215 Ill. Comp. Stat. § 134/5. Health care patient rights: Managed Care Reform and Patient Rights Act – Illinois
Status: Enacted Year Enacted: 2000
A patient has the right, regardless of source of payment, to examine and to receive a reasonable explanation of his or her total bill for health care services rendered by his or her physician or …
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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. § 5/143.10a. Loss Information: Illinois Insurance Code — Provisions Applicable to All Companies – Illinois
Status: Enacted Year Enacted: 1937
A consistent failure to provide loss information upon request constitutes an unfair trade practice.
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215 Ill. Comp. Stat. § 5/143.31. Uniform medical claim and billing forms: Illinois Insurance Code — Provisions Applicable to All Companies – Illinois
Status: Enacted Year Enacted: 1994
When a health insurer sends an explanation of benefits paid statements or claims summary statements to an insured it shall be in a format and written in a manner that promotes understanding by the insured …
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215 Ill. Comp. Stat. § 5/356a. Form of policy: Accident and Health Insurance – Illinois
Status: Enacted Year Enacted: 1951
No policy of accident or health insurance is allowed to be delivered or issued in Illinois unless the entire money and other consideration are expressed therein and the exceptions and reductions or indemnity are set …
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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.3a. Nonparticipating facility-based physicians and providers: Accident and Health Insurance – Illinois
Status: Enacted Year Enacted: 2011
When a beneficiary, insured, or enrollee utilizes a participating network hospital or a participating network ambulatory surgery center and, due to any reason, in network services for radiology, anesthesiology, pathology, emergency physician, or neonatology are …
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215 Ill. Comp. Stat. §§ 122/5-1 through 122/5-10: Health Benefits Exchange Law – Illinois
Status: Enacted Year Enacted: 2011
Statutes creating Illinois Affordable Care Act exchange marketplace.
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215 Ill. Comp. Stat. §§ 124/1 through 124/25: Network Adequacy and Transparency Act – Illinois
Status: Enacted Year Enacted: 2017
Statutes prohibit an insurer from prohibiting a preferred provider from discussing any specific or all treatment options with beneficiaries or from advocating on behalf of beneficiaries within utilization review. If the insurer does not have …
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215 Ill. Comp. Stat. §§ 125/4-10 through 125/4-20: Health Maintenance Organization Act — Delivery of Services – Required Provisions and Marketing – Illinois
Status: Enacted Year Enacted: 1987
Statutes lay out indepenent review process for what constitutes “medically necessary” for a certain patient. Statutes require a health maintenance organization to file with the Director, prior to use, a notice of any change in …
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215 Ill. Comp. Stat. §§ 180/1 through 180/42: Health Carrier External Review Act – Illinois
Status: Enacted Year Enacted: 2010
The Health Carrier External Review Act’s purpose is to provide uniform standards for the establishment and maintenance of external review procedures. Statutes set out timeline and process for a standard review.
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