All Roll Calls
Yes: 282 • No: 58
IllinoisHB3800104th General Assembly (2025–2026)HouseWALLET
INSURANCE-VARIOUS
Sponsored By: Sponsor information unavailable
Signed by Governor
Summary
Amends the Burn Victims Relief Act. Dissolves the George Bailey Memorial Fund on June 30, 2025, or as soon thereafter as practical, and assigns any future deposits due to that Fund to the General Revenue Fund. Amends the Illinois Insurance Code. Requires every company licensed to do business in this State that is transacting the kind or kinds of business under Class 1, 2, or 3, as defined in the Code, to establish a customer affairs and information department to respond to policyholder inquiries and complaints. In provisions concerning kinds of agreements requiring approval, provides that the Director of Insurance has the right to request additional filing review and approval of all contracts that contribute to the statutory threshold trigger. Removes provisions concerning a working group related to the treatment and coverage of mental, emotional, nervous, or substance use disorders. Makes other changes. Amends the Dental Care Patient Protection Act. Makes changes concerning preemption of provisions. Amends the Health Maintenance Organization Act. Provides that health maintenance organizations are subject to provisions of the Illinois Insurance Code requiring coverage for certain at-home pregnancy tests and certain medically necessary treatments to address a major injury to the jaw. Amends the Network Adequacy and Transparency Act to make technical and combining changes to conform the changes made by Public Act 103-777 and 103-650. Amends the Limited Health Service Organization Act to make conforming changes. Amends the Criminal Code of 2012. Changes the definition of "insurance company". Effective immediately, except that certain changes to the Illinois Insurance Code are effective January 1, 2026 and certain other changes to the Illinois Insurance Code are effective 60 days after becoming law.
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Bill Overview
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20 provisions identified: 15 benefits, 3 costs, 2 mixed.
More accurate provider directories for patients
Insurers must provide searchable public online directories and printed directories on request, with provider details and instructions for disputing charges from incorrect listings. Listings include populations served, appointment availability, supplied digital contacts, and confirmed departure dates posted within 10 days. Providers must report information changes within 10 business days. They have 20 business days to report stopped acceptance of new patients when it is expected to last at least 40 business days. Insurers must update listings within 2 business days, audit every 90 days, correct errors, retain records, and submit audits and summaries. Penalties include $5,000 per month for missed updates, plus up to $5,000 per inaccurate-listing violation or $25,000 when the insurer knew or should have known.
Faster access to behavioral health care
Plans must use comparable network-access processes for mental health, substance use treatment, and medical or surgical care. Outpatient travel limits are 30 minutes or 30 miles in Cook, DuPage, Kane, Lake, McHenry, and Will counties. Elsewhere, the limit is 60 minutes or 60 miles; inpatient and residential care use that limit statewide. First appointments must be available within 10 business days and follow-ups within 20, unless the patient or provider voluntarily chooses later. Plans must provide needed network exceptions when no provider meets these standards. Stronger applicable federal standards control, including for large-group and off-Exchange plans, for the required periods and plan years.
In-network costs when networks fall short
Covered emergency care costs no more because the provider is outside your network. Other covered care also gets in-network costs when an appropriate preferred provider is unavailable despite your good-faith search. You must check the directory, call the plan, and call the provider. Provider shortages, unreasonable travel or delays, and legally protected conscience-based refusals count; this search-based protection excludes HMO members and voluntary out-of-network choices when preferred care is available. Separately, when a county's network is inadequate for a provider type without an approved exception, affected covered claims receive in-network benefits. Insurers must reprocess earlier claims wrongly paid at out-of-network levels and reimburse members.
Marketplace plans must include community providers
Individual and small-group marketplace insurers must show that their networks include essential community providers. The same requirement applies to matching plans sold outside the Illinois marketplace. Insurers must meet the marketplace's rules for each plan year.
More in-network specialists at hospitals
Beginning January 1, 2026, insurers must show that each in-network hospital has four types of preferred specialists. Each hospital must have at least one radiologist, pathologist, anesthesiologist, and emergency room physician in that role. The Illinois Department of Insurance can require additional specialist types by rule. This does not mean every specialist at the hospital is in-network.
Stronger provider access standards for patients
Network plans must meet minimum provider ratios and travel, distance, and appointment-wait standards at least as protective as applicable federal rules. Federal requirements reach large-group and off-Exchange plans; federal standards also govern when no applicable Illinois rule exists. The separate state travel and wait standards exclude plans offered solely as group health plans; tiered networks use the lowest-cost-sharing tier. Network-plan rules cover provider arrangements through insurers or contracted third parties, and providers include health care institutions and facilities. The law also updates the definition of excepted benefits to address individual, group, and blanket forms of coverage.
Current printed directories and regular audits
Insurers must give current printed provider directories or requested directory information to members and people considering coverage. Printed directories need updates and correction sheets at least every 90 days, unless they match the online directory when printed. Insurers must also audit each plan’s directories at least every 90 days, fix errors, and keep records. Audits must contact providers who have not billed the plan or otherwise confirmed they intend to stay in its network. Insurers must send audits and summaries to the state, which must publish the summaries.
Faster fixes to provider directory errors
Providers must report directory changes within 10 business days; plans must update listings within 2 business days after notice. Providers have 20 business days to report new-patient limits expected to last at least 40 business days. When an insurer or the state finds a wrongly listed provider, the insurer must check all its plan directories within 2 business days and remove incorrect listings without delay. Insurers face a $5,000 monthly penalty for failing to update directories. Separate fines reach $5,000 per violation, excluding provider-supplied errors, or $25,000 when the insurer or its representative knew or should have known a listing was wrong.
Closer checks on shrinking provider networks
Before issuing, delivering, or renewing plans, insurers must file provider, service, referral, enrollment, directory, and access information for state review. Filings must explain round-the-clock access to primary, emergency, and obstetric and gynecological care. A county's loss of at least 10% of one provider type is a material change; losing a major health system also counts when it significantly changes the purchased network. Insurers must report material changes within 15 business days and file marked revisions; late revised filings can bring $5,000 daily fines. The state can block sales or renewals in an inadequate county without an approved exception or required compliance process, with $5,000 penalties per policy issued or renewed in violation. A later finding based on a material change cannot end existing coverage before the policy period expires.
Stronger treatment and advocacy protections
Ongoing treatment includes serious or complex conditions, inpatient care, terminal illness treatment, and repeated services under a provider's treatment plan. It also includes scheduled nonelective surgery and that provider's care before and after surgery. Insurers cannot stop preferred providers from discussing treatment options or advocating for patients in reviews, complaints, or appeals. This protection applies even when the insurer disagrees with the treatment. Network-plan limits on prior approval must also follow the referenced protections in the Prior Authorization Reform Act.
Criminal insurance rules cover more organizations
Illinois criminal law uses a broader definition of an insurance company. It includes insurance-code companies, dental service plans, health maintenance organizations, limited health service organizations, and health services plans. It also includes trusts under the state’s religious and charitable risk-pooling law. The change applies to criminal-code rules using that definition; it does not identify a new offense or household payment.
More insurance rules cover health plans
Health maintenance organizations and limited health service organizations must follow additional Illinois insurance-code rules. This does not require limited health plans to cover services outside their limited scope. The listed changes do not describe the added rules, so they do not establish specific savings or coverage gains.
Closer financial checks on insurance companies
Before authorizing an insurer, the state must find that its leaders have enough experience and no identified financial concerns threaten solvency or needed capital. For Class 2 and Class 3 insurers, reinsurance review uses net unearned premium reserves for existing business not already reinsured. The Director can require review and approval of all contributing contracts when transfers exceed 20% at once or over six consecutive months. Domestic insurers must request approval for covered agreements at least 30 working days before their stated start date. Agreements are deemed approved unless rejected within 30 working days after a complete filing.
Shorter payment clawback window for providers
Insurers, HMOs, independent practice associations, and physician hospital organizations generally cannot recover provider payments 12 months or more after payment. This replaces the prior 18-month limit. Exceptions include formal fraud or material-misrepresentation findings, specified Comprehensive Health Insurance Plan administration, prior full payment by another payer, and federal Medicaid requirements. Providers and insurers can agree to later withholding from future payments if repayment was requested within 12 months. Repayment notices must explain the claim, amount, reason, and appeal contacts; providers have 60 days to appeal.
Safety-net hospitals avoid insurance purchase taxes
Qualifying Safety-Net Hospitals are exempt from reporting, tax, and countersigning-fee duties for covered insurance bought directly from unauthorized insurers. The hospital must also qualify as an industrial insured. Safety-Net Hospital status follows the Illinois Public Aid Code definition.
Insurers can seek network access exceptions
Insurers unable to meet provider, travel, or appointment standards can request state approval to operate below those standards. Grounds include unavailable providers, local care patterns that do not support required provider numbers, or another state-approved circumstance. For unavailable providers, insurers must disclose extra travel time and distance and identify the next closest contracted provider or facility. Requests based on local care patterns require supporting local data. Approval is not automatic, and this process excludes the separate requirements in subsection (d-5).
Public adjusters pay two-year license fees
Public adjuster license applicants who live in Illinois pay $250 every two years. Applicants who live outside Illinois pay $500 every two years. These are licensing charges for adjusters, not fees charged directly to insurance customers.
Business insurance purchases carry filing duties
These rules cover Illinois-home-state industrial insureds buying Class 2 or Class 3 coverage directly from unauthorized insurers. They must use a qualified risk manager, buy without an insurance producer, and qualify as exempt commercial purchasers. Except for qualifying Safety-Net Hospitals, they must report within 90 days after coverage starts and pay taxes and a countersigning fee within 30 days after filing. Contracts starting in 2018 or later carry a 0.5% gross-premium payment plus applicable fire marshal tax; 2015–2017 contracts carry surplus line tax plus applicable fire marshal tax. For covered contracts starting in 2015 or later, the countersigning fee equals the statutory member rate, and required amounts must be withheld from premiums or paid despite the failure to withhold.
Dental network protections have separate limits
Stand-alone dental plans are outside Illinois's Network Adequacy and Transparency Act, but the state must enforce applicable federal standards. This includes applicable federal appointment-wait rules. Federal provider-ratio and travel standards apply when established for Illinois's marketplace type and the relevant plan year. For plans covered by both state dental-patient and network laws, network requirements take priority when dental-law rules block them.
Stronger network checks with limited exceptions
Insurers must report major network changes and file revised documents showing those changes within 15 business days, or face fines of $5,000 per late day. Insurers unable to meet provider, travel, or appointment standards can request exceptions, with a legal basis and supporting information. The state can stop plan sales or renewals in a county when the network is inadequate, no exception applies, and the insurer lacks a required mental health and substance use access process. Violating that order can bring a $5,000 penalty per policy. Existing coverage cannot end before the policy period expires solely because of a network inadequacy or later major-change finding.
Sponsors & Cosponsors
Sponsors
There is no primary sponsor on record.
Cosponsors
Bob Morgan
Democratic • House
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
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