Illinois 2025-2026 Regular Session

Illinois Senate Bill SB1984 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1984 Introduced 2/6/2025, by Sen. Dave Syverson SYNOPSIS AS INTRODUCED: 215 ILCS 111/15215 ILCS 111/20215 ILCS 111/25215 ILCS 111/30 new215 ILCS 111/35 new215 ILCS 111/40 new215 ILCS 111/45 new Amends the Uniform Electronic Transactions in Dental Care Billing Act. Provides that beginning January 1, 2028 (instead of 2026), no dental plan carrier is required to accept from a dental care provider eligibility for a dental plan transaction or dental care claims or equivalent encounter information transaction. Sets forth exemptions from the requirements of the Act, and requires a dental care provider who is exempt from the requirements of the Act to file a form with the Department of Insurance indicating the applicable exemption. Requires each dental plan carrier to establish a portal that provides certain benefit and billing information. Requires a dental plan carrier to establish an electronic portal that allows dental care providers to submit claims electronically and directly to the dental care provider; accept attachments in an electronic format with the initial electronic claim's submission; and provide remittance advice with the corresponding payment. Provides that nothing in the Act requires a dental care provider to only accept electronic payment from a dental plan carrier. Provides that dental plan carriers shall allow alternative forms of payment, without additional fees or charges, to a dental care provider, if requested. Effective immediately. LRB104 06096 BAB 16129 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1984 Introduced 2/6/2025, by Sen. Dave Syverson SYNOPSIS AS INTRODUCED: 215 ILCS 111/15215 ILCS 111/20215 ILCS 111/25215 ILCS 111/30 new215 ILCS 111/35 new215 ILCS 111/40 new215 ILCS 111/45 new 215 ILCS 111/15 215 ILCS 111/20 215 ILCS 111/25 215 ILCS 111/30 new 215 ILCS 111/35 new 215 ILCS 111/40 new 215 ILCS 111/45 new Amends the Uniform Electronic Transactions in Dental Care Billing Act. Provides that beginning January 1, 2028 (instead of 2026), no dental plan carrier is required to accept from a dental care provider eligibility for a dental plan transaction or dental care claims or equivalent encounter information transaction. Sets forth exemptions from the requirements of the Act, and requires a dental care provider who is exempt from the requirements of the Act to file a form with the Department of Insurance indicating the applicable exemption. Requires each dental plan carrier to establish a portal that provides certain benefit and billing information. Requires a dental plan carrier to establish an electronic portal that allows dental care providers to submit claims electronically and directly to the dental care provider; accept attachments in an electronic format with the initial electronic claim's submission; and provide remittance advice with the corresponding payment. Provides that nothing in the Act requires a dental care provider to only accept electronic payment from a dental plan carrier. Provides that dental plan carriers shall allow alternative forms of payment, without additional fees or charges, to a dental care provider, if requested. Effective immediately. LRB104 06096 BAB 16129 b LRB104 06096 BAB 16129 b A BILL FOR
2	2	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1984 Introduced 2/6/2025, by Sen. Dave Syverson SYNOPSIS AS INTRODUCED:
3	3	215 ILCS 111/15215 ILCS 111/20215 ILCS 111/25215 ILCS 111/30 new215 ILCS 111/35 new215 ILCS 111/40 new215 ILCS 111/45 new 215 ILCS 111/15 215 ILCS 111/20 215 ILCS 111/25 215 ILCS 111/30 new 215 ILCS 111/35 new 215 ILCS 111/40 new 215 ILCS 111/45 new
4	4	215 ILCS 111/15
5	5	215 ILCS 111/20
6	6	215 ILCS 111/25
7	7	215 ILCS 111/30 new
8	8	215 ILCS 111/35 new
9	9	215 ILCS 111/40 new
10	10	215 ILCS 111/45 new
11	11	Amends the Uniform Electronic Transactions in Dental Care Billing Act. Provides that beginning January 1, 2028 (instead of 2026), no dental plan carrier is required to accept from a dental care provider eligibility for a dental plan transaction or dental care claims or equivalent encounter information transaction. Sets forth exemptions from the requirements of the Act, and requires a dental care provider who is exempt from the requirements of the Act to file a form with the Department of Insurance indicating the applicable exemption. Requires each dental plan carrier to establish a portal that provides certain benefit and billing information. Requires a dental plan carrier to establish an electronic portal that allows dental care providers to submit claims electronically and directly to the dental care provider; accept attachments in an electronic format with the initial electronic claim's submission; and provide remittance advice with the corresponding payment. Provides that nothing in the Act requires a dental care provider to only accept electronic payment from a dental plan carrier. Provides that dental plan carriers shall allow alternative forms of payment, without additional fees or charges, to a dental care provider, if requested. Effective immediately.
12	12	LRB104 06096 BAB 16129 b LRB104 06096 BAB 16129 b
13	13	LRB104 06096 BAB 16129 b
14	14	A BILL FOR
15	15	SB1984LRB104 06096 BAB 16129 b SB1984 LRB104 06096 BAB 16129 b
16	16	SB1984 LRB104 06096 BAB 16129 b
17	17	1 AN ACT concerning regulation.
18	18	2 Be it enacted by the People of the State of Illinois,
19	19	3 represented in the General Assembly:
20	20	4 Section 5. The Uniform Electronic Transactions in Dental
21	21	5 Care Billing Act is amended by changing Sections 15, 20, and 25
22	22	6 and by adding Sections 30, 35, 40, and 45 as follows:
23	23	7 (215 ILCS 111/15)
24	24	8 Sec. 15. Definitions. As used in this Act:
25	25	9 "Department" means the Department of Insurance.
26	26	10 "Director" means the Director of Insurance.
27	27	11 "Dental care provider" means a dentist who bills for
28	28	12 services in Illinois.
29	29	13 "Dental plan carrier" means an entity subject to the
30	30	14 insurance laws and regulations of this State or subject to the
31	31	15 jurisdiction of the Director that contracts or offers to
32	32	16 contract to provide, deliver, arrange for, pay for, or
33	33	17 reimburse any of the costs of dental care services, including
34	34	18 an accident and health insurance company, a health maintenance
35	35	19 organization, a limited health service organization, a dental
36	36	20 service plan corporation, a health services plan corporation,
37	37	21 a voluntary health services plan, or any other entity
38	38	22 providing a plan of dental insurance, dental benefits, or
39	39	23 dental health care services.
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43	43	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1984 Introduced 2/6/2025, by Sen. Dave Syverson SYNOPSIS AS INTRODUCED:
44	44	215 ILCS 111/15215 ILCS 111/20215 ILCS 111/25215 ILCS 111/30 new215 ILCS 111/35 new215 ILCS 111/40 new215 ILCS 111/45 new 215 ILCS 111/15 215 ILCS 111/20 215 ILCS 111/25 215 ILCS 111/30 new 215 ILCS 111/35 new 215 ILCS 111/40 new 215 ILCS 111/45 new
45	45	215 ILCS 111/15
46	46	215 ILCS 111/20
47	47	215 ILCS 111/25
48	48	215 ILCS 111/30 new
49	49	215 ILCS 111/35 new
50	50	215 ILCS 111/40 new
51	51	215 ILCS 111/45 new
52	52	Amends the Uniform Electronic Transactions in Dental Care Billing Act. Provides that beginning January 1, 2028 (instead of 2026), no dental plan carrier is required to accept from a dental care provider eligibility for a dental plan transaction or dental care claims or equivalent encounter information transaction. Sets forth exemptions from the requirements of the Act, and requires a dental care provider who is exempt from the requirements of the Act to file a form with the Department of Insurance indicating the applicable exemption. Requires each dental plan carrier to establish a portal that provides certain benefit and billing information. Requires a dental plan carrier to establish an electronic portal that allows dental care providers to submit claims electronically and directly to the dental care provider; accept attachments in an electronic format with the initial electronic claim's submission; and provide remittance advice with the corresponding payment. Provides that nothing in the Act requires a dental care provider to only accept electronic payment from a dental plan carrier. Provides that dental plan carriers shall allow alternative forms of payment, without additional fees or charges, to a dental care provider, if requested. Effective immediately.
53	53	LRB104 06096 BAB 16129 b LRB104 06096 BAB 16129 b
54	54	LRB104 06096 BAB 16129 b
55	55	A BILL FOR
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61	61	215 ILCS 111/15
62	62	215 ILCS 111/20
63	63	215 ILCS 111/25
64	64	215 ILCS 111/30 new
65	65	215 ILCS 111/35 new
66	66	215 ILCS 111/40 new
67	67	215 ILCS 111/45 new
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71	71	LRB104 06096 BAB 16129 b
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86	86	1 "Portal" means a website or reasonably similar method of
87	87	2 sharing information that (i) is compliant with the federal
88	88	3 Health Insurance Portability and Accountability Act of 1996
89	89	4 and the regulations promulgated thereunder, (ii) provides
90	90	5 resources and information to dentists and subscribers, and
91	91	6 (iii) is compatible with dental software so universal
92	92	7 accessibility may be achieved.
93	93	8 (Source: P.A. 102-146, eff. 7-23-21.)
94	94	9 (215 ILCS 111/20)
95	95	10 Sec. 20. Uniform electronic claims and eligibility
96	96	11 transactions required.
97	97	12 (a) Beginning January 1, 2028 2026, no dental plan carrier
98	98	13 is required to accept from a dental care provider eligibility
99	99	14 for a dental plan transaction or dental care claims or
100	100	15 equivalent encounter information transaction except as
101	101	16 provided in this Act.
102	102	17 (b) All dental plan carriers and dental care providers
103	103	18 must exchange claims and eligibility information
104	104	19 electronically using the standard electronic data interchange
105	105	20 transactions for claims submissions, payments, and
106	106	21 verification of benefits required under the Health Insurance
107	107	22 Portability and Accountability Act in order to be compensable
108	108	23 by the dental plan carrier.
109	109	24 (Source: P.A. 102-146, eff. 7-23-21; 103-705, eff. 7-19-24.)
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120	120	1 (215 ILCS 111/25)
121	121	2 Sec. 25. Rules; modification of rules.
122	122	3 (a) The Department may shall adopt rules as necessary to
123	123	4 implement this Act and may establish further exemptions to
124	124	5 this Act by rule.
125	125	6 (b) A dental plan carrier or dental care provider may not
126	126	7 add to or modify the uniform electronic claims and eligibility
127	127	8 requirements adopted by the Department.
128	128	9 (Source: P.A. 102-146, eff. 7-23-21.)
129	129	10 (215 ILCS 111/30 new)
130	130	11 Sec. 30. Exemptions. Notwithstanding any other provision
131	131	12 of this Act, a dental care provider shall not be required to
132	132	13 submit claims electronically under any of the following
133	133	14 circumstances:
134	134	15 (1) The dental care provider is with a dental practice
135	135	16 that, including the dental care provider, employs 4 or
136	136	17 fewer full-time or full-time equivalent employees.
137	137	18 (2) There is a temporary technological or electrical
138	138	19 failure that prevents a claim from being submitted
139	139	20 electronically.
140	140	21 (3) The dental care provider graduated from a dental
141	141	22 school in 1985 or before.
142	142	23 (4) The dental care provider graduated from a dental
143	143	24 school within 10 years before the effective date of this
144	144	25 amendatory Act of the 104th General Assembly and meets one
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155	155	1 of the following criteria:
156	156	2 (A) The dental care provider started his or her
157	157	3 own practice.
158	158	4 (B) The dental care provider has purchased a
159	159	5 practice that has been previously exempted from the
160	160	6 requirements of this Act.
161	161	7 (5) The dental care provider demonstrates financial
162	162	8 difficulties in buying or managing an electronic claims
163	163	9 submission software system.
164	164	10 (6) The dental care provider has a disability or
165	165	11 medical reason that prohibits the dental care provider
166	166	12 from submitting claims electronically.
167	167	13 (7) The dental care provider is a temporary dentist
168	168	14 operating a practice for another dentist who is
169	169	15 temporarily unable to practice.
170	170	16 (8) There are other unforeseen practice disruptions,
171	171	17 including, but not limited to, natural disasters, physical
172	172	18 damage to the practice, or damage to the data system.
173	173	19 A dental care provider who is exempted from filing claims
174	174	20 electronically under this Section shall file a form with the
175	175	21 Department indicating the applicable exemption. The Department
176	176	22 shall provide the form no later than January 1, 2028.
177	177	23 (215 ILCS 111/35 new)
178	178	24 Sec. 35. Eligibility and benefit verification portal.
179	179	25 (a) Each dental plan carrier shall establish a portal as
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190	190	1 described in this Section and shall include information about
191	191	2 each type of subscription contract that is sufficient to allow
192	192	3 subscribers and dentists to determine the covered services
193	193	4 under each subscription contract and the payment or
194	194	5 reimbursement amounts for those covered services at the
195	195	6 procedure level. The information in the portal shall include
196	196	7 the following, as appropriate:
197	197	8 (1) Effective date of plan.
198	198	9 (2) Status of plan.
199	199	10 (3) Termination date of plan.
200	200	11 (4) Coordination of benefits; standard or
201	201	12 non-duplicating.
202	202	13 (5) Claim address.
203	203	14 (6) Payer identification.
204	204	15 (7) Covered services.
205	205	16 (8) Whether a deductible applies and to which
206	206	17 services.
207	207	18 (9) Remaining deductible: family.
208	208	19 (10) Remaining deductible: individual.
209	209	20 (11) Preferred in-network co-insurance amount.
210	210	21 (12) In-network co-insurance amount.
211	211	22 (13) Out-of-network co-insurance amount.
212	212	23 (14) Preferred in-network co-payment amount.
213	213	24 (15) In-network co-payment amount.
214	214	25 (16) Out-of-network co-payment amount.
215	215	26 (17) Remaining plan maximum.
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226	226	1 (18) Remaining lifetime maximum.
227	227	2 (19) Last treatment plan payment date applied to the
228	228	3 annual maximum or deductible to help determine if a
229	229	4 benefit has been used outside of the primary office.
230	230	5 (20) Age limitation.
231	231	6 (21) Frequency limit by time period.
232	232	7 (22) Frequency limit by tooth number.
233	233	8 (23) Next available service date based on any
234	234	9 frequency limit due to prior treatment history or added
235	235	10 custom benefits, such as medical conditions and roll-over.
236	236	11 (24) Whether there is a missing tooth clause.
237	237	12 (25) Number of quads benefited per visit.
238	238	13 (26) Waiting period due to preexisting condition or
239	239	14 missing tooth limitation.
240	240	15 (27) Prior authorization requirements.
241	241	16 (28) Processing policies, such as bundling,
242	242	17 downcoding, least expensive alternative treatment
243	243	18 requirements, fees disallowed in conjunction with other
244	244	19 treatments, and limitations by location.
245	245	20 (29) A comprehensive list of all current American
246	246	21 Dental Association Codes stating if they are covered, the
247	247	22 percentage of coverage, and if there are any conditions
248	248	23 that preclude coverage.
249	249	24 (b) At minimum, the portal shall provide current and
250	250	25 accurate real-time benefit eligibility and benefits
251	251	26 information. It is the responsibility of the dental plan
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262	262	1 carrier to ensure patient eligibility and benefits reporting
263	263	2 is timely and accurate.
264	264	3 (215 ILCS 111/40 new)
265	265	4 Sec. 40. Dental plan carrier requirements. A dental plan
266	266	5 carrier must:
267	267	6 (1) Provide an electronic portal that is compliant
268	268	7 with the federal Health Insurance Portability and
269	269	8 Accountability Act of 1996 and the regulations promulgated
270	270	9 thereunder and that allows dental care providers to submit
271	271	10 claims electronically and directly to dental plan carrier.
272	272	11 The portal shall be provided free of charge to the dental
273	273	12 care provider.
274	274	13 (2) Accept attachments, including, but not limited to,
275	275	14 x-rays and other supporting information for claims, in an
276	276	15 electronic format with the initial electronic claim's
277	277	16 submission and any further submissions thereafter.
278	278	17 (3) Provide remittance advice with the corresponding
279	279	18 payment that outlines individually per claim: the name of
280	280	19 the patient; the date of service; the service code or, if
281	281	20 no service code is available, a service description; the
282	282	21 amount being paid; the claim number; and other identifying
283	283	22 claim information found on an explanation of benefits
284	284	23 form.
285	285	24 (215 ILCS 111/45 new)
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296	296	1 Sec. 45. Payment. Nothing in this Act requires a dental
297	297	2 care provider to only accept electronic payment from a dental
298	298	3 plan carrier. Dental plan carriers shall allow alternative
299	299	4 forms of payment, without additional fees or charges, to a
300	300	5 dental care provider, if requested.
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