104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026 SB1346 Introduced 1/28/2025, by Sen. Laura Fine SYNOPSIS AS INTRODUCED: 215 ILCS 134/15215 ILCS 134/90215 ILCS 139/15 Amends the Managed Care Reform and Patient Rights Act. Provides that a health care plan shall provide annually to enrollees and prospective enrollees, upon request, a statement of all basic health care services and all specific benefits and services mandated to be provided to enrollees by State law or administrative rule, highlighting any newly enacted State law or administrative rule. Provides that this requirement can be fulfilled by providing enrollees the most up-to-date accident and health checklist submitted to the Department of Insurance, reflecting statutory health care coverage compliance by the health care plan. Requires the Office of Consumer Health Insurance to post in a prominent location on the Department's publicly accessible website an annual report on the development and implementation of federal, State, and local laws, regulations, and other governmental policies and actions that pertain to the adequacy of health care plans, facilities, and services in the State and summary of all State health insurance benefit related legislation enacted in the prior calendar year that includes, at minimum, a link to the Public Act, the statutory citation, the subject, a brief summary, and the effective date. Amends the Uniform Health Care Services Benefit Information Card Act. Adds a health benefit plan offering dental coverage to the list of plans required to issue a health care benefit information card. Specifies health care benefit information cards may be electronic or physical. Requires uniform health care benefit information to display on the back of the card a statement indicating whether the plan is self-insured or fully funded and if the plan is subject to regulation by the Department of Insurance. Makes other changes. LRB104 07692 BAB 17736 b A BILL FOR 104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026 SB1346 Introduced 1/28/2025, by Sen. Laura Fine SYNOPSIS AS INTRODUCED: 215 ILCS 134/15215 ILCS 134/90215 ILCS 139/15 215 ILCS 134/15 215 ILCS 134/90 215 ILCS 139/15 Amends the Managed Care Reform and Patient Rights Act. Provides that a health care plan shall provide annually to enrollees and prospective enrollees, upon request, a statement of all basic health care services and all specific benefits and services mandated to be provided to enrollees by State law or administrative rule, highlighting any newly enacted State law or administrative rule. Provides that this requirement can be fulfilled by providing enrollees the most up-to-date accident and health checklist submitted to the Department of Insurance, reflecting statutory health care coverage compliance by the health care plan. Requires the Office of Consumer Health Insurance to post in a prominent location on the Department's publicly accessible website an annual report on the development and implementation of federal, State, and local laws, regulations, and other governmental policies and actions that pertain to the adequacy of health care plans, facilities, and services in the State and summary of all State health insurance benefit related legislation enacted in the prior calendar year that includes, at minimum, a link to the Public Act, the statutory citation, the subject, a brief summary, and the effective date. Amends the Uniform Health Care Services Benefit Information Card Act. Adds a health benefit plan offering dental coverage to the list of plans required to issue a health care benefit information card. Specifies health care benefit information cards may be electronic or physical. Requires uniform health care benefit information to display on the back of the card a statement indicating whether the plan is self-insured or fully funded and if the plan is subject to regulation by the Department of Insurance. Makes other changes. LRB104 07692 BAB 17736 b LRB104 07692 BAB 17736 b A BILL FOR
104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026 SB1346 Introduced 1/28/2025, by Sen. Laura Fine SYNOPSIS AS INTRODUCED:
215 ILCS 134/15215 ILCS 134/90215 ILCS 139/15 215 ILCS 134/15 215 ILCS 134/90 215 ILCS 139/15
215 ILCS 134/15
215 ILCS 134/90
215 ILCS 139/15
Amends the Managed Care Reform and Patient Rights Act. Provides that a health care plan shall provide annually to enrollees and prospective enrollees, upon request, a statement of all basic health care services and all specific benefits and services mandated to be provided to enrollees by State law or administrative rule, highlighting any newly enacted State law or administrative rule. Provides that this requirement can be fulfilled by providing enrollees the most up-to-date accident and health checklist submitted to the Department of Insurance, reflecting statutory health care coverage compliance by the health care plan. Requires the Office of Consumer Health Insurance to post in a prominent location on the Department's publicly accessible website an annual report on the development and implementation of federal, State, and local laws, regulations, and other governmental policies and actions that pertain to the adequacy of health care plans, facilities, and services in the State and summary of all State health insurance benefit related legislation enacted in the prior calendar year that includes, at minimum, a link to the Public Act, the statutory citation, the subject, a brief summary, and the effective date. Amends the Uniform Health Care Services Benefit Information Card Act. Adds a health benefit plan offering dental coverage to the list of plans required to issue a health care benefit information card. Specifies health care benefit information cards may be electronic or physical. Requires uniform health care benefit information to display on the back of the card a statement indicating whether the plan is self-insured or fully funded and if the plan is subject to regulation by the Department of Insurance. Makes other changes.
LRB104 07692 BAB 17736 b LRB104 07692 BAB 17736 b
LRB104 07692 BAB 17736 b
A BILL FOR
SB1346LRB104 07692 BAB 17736 b SB1346 LRB104 07692 BAB 17736 b
SB1346 LRB104 07692 BAB 17736 b
1 AN ACT concerning regulation.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Managed Care Reform and Patient Rights Act
5 is amended by changing Sections 15 and 90 as follows:
6 (215 ILCS 134/15)
7 Sec. 15. Provision of information.
8 (a) A health care plan shall provide annually to enrollees
9 and prospective enrollees, upon request, a complete list of
10 participating health care providers in the health care plan's
11 service area and a description of the following terms of
12 coverage:
13 (1) the service area;
14 (2) the covered benefits and services with all
15 exclusions, exceptions, and limitations;
16 (3) the pre-certification and other utilization review
17 procedures and requirements;
18 (4) a description of the process for the selection of
19 a primary care physician, any limitation on access to
20 specialists, and the plan's standing referral policy;
21 (5) the emergency coverage and benefits, including any
22 restrictions on emergency care services;
23 (6) the out-of-area coverage and benefits, if any;
104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026 SB1346 Introduced 1/28/2025, by Sen. Laura Fine SYNOPSIS AS INTRODUCED:
215 ILCS 134/15215 ILCS 134/90215 ILCS 139/15 215 ILCS 134/15 215 ILCS 134/90 215 ILCS 139/15
215 ILCS 134/15
215 ILCS 134/90
215 ILCS 139/15
Amends the Managed Care Reform and Patient Rights Act. Provides that a health care plan shall provide annually to enrollees and prospective enrollees, upon request, a statement of all basic health care services and all specific benefits and services mandated to be provided to enrollees by State law or administrative rule, highlighting any newly enacted State law or administrative rule. Provides that this requirement can be fulfilled by providing enrollees the most up-to-date accident and health checklist submitted to the Department of Insurance, reflecting statutory health care coverage compliance by the health care plan. Requires the Office of Consumer Health Insurance to post in a prominent location on the Department's publicly accessible website an annual report on the development and implementation of federal, State, and local laws, regulations, and other governmental policies and actions that pertain to the adequacy of health care plans, facilities, and services in the State and summary of all State health insurance benefit related legislation enacted in the prior calendar year that includes, at minimum, a link to the Public Act, the statutory citation, the subject, a brief summary, and the effective date. Amends the Uniform Health Care Services Benefit Information Card Act. Adds a health benefit plan offering dental coverage to the list of plans required to issue a health care benefit information card. Specifies health care benefit information cards may be electronic or physical. Requires uniform health care benefit information to display on the back of the card a statement indicating whether the plan is self-insured or fully funded and if the plan is subject to regulation by the Department of Insurance. Makes other changes.
LRB104 07692 BAB 17736 b LRB104 07692 BAB 17736 b
LRB104 07692 BAB 17736 b
A BILL FOR
215 ILCS 134/15
215 ILCS 134/90
215 ILCS 139/15
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1 (7) the enrollee's financial responsibility for
2 copayments, deductibles, premiums, and any other
3 out-of-pocket expenses;
4 (8) the provisions for continuity of treatment in the
5 event a health care provider's participation terminates
6 during the course of an enrollee's treatment by that
7 provider;
8 (9) the appeals process, forms, and time frames for
9 health care services appeals, complaints, and external
10 independent reviews, administrative complaints, and
11 utilization review complaints, including a phone number to
12 call to receive more information from the health care plan
13 concerning the appeals process; and
14 (10) a statement of all basic health care services and
15 all specific benefits and services mandated to be provided
16 to enrollees by any State law or administrative rule,
17 highlighting any newly enacted State law or administrative
18 rule, must be provided annually to enrollees. This
19 requirement can be fulfilled by providing enrollees the
20 most up-to-date accident and health checklist submitted to
21 the Department, reflecting statutory health care coverage
22 compliance by the health care plan.
23 (a-5) Without limiting the generality of subsection (a) of
24 this Section, no qualified health plans shall be offered for
25 sale directly to consumers through the health insurance
26 marketplace operating in the State in accordance with Sections
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1 1311 and 1321 of the federal Patient Protection and Affordable
2 Care Act (Public Law 111-148), as amended by the federal
3 Health Care and Education Reconciliation Act of 2010 (Public
4 Law 111-152), and any amendments thereto, or regulations or
5 guidance issued thereunder (collectively, "the Federal Act"),
6 unless, in addition to the information required under
7 subsection (a) of this Section, the following information is
8 available to the consumer at the time he or she is comparing
9 health care plans and their premiums:
10 (1) With respect to prescription drug benefits, the
11 most recently published formulary where a consumer can
12 view in one location covered prescription drugs;
13 information on tiering and the cost-sharing structure for
14 each tier; and information about how a consumer can obtain
15 specific copayment amounts or coinsurance percentages for
16 a specific qualified health plan before enrolling in that
17 plan. This information shall clearly identify the
18 qualified health plan to which it applies.
19 (2) The most recently published provider directory
20 where a consumer can view the provider network that
21 applies to each qualified health plan and information
22 about each provider, including location, contact
23 information, specialty, medical group, if any, any
24 institutional affiliation, and whether the provider is
25 accepting new patients. The information shall clearly
26 identify the qualified health plan to which it applies.
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1 In the event of an inconsistency between any separate
2 written disclosure statement and the enrollee contract or
3 certificate, the terms of the enrollee contract or certificate
4 shall control.
5 (b) Upon written request, a health care plan shall provide
6 to enrollees a description of the financial relationships
7 between the health care plan and any health care provider and,
8 if requested, the percentage of copayments, deductibles, and
9 total premiums spent on healthcare related expenses and the
10 percentage of copayments, deductibles, and total premiums
11 spent on other expenses, including administrative expenses,
12 except that no health care plan shall be required to disclose
13 specific provider reimbursement.
14 (c) A participating health care provider shall provide all
15 of the following, where applicable, to enrollees upon request:
16 (1) Information related to the health care provider's
17 educational background, experience, training, specialty,
18 and board certification, if applicable.
19 (2) The names of licensed facilities on the provider
20 panel where the health care provider presently has
21 privileges for the treatment, illness, or procedure that
22 is the subject of the request.
23 (3) Information regarding the health care provider's
24 participation in continuing education programs and
25 compliance with any licensure, certification, or
26 registration requirements, if applicable.
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1 (d) A health care plan shall provide the information
2 required to be disclosed under this Act upon enrollment and
3 annually thereafter in a legible and understandable format.
4 The Department shall promulgate rules to establish the format
5 based, to the extent practical, on the standards developed for
6 supplemental insurance coverage under Title XVIII of the
7 federal Social Security Act as a guide, so that a person can
8 compare the attributes of the various health care plans.
9 (e) The written disclosure requirements of this Section
10 may be met by disclosure to one enrollee in a household.
11 (f) Each issuer of qualified health plans for sale
12 directly to consumers through the health insurance marketplace
13 operating in the State shall make the information described in
14 subsection (a) of this Section, for each qualified health plan
15 that it offers, available and accessible to the general public
16 on the company's Internet website and through other means for
17 individuals without access to the Internet.
18 (g) The Department shall ensure that State-operated
19 Internet websites, in addition to the Internet website for the
20 health insurance marketplace established in this State in
21 accordance with the Federal Act and its implementing
22 regulations, prominently provide links to Internet-based
23 materials and tools to help consumers be informed purchasers
24 of health care plans.
25 (h) Nothing in this Section shall be interpreted or
26 implemented in a manner not consistent with the Federal Act.
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1 This Section shall apply to all qualified health plans offered
2 for sale directly to consumers through the health insurance
3 marketplace operating in this State for any coverage year
4 beginning on or after January 1, 2015.
5 (Source: P.A. 103-154, eff. 6-30-23.)
6 (215 ILCS 134/90)
7 Sec. 90. Office of Consumer Health Insurance.
8 (a) The Director of Insurance shall establish the Office
9 of Consumer Health Insurance within the Department of
10 Insurance to provide assistance and information to all health
11 care consumers within the State. Within the appropriation
12 allocated, the Office shall provide information and assistance
13 to all health care consumers by:
14 (1) assisting consumers in understanding health
15 insurance marketing materials and the coverage provisions
16 of individual plans;
17 (2) educating enrollees about their rights within
18 individual plans;
19 (3) assisting enrollees with the process of filing
20 formal grievances and appeals;
21 (4) establishing and operating a toll-free "800"
22 telephone number line to handle consumer inquiries;
23 (5) making related information available in languages
24 other than English that are spoken as a primary language
25 by a significant portion of the State's population, as
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1 determined by the Department;
2 (6) analyzing, commenting on, monitoring, and making
3 publicly available an annual report, posted in a prominent
4 location on the Department's publicly accessible website,
5 reports on the development and implementation of federal,
6 State, and local laws, regulations, and other governmental
7 policies and actions that pertain to the adequacy of
8 health care plans, facilities, and services in the State
9 and summary of all State health insurance benefit related
10 legislation enacted in the prior calendar year that
11 includes, at minimum, a link to the Public Act, the
12 statutory citation, the subject, a brief summary, and the
13 effective date;
14 (7) filing an annual report with the Governor, the
15 Director, and the General Assembly, which shall contain
16 recommendations for improvement of the regulation of
17 health insurance plans, including recommendations on
18 improving health care consumer assistance and patterns,
19 abuses, and progress that it has identified from its
20 interaction with health care consumers; and
21 (8) performing all duties assigned to the Office by
22 the Director.
23 (a-5) The report required under paragraph (6) of
24 subsection (a) shall be posted by January 31, 2026 and each
25 January 31 thereafter on the Department's publicly accessible
26 website.
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1 (b) The report required under paragraph (7) of subsection
2 (a) subsection (a)(7) shall be filed and posted by January 31,
3 2026 January 31, 2001 and each January 31 thereafter on the
4 Department's publicly accessible website.
5 (c) Nothing in this Section shall be interpreted to
6 authorize access to or disclosure of individual patient or
7 health care professional or provider records.
8 (Source: P.A. 91-617, eff. 1-1-00.)
9 Section 10. The Uniform Health Care Service Benefits
10 Information Card Act is amended by changing Section 15 as
11 follows:
12 (215 ILCS 139/15)
13 Sec. 15. Uniform health care benefit information cards
14 required.
15 (a) A health benefit plan, health benefit plan offering
16 dental coverage, or a dental plan that issues a physical or
17 electronic card or other technology and provides coverage for
18 health care services including prescription drugs or devices
19 also referred to as health care benefits and an administrator
20 of such a plan including, but not limited to, third-party
21 administrators for self-insured plans and state-administered
22 plans shall issue to its insureds a card or other technology
23 containing uniform health care benefit information. The health
24 care benefit information physical card, electronic card, and
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1 or other technology shall specifically identify and display
2 the following mandatory data elements on the physical and
3 electronic cards card:
4 (1) processor control number, if required for claims
5 adjudication;
6 (2) group number;
7 (3) card issuer identifier;
8 (4) cardholder ID number;
9 (5) (blank); except for dental plans, the regulatory
10 entity that holds authority over the plan; for the purpose
11 of this requirement, the Department of Healthcare and
12 Family Services is the regulatory entity that holds
13 authority over plans that the Department of Healthcare and
14 Family Services has contracted with to provide services
15 under the medical assistance program;
16 (6) except for dental plans, any deductible applicable
17 to the plan;
18 (7) except for dental plans, any out-of-pocket maximum
19 limitation applicable to the plan;
20 (8) a toll-free telephone number and Internet website
21 address through which the cardholder may seek consumer
22 assistance information, such as up-to-date lists of
23 preferred providers, including health care professionals,
24 hospitals, and other facilities, offices, or sites that
25 are contracted to furnish items or services under the
26 plan, and additional information about the plan; and
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1 (9) cardholder name.
2 (b) The uniform health care benefit information physical
3 card, electronic card, and or other technology shall
4 specifically identify and display the following mandatory data
5 elements on the back of the card:
6 (1) claims submission names and addresses; and
7 (2) help desk telephone numbers and names; and .
8 (3) (b-5) A uniform health care benefit information
9 card or other technology for a health benefit plan
10 offering dental coverage or dental plan shall include a
11 statement indicating whether the health benefit plan
12 offering dental coverage or dental plan is self-insured or
13 fully funded and if the plan is subject to regulation by
14 the Department of Insurance. For the purpose of this
15 requirement, the Department of Healthcare and Family
16 Services is the regulatory entity that holds authority
17 over plans that the Department of Healthcare and Family
18 Services has contracted with to provide services under the
19 medical assistance program.
20 (c) A new uniform health care benefit information physical
21 card, electronic card, and or other technology shall be issued
22 by a health benefit plan or dental plan upon enrollment and
23 reissued upon any change in the insured's coverage that
24 affects mandatory data elements contained on the card.
25 (d) Notwithstanding subsections (a), (b), and (c) of this
26 Section, a discounted health care services plan administrator
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1 shall issue to its beneficiaries a card containing the
2 following mandatory data elements:
3 (1) an Internet website for beneficiaries to access
4 up-to-date lists of preferred providers;
5 (2) a toll-free help desk number for beneficiaries and
6 providers to access up-to-date lists of preferred
7 providers and additional information about the discounted
8 health care services plan;
9 (3) the name or logo of the provider network;
10 (4) a group number, if necessary for the processing of
11 benefits;
12 (5) a cardholder ID number;
13 (6) the cardholder's name or a space to permit the
14 cardholder to print his or her name, if the cardholder
15 pays a periodic charge for use of the card;
16 (7) a processor control number, if required for claims
17 adjudication; and
18 (8) a statement that the plan is not insurance.
19 (e) As used in this Section, "discounted health care
20 services plan administrator" means any person, partnership, or
21 corporation, other than an insurer, health service
22 corporation, limited health service organization holding a
23 certificate of authority under the Limited Health Service
24 Organization Act, or health maintenance organization holding a
25 certificate of authority under the Health Maintenance
26 Organization Act that arranges, contracts with, or administers
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