104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB3181
 
Introduced 2/2/2026, by Sen. Omar Aquino
 
SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/368k new
    Amends the Illinois Insurance Code. Sets forth provisions concerning minimum reimbursement rates that a health insurance company must provide for a physician providing health care services in the specified counties. Prohibits a physician from waiving minimum reimbursement protections as a condition of participation in a health benefit plan or for any other reason. Grants the Department of Insurance rulemaking authority and establishes penalty provisions for violations of the minimum reimbursement provisions.


LRB104 18630 BAB 32073 b

 
 
A BILL FOR
 
SB3181LRB104 18630 BAB 32073 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois, 
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by 
5adding Section 368k as follows:
 
6    (215 ILCS 5/368k new)
7    Sec. 368k. Fair physician payment; minimum reimbursement; 
8penalties.
9    (a) In this Section:
10    "County" means one or all of the following 4 counties: 
11Cook, DuPage, Lake, and Will Counties in Illinois.
12    "Covered health care service" means any service for which 
13a Medicare rate has been established at the time the physician 
14service is provided.
15    "Health insurance company" means any insurance company, 
16health maintenance organization, preferred provider 
17organization, or other entity that administers a health 
18insurance plan subject to regulation under the laws of 
19Illinois.
20    "Health insurance plan" does not include a noncommercial 
21insurance plan, such as a personal line or a policy of excepted 
22benefits.
23    "Medicare rate" means the applicable Current Procedural 
 
 
SB3181- 2 -LRB104 18630 BAB 32073 b

1Terminology (CPT) Code established under the Medicare 
2Physician Fee Schedule in effect on the date the physician 
3services are rendered.
4    "Physician" means an individual licensed to practice 
5medicine or osteopathy under applicable State law and any 
6advanced practice provider practicing under the supervision of 
7a physician.
8    (b) A health insurance company shall reimburse a physician 
9providing covered health care services in any county for no 
10less than 160% of the Medicare rate then in effect for the same 
11service.
12    (c) If Medicare established multiple payment rates for a 
13service, the reimbursement floor shall be calculated using the 
14rate that most closely corresponds to the setting and type of 
15service.
16    (d) Any contract, policy, or agreement that provides for 
17reimbursement at a rate lower than the minimum reimbursement 
18in subsections (b) and (c) shall be void and unenforceable to 
19the extent of the conflict.
20    (e) A physician shall not waive the protections of this 
21Section as a condition of participation in a health benefit 
22plan or for any other reason.
23    (f) The Department shall enforce this Section and may 
24adopt rules necessary to implement its provisions.
25    (g) A health insurance company that violates this Section 
26shall be subject to:
 
 
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1        (1) civil penalties of up to $15,000 per individual 
2    violation;
3        (2) payment of restitution to the affected physician; 
4    and
5        (3) any additional remedies authorized by the 
6    Department.