INS CD-FAIR PHYSICIAN PAYMENT

Illinois General Assembly - Full Text of SB3181

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Introduced

Senate Amendment 001

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Introduced

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB3181

Introduced 2/2/2026, by Sen. Omar Aquino

SYNOPSIS AS INTRODUCED:

215 ILCS 5/368k new

Amends the Illinois Insurance Code. Sets forth provisions concerning
minimum reimbursement rates that a health insurance company must provide
for a physician providing health care services in the specified counties.
Prohibits a physician from waiving minimum reimbursement protections as a
condition of participation in a health benefit plan or for any other
reason. Grants the Department of Insurance rulemaking authority and
establishes penalty provisions for violations of the minimum reimbursement
provisions.
LRB104 18630 BAB 32073 b

A BILL FOR

SB3181
LRB104 18630 BAB 32073 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
adding Section 368k as follows:

6

(215 ILCS 5/368k new)
7

Sec. 368k.
Fair physician payment; minimum reimbursement;
8
penalties.
9

(a) In this Section:
10

"County" means one or all of the following 4 counties:
11
Cook, DuPage, Lake, and Will Counties in Illinois.
12

"Covered health care service" means any service for which
13
a Medicare rate has been established at the time the physician
14
service is provided.
15

"Health insurance company" means any insurance company,
16
health maintenance organization, preferred provider
17
organization, or other entity that administers a health
18
insurance plan subject to regulation under the laws of
19
Illinois.
20

"Health insurance plan" does not include a noncommercial
21
insurance plan, such as a personal line or a policy of excepted
22
benefits.
23

"Medicare rate" means the applicable Current Procedural

SB3181
- 2 -
LRB104 18630 BAB 32073 b
1
Terminology (CPT) Code established under the Medicare
2
Physician Fee Schedule in effect on the date the physician
3
services are rendered.
4

"Physician" means an individual licensed to practice
5
medicine or osteopathy under applicable State law and any
6
advanced practice provider practicing under the supervision of
7
a physician.
8

(b) A health insurance company shall reimburse a physician
9
providing covered health care services in any county for no
10
less than 160% of the Medicare rate then in effect for the same
11
service.
12

(c) If Medicare established multiple payment rates for a
13
service, the reimbursement floor shall be calculated using the
14
rate that most closely corresponds to the setting and type of
15
service.
16

(d) Any contract, policy, or agreement that provides for
17
reimbursement at a rate lower than the minimum reimbursement
18
in subsections (b) and (c) shall be void and unenforceable to
19
the extent of the conflict.
20

(e) A physician shall not waive the protections of this
21
Section as a condition of participation in a health benefit
22
plan or for any other reason.
23

(f) The Department shall enforce this Section and may
24
adopt rules necessary to implement its provisions.
25

(g) A health insurance company that violates this Section
26
shall be subject to:

SB3181
- 3 -
LRB104 18630 BAB 32073 b
1

(1) civil penalties of up to $15,000 per individual
2

violation;
3

(2) payment of restitution to the affected physician;
4

and
5

(3) any additional remedies authorized by the
6

Department.

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