Illinois 2023-2024 Regular Session

Illinois House Bill HB2072 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	Public Act 103-0024
2	1		HB2072 EnrolledLRB103 04625 BMS 51012 b HB2072 Enrolled LRB103 04625 BMS 51012 b
3	2		HB2072 Enrolled LRB103 04625 BMS 51012 b
4		-	AN ACT concerning regulation.
5		-	Be it enacted by the People of the State of Illinois,
6		-	represented in the General Assembly:
7		-	Section 5. The Illinois Insurance Code is amended by
8		-	changing Section 355.4 and by adding Section 355.5 as follows:
9		-	(215 ILCS 5/355.4)
10		-	Sec. 355.4. Provider notification of network plan changes.
11		-	(a) As used in this Section:
12		-	"Contracting entity" means any person or company that
13		-	enters into direct contracts with providers for the delivery
14		-	of dental services in the ordinary course of business,
15		-	including a third-party administrator and a dental carrier.
16		-	"Dental carrier" means a dental insurance company, dental
17		-	service corporation, dental plan organization authorized to
18		-	provide dental benefits, or a health insurance plan that
19		-	includes coverage for dental services.
20		-	(b) No dental carrier may automatically enroll a provider
21		-	in a leased network without allowing any provider that is part
22		-	of the dental carrier's provider network to choose to not
23		-	participate by opting out.
24		-	(c) Any contract entered into or renewed on or after the
25		-	effective date of this amendatory Act of the 103rd General
26		-	Assembly this amendatory Act of the 99th General Assembly that
	3	+	1 AN ACT concerning regulation.
	4	+	2 Be it enacted by the People of the State of Illinois,
	5	+	3 represented in the General Assembly:
	6	+	4 Section 5. The Illinois Insurance Code is amended by
	7	+	5 changing Section 355.4 and by adding Section 355.5 as follows:
	8	+	6 (215 ILCS 5/355.4)
	9	+	7 Sec. 355.4. Provider notification of network plan changes.
	10	+	8 (a) As used in this Section:
	11	+	9 "Contracting entity" means any person or company that
	12	+	10 enters into direct contracts with providers for the delivery
	13	+	11 of dental services in the ordinary course of business,
	14	+	12 including a third-party administrator and a dental carrier.
	15	+	13 "Dental carrier" means a dental insurance company, dental
	16	+	14 service corporation, dental plan organization authorized to
	17	+	15 provide dental benefits, or a health insurance plan that
	18	+	16 includes coverage for dental services.
	19	+	17 (b) No dental carrier may automatically enroll a provider
	20	+	18 in a leased network without allowing any provider that is part
	21	+	19 of the dental carrier's provider network to choose to not
	22	+	20 participate by opting out.
	23	+	21 (c) Any contract entered into or renewed on or after the
	24	+	22 effective date of this amendatory Act of the 103rd General
	25	+	23 Assembly this amendatory Act of the 99th General Assembly that
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33		-	allows the rights and obligations of the contract to be
34		-	assigned or leased to another insurer shall provide for notice
35		-	that informs each provider in writing via certified mail 60
36		-	days before any scheduled assignment or lease of the network
37		-	to which the provider is a contracted provider. To be in
38		-	compliance with this Section, the notification must include
39		-	all contract terms, a policy manual, a fee schedule, and a
40		-	statement that the provider has the right to choose not to
41		-	participate in third-party access of that assignment or lease
42		-	within 30 days after the assignment or lease to the
43		-	contracting dentist.
44		-	(d) A dental carrier that leases or assigns its network
45		-	shall not cancel a network participating dentist's contractual
46		-	relationship or otherwise penalize a network participating
47		-	dentist in any way based on whether or not the dentist accepts
48		-	the terms of the assignment or lease. Before accepting the
49		-	terms of an assignment or lease agreement as described in this
50		-	Section, any provider who receives notification of an
51		-	impending assignment or lease must be given the option to
52		-	contract directly with the entities proposing to gain access
53		-	to the provider's network.
54		-	(e) The provisions of this Section do not apply:
55		-	(1) if access to a provider network contract is
56		-	granted to a dental carrier or an entity operating in
57		-	accordance with the same brand licensee program as the
58		-	contracting entity; or
	32	+	HB2072 Enrolled- 2 -LRB103 04625 BMS 51012 b HB2072 Enrolled - 2 - LRB103 04625 BMS 51012 b
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	34	+	1 allows the rights and obligations of the contract to be
	35	+	2 assigned or leased to another insurer shall provide for notice
	36	+	3 that informs each provider in writing via certified mail 60
	37	+	4 days before any scheduled assignment or lease of the network
	38	+	5 to which the provider is a contracted provider. To be in
	39	+	6 compliance with this Section, the notification must include
	40	+	7 all contract terms, a policy manual, a fee schedule, and a
	41	+	8 statement that the provider has the right to choose not to
	42	+	9 participate in third-party access of that assignment or lease
	43	+	10 within 30 days after the assignment or lease to the
	44	+	11 contracting dentist.
	45	+	12 (d) A dental carrier that leases or assigns its network
	46	+	13 shall not cancel a network participating dentist's contractual
	47	+	14 relationship or otherwise penalize a network participating
	48	+	15 dentist in any way based on whether or not the dentist accepts
	49	+	16 the terms of the assignment or lease. Before accepting the
	50	+	17 terms of an assignment or lease agreement as described in this
	51	+	18 Section, any provider who receives notification of an
	52	+	19 impending assignment or lease must be given the option to
	53	+	20 contract directly with the entities proposing to gain access
	54	+	21 to the provider's network.
	55	+	22 (e) The provisions of this Section do not apply:
	56	+	23 (1) if access to a provider network contract is
	57	+	24 granted to a dental carrier or an entity operating in
	58	+	25 accordance with the same brand licensee program as the
	59	+	26 contracting entity; or
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61		-	(2) to a provider network contract for dental services
62		-	provided to beneficiaries of the State employee group
63		-	health insurance program or the medical assistance program
64		-	under the Illinois Public Aid Code.
65		-	(Source: P.A. 99-568, eff. 7-15-16.)
66		-	(215 ILCS 5/355.5 new)
67		-	Sec. 355.5. Dental coverage reimbursement; prohibitions.
68		-	No insurer, dental service plan corporation, professional
69		-	service corporation, insurance network leasing company, or any
70		-	company that amends, delivers, issues, or renews an individual
71		-	or group policy of accident and health insurance on or after
72		-	the effective date of this amendatory Act of the 103rd General
73		-	Assembly shall require a dental care provider to incur a fee to
74		-	access and obtain payment or reimbursement for services
75		-	provided. A dental plan carrier shall provide a dental care
76		-	provider with 100% of the contracted amount of the payment or
77		-	reimbursement. Fees incurred directly by a dental care
78		-	provider from third parties related to transmitting an
79		-	automated clearing house network claim, transaction
80		-	management, data management, or portal services and other fees
81		-	charged by third parties that are not in the control of the
82		-	dental plan carrier shall not be prohibited by this Section.
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	70	+	1 (2) to a provider network contract for dental services
	71	+	2 provided to beneficiaries of the State employee group
	72	+	3 health insurance program or the medical assistance program
	73	+	4 under the Illinois Public Aid Code.
	74	+	5 (Source: P.A. 99-568, eff. 7-15-16.)
	75	+	6 (215 ILCS 5/355.5 new)
	76	+	7 Sec. 355.5. Dental coverage reimbursement; prohibitions.
	77	+	8 No insurer, dental service plan corporation, professional
	78	+	9 service corporation, insurance network leasing company, or any
	79	+	10 company that amends, delivers, issues, or renews an individual
	80	+	11 or group policy of accident and health insurance on or after
	81	+	12 the effective date of this amendatory Act of the 103rd General
	82	+	13 Assembly shall require a dental care provider to incur a fee to
	83	+	14 access and obtain payment or reimbursement for services
	84	+	15 provided. A dental plan carrier shall provide a dental care
	85	+	16 provider with 100% of the contracted amount of the payment or
	86	+	17 reimbursement. Fees incurred directly by a dental care
	87	+	18 provider from third parties related to transmitting an
	88	+	19 automated clearing house network claim, transaction
	89	+	20 management, data management, or portal services and other fees
	90	+	21 charged by third parties that are not in the control of the
	91	+	22 dental plan carrier shall not be prohibited by this Section.
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	97	+	HB2072 Enrolled - 3 - LRB103 04625 BMS 51012 b