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SB 3413

CMS-HEALTH CARE OMBUDSPERSONS

104th Regular Session Introduced by Rob Martwick

Creates Health Care Ombudspersons in CMS to help state employees understand benefits, determine eligibility, and resolve issues with providers.

Rule 2-10 Committee/3rd Reading Deadline Established As May 22, 2026
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Bill Summary · SB 3413

Summary of SB 3413 (104th General Assembly, Illinois)

Purpose and Intent

  • To improve support for participants in the State Employees Group Health Insurance program by creating designated Health Care Ombudspersons within the Department of Central Management Services (CMS).
  • The Ombudspersons are intended to help members understand available benefits, determine eligibility, and facilitate communication between members and third-party service providers under the group health insurance program.

Key Provisions

  • New Section Created: Adds Section 15.2 to the State Employees Group Insurance Act of 1971 (5 ILCS 375/15.2 new).
  • Designation of Ombudspersons: The Director of CMS must designate one or more CMS employees to serve as Health Care Ombudspersons.
  • Duties of Ombudspersons:
    • Monitor and respond to members’ email and telephone inquiries related to the benefits available under the Act.
    • Address questions about member eligibility for those benefits.
  • Accessibility of Ombudsperson Contact Information:
    • Ombudsperson contact information must be included in any CMS communications regarding group health insurance benefits.
    • Ombudsperson contact information must be readily available on CMS’s website.
  • Primary Goals:
    • Provide answers and generate information useful to participants in the group health benefits program.
    • When possible, help resolve issues between members and third-party providers of services established under the Act.

Who is Affected

  • Primary Beneficiaries: State employees and other participants covered under the State Employees Group Insurance Act of 1971.
  • CMS Employees: Designated CMS staff serving as Health Care Ombudspersons, who will handle inquiries and assist with benefits- and eligibility-related questions.

Procedural and Timeline Aspects

  • Effective Date: The bill text is introduced with sections to be codified; specific effective date is not stated in the provided text. It would be determined by enactment and the bill’s effective date language if enacted.
  • New Authority and Implementation: CMS would establish the Ombudsperson role(s) and begin applying duties upon designation of Ombudspersons by the Director.

Administrative Notes

  • The bill is introduced by Sen. Robert F. Martwick and has a co-sponsor (Rob Martwick).
  • Current action history indicates assignment to appropriations and committee deadlines, with typical legislative process steps (Rule 2-10 deadlines, readings, etc.) prior to potential passage.

Potential Impact

  • Improved member understanding of benefits and eligibility.
  • Potentially faster resolution of member concerns regarding benefits and third-party providers.
  • Enhanced transparency by providing Ombudsperson contact information in communications and on the CMS website.
  • Creates a formal, customer-service oriented liaison within CMS for the group health insurance program.

If you’d like, I can add a brief comparison to existing CMS processes or draft a one-page briefing for stakeholders.

Compiled from official sources — confirm details with the bill’s official record.

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