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210 Ill. Comp. Stat. §§ 89/1 through 89/25: Hospital Uninsured Patient Discount Act – Illinois
Status: Enacted     Year Enacted: 2008
For all health care services exceeding $300 in any one inpatient admission or outpatient encounter, a hospital shall not collect from an uninsured patient, deemed eligible under subsection (a), more than its charges less the …
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215 Ill. Comp. Stat. § 105/15. Alternative portable coverage for federally eligible individuals: Comprehensive Health Insurance Plan Act – Illinois
Status: Enacted     Year Enacted: 1997
Statute governs portability provisions of comprehensive health insurance plan and requires that the coverages offered under this statute, the schedule of benefits, deductibles, co-payments, exclusions and other limitations be approved by the board.The board is …
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215 Ill. Comp. Stat. § 125/1-2. Definitions: Health Maintenance Organization Act – Illinois
Status: Enacted     Year Enacted: 1974
Definitions for the Health Maintenance Organization Act.
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215 Ill. Comp. Stat. § 125/4-10. Medical necessity; dispute resolution; independent second opinion: Health Maintenance Organization Act – Illinois
Status: Enacted     Year Enacted: 1987
There is an indepenent review process for what constitutes “medically necessary“ for a certain patient.
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215 Ill. Comp. Stat. § 125/4.5-1. Point-of-service health service contracts: Health Maintenance Organization Act – Illinois
Status: Enacted     Year Enacted: 2002
HMOs may offer point-of-service contracts must abide by these limitations, including that the contract must include as in-plan covered services all services required by law to be provided by a health maintenance organization; must provide …
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215 Ill. Comp. Stat. § 125/5-7. Rules and regulations to carry out provisions of Act: General Provisions– Health Maintenance Organization Act – Illinois
Status: Enacted     Year Enacted: 1974
Statute allows Director to promulgate reasonable rules and regulations that are necessary and proper to establish specific standards including full and fair disclosure of health care services provided by group contracts or evidences of coverage …
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215 Ill. Comp. Stat. § 130/1002. Definitions: Limited Health Service Organization Act – Illinois
Status: Enacted     Year Enacted: 1989
Statute includes definitions relevant to the Limited Health Service Organization Act including a definition of per capita prepayment for providers.
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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.
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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 …
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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 …
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215 Ill. Comp. Stat. § 134/40. Access to specialists: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted     Year Enacted: 2000
A health care plan shall establish a procedure by which an enrollee who has a condition that requires ongoing care from a specialist physician or other health care provider may apply for a standing referral …
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215 Ill. Comp. Stat. § 134/45.1. Medical exceptions procedures required: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted     Year Enacted: 2014
Notwithstanding any other provision of law, on or after the effective date of this amendatory Act of the 99th General Assembly, every insurer licensed in this State to sell a policy of group or individual …
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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. …
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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 …
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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 …
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215 Ill. Comp. Stat. § 134/72. Pharmacy providers: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted     Year Enacted: 2000
A health care plan shall apply the same co-insurance, copayment, and deductible factors to all drug prescriptions filled by a pharmacy provider that participates in the health care plan’s network. A health care plan may …
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