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1    AN ACT concerning regulation.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Department of Insurance Law is amended by
5adding Section 1405-50 as follows:
6    (20 ILCS 1405/1405-50 new)
7    Sec. 1405-50. Health insurance coverage, affordability,
8and cost transparency annual report.
9    (a) On or before May 1, 2026, and each May 1 thereafter,
10the Department of Insurance shall report to the Governor and
11the General Assembly on health insurance coverage,
12affordability, and cost trends, including:
13        (1) medical cost trends by major service category,
14    including prescription drugs;
15        (2) utilization patterns of services by major service
16    categories;
17        (3) impact of benefit changes, including essential
18    health benefits and non-essential health benefits;
19        (4) enrollment trends;
20        (5) demographic shifts;
21        (6) geographic factors and variations, including
22    changes in provider availability;
23        (7) health care quality improvement initiatives;



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1        (8)inflation and other factors impacting this State's
2    economic condition;
3        (9) the availability of financial assistance and tax
4    credits to pay for health insurance coverage for
5    individuals and small businesses;
6        (10) trends in out-of-pocket costs for consumers; and
7        (11) factors contributing to costs that are not
8    otherwise specified in paragraphs (1) through (10) of this
9    subsection.
10    (b) This report shall not attribute any information or
11trend to a specific company and shall not disclose any
12information otherwise considered confidential or proprietary.
13    Section 10. The Illinois Insurance Code is amended by
14changing Section 355 as follows:
15    (215 ILCS 5/355)  (from Ch. 73, par. 967)
16    Sec. 355. Accident and health policies; provisions.
18    (a) As used in this Section:
19    "Inadequate rate" means a rate:
20        (1) that is insufficient to sustain projected losses
21    and expenses to which the rate applies; and
22        (2) the continued use of which endangers the solvency
23    of an insurer using that rate.
24    "Large employer" has the meaning provided in the Illinois



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1Health Insurance Portability and Accountability Act.
2    "Plain language" has the meaning provided in the federal
3Plain Writing Act of 2010 and subsequent guidance documents,
4including the Federal Plain Language Guidelines.
5    "Unreasonable rate increase" means a rate increase that
6the Director determines to be excessive, unjustified, or
7unfairly discriminatory in accordance with 45 CFR 154.205.
8    (b) No policy of insurance against loss or damage from the
9sickness, or from the bodily injury or death of the insured by
10accident shall be issued or delivered to any person in this
11State until a copy of the form thereof and of the
12classification of risks and the premium rates pertaining
13thereto have been filed with the Director; nor shall it be so
14issued or delivered until the Director shall have approved
15such policy pursuant to the provisions of Section 143. If the
16Director disapproves the policy form, he or she shall make a
17written decision stating the respects in which such form does
18not comply with the requirements of law and shall deliver a
19copy thereof to the company and it shall be unlawful
20thereafter for any such company to issue any policy in such
21form. On and after January 1, 2025, any form filing submitted
22for large employer group accident and health insurance shall
23be automatically deemed approved within 90 days of the
24submission date unless the Director extends by not more than
25an additional 30 days the period within which the form shall be
26approved or disapproved by giving written notice to the



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1insurer of such extension before the expiration of the 90
2days. Any form in receipt of such an extension shall be
3automatically deemed approved within 120 days of the
4submission date. The Director may toll the filing due to a
5conflict in legal interpretation of federal or State law as
6long as the tolling is applied uniformly to all applicable
7forms, written notification is provided to the insurer prior
8to the tolling, the duration of the tolling is provided within
9the notice to the insurer, and justification for the tolling
10is posted to the Department's website. The Director may
11disapprove the filing if the insurer fails to respond to an
12objection or request for additional information within the
13timeframe identified for response. As used in this subsection,
14"large employer" has the meaning given in Section 5 of the
15federal Health Insurance Portability and Accountability Act.
16    (c) For plan year 2026 and thereafter, premium rates for
17all individual and small group accident and health insurance
18policies must be filed with the Department for approval.
19Unreasonable rate increases or inadequate rates shall be
20modified or disapproved. For any plan year during which the
21Illinois Health Benefits Exchange operates as a full
22State-based exchange, the Department shall provide insurers at
23least 30 days' notice of the deadline to submit rate filings.
24    (d) For plan year 2025 and thereafter, the Department
25shall post all insurers' rate filings and summaries on the
26Department's website 5 business days after the rate filing



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1deadline set by the Department in annual guidance. The rate
2filings and summaries posted to the Department's website shall
3exclude information that is proprietary or trade secret
4information protected under paragraph (g) of subsection (1) of
5Section 7 of the Freedom of Information Act or confidential or
6privileged under any applicable insurance law or rule. All
7summaries shall include a brief justification of any rate
8increase or decrease requested, including the number of
9individual members, the medical loss ratio, medical trend,
10administrative costs, and any other information required by
11rule. The plain writing summary shall include notification of
12the public comment period established in subsection (e).
13    (e) The Department shall open a 30-day public comment
14period on the rate filings beginning on the date that all of
15the rate filings are posted on the Department's website. The
16Department shall post all of the comments received to the
17Department's website within 5 business days after the comment
18period ends.
19    (f) After the close of the public comment period described
20in subsection (e), the Department, beginning for plan year
212026, shall issue a decision to approve, disapprove, or modify
22a rate filing within 60 days. Any rate filing or any rates
23within a filing on which the Director does not issue a decision
24within 60 days shall automatically be deemed approved. The
25Director's decision shall take into account the actuarial
26justifications and public comments. The Department shall



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1notify the insurer of the decision, make the decision
2available to the public by posting it on the Department's
3website, and include an explanation of the findings, actuarial
4justifications, and rationale that are the basis for the
5decision. Any company whose rate has been modified or
6disapproved shall be allowed to request a hearing within 10
7days after the action taken. The action of the Director in
8disapproving a rate shall be subject to judicial review under
9the Administrative Review Law.
10    (g) If, following the issuance of a decision but before
11the effective date of the premium rates approved by the
12decision, an event occurs that materially affects the
13Director's decision to approve, deny, or modify the rates, the
14Director may consider supplemental facts or data reasonably
15related to the event.
16    (h) The Department shall adopt rules implementing the
17procedures described in subsections (d) through (g) by March
1831, 2024.
19    (i) Subsection (a) and subsections (c) through (h) of this
20Section do not apply to grandfathered health plans as defined
21in 45 CFR 147.140; excepted benefits as defined in 42 U.S.C.
22300gg-91; student health insurance coverage as defined in 45
23CFR 147.145; the large group market as defined in Section 5 of
24the Illinois Health Insurance Portability and Accountability
25Act; or short-term, limited-duration health insurance coverage
26as defined in Section 5 of the Short-Term, Limited-Duration



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1Health Insurance Coverage Act. For a filing of premium rates
2or classifications of risk for any of these types of coverage,
3the Director's initial review period shall not exceed 60 days
4to issue informal objections to the company that request
5additional clarification, explanation, substantiating
6documentation, or correction of concerns identified in the
7filing before the company implements the premium rates,
8classifications, or related rate-setting methodologies
9described in the filing, except that the Director may extend
10by not more than an additional 30 days the period of initial
11review by giving written notice to the company of such
12extension before the expiration of the initial 60-day period.
13Nothing in this subsection shall confer authority upon the
14Director to approve, modify, or disapprove rates where that
15authority is not provided by other law. Nothing in this
16subsection shall prohibit the Director from conducting any
17investigation, examination, hearing, or other formal
18administrative or enforcement proceeding with respect to a
19company's rate filing or implementation thereof under
20applicable law at any time, including after the period of
21initial review.
22(Source: P.A. 79-777.)
23    Section 15. The Health Maintenance Organization Act is
24amended by changing Section 4-12 as follows:



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1    (215 ILCS 125/4-12)  (from Ch. 111 1/2, par. 1409.5)
2    Sec. 4-12. Changes in Rate Methodology and Benefits,
3Material Modifications. A health maintenance organization
4shall file with the Director, prior to use, a notice of any
5change in rate methodology, or benefits and of any material
6modification of any matter or document furnished pursuant to
7Section 2-1, together with such supporting documents as are
8necessary to fully explain the change or modification.
9    (a) Contract modifications described in subsections
10(c)(5), (c)(6) and (c)(7) of Section 2-1 shall include all
11form agreements between the organization and enrollees,
12providers, administrators of services and insurers of health
13maintenance organizations.
14    (b) Material transactions or series of transactions other
15than those described in subsection (a) of this Section, the
16total annual value of which exceeds the greater of $100,000 or
175% of net earned subscription revenue for the most current
1812-month twelve month period as determined from filed
19financial statements.
20    (c) Any agreement between the organization and an insurer
21shall be subject to the provisions of the laws of this State
22regarding reinsurance as provided in Article XI of the
23Illinois Insurance Code. All reinsurance agreements must be
24filed. Approval of the Director is required for all agreements
25except the following: individual stop loss, aggregate excess,
26hospitalization benefits or out-of-area of the participating



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1providers unless 20% or more of the organization's total risk
2is reinsured, in which case all reinsurance agreements require
4    (d) In addition to any applicable provisions of this Act,
5premium rate filings shall be subject to subsections (a) and
6(c) through (i) of Section 355 of the Illinois Insurance Code.
7(Source: P.A. 86-620.)
8    Section 20. The Limited Health Service Organization Act is
9amended by changing Section 3006 as follows:
10    (215 ILCS 130/3006)  (from Ch. 73, par. 1503-6)
11    Sec. 3006. Changes in rate methodology and benefits;
12material modifications; addition of limited health services.
13    (a) A limited health service organization shall file with
14the Director prior to use, a notice of any change in rate
15methodology, charges or benefits and of any material
16modification of any matter or document furnished pursuant to
17Section 2001, together with such supporting documents as are
18necessary to fully explain the change or modification.
19        (1) Contract modifications described in paragraphs (5)
20    and (6) of subsection (c) of Section 2001 shall include
21    all agreements between the organization and enrollees,
22    providers, administrators of services and insurers of
23    limited health services; also other material transactions
24    or series of transactions, the total annual value of which



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1    exceeds the greater of $100,000 or 5% of net earned
2    subscription revenue for the most current 12 month period
3    as determined from filed financial statements.
4        (2) Contract modification for reinsurance. Any
5    agreement between the organization and an insurer shall be
6    subject to the provisions of Article XI of the Illinois
7    Insurance Code, as now or hereafter amended. All
8    reinsurance agreements must be filed with the Director.
9    Approval of the Director in required agreements must be
10    filed. Approval of the director is required for all
11    agreements except individual stop loss, aggregate excess,
12    hospitalization benefits or out-of-area of the
13    participating providers, unless 20% or more of the
14    organization's total risk is reinsured, in which case all
15    reinsurance agreements shall require approval.
16    (b) If a limited health service organization desires to
17add one or more additional limited health services, it shall
18file a notice with the Director and, at the same time, submit
19the information required by Section 2001 if different from
20that filed with the prepaid limited health service
21organization's application. Issuance of such an amended
22certificate of authority shall be subject to the conditions of
23Section 2002 of this Act.
24    (c) In addition to any applicable provisions of this Act,
25premium rate filings shall be subject to subsection (i) of
26Section 355 of the Illinois Insurance Code.



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1(Source: P.A. 86-600.)