Rep. Bob Morgan

Filed: 4/5/2019

 

 


 

 


 
10100HB0471ham002LRB101 03392 SMS 59377 a

1
AMENDMENT TO HOUSE BILL 471

2    AMENDMENT NO. ______. Amend House Bill 471 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Insurance Code is amended by
5changing Section 355 as follows:
 
6    (215 ILCS 5/355)  (from Ch. 73, par. 967)
7    Sec. 355. Accident and health policies; provisions.
8policies-Provisions.)
9    (a) As used in this Section, "unreasonable rate increase"
10means a rate increase that the Director determines to be
11excessive, unjustified, or unfairly discriminatory in
12accordance with 45 CFR 154.205.
13    (b) No policy of insurance against loss or damage from the
14sickness, or from the bodily injury or death of the insured by
15accident shall be issued or delivered to any person in this
16State until a copy of the form thereof and of the

 

 

10100HB0471ham002- 2 -LRB101 03392 SMS 59377 a

1classification of risks and the premium rates pertaining
2thereto have been filed with the Director; nor shall it be so
3issued or delivered until the Director shall have approved such
4policy pursuant to the provisions of Section 143. If the
5Director disapproves the policy form he shall make a written
6decision stating the respects in which such form does not
7comply with the requirements of law and shall deliver a copy
8thereof to the company and it shall be unlawful thereafter for
9any such company to issue any policy in such form.
10    (c) All individual and small group accident and health
11policies written in compliance with the Patient Protection and
12Affordable Care Act must file rates with the Department for
13approval. Rate increases found to be unreasonable rate
14increases in relation to benefits under the policy provided
15shall be disapproved. The Department shall provide a report to
16the General Assembly on or after January 1, 2021, regarding
17both on and off exchange individual and small group rates in
18the Illinois market.
19    (d) A rate increase filed under this Section must be
20approved or denied within 60 calendar days after the date the
21rate increase is filed with the Department. Any rate increase
22that is not approved or denied by the Department shall
23automatically be approved on the 61st calendar day.
24    (e) No less than 30 days after the federal Centers for
25Medicare and Medicaid Services has certified the policies
26described in this Section for the upcoming plan year, the

 

 

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1Department shall publish on its website a report explaining the
2rates for the subsequent calendar year's certified policies.
3(Source: P.A. 79-777.)
 
4    Section 10. The Health Maintenance Organization Act is
5amended by changing Section 4-12 as follows:
 
6    (215 ILCS 125/4-12)  (from Ch. 111 1/2, par. 1409.5)
7    Sec. 4-12. Changes in Rate Methodology and Benefits,
8Material Modifications. A health maintenance organization
9shall file with the Director, prior to use, a notice of any
10change in rate methodology, or benefits and of any material
11modification of any matter or document furnished pursuant to
12Section 2-1, together with such supporting documents as are
13necessary to fully explain the change or modification.
14    (a) Contract modifications described in subsections
15(c)(5), (c)(6) and (c)(7) of Section 2-1 shall include all form
16agreements between the organization and enrollees, providers,
17administrators of services and insurers of health maintenance
18organizations.
19    (b) Material transactions or series of transactions other
20than those described in subsection (a) of this Section, the
21total annual value of which exceeds the greater of $100,000 or
225% of net earned subscription revenue for the most current
23twelve month period as determined from filed financial
24statements.

 

 

10100HB0471ham002- 4 -LRB101 03392 SMS 59377 a

1    (c) Any agreement between the organization and an insurer
2shall be subject to the provisions of the laws of this State
3regarding reinsurance as provided in Article XI of the Illinois
4Insurance Code. All reinsurance agreements must be filed.
5Approval of the Director is required for all agreements except
6the following: individual stop loss, aggregate excess,
7hospitalization benefits or out-of-area of the participating
8providers unless 20% or more of the organization's total risk
9is reinsured, in which case all reinsurance agreements require
10approval.
11    (d) All individual and small group accident and health
12policies written in compliance with the Patient Protection and
13Affordable Care Act must file rates with the Department for
14approval. Rate increases found to be unreasonable rate
15increases in relation to benefits under the policy provided
16shall be disapproved. The Department shall provide a report to
17the General Assembly on or after January 1, 2021, regarding
18both on and off exchange individual and small group rates in
19the Illinois market.
20    (e) A rate increase filed under this Section must be
21approved or denied within 60 calendar days after the date the
22rate increase is filed with the Department. Any rate increase
23that is not approved or denied by the Department shall
24automatically be approved on the 61st calendar day.
25    (f) No less than 30 days after the federal Centers for
26Medicare and Medicaid Services has certified the policies

 

 

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1described in this Section for the upcoming plan year, the
2Department shall publish on its website a report explaining the
3rates for the subsequent calendar year's certified policies.
4    (g) As used in this Section, "unreasonable rate increase"
5means a rate increase that the Director determines to be
6excessive, unjustified, or unfairly discriminatory in
7accordance with 45 CFR 154.205.
8(Source: P.A. 86-620.)".