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| 1 | AN ACT concerning insurance.
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| 2 | Be it enacted by the People of the State of Illinois,
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| 3 | represented in the General Assembly:
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| 4 | Section 5. The Illinois Insurance Code is amended by | ||||||
| 5 | changing Section 359c as follows: | ||||||
| 6 | (215 ILCS 5/359c)
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| 7 | Sec. 359c. Accident and health expense reporting. | ||||||
| 8 | (a) Beginning January 1, 2011 and every 6 months | ||||||
| 9 | thereafter, any carrier providing a group or individual major | ||||||
| 10 | medical policy of accident or health insurance shall prepare | ||||||
| 11 | and provide to the Department of Insurance a statement of the | ||||||
| 12 | aggregate administrative expenses of the carrier, based on the | ||||||
| 13 | premiums earned in the immediately preceding 6-month period on | ||||||
| 14 | the accident or health insurance business of the carrier. The | ||||||
| 15 | semi-annual statements shall be filed on or before October 1 | ||||||
| 16 | July 31 for the preceding 6-month period ending June 30 and on | ||||||
| 17 | or before April 1 February 1 for the preceding 6-month period | ||||||
| 18 | ending December 31. The statements shall itemize and separately | ||||||
| 19 | detail all of the following information with respect to the | ||||||
| 20 | carrier's accident or health insurance business: | ||||||
| 21 | (1) the amount of premiums earned by the carrier both | ||||||
| 22 | before and after any costs related to the carrier's | ||||||
| 23 | purchase of reinsurance coverage; | ||||||
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| 1 | (2) the total amount of claims for losses paid by the | ||||||
| 2 | carrier both before and after any reimbursement from | ||||||
| 3 | reinsurance coverage including any costs incurred related | ||||||
| 4 | to: | ||||||
| 5 | (A) disease, case, or chronic care management | ||||||
| 6 | programs; | ||||||
| 7 | (B) wellness and health education programs; | ||||||
| 8 | (C) fraud prevention; | ||||||
| 9 | (D) maintaining provider networks and provider | ||||||
| 10 | credentialing; | ||||||
| 11 | (E) health information technology for personal | ||||||
| 12 | electronic health records; and | ||||||
| 13 | (F) utilization review and utilization management; | ||||||
| 14 | (3) the amount of any losses incurred by the carrier | ||||||
| 15 | but not reported to the carrier in the current or prior | ||||||
| 16 | reporting period; | ||||||
| 17 | (4) the amount of costs incurred by the carrier for | ||||||
| 18 | State fees and federal and State taxes including: | ||||||
| 19 | (A) any high risk pool and guaranty fund | ||||||
| 20 | assessments levied on the carrier by the State; and | ||||||
| 21 | (B) any regulatory compliance costs including | ||||||
| 22 | State fees for form and rate filings, licensures, | ||||||
| 23 | market conduct exams, and financial reports; | ||||||
| 24 | (5) the amount of costs incurred by the carrier for | ||||||
| 25 | reinsurance coverage; | ||||||
| 26 | (6) the amount of costs incurred by the carrier that | ||||||
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| 1 | are related to the carrier's payment of marketing expenses | ||||||
| 2 | including commissions; and | ||||||
| 3 | (7) any other administrative expenses incurred by the | ||||||
| 4 | carrier. | ||||||
| 5 | (b) The information provided pursuant to subsection (a) of | ||||||
| 6 | this Section shall be separately aggregated for the following | ||||||
| 7 | lines of major medical insurance: | ||||||
| 8 | (1) individually underwritten; | ||||||
| 9 | (2) groups of 2 to 25 members; | ||||||
| 10 | (3) groups of 26 to 50 members; | ||||||
| 11 | (4) groups of 51 or more members. | ||||||
| 12 | (c) The Department shall make the submitted information | ||||||
| 13 | publicly available on the Department's website or such other | ||||||
| 14 | media as appropriate in a form useful for consumers.
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| 15 | (Source: P.A. 96-857, eff. 1-5-10.)
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