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Sen. Laura Fine
Filed: 5/24/2023
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1 | | AMENDMENT TO HOUSE BILL 2296
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2 | | AMENDMENT NO. ______. Amend House Bill 2296, AS AMENDED, |
3 | | by replacing everything after the enacting clause with the |
4 | | following:
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5 | | "Section 5. The Department of Insurance Law is amended by |
6 | | adding Section 1405-50 as follows: |
7 | | (20 ILCS 1405/1405-50 new) |
8 | | Sec. 1405-50. Health insurance coverage, affordability, |
9 | | and cost transparency annual report. |
10 | | (a) On or before May 1, 2026, and each May 1 thereafter, |
11 | | the Department of Insurance shall report to the Governor and |
12 | | the General Assembly on health insurance coverage, |
13 | | affordability, and cost trends, including: |
14 | | (1) medical cost trends by major service category, |
15 | | including prescription drugs; |
16 | | (2) utilization patterns of services by major service |
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1 | | categories; |
2 | | (3) impact of benefit changes, including essential |
3 | | health benefits and non-essential health benefits; |
4 | | (4) enrollment trends; |
5 | | (5) demographic shifts; |
6 | | (6) geographic factors and variations, including |
7 | | changes in provider availability; |
8 | | (7) health care quality improvement initiatives; |
9 | | (8)inflation and other factors impacting this State's |
10 | | economic condition; |
11 | | (9) the availability of financial assistance and tax |
12 | | credits to pay for health insurance coverage for |
13 | | individuals and small businesses; |
14 | | (10) trends in out-of-pocket costs for consumers; and |
15 | | (11) factors contributing to costs that are not |
16 | | otherwise specified in paragraphs (1) through (10) of this |
17 | | subsection. |
18 | | (b) This report shall not attribute any information or |
19 | | trend to a specific company and shall not disclose any |
20 | | information otherwise considered confidential or proprietary. |
21 | | Section 10. The Illinois Insurance Code is amended by |
22 | | changing Section 355 as follows:
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23 | | (215 ILCS 5/355) (from Ch. 73, par. 967)
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24 | | Sec. 355. Accident
and health policies; provisions. |
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1 | | policies-Provisions.)
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2 | | (a) As used in this Section: |
3 | | "Inadequate rate" means a rate: |
4 | | (1) that is insufficient to sustain projected losses |
5 | | and expenses to which the rate applies; and |
6 | | (2) the continued use of which endangers the solvency |
7 | | of an insurer using that rate. |
8 | | "Large employer" has the meaning provided in the Illinois |
9 | | Health Insurance Portability and Accountability Act. |
10 | | "Plain language" has the meaning provided in the federal |
11 | | Plain Writing Act of 2010 and subsequent guidance documents, |
12 | | including the Federal Plain Language Guidelines. |
13 | | "Unreasonable rate increase" means a rate increase that |
14 | | the Director determines to be excessive, unjustified, or |
15 | | unfairly discriminatory in accordance with 45 CFR 154.205. |
16 | | (b) No policy of insurance against loss or damage from the |
17 | | sickness, or from
the bodily injury or death of the insured by |
18 | | accident shall be issued or
delivered to any person in this |
19 | | State until a copy of the form thereof and
of the |
20 | | classification of risks and the premium rates pertaining |
21 | | thereto
have been filed with the Director; nor shall it be so |
22 | | issued or delivered
until the Director shall have approved |
23 | | such policy pursuant to the provisions
of Section 143. If the |
24 | | Director
disapproves the policy form , he or she shall make a |
25 | | written decision stating the
respects in which such form does |
26 | | not comply with the requirements of law
and shall deliver a |
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1 | | copy thereof to the company and it shall be unlawful
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2 | | thereafter for any such company to issue any policy in such |
3 | | form. On and after January 1, 2025, any form filing submitted |
4 | | for large employer group accident and health insurance shall |
5 | | be automatically deemed approved within 90 days of the |
6 | | submission date unless the Director extends by not more than |
7 | | an additional 30 days the period within which the form shall be |
8 | | approved or disapproved by giving written notice to the |
9 | | insurer of such extension before the expiration of the 90 |
10 | | days. Any form in receipt of such an extension shall be |
11 | | automatically deemed approved within 120 days of the |
12 | | submission date. The Director may toll the filing due to a |
13 | | conflict in legal interpretation of federal or State law as |
14 | | long as the tolling is applied uniformly to all applicable |
15 | | forms, written notification is provided to the insurer prior |
16 | | to the tolling, the duration of the tolling is provided within |
17 | | the notice to the insurer, and justification for the tolling |
18 | | is posted to the Department's website. The Director may |
19 | | disapprove the filing if the insurer fails to respond to an |
20 | | objection or request for additional information within the |
21 | | timeframe identified for response. As used in this subsection, |
22 | | "large employer" has the meaning given in Section 5 of the |
23 | | federal Health Insurance Portability and Accountability Act. |
24 | | (c) For plan year 2026 and thereafter, premium rates for |
25 | | all individual and small group accident and health insurance |
26 | | policies must be filed with the Department for approval. |
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1 | | Unreasonable rate increases or inadequate rates shall be |
2 | | modified or disapproved. For any plan year during which the |
3 | | Illinois Health Benefits Exchange operates as a full |
4 | | State-based exchange, the Department shall provide insurers at |
5 | | least 30 days' notice of the deadline to submit rate filings.
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6 | | (d) For plan year 2025 and thereafter, the Department |
7 | | shall post all insurers' rate filings and summaries on the |
8 | | Department's website 5 business days after the rate filing |
9 | | deadline set by the Department in annual guidance. The rate |
10 | | filings and summaries posted to the Department's website shall |
11 | | exclude information that is proprietary or trade secret |
12 | | information protected under paragraph (g) of subsection (1) of |
13 | | Section 7 of the Freedom of Information Act or confidential or |
14 | | privileged under any applicable insurance law or rule. All |
15 | | summaries shall include a brief justification of any rate |
16 | | increase or decrease requested, including the number of |
17 | | individual members, the medical loss ratio, medical trend, |
18 | | administrative costs, and any other information required by |
19 | | rule. The plain writing summary shall include notification of |
20 | | the public comment period established in subsection (e). |
21 | | (e) The Department shall open a 30-day public comment |
22 | | period on the rate filings beginning on the date that all of |
23 | | the rate filings are posted on the Department's website. The |
24 | | Department shall post all of the comments received to the |
25 | | Department's website within 5 business days after the comment |
26 | | period ends. |
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1 | | (f) After the close of the public comment period described |
2 | | in subsection (e), the Department, beginning for plan year |
3 | | 2026, shall issue a decision to approve, disapprove, or modify |
4 | | a rate filing within 60 days. Any rate filing or any rates |
5 | | within a filing on which the Director does not issue a decision |
6 | | within 60 days shall automatically be deemed approved. The |
7 | | Director's decision shall take into account the actuarial |
8 | | justifications and public comments. The Department shall |
9 | | notify the insurer of the decision, make the decision |
10 | | available to the public by posting it on the Department's |
11 | | website, and include an explanation of the findings, actuarial |
12 | | justifications, and rationale that are the basis for the |
13 | | decision. Any company whose rate has been modified or |
14 | | disapproved shall be allowed to request a hearing within 10 |
15 | | days after the action taken. The action of the Director in |
16 | | disapproving a rate shall be subject to judicial review under |
17 | | the Administrative Review Law. |
18 | | (g) If, following the issuance of a decision but before |
19 | | the effective date of the premium rates approved by the |
20 | | decision, an event occurs that materially affects the |
21 | | Director's decision to approve, deny, or modify the rates, the |
22 | | Director may consider supplemental facts or data reasonably |
23 | | related to the event. |
24 | | (h) The Department shall adopt rules implementing the |
25 | | procedures described in subsections (d) through (g) by March |
26 | | 31, 2024. |
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1 | | (i) Subsection (a) and subsections (c) through (h) of this |
2 | | Section do not apply to grandfathered health plans as defined |
3 | | in 45 CFR 147.140; excepted benefits as defined in 42 U.S.C. |
4 | | 300gg-91; student health insurance coverage as defined in 45 |
5 | | CFR 147.145; the large group market as defined in Section 5 of |
6 | | the Illinois Health Insurance Portability and Accountability |
7 | | Act; or short-term, limited-duration health insurance coverage |
8 | | as defined in Section 5 of the Short-Term, Limited-Duration |
9 | | Health Insurance Coverage Act. For a filing of premium rates |
10 | | or classifications of risk for any of these types of coverage, |
11 | | the Director's initial review period shall not exceed 60 days |
12 | | to issue informal objections to the company that request |
13 | | additional clarification, explanation, substantiating |
14 | | documentation, or correction of concerns identified in the |
15 | | filing before the company implements the premium rates, |
16 | | classifications, or related rate-setting methodologies |
17 | | described in the filing, except that the Director may extend |
18 | | by not more than an additional 30 days the period of initial |
19 | | review by giving written notice to the company of such |
20 | | extension before the expiration of the initial 60-day period. |
21 | | Nothing in this subsection shall confer authority upon the |
22 | | Director to approve, modify, or disapprove rates where that |
23 | | authority is not provided by other law. Nothing in this |
24 | | subsection shall prohibit the Director from conducting any |
25 | | investigation, examination, hearing, or other formal |
26 | | administrative or enforcement proceeding with respect to a |
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1 | | company's rate filing or implementation thereof under |
2 | | applicable law at any time, including after the period of |
3 | | initial review. |
4 | | (Source: P.A. 79-777.)
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5 | | Section 15. The Health Maintenance Organization Act is |
6 | | amended by changing Section 4-12 as follows:
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7 | | (215 ILCS 125/4-12) (from Ch. 111 1/2, par. 1409.5)
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8 | | Sec. 4-12. Changes in Rate Methodology and Benefits, |
9 | | Material
Modifications. A health maintenance organization |
10 | | shall file with the
Director, prior to use, a notice of any |
11 | | change in rate methodology, or
benefits and of any material |
12 | | modification of any matter or document
furnished pursuant to |
13 | | Section 2-1, together with such supporting documents
as are |
14 | | necessary to fully explain the change or modification.
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15 | | (a) Contract modifications described in subsections |
16 | | (c)(5), (c)(6) and
(c)(7) of Section 2-1 shall include all |
17 | | form agreements between the
organization and enrollees, |
18 | | providers, administrators of services and
insurers of health |
19 | | maintenance organizations.
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20 | | (b) Material transactions or series of transactions other |
21 | | than those
described in subsection (a) of this Section, the |
22 | | total annual value of
which exceeds the greater of $100,000 or |
23 | | 5% of net earned subscription
revenue for the most current |
24 | | 12-month twelve month period as determined from filed
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1 | | financial statements.
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2 | | (c) Any agreement between the organization and an insurer |
3 | | shall be
subject to the provisions of the laws of this State |
4 | | regarding reinsurance
as provided in Article XI of the |
5 | | Illinois Insurance Code. All reinsurance
agreements must be |
6 | | filed. Approval of the Director is required for all
agreements |
7 | | except the following: individual stop loss, aggregate excess,
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8 | | hospitalization benefits or out-of-area of the participating |
9 | | providers
unless 20% or more of the organization's total risk |
10 | | is reinsured, in which
case all reinsurance agreements require |
11 | | approval. |
12 | | (d) In addition to any applicable provisions of this Act, |
13 | | premium rate filings shall be subject to subsections (a) and |
14 | | (c) through (i) of Section 355 of the Illinois Insurance Code.
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15 | | (Source: P.A. 86-620.)
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16 | | Section 20. The Limited Health Service Organization Act is |
17 | | amended by changing Section 3006 as follows:
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18 | | (215 ILCS 130/3006) (from Ch. 73, par. 1503-6)
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19 | | Sec. 3006.
Changes in rate methodology and benefits; |
20 | | material modifications;
addition of limited health services.
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21 | | (a) A limited health service organization shall file with |
22 | | the Director
prior to use, a notice of any change in rate |
23 | | methodology, charges or
benefits and of any material |
24 | | modification of any matter or document
furnished pursuant to |
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1 | | Section 2001, together with such supporting documents
as are |
2 | | necessary to fully explain the change or modification.
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3 | | (1) Contract modifications described in paragraphs (5) |
4 | | and (6) of
subsection (c) of Section 2001 shall include |
5 | | all agreements between the
organization and enrollees, |
6 | | providers, administrators of services and
insurers of |
7 | | limited health services; also other material transactions |
8 | | or
series of transactions, the total annual value of which |
9 | | exceeds the greater
of $100,000 or 5% of net earned |
10 | | subscription revenue for the most current
12 month period |
11 | | as determined from filed financial statements.
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12 | | (2) Contract modification for reinsurance. Any |
13 | | agreement between the
organization and an insurer shall be |
14 | | subject to the provisions of Article
XI of the Illinois |
15 | | Insurance Code, as now or hereafter amended. All
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16 | | reinsurance agreements must be filed with the Director. |
17 | | Approval of the
Director in required agreements must be |
18 | | filed. Approval of the director is
required for all |
19 | | agreements except individual stop loss, aggregate excess,
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20 | | hospitalization benefits or out-of-area of the |
21 | | participating providers,
unless 20% or more of the |
22 | | organization's total risk is reinsured, in which
case all |
23 | | reinsurance agreements shall require approval.
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24 | | (b) If a limited health service organization desires to |
25 | | add one or more
additional limited health services, it shall |
26 | | file a notice with the Director
and, at the same time, submit |
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1 | | the information required by Section
2001 if different from |
2 | | that filed with the prepaid limited health service
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3 | | organization's application. Issuance of such an amended |
4 | | certificate of
authority shall be subject to the conditions of |
5 | | Section 2002 of this Act. |
6 | | (c) In addition to any applicable provisions of this Act, |
7 | | premium rate filings shall be subject to subsection (i) of |
8 | | Section 355 of the Illinois Insurance Code.
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9 | | (Source: P.A. 86-600.)".
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