20 Ill. Comp. Stat. § 505/5.45. Managed care plan services: Children and Family Services Act – Illinois
Status: Enacted Year Enacted: 2018
Statute regulates Medicaid managed care organizations and plans that cover children. Statute requires managed care organizations to post certain information on its website, including defined prior authorization requirements. Prior to transitioning a child to managed …
Download
215 Ill. Comp. Stat. § 134/10. Definitions: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted Year Enacted: 2000
Definitions for the Managed Care Reform and Patient Rights Act.
Download
215 Ill. Comp. Stat. § 134/15. Provision of information: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted Year Enacted: 2000
A health care plan shall provide annually to enrollees and prospective enrollees, upon request, a complete list of participating health care providers in the health care plan’s service area and a description of the following …
Download
215 Ill. Comp. Stat. § 134/25. Transition of services: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted Year Enacted: 2000
Statute allows an enrollee to continue using a provider that moves out-of-network, but the physician must agree to accept reimbursement from the health care plan at rates established by the health care plan, the physician …
Download
215 Ill. Comp. Stat. § 134/43. Utilization of health care facilities: Managed Care and Patients Rights Act – Illinois
Status: Enacted Year Enacted: 2003
A health care plan must provide its enrollees with a description of their rights and responsibilities in obtaining referrals to and making appropriate use of health care facilities when access to their primary care physician …
Download
215 Ill. Comp. Stat. § 134/45.2. Prior authorization form; prescription benefits: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted Year Enacted: 2014
A health insurer that provides prescription drug benefits must, within 72 hours after receipt of a paper or electronic prior authorization form from a prescribing provider or pharmacist, either approve or deny the prior authorization. …
Download
215 Ill. Comp. Stat. § 134/60. Choosing a physician: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted Year Enacted: 2000
Statute governs how an enrollee may access specialist physicians. The Director and Department of Public Health may promulgate rules to ensure appropriate access to and quality of care for enrollees in any plan that allows …
Download
215 Ill. Comp. Stat. § 134/65. Emergency services prior to stabilization: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted Year Enacted: 2000
A health care plan that provides or that is required by law to provide coverage for emergency services shall provide coverage such that payment under this coverage is not dependent upon whether the services are …
Download
215 Ill. Comp. Stat. § 134/70. Post-stabilization medical services: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted Year Enacted: 2000
If prior authorization for covered post-stabilization services is required by the health care plan, the plan shall provide access 24 hours a day, 7 days a week to persons designated by the plan to make …
Download
215 Ill. Comp. Stat. § 5/356r. Woman’s principal health care provider: Accident and Health Insurance – Illinois
Status: Enacted Year Enacted: 1997
Women shall have the right to select a female principal health provider. If a female insured or enrollee has designated a woman’s principal health care provider, then the insured or enrollee must be given direct …
Download
215 Ill. Comp. Stat. § 5/356z.18. Prosthetic and customized orthotic devices: Accident and Health Insurance – Illinois
Status: Enacted Year Enacted: 2010
Expenses incurred in obtaining a prosthetic or custom orthotic device shall be a covered benefit. The policy or plan or contract may require prior authorization for the prosthetic or orthotic devices in the same manner …
Download
215 Ill. Comp. Stat. § 5/356z.4. Coverage for contraceptives: Accident and Health Insurance – Illinois
Status: Enacted Year Enacted: 2004
The General Assembly hereby finds and declares medical management techniques such as denials, step therapy, or prior authorization in public and private health care coverage can impede access to the most effective contraceptive methods. All …
Download
215 Ill. Comp. Stat. § 5/370c. Mental and emotional disorders: Accident and Health Insurance – Illinois
Status: Enacted Year Enacted: 1977
Plans shall shall provide coverage based upon medical necessity for the treatment of a mental, emotional, nervous, or substance use disorder or condition in parity with physical treatments. Plans shall not impose additional prior authorization …
Download
215 Ill. Comp. Stat. § 5/370c.1. Mental, emotional, nervous, or substance use disorder or condition parity: Accident and Health Insurance – Illinois
Status: Enacted Year Enacted: 2011
Every insurer providing coverage for hospital or medical treatment and for the treatment of mental, emotional, nervous, or substance use disorders or conditions shall ensure that the financial requirements applicable to such mental, emotional, nervous, …
Download
215 Ill. Comp. Stat. §§ 105/1 through 105/8: Comprehensive Health Insurance Plan Act – Illinois
Status: Enacted Year Enacted: 1987
Statutes create a board to supervise and control the Illinois Comprehensive Health Insurance Plan, the board may provide for and employ cost containment measures and requirements including utilization programs. The board has authority to establish …
Download
215 Ill. Comp. Stat. §§ 170/47 through 170/52: Covering All Kids Health Insurance Act – Illinois
Status: Enacted Year Enacted: 2006
The Department shall report information on the number of professionals serving in the primary care management program and the number of non-primary care providers accepting referrals for counties with a population of 100,000 or greater. …
Download