215 Ill. Comp. Stat. § 134/30. Prohibitions: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted Year Enacted: 2000
No health care plan or its subcontractors may prohibit or discourage health care providers by contract or policy from discussing any health care services and health care providers, utilization review and quality assurance policies, terms …
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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 …
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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. § 134/55. Record of complaints: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted Year Enacted: 2000
The Department shall make a summary of all data collected of complaints against health care plans available upon request and publish the summary on the internet. The complaints shall be classified under several categories, including, …
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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 …
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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. § 134/80. Quality assessment program: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted Year Enacted: 2000
A health care plan shall develop and implement a quality assessment and improvement strategy designed to identify and evaluate accessibility, continuity, and quality of care.
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215 Ill. Comp. Stat. § 134/85. Utilization review program registration: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted Year Enacted: 2000
Plans must have utilization review programs filed with the department, and shall comply with these probisions.
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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 …
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215 Ill. Comp. Stat. § 5/356z.17. Wellness coverage: Accident and Health Insurance – Illinois
Status: Enacted Year Enacted: 2010
A group or individual policy of health insurance or managed care plan may offer a reasonably designed program for wellness coverage that allows for a reward, a contribution, a reduction in premiums or reduced copayments, …
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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 …
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215 Ill. Comp. Stat. § 5/356z.21. Tobacco use cessation programs; coverage offer: Accident and Health Insurance –
Status: Year Enacted: 2012
Comprehensive smoking cessation treatment is one of the 3 most important and cost effective preventive services that can be provided in medical practice. The coverage required by this Section shall be subject to other general …
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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 …
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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 …
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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, …
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