On August 24, 2012, Governor Quinn signed into law SB 3240 that allows State of Illinois members and their covered dependents to assign their health and dental benefits to out-of-network providers, if the provider accepts assignment. Assignment is the member permitting payment to be made directly to the provider from the appropriate plan administrator. This law is applicable to persons covered under the Quality Care Health Plan (QCHP) and the Quality Care Dental Plan (QCDP).
The public act does not require out-of-network providers to accept assignment, but identifies certain criteria when they do. The legislation requires that if a provider accepts assignment of benefits, the provider can only collect at the point of service the estimated amount that will not be reimbursed by the plan’s insurance benefit. This will usually be copayments, coinsurance, deductibles, and payment for noncovered services. If a provider requires full payment, or payment of any portion of the costs expected to be covered by the plan, s/he cannot also accept assignment of benefits. Providers who accept assignment will be required to wait for payment from the State of Illinois’ plan administrator (Cigna or Delta Dental of Illinois) for reimbursement of the covered services.
This law was effective immediately upon the law being signed. Any claims after that date can be assigned to an out-of-network dentist or health provider, subject to the provider accepting assignment.