Illinois HB 1085: What the New Mental Health Insurance Law Means for Your Care in 2027

Finding a therapist you connect with can take time. Figuring out whether your insurance will cover that care can add another layer of stress. At Serenity Counseling and Wellness, we believe understanding your benefits should feel more manageable.

Illinois recently passed House Bill 1085, now Public Act 104-0446, which introduces new requirements for certain insurance plans covering mental health and substance use disorder treatment. The law addresses provider reimbursement, coverage for medically necessary therapy, and insurance practices that can affect access to care.

We are sharing this information now because these changes begin applying to qualifying policies in 2027 and may affect what some clients pay for therapy. Clients whose therapy benefits are subject to a deductible or coinsurance should pay particular attention: if their insurer’s allowed amount increases, their responsibility for each session could increase too.

Our goal is to help you understand what is changing, determine whether your plan is affected, and prepare before your coverage renews.

When will these changes affect my plan?

The requirements apply to qualifying policies amended, delivered, issued, or renewed on or after January 1, 2027.

If your qualifying policy renews on January 1, the changes apply then. If it renews later in 2027, the changes may apply on that later date. Your insurer can confirm the timing for your coverage.

Which insurance policies are affected?

The company’s name alone does not determine whether your policy qualifies. Two people with cards from the same insurer may have different types of coverage.

Illinois Department of Insurance guidance makes these distinctions:

Policy type	Do these requirements apply?
Illinois regulated, fully insured PPO policies	Generally yes
Non-network indemnity policies	Certain coverage protections apply
Self-funded Illinois county, municipal, or school district employee plans	Yes, with a qualifying coverage structure
Most other self-funded employer plans	No
HMO policies	No
Medicaid, All Kids, Medicare, and TRICARE	No
Employer policies issued outside Illinois	Generally no, even if you live in Illinois

Confirm applicability with your insurer.

How can I tell what kind of policy I have?

Blue Cross Blue Shield, Aetna, UnitedHealthcare, and Cigna can administer different types of coverage, including fully insured and self-funded plans.

With a fully insured plan, the insurance company assumes financial responsibility for covered claims. With a self-funded plan, your employer pays the claims, while an insurance company may administer the benefits and process payments.

Check both the front and back of your insurance card for these clues:

Wording on your card	What it may indicate
“Fully insured,” “fully insured coverage,” or “underwritten by”	A fully insured policy
“DOI,” “IDOI,” or “regulated by Illinois DOI”	A policy regulated by the Illinois Department of Insurance
“Self-funded” or “self-insured”	A self-funded plan
“Administrative Services Only” or “ASO”	A self-funded plan
The company processes claims only and assumes no financial risk	A self-funded plan
“Administered by”	May indicate a self-funded plan; confirm with your insurer

These are clues, not a final determination. Your insurer or employer’s benefits department can confirm your plan type and whether this law applies.

You can ask:

“Is my policy subject to Illinois Public Act 104-0446, also called HB 1085? If so, when will the requirements apply in 2027, and could they change what I pay for therapy before and after meeting my deductible?”

Ask for written confirmation when possible, and keep it with your benefit information.

Why clients with deductibles should pay particular attention

The law establishes minimum reimbursement rates for eligible services provided by clinicians within qualifying insurance networks.

These changes may support access to clinicians who accept insurance. They also have potential financial implications for clients whose therapy benefits are subject to a deductible.

Before meeting your deductible, you may be responsible for the full amount your insurer allows for a covered session. If that allowed amount increases, your per-session cost may rise until you meet your deductible. Afterward, clients who pay coinsurance may also pay more because their responsibility is a percentage of the allowed amount. This is a possible effect, not a guaranteed increase for every client.

For illustration, suppose your insurer’s allowed amount for a session increases from $150 to $200:

Your therapy benefit	At a $150 allowed amount	At a $200 allowed amount
You owe the full amount toward an unmet deductible	$150	$200
You owe 20% coinsurance after meeting your deductible	$30	$40
You owe a fixed $25 copay with no deductible applying to the session	$25	$25

These are hypothetical amounts, not Serenity’s rates or a prediction of your benefits.

The law does not itself increase your deductible. A higher allowed amount could mean paying more at each visit while reaching your deductible sooner. If you have a fixed copay, your session cost may remain the same, provided your plan’s benefits do not change.

More support for medically necessary therapy sessions

For qualifying plans, the law requires coverage of medically necessary 60-minute individual psychotherapy. It also prohibits insurers from placing heavier documentation requirements or more frequent audits on these sessions than on other psychotherapy billing codes.

Session length matters. You and your therapist can discuss the session length that best supports your treatment needs.

Receiving more than one service in a day

Sometimes your care involves both therapy and a medication management appointment. Qualifying insurers cannot deny or reduce coverage for a medically necessary mental health service solely because you received another covered mental health service that day. Other coverage and billing requirements still apply.

What should I do before my plan renews?

Along with confirming whether HB 1085 applies, ask your insurer:

• Is my clinician in my specific network?

• Are therapy visits subject to my deductible?

• When does my deductible reset?

• After meeting my deductible, will I owe a fixed copay or a percentage of the session cost?

• What is my estimated cost for a therapy session under my 2027 benefits?

  
  

Reviewing these details before your plan renews can help you budget for care and avoid unexpected bills.

Where can I learn more?

You can read the Illinois Department of Insurance’s official guidance on HB 1085, which explains the requirements, when they apply, and which policies are affected.

The guidance contains technical language, so you do not need to figure it all out on your own. Your insurer or employer’s benefits department can help confirm how the law applies to your specific policy.

We are here to help

You deserve clear information about your care and the costs involved. If you are a Serenity client and have questions about your benefits, contact our administrative team. We can help review the information available to us and identify questions to bring to your insurer.

We know that insurance changes can feel overwhelming, especially when you are already managing the cost of treatment. Our goal is to help you feel informed and supported as you prepare for 2027 and continue caring for your mental health.

Information reviewed October 5, 2026. Individual coverage and costs depend on your policy and benefits.