State of Illinois
90th General Assembly
Legislation

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[ Introduced ][ Enrolled ][ House Amendment 001 ]
[ Senate Amendment 001 ]

90_HB3427eng

      215 ILCS 5/356r
          Amends the  Illinois  Insurance  Code  regarding  women's
      health  care providers.  Requires insurers to notify insureds
      of the right to designate a  woman's  principal  health  care
      provider  and  to  provide  a  list  of participating women's
      health care providers within 30 days after a request for  the
      list is made.  Effective immediately.
                                                    LRB9008922JSgcB
HB3427 Engrossed                              LRB9008922JSgcB
 1        AN  ACT  to amend the Illinois Insurance Code by changing
 2    Section 356r.
 3        Be it enacted by the People of  the  State  of  Illinois,
 4    represented in the General Assembly:
 5        Section  5.  The  Illinois  Insurance  Code is amended by
 6    changing Section 356r as follows:
 7        (215 ILCS 5/356r)
 8        Sec. 356r.  Woman's principal health care provider.
 9        (a)  An individual or group policy of accident and health
10    insurance or a managed care plan amended, delivered,  issued,
11    or  renewed  in  this  State  after  November  14,  1996 that
12    requires an insured or enrollee to designate an individual to
13    coordinate care or to control access to health care  services
14    shall also permit a female insured or enrollee to designate a
15    participating woman's principal health care provider, and the
16    insurer or managed care plan shall inform all female insureds
17    or  enrollees in writing of this right to designate a woman's
18    principal health care provider as part of  the  insurer's  or
19    plan's  regular  notice  of coverage to insureds or enrollees
20    and at any time a female  insured  designates  or  changes  a
21    designation,  or  is given an opportunity to do either, of an
22    individual to coordinate care or to control access to  health
23    care  services.   The  insurer  or  managed  care plan shall,
24    within 30 days  after  a  request,  provide  a  list  of  all
25    physicians  licensed to practice medicine in all its branches
26    specializing in obstetrics or gynecology who have  contracted
27    with  the  insurer or managed care plan from which the female
28    insured or enrollee may make this designation.  No insurer or
29    plan  formal  or  informal  policy  may  restrict  a   female
30    insured's   or   enrollee's  right  to  designate  a  woman's
31    principal health care provider.  If the  insurer  or  managed
HB3427 Engrossed            -2-               LRB9008922JSgcB
 1    care  plan  fails  to provide the list within 30 days after a
 2    request, the female insured or  enrollee  may  designate  any
 3    physician  licensed  to practice medicine in all its branches
 4    specializing in  obstetrics  or  gynecology  as  the  woman's
 5    principal health care provider.  If the female enrollee is an
 6    enrollee  of  a  managed  care  plan  under contract with the
 7    Department  of  Public  Aid,  the  physician  chosen  by  the
 8    enrollee as her woman's principal health care  provider  must
 9    be a Medicaid-enrolled provider.
10        (b)  If  a  female  insured  or enrollee has designated a
11    woman's principal health care provider, then the  insured  or
12    enrollee must be given direct access to the woman's principal
13    health  care  provider  for services covered by the policy or
14    plan without the need  for  a  referral  or  prior  approval.
15    Nothing  shall prohibit the insurer or managed care plan from
16    requiring prior  authorization  or  approval  from  either  a
17    primary  care  provider  or the woman's principal health care
18    provider for referrals for additional care or services.
19        (c)  For the purposes of this Section the following terms
20    are defined:
21             (1)  "Woman's principal health care provider"  means
22        a  physician  licensed to practice medicine in all of its
23        branches specializing in obstetrics or gynecology.
24             (2)  "Managed  care   entity"   means   any   entity
25        including  a  licensed  insurance  company,  hospital  or
26        medical  service  plan,  health maintenance organization,
27        limited health service organization,  preferred  provider
28        organization,  third  party administrator, an employer or
29        employee organization,  or  any  person  or  entity  that
30        establishes,   operates,   or   maintains  a  network  of
31        participating providers.
32             (3)  "Managed care plan" means a plan operated by  a
33        managed  care  entity  that provides for the financing of
34        health care services to  persons  enrolled  in  the  plan
HB3427 Engrossed            -3-               LRB9008922JSgcB
 1        through:
 2                  (A)  organizational  arrangements  for  ongoing
 3             quality  assurance,  utilization review programs, or
 4             dispute resolution; or
 5                  (B)  financial incentives for persons  enrolled
 6             in  the  plan to use the participating providers and
 7             procedures covered by the plan.
 8             (4)  "Participating provider" means a physician  who
 9        has  contracted  with  an insurer or managed care plan to
10        provide services to insureds or enrollees as  defined  by
11        the contract.
12        (d)  The  original  provisions of this Section became law
13    on July 17, 1996 and took effect November 14, 1996, which  is
14    120 days after becoming law.
15    (Source: P.A. 89-514; 90-14, eff. 7-1-97.)
16        Section  99.  Effective date.  This Act takes effect upon
17    becoming law.

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