HB0471eng 101ST GENERAL ASSEMBLY

HB0471 Engrossed LRB101 03392 JRG 48400 b

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Insurance Code is amended by changing Section 355 as follows:

(215 ILCS 5/355) (from Ch. 73, par. 967)

Sec. 355. Accident and health policies; provisions. policies-Provisions.)

(a) As used in this Section, "unreasonable rate increase" means a rate increase that the Director determines to be excessive, unjustified, or unfairly discriminatory in accordance with 45 CFR 154.205.

(b) No policy of insurance against loss or damage from the sickness, or from the bodily injury or death of the insured by accident shall be issued or delivered to any person in this State until a copy of the form thereof and of the classification of risks and the premium rates pertaining thereto have been filed with the Director; nor shall it be so issued or delivered until the Director shall have approved such policy pursuant to the provisions of Section 143. If the Director disapproves the policy form he shall make a written decision stating the respects in which such form does not comply with the requirements of law and shall deliver a copy thereof to the company and it shall be unlawful thereafter for any such company to issue any policy in such form.

(c) All individual and small group accident and health policies written in compliance with the Patient Protection and Affordable Care Act must file rates with the Department for approval. Rate increases found to be unreasonable rate increases in relation to benefits under the policy provided shall be disapproved. The Department shall provide a report to the General Assembly on or after January 1, 2021, regarding both on and off exchange individual and small group rates in the Illinois market.

(d) A rate increase filed under this Section must be approved or denied within 60 calendar days after the date the rate increase is filed with the Department. Any rate increase that is not approved or denied by the Department shall automatically be approved on the 61st calendar day.

(e) No less than 30 days after the federal Centers for Medicare and Medicaid Services has certified the policies described in this Section for the upcoming plan year, the Department shall publish on its website a report explaining the rates for the subsequent calendar year's certified policies.

(Source: P.A. 79-777.)

Section 10. The Health Maintenance Organization Act is amended by changing Section 4-12 as follows:

(215 ILCS 125/4-12) (from Ch. 111 1/2, par. 1409.5)

Sec. 4-12. Changes in Rate Methodology and Benefits, Material Modifications. A health maintenance organization shall file with the Director, prior to use, a notice of any change in rate methodology, or benefits and of any material modification of any matter or document furnished pursuant to Section 2-1, together with such supporting documents as are necessary to fully explain the change or modification.

(a) Contract modifications described in subsections (c)(5), (c)(6) and (c)(7) of Section 2-1 shall include all form agreements between the organization and enrollees, providers, administrators of services and insurers of health maintenance organizations.

(b) Material transactions or series of transactions other than those described in subsection (a) of this Section, the total annual value of which exceeds the greater of $100,000 or 5% of net earned subscription revenue for the most current twelve month period as determined from filed financial statements.

(c) Any agreement between the organization and an insurer shall be subject to the provisions of the laws of this State regarding reinsurance as provided in Article XI of the Illinois Insurance Code. All reinsurance agreements must be filed. Approval of the Director is required for all agreements except the following: individual stop loss, aggregate excess, hospitalization benefits or out-of-area of the participating providers unless 20% or more of the organization's total risk is reinsured, in which case all reinsurance agreements require approval.

(d) All individual and small group accident and health policies written in compliance with the Patient Protection and Affordable Care Act must file rates with the Department for approval. Rate increases found to be unreasonable rate increases in relation to benefits under the policy provided shall be disapproved. The Department shall provide a report to the General Assembly on or after January 1, 2021, regarding both on and off exchange individual and small group rates in the Illinois market.

(e) A rate increase filed under this Section must be approved or denied within 60 calendar days after the date the rate increase is filed with the Department. Any rate increase that is not approved or denied by the Department shall automatically be approved on the 61st calendar day.

(f) No less than 30 days after the federal Centers for Medicare and Medicaid Services has certified the policies described in this Section for the upcoming plan year, the Department shall publish on its website a report explaining the rates for the subsequent calendar year's certified policies.

(g) As used in this Section, "unreasonable rate increase" means a rate increase that the Director determines to be excessive, unjustified, or unfairly discriminatory in accordance with 45 CFR 154.205.

(Source: P.A. 86-620.)