Illinois Compiled Statutes 215 ILCS 5/355.4 – Provider notification of network plan changes
Current as of: 2024 | Check for updates
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(a) As used in this Section:
“Contracting entity” means any person or company that enters into direct contracts with providers for the delivery of dental services in the ordinary course of business, including a third-party administrator and a dental carrier.
“Dental carrier” means a dental insurance company, dental service corporation, dental plan organization authorized to provide dental benefits, or a health insurance plan that includes coverage for dental services.
(b) No dental carrier may automatically enroll a provider in a leased network without allowing any provider that is part of the dental carrier’s provider network to choose to not participate by opting out.
(c) Any contract entered into or renewed on or after the effective date of this amendatory Act of the 103rd General Assembly that allows the rights and obligations of the contract to be assigned or leased to another insurer shall provide for notice that informs each provider in writing via certified mail 60 days before any scheduled assignment or lease of the network to which the provider is a contracted provider. To be in compliance with this Section, the notification must include all contract terms, a policy manual, a fee schedule, and a statement that the provider has the right to choose not to participate in third-party access.
(d) A dental carrier that leases or assigns its network shall not cancel a network participating dentist’s contractual relationship or otherwise penalize a network participating dentist in any way based on whether or not the dentist accepts the terms of the assignment or lease. Before accepting the terms of an assignment or lease agreement as described in this Section, any provider who receives notification of an impending assignment or lease must be given the option to contract directly with the entities proposing to gain access to the provider’s network.
(e) The provisions of this Section do not apply:
(1) if access to a provider network contract is
“Contracting entity” means any person or company that enters into direct contracts with providers for the delivery of dental services in the ordinary course of business, including a third-party administrator and a dental carrier.
Terms Used In Illinois Compiled Statutes 215 ILCS 5/355.4
- Contract: A legal written agreement that becomes binding when signed.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
- State: when applied to different parts of the United States, may be construed to include the District of Columbia and the several territories, and the words "United States" may be construed to include the said district and territories. See Illinois Compiled Statutes 5 ILCS 70/1.14
“Dental carrier” means a dental insurance company, dental service corporation, dental plan organization authorized to provide dental benefits, or a health insurance plan that includes coverage for dental services.
(b) No dental carrier may automatically enroll a provider in a leased network without allowing any provider that is part of the dental carrier’s provider network to choose to not participate by opting out.
(c) Any contract entered into or renewed on or after the effective date of this amendatory Act of the 103rd General Assembly that allows the rights and obligations of the contract to be assigned or leased to another insurer shall provide for notice that informs each provider in writing via certified mail 60 days before any scheduled assignment or lease of the network to which the provider is a contracted provider. To be in compliance with this Section, the notification must include all contract terms, a policy manual, a fee schedule, and a statement that the provider has the right to choose not to participate in third-party access.
(d) A dental carrier that leases or assigns its network shall not cancel a network participating dentist’s contractual relationship or otherwise penalize a network participating dentist in any way based on whether or not the dentist accepts the terms of the assignment or lease. Before accepting the terms of an assignment or lease agreement as described in this Section, any provider who receives notification of an impending assignment or lease must be given the option to contract directly with the entities proposing to gain access to the provider’s network.
(e) The provisions of this Section do not apply:
(1) if access to a provider network contract is
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granted to a dental carrier or an entity operating in accordance with the same brand licensee program as the contracting entity; or
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(2) to a provider network contract for dental
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services provided to beneficiaries of the State employee group health insurance program or the medical assistance program under the Illinois Public Aid Code.
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