Illinois Compiled Statutes 215 ILCS 5/370m – Program Requirements
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Terms Used In Illinois Compiled Statutes 215 ILCS 5/370m
- Administrator: means any person, partnership or corporation, other than an insurer or health maintenance organization holding a certificate of authority under the "Health Maintenance Organization Act" as now or hereafter amended, that arranges, contracts with, or administers contracts with a provider whereby beneficiaries are provided an incentive to use the services of such provider. See Illinois Compiled Statutes 215 ILCS 5/370g
- Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
- Beneficiary: means an individual entitled to reimbursement for expenses of or the discount of provider fees for health care services under a program where the beneficiary has an incentive to utilize the services of a provider which has entered into an agreement or arrangement with an administrator. See Illinois Compiled Statutes 215 ILCS 5/370g
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Health care services: means health care services or products rendered or sold by a provider within the scope of the provider's license or legal authorization. See Illinois Compiled Statutes 215 ILCS 5/370g
- Provider: means an individual or entity duly licensed or legally authorized to provide health care services. See Illinois Compiled Statutes 215 ILCS 5/370g
Each administrator shall provide to each beneficiary of any program subject to this Article a document which (1) sets forth those providers with which agreements or arrangements have been made to provide health care services to such beneficiary, a source for the beneficiary to contact regarding changes in such providers and a clear description of any incentives for the beneficiary to utilize such providers, (2) discloses the extent of coverage as well as any limitations or exclusions of health care services under the program, (3) clearly sets out the circumstances under which reimbursement will be made to a beneficiary unable to utilize the services of a provider with which an arrangement or agreement has been made, (4) a description of the process for addressing a beneficiary complaint under the program, and (5) discloses deductible and coinsurance amounts charged to any person receiving health care services from such a provider.