IL HB5793

Amends the Health Maintenance Organization Act to add "referral system" as a voluntary power of health maintenance organizations, allowing them to use systems where primary care providers coordinate and refer enrollees to specialists.

Clarifies that use of a referral system is not required to obtain a certificate of authority to operate as an HMO.

Modifies the definition of "health care plan" to explicitly state that no referral system is mandated for enrollees to access basic health care services and other services from contracted or employed providers.

Adds a new definition of "referral system" as an arrangement in which a primary care provider coordinates or manages an enrollee's care by referring them to other providers or specialists.

Effective January 1, 2023.