§ 355.6 — Health care provider reimbursement

Illinois § 355.6

• Jurisdiction: Illinois
• Topic: REGULATION
• Ch. 215: INSURANCE
• Act 215 ILCS 5/: Illinois Insurance Code.
• Art.: Article XX - Accident And Health Insurance

Text

(a) In this Section, "health care provider" has the meaning given to the term "provider" in Section 370g. (b) Any group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after January 1, 2026 shall offer all reasonably available methods of payment from the insurer or managed care plan, or its contracted vendor, to the contracted health care provider, which shall include, but not be limited to, payment by check and electronic funds transfer. An insurer or managed care plan shall not mandate payment by credit card. For purposes of this subsection, "credit card" means a single-use or virtual credit card provided in an electronic, digital, facsimile, physical, or paper format. (c) If one of the available payment methods has a fee associated with it, the insurer or managed care plan, or its contracted vendor, shall, prior to initiating the first payment to an in-network health care provider or upon changing the payment methods available to a health care provider: (1) notify the health care provider that there may be fees associated with a particular payment method and that the insurer or managed care plan, or its contracted vendor, shall disclose any fees beyond what the health care provider would normally pay to process a payment using that payment method; and (2) provide the health care provider with clear instructions on the insurer's or managed care plan's, or its contracted vendor's, website or through means other than the contract offered to the health care provider as to how to select each method. (d) If a health care provider requests a change in the available payment method, the insurer or managed care plan, or its contracted vendor, shall implement the change to the payment method selected by the health care provider within 30 business days, subject to federal and State verification measures to prevent fraud and abuse. (e) An insurer or managed care plan shall not use a health care provider's preferred method of payment as a factor when deciding whether to provide credentials to a health care provider.

Legislative History

(Source: P.A. 103-618, eff. 1-1-25 .)