Relating to health care benefits for part-time faculty.

2025 Regular Session Introduced by Zach Hudson

HB 3607 caps cost-sharing in Illinois health plans: bans copays, caps deductibles at $1,000 and annual out-of-pocket max at $1,500 for new policies starting 2027.

In committee upon adjournment.

Purpose / Intent

HB 3607 would limit cost‑sharing in Illinois health insurance and require public and certain private plans to conform to those limits. The stated aim is to reduce out‑of‑pocket costs for insured persons (including part‑time faculty and other employees covered under public employer plans) by restricting copayments, deductibles, and annual maximums.

Key provisions

Adds a new provision to the Illinois Insurance Code (new 215 ILCS 5/356z.80) that applies to group and individual accident or health insurance policies that are issued, amended, delivered, or renewed on or after January 1, 2027:

Prohibits charging insured persons a copayment as a method of cost‑sharing.
Caps deductibles at no greater than $1,000.
Limits yearly out‑of‑pocket expenses for insured persons to be less than or equal to $1,500.

Amends multiple Illinois laws to require coverage consistent with the Insurance Code changes, including:

State Employees Group Insurance Act of 1971 (5 ILCS 375/6.11)
Counties Code (55 ILCS 5/5-1069.3)
Illinois Municipal Code (65 ILCS 5/10-4-2.3)
School Code (105 ILCS 5/10-22.3f) — relevant to school employees/part‑time faculty
Health Maintenance Organization Act; Limited Health Service Organization Act; Voluntary Health Services Plans Act; Illinois Public Aid Code; and related sections cited in the bill

Enforcement: generally assigned to the Department of Insurance; some state‑employee plan provisions enforced by the Department of Central Management Services, consistent with existing statutes.

Who would be affected

Insured individuals under Illinois group and individual accident and health policies (including employees, part‑time faculty, dependents).

Insurers and health plans operating in Illinois (must redesign plans to comply).

Public employers and self‑insured governmental entities (state, counties, municipalities, school districts) required to provide plans that meet the new limits.

Public health programs referenced in the Public Aid Code (potential state fiscal implications).

Timeline / Procedural status

Effective trigger for new coverage rules: policies issued/amended/delivered/renewed on or after January 1, 2027.

Legislative history (selected): Filed 02/07/2025; first reading 02/18/2025; referred to multiple committees (Insurance; Higher Education & Workforce Development; Rules); passed out of Insurance Committee with “Do Pass/Short Debate” (03/20/2025); as of 06/28/2025 in committee upon adjournment.

Potential impacts / considerations

Lowers direct cost burden for many insured people by reducing deductibles and annual maximums and eliminating copayments as a cost‑sharing method.

Likely increases costs for insurers and employers (including public budgets for self‑insured plans); these costs could be reflected in higher premiums, increased employer contributions, or budgetary adjustments.

Operational impacts for insurers and plan administrators to redesign benefit structures and update systems by the 2027 effective threshold.

Interaction with federal law (e.g., ACA requirements) and administrative rulemaking/ enforcement practices may affect implementation details.

Sponsor: Rep. Camille Y. Lilly.

Bill