State of Illinois
90th General Assembly
Legislation

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90_HB3317

      5 ILCS 375/6.12 new
      55 ILCS 5/5-1069.6 new
      65 ILCS 5/10-4-2.6 new
      105 ILCS 5/10-22.3g new
      215 ILCS 5/364.2 new
      215 ILCS 125/5-3.7 new
      215 ILCS 130/4002.2 new
      215 ILCS 165/15.10-1 new
          Amends the Illinois Insurance Code, the  State  Employees
      Group  Insurance Act of 1971, the Counties Code, the Illinois
      Municipal  Code,  and  various  insurance  regulatory   Acts.
      Provides  that the coverage for eye care benefits under those
      Acts may not discriminate against optometrists  with  respect
      to the provision of services or payment for services.
                                                     LRB9009784JSgc
                                               LRB9009784JSgc
 1        AN  ACT  concerning  patient access to eye care, amending
 2    named Acts.
 3        Be it enacted by the People of  the  State  of  Illinois,
 4    represented in the General Assembly:
 5        Section  5.  The  State  Employees Group Insurance Act of
 6    1971 is amended by adding Section 6.12 as follows:
 7        (5 ILCS 375/6.12 new)
 8        Sec. 6.12.  Eye care benefits.   The  program  of  health
 9    benefits is subject to the provisions of Section 364.2 of the
10    Illinois Insurance Code.
11        Section  10.  The  Counties  Code  is  amended  by adding
12    Section 5-1069.6 as follows:
13        (55 ILCS 5/5-1069.6 new)
14        Sec.  5-1069.6.  Eye  care   benefits.    All   counties,
15    including home rule counties are subject to the provisions of
16    Section   364.2   of   the   Illinois  Insurance  Code.   The
17    requirement under this  Section  that  health  care  benefits
18    provided  by  counties  comply  with  Section  364.2  of  the
19    Illinois Insurance Code is an exclusive power and function of
20    the  State  and  is denial and limitation of home rule county
21    powers under Article VII, Section 6, subsection  (h)  of  the
22    Illinois Constitution.
23        Section  15.  The  Illinois  Municipal Code is amended by
24    adding Section 10-4-2.6 as follows:
25        (65 ILCS 5/10-4-2.6 new)
26        Sec.  10-4-2.6.  Eye  care   benefits.    The   corporate
27    authorities   of   all  municipalities  are  subject  to  the
                            -2-                LRB9009784JSgc
 1    provisions of Section 364.2 of the Illinois  Insurance  Code.
 2    The  requirement under this Section that health care benefits
 3    provided by municipalities comply with Section 364.2  of  the
 4    Illinois Insurance Code is an exclusive power and function of
 5    the  State  and  is  a  denial  and  limitation  of home rule
 6    municipality powers under Article VII, Section 6,  subsection
 7    (h) of the Illinois Constitution.
 8        Section 20.  The School Code is amended by adding Section
 9    10-22.3g as follows:
10        (105 ILCS 5/10-22.3g new)
11        Sec.  10-22.3g.  Eye care benefits.  Insurance protection
12    and benefits for employees are subject to the  provisions  of
13    Section 364.2 of the Illinois Insurance Code.
14        Section  25.  The  Illinois  Insurance Code is amended by
15    adding Section 364.2 as follows:
16        (215 ILCS 5/364.2 new)
17        Sec. 364.2.  Eye care benefits.
18        (a)  As used in this Section:
19        "Covered person" means an insured, an individual enrolled
20    in a health benefit plan, or an eligible dependent thereof.
21        "Covered services" means those health care services  that
22    a health care insurer is obligated to pay for or provide to a
23    covered person under a health benefit plan.
24        "Eye care" means those health care services and materials
25    related  to  the  care  of the eye and related structures and
26    vision care services that a health care insurer is  obligated
27    to  pay  for  or  provide to covered persons under the health
28    benefit plan.
29        "Eye care provider"  means  a  therapeutically  certified
30    optometrist  licensed  under the Illinois Optometric Practice
                            -3-                LRB9009784JSgc
 1    Act of  1987  or  an  Ophthalmologist  licensed  to  practice
 2    medicine in all its branches.
 3        (b)  A  group or individual policy of accident and health
 4    insurance or a managed care plan, as defined in Section 356r,
 5    that provides eye care benefits and  is  amended,  delivered,
 6    issued or renewed after the effective date of this amendatory
 7    Act of 1998 shall:
 8             (1)  not  set professional fees or reimbursement for
 9        the  same  eye  care  services  as  defined  by   Current
10        Procedural  Terminology codes established by the American
11        Medical  Association  in  a  manner  that   discriminates
12        against an individual eye care provider or a class of eye
13        care providers;
14             (2)  not  preclude  a  covered  person who seeks eye
15        care from obtaining the service directly from a  provider
16        on the health benefit plan provider panel who is licensed
17        to provide eye care;
18             (3)  not promote or recommend any class of providers
19        to the detriment of any other class of providers for  the
20        same eye care service;
21             (4)  ensure  that all eye care providers on a health
22        benefit plan provider panel are included on any  publicly
23        accessible list of participating providers for the plan;
24             (5)  allow  each  eye  care  provider  on  a  health
25        benefit   plan  provider  panel,  without  discrimination
26        between classes of eye care providers, to furnish covered
27        eye care  services  to  covered  persons  to  the  extent
28        permitted by the provider's license;
29             (6)  not  require  any  eye  care  provider  to hold
30        hospital privileges or  impose  any  other  condition  or
31        restriction  for  initial  admittance to a provider panel
32        not necessary for the  delivery  of  eye  care  upon  the
33        providers  that  would  have  the  effect of excluding an
34        individual  eye  care  provider  or  class  of  eye  care
                            -4-                LRB9009784JSgc
 1        providers from participation on the health benefit plan;
 2             (7)  include  eye  care  providers  on  the   health
 3        benefit plan provider panel in a manner that ensures plan
 4        enrollees timely access and geographic access;
 5             (8)  not restrict the patient from seeking emergency
 6        treatment  from  any eye care provider for a condition of
 7        the eye that would lead an  ordinary  person  to  believe
 8        that  such  an injury could result in loss of sight.  The
 9        health benefit plan shall provide coverage  at  the  same
10        level   in  this  instance  for  both  participating  and
11        non-participating eye care providers.
12        (c)  Nothing in this Section  shall  preclude  a  covered
13    person from receiving eye care or other covered services from
14    the  covered  person's  personal physician in accordance with
15    the terms of the  health  benefit  plan  if  the  patient  so
16    desires.
17        (d)  A  person  adversely affected by a violation of this
18    Section by a health care insurer may bring  an  action  in  a
19    court of competent jurisdiction for injunctive relief against
20    the   insurer  and,  upon  prevailing,  in  addition  to  any
21    injunctive relief that may be granted, shall recover from the
22    insurer damages of not more than $5,000 and  attorney's  fees
23    and costs.
24        (e)  Nothing  in  this  Section requires a health benefit
25    plan to include eye care benefits.
26        Section 30.  The Health Maintenance Organization  Act  is
27    amended by adding Section 5-3.7 as follows:
28        (215 ILCS 125/5-3.7 new)
29        Sec.   5-3.7.  Eye  care  benefits.   Health  maintenance
30    organizations are subject to the provisions of Section  364.2
31    of the Illinois Insurance Code.
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 1        Section  35.  The Limited Health Service Organization Act
 2    is amended by adding Section 4002.2 as follows:
 3        (215 ILCS 130/4002.2 new)
 4        Sec. 4002.2.  Eye care benefits.  Limited health  service
 5    organizations  are  subject  to Section 364.2 of the Illinois
 6    Insurance Code.
 7        Section 40.  The Voluntary Health Services Plans  Act  is
 8    amended by adding Section 15.10-1 as follows:
 9        (215 ILCS 165/15.10-1 new)
10        Sec.  15.10-1.  Eye care benefits.  A health service plan
11    corporation is subject to the provisions of Section 364.2  of
12    the Illinois Insurance Code.

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