215 ILCS 5/356r
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 356r. Woman's principal health care provider.(a) An individual or group policy of accident and health insurance or a  managed care plan amended, delivered, issued, or renewed in this State after  November 14, 1996 that  requires an insured or enrollee to designate an individual to coordinate care  or to control access to health care services shall also permit a female insured  or enrollee to designate a participating woman's principal health care  provider,  and the insurer or managed care plan shall provide the following written  notice to all female insureds or enrollees no later than 120 days after the  effective date of this amendatory Act of 1998; to all new enrollees at the  time of enrollment;  and thereafter to all existing enrollees at least annually, as a part of a  regular publication or informational mailing:       "NOTICE TO ALL FEMALE PLAN MEMBERS: YOUR RIGHT TO SELECT A WOMAN'S PRINCIPAL HEALTH CARE PROVIDER.Illinois law allows you to select "a woman's     principal health care provider" in addition to your selection of  a primary care physician.   A woman's principal health care provider is a physician licensed to practice medicine in all its branches specializing in obstetrics or gynecology or specializing in family practice.  A woman's principal health care provider may be seen for care without referrals from your primary care physician.  If you have not already selected a woman's principal health care provider, you may do so now or at any other time. You are not required to have or to select a woman's principal health care provider.Your woman's principal health care provider must be a     part of your plan.  You may get the list of participating obstetricians, gynecologists, and family practice specialists from your employer's employee benefits coordinator, or for your own copy of the current list, you may call [insert plan's toll free number].  The list will be sent to you within 10 days after your call.  To designate a woman's principal health care provider from the list, call [insert plan's toll free number] and tell our staff the name of the physician you have selected.".       If the insurer or managed care plan exercises the option set forth in  subsection  (a-5), the notice shall also state:"Your plan requires that your primary care physician     and your woman's principal health care provider have a referral arrangement with one another.  If the woman's principal health care provider that you select does not have a referral arrangement with your primary care physician, you will have to select a new primary care physician who has a referral arrangement with your woman's principal health care provider or you may select a woman's principal health care provider who has a referral arrangement with your primary care physician.  The list  of woman's principal health care providers will also have the names of the primary care physicians and their referral arrangements.".No later than 120 days after the effective date of this amendatory Act of  1998, the insurer or managed  care plan shall provide each employer who has a policy of insurance or a  managed  care plan with the insurer or managed care plan with a list of physicians  licensed to practice medicine in all its branches specializing in obstetrics or  gynecology or specializing in family practice who have contracted with the  plan. At the time of enrollment and thereafter within 10 days after a request  by an insured  or enrollee, the insurer or managed care plan also shall provide  this list directly to the insured or enrollee.  The list shall include each physician's address, telephone  number, and specialty.  No insurer or plan formal or informal  policy may restrict a female insured's or enrollee's right to designate a  woman's  principal health care provider, except as set forth in subsection (a-5).  If the  female enrollee is an enrollee of a managed care plan under contract with the  Department of Healthcare and Family Services, the physician chosen by the enrollee as her woman's  principal health care provider must be a Medicaid-enrolled provider.  This requirement does not require a female insured or enrollee to make a  selection of a woman's principal health care provider.  The female insured or enrollee may designate a physician licensed to practice  medicine in  all its branches specializing in family practice as her woman's principal  health care provider.(a-5) The insured or enrollee may be required by the insurer or managed care  plan to select a woman's principal health care provider who has a  referral  arrangement with the insured's or enrollee's individual who coordinates care or  controls access to health care services  if such referral arrangement exists  or to  select a new individual to coordinate care or to control access to health care  services who has a referral arrangement with the  woman's principal health care provider chosen by the insured or enrollee, if  such referral arrangement exists.  If an  insurer or a managed care plan requires an insured or enrollee to select a new  physician under this subsection (a-5), the insurer or managed care plan must  provide the insured or enrollee with both options to select a new physician  provided in this subsection  (a-5).Notwithstanding a plan's restrictions of the frequency or timing of making  designations of primary care providers, a female enrollee or insured who is  subject to the selection requirements of this subsection, may, at any time,  effect a change in primary care physicians in order to make a  selection of a woman's principal health care provider.(a-6) If an insurer or managed care plan exercises the option in  subsection (a-5), the list to be provided under subsection (a) shall identify  the referral arrangements that exist between the individual who  coordinates  care or controls access to health care services and the woman's principal  health care provider in order to assist the female insured or enrollee to make  a selection within the insurer's or managed care plan's requirement.(b) If a female insured or enrollee has designated a woman's principal  health care provider, then the insured or enrollee must be given direct access  to the woman's principal health care provider for services covered by the  policy or plan without the need  for a referral or prior approval.  Nothing shall prohibit the insurer or  managed care plan from requiring prior authorization or approval from either a  primary care provider or the woman's principal health care provider for  referrals for additional care or services.(c) For the purposes of this Section the following terms are defined:(1) "Woman's principal health care provider" means a     physician licensed to practice medicine in all of its branches specializing in obstetrics or gynecology or specializing in family practice.(2) "Managed care entity" means any entity including     a licensed insurance company, hospital or medical service plan, health maintenance organization, limited health service organization, preferred provider organization, third party administrator, an employer or employee organization, or any person or entity that establishes, operates, or maintains a network of participating providers.(3) "Managed care plan" means a plan operated by a     managed care entity that provides for the financing of health care services to persons enrolled in the plan through:(A) organizational arrangements for ongoing         quality assurance, utilization review programs, or dispute resolution; or(B) financial incentives for persons enrolled in         the plan to use the participating providers and procedures covered by the plan.(4) "Participating provider" means a physician who     has contracted with an insurer or managed care plan to provide services to insureds or enrollees as defined by the contract.(d) The original provisions of this Section became law on July 17,  1996 and took effect November 14, 1996, which is 120 days after  becoming law.       (Source: P.A. 95-331, eff. 8-21-07.)