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HB4908 - 104th General Assembly

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB4908

Introduced , by Rep. Martha Deuter

SYNOPSIS AS INTRODUCED:

5 ILCS 375/10

from Ch. 127, par. 530
215 ILCS 5/368h new

Amends the State Employees Group Insurance Act of 1971. Provides that
the Department of Central Management Services shall require all contracts,
managed care arrangements, and third-party administrator agreements under
the State Employees Group Insurance Program to apply site-neutral payment
principles for covered services. Grants the Department rulemaking
authority, including specified rules. Amends the Illinois Insurance Code.
Requires the Department of Insurance to instruct health insurance
companies operating in the State to apply site-neutral payment principles
for any covered service for any health insurance product the health
insurance company sells, manages, offers, or markets in the State. Grants
the Department rulemaking authority, including specified rules. Effective
January 1, 2027.
LRB104 18917 BAB 32362 b

A BILL FOR

HB4908
LRB104 18917 BAB 32362 b
1

AN ACT concerning regulation.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 5.
The State Employees Group Insurance Act of 1971
5
is amended by changing Section 10 as follows:

6

(5 ILCS 375/10)

(from Ch. 127, par. 530)
7

Sec. 10.
Contributions by the State and members.
8

(a) The State shall pay the cost of basic non-contributory
9
group life insurance and, subject to member paid contributions
10
set by the Department or required by this Section and except as
11
provided in this Section, the basic program of group health
12
benefits on each eligible member, except a member, not
13
otherwise covered by this Act, who has retired as a
14
participating member under Article 2 of the Illinois Pension
15
Code but is ineligible for the retirement annuity under
16
Section 2-119 of the Illinois Pension Code, and part of each
17
eligible member's and retired member's premiums for health
18
insurance coverage for enrolled dependents as provided by
19
Section 9. The State shall pay the cost of the basic program of
20
group health benefits only after benefits are reduced by the
21
amount of benefits covered by Medicare for all members and
22
dependents who are eligible for benefits under Social Security
23
or the Railroad Retirement system or who had sufficient

HB4908
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LRB104 18917 BAB 32362 b
1
Medicare-covered government employment, except that such
2
reduction in benefits shall apply only to those members and
3
dependents who (1) first become eligible for such Medicare
4
coverage on or after July 1, 1992; or (2) are
5
Medicare-eligible members or dependents of a local government
6
unit which began participation in the program on or after July
7
1, 1992; or (3) remain eligible for, but no longer receive
8
Medicare coverage which they had been receiving on or after
9
July 1, 1992. The Department may determine the aggregate level
10
of the State's contribution on the basis of actual cost of
11
medical services adjusted for age, sex or geographic or other
12
demographic characteristics which affect the costs of such
13
programs.
14

The cost of participation in the basic program of group
15
health benefits for the dependent or survivor of a living or
16
deceased retired employee who was formerly employed by the
17
University of Illinois in the Cooperative Extension Service
18
and would be an annuitant but for the fact that he or she was
19
made ineligible to participate in the State Universities
20
Retirement System by clause (4) of subsection (a) of Section
21
15-107 of the Illinois Pension Code shall not be greater than
22
the cost of participation that would otherwise apply to that
23
dependent or survivor if he or she were the dependent or
24
survivor of an annuitant under the State Universities
25
Retirement System.
26

(a-1) (Blank).

HB4908
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LRB104 18917 BAB 32362 b
1

(a-2) (Blank).
2

(a-3) (Blank).
3

(a-4) (Blank).
4

(a-5) (Blank).
5

(a-6) (Blank).
6

(a-7) (Blank).
7

(a-8) Any annuitant, survivor, or retired employee may
8
waive or terminate coverage in the program of group health
9
benefits. Any such annuitant, survivor, or retired employee
10
who has waived or terminated coverage may enroll or re-enroll
11
in the program of group health benefits only during the annual
12
benefit choice period, as determined by the Director; except
13
that in the event of termination of coverage due to nonpayment
14
of premiums, the annuitant, survivor, or retired employee may
15
not re-enroll in the program.
16

(a-8.5) Beginning on July 1, 2012 (the effective date of
17
Public Act 97-695), the Director of Central Management
18
Services shall, on an annual basis, determine the amount that
19
the State shall contribute toward the basic program of group
20
health benefits on behalf of annuitants (including individuals
21
who (i) participated in the General Assembly Retirement
22
System, the State Employees' Retirement System of Illinois,
23
the State Universities Retirement System, the Teachers'
24
Retirement System of the State of Illinois, or the Judges
25
Retirement System of Illinois and (ii) qualify as annuitants
26
under subsection (b) of Section 3 of this Act), survivors

HB4908
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LRB104 18917 BAB 32362 b
1
(including individuals who (i) receive an annuity as a
2
survivor of an individual who participated in the General
3
Assembly Retirement System, the State Employees' Retirement
4
System of Illinois, the State Universities Retirement System,
5
the Teachers' Retirement System of the State of Illinois, or
6
the Judges Retirement System of Illinois and (ii) qualify as
7
survivors under subsection (q) of Section 3 of this Act), and
8
retired employees (as defined in subsection (p) of Section 3
9
of this Act). The remainder of the cost of coverage for each
10
annuitant, survivor, or retired employee, as determined by the
11
Director of Central Management Services, shall be the
12
responsibility of that annuitant, survivor, or retired
13
employee.
14

Contributions required of annuitants, survivors, and
15
retired employees shall be the same for all retirement systems
16
and shall also be based on whether an individual has made an
17
election under Section 15-135.1 of the Illinois Pension Code.
18
Contributions may be based on annuitants', survivors', or
19
retired employees' Medicare eligibility, but may not be based
20
on Social Security eligibility.
21

(a-9) No later than May 1 of each calendar year, the
22
Director of Central Management Services shall certify in
23
writing to the Executive Secretary of the State Employees'
24
Retirement System of Illinois the amounts of the Medicare
25
supplement health care premiums and the amounts of the health
26
care premiums for all other retirees who are not Medicare

HB4908
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LRB104 18917 BAB 32362 b
1
eligible.
2

A separate calculation of the premiums based upon the
3
actual cost of each health care plan shall be so certified.
4

The Director of Central Management Services shall provide
5
to the Executive Secretary of the State Employees' Retirement
6
System of Illinois such information, statistics, and other
7
data as he or she may require to review the premium amounts
8
certified by the Director of Central Management Services.
9

The Department of Central Management Services, or any
10
successor agency designated to procure health care contracts
11
pursuant to this Act, is authorized to establish funds,
12
separate accounts provided by any bank or banks as defined by
13
the Illinois Banking Act, or separate accounts provided by any
14
savings and loan association or associations as defined by the
15
Illinois Savings and Loan Act of 1985 to be held by the
16
Director, outside the State treasury, for the purpose of
17
receiving the transfer of moneys from the Local Government
18
Health Insurance Reserve Fund. The Department may promulgate
19
rules further defining the methodology for the transfers. Any
20
interest earned by moneys in the funds or accounts shall inure
21
to the Local Government Health Insurance Reserve Fund. The
22
transferred moneys, and interest accrued thereon, shall be
23
used exclusively for transfers to administrative service
24
organizations or their financial institutions for payments of
25
claims to claimants and providers under the self-insurance
26
health plan. The transferred moneys, and interest accrued

HB4908
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LRB104 18917 BAB 32362 b
1
thereon, shall not be used for any other purpose including,
2
but not limited to, reimbursement of administration fees due
3
the administrative service organization pursuant to its
4
contract or contracts with the Department.
5

(a-10) To the extent that participation, benefits, or
6
premiums under this Act are based on a person's service credit
7
under an Article of the Illinois Pension Code, service credit
8
terminated in exchange for an accelerated pension benefit
9
payment under Section 14-147.5, 15-185.5, or 16-190.5 of that
10
Code shall be included in determining a person's service
11
credit for the purposes of this Act.
12

(b) State employees who become eligible for this program
13
on or after January 1, 1980 in positions normally requiring
14
actual performance of duty not less than 1/2 of a normal work
15
period but not equal to that of a normal work period, shall be
16
given the option of participating in the available program. If
17
the employee elects coverage, the State shall contribute on
18
behalf of such employee to the cost of the employee's benefit
19
and any applicable dependent supplement, that sum which bears
20
the same percentage as that percentage of time the employee
21
regularly works when compared to normal work period.
22

(c) The basic non-contributory coverage from the basic
23
program of group health benefits shall be continued for each
24
employee not in pay status or on active service by reason of
25
(1) leave of absence due to illness or injury, (2) authorized
26
educational leave of absence or sabbatical leave, or (3)

HB4908
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LRB104 18917 BAB 32362 b
1
military leave. This coverage shall continue until expiration
2
of authorized leave and return to active service, but not to
3
exceed 24 months for leaves under item (1) or (2). This
4
24-month limitation and the requirement of returning to active
5
service shall not apply to persons receiving ordinary or
6
accidental disability benefits or retirement benefits through
7
the appropriate State retirement system or benefits under the
8
Workers' Compensation Act or the Workers' Occupational
9
Diseases Act.
10

(d) The basic group life insurance coverage shall
11
continue, with full State contribution, where such person is
12
(1) absent from active service by reason of disability arising
13
from any cause other than self-inflicted, (2) on authorized
14
educational leave of absence or sabbatical leave, or (3) on
15
military leave.
16

(e) Where the person is in non-pay status for a period in
17
excess of 30 days or on leave of absence, other than by reason
18
of disability, educational or sabbatical leave, or military
19
leave, such person may continue coverage only by making
20
personal payment equal to the amount normally contributed by
21
the State on such person's behalf. Such payments and coverage
22
may be continued: (1) until such time as the person returns to
23
a status eligible for coverage at State expense, but not to
24
exceed 24 months or (2) until such person's employment or
25
annuitant status with the State is terminated (exclusive of
26
any additional service imposed pursuant to law).

HB4908
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LRB104 18917 BAB 32362 b
1

(f) The Department shall establish by rule the extent to
2
which other employee benefits will continue for persons in
3
non-pay status or who are not in active service.
4

(g) The State shall not pay the cost of the basic
5
non-contributory group life insurance, program of health
6
benefits and other employee benefits for members who are
7
survivors as defined by paragraphs (1) and (2) of subsection
8
(q) of Section 3 of this Act. The costs of benefits for these
9
survivors shall be paid by the survivors or by the University
10
of Illinois Cooperative Extension Service, or any combination
11
thereof. However, the State shall pay the amount of the
12
reduction in the cost of participation, if any, resulting from
13
the amendment to subsection (a) made by Public Act 91-617.
14

(h) Those persons occupying positions with any department
15
as a result of emergency appointments pursuant to Section 8b.8
16
of the Personnel Code who are not considered employees under
17
this Act shall be given the option of participating in the
18
programs of group life insurance, health benefits and other
19
employee benefits. Such persons electing coverage may
20
participate only by making payment equal to the amount
21
normally contributed by the State for similarly situated
22
employees. Such amounts shall be determined by the Director.
23
Such payments and coverage may be continued until such time as
24
the person becomes an employee pursuant to this Act or such
25
person's appointment is terminated.
26

(i) Any unit of local government within the State of

HB4908
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LRB104 18917 BAB 32362 b
1
Illinois may apply to the Director to have its employees,
2
annuitants, and their dependents provided group health
3
coverage under this Act on a non-insured basis. To
4
participate, a unit of local government must agree to enroll
5
all of its employees, who may select coverage under any group
6
health benefits plan made available by the Department under
7
the health benefits program established under this Section or
8
a health maintenance organization that has contracted with the
9
State to be available as a health care provider for employees
10
as defined in this Act. A unit of local government must remit
11
the entire cost of providing coverage under the health
12
benefits program established under this Section or, for
13
coverage under a health maintenance organization, an amount
14
determined by the Director based on an analysis of the sex,
15
age, geographic location, or other relevant demographic
16
variables for its employees, except that the unit of local
17
government shall not be required to enroll those of its
18
employees who are covered spouses or dependents under the
19
State group health benefits plan or another group policy or
20
plan providing health benefits as long as (1) an appropriate
21
official from the unit of local government attests that each
22
employee not enrolled is a covered spouse or dependent under
23
this plan or another group policy or plan, and (2) at least 50%
24
of the employees are enrolled and the unit of local government
25
remits the entire cost of providing coverage to those
26
employees, except that a participating school district must

HB4908
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LRB104 18917 BAB 32362 b
1
have enrolled at least 50% of its full-time employees who have
2
not waived coverage under the district's group health plan by
3
participating in a component of the district's cafeteria plan.
4
A participating school district is not required to enroll a
5
full-time employee who has waived coverage under the
6
district's health plan, provided that an appropriate official
7
from the participating school district attests that the
8
full-time employee has waived coverage by participating in a
9
component of the district's cafeteria plan. For the purposes
10
of this subsection, "participating school district" includes a
11
unit of local government whose primary purpose is education as
12
defined by the Department's rules.
13

Employees of a participating unit of local government who
14
are not enrolled due to coverage under another group health
15
policy or plan may enroll in the event of a qualifying change
16
in status, special enrollment, special circumstance as defined
17
by the Director, or during the annual benefit choice period. A
18
participating unit of local government may also elect to cover
19
its annuitants. Dependent coverage shall be offered on an
20
optional basis, with the costs paid by the unit of local
21
government, its employees, or some combination of the two as
22
determined by the unit of local government. The unit of local
23
government shall be responsible for timely collection and
24
transmission of dependent premiums.
25

The Director shall annually determine monthly rates of
26
payment, subject to the following constraints:

HB4908
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LRB104 18917 BAB 32362 b
1

(1) In the first year of coverage, the rates shall be
2

equal to the amount normally charged to State employees
3

for elected optional coverages or for enrolled dependents
4

coverages or other contributory coverages, or contributed
5

by the State for basic insurance coverages on behalf of
6

its employees, adjusted for differences between State
7

employees and employees of the local government in age,
8

sex, geographic location or other relevant demographic
9

variables, plus an amount sufficient to pay for the
10

additional administrative costs of providing coverage to
11

employees of the unit of local government and their
12

dependents.
13

(2) In subsequent years, a further adjustment shall be
14

made to reflect the actual prior years' claims experience
15

of the employees of the unit of local government.
16

In the case of coverage of local government employees
17
under a health maintenance organization, the Director shall
18
annually determine for each participating unit of local
19
government the maximum monthly amount the unit may contribute
20
toward that coverage, based on an analysis of (i) the age, sex,
21
geographic location, and other relevant demographic variables
22
of the unit's employees and (ii) the cost to cover those
23
employees under the State group health benefits plan. The
24
Director may similarly determine the maximum monthly amount
25
each unit of local government may contribute toward coverage
26
of its employees' dependents under a health maintenance

HB4908
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LRB104 18917 BAB 32362 b
1
organization.
2

Monthly payments by the unit of local government or its
3
employees for group health benefits plan or health maintenance
4
organization coverage shall be deposited into the Local
5
Government Health Insurance Reserve Fund.
6

The Local Government Health Insurance Reserve Fund is
7
hereby created as a nonappropriated trust fund to be held
8
outside the State treasury, with the State Treasurer as
9
custodian. The Local Government Health Insurance Reserve Fund
10
shall be a continuing fund not subject to fiscal year
11
limitations. The Local Government Health Insurance Reserve
12
Fund is not subject to administrative charges or charge-backs,
13
including, but not limited to, those authorized under Section
14
8h of the State Finance Act. All revenues arising from the
15
administration of the health benefits program established
16
under this Section shall be deposited into the Local
17
Government Health Insurance Reserve Fund. Any interest earned
18
on moneys in the Local Government Health Insurance Reserve
19
Fund shall be deposited into the Fund. All expenditures from
20
this Fund shall be used for payments for health care benefits
21
for local government and rehabilitation facility employees,
22
annuitants, and dependents, and to reimburse the Department or
23
its administrative service organization for all expenses
24
incurred in the administration of benefits. No other State
25
funds may be used for these purposes.
26

A local government employer's participation or desire to

HB4908
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LRB104 18917 BAB 32362 b
1
participate in a program created under this subsection shall
2
not limit that employer's duty to bargain with the
3
representative of any collective bargaining unit of its
4
employees.
5

(j) Any rehabilitation facility within the State of
6
Illinois may apply to the Director to have its employees,
7
annuitants, and their eligible dependents provided group
8
health coverage under this Act on a non-insured basis. To
9
participate, a rehabilitation facility must agree to enroll
10
all of its employees and remit the entire cost of providing
11
such coverage for its employees, except that the
12
rehabilitation facility shall not be required to enroll those
13
of its employees who are covered spouses or dependents under
14
this plan or another group policy or plan providing health
15
benefits as long as (1) an appropriate official from the
16
rehabilitation facility attests that each employee not
17
enrolled is a covered spouse or dependent under this plan or
18
another group policy or plan, and (2) at least 50% of the
19
employees are enrolled and the rehabilitation facility remits
20
the entire cost of providing coverage to those employees.
21
Employees of a participating rehabilitation facility who are
22
not enrolled due to coverage under another group health policy
23
or plan may enroll in the event of a qualifying change in
24
status, special enrollment, special circumstance as defined by
25
the Director, or during the annual benefit choice period. A
26
participating rehabilitation facility may also elect to cover

HB4908
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LRB104 18917 BAB 32362 b
1
its annuitants. Dependent coverage shall be offered on an
2
optional basis, with the costs paid by the rehabilitation
3
facility, its employees, or some combination of the 2 as
4
determined by the rehabilitation facility. The rehabilitation
5
facility shall be responsible for timely collection and
6
transmission of dependent premiums.
7

The Director shall annually determine quarterly rates of
8
payment, subject to the following constraints:
9

(1) In the first year of coverage, the rates shall be
10

equal to the amount normally charged to State employees
11

for elected optional coverages or for enrolled dependents
12

coverages or other contributory coverages on behalf of its
13

employees, adjusted for differences between State
14

employees and employees of the rehabilitation facility in
15

age, sex, geographic location or other relevant
16

demographic variables, plus an amount sufficient to pay
17

for the additional administrative costs of providing
18

coverage to employees of the rehabilitation facility and
19

their dependents.
20

(2) In subsequent years, a further adjustment shall be
21

made to reflect the actual prior years' claims experience
22

of the employees of the rehabilitation facility.
23

Monthly payments by the rehabilitation facility or its
24
employees for group health benefits shall be deposited into
25
the Local Government Health Insurance Reserve Fund.
26

(k) Any domestic violence shelter or service within the

HB4908
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LRB104 18917 BAB 32362 b
1
State of Illinois may apply to the Director to have its
2
employees, annuitants, and their dependents provided group
3
health coverage under this Act on a non-insured basis. To
4
participate, a domestic violence shelter or service must agree
5
to enroll all of its employees and pay the entire cost of
6
providing such coverage for its employees. The domestic
7
violence shelter shall not be required to enroll those of its
8
employees who are covered spouses or dependents under this
9
plan or another group policy or plan providing health benefits
10
as long as (1) an appropriate official from the domestic
11
violence shelter attests that each employee not enrolled is a
12
covered spouse or dependent under this plan or another group
13
policy or plan and (2) at least 50% of the employees are
14
enrolled and the domestic violence shelter remits the entire
15
cost of providing coverage to those employees. Employees of a
16
participating domestic violence shelter who are not enrolled
17
due to coverage under another group health policy or plan may
18
enroll in the event of a qualifying change in status, special
19
enrollment, or special circumstance as defined by the Director
20
or during the annual benefit choice period. A participating
21
domestic violence shelter may also elect to cover its
22
annuitants. Dependent coverage shall be offered on an optional
23
basis, with employees, or some combination of the 2 as
24
determined by the domestic violence shelter or service. The
25
domestic violence shelter or service shall be responsible for
26
timely collection and transmission of dependent premiums.

HB4908
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LRB104 18917 BAB 32362 b
1

The Director shall annually determine rates of payment,
2
subject to the following constraints:
3

(1) In the first year of coverage, the rates shall be
4

equal to the amount normally charged to State employees
5

for elected optional coverages or for enrolled dependents
6

coverages or other contributory coverages on behalf of its
7

employees, adjusted for differences between State
8

employees and employees of the domestic violence shelter
9

or service in age, sex, geographic location or other
10

relevant demographic variables, plus an amount sufficient
11

to pay for the additional administrative costs of
12

providing coverage to employees of the domestic violence
13

shelter or service and their dependents.
14

(2) In subsequent years, a further adjustment shall be
15

made to reflect the actual prior years' claims experience
16

of the employees of the domestic violence shelter or
17

service.
18

Monthly payments by the domestic violence shelter or
19
service or its employees for group health insurance shall be
20
deposited into the Local Government Health Insurance Reserve
21
Fund.
22

(l) A public community college or entity organized
23
pursuant to the Public Community College Act may apply to the
24
Director initially to have only annuitants not covered prior
25
to July 1, 1992 by the district's health plan provided health
26
coverage under this Act on a non-insured basis. The community

HB4908
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LRB104 18917 BAB 32362 b
1
college must execute a 2-year contract to participate in the
2
Local Government Health Plan. Any annuitant may enroll in the
3
event of a qualifying change in status, special enrollment,
4
special circumstance as defined by the Director, or during the
5
annual benefit choice period.
6

The Director shall annually determine monthly rates of
7
payment subject to the following constraints: for those
8
community colleges with annuitants only enrolled, first year
9
rates shall be equal to the average cost to cover claims for a
10
State member adjusted for demographics, Medicare
11
participation, and other factors; and in the second year, a
12
further adjustment of rates shall be made to reflect the
13
actual first year's claims experience of the covered
14
annuitants.
15

(l-5) The provisions of subsection (l) become inoperative
16
on July 1, 1999.
17

(m) The Director shall adopt any rules deemed necessary
18
for implementation of this amendatory Act of 1989 (Public Act
19
86-978).
20

(n) Any child advocacy center within the State of Illinois
21
may apply to the Director to have its employees, annuitants,
22
and their dependents provided group health coverage under this
23
Act on a non-insured basis. To participate, a child advocacy
24
center must agree to enroll all of its employees and pay the
25
entire cost of providing coverage for its employees. The child
26
advocacy center shall not be required to enroll those of its

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employees who are covered spouses or dependents under this
2
plan or another group policy or plan providing health benefits
3
as long as (1) an appropriate official from the child advocacy
4
center attests that each employee not enrolled is a covered
5
spouse or dependent under this plan or another group policy or
6
plan and (2) at least 50% of the employees are enrolled and the
7
child advocacy center remits the entire cost of providing
8
coverage to those employees. Employees of a participating
9
child advocacy center who are not enrolled due to coverage
10
under another group health policy or plan may enroll in the
11
event of a qualifying change in status, special enrollment, or
12
special circumstance as defined by the Director or during the
13
annual benefit choice period. A participating child advocacy
14
center may also elect to cover its annuitants. Dependent
15
coverage shall be offered on an optional basis, with the costs
16
paid by the child advocacy center, its employees, or some
17
combination of the 2 as determined by the child advocacy
18
center. The child advocacy center shall be responsible for
19
timely collection and transmission of dependent premiums.
20

The Director shall annually determine rates of payment,
21
subject to the following constraints:
22

(1) In the first year of coverage, the rates shall be
23

equal to the amount normally charged to State employees
24

for elected optional coverages or for enrolled dependents
25

coverages or other contributory coverages on behalf of its
26

employees, adjusted for differences between State

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1

employees and employees of the child advocacy center in
2

age, sex, geographic location, or other relevant
3

demographic variables, plus an amount sufficient to pay
4

for the additional administrative costs of providing
5

coverage to employees of the child advocacy center and
6

their dependents.
7

(2) In subsequent years, a further adjustment shall be
8

made to reflect the actual prior years' claims experience
9

of the employees of the child advocacy center.
10

Monthly payments by the child advocacy center or its
11
employees for group health insurance shall be deposited into
12
the Local Government Health Insurance Reserve Fund.
13

(o) In this subsection, "health insurance company",
14
"provider", and "site-neutral payment" have the meanings given
15
to those terms in Section 368h of the Illinois Insurance Code.
16
The Department of Central Management Services shall require
17
all contracts, managed care arrangements, and third-party
18
administrator agreements under the State Employees Group
19
Insurance Program to apply site-neutral payment principles for
20
covered services. The Department may adopt rules necessary to
21
implement this Act, including, but not limited to, rules
22
addressing:

23

(1) identification of services subject to site-neutral
24

payment;

25

(2) methodologies for determining equivalent
26

reimbursement rates; and

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1

(3) reporting and compliance requirements for
2

providers, contractors, and health insurance companies.

3
(Source: P.A. 104-417, eff. 8-15-25.)

4

Section 10.
The Illinois Insurance Code is amended by
5
adding Section 368h as follows:

6

(215 ILCS 5/368h new)
7

Sec. 368h.
Site-neutral payment principles.

8

(a) In this Section:
9

"Health insurance company" means any health maintenance
10
organization, preferred provider organization, or other entity
11
that pays for, manages, or arranges for other entities to pay
12
for health care services provided in this State.

13

"Provider" means any individual or entity licensed or
14
otherwise authorized under Illinois law to provide health care
15
services.

16

"Site-neutral payment" means reimbursement for a covered
17
health care service at the same rate, regardless of the
18
setting in which the service is provided, when the service is
19
clinically comparable and furnished by a health care provider
20
acting within the scope of the provider's license.

21

(b) The Department shall instruct health insurance
22
companies operating in this State to apply site-neutral
23
payment principles for any covered service for any health
24
insurance product the health insurance company sells, manages,

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1
offers, or markets in the State.

2

(c) The Department may adopt rules necessary to implement
3
this Act, including, but not limited to, rules addressing:

4

(1) identification of services subject to site-neutral
5

payment;

6

(2) methodologies for determining equivalent
7

reimbursement rates; and

8

(3) reporting and compliance requirements for
9

providers, contractors, and health insurance companies.

10

Section 99.
Effective date.
This Act takes effect January
11
1, 2027.

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