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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,
3
represented in the General Assembly:

4

Section 5.
The Vision Care Plan Regulation Act is amended
5
by changing Sections 5, 10, 15, 20, 35, and 40 and by adding
6
Sections 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
10
Sections 370g and 511.101 of the Illinois Insurance Code.

11

"Affiliate" has the meaning given to that term in
12
subsection (a) of Section 131.1 of the Illinois Insurance
13
Code.

14

"Covered materials" means materials for which
15
reimbursement from
an enrollee's

the
vision care plan is
16
provided to an eye care provider
or for which reimbursement is
17
provided to

by
an
enrollee under a vision care

enrollee's
plan
18
contract or for which a reimbursement would be available
but
19
for the application of the enrollee's
plan

contractual

20
limitation 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
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LRB104 20689 JDS 34188 b
1

"Covered services" means services for which reimbursement
2
from
an enrollee's

the
vision care plan is provided to an eye
3
care provider
or for which reimbursement is provided to

by
an
4
enrollee under a vision care

enrollee's
plan
contract or for
5
which a reimbursement would be available
but for the
6
application of the enrollee's
contractual
plan limitation of
7
deductibles, copayments, or coinsurance regardless of how the
8
benefits are listed in an enrollee's
benefit
plan's definition
9
of benefits.
10

"Enrollee" means any individual enrolled in a vision care
11
plan provided by a group, employer, or other entity that
12
purchases or supplies coverage for a vision care plan.
13

"Excepted benefits" has the meaning given to that term in
14
subsection (c) of Section 2791 of the federal Public Health
15
Service Act (42 U.S.C. 300gg-91(c)) and federal regulations
16
promulgated in accordance with that subsection.

17

"Eye care provider" means a doctor of optometry licensed
18
pursuant to the Illinois Optometric Practice Act of 1987 or a
19
physician licensed to practice medicine in all of its branches
20
pursuant to the Medical Practice Act of 1987.
21

"Fee schedule" means documents that provide the
22
predetermined rates or allowed amounts for covered services
23
and covered materials, paid to the eye care provider by the
24
vision care organization.

25

"Health insurance coverage" has the meaning given to that
26
term in Section 5 of the Illinois Health Insurance Portability

SB3707 Enrolled
- 3 -
LRB104 20689 JDS 34188 b
1
and Accountability Act.

2

"Health insurance issuer" or "issuer" has the meaning
3
given to that term in Section 5 of the Illinois Health
4
Insurance Portability and Accountability Act.

5

"Materials" means ophthalmic devices, including, but not
6
limited 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
16
between a vision care organization and an eye care provider
17
setting forth the terms and conditions under which covered
18
services and covered materials are provided to an enrollee
19
under the vision care plan, including but not limited to,
20
provider manuals, policies and procedures, fee schedules,
21
dispute resolution processes, and any documents incorporated
22
by reference.

23

"Services" means the professional work performed by an eye
24
care provider.
25

"Subcontractor" means any company, group,
affiliate,
or
26
third-party entity, including agents
or

,
servants
, that

SB3707 Enrolled
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LRB104 20689 JDS 34188 b
1
performs or administers functions or services on behalf of the
2
vision 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
6
benefit plan of a vision care plan
or a vision care discount
7
plan. The location of the person's or entity's domicile,
8
whether in Illinois or a foreign or alien jurisdiction, does
9
not affect the person's or entity's status as a subcontractor
.
10

"Vision care discount plan" means a policy, contract, or
11
agreement offered by a vision care organization to an enrollee
12
that solely provides for a discount for noncovered vision care
13
services or materials.

14

"Vision care organization" means an
administrator or
15
issuer

entity
formed under the laws of this State or another
16
state that issues
or administers
a vision care plan.
17

"Vision care plan" means a
policy, certificate, contract,
18
or other
plan
of health insurance coverage, whether excepted
19
benefits 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
22
and 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
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LRB104 20689 JDS 34188 b
1

(a) No vision care organization that issues, delivers,
2
amends, or renews a
provider agreement

vision care plan
on or
3
after the effective date of this
amendatory
Act
of the 104th
4
General Assembly
shall issue a contract that requires an eye
5
care provider, as a condition of participation in the vision
6
care plan, to provide services or materials to an enrollee at a
7
fee set by the vision care plan unless the services or
8
materials are covered services or covered materials under the
9
vision care plan. De minimis reimbursements shall not qualify
10
a service or material as a covered service or a covered
11
material under this Act.
12

(b) An eye care provider who chooses not to accept as
13
payment an amount set by a vision care plan for services or
14
materials that are not covered services or covered materials
15
shall post, in a conspicuous place, a notice stating the
16
following: "IMPORTANT:
In accordance with State law, this

This

17
eye care provider
may choose

does
not
to
accept
discounts

the
18
fee schedule
set by your insurer for
noncovered

vision care

19
services 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
23
each noncovered service or noncovered material
will be made
24
available
upon your request."
25
(Source: P.A. 103-482, eff. 8-4-23.)

SB3707 Enrolled
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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
4
services and covered materials, regardless of the supplier or
5
optical lab used to obtain materials, shall be reasonable and
6
shall be clearly listed on a fee schedule that has been
7
provided to the eye care provider before entering into a
8
provider agreement

contract
with the vision care organization.
9
Fees paid for materials supplied by a non-network lab are not
10
required to be identical to fees paid for materials ordered
11
through a network lab, but non-network lab fees shall be
12
reasonable.
13

(b) A vision care organization shall, before entering into
14
a provider agreement, inform the eye care provider by email
15
or, if requested by the eye care provider, by mail, on how to
16
access the fee schedule. A vision care organization may make
17
this information available by mail, email, or website listing.
18

(c) A vision care organization shall make an updated copy
19
of a fee schedule available to the eye care provider every
20
calendar quarter. Nothing in this subsection precludes a
21
vision care organization from making the fee schedule
22
available to the eye care provider more frequently than every
23
calendar quarter or available at all times.

24
(Source: P.A. 103-482, eff. 8-4-23.)

25

(215 ILCS 161/17 new)

SB3707 Enrolled
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LRB104 20689 JDS 34188 b
1

Sec. 17.
Payments.
2

(a) A vision care organization shall comply with Section
3
355.6 of the Illinois Insurance Code.

4

(b) A vision care organization shall not prohibit an eye
5
care provider from offering a cash payment option to the
6
enrollee if the cash payment option is less costly to the
7
enrollee than the total out-of-pocket cost of the covered
8
service or covered material.

9

(215 ILCS 161/18 new)
10

Sec. 18.
Vision care plan benefits.
A vision care
11
organization shall clearly list, in the schedule of benefits
12
and vision care plan documents provided to an enrollee and eye
13
care provider, the cost-sharing amounts associated with
14
covered materials and covered services.

15

(215 ILCS 161/20)
16

Sec. 20.
Misrepresentation.
17

(a) A vision care organization and its officers,
18
directors, agents, and employees are subject to the provisions
19
of Sections 149
,

and
154.6
, and 424
of the Illinois Insurance
20
Code.
21

(b) The provisions of this Act apply to any limited health
22
service organization certified under the Limited Health
23
Service Organization Act that is a vision care organization.

24

(c)

(b)
Incorporation by reference in this Act to specific

SB3707 Enrolled
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LRB104 20689 JDS 34188 b
1
laws of this State shall not be construed to exempt a vision
2
care organization or vision care plan from otherwise
3
applicable laws that are not specifically referenced in this
4
Act.
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
9
reimbursement rates in a
provider agreement

vision care plan

10
may not be changed during the term of the
provider agreement

11
contract
unless mutually agreed to in writing by the eye care
12
provider and the vision care organization that issued the
13
provider agreement

vision care plan
. However, a change
14
proposed to a
provider agreement

vision care plan
by the
15
vision care organization shall become effective if the eye
16
care provider fails to respond to the vision care organization
17
within 60 days after
verification of
receipt of notice of the
18
proposed changes
, as provided in subsections (b) and (c)
.
19

(b) Notification of any proposed changes to the provider
20
agreement, and the details in the provider agreement, shall be
21
sent to the eye care provider by electronic communication with
22
verification upon receipt, or upon request of the eye care
23
provider, through certified mail.
24

(c) A vision care organization shall provide to the eye
25
care provider reasonable access to agreement terms, policy

SB3707 Enrolled
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LRB104 20689 JDS 34188 b
1
manuals, fee schedules, and any other policies and procedures
2
referenced in the agreement or proposed amendments to the
3
agreement. As used in this subsection, "reasonable access"
4
includes making this information available upon request by
5
mail, email, or website listing.

6

(d) The term of a provider agreement may not exceed 2 years
7
unless a different term length is mutually agreed to in
8
writing 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
11
the effective date of this
amendatory Act of the 104th General
12
Assembly

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,
17
amends, or renews a
provider agreement

vision care plan
on or
18
after the effective date of this
amendatory
Act
of the 104th
19
General 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
5
agreement with a health care plan to deliver routine vision
6
care services that are covered under the enrollee's plan.
7

(c) A vision care
organization

plan
may
administer

act as

8
a network regarding routine vision care services offered by a
9
health 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
13
vision care organization shall not require an eye care
14
provider to contract for services under a vision care discount
15
plan as a condition of contracting for services under a
16
provider agreement.

17

(215 ILCS 161/50 new)
18

Sec. 50.
Prohibition on a security interest.
A vision care
19
organization shall not require an eye care provider to
20
establish a security interest in any property or assets of the
21
eye care provider, including pertaining to the eye care
22
provider's practice.

23

(215 ILCS 161/55 new)

SB3707 Enrolled
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LRB104 20689 JDS 34188 b
1

Sec. 55.
Nonretaliation.
A vision care organization may
2
not retaliate against an eye care provider for exercising any
3
rights 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
14
Practices Act is amended by repealing Section 2CCCC.

15

Section 99.
Effective date.
This Act takes effect January
16
1, 2027.

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