SB2807 Summary

• Prohibits insurers offering group or individual accident and health insurance policies or qualified health plans from stating that physician-recommended treatments are "not medically necessary" in policy documents, explanations of benefits, or any publications, effective upon passage.

• Defines "medically necessary" as health care services, devices, drugs, or supplies recommended by a treating or consulting physician or health care provider that are appropriate to treatment and consistent with applicable standard of care, including experimental or investigational services.

• Preserves insurers' right to make coverage determinations regarding whether specific treatments are covered under a policy or plan, separate from medical necessity determinations.

• Applies requirements to state employee health programs, county and municipal self-insured health plans, school districts, health maintenance organizations, limited health service organizations, voluntary health services plans, and Medicaid.

• Declares violations to be unfair and deceptive insurance practices under the Illinois Insurance Code.