Public Act No. 21-22 Summary

• Requires health insurers and related entities to make available in readable format information about coverage exclusions, benefit restrictions, deductible treatment of prescription drugs, copayment and coinsurance amounts, and processes for seeking coverage of non-covered drugs.

• Mandates insurers provide consumers a way to determine prescription drug availability on their formulary, applicable out-of-pocket costs, prior authorization requirements, in-network specialist availability, and in-network provider/hospital status.

• Permits covered individuals to specify in writing whether to receive explanations of benefits, request they be issued solely to the individual, and choose delivery method (mail or electronic) with compliance required within three business days.

• Allows consumers to opt out entirely from receiving explanations of benefits for their covered benefits without requiring explanation of their reason, and prohibits insurers from requiring waiver of these rights as a condition of coverage.

• Requires insurers to disclose consumer rights regarding explanations of benefits clearly and conspicuously in all evidence of coverage documents, privacy communications, explanations of benefits, and websites, effective January 1, 2023.