SB 3707

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Full Text of SB3707
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	SB3707 - 104th General Assembly
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			Senate Amendment 001
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		SB3707 Enrolled		LRB104 20689 JDS 34188 b
1    AN ACT concerning regulation.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Vision Care Plan Regulation Act is amended
5by changing Sections 5, 10, 15, 20, 35, and 40 and by adding
6Sections 17, 18, 45, 50, and 55 as follows:
7    (215 ILCS 161/5)
8    Sec. 5. Definitions. As used in this Act:
9    "Administrator" has the meanings given to that term in 
10Sections 370g and 511.101 of the Illinois Insurance Code.
11    "Affiliate" has the meaning given to that term in 
12subsection (a) of Section 131.1 of the Illinois Insurance 
13Code.
14    "Covered materials" means materials for which
15reimbursement from an enrollee's [the] vision care plan is
16provided to an eye care provider or for which reimbursement is 
17provided to [by] an enrollee under a vision care [enrollee's] plan
18[contract or for which a reimbursement would be available] but
19for the application of the enrollee's plan [contractual]
20limitation of deductibles, copayments, or coinsurance.
21["Covered materials" includes lens treatment or coatings added ]
22[to a spectacle lens if the base spectacle lens is a covered ]
23[material.]
		SB3707 Enrolled	- 2 -	LRB104 20689 JDS 34188 b
1    "Covered services" means services for which reimbursement
2from an enrollee's [the] vision care plan is provided to an eye
3care provider or for which reimbursement is provided to [by] an
4enrollee under a vision care [enrollee's] plan [contract or for ]
5[which a reimbursement would be available] but for the
6application of the enrollee's [contractual] plan limitation of
7deductibles, copayments, or coinsurance regardless of how the
8benefits are listed in an enrollee's [benefit] plan's definition
9of benefits.
10    "Enrollee" means any individual enrolled in a vision care
11plan provided by a group, employer, or other entity that
12purchases or supplies coverage for a vision care plan.
13    "Excepted benefits" has the meaning given to that term in 
14subsection (c) of Section 2791 of the federal Public Health 
15Service Act (42 U.S.C. 300gg-91(c)) and federal regulations 
16promulgated in accordance with that subsection.
17    "Eye care provider" means a doctor of optometry licensed
18pursuant to the Illinois Optometric Practice Act of 1987 or a
19physician licensed to practice medicine in all of its branches
20pursuant to the Medical Practice Act of 1987.
21    "Fee schedule" means documents that provide the 
22predetermined rates or allowed amounts for covered services 
23and covered materials, paid to the eye care provider by the 
24vision care organization.
25    "Health insurance coverage" has the meaning given to that 
26term in Section 5 of the Illinois Health Insurance Portability 
		SB3707 Enrolled	- 3 -	LRB104 20689 JDS 34188 b
1and Accountability Act.
2    "Health insurance issuer" or "issuer" has the meaning 
3given to that term in Section 5 of the Illinois Health 
4Insurance Portability and Accountability Act.
5    "Materials" means ophthalmic devices, including, but not
6limited to:
7        (i) lenses, devices containing lenses, ophthalmic
8    frames, and other lens mounting apparatus, prisms, lens
9    treatments, and coatings;
10        (ii) contact lenses and prosthetic devices that
11    correct, relieve, or treat defects or abnormal conditions
12    of the human eye or adnexa; and
13        (iii) any devices that deliver medication or other
14    therapeutic treatment to the human eye or adnexa.
15    "Provider agreement" means the contractual relationship 
16between a vision care organization and an eye care provider 
17setting forth the terms and conditions under which covered 
18services and covered materials are provided to an enrollee 
19under the vision care plan, including but not limited to, 
20provider manuals, policies and procedures, fee schedules, 
21dispute resolution processes, and any documents incorporated 
22by reference.
23    "Services" means the professional work performed by an eye
24care provider.
25    "Subcontractor" means any company, group, affiliate, or
26third-party entity, including agents or [,] servants, that 
		SB3707 Enrolled	- 4 -	LRB104 20689 JDS 34188 b
1performs or administers functions or services on behalf of the 
2vision care organization to execute or [, partially owned or ]
3[wholly owned subsidiaries and controlled organizations, that ]
4[the vision care plan contracts with to supply services or ]
5[materials for an eye care provider or enrollee to] fulfill the
6benefit plan of a vision care plan or a vision care discount 
7plan. The location of the person's or entity's domicile, 
8whether in Illinois or a foreign or alien jurisdiction, does 
9not affect the person's or entity's status as a subcontractor.
10    "Vision care discount plan" means a policy, contract, or 
11agreement offered by a vision care organization to an enrollee 
12that solely provides for a discount for noncovered vision care 
13services or materials.
14    "Vision care organization" means an administrator or 
15issuer [entity] formed under the laws of this State or another
16state that issues or administers a vision care plan.
17    "Vision care plan" means a policy, certificate, contract, 
18or other plan of health insurance coverage, whether excepted 
19benefits or any other coverage that [creates, promotes, sells, ]
20[provides, advertises, or administers an integrated or ]
21[stand-alone plan that] provides coverage for covered services
22and covered materials.
23(Source: P.A. 103-482, eff. 8-4-23; 104-417, eff. 8-15-25.)
24    (215 ILCS 161/10)
25    Sec. 10. Noncovered services.
		SB3707 Enrolled	- 5 -	LRB104 20689 JDS 34188 b
1    (a) No vision care organization that issues, delivers,
2amends, or renews a provider agreement [vision care plan] on or
3after the effective date of this amendatory Act of the 104th 
4General Assembly shall issue a contract that requires an eye
5care provider, as a condition of participation in the vision
6care plan, to provide services or materials to an enrollee at a
7fee set by the vision care plan unless the services or
8materials are covered services or covered materials under the
9vision care plan. De minimis reimbursements shall not qualify
10a service or material as a covered service or a covered
11material under this Act.
12    (b) An eye care provider who chooses not to accept as
13payment an amount set by a vision care plan for services or
14materials that are not covered services or covered materials
15shall post, in a conspicuous place, a notice stating the
16following: "IMPORTANT: In accordance with State law, this [This]
17eye care provider may choose [does] not to accept discounts [the ]
18[fee schedule] set by your insurer for noncovered [vision care]
19services and noncovered [vision care] materials [that are not ]
20[covered benefits under your plan and instead charges his or ]
21[her normal fee for those services and materials]. However, [This ]
22[eye care provider will provide you with] an estimated cost for
23each noncovered service or noncovered material will be made 
24available upon your request."
25(Source: P.A. 103-482, eff. 8-4-23.)
		SB3707 Enrolled	- 6 -	LRB104 20689 JDS 34188 b
1    (215 ILCS 161/15)
2    Sec. 15. Fees for covered services and covered materials.
3    (a) Fees paid under a vision care plan for covered
4services and covered materials, regardless of the supplier or
5optical lab used to obtain materials, shall be reasonable and
6shall be clearly listed on a fee schedule that has been
7provided to the eye care provider before entering into a
8provider agreement [contract] with the vision care organization.
9Fees paid for materials supplied by a non-network lab are not
10required to be identical to fees paid for materials ordered
11through a network lab, but non-network lab fees shall be
12reasonable.
13    (b) A vision care organization shall, before entering into 
14a provider agreement, inform the eye care provider by email 
15or, if requested by the eye care provider, by mail, on how to 
16access the fee schedule. A vision care organization may make 
17this information available by mail, email, or website listing.
18    (c) A vision care organization shall make an updated copy 
19of a fee schedule available to the eye care provider every 
20calendar quarter. Nothing in this subsection precludes a 
21vision care organization from making the fee schedule 
22available to the eye care provider more frequently than every 
23calendar quarter or available at all times.
24(Source: P.A. 103-482, eff. 8-4-23.)
25    (215 ILCS 161/17 new)
		SB3707 Enrolled	- 7 -	LRB104 20689 JDS 34188 b
1    Sec. 17. Payments.
2    (a) A vision care organization shall comply with Section 
3355.6 of the Illinois Insurance Code.
4    (b) A vision care organization shall not prohibit an eye 
5care provider from offering a cash payment option to the 
6enrollee if the cash payment option is less costly to the 
7enrollee than the total out-of-pocket cost of the covered 
8service or covered material.
9    (215 ILCS 161/18 new)
10    Sec. 18. Vision care plan benefits. A vision care 
11organization shall clearly list, in the schedule of benefits 
12and vision care plan documents provided to an enrollee and eye 
13care provider, the cost-sharing amounts associated with 
14covered materials and covered services.
15    (215 ILCS 161/20)
16    Sec. 20. Misrepresentation.
17    (a) A vision care organization and its officers,
18directors, agents, and employees are subject to the provisions
19of Sections 149, [and] 154.6, and 424 of the Illinois Insurance
20Code.
21    (b) The provisions of this Act apply to any limited health 
22service organization certified under the Limited Health 
23Service Organization Act that is a vision care organization.
24    (c) [(b)] Incorporation by reference in this Act to specific
		SB3707 Enrolled	- 8 -	LRB104 20689 JDS 34188 b
1laws of this State shall not be construed to exempt a vision
2care organization or vision care plan from otherwise
3applicable laws that are not specifically referenced in this
4Act.
5(Source: P.A. 103-482, eff. 8-4-23.)
6    (215 ILCS 161/35)
7    Sec. 35. Modification of a provider agreement [plan].
8    (a) The terms, fees, discounts, provider manuals, or
9reimbursement rates in a provider agreement [vision care plan]
10may not be changed during the term of the provider agreement
11[contract] unless mutually agreed to in writing by the eye care
12provider and the vision care organization that issued the
13provider agreement [vision care plan]. However, a change
14proposed to a provider agreement [vision care plan] by the
15vision care organization shall become effective if the eye
16care provider fails to respond to the vision care organization
17within 60 days after verification of receipt of notice of the
18proposed changes, as provided in subsections (b) and (c).
19    (b) Notification of any proposed changes to the provider 
20agreement, and the details in the provider agreement, shall be 
21sent to the eye care provider by electronic communication with 
22verification upon receipt, or upon request of the eye care 
23provider, through certified mail.
24    (c) A vision care organization shall provide to the eye 
25care provider reasonable access to agreement terms, policy 
		SB3707 Enrolled	- 9 -	LRB104 20689 JDS 34188 b
1manuals, fee schedules, and any other policies and procedures 
2referenced in the agreement or proposed amendments to the 
3agreement. As used in this subsection, "reasonable access" 
4includes making this information available upon request by 
5mail, email, or website listing.
6    (d) The term of a provider agreement may not exceed 2 years 
7unless a different term length is mutually agreed to in 
8writing by all parties.
9    (e) [(b)] The terms of a provider agreement [vision care plan ]
10[contract] that is amended, delivered, issued, or renewed after
11the effective date of this amendatory Act of the 104th General 
12Assembly [Act] shall comply with the provisions of this Act.
13(Source: P.A. 103-482, eff. 8-4-23.)
14    (215 ILCS 161/40)
15    Sec. 40. Prohibitions; medical plan preconditions.
16    (a) No vision care organization that issues, delivers,
17amends, or renews a provider agreement [vision care plan] on or
18after the effective date of this amendatory Act of the 104th 
19General Assembly shall issue a provider agreement [vision care ]
20[plan contract] that requires:
21        (1) an eye care provider to participate in [contract ]
22    [with] a plan that offers supplemental or specialty health
23    care services as a condition of entering into or 
24    maintaining a provider agreement relating to [contracting ]
25    [with] a plan that offers basic health services; or
		SB3707 Enrolled	- 10 -	LRB104 20689 JDS 34188 b
1        (2) an eye care provider to participate in [contract ]
2    [with] a vision care plan as a condition to participation in
3    a medical plan or in-network.
4    (b) A vision care organization [plan] may enter into an
5agreement with a health care plan to deliver routine vision
6care services that are covered under the enrollee's plan.
7    (c) A vision care organization [plan] may administer [act as]
8a network regarding routine vision care services offered by a
9health care plan.
10(Source: P.A. 103-482, eff. 8-4-23.)
11    (215 ILCS 161/45 new)
12    Sec. 45. Participation in vision care discount plans. A 
13vision care organization shall not require an eye care 
14provider to contract for services under a vision care discount 
15plan as a condition of contracting for services under a 
16provider agreement.
17    (215 ILCS 161/50 new)
18    Sec. 50. Prohibition on a security interest. A vision care 
19organization shall not require an eye care provider to 
20establish a security interest in any property or assets of the 
21eye care provider, including pertaining to the eye care 
22provider's practice.
23    (215 ILCS 161/55 new)
		SB3707 Enrolled	- 11 -	LRB104 20689 JDS 34188 b
1    Sec. 55. Nonretaliation. A vision care organization may 
2not retaliate against an eye care provider for exercising any 
3rights under this Act, including, but not limited to:
4        (1) communicating with the Department of Insurance, 
5    federal regulators, State or federal legislators, or 
6    professional associations regarding the enforcement or 
7    interpretation of this Act; or
8        (2) filing a complaint or report with the Department 
9    of Insurance regarding the enforcement of this Act or any 
10    other provisions of the Illinois Insurance Code or the 
11    Illinois Administrative Code.
12    (815 ILCS 505/2CCCC rep.)
13    Section 90. The Consumer Fraud and Deceptive Business
14Practices Act is amended by repealing Section 2CCCC.
15    Section 99. Effective date. This Act takes effect January
161, 2027.