093_HB1687

 
                                     LRB093 04825 JLS 04881 b

 1        AN ACT in relation to insurance.

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

 4        Section 5.  The Health Maintenance  Organization  Act  is
 5    amended by changing Section 2-5 as follows:

 6        (215 ILCS 125/2-5) (from Ch. 111 1/2, par. 1406.1)
 7        Sec.   2-5.    Claims   Liabilities.    A   Every  Health
 8    Maintenance  Organization  shall,  at  all  times,   maintain
 9    liabilities  in  an  amount  estimated  in  the  aggregate to
10    provide for the payment of all claims incurred  and  any  due
11    and   unpaid   provider   capitation,   whether  reported  or
12    unreported, which are unpaid and for which such  organization
13    is  or  may  be  liable,  and  to  provide for the expense of
14    adjustment or settlement of such  claims.   Such  liabilities
15    shall  be computed in accordance with regulations promulgated
16    by  the  Director  upon  reasonable  consideration   of   the
17    ascertained experience and character of such business for the
18    purpose  of  adequately protecting enrollees and securing the
19    solvency of such organizations.
20        Whenever the claim and claim expense  experience  of  any
21    such   organization   shows  the  liabilities  calculated  in
22    accordance  with  such  regulations  to  be  inadequate,  the
23    Director may require such organization to maintain additional
24    liabilities.
25    (Source: P.A. 86-620.)