Illinois 2023-2024 Regular Session

Illinois Senate Bill SB0764 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	Public Act 103-0482
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3	2		SB0764 Enrolled LRB103 03219 BMS 48225 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 1. Short title. This Act may be cited as the Vision
8		-	Care Plan Regulation Act.
9		-	Section 5. Definitions. As used in this Act:
10		-	"Covered materials" means materials for which
11		-	reimbursement from the vision care plan is provided to an eye
12		-	care provider by an enrollee's plan contract or for which a
13		-	reimbursement would be available but for the application of
14		-	the enrollee's contractual limitation of deductibles,
15		-	copayments, or coinsurance. "Covered materials" includes lens
16		-	treatment or coatings added to a spectacle lens if the base
17		-	spectacle lens is a covered material.
18		-	"Covered services" means services for which reimbursement
19		-	from the vision care plan is provided to an eye care provider
20		-	by an enrollee's plan contract or for which a reimbursement
21		-	would be available but for the application of the enrollee's
22		-	contractual plan limitation of deductibles, copayments, or
23		-	coinsurance regardless of how the benefits are listed in an
24		-	enrollee's benefit plan's definition of benefits.
25		-	"Enrollee" means any individual enrolled in a vision care
26		-	plan provided by a group, employer, or other entity 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 1. Short title. This Act may be cited as the Vision
	7	+	5 Care Plan Regulation Act.
	8	+	6 Section 5. Definitions. As used in this Act:
	9	+	7 "Covered materials" means materials for which
	10	+	8 reimbursement from the vision care plan is provided to an eye
	11	+	9 care provider by an enrollee's plan contract or for which a
	12	+	10 reimbursement would be available but for the application of
	13	+	11 the enrollee's contractual limitation of deductibles,
	14	+	12 copayments, or coinsurance. "Covered materials" includes lens
	15	+	13 treatment or coatings added to a spectacle lens if the base
	16	+	14 spectacle lens is a covered material.
	17	+	15 "Covered services" means services for which reimbursement
	18	+	16 from the vision care plan is provided to an eye care provider
	19	+	17 by an enrollee's plan contract or for which a reimbursement
	20	+	18 would be available but for the application of the enrollee's
	21	+	19 contractual plan limitation of deductibles, copayments, or
	22	+	20 coinsurance regardless of how the benefits are listed in an
	23	+	21 enrollee's benefit plan's definition of benefits.
	24	+	22 "Enrollee" means any individual enrolled in a vision care
	25	+	23 plan provided by a group, employer, or other entity that
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33		-	purchases or supplies coverage for a vision care plan.
34		-	"Eye care provider" means a doctor of optometry licensed
35		-	pursuant to the Illinois Optometric Practice Act of 1987 or a
36		-	physician licensed to practice medicine in all of its branches
37		-	pursuant to the Medical Practice Act of 1987.
38		-	"Materials" means ophthalmic devices, including, but not
39		-	limited to:
40		-	(i) lenses, devices containing lenses, ophthalmic
41		-	frames, and other lens mounting apparatus, prisms, lens
42		-	treatments, and coatings;
43		-	(ii) contact lenses and prosthetic devices that
44		-	correct, relieve, or treat defects or abnormal conditions
45		-	of the human eye or adnexa; and
46		-	(iii) any devices that deliver medication or other
47		-	therapeutic treatment to the human eye or adnexa.
48		-	"Services" means the professional work performed by an eye
49		-	care provider.
50		-	"Subcontractor" means any company, group, or third-party
51		-	entity, including agents, servants, partially-owned or
52		-	wholly-owned subsidiaries and controlled organizations, that
53		-	the vision care plan contracts with to supply services or
54		-	materials for an eye care provider or enrollee to fulfill the
55		-	benefit plan of a vision care plan.
56		-	"Vision care organization" means an entity formed under
57		-	the laws of this State or another state that issues a vision
58		-	care plan.
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	34	+	1 purchases or supplies coverage for a vision care plan.
	35	+	2 "Eye care provider" means a doctor of optometry licensed
	36	+	3 pursuant to the Illinois Optometric Practice Act of 1987 or a
	37	+	4 physician licensed to practice medicine in all of its branches
	38	+	5 pursuant to the Medical Practice Act of 1987.
	39	+	6 "Materials" means ophthalmic devices, including, but not
	40	+	7 limited to:
	41	+	8 (i) lenses, devices containing lenses, ophthalmic
	42	+	9 frames, and other lens mounting apparatus, prisms, lens
	43	+	10 treatments, and coatings;
	44	+	11 (ii) contact lenses and prosthetic devices that
	45	+	12 correct, relieve, or treat defects or abnormal conditions
	46	+	13 of the human eye or adnexa; and
	47	+	14 (iii) any devices that deliver medication or other
	48	+	15 therapeutic treatment to the human eye or adnexa.
	49	+	16 "Services" means the professional work performed by an eye
	50	+	17 care provider.
	51	+	18 "Subcontractor" means any company, group, or third-party
	52	+	19 entity, including agents, servants, partially-owned or
	53	+	20 wholly-owned subsidiaries and controlled organizations, that
	54	+	21 the vision care plan contracts with to supply services or
	55	+	22 materials for an eye care provider or enrollee to fulfill the
	56	+	23 benefit plan of a vision care plan.
	57	+	24 "Vision care organization" means an entity formed under
	58	+	25 the laws of this State or another state that issues a vision
	59	+	26 care plan.
59	60
60	61
61		-	"Vision care plan" means a plan that creates, promotes,
62		-	sells, provides, advertises, or administers an integrated or
63		-	stand-alone plan that provides coverage for covered services
64		-	and covered materials.
65		-	Section 10. Noncovered services.
66		-	(a) No vision care organization that issues, delivers,
67		-	amends, or renews a vision care plan on or after the effective
68		-	date of this Act shall issue a contract that requires an eye
69		-	care provider, as a condition of participation in the vision
70		-	care plan, to provide services or materials to an enrollee at a
71		-	fee set by the vision care plan unless the services or
72		-	materials are covered services or covered materials under the
73		-	vision care plan. De minimis reimbursements shall not qualify
74		-	a service or material as a covered service or a covered
75		-	material under this Act.
76		-	(b) An eye care provider who chooses not to accept as
77		-	payment an amount set by a vision care plan for services or
78		-	materials that are not covered services or covered materials
79		-	shall post, in a conspicuous place, a notice stating the
80		-	following: "IMPORTANT: This eye care provider does not accept
81		-	the fee schedule set by your insurer for vision care services
82		-	and vision care materials that are not covered benefits under
83		-	your plan and instead charges his or her normal fee for those
84		-	services and materials. This eye care provider will provide
85		-	you with an estimated cost for each noncovered service or
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88		-	noncovered material upon your request."
89		-	Section 15. Fees for covered services and covered
90		-	materials. Fees paid under a vision care plan for covered
91		-	services and covered materials, regardless of the supplier or
92		-	optical lab used to obtain materials, shall be reasonable and
93		-	shall be clearly listed on a fee schedule that has been
94		-	provided to the eye care provider before entering into a
95		-	contract with the vision care organization. Fees paid for
96		-	materials supplied by a non-network lab are not required to be
97		-	identical to fees paid for materials ordered through a network
98		-	lab, but non-network lab fees shall be reasonable.
99		-	Section 20. Misrepresentation.
100		-	(a) A vision care organization and its officers,
101		-	directors, agents, and employees are subject to the provisions
102		-	of Sections 149 and 154.6 of the Illinois Insurance Code.
103		-	(b) Incorporation by reference in this Act to specific
104		-	laws of this State shall not be construed to exempt a vision
105		-	care organization or vision care plan from otherwise
106		-	applicable laws that are not specifically referenced in this
107		-	Act.
108		-	Section 25. Subcontractors. The provisions of this Act
109		-	apply to any subcontractors used by a vision care organization
110		-	to supply materials or services to an eye care provider or an
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113		-	enrollee under a vision care plan.
114		-	Section 30. Suppliers; optical labs.
115		-	(a) A vision care organization may not restrict or limit
116		-	an eye care provider's choice of suppliers of services,
117		-	covered materials, or the use of an optical lab.
118		-	(b) A vision care organization may not require an eye care
119		-	provider or patient to order or purchase covered materials,
120		-	including, but not limited to, ophthalmic lenses, from any
121		-	source owned by, controlled by, or in a common ownership
122		-	scheme with the entity that issued the vision care plan.
123		-	(c) At the request of an enrollee, an eye care provider
124		-	recommending an out-of-network source or supplier of vision
125		-	care materials to an enrollee shall provide written notice to
126		-	the enrollee stating:
127		-	(1) that the source or supplier is an out-of-network
128		-	laboratory or supplier of vision care materials; and
129		-	(2) any business interest that the eye care provider
130		-	has in the out-of-network source or supplier recommended
131		-	to the enrollee.
132		-	(d) An eye care provider is required to offer an enrollee
133		-	in-network sources or suppliers of vision care materials at
134		-	the enrollee's request.
135		-	Section 35. Modification of plan.
136		-	(a) The terms, fees, discounts, or reimbursement rates in
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	70	+	1 "Vision care plan" means a plan that creates, promotes,
	71	+	2 sells, provides, advertises, or administers an integrated or
	72	+	3 stand-alone plan that provides coverage for covered services
	73	+	4 and covered materials.
	74	+	5 Section 10. Noncovered services.
	75	+	6 (a) No vision care organization that issues, delivers,
	76	+	7 amends, or renews a vision care plan on or after the effective
	77	+	8 date of this Act shall issue a contract that requires an eye
	78	+	9 care provider, as a condition of participation in the vision
	79	+	10 care plan, to provide services or materials to an enrollee at a
	80	+	11 fee set by the vision care plan unless the services or
	81	+	12 materials are covered services or covered materials under the
	82	+	13 vision care plan. De minimis reimbursements shall not qualify
	83	+	14 a service or material as a covered service or a covered
	84	+	15 material under this Act.
	85	+	16 (b) An eye care provider who chooses not to accept as
	86	+	17 payment an amount set by a vision care plan for services or
	87	+	18 materials that are not covered services or covered materials
	88	+	19 shall post, in a conspicuous place, a notice stating the
	89	+	20 following: "IMPORTANT: This eye care provider does not accept
	90	+	21 the fee schedule set by your insurer for vision care services
	91	+	22 and vision care materials that are not covered benefits under
	92	+	23 your plan and instead charges his or her normal fee for those
	93	+	24 services and materials. This eye care provider will provide
	94	+	25 you with an estimated cost for each noncovered service or
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139		-	a vision care plan may not be changed during the term of the
140		-	contract unless mutually agreed to in writing by the eye care
141		-	provider and the vision care organization that issued the
142		-	vision care plan. However, a change proposed to a vision care
143		-	plan by the vision care organization shall become effective if
144		-	the eye care provider fails to respond to the vision care
145		-	organization within 60 days after receipt of notice of the
146		-	proposed changes.
147		-	(b) The terms of a vision care plan contract that is
148		-	amended, delivered, issued, or renewed after the effective
149		-	date of this Act shall comply with the provisions of this Act.
150		-	Section 40. Prohibitions; medical plan preconditions.
151		-	(a) No vision care organization that issues, delivers,
152		-	amends, or renews a vision care plan on or after the effective
153		-	date of this Act shall issue a vision care plan contract that
154		-	requires:
155		-	(1) an eye care provider to contract with a plan that
156		-	offers supplemental or specialty health care services as a
157		-	condition of contracting with a plan that offers basic
158		-	health services; or
159		-	(2) an eye care provider to contract with a vision
160		-	care plan as a condition to participation in a medical
161		-	plan or in-network.
162		-	(b) A vision care plan may enter into an agreement with a
163		-	health care plan to deliver routine vision care services that
164	97
165	98
166		-	are covered under the enrollee's plan.
167		-	(c) A vision care plan may act as a network regarding
168		-	routine vision care services offered by a health care plan.
169		-	Section 900. The Consumer Fraud and Deceptive Business
170		-	Practices Act is amended by adding Section 2BBBB as follows:
171		-	(815 ILCS 505/2BBBB new)
172		-	Sec. 2BBBB. Violations of the Vision Care Plan Regulation
173		-	Act. Any person who violates the Vision Care Plan Regulation
174		-	Act commits an unlawful practice within the meaning of this
175		-	Act.
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	105	+	1 noncovered material upon your request."
	106	+	2 Section 15. Fees for covered services and covered
	107	+	3 materials. Fees paid under a vision care plan for covered
	108	+	4 services and covered materials, regardless of the supplier or
	109	+	5 optical lab used to obtain materials, shall be reasonable and
	110	+	6 shall be clearly listed on a fee schedule that has been
	111	+	7 provided to the eye care provider before entering into a
	112	+	8 contract with the vision care organization. Fees paid for
	113	+	9 materials supplied by a non-network lab are not required to be
	114	+	10 identical to fees paid for materials ordered through a network
	115	+	11 lab, but non-network lab fees shall be reasonable.
	116	+	12 Section 20. Misrepresentation.
	117	+	13 (a) A vision care organization and its officers,
	118	+	14 directors, agents, and employees are subject to the provisions
	119	+	15 of Sections 149 and 154.6 of the Illinois Insurance Code.
	120	+	16 (b) Incorporation by reference in this Act to specific
	121	+	17 laws of this State shall not be construed to exempt a vision
	122	+	18 care organization or vision care plan from otherwise
	123	+	19 applicable laws that are not specifically referenced in this
	124	+	20 Act.
	125	+	21 Section 25. Subcontractors. The provisions of this Act
	126	+	22 apply to any subcontractors used by a vision care organization
	127	+	23 to supply materials or services to an eye care provider or an
	128	+
	129	+
	130	+
	131	+
	132	+
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	138	+	1 enrollee under a vision care plan.
	139	+	2 Section 30. Suppliers; optical labs.
	140	+	3 (a) A vision care organization may not restrict or limit
	141	+	4 an eye care provider's choice of suppliers of services,
	142	+	5 covered materials, or the use of an optical lab.
	143	+	6 (b) A vision care organization may not require an eye care
	144	+	7 provider or patient to order or purchase covered materials,
	145	+	8 including, but not limited to, ophthalmic lenses, from any
	146	+	9 source owned by, controlled by, or in a common ownership
	147	+	10 scheme with the entity that issued the vision care plan.
	148	+	11 (c) At the request of an enrollee, an eye care provider
	149	+	12 recommending an out-of-network source or supplier of vision
	150	+	13 care materials to an enrollee shall provide written notice to
	151	+	14 the enrollee stating:
	152	+	15 (1) that the source or supplier is an out-of-network
	153	+	16 laboratory or supplier of vision care materials; and
	154	+	17 (2) any business interest that the eye care provider
	155	+	18 has in the out-of-network source or supplier recommended
	156	+	19 to the enrollee.
	157	+	20 (d) An eye care provider is required to offer an enrollee
	158	+	21 in-network sources or suppliers of vision care materials at
	159	+	22 the enrollee's request.
	160	+	23 Section 35. Modification of plan.
	161	+	24 (a) The terms, fees, discounts, or reimbursement rates in
	162	+
	163	+
	164	+
	165	+
	166	+
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	172	+	1 a vision care plan may not be changed during the term of the
	173	+	2 contract unless mutually agreed to in writing by the eye care
	174	+	3 provider and the vision care organization that issued the
	175	+	4 vision care plan. However, a change proposed to a vision care
	176	+	5 plan by the vision care organization shall become effective if
	177	+	6 the eye care provider fails to respond to the vision care
	178	+	7 organization within 60 days after receipt of notice of the
	179	+	8 proposed changes.
	180	+	9 (b) The terms of a vision care plan contract that is
	181	+	10 amended, delivered, issued, or renewed after the effective
	182	+	11 date of this Act shall comply with the provisions of this Act.
	183	+	12 Section 40. Prohibitions; medical plan preconditions.
	184	+	13 (a) No vision care organization that issues, delivers,
	185	+	14 amends, or renews a vision care plan on or after the effective
	186	+	15 date of this Act shall issue a vision care plan contract that
	187	+	16 requires:
	188	+	17 (1) an eye care provider to contract with a plan that
	189	+	18 offers supplemental or specialty health care services as a
	190	+	19 condition of contracting with a plan that offers basic
	191	+	20 health services; or
	192	+	21 (2) an eye care provider to contract with a vision
	193	+	22 care plan as a condition to participation in a medical
	194	+	23 plan or in-network.
	195	+	24 (b) A vision care plan may enter into an agreement with a
	196	+	25 health care plan to deliver routine vision care services that
	197	+
	198	+
	199	+
	200	+
	201	+
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	207	+	1 are covered under the enrollee's plan.
	208	+	2 (c) A vision care plan may act as a network regarding
	209	+	3 routine vision care services offered by a health care plan.
	210	+	4 Section 900. The Consumer Fraud and Deceptive Business
	211	+	5 Practices Act is amended by adding Section 2BBBB as follows:
	212	+	6 (815 ILCS 505/2BBBB new)
	213	+	7 Sec. 2BBBB. Violations of the Vision Care Plan Regulation
	214	+	8 Act. Any person who violates the Vision Care Plan Regulation
	215	+	9 Act commits an unlawful practice within the meaning of this
	216	+	10 Act.
	217	+
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	219	+
	220	+
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