HB2785 amends the Illinois Insurance Code to expand and clarify how health insurers must handle out-of-network billing for emergency and certain non-emergency services. The bill keeps the existing protections for emergency services and ancillary services at participating facilities, but adds detailed rules for ground ambulance services, including new definitions for emergency ground ambulance service, urgent ground ambulance service, ground ambulance service provider, and nonparticipating ground ambulance service provider. It also sets out how insurers must calculate cost sharing, how providers are paid, and when billing disputes may proceed to binding arbitration.
Beginning January 1, 2027, group and individual health insurance policies must cover emergency ground ambulance service and urgent ground ambulance service. For nonparticipating ground ambulance providers, the bill limits what insureds can be charged out of pocket, ties payment standards to local government rates or other benchmarks, and requires annual reporting of average gross charge rates to the Department of Public Health starting October 1, 2026. The Department of Insurance is given authority to administer arbitration and enforcement, and the Department of Public Health is tasked with collecting and publishing rate information. The bill also states that home rule units may not regulate ground ambulance payments inconsistently with the Act.
Impact
The bill substantially revises Section 356z.3a of the Illinois Insurance Code by adding a new ground-ambulance coverage framework and by updating the rules governing emergency and ancillary out-of-network billing. It affects health insurance issuers, hospitals, freestanding emergency centers, ambulatory surgical treatment centers, nonparticipating providers, and especially ground ambulance service providers, while also creating new duties for the Department of Insurance and the Department of Public Health. It preserves existing patient protections against balance billing in covered emergency and ancillary-service situations and extends similar protections to ground ambulance services, while preempting inconsistent home rule regulation.
Sentiment
The voting record shows overwhelming bipartisan support, with 115-0 in the House on third reading, 56-0 in the Senate on third reading, and 116-0 in House concurrence. No committee transcript was provided, so there is no recorded floor or committee debate to indicate opposition or divided views. The unanimous votes suggest the bill was broadly viewed as a consumer-protection and insurance-billing measure with little public legislative resistance.
Contention
The main policy tension in the bill is between protecting patients from surprise bills and preserving reimbursement mechanisms for providers, particularly nonparticipating ground ambulance services. The bill addresses this by limiting patient cost sharing, setting payment benchmarks, and allowing binding arbitration when insurers and providers cannot agree on reimbursement. Another potential point of contention is the new reporting and administrative burden on ambulance providers and the Department of Public Health, as well as the preemption of local regulation through the home rule limitation. However, the recorded votes indicate these issues did not produce visible legislative opposition.