How SB 2405 changes current law

AI-generated reading aid from the bill's amendatory text — verify against the official bill.

The bill amends the Illinois Insurance Code to protect consumers from surprise billing by ensuring that out-of-pocket costs for nonparticipating ground ambulance services do not exceed costs for participating providers.

• 215 ILCS 5/356z.3a

  notwithstanding any other applicable provision, when a beneficiary, insured, or enrollee receives services from a nonparticipating ground ambulance service provider, the health insurance issuer shall ensure that the beneficiary, insured, or enrollee shall incur no greater out-of-pocket costs than the beneficiary, insured, or enrollee would have incurred with a participating ground ambulance service provider.

  This provision requires health insurers to limit out-of-pocket expenses for out-of-network ambulance services to the level required for in-network services.

• 215 ILCS 5/370g

  Sets forth provisions concerning payment for ground ambulance services; calculating the recognized amount; limitations for the cost sharing amount for any occurrence in which a ground ambulance service is provided to a beneficiary; appeals for payments made by health insurance issuers; the maximum allowable payment amounts, by individual service types, for nonparticipating ground ambulance service providers owned, operated, or controlled by a private organization; and payments to nonparticipating ground ambulance service providers owned, operated, or controlled by a unit of government which participates in the Ground Emergency Medical Transportation program administered by the Department of Healthcare and Family Services.

  This addition regulates payments for ground ambulance services, including how recognized amounts are calculated and sets limits on cost-sharing.

• Provides that the failure by a health insurance issuer to comply with the specified requirements constitutes an unlawful practice under the Consumer Fraud and Deceptive Business Practices Act and enforcement authority is granted to the Attorney General.

  This establishes penalties for noncompliance with the new billing protections, allowing the Attorney General to enforce the law.