Public Act 92-0770      

HB4220 Enrolled                               LRB9211444JSpcA

    AN ACT concerning insurance.

    Be it enacted by the People of  the  State  of  Illinois,

represented in the General Assembly:

    Section  5.  The  Managed  Care Reform and Patient Rights

Act is amended by changing Section 30 as follows:

    (215 ILCS 134/30)

    Sec. 30.  Prohibitions.

    (a)  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 and conditions of plans and plan policy with

enrollees, prospective enrollees, providers, or the public.

    (b)  No health care plan by contract, written policy,  or

procedure  may  permit  or  allow  an individual or entity to

dispense a different drug in place of the drug  or  brand  of

drug  ordered or prescribed without the express permission of

the person  ordering  or  prescribing  the  drug,  except  as

provided  under  Section  3.14 of the Illinois Food, Drug and

Cosmetic Act.

    (c)  No health care plan or  its  subcontractors  may  by

contract,  written policy, procedure, or otherwise mandate or

require an enrollee to substitute his  or  her  participating

primary  care  physician  under  the  plan  during  inpatient

hospitalization  without  the  agreement  of  that enrollee's

participating primary care physician.  "Participating primary

care physician" for health care plans and subcontractors that

do not  require  coordination  of  care  by  a  primary  care

physician  means  the  participating  physician  treating the

patient.  All health care plans shall inform enrollees of any

policies,  recommendations,  or  guidelines  concerning   the

substitution  of  the  enrollee's primary care physician when

hospitalization is necessary  in  the  manner  set  forth  in

subsections (d) and (e) of Section 15.

    (d) (c)  Any  violation  of this Section shall be subject

to the penalties under this Act.

(Source: P.A. 91-617, eff. 1-1-00.)

    Passed in the General Assembly May 29, 2002.

    Approved August 06, 2002.