SB0969 100TH GENERAL ASSEMBLY

LRB100 08240 SMS 18340 b

100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
SB0969

Introduced 2/7/2017, by Sen. Martin A. Sandoval

SYNOPSIS AS INTRODUCED:

5 ILCS 375/6.11B new
215 ILCS 5/356z.25 new

Amends the State Employees Group Insurance Act of 1971. Prohibits the program of health benefits under the Act from imposing a copayment, coinsurance, or office visit deductible amount charged to the insured for services rendered for each date of service by a physical therapist that is greater than the copayment, coinsurance, or office visit deductible amount charged to the insured for the services of a primary care physician or an osteopath for an office visit. Requires an insurer to state clearly the availability of physical therapy coverage under its policy or plan and all related limitations, conditions, and exclusions. Requires the Commission on Government Forecasting and Accountability to perform an actuarial analysis of the cost impact of that prohibition to health carriers, insureds with a health benefit plan, and other private and public payers and to issue a report on its findings on or before December 31, 2019. Amends the Illinois Insurance Code. Provides that an insurer shall not impose a copayment, coinsurance, or office visit deductible amount charged to the insured for services rendered for each date of service by a physical therapist licensed under the Illinois Physical Therapy Act that is greater than the copayment, coinsurance, or office visit deductible amount charged to the insured for the services of a primary care physician or an osteopath licensed under the Medical Practice Act of 1987 for an office visit. Provides that an insurer shall state clearly the availability of physical therapy coverage under its policy or plan and all related limitations, conditions, and exclusions.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The State Employees Group Insurance Act of 1971 is amended by adding Section 6.11B as follows:

(5 ILCS 375/6.11B new)

Sec. 6.11B. Coverage for physical therapy.

(a) The program of health benefits provided under this Act shall not impose a copayment, coinsurance, or office visit deductible amount charged to the insured for services rendered for each date of service by a physical therapist licensed under the Illinois Physical Therapy Act that is greater than the copayment, coinsurance, or office visit deductible amount charged to the insured for the services of a primary care physician or an osteopath licensed under the Medical Practice Act of 1987 for an office visit. An insurer shall state clearly the availability of physical therapy coverage under its policy or plan and all related limitations, conditions, and exclusions.

(b) The Commission on Government Forecasting and Accountability shall perform an actuarial analysis of the cost impact of this Section to health carriers, insureds with a health benefit plan, and other private and public payers. The Commission shall issue a report on its findings on or before December 31, 2019.

Section 10. The Illinois Insurance Code is amended by adding Section 356z.25 as follows:

(215 ILCS 5/356z.25 new)

Sec. 356z.25. Coverage for physical therapy. An insurer shall not impose a copayment, coinsurance, or office visit deductible amount charged to the insured for services rendered for each date of service by a physical therapist licensed under the Illinois Physical Therapy Act that is greater than the copayment, coinsurance, or office visit deductible amount charged to the insured for the services of a primary care physician or an osteopath licensed under the Medical Practice Act of 1987 for an office visit. An insurer shall state clearly the availability of physical therapy coverage under its policy or plan and all related limitations, conditions, and exclusions.