State of Illinois
Public Acts
92^nd General Assembly

Public Act 92-0770

HB4220 Enrolled                               LRB9211444JSpcA

    AN ACT concerning insurance.

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

    Section  5.  The  Managed  Care Reform and Patient Rights
Act is amended by changing Section 30 as follows:

    (215 ILCS 134/30)
    Sec. 30.  Prohibitions.
    (a)  No  health  care  plan  or  its  subcontractors  may
prohibit or discourage health care providers by  contract  or
policy  from  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.
    (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.
    (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  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  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.
    (d) (c)  Any  violation  of this Section shall be subject
to the penalties under this Act.
(Source: P.A. 91-617, eff. 1-1-00.)
    Passed in the General Assembly May 29, 2002.
    Approved August 06, 2002.
    Effective January 01, 2003.