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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB3288

Introduced 2/3/2026, by Sen. Ram Villivalam

SYNOPSIS AS INTRODUCED:

215 ILCS 5/356z.3a

Amends the Illinois Insurance Code. Provides that the reimbursement
rate a health insurance issuer must pay to nonparticipating ground
ambulance service providers subject to a unit of local government is equal
to the rate established or approved by the governing body of the local
government providing ground ambulance service (instead of the local
government having jurisdiction for that area or subarea).
LRB104 16103 BAB 29407 b

A BILL FOR

SB3288
LRB104 16103 BAB 29407 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 356z.3a as follows:

6

(215 ILCS 5/356z.3a)
7

(Text of Section before amendment by P.A. 104-60
)
8

Sec. 356z.3a.
Billing; emergency services;
9
nonparticipating providers.
10

(a) As used in this Section:
11

"Ancillary services" means:
12

(1) items and services related to emergency medicine,
13

anesthesiology, pathology, radiology, and neonatology that
14

are provided by any health care provider;
15

(2) items and services provided by assistant surgeons,
16

hospitalists, and intensivists;
17

(3) diagnostic services, including radiology and
18

laboratory services, except for advanced diagnostic
19

laboratory tests identified on the most current list
20

published by the United States Secretary of Health and
21

Human Services under 42 U.S.C. 300gg-132(b)(3);
22

(4) items and services provided by other specialty
23

practitioners as the United States Secretary of Health and

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LRB104 16103 BAB 29407 b
1

Human Services specifies through rulemaking under 42
2

U.S.C. 300gg-132(b)(3);
3

(5) items and services provided by a nonparticipating
4

provider if there is no participating provider who can
5

furnish the item or service at the facility; and
6

(6) items and services provided by a nonparticipating
7

provider if there is no participating provider who will
8

furnish the item or service because a participating
9

provider has asserted the participating provider's rights
10

under the Health Care Right of Conscience Act.
11

"Average gross charge rate" means, with respect to
12
nonparticipating ground ambulance service providers, the
13
average of the provider's gross charge rates in place for each
14
individual charge described in subsection (b-15) of this
15
Section for dates of service that fall within the 12-month
16
period ending on June 30 immediately preceding the date on
17
which the reporting of average gross charge rates is required.
18

"Cost sharing" means the amount an insured, beneficiary,
19
or enrollee is responsible for paying for a covered item or
20
service under the terms of the policy or certificate. "Cost
21
sharing" includes copayments, coinsurance, and amounts paid
22
toward deductibles, but does not include amounts paid towards
23
premiums, balance billing by out-of-network providers, or the
24
cost of items or services that are not covered under the policy
25
or certificate.
26

"Emergency department of a hospital" means any hospital

SB3288
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LRB104 16103 BAB 29407 b
1
department that provides emergency services, including a
2
hospital outpatient department.
3

"Emergency medical condition" has the meaning ascribed to
4
that term in Section 10 of the Managed Care Reform and Patient
5
Rights Act.
6

"Emergency medical screening examination" has the meaning
7
ascribed to that term in Section 10 of the Managed Care Reform
8
and Patient Rights Act.
9

"Emergency services" means, with respect to an emergency
10
medical condition:
11

(1) in general, an emergency medical screening
12

examination, including ancillary services routinely
13

available to the emergency department to evaluate such
14

emergency medical condition, and such further medical
15

examination and treatment as would be required to
16

stabilize the patient regardless of the department of the
17

hospital or other facility in which such further
18

examination or treatment is furnished; or
19

(2) additional items and services for which benefits
20

are provided or covered under the coverage and that are
21

furnished by a nonparticipating provider or
22

nonparticipating emergency facility regardless of the
23

department of the hospital or other facility in which such
24

items are furnished after the insured, beneficiary, or
25

enrollee is stabilized and as part of outpatient
26

observation or an inpatient or outpatient stay with

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LRB104 16103 BAB 29407 b
1

respect to the visit in which the services described in
2

paragraph (1) are furnished. Services after stabilization
3

cease to be emergency services only when all the
4

conditions of 42 U.S.C. 300gg-111(a)(3)(C)(ii)(II) and
5

regulations thereunder are met.
6

"Emergency ground ambulance service" means ground
7
ambulance service provided by ground ambulance service
8
providers, regardless of whether the patient was transported,
9
if the service was provided pursuant to a request to 9-1-1 or
10
an equivalent telephone number, texting system, or other
11
method of summoning emergency service or if the service
12
provided was provided when a patient's condition, at the time
13
of service, was considered to be an emergency medical
14
condition as determined by a physician licensed under the
15
Medical Practice Act of 1987.
16

"Evaluation" means, with respect to emergency ground
17
ambulance service, the provision of a medical screening
18
examination to determine whether an emergency medical
19
condition exists.
20

"Freestanding Emergency Center" means a facility licensed
21
under Section 32.5 of the Emergency Medical Services (EMS)
22
Systems Act.
23

"Ground ambulance service" means both medical
24
transportation service that is described as ground ambulance
25
service by the Centers for Medicare and Medicaid Services and
26
medical nontransportation service, such as evaluation without

SB3288
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LRB104 16103 BAB 29407 b
1
transport, treatment without transport, or paramedic
2
intercept, and that is, in either case, provided in a vehicle
3
that is licensed as an ambulance under the Emergency Medical
4
Services (EMS) Systems Act or by EMS Personnel assigned to a
5
vehicle that is licensed as an ambulance under the Emergency
6
Medical Services (EMS) Systems Act. "Ground ambulance service"
7
may include any combination of the following: emergency ground
8
ambulance service in a ground ambulance, urgent ground
9
ambulance service, evaluation without treatment, treatment
10
without transport, and paramedic intercept.
11

"Ground ambulance service provider" means a vehicle
12
service provider under the Emergency Medical Services (EMS)
13
Systems Act that operates licensed ground ambulances for the
14
purpose of providing emergency ground ambulance services,
15
urgent ground ambulances services, or both. "Ground ambulance
16
service provider" includes both ambulance providers and
17
ambulance suppliers as described by the Centers for Medicare
18
and Medicaid Services.
19

"Health care facility" means, in the context of
20
non-emergency services, any of the following:
21

(1) a hospital as defined in 42 U.S.C. 1395x(e);
22

(2) a hospital outpatient department;
23

(3) a critical access hospital certified under 42
24

U.S.C. 1395i-4(e);
25

(4) an ambulatory surgical treatment center as defined
26

in the Ambulatory Surgical Treatment Center Act; or

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LRB104 16103 BAB 29407 b
1

(5) any recipient of a license under the Hospital
2

Licensing Act that is not otherwise described in this
3

definition.
4

"Health care provider" means a provider as defined in
5
subsection (d) of Section 370g. "Health care provider" does
6
not include a provider of air ambulance or ground ambulance
7
services.
8

"Health care services" has the meaning ascribed to that
9
term in subsection (a) of Section 370g.
10

"Health insurance issuer" has the meaning ascribed to that
11
term in Section 5 of the Illinois Health Insurance Portability
12
and Accountability Act.
13

"Nonparticipating emergency facility" means, with respect
14
to the furnishing of an item or service under a policy of group
15
or individual health insurance coverage, any of the following
16
facilities that does not have a contractual relationship
17
directly or indirectly with a health insurance issuer in
18
relation to the coverage:
19

(1) an emergency department of a hospital;
20

(2) a Freestanding Emergency Center;
21

(3) an ambulatory surgical treatment center as defined
22

in the Ambulatory Surgical Treatment Center Act; or
23

(4) with respect to emergency services described in
24

paragraph (2) of the definition of "emergency services", a
25

hospital.
26

"Nonparticipating ground ambulance service provider"

SB3288
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LRB104 16103 BAB 29407 b
1
means, with respect to the furnishing of an item or services
2
under a policy of group or individual health insurance
3
coverage, any ground ambulance service provider that does not
4
have a contractual relationship directly or indirectly with a
5
health insurance issuer in relation to the coverage.
6

"Nonparticipating provider" means, with respect to the
7
furnishing of an item or service under a policy of group or
8
individual health insurance coverage, any health care provider
9
who does not have a contractual relationship directly or
10
indirectly with a health insurance issuer in relation to the
11
coverage.
12

"Paramedic intercept" means a service in which a ground
13
ambulance staffed by licensed paramedics rendezvouses with a
14
ground ambulance staffed with nonparamedics to provide
15
advanced life support care. As used in this definition,
16
"advanced life support care" means life support care that is
17
warranted when a patient's condition and need for treatment
18
exceed the basic life support or intermediate life support
19
level of care.
20

"Participating emergency facility" means any of the
21
following facilities that has a contractual relationship
22
directly or indirectly with a health insurance issuer offering
23
group or individual health insurance coverage setting forth
24
the terms and conditions on which a relevant health care
25
service is provided to an insured, beneficiary, or enrollee
26
under the coverage:

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LRB104 16103 BAB 29407 b
1

(1) an emergency department of a hospital;
2

(2) a Freestanding Emergency Center;
3

(3) an ambulatory surgical treatment center as defined
4

in the Ambulatory Surgical Treatment Center Act; or
5

(4) with respect to emergency services described in
6

paragraph (2) of the definition of "emergency services", a
7

hospital.
8

For purposes of this definition, a single case agreement
9
between an emergency facility and an issuer that is used to
10
address unique situations in which an insured, beneficiary, or
11
enrollee requires services that typically occur out-of-network
12
constitutes a contractual relationship and is limited to the
13
parties to the agreement.
14

"Participating ground ambulance service provider" means
15
any ground ambulance service provider that has a contractual
16
relationship directly or indirectly with a health insurance
17
issuer offering group or individual health insurance coverage
18
setting forth the terms and conditions on which a relevant
19
health care service is provided to an insured, beneficiary, or
20
enrollee under the coverage. As used in this definition, a
21
single case agreement between a ground ambulance service
22
provider and a health insurance issuer that is used to address
23
unique situations in which an insured, beneficiary, or
24
enrollee requires services that typically occur out-of-network
25
constitutes a contractual relationship and is limited to the
26
parties of the agreement.

SB3288
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LRB104 16103 BAB 29407 b
1

"Participating health care facility" means any health care
2
facility that has a contractual relationship directly or
3
indirectly with a health insurance issuer offering group or
4
individual health insurance coverage setting forth the terms
5
and conditions on which a relevant health care service is
6
provided to an insured, beneficiary, or enrollee under the
7
coverage. A single case agreement between an emergency
8
facility and an issuer that is used to address unique
9
situations in which an insured, beneficiary, or enrollee
10
requires services that typically occur out-of-network
11
constitutes a contractual relationship for purposes of this
12
definition and is limited to the parties to the agreement.
13

"Participating provider" means any health care provider
14
that has a contractual relationship directly or indirectly
15
with a health insurance issuer offering group or individual
16
health insurance coverage setting forth the terms and
17
conditions on which a relevant health care service is provided
18
to an insured, beneficiary, or enrollee under the coverage.
19

"Qualifying payment amount" has the meaning given to that
20
term in 42 U.S.C. 300gg-111(a)(3)(E) and the regulations
21
promulgated thereunder.
22

"Recognized amount" means, except as otherwise provided in
23
this Section, the lesser of the amount initially billed by the
24
provider or the qualifying payment amount.
25

"Stabilize" means "stabilization" as defined in Section 10
26
of the Managed Care Reform and Patient Rights Act.

SB3288
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LRB104 16103 BAB 29407 b
1

"Treating provider" means a health care provider who has
2
evaluated the individual.
3

"Treatment" means, with respect to the provision of
4
emergency ground ambulance service, the provision of an
5
evaluation and either (i) a therapy or therapeutic agent used
6
to treat an emergency medical condition or (ii) a procedure
7
used to treat an emergency medical condition.
8

"Urgent ground ambulance service" means ground ambulance
9
service that is deemed medically necessary by a health care
10
professional and is required within 12 hours after the
11
certification of the need for the service.
12

"Visit" means, with respect to health care services
13
furnished to an individual at a health care facility, health
14
care services furnished by a provider at the facility, as well
15
as equipment, devices, telehealth services, imaging services,
16
laboratory services, and preoperative and postoperative
17
services regardless of whether the provider furnishing such
18
services is at the facility.
19

(b) Emergency services. When a beneficiary, insured, or
20
enrollee receives emergency services from a nonparticipating
21
provider or a nonparticipating emergency facility, the health
22
insurance issuer shall ensure that the beneficiary, insured,
23
or enrollee shall incur no greater out-of-pocket costs than
24
the beneficiary, insured, or enrollee would have incurred with
25
a participating provider or a participating emergency
26
facility. Any cost-sharing requirements shall be applied as

SB3288
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LRB104 16103 BAB 29407 b
1
though the emergency services had been received from a
2
participating provider or a participating facility. Cost
3
sharing shall be calculated based on the recognized amount for
4
the emergency services. If the cost sharing for the same item
5
or service furnished by a participating provider would have
6
been a flat-dollar copayment, that amount shall be the
7
cost-sharing amount unless the provider has billed a lesser
8
total amount. In no event shall the beneficiary, insured,
9
enrollee, or any group policyholder or plan sponsor be liable
10
to or billed by the health insurance issuer, the
11
nonparticipating provider, or the nonparticipating emergency
12
facility for any amount beyond the cost sharing calculated in
13
accordance with this subsection with respect to the emergency
14
services delivered. Administrative requirements or limitations
15
shall be no greater than those applicable to emergency
16
services received from a participating provider or a
17
participating emergency facility.
18

(b-5) Non-emergency services at participating health care
19
facilities.
20

(1) When a beneficiary, insured, or enrollee utilizes
21

a participating health care facility and, due to any
22

reason, covered ancillary services are provided by a
23

nonparticipating provider during or resulting from the
24

visit, the health insurance issuer shall ensure that the
25

beneficiary, insured, or enrollee shall incur no greater
26

out-of-pocket costs than the beneficiary, insured, or

SB3288
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LRB104 16103 BAB 29407 b
1

enrollee would have incurred with a participating provider
2

for the ancillary services. Any cost-sharing requirements
3

shall be applied as though the ancillary services had been
4

received from a participating provider. Cost sharing shall
5

be calculated based on the recognized amount for the
6

ancillary services. If the cost sharing for the same item
7

or service furnished by a participating provider would
8

have been a flat-dollar copayment, that amount shall be
9

the cost-sharing amount unless the provider has billed a
10

lesser total amount. In no event shall the beneficiary,
11

insured, enrollee, or any group policyholder or plan
12

sponsor be liable to or billed by the health insurance
13

issuer, the nonparticipating provider, or the
14

participating health care facility for any amount beyond
15

the cost sharing calculated in accordance with this
16

subsection with respect to the ancillary services
17

delivered. In addition to ancillary services, the
18

requirements of this paragraph shall also apply with
19

respect to covered items or services furnished as a result
20

of unforeseen, urgent medical needs that arise at the time
21

an item or service is furnished, regardless of whether the
22

nonparticipating provider satisfied the notice and consent
23

criteria under paragraph (2) of this subsection.
24

(2) When a beneficiary, insured, or enrollee utilizes
25

a participating health care facility and receives
26

non-emergency covered health care services other than

SB3288
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LRB104 16103 BAB 29407 b
1

those described in paragraph (1) of this subsection from a
2

nonparticipating provider during or resulting from the
3

visit, the health insurance issuer shall ensure that the
4

beneficiary, insured, or enrollee incurs no greater
5

out-of-pocket costs than the beneficiary, insured, or
6

enrollee would have incurred with a participating provider
7

unless the nonparticipating provider or the participating
8

health care facility on behalf of the nonparticipating
9

provider satisfies the notice and consent criteria
10

provided in 42 U.S.C. 300gg-132 and regulations
11

promulgated thereunder. If the notice and consent criteria
12

are not satisfied, then:
13

(A) any cost-sharing requirements shall be applied
14

as though the health care services had been received
15

from a participating provider;
16

(B) cost sharing shall be calculated based on the
17

recognized amount for the health care services; and
18

(C) in no event shall the beneficiary, insured,
19

enrollee, or any group policyholder or plan sponsor be
20

liable to or billed by the health insurance issuer,
21

the nonparticipating provider, or the participating
22

health care facility for any amount beyond the cost
23

sharing calculated in accordance with this subsection
24

with respect to the health care services delivered.
25

(b-10) Coverage for ground ambulance services provided by
26
nonparticipating ground ambulance service providers.

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LRB104 16103 BAB 29407 b
1

(1) Any group or individual policy of accident and
2

health insurance amended, delivered, issued, or renewed on
3

or after January 1, 2027 shall provide coverage for both
4

emergency ground ambulance service and urgent ground
5

ambulance service.
6

(2) Beginning on January 1, 2027, when a beneficiary,
7

insured, or enrollee receives emergency ground ambulance
8

services or urgent ambulance services from a
9

nonparticipating ground ambulance service provider, the
10

health insurance issuer shall ensure that the beneficiary,
11

insured, or enrollee shall incur no greater out-of-pocket
12

costs than the beneficiary, insured, or enrollee would
13

have incurred with a participating ground ambulance
14

provider. Any cost-sharing requirements shall be applied
15

as though the emergency ground ambulance services or
16

urgent ground ambulance services had been received from a
17

participating ground ambulance service provider. Except as
18

otherwise provided in State or federal law, cost sharing
19

shall be calculated based on the lesser of the policy's
20

copayment or coinsurance for an emergency room visit or
21

10% of the recognized amount. For purposes of this
22

subsection, the recognized amount shall be calculated as
23

provided for in paragraph (3) of this subsection. Except
24

as otherwise provided for in State or federal law, if the
25

cost sharing for the same item or service furnished by a
26

participating ground ambulance provider would have been a

SB3288
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LRB104 16103 BAB 29407 b
1

flat-dollar copayment, that amount shall be the
2

cost-sharing amount unless the nonparticipating ground
3

ambulance provider has billed a lesser total amount.
4

(3) Upon reasonable demand by a nonparticipating
5

ground ambulance service provider and after subtracting
6

the beneficiary's, insured's, or enrollee's cost sharing
7

amount, a health insurance issuer shall pay the
8

nonparticipating ground ambulance service provider as
9

follows:
10

(A) for nonparticipating ground ambulance service
11

providers subject to a unit of local government
that
12

has jurisdiction over where the service was provided
,
13

a rate that is equal to the rate established or
14

approved by the governing body of the local government
15

providing ground ambulance service

having jurisdiction
16

for that area or subarea
; or
17

(B) for nonparticipating ground ambulance service
18

providers that are not subject to the jurisdiction of
19

a unit of local government, a rate that is equal to the
20

lesser of (i) the negotiated rate between the
21

nonparticipating ground ambulance service provider and
22

the health insurance issuer; (ii) 85% of the
23

nonparticipating ground ambulance service provider's
24

billed charges; or (iii) the average gross charge rate
25

in effect for the date of service in question for a
26

base charge and, if applicable, a loaded mileage

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LRB104 16103 BAB 29407 b
1

charge, the nonparticipating ground ambulance service
2

provider has filed with the Department of Public
3

Health in accordance with subsection (b-15).
4

By accepting the payment from the health insurance
5

issuer, the nonparticipating ground ambulance service
6

provider shall not seek any payment from the
7

beneficiary, insured, or enrollee for any amount that
8

exceeds the deductible, coinsurance, or copay for
9

services provided to the beneficiary, insured, or
10

enrollee.
11

(b-15) Beginning on October 1, 2026, and each October 1
12
thereafter, each nonparticipating ground ambulance service
13
provider shall file annually with the Department of Public
14
Health, in the form and manner prescribed by the Department of
15
Public Health, its average gross charge rates and any other
16
information required by the Department of Public Health, by
17
rule, for each of the following ground ambulance charge
18
descriptions, as applicable: (1) basic life support, urgent
19
base; (2) basic life support, emergency base; (3) advanced
20
life support, urgent, level 1 base; (4) advanced life support,
21
emergency, level 1 base; (5) advanced life support, emergency,
22
level 2 base; (6) specialty care transport base; (7) emergency
23
response, evaluation without transport base; (8) emergency
24
response, treatment without transport base; (9) emergency
25
response, paramedic intercept base; and (10) loaded mileage,
26
per loaded mile charge for each of the applicable base charge

SB3288
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LRB104 16103 BAB 29407 b
1
descriptions services. The Department of Public Health shall
2
publish the submitted rate information by January 1, 2027 and
3
every January 1 thereafter. The Department of Public Health
4
may request information from ground ambulance service
5
providers and health insurance issuers regarding factors
6
contributing to the network status of the ground ambulance
7
service providers. The Department of Public Health may, upon
8
the submission of rate information, assess a fee to each
9
ground ambulance service provider that shall not exceed the
10
administrative costs to complete the Department of Public
11
Health's obligations in this subsection. The Department of
12
Public Health may also request information from nationally
13
recognized organizations that provide data on health care
14
costs. The Department of Insurance shall direct the health
15
insurance issuer to the location in which the information
16
reported to the Department of Public Health is stored.
17

(c) Notwithstanding any other provision of this Code,
18
except when the notice and consent criteria are satisfied for
19
the situation in paragraph (2) of subsection (b-5), any
20
benefits a beneficiary, insured, or enrollee receives for
21
services under the situations in subsection (b), (b-5),
22
(b-10), or (b-15) are assigned to the nonparticipating
23
providers, nonparticipating ground ambulance service provider,
24
or the facility acting on their behalf. Upon receipt of the
25
provider's bill or facility's bill, the health insurance
26
issuer shall provide the nonparticipating provider,

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1
nonparticipating ground ambulance service provider, or the
2
facility with a written explanation of benefits that specifies
3
the proposed reimbursement and the applicable deductible,
4
copayment, or coinsurance amounts owed by the insured,
5
beneficiary, or enrollee. The health insurance issuer shall
6
pay any reimbursement subject to this Section directly to the
7
nonparticipating provider, nonparticipating ground ambulance
8
service provider, or the facility.
9

(d) For bills assigned under subsection (c), the
10
nonparticipating provider or the facility may bill the health
11
insurance issuer for the services rendered, and the health
12
insurance issuer may pay the billed amount or attempt to
13
negotiate reimbursement with the nonparticipating provider or
14
the facility. Within 30 calendar days after the provider or
15
facility transmits the bill to the health insurance issuer,
16
the issuer shall send an initial payment or notice of denial of
17
payment with the written explanation of benefits to the
18
provider or facility. If attempts to negotiate reimbursement
19
for services provided by a nonparticipating provider do not
20
result in a resolution of the payment dispute within 30 days
21
after receipt of written explanation of benefits by the health
22
insurance issuer, then the health insurance issuer or
23
nonparticipating provider or the facility may initiate binding
24
arbitration to determine payment for services provided on a
25
per-bill or batched-bill basis, in accordance with Section
26
300gg-111 of the Public Health Service Act and the regulations

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1
promulgated thereunder. The party requesting arbitration shall
2
notify the other party arbitration has been initiated and
3
state its final offer before arbitration. In response to this
4
notice, the nonrequesting party shall inform the requesting
5
party of its final offer before the arbitration occurs.
6
Arbitration shall be initiated by filing a request with the
7
Department of Insurance.
8

(e) The Department of Insurance shall publish a list of
9
approved arbitrators or entities that shall provide binding
10
arbitration. These arbitrators shall be American Arbitration
11
Association or American Health Lawyers Association trained
12
arbitrators. Both parties must agree on an arbitrator from the
13
Department of Insurance's or its approved entity's list of
14
arbitrators. If no agreement can be reached, then a list of 5
15
arbitrators shall be provided by the Department of Insurance
16
or the approved entity. From the list of 5 arbitrators, the
17
health insurance issuer can veto 2 arbitrators and the
18
provider or facility can veto 2 arbitrators. The remaining
19
arbitrator shall be the chosen arbitrator. This arbitration
20
shall consist of a review of the written submissions by both
21
parties. The arbitrator shall not establish a rebuttable
22
presumption that the qualifying payment amount should be the
23
total amount owed to the provider or facility by the
24
combination of the issuer and the insured, beneficiary, or
25
enrollee. Binding arbitration shall provide for a written
26
decision within 45 days after the request is filed with the

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1
Department of Insurance. Both parties shall be bound by the
2
arbitrator's decision. The arbitrator's expenses and fees,
3
together with other expenses, not including attorney's fees,
4
incurred in the conduct of the arbitration, shall be paid as
5
provided in the decision.
6

(f) (Blank).
7

(g) Section 368a of this
Code

Act
shall not apply during
8
the pendency of a decision under subsection (d). Upon the
9
issuance of the arbitrator's decision, Section 368a applies
10
with respect to the amount, if any, by which the arbitrator's
11
determination exceeds the issuer's initial payment under
12
subsection (c), or the entire amount of the arbitrator's
13
determination if initial payment was denied. Any interest
14
required to be paid to a provider under Section 368a shall not
15
accrue until after 30 days of an arbitrator's decision as
16
provided in subsection (d), but in no circumstances longer
17
than 150 days from the date the nonparticipating
18
facility-based provider billed for services rendered.
19

(h) Nothing in this Section shall be interpreted to change
20
the prudent layperson provisions with respect to emergency
21
services under the Managed Care Reform and Patient Rights Act.
22

(i) Nothing in this Section shall preclude a health care
23
provider from billing a beneficiary, insured, or enrollee for
24
reasonable administrative fees, such as service fees for
25
checks returned for nonsufficient funds and missed
26
appointments.

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1

(j) Nothing in this Section shall preclude a beneficiary,
2
insured, or enrollee from assigning benefits to a
3
nonparticipating provider when the notice and consent criteria
4
are satisfied under paragraph (2) of subsection (b-5) or in
5
any other situation not described in subsection (b) or (b-5).
6

(k) Except when the notice and consent criteria are
7
satisfied under paragraph (2) of subsection (b-5), if an
8
individual receives health care services under the situations
9
described in subsection (b) or (b-5), no referral requirement
10
or any other provision contained in the policy or certificate
11
of coverage shall deny coverage, reduce benefits, or otherwise
12
defeat the requirements of this Section for services that
13
would have been covered with a participating provider.
14
However, this subsection shall not be construed to preclude a
15
provider contract with a health insurance issuer, or with an
16
administrator or similar entity acting on the issuer's behalf,
17
from imposing requirements on the participating provider,
18
participating emergency facility, or participating health care
19
facility relating to the referral of covered individuals to
20
nonparticipating providers.
21

(l) Except if the notice and consent criteria are
22
satisfied under paragraph (2) of subsection (b-5),
23
cost-sharing amounts calculated in conformity with this
24
Section shall count toward any deductible or out-of-pocket
25
maximum applicable to in-network coverage.
26

(m) The Department has the authority to enforce the

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1
requirements of this Section in the situations described in
2
subsections (b) and (b-5), and in any other situation for
3
which 42 U.S.C. Chapter 6A, Subchapter XXV, Parts D or E and
4
regulations promulgated thereunder would prohibit an
5
individual from being billed or liable for emergency services
6
furnished by a nonparticipating provider or nonparticipating
7
emergency facility or for non-emergency health care services
8
furnished by a nonparticipating provider at a participating
9
health care facility.
10

(n) This Section does not apply with respect to air
11
ambulance services. This Section does not apply to any policy
12
of excepted benefits or to short-term, limited-duration health
13
insurance coverage.
14

(o) A home rule unit may not regulate payments for ground
15
ambulance service in a manner inconsistent with this Section.
16
This subsection is a limitation under subsection (i) of
17
Section 6 of Article VII of the Illinois Constitution on the
18
concurrent exercise by home rule units of powers and functions
19
exercised by the State.
20
(Source: P.A. 103-440, eff. 1-1-24; 104-248, eff. 8-15-25;
21
revised 9-12-25.)

22

(Text of Section after amendment by P.A. 104-60
)
23

Sec. 356z.3a.
Billing; emergency services;
24
nonparticipating providers.
25

(a) As used in this Section:

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1

"Ancillary services" means:
2

(1) items and services related to emergency medicine,
3

anesthesiology, pathology, radiology, and neonatology that
4

are provided by any health care provider;
5

(2) items and services provided by assistant surgeons,
6

hospitalists, and intensivists;
7

(3) diagnostic services, including radiology and
8

laboratory services, except for advanced diagnostic
9

laboratory tests identified on the most current list
10

published by the United States Secretary of Health and
11

Human Services under 42 U.S.C. 300gg-132(b)(3);
12

(4) items and services provided by other specialty
13

practitioners as the United States Secretary of Health and
14

Human Services specifies through rulemaking under 42
15

U.S.C. 300gg-132(b)(3);
16

(5) items and services provided by a nonparticipating
17

provider if there is no participating provider who can
18

furnish the item or service at the facility; and
19

(6) items and services provided by a nonparticipating
20

provider if there is no participating provider who will
21

furnish the item or service because a participating
22

provider has asserted the participating provider's rights
23

under the Health Care Right of Conscience Act.
24

"Average gross charge rate" means, with respect to
25
nonparticipating ground ambulance service providers, the
26
average of the provider's gross charge rates in place for each

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1
individual charge described in subsection (b-15) of this
2
Section for dates of service that fall within the 12-month
3
period ending on June 30 immediately preceding the date on
4
which the reporting of average gross charge rates is required.
5

"Cost sharing" means the amount an insured, beneficiary,
6
or enrollee is responsible for paying for a covered item or
7
service under the terms of the policy or certificate. "Cost
8
sharing" includes copayments, coinsurance, and amounts paid
9
toward deductibles, but does not include amounts paid towards
10
premiums, balance billing by out-of-network providers, or the
11
cost of items or services that are not covered under the policy
12
or certificate.
13

"Emergency department of a hospital" means any hospital
14
department that provides emergency services, including a
15
hospital outpatient department.
16

"Emergency medical condition" has the meaning ascribed to
17
that term in Section 10 of the Managed Care Reform and Patient
18
Rights Act.
19

"Emergency medical screening examination" has the meaning
20
ascribed to that term in Section 10 of the Managed Care Reform
21
and Patient Rights Act.
22

"Emergency services" means, with respect to an emergency
23
medical condition:
24

(1) in general, an emergency medical screening
25

examination, including ancillary services routinely
26

available to the emergency department to evaluate such

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1

emergency medical condition, and such further medical
2

examination and treatment as would be required to
3

stabilize the patient regardless of the department of the
4

hospital or other facility in which such further
5

examination or treatment is furnished; or
6

(2) additional items and services for which benefits
7

are provided or covered under the coverage and that are
8

furnished by a nonparticipating provider or
9

nonparticipating emergency facility regardless of the
10

department of the hospital or other facility in which such
11

items are furnished after the insured, beneficiary, or
12

enrollee is stabilized and as part of outpatient
13

observation or an inpatient or outpatient stay with
14

respect to the visit in which the services described in
15

paragraph (1) are furnished. Services after stabilization
16

cease to be emergency services only when all the
17

conditions of 42 U.S.C. 300gg-111(a)(3)(C)(ii)(II) and
18

regulations thereunder are met.
19

"Emergency ground ambulance service" means ground
20
ambulance service provided by ground ambulance service
21
providers, regardless of whether the patient was transported,
22
if the service was provided pursuant to a request to 9-1-1 or
23
an equivalent telephone number, texting system, or other
24
method of summoning emergency service or if the service
25
provided was provided when a patient's condition, at the time
26
of service, was considered to be an emergency medical

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1
condition as determined by a physician licensed under the
2
Medical Practice Act of 1987.
3

"Evaluation" means, with respect to emergency ground
4
ambulance service, the provision of a medical screening
5
examination to determine whether an emergency medical
6
condition exists.
7

"Freestanding Emergency Center" means a facility licensed
8
under Section 32.5 of the Emergency Medical Services (EMS)
9
Systems Act.
10

"Ground ambulance service" means both medical
11
transportation service that is described as ground ambulance
12
service by the Centers for Medicare and Medicaid Services and
13
medical nontransportation service, such as evaluation without
14
transport, treatment without transport, or paramedic
15
intercept, and that is, in either case, provided in a vehicle
16
that is licensed as an ambulance under the Emergency Medical
17
Services (EMS) Systems Act or by EMS Personnel assigned to a
18
vehicle that is licensed as an ambulance under the Emergency
19
Medical Services (EMS) Systems Act. "Ground ambulance service"
20
may include any combination of the following: emergency ground
21
ambulance service in a ground ambulance, urgent ground
22
ambulance service, evaluation without treatment, treatment
23
without transport, and paramedic intercept.
24

"Ground ambulance service provider" means a vehicle
25
service provider under the Emergency Medical Services (EMS)
26
Systems Act that operates licensed ground ambulances for the

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1
purpose of providing emergency ground ambulance services,
2
urgent ground ambulances services, or both. "Ground ambulance
3
service provider" includes both ambulance providers and
4
ambulance suppliers as described by the Centers for Medicare
5
and Medicaid Services.
6

"Health care facility" means, in the context of
7
non-emergency services, any of the following:
8

(1) a hospital as defined in 42 U.S.C. 1395x(e);
9

(2) a hospital outpatient department;
10

(3) a critical access hospital certified under 42
11

U.S.C. 1395i-4(e);
12

(4) an ambulatory surgical treatment center as defined
13

in the Ambulatory Surgical Treatment Center Act; or
14

(5) any recipient of a license under the Hospital
15

Licensing Act that is not otherwise described in this
16

definition.
17

"Health care provider" means a provider as defined in
18
subsection (d) of Section 370g. "Health care provider" does
19
not include a provider of air ambulance or ground ambulance
20
services.
21

"Health care services" has the meaning ascribed to that
22
term in subsection (a) of Section 370g.
23

"Health insurance issuer" has the meaning ascribed to that
24
term in Section 5 of the Illinois Health Insurance Portability
25
and Accountability Act.
26

"Nonparticipating emergency facility" means, with respect

SB3288
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1
to the furnishing of an item or service under a policy of group
2
or individual health insurance coverage, any of the following
3
facilities that does not have a contractual relationship
4
directly or indirectly with a health insurance issuer in
5
relation to the coverage:
6

(1) an emergency department of a hospital;
7

(2) a Freestanding Emergency Center;
8

(3) an ambulatory surgical treatment center as defined
9

in the Ambulatory Surgical Treatment Center Act; or
10

(4) with respect to emergency services described in
11

paragraph (2) of the definition of "emergency services", a
12

hospital.
13

"Nonparticipating ground ambulance service provider"
14
means, with respect to the furnishing of an item or services
15
under a policy of group or individual health insurance
16
coverage, any ground ambulance service provider that does not
17
have a contractual relationship directly or indirectly with a
18
health insurance issuer in relation to the coverage.
19

"Nonparticipating provider" means, with respect to the
20
furnishing of an item or service under a policy of group or
21
individual health insurance coverage, any health care provider
22
who does not have a contractual relationship directly or
23
indirectly with a health insurance issuer in relation to the
24
coverage.
25

"Paramedic intercept" means a service in which a ground
26
ambulance staffed by licensed paramedics rendezvouses with a

SB3288
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1
ground ambulance staffed with nonparamedics to provide
2
advanced life support care. As used in this definition,
3
"advanced life support care" means life support care that is
4
warranted when a patient's condition and need for treatment
5
exceed the basic life support or intermediate life support
6
level of care.
7

"Participating emergency facility" means any of the
8
following facilities that has a contractual relationship
9
directly or indirectly with a health insurance issuer offering
10
group or individual health insurance coverage setting forth
11
the terms and conditions on which a relevant health care
12
service is provided to an insured, beneficiary, or enrollee
13
under the coverage:
14

(1) an emergency department of a hospital;
15

(2) a Freestanding Emergency Center;
16

(3) an ambulatory surgical treatment center as defined
17

in the Ambulatory Surgical Treatment Center Act; or
18

(4) with respect to emergency services described in
19

paragraph (2) of the definition of "emergency services", a
20

hospital.
21

For purposes of this definition, a single case agreement
22
between an emergency facility and an issuer that is used to
23
address unique situations in which an insured, beneficiary, or
24
enrollee requires services that typically occur out-of-network
25
constitutes a contractual relationship and is limited to the
26
parties to the agreement.

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1

"Participating ground ambulance service provider" means
2
any ground ambulance service provider that has a contractual
3
relationship directly or indirectly with a health insurance
4
issuer offering group or individual health insurance coverage
5
setting forth the terms and conditions on which a relevant
6
health care service is provided to an insured, beneficiary, or
7
enrollee under the coverage. As used in this definition, a
8
single case agreement between a ground ambulance service
9
provider and a health insurance issuer that is used to address
10
unique situations in which an insured, beneficiary, or
11
enrollee requires services that typically occur out-of-network
12
constitutes a contractual relationship and is limited to the
13
parties of the agreement.
14

"Participating health care facility" means any health care
15
facility that has a contractual relationship directly or
16
indirectly with a health insurance issuer offering group or
17
individual health insurance coverage setting forth the terms
18
and conditions on which a relevant health care service is
19
provided to an insured, beneficiary, or enrollee under the
20
coverage. A single case agreement between an emergency
21
facility and an issuer that is used to address unique
22
situations in which an insured, beneficiary, or enrollee
23
requires services that typically occur out-of-network
24
constitutes a contractual relationship for purposes of this
25
definition and is limited to the parties to the agreement.
26

"Participating provider" means any health care provider

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1
that has a contractual relationship directly or indirectly
2
with a health insurance issuer offering group or individual
3
health insurance coverage setting forth the terms and
4
conditions on which a relevant health care service is provided
5
to an insured, beneficiary, or enrollee under the coverage.
6

"Qualifying payment amount" has the meaning given to that
7
term in 42 U.S.C. 300gg-111(a)(3)(E) and the regulations
8
promulgated thereunder.
9

"Recognized amount" means, except as otherwise provided in
10
this Section, the lesser of the amount initially billed by the
11
provider or the qualifying payment amount.
12

"Stabilize" means "stabilization" as defined in Section 10
13
of the Managed Care Reform and Patient Rights Act.
14

"Treating provider" means a health care provider who has
15
evaluated the individual.
16

"Treatment" means, with respect to the provision of
17
emergency ground ambulance service, the provision of an
18
evaluation and either (i) a therapy or therapeutic agent used
19
to treat an emergency medical condition or (ii) a procedure
20
used to treat an emergency medical condition.
21

"Urgent ground ambulance service" means ground ambulance
22
service that is deemed medically necessary by a health care
23
professional and is required within 12 hours after the
24
certification of the need for the service.
25

"Visit" means, with respect to health care services
26
furnished to an individual at a health care facility, health

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1
care services furnished by a provider at the facility, as well
2
as equipment, devices, telehealth services, imaging services,
3
laboratory services, and preoperative and postoperative
4
services regardless of whether the provider furnishing such
5
services is at the facility.
6

(b) Emergency services. When a beneficiary, insured, or
7
enrollee receives emergency services from a nonparticipating
8
provider or a nonparticipating emergency facility, the health
9
insurance issuer shall ensure that the beneficiary, insured,
10
or enrollee shall incur no greater out-of-pocket costs than
11
the beneficiary, insured, or enrollee would have incurred with
12
a participating provider or a participating emergency
13
facility. Any cost-sharing requirements shall be applied as
14
though the emergency services had been received from a
15
participating provider or a participating facility. Cost
16
sharing shall be calculated based on the recognized amount for
17
the emergency services. If the cost sharing for the same item
18
or service furnished by a participating provider would have
19
been a flat-dollar copayment, that amount shall be the
20
cost-sharing amount unless the provider has billed a lesser
21
total amount. In no event shall the beneficiary, insured,
22
enrollee, or any group policyholder or plan sponsor be liable
23
to or billed by the health insurance issuer, the
24
nonparticipating provider, or the nonparticipating emergency
25
facility for any amount beyond the cost sharing calculated in
26
accordance with this subsection with respect to the emergency

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1
services delivered. Administrative requirements or limitations
2
shall be no greater than those applicable to emergency
3
services received from a participating provider or a
4
participating emergency facility.
5

(b-5) Non-emergency services at participating health care
6
facilities.
7

(1) When a beneficiary, insured, or enrollee utilizes
8

a participating health care facility and, due to any
9

reason, covered ancillary services are provided by a
10

nonparticipating provider during or resulting from the
11

visit, the health insurance issuer shall ensure that the
12

beneficiary, insured, or enrollee shall incur no greater
13

out-of-pocket costs than the beneficiary, insured, or
14

enrollee would have incurred with a participating provider
15

for the ancillary services. Any cost-sharing requirements
16

shall be applied as though the ancillary services had been
17

received from a participating provider. Cost sharing shall
18

be calculated based on the recognized amount for the
19

ancillary services. If the cost sharing for the same item
20

or service furnished by a participating provider would
21

have been a flat-dollar copayment, that amount shall be
22

the cost-sharing amount unless the provider has billed a
23

lesser total amount. In no event shall the beneficiary,
24

insured, enrollee, or any group policyholder or plan
25

sponsor be liable to or billed by the health insurance
26

issuer, the nonparticipating provider, or the

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LRB104 16103 BAB 29407 b
1

participating health care facility for any amount beyond
2

the cost sharing calculated in accordance with this
3

subsection with respect to the ancillary services
4

delivered. In addition to ancillary services, the
5

requirements of this paragraph shall also apply with
6

respect to covered items or services furnished as a result
7

of unforeseen, urgent medical needs that arise at the time
8

an item or service is furnished, regardless of whether the
9

nonparticipating provider satisfied the notice and consent
10

criteria under paragraph (2) of this subsection.
11

(2) When a beneficiary, insured, or enrollee utilizes
12

a participating health care facility and receives
13

non-emergency covered health care services other than
14

those described in paragraph (1) of this subsection from a
15

nonparticipating provider during or resulting from the
16

visit, the health insurance issuer shall ensure that the
17

beneficiary, insured, or enrollee incurs no greater
18

out-of-pocket costs than the beneficiary, insured, or
19

enrollee would have incurred with a participating provider
20

unless the nonparticipating provider or the participating
21

health care facility on behalf of the nonparticipating
22

provider satisfies the notice and consent criteria
23

provided in 42 U.S.C. 300gg-132 and regulations
24

promulgated thereunder. If the notice and consent criteria
25

are not satisfied, then:
26

(A) any cost-sharing requirements shall be applied

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1

as though the health care services had been received
2

from a participating provider;
3

(B) cost sharing shall be calculated based on the
4

recognized amount for the health care services; and
5

(C) in no event shall the beneficiary, insured,
6

enrollee, or any group policyholder or plan sponsor be
7

liable to or billed by the health insurance issuer,
8

the nonparticipating provider, or the participating
9

health care facility for any amount beyond the cost
10

sharing calculated in accordance with this subsection
11

with respect to the health care services delivered.
12

(b-10) Coverage for ground ambulance services provided by
13
nonparticipating ground ambulance service providers.
14

(1) Any group or individual policy of accident and
15

health insurance amended, delivered, issued, or renewed on
16

or after January 1, 2027 shall provide coverage for both
17

emergency ground ambulance service and urgent ground
18

ambulance service.
19

(2) Beginning on January 1, 2027, when a beneficiary,
20

insured, or enrollee receives emergency ground ambulance
21

services or urgent ambulance services from a
22

nonparticipating ground ambulance service provider, the
23

health insurance issuer shall ensure that the beneficiary,
24

insured, or enrollee shall incur no greater out-of-pocket
25

costs than the beneficiary, insured, or enrollee would
26

have incurred with a participating ground ambulance

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LRB104 16103 BAB 29407 b
1

provider. Any cost-sharing requirements shall be applied
2

as though the emergency ground ambulance services or
3

urgent ground ambulance services had been received from a
4

participating ground ambulance service provider. Except as
5

otherwise provided in State or federal law, cost sharing
6

shall be calculated based on the lesser of the policy's
7

copayment or coinsurance for an emergency room visit or
8

10% of the recognized amount. For purposes of this
9

subsection, the recognized amount shall be calculated as
10

provided for in paragraph (3) of this subsection. Except
11

as otherwise provided for in State or federal law, if the
12

cost sharing for the same item or service furnished by a
13

participating ground ambulance provider would have been a
14

flat-dollar copayment, that amount shall be the
15

cost-sharing amount unless the nonparticipating ground
16

ambulance provider has billed a lesser total amount.
17

(3) Upon reasonable demand by a nonparticipating
18

ground ambulance service provider and after subtracting
19

the beneficiary's, insured's, or enrollee's cost sharing
20

amount, a health insurance issuer shall pay the
21

nonparticipating ground ambulance service provider as
22

follows:
23

(A) for nonparticipating ground ambulance service
24

providers subject to a unit of local government
that
25

has jurisdiction over where the service was provided
,
26

a rate that is equal to the rate established or

SB3288
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1

approved by the governing body of the local government
2

providing ground ambulance service

having jurisdiction
3

for that area or subarea
; or
4

(B) for nonparticipating ground ambulance service
5

providers that are not subject to the jurisdiction of
6

a unit of local government, a rate that is equal to the
7

lesser of (i) the negotiated rate between the
8

nonparticipating ground ambulance service provider and
9

the health insurance issuer; (ii) 85% of the
10

nonparticipating ground ambulance service provider's
11

billed charges; or (iii) the average gross charge rate
12

in effect for the date of service in question for a
13

base charge and, if applicable, a loaded mileage
14

charge, the nonparticipating ground ambulance service
15

provider has filed with the Department of Public
16

Health in accordance with subsection (b-15).
17

By accepting the payment from the health insurance
18

issuer, the nonparticipating ground ambulance service
19

provider shall not seek any payment from the
20

beneficiary, insured, or enrollee for any amount that
21

exceeds the deductible, coinsurance, or copay for
22

services provided to the beneficiary, insured, or
23

enrollee.
24

(b-15) Beginning on October 1, 2026, and each October 1
25
thereafter, each nonparticipating ground ambulance service
26
provider shall file annually with the Department of Public

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1
Health, in the form and manner prescribed by the Department of
2
Public Health, its average gross charge rates and any other
3
information required by the Department of Public Health, by
4
rule, for each of the following ground ambulance charge
5
descriptions, as applicable: (1) basic life support, urgent
6
base; (2) basic life support, emergency base; (3) advanced
7
life support, urgent, level 1 base; (4) advanced life support,
8
emergency, level 1 base; (5) advanced life support, emergency,
9
level 2 base; (6) specialty care transport base; (7) emergency
10
response, evaluation without transport base; (8) emergency
11
response, treatment without transport base; (9) emergency
12
response, paramedic intercept base; and (10) loaded mileage,
13
per loaded mile charge for each of the applicable base charge
14
descriptions services. The Department of Public Health shall
15
publish the submitted rate information by January 1, 2027 and
16
every January 1 thereafter. The Department of Public Health
17
may request information from ground ambulance service
18
providers and health insurance issuers regarding factors
19
contributing to the network status of the ground ambulance
20
service providers. The Department of Public Health may, upon
21
the submission of rate information, assess a fee to each
22
ground ambulance service provider that shall not exceed the
23
administrative costs to complete the Department of Public
24
Health's obligations in this subsection. The Department of
25
Public Health may also request information from nationally
26
recognized organizations that provide data on health care

SB3288
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LRB104 16103 BAB 29407 b
1
costs. The Department of Insurance shall direct the health
2
insurance issuer to the location in which the information
3
reported to the Department of Public Health is stored.
4

(c) Notwithstanding any other provision of this Code,
5
except when the notice and consent criteria are satisfied for
6
the situation in paragraph (2) of subsection (b-5), any
7
benefits a beneficiary, insured, or enrollee receives for
8
services under the situations in subsection (b), (b-5),
9
(b-10), or (b-15) are assigned to the nonparticipating
10
providers, nonparticipating ground ambulance service provider,
11
or the facility acting on their behalf. Upon receipt of the
12
provider's bill or facility's bill, the health insurance
13
issuer shall provide the nonparticipating provider,
14
nonparticipating ground ambulance service provider, or the
15
facility with a written explanation of benefits that specifies
16
the proposed reimbursement and the applicable deductible,
17
copayment, or coinsurance amounts owed by the insured,
18
beneficiary, or enrollee. The health insurance issuer shall
19
pay any reimbursement subject to this Section directly to the
20
nonparticipating provider, nonparticipating ground ambulance
21
service provider, or the facility.
22

(d) For bills assigned under subsection (c), the
23
nonparticipating provider or the facility may bill the health
24
insurance issuer for the services rendered, and the health
25
insurance issuer may pay the billed amount or attempt to
26
negotiate reimbursement with the nonparticipating provider or

SB3288
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LRB104 16103 BAB 29407 b
1
the facility. Within 30 calendar days after the provider or
2
facility transmits the bill to the health insurance issuer,
3
the issuer shall send an initial payment or notice of denial of
4
payment with the written explanation of benefits to the
5
provider or facility. If attempts to negotiate reimbursement
6
for services provided by a nonparticipating provider do not
7
result in a resolution of the payment dispute within 30 days
8
after receipt of written explanation of benefits by the health
9
insurance issuer, then the health insurance issuer or
10
nonparticipating provider or the facility may initiate binding
11
arbitration to determine payment for services provided on a
12
per-bill or batched-bill basis, in accordance with Section
13
300gg-111 of the Public Health Service Act and the regulations
14
promulgated thereunder. The party requesting arbitration shall
15
notify the other party arbitration has been initiated and
16
state its final offer before arbitration. In response to this
17
notice, the nonrequesting party shall inform the requesting
18
party of its final offer before the arbitration occurs.
19
Arbitration shall be initiated by filing a request with the
20
Department of Insurance.
21

(e) The Department of Insurance shall publish a list of
22
approved arbitrators or entities that shall provide binding
23
arbitration. These arbitrators shall be American Arbitration
24
Association or American Health Lawyers Association trained
25
arbitrators. Both parties must agree on an arbitrator from the
26
Department of Insurance's or its approved entity's list of

SB3288
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LRB104 16103 BAB 29407 b
1
arbitrators. If no agreement can be reached, then a list of 5
2
arbitrators shall be provided by the Department of Insurance
3
or the approved entity. From the list of 5 arbitrators, the
4
health insurance issuer can veto 2 arbitrators and the
5
provider or facility can veto 2 arbitrators. The remaining
6
arbitrator shall be the chosen arbitrator. This arbitration
7
shall consist of a review of the written submissions by both
8
parties. The arbitrator shall not establish a rebuttable
9
presumption that the qualifying payment amount should be the
10
total amount owed to the provider or facility by the
11
combination of the issuer and the insured, beneficiary, or
12
enrollee. Binding arbitration shall provide for a written
13
decision within 45 days after the request is filed with the
14
Department of Insurance. Both parties shall be bound by the
15
arbitrator's decision. The arbitrator's expenses and fees,
16
together with other expenses, not including attorney's fees,
17
incurred in the conduct of the arbitration, shall be paid as
18
provided in the decision.
19

(f) (Blank).
20

(g) Section 368a of this
Code

Act
shall not apply during
21
the pendency of a decision under subsection (d). Upon the
22
issuance of the arbitrator's decision, Section 368a applies
23
with respect to the amount, if any, by which the arbitrator's
24
determination exceeds the issuer's initial payment under
25
subsection (c), or the entire amount of the arbitrator's
26
determination if initial payment was denied. Any interest

SB3288
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LRB104 16103 BAB 29407 b
1
required to be paid to a provider under Section 368a shall not
2
accrue until after 30 days of an arbitrator's decision as
3
provided in subsection (d), but in no circumstances longer
4
than 150 days from the date the nonparticipating
5
facility-based provider billed for services rendered.
6

(h) Nothing in this Section shall be interpreted to change
7
the prudent layperson provisions with respect to emergency
8
services under the Managed Care Reform and Patient Rights Act.
9

(i) Nothing in this Section shall preclude a health care
10
provider from billing a beneficiary, insured, or enrollee for
11
reasonable administrative fees, such as service fees for
12
checks returned for nonsufficient funds and missed
13
appointments.
14

(j) Nothing in this Section shall preclude a beneficiary,
15
insured, or enrollee from assigning benefits to a
16
nonparticipating provider when the notice and consent criteria
17
are satisfied under paragraph (2) of subsection (b-5) or in
18
any other situation not described in subsection (b) or (b-5).
19

(k) Except when the notice and consent criteria are
20
satisfied under paragraph (2) of subsection (b-5), if an
21
individual receives health care services under the situations
22
described in subsection (b) or (b-5), no referral requirement
23
or any other provision contained in the policy or certificate
24
of coverage shall deny coverage, reduce benefits, or otherwise
25
defeat the requirements of this Section for services that
26
would have been covered with a participating provider.

SB3288
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LRB104 16103 BAB 29407 b
1
However, this subsection shall not be construed to preclude a
2
provider contract with a health insurance issuer, or with an
3
administrator or similar entity acting on the issuer's behalf,
4
from imposing requirements on the participating provider,
5
participating emergency facility, or participating health care
6
facility relating to the referral of covered individuals to
7
nonparticipating providers.
8

(l) Except if the notice and consent criteria are
9
satisfied under paragraph (2) of subsection (b-5),
10
cost-sharing amounts calculated in conformity with this
11
Section shall count toward any deductible or out-of-pocket
12
maximum applicable to in-network coverage.
13

(m) The Department has the authority to enforce the
14
requirements of this Section in the situations described in
15
subsections (b) and (b-5), and in any other situation for
16
which 42 U.S.C. Chapter 6A, Subchapter XXV, Parts D or E and
17
regulations promulgated thereunder would prohibit an
18
individual from being billed or liable for emergency services
19
furnished by a nonparticipating provider or nonparticipating
20
emergency facility or for non-emergency health care services
21
furnished by a nonparticipating provider at a participating
22
health care facility.
23

(n) This Section does not apply with respect to air
24
ambulance services. This Section does not apply to any policy
25
of excepted benefits or to short-term, limited-duration health
26
insurance coverage.

SB3288
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LRB104 16103 BAB 29407 b
1

(o) A home rule unit may not regulate payments for ground
2
ambulance service in a manner inconsistent with this Section.
3
This subsection is a limitation under subsection (i) of
4
Section 6 of Article VII of the Illinois Constitution on the
5
concurrent exercise by home rule units of powers and functions
6
exercised by the State.
7

(p)

(o)
Notwithstanding any other provision of law to the
8
contrary, if a beneficiary, insured, or enrollee receives
9
neonatal intensive care from a nonparticipating provider or
10
nonparticipating facility, a health insurance issuer shall
11
ensure that the beneficiary, insured, or enrollee shall incur
12
no greater out-of-pocket costs than he or she would have
13
incurred with a participating provider or a participating
14
facility, as long as the nonparticipating provider or
15
nonparticipating facility bills the neonatal intensive care as
16
emergency services.
17
(Source: P.A. 103-440, eff. 1-1-24; 104-60, eff. 1-1-26;
18
104-248, eff. 8-15-25; revised 9-12-25.)

19

Section 95.
No acceleration or delay.
Where this Act makes
20
changes in a statute that is represented in this Act by text
21
that is not yet or no longer in effect (for example, a Section
22
represented by multiple versions), the use of that text does
23
not accelerate or delay the taking effect of (i) the changes
24
made by this Act or (ii) provisions derived from any other
25
Public Act.

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