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SB 2405

Mississippi Windstorm Mitigation Association; establish under Commissioner of Insurance.

2025 Regular Session Introduced by Brian Rhodes

Protect patients from surprise bills for ground ambulance services by ensuring cost-sharing is treated as in-network and setting insurer payment and dispute rules.

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Bill Summary · SB 2405

SB 2405 — Summary (Consumer Protection from Surprise Health Care Billing Act / Ground Ambulance Billing)

Note: the document header originally referenced a different subject (“Mississippi Windstorm Mitigation Association”), but the attached bill text and legislative history show SB 2405 (Sen. Ram Villivalam) is an Illinois measure establishing consumer protections against surprise health care billing — principally for ground ambulance services — and amending multiple Illinois insurance and local-government self‑insurance statutes.

Main purpose

To protect patients from surprise out‑of‑network bills for emergency services, with a particular focus on ground ambulance services, by (1) treating patient cost‑sharing for certain nonparticipating ground ambulance services as if those services were provided in‑network, (2) setting rules for insurer payment and dispute resolution, and (3) making violations enforceable under consumer‑protection law. The bill also makes conforming and related changes to State employee, county, and municipal self‑insured health benefit requirements.

Key provisions

  • Defines core terms (emergency services, emergency medical condition, ground ambulance service/provider, ancillary services, nonparticipating/participating facility/provider, evaluation without transport, etc.). Several Senate amendments clarified and expanded these definitions (including evaluation/treatment without transport and EMS licensing points).
  • Cost‑sharing parity: When a beneficiary receives covered services from a nonparticipating ground ambulance service provider, the health insurance issuer must ensure the beneficiary’s out‑of‑pocket costs are no greater than they would have been had a participating provider furnished the services. Cost‑sharing (copays, coinsurance, deductibles) is applied as if the provider were in‑network.
  • Payment mechanics and dispute resolution: Establishes rules for insurer payment to nonparticipating ground ambulance providers, methods for calculating a “recognized amount,” limits on patient cost‑sharing per occurrence, and an appeals process for insurer payments. The bill differentiates payment rules for privately owned providers vs. government providers that participate in the State’s Ground Emergency Medical Transportation (GEMT) program.
  • Enforcement: Failure of a health insurance issuer to comply is treated as an unlawful practice under the Illinois Consumer Fraud and Deceptive Business Practices Act and may be enforced by the Attorney General.
  • Conforming changes: Amends the Health Maintenance Organization Act and specified sections of the Illinois Insurance Code; requires that certain benefit mandates (listed 356z.xx sections) be included in State Employees Group Insurance and applicable self‑insured county and municipal plans.

Who is affected

  • Patients/beneficiaries/enrollees receiving emergency and ambulance care (reduced risk of surprise bills).
  • Health insurance issuers and HMOs (new payment, claims‑processing and dispute‑resolution obligations).
  • Ground ambulance providers (private and governmental), hospitals, and emergency facilities (payment/reimbursement implications).
  • State and local employers that self‑insure (new mandated benefits referenced).
  • Attorney General (enforcement authority under Consumer Fraud Act).

Procedural status and timeline

  • Introduced: Feb 7, 2025 (Sen. Ram Villivalam). Companion: HB 1515.
  • Multiple committee and floor amendments were filed April–May 2025.
  • Passed both chambers; sent to Governor and signed (legislative history shows Governor’s signature on 2025‑06‑20).
  • Effective date: legislative materials show an effective date in 2025 (documents variously state July 1, 2025, and Sept 1, 2025); the enrolled/legislative actions indicate it was signed 6/20/2025 with a 9/1/2025 effective date.

Potential impact

  • Likely reduces surprise out‑of‑pocket costs for patients using ground ambulance services and shifts payment disputes away from patients toward insurers and providers.
  • May affect insurer costs and provider reimbursement negotiations; private ambulance companies and public providers may see changes in revenue flows depending on recognized‑amount formulas and maximums established by the law.
  • Requires administrative updates by insurers, providers, and plan administrators, plus additional enforcement capacity at the Attorney General’s office.

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

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