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Public Act 101-0190


 

Public Act 0190 101ST GENERAL ASSEMBLY

  
  
  

 


 
Public Act 101-0190
 
SB0174 EnrolledLRB101 04949 SMS 49958 b

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

Effective Date: 8/2/2019