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HB 2464

INS-HEALTH/NEONATAL COST SHARE

104th Regular Session Introduced by Dee Avelar and 13 co-sponsors

Prohibits out-of-network cost-sharing for neonatal care at hospitals; insurers must treat neonatology as in-network, shielding families from surprise bills.

Public Act . . . . . . . . . 104-0060
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Bill Summary · HB 2464

Summary — HB 2464 (Public Act 104-0060)

Title: INS-HEALTH/NEONATAL COST SHARE
Public Act: 104-0060 (amends 215 ILCS 5/356z.3a — Illinois Insurance Code)
Primary sponsors / supporters: Rep. Laura Faver Dias; Rep. Stephanie Stahl Hamilton; Sen. Laura Fine; plus multiple cosponsors.

Purpose / intent

HB 2464 limits patient cost exposure for newborns receiving neonatal care by preventing health insurers from charging out‑of‑network cost‑sharing rates for neonatal services provided at hospitals. The change is intended to protect families from surprise higher out‑of‑pocket costs when neonatal care is delivered by nonparticipating providers or specialists while the infant is receiving hospital care.

Key provisions

  • Amends Section 356z.3a of the Illinois Insurance Code (billing; emergency services; nonparticipating providers).
  • Expands the statutory definition of “ancillary services” to explicitly include neonatology and related items and services provided by any health care provider.
  • Provides that health insurance issuers may not impose out‑of‑network rates or require out‑of‑network cost‑sharing for neonatal care furnished at a hospital (i.e., neonatal services categorized as ancillary/neonatology are treated such that patients are not charged out‑of‑network cost‑sharing).
  • Retains existing definitions and cross‑references in the section for related terms such as “cost sharing,” “emergency services,” “participating/nonparticipating provider,” “qualifying payment amount,” and “recognized amount.”

Note: The enrolled text is truncated in the source; the core, consistently stated policy change is the prohibition on charging out‑of‑network cost‑sharing for neonatal care at any hospital.

Who is affected

  • Insured individuals and families — particularly infants and their parents or guardians — who receive neonatal care in hospitals: these patients should no longer face higher out‑of‑network copayments, coinsurance, or deductible requirements for neonatal services.
  • Health insurance issuers (carriers) offering individual or group policies in Illinois — they must apply in‑network cost‑sharing treatment to neonatal services per this law.
  • Hospitals and neonatal care providers (neonatologists, neonatal intensivists, ancillary specialists) — changes payment and cost‑sharing handling when providers lack a direct contractual relationship with the issuer.
  • Employers and plan administrators — may see administrative or premium impacts as insurers adjust reimbursement arrangements.

Procedural / timeline highlights

  • Filed/introduced in the Illinois General Assembly early February 2025.
  • Passed both chambers in May 2025 after committee consideration and floor amendments.
  • Enrolled and sent to the Governor in late May 2025; Governor approved the bill.
  • Became Public Act 104-0060; effective date: January 1, 2026.

Potential impacts and considerations

  • Consumer protection: reduces the risk of surprise higher cost‑sharing for neonatal hospital care.
  • Payment disputes: may shift reimbursement disputes between insurers and nonparticipating providers (rather than to families).
  • Insurer/provider economics: insurers may incur higher costs or renegotiate network terms; providers may pursue changes to reimbursement or contracting practices.
  • Implementation details (billing codes, claims processing, and whether any payment floors or dispute mechanisms apply) will depend on the full statutory text and insurer guidance; affected stakeholders should review carrier communications and administrative rules once issued.

For full statutory language and implementation details, consult the enrolled Public Act 104-0060 and related administrative guidance from the Illinois Department of Insurance.

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

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