IllinoisVision plans must show costs and follow provider contract limits
Starting January 1, 2027, vision care organizations must show members’ cost shares and follow limits on the contracts they require providers to accept.
What it does
Plan documents must clearly show members’ share of covered care costs. Providers may offer a cash price when it is lower than the member’s total out-of-pocket cost under the plan.
Vision care organizations may not tie some provider contracts to joining other plans, or require providers to pledge property. Health plans may still arrange covered routine vision care.
Organizations must give providers notice of proposed contract changes, and silence for 60 days after confirmed receipt lets a change take effect. They may not punish providers for exercising rights under the Act.
Argument forMembers could see their share of covered care costs in plan documents, and providers could offer a lower cash price when it costs members less.
Argument againstA provider who misses the 60-day response window could face a contract change without agreeing to it in writing.
More detail
Vision care organizations must list members’ cost-sharing amounts in plan documents and may not block a lower-cost cash option. Cost-sharing amounts must be listed in the benefit schedule and plan documents provided to members and eye care providers. A provider may offer the cash option only when it costs the member less than the total out-of-pocket cost for the covered service or material. These provisions take effect January 1, 2027.
Vision care organizations may not require certain contracts or take security in a provider’s property. The contract restrictions cover requirements to join specialty or supplemental health plans to contract for basic health services, or to join a vision plan to participate in a medical plan. Health plans may still contract to provide routine vision care covered by a member’s plan. An organization may not require a provider to join a discount plan as a condition of contracting under a provider agreement. An organization may not require a provider to pledge property or assets, including property tied to the provider’s practice. The restrictions in Section 40 apply to plans issued, delivered, amended, or renewed on or after January 1, 2027. The property and discount-plan provisions take effect January 1, 2027.
Vision care organizations must follow rules for proposed provider contract changes and may not retaliate against providers for exercising rights under the Act. A provider agreement may last up to two years unless all parties agree in writing to a different term. The no-retaliation rule covers providers who communicate with regulators, lawmakers, or professional groups, or file complaints or reports. A proposed change takes effect if the provider does not respond within 60 days after confirmed receipt of notice. Organizations must give providers access to agreement terms and referenced policies. These provisions take effect January 1, 2027.
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Where it stands
- Introduced
- Passed Senate
- Passed House
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Aug 21Public Act . . . . . . . . . 104-0851Latest
- Aug 21Effective Date January 1, 2027
- Aug 21Governor J. B. Pritzker ApprovedBecame Law
- Jun 29Sent to the GovernorTo Governor
- May 31Passed Both Houses
- Vote recorded Third Reading. Result: pass.Lower
- May 31Third Reading - Short Debate - Passed 117-000-000Passed House
- May 31Placed on Calendar Order of 3rd Reading - Short Debate
- May 29Held on Calendar Order of Second Reading - Short DebateMinor
- Vote recorded Do Pass. Result: pass.Lower
- May 29Second Reading - Short DebateMinor
- May 29Placed on Calendar 2nd Reading - Short DebateMinor
- May 29Do Pass / Short Debate Insurance Committee; 016-000-000
- May 29Added Alternate Chief Co-Sponsor Rep. Travis Weaver
- May 29Motion to Suspend Rule 21 - Prevailed 074-038-001
- May 29Motion Filed to Suspend Rule 21 Insurance Committee; Rep. Katie Stuart
- May 29Committee/Final Action Deadline Extended-9(b) May 31, 2026
- May 29Assigned to Insurance CommitteeMinor
- May 28Referred to Rules Committee
- Vote recorded Third Reading. Result: pass.Upper
- May 28First ReadingMinor
- May 28Chief House Sponsor Rep. Jeff Keicher
- May 28Arrived in HouseMinor
- May 28Third Reading - Passed; 057-000-000Passed Senate
- May 25Placed on Calendar Order of 3rd Reading May 26, 2026
- May 25Second ReadingMinor
- May 22Rule 2-10 Third Reading Deadline Established As May 31, 2026
- May 20Placed on Calendar Order of 2nd Reading May 21, 2026Minor
- Vote recorded Do Pass, Amendment 1. Result: pass.Upper
- Vote recorded Do Pass. Result: pass.Upper
- May 20Do Pass as Amended Executive; 011-000-000
- May 20Senate Committee Amendment No. 1 AdoptedMajor
- May 20Added as Co-Sponsor Sen. Jil Tracy
- May 19Waive Posting Notice
- May 19Senate Committee Amendment No. 1 Assignments Refers to Executive
- May 15Rule 2-10 Committee/3rd Reading Deadline Established As May 22, 2026
- May 15Senate Committee Amendment No. 1 Referred to Assignments
- May 15Senate Committee Amendment No. 1 Filed with Secretary by Sen. Cristina CastroMinor
- Apr 24Rule 2-10 Committee/3rd Reading Deadline Established As May 15, 2026
- Apr 8Added as Co-Sponsor Sen. Michael W. Halpin
- Mar 27Rule 2-10 Committee Deadline Established As April 24, 2026
- Mar 25Postponed - Executive
- Mar 13Rule 2-10 Committee Deadline Established As March 27, 2026
- Mar 4Assigned to ExecutiveMinor
- Feb 5Referred to Assignments
- Feb 5First ReadingMinor
- Feb 5Filed with Secretary by Sen. Cristina CastroIntroduced
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