Illinois SB 1346: MANAGED CARE & INSURANCE CARDS

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 Full Text of SB1346

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SB1346 EnrolledLRB104 07692 BAB 17736 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 Sections 15 and 90 as follows:

6 (215 ILCS 134/15)

7 Sec. 15. Provision of information. 

8 (a) A health care plan shall provide annually to enrollees 

9and prospective enrollees, upon request, a complete list of 

10participating health care providers in the health care plan's 

11service area and a description of the following terms of 

12coverage:

13 (1) the service area;

14 (2) the covered benefits and services with all 

15 exclusions, exceptions, and limitations;

16 (3) the pre-certification and other utilization review 

17 procedures and requirements;

18 (4) a description of the process for the selection of 

19 a primary care physician, any limitation on access to 

20 specialists, and the plan's standing referral policy;

21 (5) the emergency coverage and benefits, including any 

22 restrictions on emergency care services;

23 (6) the out-of-area coverage and benefits, if any;

SB1346 Enrolled- 2 -LRB104 07692 BAB 17736 b

1 (7) the enrollee's financial responsibility for 

2 copayments, deductibles, premiums, and any other 

3 out-of-pocket expenses;

4 (8) the provisions for continuity of treatment in the 

5 event a health care provider's participation terminates 

6 during the course of an enrollee's treatment by that 

7 provider;

8 (9) the appeals process, forms, and time frames for 

9 he