Bill Text: IL HB4464 | 2025-2026 | 104th General Assembly | Enrolled

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Bill Title: 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.

Sponsorship: Partisan Bill (Democrat 4)

Status: (Enrolled) 2026-06-12 - Sent to the Governor [HB4464 Detail]

Download: Illinois-2025-HB4464-Enrolled.html

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AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by
changing Section 355.5 as follows:
(215 ILCS 5/355.5)
Sec. 355.5. Dental coverage reimbursement; prohibitions.
(a) No 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 this amendatory Act of the 104th General
Assembly the effective date of this amendatory Act of the
103rd General Assembly shall require a dental care provider to
only accept payment from a credit card or electronic funds
transfer or to incur a fee to access and obtain payment or
reimbursement for services provided.
(b) 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 A dental plan carrier

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shall provide a dental care provider with 100% of the
contracted amount of the payment or reimbursement.
(c) In this subsection, "express acceptance" means a clear
and direct agreement to the terms of payment method,
communicated explicitly by the dental plan to the dental care
provider, in writing, signifying acceptance of the payment
method without any ambiguity or implied actions. 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:
(1) the dental care provider is notified of any fees
associated with a particular payment method;
(2) the insurer, dental service plan corporation,
professional service corporation, insurance network
leasing company, or other company or its contracted vendor
advises the dental care provider of the available methods
of payment and provides clear instructions to the dentist
as to how to select an alternative payment method that
does not impose fees or similar charges on the provider;
and
(3) the dental care provider or a designee of the
provider elects, through express acceptance, to accept a

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payment of the claim using the credit card or electronic
funds transfer payment method. A dental care provider's
express acceptance may be given by an electronic or
digital signature if the form of the signature is
recognized as a valid signature under applicable federal
or State law, including, but not limited to, checking a
box indicating affirmative consent. Violation of express
acceptance nullifies an election on claim payment
methodology until the express agreement is executed.
(d) A dental care provider's selected form of claim
payment methodology remains effective until the dental care
provider chooses an alternative method of payment or a new
contract is executed.
(e) The insurer, dental service plan corporation,
professional service corporation, insurance network leasing
company, or other company or its contracted vendor shall
comply with subsections (d) and (e) of Section 355.6.
(f) A dental benefit plan or its contracted vendor or
health maintenance organization that initiates or changes
payments to a dentist through the Automated Clearing House
Network in accordance with 45 CFR 162.1601 and 45 CFR 162.1602
shall not charge a fee solely to transmit the payment to the
dental care provider unless the dental care provider has
consented to the fee. A dental care provider agent may charge
reasonable fees when transmitting an Automated Clearing House
Network payment related to transaction management, data

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management, portal services, and other value-added services,
in addition to bank transmittal.
(g) The requirements of this Section shall not be waived
by contract, and any contractual clause in conflict with the
requirements of this Section or that purports to waive any
requirements of this Section is void. Fees incurred directly
by a dental care provider from third parties related to
transmitting an automated clearing house network claim,
transaction management, data management, or portal services
and other fees charged by third parties that are not in the
control of the dental plan carrier shall not be prohibited by
this Section.
(Source: P.A. 103-24, eff. 1-1-24.)
Section 99. Effective date. This Act takes effect January
1, 2027.