All Roll Calls
Yes: 282 • No: 58
IllinoisHB3800104th General Assembly (2025–2026)HouseWALLET
INSURANCE-VARIOUS
Sponsored By: Bob Morgan (Democratic)
Became Law
insuranceassignments
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Bill Overview
Analyzed Economic Effects
16 provisions identified: 13 benefits, 1 costs, 2 mixed.
In-network costs when care isn't available
Emergency care is covered the same whether the provider is in-network or not. You do not pay more than in-network cost-sharing for emergencies. If you make a good-faith effort (use the directory, call the plan, and call the provider) and the network lacks an appropriate in-network option because of numbers, distance, delay, or conscience refusals, the plan must cover your care at in-network costs. This protection does not apply if you willfully choose an out-of-network provider or are in an HMO. If a county’s network is inadequate and no approved exception exists, the plan must pay out-of-network claims at in-network levels and reimburse people who were overcharged. The Department can bar plans from being sold in a county and fine $5,000 per policy issued in violation; current coverage is not cut mid-term.
Accurate doctor directories and fast fixes
Plans must post a public, no‑login provider directory and keep it current. Providers must report changes within 10 business days (and report stopping new patients within 20 business days if it will last 40 business days or more); plans must update listings within 10 business days. Directories must show how the network was built, telehealth details, a dispute process, contacts, and any provider’s expected departure date within 10 days of confirmation. Plans must audit at least 25% of directory entries regularly and send a summary to the Department, which is posted publicly. Fines apply: $5,000 per month for not updating monthly; generally up to $5,000 per inaccurate listing, or up to $25,000 if the issuer knew or should have known. Printed directories are available on request and updated at least quarterly with an errata and accuracy date.
Cap on inpatient pre-cert penalties
If your plan fines you for not pre‑certifying an inpatient hospital stay, that extra penalty cannot exceed $1,000 per occurrence. Regular plan deductibles, copays, and coinsurance still apply. This limit follows the state’s prior authorization rules.
Coverage protection if your insurer fails
If a court orders rehabilitation or liquidation, rights are set as of that date. Policies covered by guaranty associations (life, health, disability, long‑term care, or annuities) stay in force so guaranty associations can pay claims. Policies not covered end unless a court, at the Director’s request, uses estate assets to keep them or transfers them to another insurer. The Director can bring actions for two years, certain time limits pause while complaints are pending, and people get at least 180 days to sue after a denial.
Stronger mental health and addiction parity
Plans that cover medical and behavioral health must treat mental health and substance use care no worse than medical care. Deductibles, copays, coinsurance, out-of-pocket maximums, and visit limits for behavioral health cannot be more restrictive. Lifetime and annual limits cannot be stricter than for medical care. Substance use treatment drugs must have equal formulary placement and faster coverage decisions. The rules follow federal parity standards.
Stronger network and wait-time rules
The Department sets minimum doctor-to-member ratios and travel and wait-time limits each year, at least as strict as federal rules. For mental health and substance use care: in Cook, DuPage, Kane, Lake, McHenry, and Will counties, outpatient care must be within 30 minutes or 30 miles and first visits within 10 business days (20 for follow-ups); in other counties, 60 minutes or 60 miles with the same waits. Inpatient or residential MH/SUD care must be within 60 minutes or 60 miles statewide, and plans must allow exceptions if no in-network provider is available. Starting January 1, 2026, each in-network hospital must include at least one radiologist, pathologist, anesthesiologist, and ER doctor as preferred providers. The Department may grant limited exceptions (not for the MH timely-access rule), will review standards over time, and will give issuers notice by May 15 when enforcing new federal standards. The law defines key terms, including that a “material change” includes a 10% drop in a provider type in a county.
Fair limits on insurer payment take-backs
Insurers must send a detailed remittance advice for any recoupment and give providers 60 days to appeal. Insurers cannot recoup or offset payments 12 months or more after the original payment, except for fraud findings, full payment by another payer, certain Medicaid or state plan duties, CHIPlan administration, or a mutual agreement after a timely request. Contracts cannot allow recoupments that break these rules.
More Insurance Code rules for HMOs
HMOs must follow additional sections of the Illinois Insurance Code. This increases oversight and compliance duties for HMOs, which supports stronger protections for their enrollees.
Approval rules for big reinsurance deals
Some reinsurance deals now need written approval. Approval is required when the assuming insurer would take on more than 20% of its aggregate reserves and claim liabilities. It is also required when a Class 2 or 3 company cedes more than 20% of its net previously retained unearned premium reserve liability at one time or within six months. Companies must file for approval at least 30 working days before the stated effective date. A complete filing is deemed approved if not disapproved within 30 working days.
Stronger oversight of insurance company leaders
The Department must find a new insurance company has a sound plan and trustworthy leaders before it gets a license. Companies must tell the Director within 30 days when they add a new officer or director. After notice and a hearing, the Director can order removal of an unfit officer and suspend the company's license if it does not comply within 30 days. Companies cannot borrow from people convicted of fraud, theft, conversion, or similar crimes, or from people the Director finds untrustworthy.
Add a parent as a dependent
Beginning January 1, 2026, plans that offer dependent coverage must also offer it to your parent or stepparent who is your IRS qualifying relative and lives in the plan’s service area. This does not apply to Medicare supplement, hospital‑only, accident‑only, specified disease, or certain specialized plans.
Network and directory rules for dental plans
Provider directory and transparency rules apply to dental network plans that are not exempt and are subject to federal requirements. If federal law sets network adequacy and transparency standards for stand‑alone dental plans, the state enforces those standards for plans on or after January 1, 2025. For managed care dental plans, if this law conflicts with the Network Adequacy and Transparency Act, that Act controls. Asking people to enroll is not illegal solicitation by a managed care entity.
Faster reporting after big network changes
Insurers must report any material network change within 15 business days and file the revisions. The Director can reassess compliance and fine $5,000 for each day the filing is late after the 15‑business‑day window.
What insurers must file and allow
Before selling or renewing a plan, insurers must file how they add providers, make referrals, and give 24/7 access to primary care, emergency, and OB‑GYN care. They must also file maps, provider locations, expected members, a website and toll‑free number, and how services will be accessible, including travel limits and telehealth. Exchange plans must include essential community providers each plan year. Insurers cannot stop in‑network providers from discussing treatment options or advocating for patients in reviews or appeals.
Higher fees for public adjusters
The law sets clear fees for public adjuster licenses. Illinois residents pay $250 every two years. Nonresidents pay $500 every two years. A business entity license costs $250 every two years. Each request to take the written exam costs $50.
When these insurance rules take effect
The Act takes effect upon becoming law. Changes to Section 1563 take effect January 1, 2026. Changes to Section 174 take effect 60 days after the Act becomes law. These dates control when the new insurance rules apply.
Sponsors & Cosponsors
Sponsor
Bob Morgan
Democratic • House
Cosponsors
Julie A. Morrison
Democratic • Senate
Thaddeus Jones
Democratic • House
Roll Call Votes
House vote • 5/31/2025
Senate Committee Amendment No. 1 House Concurs
Yes: 114 • No: 0
House vote • 5/29/2025
Senate Committee Amendment No. 1 Motion to Concur Recommends Be Adopted Insurance Committee;
Yes: 15 • No: 0
Senate vote • 5/22/2025
Third Reading - Passed;
Yes: 46 • No: 10
Senate vote • 5/7/2025
Do Pass as Amended Insurance;
Yes: 12 • No: 0
House vote • 4/10/2025
Third Reading - Short Debate - Passed
Yes: 73 • No: 38
House vote • 4/9/2025
House Floor Amendment No. 1 Recommends Be Adopted Insurance Committee;
Yes: 11 • No: 4
House vote • 3/20/2025
Do Pass / Short Debate Insurance Committee;
Yes: 11 • No: 6
Actions Timeline
Public Act . . . . . . . . . 104-0334
8/15/2025HouseEffective Date January 1, 2026; some provisions
8/15/2025HouseEffective Date October 14, 2025; some provisions
8/15/2025HouseEffective Date August 15, 2025; some provisions
8/15/2025HouseGovernor Approved
8/15/2025HouseSent to the Governor
6/24/2025HousePassed Both Houses
5/31/2025HouseHouse Concurs
5/31/2025HouseSenate Committee Amendment No. 1 House Concurs 114-000-000
5/31/2025HouseSenate Committee Amendment No. 1 Motion to Concur Recommends Be Adopted Insurance Committee; 015-000-000
5/29/2025HouseSenate Committee Amendment No. 1 Motion to Concur Rules Referred to Insurance Committee
5/28/2025HouseSenate Committee Amendment No. 1 Motion to Concur Referred to Rules Committee
5/23/2025HouseSenate Committee Amendment No. 1 Motion Filed Concur Rep. Bob Morgan
5/23/2025HousePlaced on Calendar Order of Concurrence Senate Amendment(s) 1
5/23/2025HouseArrived in House
5/23/2025HouseThird Reading - Passed; 046-010-000
5/22/2025SenatePlaced on Calendar Order of 3rd Reading May 13, 2025
5/8/2025SenateSecond Reading
5/8/2025SenatePlaced on Calendar Order of 2nd Reading May 8, 2025
5/7/2025SenateDo Pass as Amended Insurance; 012-000-000
5/7/2025SenateSenate Committee Amendment No. 1 Adopted
5/6/2025SenateSenate Committee Amendment No. 1 Assignments Refers to Insurance
5/6/2025SenateSenate Committee Amendment No. 1 Referred to Assignments
5/5/2025SenateSenate Committee Amendment No. 1 Filed with Secretary by Sen. Julie A. Morrison
5/5/2025SenateAssigned to Insurance
4/29/2025Senate
Bill Text
Engrossed
Enrolled
House Amendment 1
Introduced
Senate Amendment 1