Public Act 101-0190
Public Act 0190 101ST GENERAL ASSEMBLY
|Public Act 101-0190|
|SB0174 Enrolled||LRB101 04949 SMS 49958 b|
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
This Act may be cited as the
In-Office Membership Care Act.
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.
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
"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.
In-office membership care agreement
(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
(3) the location or locations where services are to be
(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.
Location of in-office membership care
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.
Insurance billing prohibited.
patient nor the dental care provider shall submit a bill to an
insurer for the services provided under an in-office membership
In-office membership care agreements not
classified as insurance.
In-office membership care agreements
are not subject to regulation as insurance under the Illinois
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.".
Restrictions on transfer.
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
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.
The Illinois Insurance Code is amended by
changing Section 352 as follows:
(215 ILCS 5/352)
(from Ch. 73, par. 964)
Scope of Article.
(a) Except as provided in subsections (b), (c), (d), and
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;
Article shall apply to policies and contracts
which contain benefits
providing reimbursement for the
expenses of long term health care which are
ordered by a physician including but not limited to
professional nursing care, custodial nursing care, and
custodial care provided in a nursing home or at a
residence of the insured.
(c) A policy issued and delivered in this State
provides coverage under that policy for
certificate holders who
are neither residents of nor employed in this State
need to provide to those nonresident
certificate holders who
are not employed in this State the coverages or
mandated by this Article.
(d) Stop-loss insurance is exempt from all Sections
Article, except this Section and Sections 353a, 354, 357.30,
370. For purposes of this exemption, stop-loss insurance is
further defined as
(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
(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,
participants, or health care providers.
(e) A policy issued or delivered in this State to the
Department of Healthcare and Family Services (formerly
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
standards, rules, or regulations
respecting benefits imposed by or under
authority of this Code,
except those specified by subsection (1) of Section
Section 370c, and Section 370c.1. Nothing in this subsection,
however, affects the total medical services
persons eligible for medical assistance under the Illinois
(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.)
This Act takes effect upon
Effective Date: 8/2/2019