Bill > SB3517

This bill modifies existing Illinois law regarding health insurance coverage for ground ambulance services, particularly when a patient uses a nonparticipating provider, meaning a provider without a contract with the insurance company. For ground ambulance services provided by entities that are subject to a local government's jurisdiction, the bill clarifies that the payment rate from the health insurance issuer to the nonparticipating provider will be set by the governing body of that local government. For nonparticipating ground ambulance providers not under the jurisdiction of a local government, the bill establishes that the payment rate will be the lesser of the negotiated rate between the provider and the insurer, 85% of the provider's billed charges, or a rate filed with the Department of Public Health based on their average gross charges. This aims to ensure that patients using nonparticipating ground ambulance services do not face higher out-of-pocket costs than they would with a participating provider, and it clarifies how these providers are to be reimbursed by insurance companies. The bill also makes conforming changes to the Health Maintenance Organization Act to align with these provisions.