Illinois HB 1918: JOINT SELF-INSURANCE

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HB1918 EngrossedLRB104 06023 BAB 16056 b

1 AN ACT concerning regulation.

2 Be it enacted by the People of the State of Illinois, 

3represented in the General Assembly:

4 Section 5. The Managed Care Reform and Patient Rights Act 

5is amended by changing Section 10 as follows:

6 (215 ILCS 134/10)

7 Sec. 10. Definitions. In this Act: 

8 For a health care plan under Section 45 or for a 

9utilization review program under Section 85, "adverse 

10determination" has the meaning given to that term in Section 

1110 of the Health Carrier External Review Act.

12 "Clinical peer" means a health care professional who is in 

13the same profession and the same or similar specialty as the 

14health care provider who typically manages the medical 

15condition, procedures, or treatment under review.

16 "Department" means the Department of Insurance.

17 "Emergency medical condition" means a medical condition 

18manifesting itself by acute symptoms of sufficient severity, 

19regardless of the final diagnosis given, such that a prudent 

20layperson, who possesses an average knowledge of health and 

21medicine, could reasonably expect the absence of immediate 

22medical attention to result in:

23 (1) placing the health of the individual (or, with 

HB1918 Engrossed- 2 -LRB104 06023 BAB 16056 b

1 respect to a pregnant woman, the health of the woman or her 

2 unborn child) in serious jeopardy;

3 (2) serious impairment to bodily functions;

4 (3) serious dysfunction of any bodily organ or part;

5 (4) inadequately controlled pain; or

6 (5) with respect to a pregnant woman who is having 

7 contractions:

8 (A) inadequate time to complete a safe transfer to 

9 another hospital before delivery; or

10 (B) a t