Bill
SB 1286
DV survivors who aren't the policyholder may opt out of insurer billing for medical-forensic services; DHS reimburses providers to protect privacy and safety.
Status and context
- Title: Domestic Violence Survivor Health Care Billing Act (SB 1286)
- Subject: Health care billing for medical forensic services provided to domestic violence survivors
- Introduced: 2025 (sponsor information and legislative timeline provided in source materials)
- Jurisdiction: Text submitted mirrors a proposed Illinois bill; related materials also reference comparable proposals in other states. Confirm current status with your state legislature.
Purpose
- To allow a domestic violence survivor who is not the subscriber or primary policyholder on a health insurance plan to opt out of having their health insurer billed for medical forensic services related to domestic violence. The intent is to protect survivors’ privacy and prevent insurer billing that might alert an abuser or otherwise harm the survivor.
Key provisions
- Opt‑out right: A domestic violence survivor who is not the subscriber/primary policyholder may choose not to have the health insurer billed for medical forensic services.
- Verification: To exercise the opt‑out, the survivor must provide a sworn statement or affidavit attesting to the domestic violence and may supply additional supporting documentation if requested (examples provided in the bill: police report, protective order, documentation from a domestic violence shelter or program).
- Provider responsibilities:
- The health care practitioner providing medical forensic services must inform the survivor of the opt‑out option.
- If the survivor opts out, the health care practitioner must submit the bill for the medical forensic services to the Department of Human Services (DHS) for reimbursement through the Domestic Violence Prevention and Intervention Program (or a similar DHS program).
- Reimbursement rules:
- Reimbursement may be provided regardless of when the domestic violence incident occurred (i.e., no retroactivity limit in the text).
- Reimbursement is limited to medical forensic services that are directly related to an incident of domestic violence.
- Definitions and scope:
- “Domestic violence” is linked to the Illinois Domestic Violence Act definition (abuse by family/household members).
- “Domestic violence survivor” is a person subjected to domestic violence.
- “Health care practitioner” is broadly defined to include physicians, nurses, physician assistants, clinics, health departments, etc.
- “Health insurer” is defined broadly to include insurance companies, HMOs, and other entities providing health plans.
- Rulemaking: DHS is directed to adopt rules to implement and administer the Act.
Who is affected
- Domestic violence survivors who are patients but not the plan’s subscriber/primary policyholder (e.g., minors covered on a parent’s plan or spouses covered on a partner’s plan).
- Health care practitioners and clinics that provide medical forensic exams and related services.
- Health insurers: insurers may not be billed for covered forensic services when an eligible survivor validly opts out.
- Department of Human Services (or equivalent): will receive and process reimbursement claims and must establish implementing rules and administrative processes.
Potential impacts and considerations
- Privacy and safety: The option protects survivors from insurer notices or EOBs (explanation of benefits) that could disclose services to an abuser.
- Cost and administration: Shifts payment responsibility for certain forensic services from insurers to a DHS program. The bill text does not specify dedicated new funding; fiscal impacts depend on DHS program capacity and appropriations.
- Provider administration: Health care providers must implement intake procedures to collect affidavits/supporting documentation and submit claims to DHS when requested. DHS rulemaking will determine operational details.
- Scope limits: Reimbursement limited to “medical forensic services directly related” to an incident — other medical care would still follow normal insurance rules.
Effective date
- The bill text (as provided) does not state a specific effective date. Check the enacted version or state legislative records for final timing and any funding provisions.
For further action
- Consult the final enacted text (if applicable), DHS implementing rules, and any appropriations language to determine how reimbursement will be funded and operationalized in practice.
Compiled from official sources — confirm details with the bill’s official record.
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