215 ILCS 109/1
Short title
Short title. This Act may be cited as the Dental Care Patient Protection Act. (Source: P.A. 91-355, eff. 1-1-00.)
Illinois Compiled Statutes 215 ILCS 109 — Dental Care Patient Protection Act.
Illinois · statute · 215 ILCS 109 · 16 active provisions
215 ILCS 109/5
Purpose; dental care patient rights
Purpose; dental care patient rights. (a) The purpose of this Act is to provide fairness and choice to dental patients and dentists under managed care dental benefit plans. (b) Dental care patients have the following rights: (1) A patient has the right to care consistent with professional standards of practice to assure…
215 ILCS 109/10
Definitions
Definitions. As used in this Act: "Dental care services" means services permitted to be performed by a licensed dentist or any person working under the dentist's supervision as permitted by law. "Dentist" means a person licensed to practice dentistry in any state. "Department" means the Department of Insurance. "Direct…
215 ILCS 109/15
Rules
Rules. The Department may promulgate such rules as it deems reasonably necessary to implement the terms of this Act. The Department shall establish an advisory committee made up of representatives from the dental profession to provide clinical advice and counsel to the Department regarding dental managed care issues fo…
215 ILCS 109/25
Provision of information
Provision of information. (a) A managed care dental plan shall provide upon request to prospective enrollees a written summary description of all of the following terms of coverage: (1) Information about the dental plan, including how the plan operates and what general types of financial arrangements exist between dent…
215 ILCS 109/35
Credentialing; utilization review; provider input
Credentialing; utilization review; provider input. (a) Participating dentists shall be given an opportunity to comment on the plan's policies affecting their services to include the plan's dental policy, including coverage of a new technology and procedures, utilization review criteria and procedures, quality and crede…
215 ILCS 109/40
Coverage; prior authorization
Coverage; prior authorization. A managed care dental plan shall: (1) cover palliative treatment for emergency dental services, as included in its certificate of coverage, without regard to whether the provider furnishing the services has a contractual or other arrangement with the entity to provide items or services to…
215 ILCS 109/45
Prior authorization; consent forms
Prior authorization; consent forms. A plan for which prior authorization is a condition to coverage of a service must clearly disclose this provision in the evidence of coverage. (Source: P.A. 91-355, eff. 1-1-00.)
215 ILCS 109/50
Point-of-service plans
Point-of-service plans. (a) If an employer who has 25 or more employees and contributes 25% or more to the cost of the dental benefit plan coverage to employees and the only dental plan coverage being offered requires enrollees to select a primary care provider (dentist) and has no out-of-plan covered services option,…
215 ILCS 109/55
Private cause of action; existing remedies
Private cause of action; existing remedies. This Act and rules adopted under this Act do not: (1) provide a private cause of action for damages or create a standard of care, obligation, or duty that provides a basis for a private cause of action for damages; or (2) abrogate a statutory or common law cause of action, ad…
215 ILCS 109/60
Record of complaints
Record of complaints. (a) The Department shall maintain records concerning the complaints filed against the plan with the Department. The Department shall make a summary of all data collected available upon request and publish the summary on the World Wide Web. (b) The Department shall maintain records on the number of…
215 ILCS 109/65
Administration of Act
Administration of Act. The Director may adopt rules necessary to implement the Department's responsibility under this Act. To enforce the provisions of this Act, the director may issue a cease and desist order or require a managed care dental plan to submit a plan of correction for violations of this Act, or both. Subj…
215 ILCS 109/70
Retaliation prohibited
Retaliation prohibited. A managed care dental plan may not take any retaliatory actions, including cancellation or refusal to renew a policy, against an employer or enrollee solely because the employer or enrollee has filed complaints with the plan or appealed a decision of the plan. (Source: P.A. 91-355, eff. 1-1-00.)
215 ILCS 109/75
Application of other law
Application of other law. (a) All provisions of this Act and other applicable law that are not in conflict with this Act shall apply to managed care dental plans and other persons subject to this Act. To the extent that any provision of this Act or rule under this Act would prevent the application of any standard or re…
215 ILCS 109/80
Limitations on indemnification provisions
Limitations on indemnification provisions. No contract between a managed care dental plan and a provider may require that the provider indemnify the managed care dental plan for the Plan's, or its officers, employees, or agents, negligence, willful misconduct, or breach of contract, if any, provided nothing herein shal…
215 ILCS 109/85
Severability
Severability. The provisions of this Act are severable under Section 1.31 of the Statute on Statutes. (Source: P.A. 91-355, eff. 1-1-00.)