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| Public Act 102-0704 | ||||
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Managed Care Reform and Patient Rights Act | ||||
is amended by changing Section 30 as follows:
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(215 ILCS 134/30)
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Sec. 30. Prohibitions.
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(a) No health care plan or its subcontractors may prohibit | ||||
or discourage
health care providers
by contract or policy from
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discussing any health care services and health care providers, | ||||
utilization
review and quality assurance policies, terms and | ||||
conditions of plans and plan
policy with enrollees, | ||||
prospective enrollees, providers, or the public.
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(b) No health care plan by contract, written policy, or | ||||
procedure may
permit or allow an individual or entity to | ||||
dispense a different
drug in place of the drug or brand of drug | ||||
ordered or prescribed without the
express permission of the | ||||
person ordering or prescribing the drug, except as
provided | ||||
under Section 3.14 of the Illinois Food, Drug and Cosmetic | ||||
Act.
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(c) No health care plan or its subcontractors may by | ||||
contract, written
policy, procedure, or otherwise mandate or | ||||
require an enrollee
to substitute his or her participating | ||||
primary care physician
under the plan during inpatient | ||
hospitalization, such as with a hospitalist physician licensed | ||
to practice medicine in all its branches,
without the | ||
agreement of that enrollee's
participating primary care | ||
physician. "Participating primary care
physician" for health | ||
care plans and subcontractors that do not require
coordination | ||
of care by a primary care physician means the participating
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physician treating the patient. All health care plans shall | ||
inform enrollees
of any policies, recommendations, or | ||
guidelines concerning the
substitution of the enrollee's | ||
primary care physician when hospitalization is
necessary in | ||
the manner set forth in subsections (d) and (e) of Section 15.
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(d) A health care plan shall apply any third-party | ||
payments, financial assistance, discount, product vouchers, or | ||
any other reduction in out-of-pocket expenses made by or on | ||
behalf of such insured for prescription drugs toward a covered | ||
individual's deductible, copay, or cost-sharing | ||
responsibility, or out-of-pocket maximum associated with the | ||
individual's health insurance. If, under federal law, | ||
application of this requirement would result in health savings | ||
account ineligibility under Section 223 of the Internal | ||
Revenue Code, this requirement applies to health savings | ||
account-qualified high deductible health plans with respect to | ||
the deductible of such a plan after the enrollee has satisfied | ||
the minimum deductible under Section 223, except with respect | ||
to items or services that are preventive care pursuant to | ||
Section 223(c)(2)(C) of the Internal Revenue Code, in which | ||
case the requirement of this subsection applies regardless of | ||
whether the minimum deductible under Section 223 has been | ||
satisfied. | ||
(e) Any violation of this Section shall be subject to the
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penalties under this Act.
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(Source: P.A. 101-452, eff. 1-1-20.)
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Section 99. Effective date. This Act takes effect upon | ||
becoming law.
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