IL HB1186

Amends the Health Maintenance Organization Act to add a new definition of "referral system" as an arrangement where a primary care provider coordinates or manages care by referring enrollees to other providers or specialists.

Allows health maintenance organizations to voluntarily use a referral system for enrollees to access contracted or employed providers, but does not require a referral system to obtain a certificate of authority.

Clarifies that the definition of "health care plan" does not require HMOs to utilize a referral system, and allows the Director of Insurance to prescribe language for plan names, marketing, and advertising to differentiate plans that use referral systems from those that do not.

Makes technical revisions to the definitions section, reorganizing numbered definitions and adjusting language regarding how HMOs provide, arrange, and pay for health care services.

Takes effect January 1, 2024.