Purpose

Section 2051.210  Purpose a)         The purpose of this Part is to implement Article XX½ of the Illinois Insurance Code, which, in part, provides for the regulation of preferred provider programs for health care benefit plans and for the provision of workers' compensation medical benefits by employers, including those programs that provide insureds or beneficiaries access to discounted health care provider fees. This Part defines the authority of an administrator to operate preferred provider programs in this State, establishes criteria for the registration of administrators with the Director of Insurance and establishes appropriate fees for the registration and regulation of programs. This Part also establishes requirements for any person, partnership or corporation engaged in any conduct regulated by the Act, including, but not limited to, administrators, discounted health care services plan administrators, and insurers that, under Sections 370h and 370i of the Act, enters into a preferred provider arrangement or offers a preferred provider program. The entity must comply with this Part when offering incentives to insureds or beneficiaries to utilize the services of contracted providers. This Part does not apply to employee benefit trust funds, other ERISA exempt organizations, self-funded State of Illinois health benefit plans, Medicare approved prescription drug plans or any State of Illinois discount drug program, except as otherwise set forth in this Part. b)         This Part also implements Section 8.1a of the Workers' Compensation Act [820 ILCS 305], which provides for the regulation of certain preferred provider programs for the provision of health care services to employees under the Workers' Compensation Act. This Part defines the authority of a workers' compensation preferred provider program administrator to operate the preferred provider programs in this State, establishes criteria for the registration of those administrators with the Director of Insurance and establishes appropriate fees for the registration and regulation of the programs. This Part also establishes requirements for any person, partnership or corporation engaged in any conduct regulated by Section 8.1a, including, but not limited to, workers' compensation preferred provider program administrators, employers, including self-funded employers, and insurers that offer a preferred provider program. The entity must comply with this Part when requiring employees to make a choice of a health care services provider from within the preferred provider program under Section 8(a)(4) of the Workers' Compensation Act.