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. § 134/5. 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. § 134/72. 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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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. § 170/56. Care coordination: Covering All Kids Health Insurance Act – Illinois
Status: Enacted Year Enacted: 2011
Payment for such coordinated care shall be based on arrangements where the State pays for performance related to health care outcomes, the use of evidence-based practices, the use of primary care delivered through comprehensive medical …
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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. § 5/356r. 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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