HB 4464

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Full Text of HB4464
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	HB4464 - 104th General Assembly
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			House Amendment 001
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		House Amendment 001
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		HB4464 Enrolled		LRB104 16881 BAB 30291 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
5changing Section 355.5 as follows:
6    (215 ILCS 5/355.5)
7    Sec. 355.5. Dental coverage reimbursement; prohibitions.
8    (a) No insurer, dental service plan corporation,
9professional service corporation, insurance network leasing
10company, or any other company or its contracted vendor that
11amends, delivers, issues, or renews an individual or group
12policy of accident and health insurance on or after the 
13effective date of this amendatory Act of the 104th General 
14Assembly [the effective date of this amendatory Act of the ]
15[103rd General Assembly] shall require a dental care provider to
16only accept payment from a credit card or electronic funds 
17transfer or to incur a fee to access and obtain payment or
18reimbursement for services provided.
19    (b) Any insurer, dental service plan corporation, 
20professional service corporation, insurance network leasing 
21company, or any other company or its contracted vendor that 
22amends, delivers, issues, or renews an individual or group 
23policy of accident and health insurance [A dental plan carrier]
		HB4464 Enrolled	- 2 -	LRB104 16881 BAB 30291 b
1shall provide a dental care provider with 100% of the
2contracted amount of the payment or reimbursement.
3    (c) In this subsection, "express acceptance" means a clear 
4and direct agreement to the terms of payment method, 
5communicated explicitly by the dental plan to the dental care 
6provider, in writing, signifying acceptance of the payment 
7method without any ambiguity or implied actions. Any insurer, 
8dental service plan corporation, professional service 
9corporation, insurance network leasing company, or any other 
10company or its contracted vendor that amends, delivers, 
11issues, or renews an individual or group policy of accident 
12and health insurance may initiate or change payment 
13methodology to a dental care provider using electronic funds 
14transfer payments, including virtual credit card payments, if:
15        (1) the dental care provider is notified of any fees 
16    associated with a particular payment method;
17        (2) the insurer, dental service plan corporation, 
18    professional service corporation, insurance network 
19    leasing company, or other company or its contracted vendor 
20    advises the dental care provider of the available methods 
21    of payment and provides clear instructions to the dentist 
22    as to how to select an alternative payment method that 
23    does not impose fees or similar charges on the provider; 
24    and
25        (3) the dental care provider or a designee of the 
26    provider elects, through express acceptance, to accept a 
		HB4464 Enrolled	- 3 -	LRB104 16881 BAB 30291 b
1    payment of the claim using the credit card or electronic 
2    funds transfer payment method. A dental care provider's 
3    express acceptance may be given by an electronic or 
4    digital signature if the form of the signature is 
5    recognized as a valid signature under applicable federal 
6    or State law, including, but not limited to, checking a 
7    box indicating affirmative consent. Violation of express 
8    acceptance nullifies an election on claim payment 
9    methodology until the express agreement is executed.
10    (d) A dental care provider's selected form of claim 
11payment methodology remains effective until the dental care 
12provider chooses an alternative method of payment or a new 
13contract is executed.
14    (e) The insurer, dental service plan corporation, 
15professional service corporation, insurance network leasing 
16company, or other company or its contracted vendor shall 
17comply with subsections (d) and (e) of Section 355.6.
18    (f) A dental benefit plan or its contracted vendor or 
19health maintenance organization that initiates or changes 
20payments to a dentist through the Automated Clearing House 
21Network in accordance with 45 CFR 162.1601 and 45 CFR 162.1602 
22shall not charge a fee solely to transmit the payment to the 
23dental care provider unless the dental care provider has 
24consented to the fee. A dental care provider agent may charge 
25reasonable fees when transmitting an Automated Clearing House 
26Network payment related to transaction management, data 
		HB4464 Enrolled	- 4 -	LRB104 16881 BAB 30291 b
1management, portal services, and other value-added services, 
2in addition to bank transmittal.
3    (g) The requirements of this Section shall not be waived 
4by contract, and any contractual clause in conflict with the 
5requirements of this Section or that purports to waive any 
6requirements of this Section is void. [Fees incurred directly ]
7[by a dental care provider from third parties related to ]
8[transmitting an automated clearing house network claim, ]
9[transaction management, data management, or portal services ]
10[and other fees charged by third parties that are not in the ]
11[control of the dental plan carrier shall not be prohibited by ]
12[this Section.]
13(Source: P.A. 103-24, eff. 1-1-24.)
14    Section 99. Effective date. This Act takes effect January
151, 2027.