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HB 5481

INS-CONFIDENTIAL BENEFIT FORMS

104th Regular Session Introduced by Anne Stava

The bill requires health insurers to suppress or withhold disclosure of personal sensitive health information in benefit communications unless the member explicitly requests it.

Rule 19(a) / Re-referred to Rules Committee
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Bill Summary · HB 5481

Overview

HB5481 (104th General Assembly, Illinois) would expand and standardize protections around disclosure of sensitive health care information in benefit communications. It prohibits health insurance issuers from including or describing personal sensitive health care information in explanations of benefits, payments, claims histories, or other payment/coverage communications unless the insured member explicitly requests suppression to be lifted. The bill also requires rulemaking, education efforts, and applies the same requirements across multiple state health plans and local government self-insured programs. It becomes effective one year after becoming law.

Purpose and intent

  • Prevents health insurance issuers from disclosing or describing personal sensitive health care information in benefit communications to insured members, unless the member requests otherwise.
  • Promotes privacy protections for sensitive services (to be defined by the Department of Insurance).
  • Involves state agencies (Department of Insurance and Department of Public Health) in educating providers and consumers about members’ rights and issuer responsibilities.
  • Extends the same confidentiality requirements to various state and local government health programs and self-insured plans.

Key provisions and changes

  • Prohibition on disclosure:
    • Section 356z.88 (added) prohibits issuers from specifying or describing personal sensitive health care information in explanations of benefits, summary of payments, claims history, or any payment/coverage records related to services involving sensitive health care for an insured member, unless the member who received the service clearly requests suppression of that information.
  • Definition and rules:
    • The Department of Insurance (DOI) shall define what constitutes sensitive health care information/services.
    • DOI shall adopt rules to implement and enforce these protections and to collect reporting on compliance and complaints.
  • Education and outreach:
    • DOI, in collaboration with the Department of Public Health, must develop and implement a plan to educate health care providers and consumers about rights and responsibilities to promote compliance.
    • Plan design includes training for hospitals, clinics, school-based health centers, and billing staff.
  • Scope and applicability:
    • Applies to the Illinois Public Aid Code, School Code, State Employees Group Insurance Act, Counties Code, Illinois Municipal Code, Health Maintenance Organization Act, Limited Health Service Organization Act, and Voluntary Health Services Plans Act, extending the confidentiality requirements across these statutes.
  • Effective date:
    • Effective one year after becoming law.
  • Rulemaking and enforcement:
    • DOI enforces the confidentiality requirements; other related provisions continue to be enforced by the appropriate entity (e.g., Central Management Services for many health benefit provisions). Rulemaking is conditioned on compliance with the Illinois Administrative Procedure Act and Joint Committee on Administrative Rules processes.

Affected entities and stakeholders

  • Health insurance issuers operating in Illinois.
  • Insured members (consumers) and patients receiving sensitive health services.
  • Health care providers, hospitals, clinics, and billing/registration staff.
  • State agencies: Department of Insurance and Department of Public Health.
  • State employee benefits programs and local government self-insured plans (counties, municipalities, school districts, etc.) covered by the bill.
  • Organizations administering health plans under:
    • State Employees Group Insurance Act
    • Counties Code
    • Illinois Municipal Code
    • School Code
    • Health Maintenance Organization Act
    • Limited Health Service Organization Act
    • Voluntary Health Services Plans Act
    • Illinois Public Aid Code

Procedural and timeline aspects

  • Introduction and assignment to committees in February 2026.
  • Referred to Insurance Committee; potential rulemaking and education plan development would follow if enacted.
  • Effective date is one year after the act becomes law, giving issuers and public entities time to develop systems and training.
  • The bill includes standard rulemaking requirements, ensuring rules are properly adopted under the Administrative Procedure Act and Joint Committee on Administrative Rules processes.

Summary

HB5481 seeks to strengthen privacy around sensitive health information in billing and payment communications by requiring health insurers to withhold or suppress mention of such information unless the patient explicitly requests disclosure. It directs the DOI, with input from the Department of Public Health, to define sensitive information, create enforcement rules, and run education efforts for providers and consumers. The protections would apply broadly to several state and local health plans and self-insured programs, aligning multiple statutes under a common confidentiality standard. The measure emphasizes consumer rights and privacy while detailing enforcement and educational responsibilities, with an effective date one year after enactment.

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

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