815 ILCS 628/ In-Office Membership Care Act.

(815 ILCS 628/1)

Sec. 1. Short title. This Act may be cited as the In-Office Membership Care Act.

(Source: P.A. 101-190, eff. 8-2-19.)

(815 ILCS 628/5)

Sec. 5. Public policy. 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.

(Source: P.A. 101-190, eff. 8-2-19.)

(815 ILCS 628/10)

Sec. 10. Definitions. 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 fee.

"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.

(Source: P.A. 101-190, eff. 8-2-19.)

(815 ILCS 628/15)

Sec. 15. In-office membership care agreement provisions.

(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 agreement;

(3) the location or locations where services are to be provided;

(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.

(Source: P.A. 101-190, eff. 8-2-19.)

(815 ILCS 628/20)

Sec. 20. Location of in-office membership care services. 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.

(Source: P.A. 101-190, eff. 8-2-19.)

(815 ILCS 628/25)

Sec. 25. Insurance billing prohibited. Neither the patient nor the dental care provider shall submit a bill to an insurer for the services provided under an in-office membership care agreement.

(Source: P.A. 101-190, eff. 8-2-19.)

(815 ILCS 628/30)

Sec. 30. In-office membership care agreements not classified as insurance. In-office membership care agreements are not subject to regulation as insurance under the Illinois Insurance Code.

(Source: P.A. 101-190, eff. 8-2-19.)

(815 ILCS 628/35)

Sec. 35. Disclaimer. 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.".

(Source: P.A. 101-190, eff. 8-2-19.)

(815 ILCS 628/40)

Sec. 40. Restrictions on transfer. An in-office 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 representatives.

(Source: P.A. 101-190, eff. 8-2-19.)

(815 ILCS 628/45)

Sec. 45. 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.

(Source: P.A. 101-190, eff. 8-2-19.)

(815 ILCS 628/80)

Sec. 80. (Amendatory provisions; text omitted).

(Source: P.A. 101-190, eff. 8-2-19; text omitted.)

(815 ILCS 628/99)

Sec. 99. Effective date. This Act takes effect upon becoming law.

(Source: P.A. 101-190, eff. 8-2-19.)