State of Illinois
92^nd General Assembly
Legislation

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92_HB4220eng

 
HB4220 Engrossed                              LRB9211444JSpcA

 1        AN ACT concerning insurance.

 2        Be it enacted by the People of  the  State  of  Illinois,
 3    represented in the General Assembly:

 4        Section  5.  The  Managed  Care Reform and Patient Rights
 5    Act is 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
 9    prohibit or discourage health care providers by  contract  or
10    policy  from  discussing  any health care services and health
11    care providers,  utilization  review  and  quality  assurance
12    policies,  terms and conditions of plans and plan policy with
13    enrollees, prospective enrollees, providers, or the public.
14        (b)  No health care plan by contract, written policy,  or
15    procedure  may  permit  or  allow  an individual or entity to
16    dispense a different drug in place of the drug  or  brand  of
17    drug  ordered or prescribed without the express permission of
18    the person  ordering  or  prescribing  the  drug,  except  as
19    provided  under  Section  3.14 of the Illinois Food, Drug and
20    Cosmetic Act.
21        (c)  No health care plan or  its  subcontractors  may  by
22    contract,  written policy, procedure, or otherwise mandate or
23    require an enrollee to substitute his  or  her  participating
24    primary  care  physician  under  the  plan  during  inpatient
25    hospitalization  without  the  agreement  of  that enrollee's
26    participating primary care physician. All health  care  plans
27    shall  inform  prospective  enrollees  and  enrollees  of any
28    policies,  recommendations,  or  guidelines  concerning   the
29    substitution  of  the  enrollee's primary care physician when
30    hospitalization is necessary  in  the  manner  set  forth  in
31    subsections (d) and (e) of Section 15.
 
HB4220 Engrossed            -2-               LRB9211444JSpcA
 1        (d) (c)  Any  violation  of this Section shall be subject
 2    to the penalties under this Act.
 3    (Source: P.A. 91-617, eff. 1-1-00.)

 4        Section 10.  The Illinois Insurance Code  is  amended  by
 5    changing Sections 155.36, 370s, and 511.118 as follows:

 6        (215 ILCS 5/155.36)
 7        Sec. 155.36.  Managed Care Reform and Patient Rights Act.
 8    Insurance  companies  that  transact  the  kinds of insurance
 9    authorized under Class 1(b) or Class 2(a)  of  Section  4  of
10    this  Code  shall  comply with Sections 30 and Section 85 and
11    the definition of the term "emergency medical  condition"  in
12    Section 10 of the Managed Care Reform and Patient Rights Act.
13    (Source: P.A. 91-617, eff. 1-1-00.)

14        (215 ILCS 5/370s)
15        Sec.  370s.  Managed  Care Reform and Patient Rights Act.
16    All administrators shall comply with Sections 30, 55, and  85
17    of the Managed Care Reform and Patient Rights Act.
18    (Source: P.A. 91-617, eff. 1-1-00.)

19        (215 ILCS 5/511.118)
20        Sec.  511.118.  Managed  Care  Reform  and Patient Rights
21    Act.  All administrators are subject  to  the  provisions  of
22    Sections  30,  55,  and  85  of  the  Managed Care Reform and
23    Patient Rights Act.
24    (Source: P.A. 91-617, eff. 1-1-00.)

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