Bill Text: IL SB3517 | 2025-2026 | 104th General Assembly | Enrolled

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Bill Title: Reinserts the provisions of the introduced bill with the following changes. In provisions concerning payment from a health insurance issuer to a nonparticipating ground ambulance service provider, provides that, for nonparticipating ground ambulance service providers subject to a unit of local government (rather than owned and operated by a unit of local government), the rate shall be equal to the rate established or approved by the governing body of the local government (rather than a unit of local government) providing the ground ambulance service. Provides that, for nonparticipating ground ambulance service providers that are not subject to the jurisdiction of a unit of local government (rather than owned and operated by a unit of local government), the rate shall be equal to the lesser of the specified rates.

Sponsorship: Slight Partisan Bill (Democrat 12-4)

Status: (Passed) 2026-07-31 - Public Act . . . . . . . . . 104-0732 [SB3517 Detail]

Download: Illinois-2025-SB3517-Enrolled.html

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SB3517 Enrolled LRB104 18998 BAB 32443 b
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 356z.3a as follows:
(215 ILCS 5/356z.3a)
Sec. 356z.3a. Billing; emergency services;
nonparticipating providers.
(a) As used in this Section:
"Ancillary services" means:
(1) items and services related to emergency medicine,
anesthesiology, pathology, radiology, and neonatology that
are provided by any health care provider;
(2) items and services provided by assistant surgeons,
hospitalists, and intensivists;
(3) diagnostic services, including radiology and
laboratory services, except for advanced diagnostic
laboratory tests identified on the most current list
published by the United States Secretary of Health and
Human Services under 42 U.S.C. 300gg-132(b)(3);
(4) items and services provided by other specialty
practitioners as the United States Secretary of Health and
Human Services specifies through rulemaking under 42

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U.S.C. 300gg-132(b)(3);
(5) items and services provided by a nonparticipating
provider if there is no participating provider who can
furnish the item or service at the facility; and
(6) items and services provided by a nonparticipating
provider if there is no participating provider who will
furnish the item or service because a participating
provider has asserted the participating provider's rights
under the Health Care Right of Conscience Act.
"Average gross charge rate" means, with respect to
nonparticipating ground ambulance service providers, the
average of the provider's gross charge rates in place for each
individual charge described in subsection (b-15) of this
Section for dates of service that fall within the 12-month
period ending on June 30 immediately preceding the date on
which the reporting of average gross charge rates is required.
"Cost sharing" means the amount an insured, beneficiary,
or enrollee is responsible for paying for a covered item or
service under the terms of the policy or certificate. "Cost
sharing" includes copayments, coinsurance, and amounts paid
toward deductibles, but does not include amounts paid towards
premiums, balance billing by out-of-network providers, or the
cost of items or services that are not covered under the policy
or certificate.
"Emergency department of a hospital" means any hospital
department that provides emergency services, including a

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hospital outpatient department.
"Emergency medical condition" has the meaning ascribed to
that term in Section 10 of the Managed Care Reform and Patient
Rights Act.
"Emergency medical screening examination" has the meaning
ascribed to that term in Section 10 of the Managed Care Reform
and Patient Rights Act.
"Emergency services" means, with respect to an emergency
medical condition:
(1) in general, an emergency medical screening
examination, including ancillary services routinely
available to the emergency department to evaluate such
emergency medical condition, and such further medical
examination and treatment as would be required to
stabilize the patient regardless of the department of the
hospital or other facility in which such further
examination or treatment is furnished; or
(2) additional items and services for which benefits
are provided or covered under the coverage and that are
furnished by a nonparticipating provider or
nonparticipating emergency facility regardless of the
department of the hospital or other facility in which such
items are furnished after the insured, beneficiary, or
enrollee is stabilized and as part of outpatient
observation or an inpatient or outpatient stay with
respect to the visit in which the services described in

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paragraph (1) are furnished. Services after stabilization
cease to be emergency services only when all the
conditions of 42 U.S.C. 300gg-111(a)(3)(C)(ii)(II) and
regulations thereunder are met.
"Emergency ground ambulance service" means ground
ambulance service provided by ground ambulance service
providers, regardless of whether the patient was transported,
if the service was provided pursuant to a request to 9-1-1 or
an equivalent telephone number, texting system, or other
method of summoning emergency service or if the service
provided was provided when a patient's condition, at the time
of service, was considered to be an emergency medical
condition as determined by a physician licensed under the
Medical Practice Act of 1987.
"Evaluation" means, with respect to emergency ground
ambulance service, the provision of a medical screening
examination to determine whether an emergency medical
condition exists.
"Freestanding Emergency Center" means a facility licensed
under Section 32.5 of the Emergency Medical Services (EMS)
Systems Act.
"Ground ambulance service" means both medical
transportation service that is described as ground ambulance
service by the Centers for Medicare and Medicaid Services and
medical nontransportation service, such as evaluation without
transport, treatment without transport, or paramedic

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intercept, and that is, in either case, provided in a vehicle
that is licensed as an ambulance under the Emergency Medical
Services (EMS) Systems Act or by EMS Personnel assigned to a
vehicle that is licensed as an ambulance under the Emergency
Medical Services (EMS) Systems Act. "Ground ambulance service"
may include any combination of the following: emergency ground
ambulance service in a ground ambulance, urgent ground
ambulance service, evaluation without treatment, treatment
without transport, and paramedic intercept.
"Ground ambulance service provider" means a vehicle
service provider under the Emergency Medical Services (EMS)
Systems Act that operates licensed ground ambulances for the
purpose of providing emergency ground ambulance services,
urgent ground ambulances services, or both. "Ground ambulance
service provider" includes both ambulance providers and
ambulance suppliers as described by the Centers for Medicare
and Medicaid Services.
"Health care facility" means, in the context of
non-emergency services, any of the following:
(1) a hospital as defined in 42 U.S.C. 1395x(e);
(2) a hospital outpatient department;
(3) a critical access hospital certified under 42
U.S.C. 1395i-4(e);
(4) an ambulatory surgical treatment center as defined
in the Ambulatory Surgical Treatment Center Act; or
(5) any recipient of a license under the Hospital

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Licensing Act that is not otherwise described in this
definition.
"Health care provider" means a provider as defined in
subsection (d) of Section 370g. "Health care provider" does
not include a provider of air ambulance or ground ambulance
services.
"Health care services" has the meaning ascribed to that
term in subsection (a) of Section 370g.
"Health insurance issuer" has the meaning ascribed to that
term in Section 5 of the Illinois Health Insurance Portability
and Accountability Act.
"Nonparticipating emergency facility" means, with respect
to the furnishing of an item or service under a policy of group
or individual health insurance coverage, any of the following
facilities that does not have a contractual relationship
directly or indirectly with a health insurance issuer in
relation to the coverage:
(1) an emergency department of a hospital;
(2) a Freestanding Emergency Center;
(3) an ambulatory surgical treatment center as defined
in the Ambulatory Surgical Treatment Center Act; or
(4) with respect to emergency services described in
paragraph (2) of the definition of "emergency services", a
hospital.
"Nonparticipating ground ambulance service provider"
means, with respect to the furnishing of an item or services

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under a policy of group or individual health insurance
coverage, any ground ambulance service provider that does not
have a contractual relationship directly or indirectly with a
health insurance issuer in relation to the coverage.
"Nonparticipating provider" means, with respect to the
furnishing of an item or service under a policy of group or
individual health insurance coverage, any health care provider
who does not have a contractual relationship directly or
indirectly with a health insurance issuer in relation to the
coverage.
"Paramedic intercept" means a service in which a vehicle
licensed under the Emergency Medical Services (EMS) Systems
Act ground ambulance staffed by licensed advanced life support
EMS Personnel paramedics rendezvouses with a ground ambulance
staffed with basic life support or intermediate life support
EMS Personnel nonparamedics to provide advanced life support
care. As used in this definition, "advanced life support care"
means life support care that is warranted when a patient's
condition and need for treatment exceed the basic life support
or intermediate life support level of care.
"Participating emergency facility" means any of the
following facilities that has a contractual relationship
directly or indirectly with a health insurance issuer offering
group or individual health insurance coverage setting forth
the terms and conditions on which a relevant health care
service is provided to an insured, beneficiary, or enrollee

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under the coverage:
(1) an emergency department of a hospital;
(2) a Freestanding Emergency Center;
(3) an ambulatory surgical treatment center as defined
in the Ambulatory Surgical Treatment Center Act; or
(4) with respect to emergency services described in
paragraph (2) of the definition of "emergency services", a
hospital.
For purposes of this definition, a single case agreement
between an emergency facility and an issuer that is used to
address unique situations in which an insured, beneficiary, or
enrollee requires services that typically occur out-of-network
constitutes a contractual relationship and is limited to the
parties to the agreement.
"Participating ground ambulance service provider" means
any ground ambulance service provider that has a contractual
relationship directly or indirectly with a health insurance
issuer offering group or individual health insurance coverage
setting forth the terms and conditions on which a relevant
health care service is provided to an insured, beneficiary, or
enrollee under the coverage. As used in this definition, a
single case agreement between a ground ambulance service
provider and a health insurance issuer that is used to address
unique situations in which an insured, beneficiary, or
enrollee requires services that typically occur out-of-network
constitutes a contractual relationship and is limited to the

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parties of the agreement.
"Participating health care facility" means any health care
facility that has a contractual relationship directly or
indirectly with a health insurance issuer offering group or
individual health insurance coverage setting forth the terms
and conditions on which a relevant health care service is
provided to an insured, beneficiary, or enrollee under the
coverage. A single case agreement between an emergency
facility and an issuer that is used to address unique
situations in which an insured, beneficiary, or enrollee
requires services that typically occur out-of-network
constitutes a contractual relationship for purposes of this
definition and is limited to the parties to the agreement.
"Participating provider" means any health care provider
that has a contractual relationship directly or indirectly
with a health insurance issuer offering group or individual
health insurance coverage setting forth the terms and
conditions on which a relevant health care service is provided
to an insured, beneficiary, or enrollee under the coverage.
"Qualifying payment amount" has the meaning given to that
term in 42 U.S.C. 300gg-111(a)(3)(E) and the regulations
promulgated thereunder.
"Recognized amount" means, except as otherwise provided in
this Section, the lesser of the amount initially billed by the
provider or the qualifying payment amount.
"Stabilize" means "stabilization" as defined in Section 10

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of the Managed Care Reform and Patient Rights Act.
"Treating provider" means a health care provider who has
evaluated the individual.
"Treatment" means, with respect to the provision of
emergency ground ambulance service, the provision of an
evaluation and either (i) a therapy or therapeutic agent used
to treat an emergency medical condition or (ii) a procedure
used to treat an emergency medical condition.
"Urgent ground ambulance service" means ground ambulance
service that is deemed medically necessary by a health care
professional and is required within 12 hours after the
certification of the need for the service.
"Visit" means, with respect to health care services
furnished to an individual at a health care facility, health
care services furnished by a provider at the facility, as well
as equipment, devices, telehealth services, imaging services,
laboratory services, and preoperative and postoperative
services regardless of whether the provider furnishing such
services is at the facility.
(b) Emergency services. When a beneficiary, insured, or
enrollee receives emergency services from a nonparticipating
provider or a nonparticipating emergency facility, 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 provider or a participating emergency

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facility. Any cost-sharing requirements shall be applied as
though the emergency services had been received from a
participating provider or a participating facility. Cost
sharing shall be calculated based on the recognized amount for
the emergency services. If the cost sharing for the same item
or service furnished by a participating provider would have
been a flat-dollar copayment, that amount shall be the
cost-sharing amount unless the provider has billed a lesser
total amount. In no event shall the beneficiary, insured,
enrollee, or any group policyholder or plan sponsor be liable
to or billed by the health insurance issuer, the
nonparticipating provider, or the nonparticipating emergency
facility for any amount beyond the cost sharing calculated in
accordance with this subsection with respect to the emergency
services delivered. Administrative requirements or limitations
shall be no greater than those applicable to emergency
services received from a participating provider or a
participating emergency facility.
(b-5) Non-emergency services at participating health care
facilities.
(1) When a beneficiary, insured, or enrollee utilizes
a participating health care facility and, due to any
reason, covered ancillary services are provided by a
nonparticipating provider during or resulting from the
visit, the health insurance issuer shall ensure that the
beneficiary, insured, or enrollee shall incur no greater

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out-of-pocket costs than the beneficiary, insured, or
enrollee would have incurred with a participating provider
for the ancillary services. Any cost-sharing requirements
shall be applied as though the ancillary services had been
received from a participating provider. Cost sharing shall
be calculated based on the recognized amount for the
ancillary services. If the cost sharing for the same item
or service furnished by a participating provider would
have been a flat-dollar copayment, that amount shall be
the cost-sharing amount unless the provider has billed a
lesser total amount. In no event shall the beneficiary,
insured, enrollee, or any group policyholder or plan
sponsor be liable to or billed by the health insurance
issuer, the nonparticipating provider, or the
participating health care facility for any amount beyond
the cost sharing calculated in accordance with this
subsection with respect to the ancillary services
delivered. In addition to ancillary services, the
requirements of this paragraph shall also apply with
respect to covered items or services furnished as a result
of unforeseen, urgent medical needs that arise at the time
an item or service is furnished, regardless of whether the
nonparticipating provider satisfied the notice and consent
criteria under paragraph (2) of this subsection.
(2) When a beneficiary, insured, or enrollee utilizes
a participating health care facility and receives

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non-emergency covered health care services other than
those described in paragraph (1) of this subsection from a
nonparticipating provider during or resulting from the
visit, the health insurance issuer shall ensure that the
beneficiary, insured, or enrollee incurs no greater
out-of-pocket costs than the beneficiary, insured, or
enrollee would have incurred with a participating provider
unless the nonparticipating provider or the participating
health care facility on behalf of the nonparticipating
provider satisfies the notice and consent criteria
provided in 42 U.S.C. 300gg-132 and regulations
promulgated thereunder. If the notice and consent criteria
are not satisfied, then:
(A) any cost-sharing requirements shall be applied
as though the health care services had been received
from a participating provider;
(B) cost sharing shall be calculated based on the
recognized amount for the health care services; and
(C) in no event shall the beneficiary, insured,
enrollee, or any group policyholder or plan sponsor be
liable to or billed by the health insurance issuer,
the nonparticipating provider, or the participating
health care facility for any amount beyond the cost
sharing calculated in accordance with this subsection
with respect to the health care services delivered.
(b-10) Coverage for ground ambulance services provided by

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nonparticipating ground ambulance service providers.
(1) Any group or individual policy of accident and
health insurance amended, delivered, issued, or renewed on
or after January 1, 2027 shall provide coverage for both
emergency ground ambulance service and urgent ground
ambulance service.
(2) Beginning on January 1, 2027, when a beneficiary,
insured, or enrollee receives emergency ground ambulance
services or urgent ambulance 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
provider. Any cost-sharing requirements shall be applied
as though the emergency ground ambulance services or
urgent ground ambulance services had been received from a
participating ground ambulance service provider. Except as
otherwise provided in State or federal law, cost sharing
shall be calculated based on the lesser of the policy's
copayment or coinsurance for an emergency room visit or
10% of the recognized amount. For purposes of this
subsection, the recognized amount shall be calculated as
provided for in paragraph (3) of this subsection. Except
as otherwise provided for in State or federal law, if the
cost sharing for the same item or service furnished by a

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participating ground ambulance provider would have been a
flat-dollar copayment, that amount shall be the
cost-sharing amount unless the nonparticipating ground
ambulance provider has billed a lesser total amount.
(3) Upon reasonable demand by a nonparticipating
ground ambulance service provider and after subtracting
the beneficiary's, insured's, or enrollee's cost sharing
amount, a health insurance issuer shall pay the
nonparticipating ground ambulance service provider as
follows:
(A) for nonparticipating ground ambulance service
providers subject to a unit of local government that
has jurisdiction over where the service was provided,
a rate that is equal to the rate established or
approved by the governing body of the local government
providing the ground ambulance service having
jurisdiction for that area or subarea; or
(B) for nonparticipating ground ambulance service
providers that are not subject to the jurisdiction of
a unit of local government, a rate that is equal to the
lesser of (i) the negotiated rate between the
nonparticipating ground ambulance service provider and
the health insurance issuer; (ii) 85% of the
nonparticipating ground ambulance service provider's
billed charges; or (iii) the average gross charge rate
in effect for the date of service in question for a

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base charge and, if applicable, a loaded mileage
charge, the nonparticipating ground ambulance service
provider has filed with the Department of Public
Health in accordance with subsection (b-15).
By accepting the payment from the health insurance
issuer, the nonparticipating ground ambulance service
provider shall not seek any payment from the
beneficiary, insured, or enrollee for any amount that
exceeds the deductible, coinsurance, or copay for
services provided to the beneficiary, insured, or
enrollee.
(b-15) Beginning on October 1, 2026, and each October 1
thereafter, each nonparticipating ground ambulance service
provider shall file annually with the Department of Public
Health, in the form and manner prescribed by the Department of
Public Health, its average gross charge rates and any other
information required by the Department of Public Health, by
rule, for each of the following ground ambulance charge
descriptions, as applicable: (1) basic life support, urgent
base; (2) basic life support, emergency base; (3) advanced
life support, urgent, level 1 base; (4) advanced life support,
emergency, level 1 base; (5) advanced life support, emergency,
level 2 base; (6) specialty care transport base; (7) emergency
response, evaluation without transport base; (8) emergency
response, treatment without transport base; (9) emergency
response, paramedic intercept base; and (10) loaded mileage,

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per loaded mile charge for each of the applicable base charge
descriptions services. The Department of Public Health shall
publish the submitted rate information by January 1, 2027 and
every January 1 thereafter. The Department of Public Health
may request information from ground ambulance service
providers and health insurance issuers regarding factors
contributing to the network status of the ground ambulance
service providers. The Department of Public Health may, upon
the submission of rate information, assess a fee to each
ground ambulance service provider that shall not exceed the
administrative costs to complete the Department of Public
Health's obligations in this subsection. The Department of
Public Health may also request information from nationally
recognized organizations that provide data on health care
costs. The Department of Insurance shall direct the health
insurance issuer to the location in which the information
reported to the Department of Public Health is stored.
(c) Notwithstanding any other provision of this Code,
except when the notice and consent criteria are satisfied for
the situation in paragraph (2) of subsection (b-5), any
benefits a beneficiary, insured, or enrollee receives for
services under the situations in subsection (b), (b-5),
(b-10), or (b-15) are assigned to the nonparticipating
providers, nonparticipating ground ambulance service provider,
or the facility acting on their behalf. Upon receipt of the
provider's bill or facility's bill, the health insurance

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issuer shall provide the nonparticipating provider,
nonparticipating ground ambulance service provider, or the
facility with a written explanation of benefits that specifies
the proposed reimbursement and the applicable deductible,
copayment, or coinsurance amounts owed by the insured,
beneficiary, or enrollee. The health insurance issuer shall
pay any reimbursement subject to this Section directly to the
nonparticipating provider, nonparticipating ground ambulance
service provider, or the facility.
(d) For bills assigned under subsection (c), the
nonparticipating provider or the facility may bill the health
insurance issuer for the services rendered, and the health
insurance issuer may pay the billed amount or attempt to
negotiate reimbursement with the nonparticipating provider or
the facility. Within 30 calendar days after the provider or
facility transmits the bill to the health insurance issuer,
the issuer shall send an initial payment or notice of denial of
payment with the written explanation of benefits to the
provider or facility. If attempts to negotiate reimbursement
for services provided by a nonparticipating provider do not
result in a resolution of the payment dispute within 30 days
after receipt of written explanation of benefits by the health
insurance issuer, then the health insurance issuer or
nonparticipating provider or the facility may initiate binding
arbitration to determine payment for services provided on a
per-bill or batched-bill basis, in accordance with Section

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300gg-111 of the Public Health Service Act and the regulations
promulgated thereunder. The party requesting arbitration shall
notify the other party arbitration has been initiated and
state its final offer before arbitration. In response to this
notice, the nonrequesting party shall inform the requesting
party of its final offer before the arbitration occurs.
Arbitration shall be initiated by filing a request with the
Department of Insurance.
(e) The Department of Insurance shall publish a list of
approved arbitrators or entities that shall provide binding
arbitration. These arbitrators shall be American Arbitration
Association or American Health Lawyers Association trained
arbitrators. Both parties must agree on an arbitrator from the
Department of Insurance's or its approved entity's list of
arbitrators. If no agreement can be reached, then a list of 5
arbitrators shall be provided by the Department of Insurance
or the approved entity. From the list of 5 arbitrators, the
health insurance issuer can veto 2 arbitrators and the
provider or facility can veto 2 arbitrators. The remaining
arbitrator shall be the chosen arbitrator. This arbitration
shall consist of a review of the written submissions by both
parties. The arbitrator shall not establish a rebuttable
presumption that the qualifying payment amount should be the
total amount owed to the provider or facility by the
combination of the issuer and the insured, beneficiary, or
enrollee. Binding arbitration shall provide for a written

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decision within 45 days after the request is filed with the
Department of Insurance. Both parties shall be bound by the
arbitrator's decision. The arbitrator's expenses and fees,
together with other expenses, not including attorney's fees,
incurred in the conduct of the arbitration, shall be paid as
provided in the decision.
(f) (Blank).
(g) Section 368a of this Code Act shall not apply during
the pendency of a decision under subsection (d). Upon the
issuance of the arbitrator's decision, Section 368a applies
with respect to the amount, if any, by which the arbitrator's
determination exceeds the issuer's initial payment under
subsection (c), or the entire amount of the arbitrator's
determination if initial payment was denied. Any interest
required to be paid to a provider under Section 368a shall not
accrue until after 30 days of an arbitrator's decision as
provided in subsection (d), but in no circumstances longer
than 150 days from the date the nonparticipating
facility-based provider billed for services rendered.
(h) Nothing in this Section shall be interpreted to change
the prudent layperson provisions with respect to emergency
services under the Managed Care Reform and Patient Rights Act.
(i) Nothing in this Section shall preclude a health care
provider from billing a beneficiary, insured, or enrollee for
reasonable administrative fees, such as service fees for
checks returned for nonsufficient funds and missed

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appointments.
(j) Nothing in this Section shall preclude a beneficiary,
insured, or enrollee from assigning benefits to a
nonparticipating provider when the notice and consent criteria
are satisfied under paragraph (2) of subsection (b-5) or in
any other situation not described in subsection (b) or (b-5).
(k) Except when the notice and consent criteria are
satisfied under paragraph (2) of subsection (b-5), if an
individual receives health care services under the situations
described in subsection (b) or (b-5), no referral requirement
or any other provision contained in the policy or certificate
of coverage shall deny coverage, reduce benefits, or otherwise
defeat the requirements of this Section for services that
would have been covered with a participating provider.
However, this subsection shall not be construed to preclude a
provider contract with a health insurance issuer, or with an
administrator or similar entity acting on the issuer's behalf,
from imposing requirements on the participating provider,
participating emergency facility, or participating health care
facility relating to the referral of covered individuals to
nonparticipating providers.
(l) Except if the notice and consent criteria are
satisfied under paragraph (2) of subsection (b-5),
cost-sharing amounts calculated in conformity with this
Section shall count toward any deductible or out-of-pocket
maximum applicable to in-network coverage.

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(m) The Department has the authority to enforce the
requirements of this Section in the situations described in
subsections (b) and (b-5), and in any other situation for
which 42 U.S.C. Chapter 6A, Subchapter XXV, Parts D or E and
regulations promulgated thereunder would prohibit an
individual from being billed or liable for emergency services
furnished by a nonparticipating provider or nonparticipating
emergency facility or for non-emergency health care services
furnished by a nonparticipating provider at a participating
health care facility.
(n) This Section does not apply with respect to air
ambulance services. This Section does not apply to any policy
of excepted benefits or to short-term, limited-duration health
insurance coverage.
(o) A home rule unit may not regulate payments for ground
ambulance service in a manner inconsistent with this Section.
This subsection is a limitation under subsection (i) of
Section 6 of Article VII of the Illinois Constitution on the
concurrent exercise by home rule units of powers and functions
exercised by the State.
(p) (o) Notwithstanding any other provision of law to the
contrary, if a beneficiary, insured, or enrollee receives
neonatal intensive care from a nonparticipating provider or
nonparticipating facility, a health insurance issuer shall
ensure that the beneficiary, insured, or enrollee shall incur
no greater out-of-pocket costs than he or she would have

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incurred with a participating provider or a participating
facility, as long as the nonparticipating provider or
nonparticipating facility bills the neonatal intensive care as
emergency services.
(Source: P.A. 103-440, eff. 1-1-24; 104-60, eff. 1-1-26;
104-248, eff. 8-15-25; revised 11-21-25.)
Section 10. The Health Maintenance Organization Act is
amended by changing Section 4-15 as follows:
(215 ILCS 125/4-15) (from Ch. 111 1/2, par. 1409.8)
Sec. 4-15. (a) No contract or evidence of coverage for
basic health care services delivered, issued for delivery,
renewed, or amended by a Health Maintenance Organization shall
exclude coverage for ground ambulance service as defined in
Section 356z.3a of the Illinois Insurance Code emergency
transportation by ambulance. For the purposes of this Section,
the term "emergency" means a need for immediate medical
attention resulting from a life threatening condition or
situation or a need for immediate medical attention as
otherwise reasonably determined by a physician, public safety
official or other emergency medical personnel.
(b) Payments to nonparticipating ground ambulance service
providers shall be as described in subsection (b-10) of
Section 356z.3a of the Illinois Insurance Code Upon reasonable
demand by a provider of emergency transportation by ambulance,

SB3517 Enrolled - 24 - LRB104 18998 BAB 32443 b
a Health Maintenance Organization shall promptly pay to the
provider, subject to coverage limitations stated in the
contract or evidence of coverage, the charges for emergency
transportation by ambulance provided to an enrollee in a
health care plan arranged for by the Health Maintenance
Organization. By accepting any such payment from the Health
Maintenance Organization, the provider of emergency
transportation by ambulance agrees not to seek any payment
from the enrollee for services provided to the enrollee.
(Source: P.A. 86-833; 86-1028.)