Law limits patients’ ground ambulance bills starting January 2027

Insurers must cover emergency and urgent ground ambulance care and limit patients’ costs for providers outside their insurance network. Coverage applies to group and individual accident and health insurance policies. Cost limits apply to emergency and urgent ground ambulance care outside the patient’s network. Emergency care includes emergency-call responses without transport. Urgent care must be medically necessary and required within 12 hours after a health professional certifies the need. Unless state or federal law provides otherwise, the patient’s share uses the lower of the emergency-room copayment or coinsurance and 10% of the payment rate. If the same in-network service has a fixed copayment, that amount applies unless the provider bills less. The insurance-code rules exclude air ambulances, short-term health insurance, and policies for certain limited benefits. Health maintenance organizations, or HMOs, cannot exclude ground ambulance services as defined here, including covered care without transport. Patient-cost limits begin January 1, 2027. Required coverage applies to policies amended, delivered, issued, or renewed on or after that date. The law takes effect January 1, 2027.

Insurers must pay ground ambulance providers outside their networks using the law’s rates when providers reasonably request payment. These rules cover payments for emergency and urgent ground ambulance care from providers outside the patient’s insurance network. For providers subject to local government authority, payment uses the rate established or approved by the governing body of the local government providing the ambulance service. For other providers, the rate is the lowest of the negotiated rate, 85% of billed charges, or the reported average charge for the service and applicable mileage. Insurers subtract the patient’s share. Providers accepting payment cannot charge patients beyond their deductible, coinsurance, or copayment. HMOs must follow these payment rules. Local governments with home rule powers cannot regulate ground ambulance payments in ways that conflict with this section. The law takes effect January 1, 2027.

Ground ambulance providers outside insurance networks must report average charges to the Illinois Department of Public Health, which must publish them. Each ground ambulance provider outside an insurance network must report its applicable average charges. Reports cover applicable ambulance-care and mileage charges. Average charges use the 12 months ending June 30 before the reporting date. The Illinois Department of Public Health may charge providers a fee no greater than its costs of carrying out these duties. Reports are due October 1, 2026 and each October 1 afterward. Publication is due January 1, 2027 and each January 1 afterward. The first reporting deadline conflicts with the recorded January 1, 2027 effective date.