IllinoisHB3796104th General Assembly (2025–2026)HouseWALLET

INSURANCE-PROVIDER PANELS

Sponsored By: Sponsor information unavailable

Signed by Governor

Summary

Amends the Managed Care Reform and Patient Rights Act. Sets forth requirements for carriers that offer a provider panel. Requires notice of the development of a provider panel to be filed with Department of Public Health prior to establishment. Provides that a carrier that uses a provider panel shall establish procedure for notifying an enrollee of the termination of a health care provider. Sets forth provisions permitting, under certain circumstances, a health care provider to continue to render health care services following termination from the carrier's provider panel. Requires a carrier to provide a list of members in the carrier's provider panel. Establishes notice requirements for benefit reductions and termination of health care providers from the carrier's provider panel. Requires any carrier requiring preauthorization for medical treatment to have personnel available to provide preauthorization at all times when the preauthorization is required. Provides that no contract between a health care provider and a carrier shall include provisions that require a health care provider to deny covered services that the provider knows to be medically necessary and appropriate that are provided with respect to a specific enrollee or group of enrollees with similar medical conditions. Sets forth prohibited provisions in a contract between a carrier and a health care provider. Defines terms. Makes other and conforming changes.

insuranceassignments

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Bill Overview

Analyzed Economic Effects

1 provisions identified: 0 benefits, 0 costs, 1 mixed.

Patients get continued care with time limits

Beginning January 1, 2027, Illinois network plans must protect continued care when a provider leaves the network. Protection also covers new members whose current doctor is outside the network but within the plan’s service area. Patients qualify through ongoing treatment or a confirmed appointment scheduled before the departure notice or enrollment date. For confirmed appointments, the provider must attest that the appointment was scheduled before that date. The 90-day period starts with the departure notice for existing members or the enrollment date for new members. Providers must remain within the plan’s service area. For patients in their third trimester when that period starts, protection includes care after birth directly related to delivery. New members or their authorized representatives must choose continued care in writing. Departing providers must accept their former contract’s payment terms; new members’ doctors receive rates set by the plan. Providers must follow plan quality, medical information, referral, and prior approval rules. Protection excludes departures involving imminent patient harm or final state licensing-board discipline. It also excludes medically unnecessary care, patients who have reached benefit limits, and patients who have successfully switched providers. Appointments or follow-ups rescheduled beyond the applicable 90-day period are not protected. The law does not add otherwise uncovered benefits or change contract limits on preexisting conditions.

Sponsors & Cosponsors

Sponsors

There is no primary sponsor on record.

Cosponsors

  • Hoan Huynh

    Democratic • House

  • Rachel Ventura

    Democratic • Senate

Roll Call Votes

All Roll Calls

Yes: 210 • No: 6

Senate vote • 5/22/2025

Third Reading - Passed;

Yes: 58 • No: 0

Senate vote • 5/7/2025

Do Pass Insurance;

Yes: 12 • No: 0

House vote • 4/11/2025

Third Reading - Short Debate - Passed

Yes: 115 • No: 0

House vote • 4/8/2025

House Floor Amendment No. 1 Recommends Be Adopted Insurance Committee;

Yes: 14 • No: 0

House vote • 3/20/2025

Do Pass / Short Debate Insurance Committee;

Yes: 11 • No: 6

Actions Timeline

  1. Public Act . . . . . . . . . 104-0333

    8/15/2025House
  2. Effective Date January 1, 2027

    8/15/2025House
  3. Governor Approved

    8/15/2025House
  4. Sent to the Governor

    6/20/2025House
  5. Passed Both Houses

    5/22/2025House
  6. Third Reading - Passed; 058-000-000

    5/22/2025Senate
  7. Placed on Calendar Order of 3rd Reading **

    5/20/2025Senate
  8. Placed on Calendar Order of 3rd Reading May 13, 2025

    5/8/2025Senate
  9. Second Reading

    5/8/2025Senate
  10. Placed on Calendar Order of 2nd Reading May 8, 2025

    5/7/2025Senate
  11. Do Pass Insurance; 012-000-000

    5/7/2025Senate
  12. Assigned to Insurance

    4/29/2025Senate
  13. Referred to Assignments

    4/14/2025Senate
  14. First Reading

    4/14/2025Senate
  15. Chief Senate Sponsor Sen. Rachel Ventura

    4/14/2025Senate
  16. Placed on Calendar Order of First Reading

    4/14/2025Senate
  17. Arrive in Senate

    4/14/2025Senate
  18. House Floor Amendment No. 2 Tabled

    4/11/2025House
  19. Third Reading - Short Debate - Passed 115-000-000

    4/11/2025House
  20. Placed on Calendar Order of 3rd Reading - Short Debate

    4/11/2025House
  21. House Floor Amendment No. 1 Adopted

    4/11/2025House
  22. House Floor Amendment No. 1 Recommends Be Adopted Insurance Committee; 014-000-000

    4/8/2025House
  23. House Floor Amendment No. 2 Rules Refers to Insurance Committee

    4/8/2025House
  24. House Floor Amendment No. 2 Referred to Rules Committee

    4/7/2025House
  25. House Floor Amendment No. 2 Filed with Clerk by Rep. Hoan Huynh

    4/7/2025House

Bill Text

  • Engrossed

  • Enrolled

  • House Amendment 1

  • House Amendment 2

  • Introduced

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