INS-DENTAL COVERAGE REIMBURSE

Illinois General Assembly - Full Text of SB2878

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Senate Amendment 001

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Introduced

Senate Amendment 001

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB2878

Introduced 1/16/2026, by Sen. Julie A. Morrison

SYNOPSIS AS INTRODUCED:

215 ILCS 5/355.5

Amends the Illinois Insurance Code. Prohibits an insurer, dental
service plan corporation, professional service corporation, insurance
network leasing company, or any other company or its contracted vendor
that amends, delivers, issues, or renews an individual or group policy of
accident and health insurance on or after the effective date of the
amendatory Act from requiring a dental care provider to only accept
payment from a credit card or electronic funds transfer, in addition to the
existing prohibition on incurred fees to access and obtain payment or
reimbursement for services provided. Provides that any insurer, dental
service plan corporation, professional service corporation, insurance
network leasing company, or any other company or its contracted vendor
that amends, delivers, issues, or renews an individual or group policy of
accident and health insurance may initiate or change payment methodology
to a dental care provider using electronic funds transfer payments,
including virtual credit card payments, if the specified conditions are
met. Sets forth provisions concerning claim payment methodologies and fees
for transmitting payments. Provides that the specified dental coverage
reimbursement provisions shall not be waived by contract. Effective
January 1, 2027.
LRB104 16882 BAB 30292 b

A BILL FOR

SB2878
LRB104 16882 BAB 30292 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 Illinois Insurance Code is amended by
5
changing Section 355.5 as follows:

6

(215 ILCS 5/355.5)
7

Sec. 355.5.
Dental coverage reimbursement; prohibitions.

8

(a)
No insurer, dental service plan corporation,
9
professional service corporation, insurance network leasing
10
company, or any
other
company
or its contracted vendor
that
11
amends, delivers, issues, or renews an individual or group
12
policy of accident and health insurance on or after
the
13
effective date of this amendatory Act of the 104th General
14
Assembly

the effective date of this amendatory Act of the
15
103rd General Assembly
shall require a dental care provider to
16
only accept payment from a credit card or electronic funds
17
transfer or to
incur a fee to access and obtain payment or
18
reimbursement for services provided.
19

(b) Any insurer, dental service plan corporation,
20
professional service corporation, insurance network leasing
21
company, or any other company or its contracted vendor that
22
amends, delivers, issues, or renews an individual or group
23
policy of accident and health insurance

A dental plan carrier

SB2878
- 2 -
LRB104 16882 BAB 30292 b
1
shall provide a dental care provider with 100% of the
2
contracted amount of the payment or reimbursement.
3

(c) In this subsection, "express acceptance" means a clear
4
and direct agreement to the terms of payment method,
5
communicated explicitly by the dental plan to the dental care
6
provider, in writing, signifying acceptance of the payment
7
method without any ambiguity or implied actions. Any insurer,
8
dental service plan corporation, professional service
9
corporation, insurance network leasing company, or any other
10
company or its contracted vendor that amends, delivers,
11
issues, or renews an individual or group policy of accident
12
and health insurance may initiate or change payment
13
methodology to a dental care provider using electronic funds
14
transfer payments, including virtual credit card payments, if:
15

(1) the dental care provider is notified of any fees
16

associated with a particular payment method;
17

(2) the insurer, dental service plan corporation,
18

professional service corporation, insurance network
19

leasing company, or other company or its contracted vendor
20

advises the dental care provider of the available methods
21

of payment and provides clear instructions to the dentist
22

as to how to select an alternative payment method that
23

does not impose fees or similar charges on the provider;
24

and
25

(3) the dental care provider or a designee of the
26

provider elects, through express acceptance, to accept a

SB2878
- 3 -
LRB104 16882 BAB 30292 b
1

payment of the claim using the credit card or electronic
2

funds transfer payment method. Violation of express
3

acceptance nullifies an election on claim payment
4

methodology until the express agreement is executed.
5

(d) A dental care provider's selected form of claim
6
payment methodology remains effective until the dental care
7
provider chooses an alternative method of payment or a new
8
contract is executed.
9

(e) If a dental care provider requests a change in the
10
available payment methodology, then the insurer, dental
11
service plan corporation, professional service corporation,
12
insurance network leasing company, or other company or its
13
contracted vendor that amends, delivers, issues, or renews an
14
individual or group policy of accident and health insurance
15
shall implement the change within 30 business days after the
16
request.
17

(f) An insurer or managed care plan shall not use a dental
18
care provider's preferred method of payment as a factor when
19
deciding whether to provide credentials to a dentist.
20

(g) A dental benefit plan or its contracted vendor or
21
health maintenance organization that initiates or changes
22
payments to a dentist through the Automated Clearing House
23
Network in accordance with 45 CFR 162.1601 and 45 CFR 162.1602
24
shall not charge a fee solely to transmit the payment to the
25
dental care provider unless the dental care provider has
26
consented to the fee. A dental care provider agent may charge

SB2878
- 4 -
LRB104 16882 BAB 30292 b
1
reasonable fees when transmitting an Automated Clearing House
2
Network payment related to transaction management, data
3
management, portal services, and other value-added services,
4
in addition to bank transmittal.
5

(h) The requirements of this Section shall not be waived
6
by contract, and any contractual clause in conflict with the
7
requirements of this Section or that purports to waive any
8
requirements of this Section is void.

Fees incurred directly
9
by a dental care provider from third parties related to
10
transmitting an automated clearing house network claim,
11
transaction management, data management, or portal services
12
and other fees charged by third parties that are not in the
13
control of the dental plan carrier shall not be prohibited by
14
this Section.
15
(Source: P.A. 103-24, eff. 1-1-24
.)

16

Section 99.
Effective date.
This Act takes effect January
17
1, 2027.

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