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210 Ill. Comp. Stat. §§ 88/1 through 88/55: Fair Patient Billing Act – Illinois
Status:
Enacted Year Enacted: 2007
The purpose of this act is to advance the prompt and accurate payment of health care services through fair and reasonable billing and collection practices of hospitals. Statutes require a hospital to provide specified information …
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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. § 125/2-8. Provider agreements: Health Maintenance Organization Act – Illinois
Status:
Enacted Year Enacted: 1987
HMO Provider agreements must include a hold-harmless clause. All HMO providers shall participate in the quality assurance program.
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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. § 125/4-12. Changes in Rate Methodology and Benefits, Material Modifications: Health Maintenance Organization Act – Illinois
Status:
Enacted Year Enacted: 1989
A health maintenance organization shall file with the Director, prior to use, a notice of any change in rate methodology, or benefits and of any material modification of any matter or document furnished pursuant to …
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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. § 125/5-3. Insurance Code provisions: Health Maintenance Organization Act — General Provisions – Illinois
Status:
Enacted Year Enacted: 1987
Statute requires the Director to give primary consideration to the continuation of benefits to enrollees and financial conditions of the acquired HMO when considering the merger, consolidation or other acquisition of control. The Director does …
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215 Ill. Comp. Stat. § 125/5-3.6. Managed Care Reform and Patient Rights Act: Health Maintenance Organization Act – Illinois
Status:
Enacted Year Enacted: 2000
HMOs are subject to the provisions of the Managed Care Reform and Patient Rights Act.
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215 Ill. Comp. Stat. § 125/5-4. Examination of affairs and quality of services by the Director; books and records: Health Maintenance Organization Act – Illinois
Status:
Enacted Year Enacted: 1974
The Director of Public Health shall make an examination concerning the quality of health care services of any health maintenance organization and providers with whom the organization has contracts, agreements, or other arrangements pursuant to …
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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. § 130/2008. Provider Contracts: Limited Health Service Organization Act – Illinois
Status:
Enacted Year Enacted: 1989
All contracts with providers shall contain a clause that prohibits the provider from seeking payment from an enrollee for services provided if the limited health service organization does not pay for the services or becomes …
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215 Ill. Comp. Stat. § 130/3006. Changes in rate methodology and benefits; material modifications; addition of limited health services: Limited Health Service Organization Act – Illinois
Status:
Enacted Year Enacted: 1989
Statute requires that limited health service organizations file with the Director prior to use a notice of any change in rate methodology, charges or benefits.
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215 Ill. Comp. Stat. § 130/3008. Evidence of coverage: Limited Health Service Organization Act – Illinois
Status:
Enacted Year Enacted: 1989
Every subscriber of a limited health service organization shall be issued an evidence of coverage, which must contain a clear and complete statement of any limitation of the services or benefits to be provided, and …
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