for health
6care plans and subcontractors that do not require coordination
7of care by a primary care physician means the participating
8physician treating the patient. All health care plans shall
9inform enrollees of any policies, recommendations, or
10guidelines concerning the substitution of the enrollee's
11primary care physician when hospitalization is necessary in
12the manner set forth in subsections (d) and (e) of Section 15.
13    (d) A health care plan shall apply any third-party
14payments, financial assistance, discount, product vouchers, or
15any other reduction in out-of-pocket expenses made by or on
16behalf of such insured for prescription drugs toward a covered
17individual's deductible, copay, or cost-sharing
18responsibility, or out-of-pocket maximum associated with the
19individual's health insurance. If, under federal law,
20application of this requirement would result in health savings
21account ineligibility under Section 223 of the Internal
22Revenue Code, this requirement applies to health savings
23account-qualified high deductible health plans with respect to
24the deductible of such a plan after the enrollee has satisfied
25the minimum deductible under Section 223, except with respect
26to items or services that are preventive care pursuant to



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1Section 223(c)(2)(C) of the Internal Revenue Code, in which
2case the requirement of this subsection applies regardless of
3whether the minimum deductible under Section 223 has been
5    (e) Any violation of this Section shall be subject to the
6penalties under this Act.
7(Source: P.A. 101-452, eff. 1-1-20.)
8    Section 99. Effective date. This Act takes effect upon
9becoming law.