IL
Illinois House Bill HB3725

Illinois 2023-2024 Regular Session

Illinois House Bill HB3725 Compare Versions

Only one version of the bill is available at this time.
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11 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3725 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED: New Act815 ILCS 505/2BBBB new Creates the Vision Care Plan Regulation Act. Provides that no vision care organization may issue a contract that requires an eye care provider to provide services or materials to an enrollee at a fee set by the vision care plan unless the services or materials are covered under the vision care plan. Provides that an eye care provider who chooses not to accept amounts set by a vision care plan for noncovered services or noncovered materials shall post a specified notice. Requires fees for covered services and materials to be reasonable and clearly listed on a fee schedule provided to the eye care provider. Prohibits a vision care organization from misrepresenting the benefits of a vision care plan as a means of selling coverage or communicating the benefit coverage to enrollees. Provides that the Act applies to any subcontractors used by a vision care organization to supply materials or services to an eye care provider or an enrollee under a vision care plan. Prohibits a vision care organization from restricting an eye care provider's freedom to choose suppliers, materials, or labs or from requiring an eye care provider to purchase materials from a source owned by the entity that issued the vision care plan. Provides that an eye care provider recommending an out-of-network supplier of vision care materials to an enrollee shall provide written notice thereof. Provides that the terms, fees, discounts, or reimbursement rates in a vision care plan may not be changed unless mutually agreed to in writing by the eye care provider and the vision care organization. Sets forth prohibited contract terms that may not be required by a vision care organization as a condition of contracting with a medical plan. Provides that a person or entity adversely affected by a violation of the Act by the vision care organization may seek injunctive relief and shall recover attorney's fees and costs from the vision care organization upon prevailing. Amends the Consumer Fraud and Deceptive Business Practices Act to provide that any person who violates the Vision Care Plan Regulation Act commits an unlawful practice. LRB103 25924 BMS 52275 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3725 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED: New Act815 ILCS 505/2BBBB new New Act 815 ILCS 505/2BBBB new Creates the Vision Care Plan Regulation Act. Provides that no vision care organization may issue a contract that requires an eye care provider to provide services or materials to an enrollee at a fee set by the vision care plan unless the services or materials are covered under the vision care plan. Provides that an eye care provider who chooses not to accept amounts set by a vision care plan for noncovered services or noncovered materials shall post a specified notice. Requires fees for covered services and materials to be reasonable and clearly listed on a fee schedule provided to the eye care provider. Prohibits a vision care organization from misrepresenting the benefits of a vision care plan as a means of selling coverage or communicating the benefit coverage to enrollees. Provides that the Act applies to any subcontractors used by a vision care organization to supply materials or services to an eye care provider or an enrollee under a vision care plan. Prohibits a vision care organization from restricting an eye care provider's freedom to choose suppliers, materials, or labs or from requiring an eye care provider to purchase materials from a source owned by the entity that issued the vision care plan. Provides that an eye care provider recommending an out-of-network supplier of vision care materials to an enrollee shall provide written notice thereof. Provides that the terms, fees, discounts, or reimbursement rates in a vision care plan may not be changed unless mutually agreed to in writing by the eye care provider and the vision care organization. Sets forth prohibited contract terms that may not be required by a vision care organization as a condition of contracting with a medical plan. Provides that a person or entity adversely affected by a violation of the Act by the vision care organization may seek injunctive relief and shall recover attorney's fees and costs from the vision care organization upon prevailing. Amends the Consumer Fraud and Deceptive Business Practices Act to provide that any person who violates the Vision Care Plan Regulation Act commits an unlawful practice. LRB103 25924 BMS 52275 b LRB103 25924 BMS 52275 b A BILL FOR
22 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3725 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED:
33 New Act815 ILCS 505/2BBBB new New Act 815 ILCS 505/2BBBB new
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66 Creates the Vision Care Plan Regulation Act. Provides that no vision care organization may issue a contract that requires an eye care provider to provide services or materials to an enrollee at a fee set by the vision care plan unless the services or materials are covered under the vision care plan. Provides that an eye care provider who chooses not to accept amounts set by a vision care plan for noncovered services or noncovered materials shall post a specified notice. Requires fees for covered services and materials to be reasonable and clearly listed on a fee schedule provided to the eye care provider. Prohibits a vision care organization from misrepresenting the benefits of a vision care plan as a means of selling coverage or communicating the benefit coverage to enrollees. Provides that the Act applies to any subcontractors used by a vision care organization to supply materials or services to an eye care provider or an enrollee under a vision care plan. Prohibits a vision care organization from restricting an eye care provider's freedom to choose suppliers, materials, or labs or from requiring an eye care provider to purchase materials from a source owned by the entity that issued the vision care plan. Provides that an eye care provider recommending an out-of-network supplier of vision care materials to an enrollee shall provide written notice thereof. Provides that the terms, fees, discounts, or reimbursement rates in a vision care plan may not be changed unless mutually agreed to in writing by the eye care provider and the vision care organization. Sets forth prohibited contract terms that may not be required by a vision care organization as a condition of contracting with a medical plan. Provides that a person or entity adversely affected by a violation of the Act by the vision care organization may seek injunctive relief and shall recover attorney's fees and costs from the vision care organization upon prevailing. Amends the Consumer Fraud and Deceptive Business Practices Act to provide that any person who violates the Vision Care Plan Regulation Act commits an unlawful practice.
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1212 1 AN ACT concerning regulation.
1313 2 Be it enacted by the People of the State of Illinois,
1414 3 represented in the General Assembly:
1515 4 Section 1. Short title. This Act may be cited as the Vision
1616 5 Care Plan Regulation Act.
1717 6 Section 5. Definitions. As used in this Act:
1818 7 "Covered materials" means materials for which
1919 8 reimbursement from the vision care plan is provided to an eye
2020 9 care provider by an enrollee's plan contract or for which a
2121 10 reimbursement would be available but for the application of
2222 11 the enrollee's contractual limitation of deductibles,
2323 12 copayments, or coinsurance.
2424 13 "Covered services" means services for which reimbursement
2525 14 from the vision care plan is provided to an eye care provider
2626 15 by an enrollee's plan contract or for which a reimbursement
2727 16 would be available but for the application of the enrollee's
2828 17 contractual plan limitation of deductibles, copayments, or
2929 18 coinsurance regardless of how the benefits are listed in an
3030 19 enrollee's benefit plan's definition of benefits.
3131 20 "Enrollee" means any individual enrolled in a vision care
3232 21 plan provided by a group, employer, or other entity that
3333 22 purchases or supplies coverage for a vision care plan.
3434 23 "Eye care provider" means a doctor of optometry licensed
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3838 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3725 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED:
3939 New Act815 ILCS 505/2BBBB new New Act 815 ILCS 505/2BBBB new
4040 New Act
4141 815 ILCS 505/2BBBB new
4242 Creates the Vision Care Plan Regulation Act. Provides that no vision care organization may issue a contract that requires an eye care provider to provide services or materials to an enrollee at a fee set by the vision care plan unless the services or materials are covered under the vision care plan. Provides that an eye care provider who chooses not to accept amounts set by a vision care plan for noncovered services or noncovered materials shall post a specified notice. Requires fees for covered services and materials to be reasonable and clearly listed on a fee schedule provided to the eye care provider. Prohibits a vision care organization from misrepresenting the benefits of a vision care plan as a means of selling coverage or communicating the benefit coverage to enrollees. Provides that the Act applies to any subcontractors used by a vision care organization to supply materials or services to an eye care provider or an enrollee under a vision care plan. Prohibits a vision care organization from restricting an eye care provider's freedom to choose suppliers, materials, or labs or from requiring an eye care provider to purchase materials from a source owned by the entity that issued the vision care plan. Provides that an eye care provider recommending an out-of-network supplier of vision care materials to an enrollee shall provide written notice thereof. Provides that the terms, fees, discounts, or reimbursement rates in a vision care plan may not be changed unless mutually agreed to in writing by the eye care provider and the vision care organization. Sets forth prohibited contract terms that may not be required by a vision care organization as a condition of contracting with a medical plan. Provides that a person or entity adversely affected by a violation of the Act by the vision care organization may seek injunctive relief and shall recover attorney's fees and costs from the vision care organization upon prevailing. Amends the Consumer Fraud and Deceptive Business Practices Act to provide that any person who violates the Vision Care Plan Regulation Act commits an unlawful practice.
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7171 1 pursuant to the Illinois Optometric Practice Act of 1987 or a
7272 2 physician licensed to practice medicine in all of its branches
7373 3 pursuant to the Medical Practice Act of 1987.
7474 4 "Materials" means ophthalmic devices, including, but not
7575 5 limited to:
7676 6 (i) lenses, devices containing lenses, artificial
7777 7 intraocular lenses, ophthalmic frames, and other lens
7878 8 mounting apparatus, prisms, lens treatments, and coatings;
7979 9 (ii) contact lenses and prosthetic devices that
8080 10 correct, relieve, or treat defects or abnormal conditions
8181 11 of the human eye or adnexa; and
8282 12 (iii) any devices that deliver medication or other
8383 13 therapeutic treatment to the human eye or adnexa.
8484 14 "Services" means the professional work performed by an eye
8585 15 care provider.
8686 16 "Subcontractor" means any company, group, or third-party
8787 17 entity, including agents, servants, partially-owned or
8888 18 wholly-owned subsidiaries and controlled organizations, that
8989 19 the vision care plan contracts with to supply services or
9090 20 materials for an eye care provider or enrollee to fulfill the
9191 21 benefit plan of a vision care plan.
9292 22 "Vision care organization" means an entity formed under
9393 23 the laws of this State or another state that issues a vision
9494 24 care plan.
9595 25 "Vision care plan" means a plan that creates, promotes,
9696 26 sells, provides, advertises, or administers an integrated or
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107107 1 stand-alone plan that provides coverage for covered services
108108 2 and covered materials.
109109 3 Section 10. Noncovered services.
110110 4 (a) No vision care organization that issues, delivers,
111111 5 amends, or renews a vision care plan on or after the effective
112112 6 date of this Act shall issue a contract that requires an eye
113113 7 care provider to provide services or materials to an enrollee
114114 8 at a fee set by the vision care plan unless the services or
115115 9 materials are covered services or covered materials under the
116116 10 vision care plan. De minimis reimbursements shall not qualify
117117 11 a service or material as a covered service or a covered
118118 12 material under this Act.
119119 13 (b) An eye care provider who chooses not to accept as
120120 14 payment an amount set by a vision care plan for services or
121121 15 materials that are not covered services or covered materials
122122 16 shall post, in a conspicuous place, a notice stating the
123123 17 following: "IMPORTANT: This eye care provider does not accept
124124 18 the fee schedule set by your insurer for vision care services
125125 19 and vision care materials that are not covered benefits under
126126 20 your plan and instead charges his or her normal fee for those
127127 21 services and materials. This eye care provider will provide
128128 22 you with an estimated cost for each noncovered service or
129129 23 noncovered material upon your request."
130130 24 Section 15. Fees for covered services and covered
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141141 1 materials. Fees paid under a vision care plan for covered
142142 2 services and covered materials, regardless of the supplier or
143143 3 optical lab used to obtain materials, shall be reasonable and
144144 4 shall be clearly listed on a fee schedule that has been
145145 5 provided to the eye care provider before entering into a
146146 6 contract with the vision care organization.
147147 7 Section 20. Misrepresentation. A vision care organization
148148 8 may not misrepresent the benefits of a vision care plan to
149149 9 groups, employers, or enrollees as a means of selling coverage
150150 10 or communicating the benefit coverage to enrollees.
151151 11 Section 25. Subcontractors. The provisions of this Act
152152 12 apply to any subcontractors used by a vision care organization
153153 13 to supply materials or services to an eye care provider or an
154154 14 enrollee under a vision care plan.
155155 15 Section 30. Suppliers; optical labs.
156156 16 (a) A vision care organization may not restrict, limit, or
157157 17 disincentivize, either directly or indirectly, an eye care
158158 18 provider's freedom to choose suppliers of services or
159159 19 materials or the use of an optical lab.
160160 20 (b) A vision care organization may not require an eye care
161161 21 provider or patient to order or purchase covered materials,
162162 22 including, but not limited to, ophthalmic lenses, from any
163163 23 source owned by, controlled by, or in a common ownership
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174174 1 scheme with the entity that issued the vision care plan.
175175 2 (c) An eye care provider recommending an out-of-network
176176 3 source or supplier of vision care materials to an enrollee
177177 4 shall provide written notice to the enrollee that the source
178178 5 or supplier is out-of-network.
179179 6 Section 35. Modification of plan. The terms, fees,
180180 7 discounts, or reimbursement rates in a vision care plan may
181181 8 not be changed unless mutually agreed to in writing by the eye
182182 9 care provider and the vision care organization that issued the
183183 10 vision care plan.
184184 11 Section 40. Prohibitions; medical plan preconditions. No
185185 12 vision care organization that issues, delivers, amends, or
186186 13 renews a vision care plan on or after the effective date of
187187 14 this Act shall issue a vision care plan contract that
188188 15 requires:
189189 16 (1) an eye care provider to contract with a plan that
190190 17 offers supplemental or specialty health care services as a
191191 18 condition of contracting with a plan that offers basic
192192 19 health services; or
193193 20 (2) an eye care provider to contract with a vision
194194 21 care plan as a condition to participation in a medical
195195 22 plan.
196196 23 Section 45. Injunctive relief. A person or entity
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207207 1 adversely affected by a violation of this Act by the vision
208208 2 care organization that issued a vision care plan may bring an
209209 3 action in a court of competent jurisdiction for injunctive
210210 4 relief and, upon prevailing, in addition to any injunctive
211211 5 relief that may be granted, shall recover attorney's fees and
212212 6 costs from the vision care organization.
213213 7 Section 900. The Consumer Fraud and Deceptive Business
214214 8 Practices Act is amended by adding Section 2BBBB as follows:
215215 9 (815 ILCS 505/2BBBB new)
216216 10 Sec. 2BBBB. Violations of the Vision Care Plan Regulation
217217 11 Act. Any person who violates the Vision Care Plan Regulation
218218 12 Act commits an unlawful practice within the meaning of this
219219 13 Act.
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