SB 2386

Abstract

Amends the Illinois Insurance Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act to provide coverage for prosthetic devices that equals those benefits provided under federal laws for health insurance for the aged and disabled. Provides that a policy or plan may require prior authorization for prosthetic devices in the same manner that prior authorization is required for any other covered benefit. Provides that covered benefits are limited to the most appropriate model that adequately meets the medical needs of the patient as determined by the insured's treating physician. Provides that repairs and replacements of prosthetic devices are also covered, subject to copayments and deductibles, unless necessitated by misuse or loss. Provides that a policy or plan may require that, if coverage is provided through a managed care plan, the benefits mandated pursuant to the provision shall be covered benefits only if the prosthetic devices are provided by a vendor and prosthetic services are render by a provider who contracts with or is designated by the carrier, to the extent that a carrier provides in-network and out-of-network service, the coverage for the prosthetic device shall be offered no less extensively. Effective immediately.