Public Act 103-0024
HB2072 EnrolledLRB103 04625 BMS 51012 b HB2072 Enrolled LRB103 04625 BMS 51012 b
HB2072 Enrolled LRB103 04625 BMS 51012 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by
changing Section 355.4 and by adding Section 355.5 as follows:
(215 ILCS 5/355.4)
Sec. 355.4. Provider notification of network plan changes.
(a) As used in this Section:
"Contracting entity" means any person or company that
enters into direct contracts with providers for the delivery
of dental services in the ordinary course of business,
including a third-party administrator and a dental carrier.
"Dental carrier" means a dental insurance company, dental
service corporation, dental plan organization authorized to
provide dental benefits, or a health insurance plan that
includes coverage for dental services.
(b) No dental carrier may automatically enroll a provider
in a leased network without allowing any provider that is part
of the dental carrier's provider network to choose to not
participate by opting out.
(c) Any contract entered into or renewed on or after the
effective date of this amendatory Act of the 103rd General
Assembly this amendatory Act of the 99th General Assembly that
HB2072 Enrolled LRB103 04625 BMS 51012 b
allows the rights and obligations of the contract to be
assigned or leased to another insurer shall provide for notice
that informs each provider in writing via certified mail 60
days before any scheduled assignment or lease of the network
to which the provider is a contracted provider. To be in
compliance with this Section, the notification must include
all contract terms, a policy manual, a fee schedule, and a
statement that the provider has the right to choose not to
participate in third-party access of that assignment or lease
within 30 days after the assignment or lease to the
contracting dentist.
(d) A dental carrier that leases or assigns its network
shall not cancel a network participating dentist's contractual
relationship or otherwise penalize a network participating
dentist in any way based on whether or not the dentist accepts
the terms of the assignment or lease. Before accepting the
terms of an assignment or lease agreement as described in this
Section, any provider who receives notification of an
impending assignment or lease must be given the option to
contract directly with the entities proposing to gain access
to the provider's network.
(e) The provisions of this Section do not apply:
(1) if access to a provider network contract is
granted to a dental carrier or an entity operating in
accordance with the same brand licensee program as the
contracting entity; or
(2) to a provider network contract for dental services
provided to beneficiaries of the State employee group
health insurance program or the medical assistance program
under the Illinois Public Aid Code.
(Source: P.A. 99-568, eff. 7-15-16.)
(215 ILCS 5/355.5 new)
Sec. 355.5. Dental coverage reimbursement; prohibitions.
No insurer, dental service plan corporation, professional
service corporation, insurance network leasing company, or any
company that amends, delivers, issues, or renews an individual
or group policy of accident and health insurance on or after
the effective date of this amendatory Act of the 103rd General
Assembly shall require a dental care provider to incur a fee to
access and obtain payment or reimbursement for services
provided. A dental plan carrier shall provide a dental care
provider with 100% of the contracted amount of the payment or
reimbursement. Fees incurred directly by a dental care
provider from third parties related to transmitting an
automated clearing house network claim, transaction
management, data management, or portal services and other fees
charged by third parties that are not in the control of the
dental plan carrier shall not be prohibited by this Section.