House Bill 4146 Amends the Managed Care Reform and Patient Rights Act to Ensure Health Plans Deliver the Policies They Sell
March 12, 2018 – The Illinois Fair Care Coalition, a group of state-based and national patient and provider groups working to ensure that health benefits will be honored throughout the health plan year, today applauded legislation that protects consumers with commercial health insurance coverage by ensuring that health plans deliver the policies they sell. Illinois House Bill 4146 would amend the Managed Care Reform and Patient Rights Act to prohibit insurers from making unfair midyear coverage changes while Illinoisans are locked into their policy. The bill passed out of the Illinois House Rules Committee last week and has been referred to the House Insurance: Health & Life Committee.
At any time during the health plan year, insurers in Illinois are free to increase out-of-pocket costs, enact restrictions on coverage (e.g. additional prior authorizations), or remove coverage of a prescription medication altogether – practices commonly referred to as “non-medical switching.” While House Bill 4146 ensures that health plans deliver the policies they advertise, it does not prohibit health plans from requiring generic substitution, adding medications to their formularies or removing treatment coverage for safety reasons. House Bill 4146 has over 50 cosponsors. Chief cosponsors include Laura Fine (D – 17th District), David Harris (R – 53rd District), Patti Bellock (R – 47th District), and Deb Conroy (D – 46th District).
“This legislation would enforce common sense protections for Illinois families by giving them assurance that the benefits they sign up for will be the benefits they receive,” said Bryan Anderson, president and CEO of the Epilepsy Foundation of Greater Chicago. “The message is clear and simple: if consumers in Illinois are committed to a health plan, then that health plan shouldn’t be able to reduce its coverage. We’re calling on members of the House Insurance: Health & Life Committee to support this bill and bring it to a hearing and vote as soon as possible.”
“It can take months or even years of trial and error for patients with complex chronic conditions to find the course of treatment that stabilizes their condition,” said Michael P. Stevens, MD, FACR, President of the Coalition of State Rheumatology Organizations. “Physicians do not make treatment decisions idly, and when payers unexpectedly restrict coverage, they are inserting themselves in the medical decision-making process without regard for patients’ stability and health outcomes.”
California, Nevada, Louisiana and Texas have already implemented similar policies to protect patients from coverage reductions during the plan year. Fifty-five million Americans who are covered through Medicare, including more than two million Illinoisans, are already protected. While House Bill 4146 ensures fair coverage, it does not prohibit health plans from requiring generic substitution, adding medications to their formularies or removing treatment coverage for safety reasons.
About the Illinois Fair Care Coalition
The Illinois Fair Care Coalition is a group of the Prairie State’s leading patient and provider groups working to ensure that commercial health insurance coverage will be concrete over the course of each year.
Members include: Alliance for Patient Access, American Diabetes Association, American Cancer Society Cancer Action Network, American Liver Foundation Great Lakes Division, Arthritis Foundation, Coalition of State Rheumatology Organizations, Global Healthy Living Foundation, IL Rare Disease Commission, International Pain Foundation, Illinois Psychiatric Society, Lupus and Allied Diseases Association, Mental Health America of Illinois, National Infusion Center Association, National MS Society, Respiratory Health Association, Sick Cells, U.S. Pain Foundation.