215 ILCS 161/1
(215 ILCS 161/1) Sec. 1. Short title. This Act may be cited as the Vision Care Plan Regulation Act. (Source: P.A. 103-482, eff. 8-4-23.)
215 ILCS 161
215 ILCS 161
in effect215 ILCS 161/5 Definitions
(215 ILCS 161/5) (Text of Section before amendment by P.A. 104-851) Sec. 5. Definitions. As used in this Act: "Covered materials" means materials for which reimbursement from the vision care plan is provided to an eye care provider by an enrollee's plan contract or for which a reimbursement would be available but for the application of the enrollee's contractual limitation of deductibles, copayments, or coinsurance. "Covered materials" includes lens treatment or coatings added to a spectacle lens if the base spectacle lens is a covered material. "Covered services" means services for which reimbursement from the vision care plan is provided to an eye care provider by an enrollee's plan contract or for which a reimbursement would be available but for the application of the enrollee's contractual plan limitation of deductibles, copayments, or coinsurance regardless of how the benefits are listed in an enrollee's benefit plan's definition of benefits. "Enrollee" means any individual enrolled in a vision care plan provided by a group, employer, or other entity that purchases or supplies coverage for a vision care plan. "Eye care provider" means a doctor of optometry licensed pursuant to the Illinois Optometric Practice Act of 1987 or a physician licensed to practice medicine in all of its branches pursuant to the Medical Practice Act of 1987. "Materials" means ophthalmic devices, including, but not limited to: (i) lenses, devices containing lenses, ophthalmic frames, and other lens mounting apparatus, prisms, lens treatments, and coatings; (ii) contact lenses and prosthetic devices that correct, relieve, or treat defects or abnormal conditions of the human eye or adnexa; and (iii) any devices that deliver medication or other therapeutic treatment to the human eye or adnexa. "Services" means the professional work performed by an eye care provider. "Subcontractor" means any company, group, or third-party entity, including agents, servants, partially owned or wholly owned subsidiaries and controlled organizations, that the vision care plan contracts with to supply services or materials for an eye care provider or enrollee to fulfill the benefit plan of a vision care plan. "Vision care organization" means an entity formed under the laws of this State or another state that issues a vision care plan. "Vision care plan" means a plan that creates, promotes, sells, provides, advertises, or administers an integrated or stand-alone plan that provides coverage for covered services and covered materials. (Source: P.A. 103-482, eff. 8-4-23; 104-417, eff. 8-15-25.) (Text of Section after amendment by P.A. 104-851) Sec. 5. Definitions. As used in this Act: "Administrator" has the meanings given to that term in Sections 370g and 511.101 of the Illinois Insurance Code. "Affiliate" has the meaning given to that term in subsection (a) of Section 131.1 of the Illinois Insurance Code. "Covered materials" means materials for which reimbursement from an enrollee's vision care plan is provided to an eye care provider or for which reimbursement is provided to an enrollee under a vision care plan but for the application of the enrollee's plan limitation of deductibles, copayments, or coinsurance. "Covered services" means services for which reimbursement from an enrollee's vision care plan is provided to an eye care provider or for which reimbursement is provided to an enrollee under a vision care plan but for the application of the enrollee's plan limitation of deductibles, copayments, or coinsurance regardless of how the benefits are listed in an enrollee's plan's definition of benefits. "Enrollee" means any individual enrolled in a vision care plan provided by a group, employer, or other entity that purchases or supplies coverage for a vision care plan. "Excepted benefits" has the meaning given to that term in subsection (c) of Section 2791 of the federal Public Health Service Act (42 U.S.C. 300gg-91(c)) and federal regulations promulgated in accordance with that subsection. "Eye care provider" means a doctor of optometry licensed pursuant to the Illinois Optometric Practice Act of 1987 or a physician licensed to practice medicine in all of its branches pursuant to the Medical Practice Act of 1987. "Fee schedule" means documents that provide the predetermined rates or allowed amounts for covered services and covered materials, paid to the eye care provider by the vision care organization. "Health insurance coverage" has the meaning given to that term in Section 5 of the Illinois Health Insurance Portability and Accountability Act. "Health insurance issuer" or "issuer" has the meaning given to that term in Section 5 of the Illinois Health Insurance Portability and Accountability Act. "Materials" means ophthalmic devices, including, but not limited to: (i) lenses, devices containing lenses, ophthalmic frames, and other lens mounting apparatus, prisms, lens treatments, and coatings; (ii) contact lenses and prosthetic devices that correct, relieve, or treat defects or abnormal conditions of the human eye or adnexa; and (iii) any devices that deliver medication or other therapeutic treatment to the human eye or adnexa. "Provider agreement" means the contractual relationship between a vision care organization and an eye care provider setting forth the terms and conditions under which covered services and covered materials are provided to an enrollee under the vision care plan, including but not limited to, provider manuals, policies and procedures, fee schedules, dispute resolution processes, and any documents incorporated by reference. "Services" means the professional work performed by an eye care provider. "Subcontractor" means any company, group, affiliate, or third-party entity, including agents or servants, that performs or administers functions or services on behalf of the vision care organization to execute or fulfill the benefit plan of a vision care plan or a vision care discount plan. The location of the person's or entity's domicile, whether in Illinois or a foreign or alien jurisdiction, does not affect the person's or entity's status as a subcontractor. "Vision care discount plan" means a policy, contract, or agreement offered by a vision care organization to an enrollee that solely provides for a discount for noncovered vision care services or materials. "Vision care organization" means an administrator or issuer formed under the laws of this State or another state that issues or administers a vision care plan. "Vision care plan" means a policy, certificate, contract, or other plan of health insurance coverage, whether excepted benefits or any other coverage that provides coverage for covered services and covered materials. (Source: P.A. 103-482, eff. 8-4-23; 104-417, eff. 8-15-25; 104-851, eff. 1-1-27.)
215 ILCS 161/10
(215 ILCS 161/10) Sec. 10. Noncovered services. (a) No vision care organization that issues, delivers, amends, or renews a vision care plan on or after the effective date of this Act shall issue a contract that requires an eye care provider, as a condition of participation in the vision care plan, to provide services or materials to an enrollee at a fee set by the vision care plan unless the services or materials are covered services or covered materials under the vision care plan. De minimis reimbursements shall not qualify a service or material as a covered service or a covered material under this Act. (b) An eye care provider who chooses not to accept as payment an amount set by a vision care plan for services or materials that are not covered services or covered materials shall post, in a conspicuous place, a notice stating the following: "IMPORTANT: This eye care provider does not accept the fee schedule set by your insurer for vision care services and vision care materials that are not covered benefits under your plan and instead charges his or her normal fee for those services and materials. This eye care provider will provide you with an estimated cost for each noncovered service or noncovered material upon your request." (Source: P.A. 103-482, eff. 8-4-23.)
215 ILCS 161/15
(215 ILCS 161/15) Sec. 15. Fees for covered services and covered materials. Fees paid under a vision care plan for covered services and covered materials, regardless of the supplier or optical lab used to obtain materials, shall be reasonable and shall be clearly listed on a fee schedule that has been provided to the eye care provider before entering into a contract with the vision care organization. Fees paid for materials supplied by a non-network lab are not required to be identical to fees paid for materials ordered through a network lab, but non-network lab fees shall be reasonable. (Source: P.A. 103-482, eff. 8-4-23.)
215 ILCS 161/20 Misrepresentation
(215 ILCS 161/20) Sec. 20. Misrepresentation. (a) A vision care organization and its officers, directors, agents, and employees are subject to the provisions of Sections 149 and 154.6 of the Illinois Insurance Code. (b) Incorporation by reference in this Act to specific laws of this State shall not be construed to exempt a vision care organization or vision care plan from otherwise applicable laws that are not specifically referenced in this Act. (Source: P.A. 103-482, eff. 8-4-23.)
215 ILCS 161/25 Subcontractors
(215 ILCS 161/25) Sec. 25. Subcontractors. The provisions of this Act apply to any subcontractors used by a vision care organization to supply materials or services to an eye care provider or an enrollee under a vision care plan. (Source: P.A. 103-482, eff. 8-4-23.)
215 ILCS 161/30
(215 ILCS 161/30) Sec. 30. Suppliers; optical labs. (a) A vision care organization may not restrict or limit an eye care provider's choice of suppliers of services, covered materials, or the use of an optical lab. (b) A vision care organization may not require an eye care provider or patient to order or purchase covered materials, including, but not limited to, ophthalmic lenses, from any source owned by, controlled by, or in a common ownership scheme with the entity that issued the vision care plan. (c) At the request of an enrollee, an eye care provider recommending an out-of-network source or supplier of vision care materials to an enrollee shall provide written notice to the enrollee stating: (1) that the source or supplier is an out-of-network laboratory or supplier of vision care materials; and (2) any business interest that the eye care provider has in the out-of-network source or supplier recommended to the enrollee. (d) An eye care provider is required to offer an enrollee in-network sources or suppliers of vision care materials at the enrollee's request. (Source: P.A. 103-482, eff. 8-4-23.)
215 ILCS 161/35
(215 ILCS 161/35) Sec. 35. Modification of plan. (a) The terms, fees, discounts, or reimbursement rates in a vision care plan may not be changed during the term of the contract unless mutually agreed to in writing by the eye care provider and the vision care organization that issued the vision care plan. However, a change proposed to a vision care plan by the vision care organization shall become effective if the eye care provider fails to respond to the vision care organization within 60 days after receipt of notice of the proposed changes. (b) The terms of a vision care plan contract that is amended, delivered, issued, or renewed after the effective date of this Act shall comply with the provisions of this Act. (Source: P.A. 103-482, eff. 8-4-23.)
215 ILCS 161/40
(215 ILCS 161/40) (Text of Section before amendment by P.A. 104-851) Sec. 40. Prohibitions; medical plan preconditions. (a) No vision care organization that issues, delivers, amends, or renews a vision care plan on or after the effective date of this Act shall issue a vision care plan contract that requires: (1) an eye care provider to contract with a plan that offers supplemental or specialty health care services as a condition of contracting with a plan that offers basic health services; or (2) an eye care provider to contract with a vision care plan as a condition to participation in a medical plan or in-network. (b) A vision care plan may enter into an agreement with a health care plan to deliver routine vision care services that are covered under the enrollee's plan. (c) A vision care plan may act as a network regarding routine vision care services offered by a health care plan. (Source: P.A. 103-482, eff. 8-4-23.) (Text of Section after amendment by P.A. 104-851) Sec. 40. Prohibitions; medical plan preconditions. (a) No vision care organization that issues, delivers, amends, or renews a provider agreement on or after the effective date of this amendatory Act of the 104th General Assembly shall issue a provider agreement that requires: (1) an eye care provider to participate in a plan that offers supplemental or specialty health care services as a condition of entering into or maintaining a provider agreement relating to a plan that offers basic health services; or (2) an eye care provider to participate in a vision care plan as a condition to participation in a medical plan or in-network. (b) A vision care organization may enter into an agreement with a health care plan to deliver routine vision care services that are covered under the enrollee's plan. (c) A vision care organization may administer a network regarding routine vision care services offered by a health care plan. (Source: P.A. 103-482, eff. 8-4-23; 104-851, eff. 1-1-27.)
215 ILCS 161/900
(215 ILCS 161/900) Sec. 900. (Amendatory provisions; text omitted). (Source: P.A. 103-482, eff. 8-4-23; text omitted.)
215 ILCS 161/999
(215 ILCS 161/999) Sec. 999. Effective date. This Act takes effect upon becoming law. (Source: P.A. 103-482, eff. 8-4-23.)
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://www.ilga.gov/legislation/ilcs/ilcs.aspFetched: 10/17/2026