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Public Act 102-0135 | ||||
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Illinois Insurance Code is amended by | ||||
changing Sections 107a.12, 130.4, 370c.1, 500-30, 500-130, | ||||
1510, and 1565 as follows:
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(215 ILCS 5/107a.12)
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Sec. 107a.12. Annual statement.
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(a) A pool authorized to do business in this State shall | ||||
file with the
Director by March
1st in each year 2 copies of | ||||
its financial statement for the year ending
December 31st
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immediately preceding on forms prescribed by the Director, | ||||
which shall conform
substantially to
the form of statement | ||||
adopted by the National Association of Insurance
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Commissioners. Unless
the Director provides otherwise, the | ||||
annual statement is to be prepared in
accordance with the
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annual statement instructions and the Accounting Practices and | ||||
Procedures
Manual adopted by
the National Association of | ||||
Insurance Commissioners. The Director may
promulgate rules for
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determining which portions of the annual statement | ||||
instructions and Accounting
Practices and
Procedures Manual | ||||
adopted by the National Association of Insurance
Commissioners | ||||
are
germane for the purpose of ascertaining the condition and |
affairs of a pool.
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(b) The Director shall have authority to extend the time | ||
for filing any
statement by any
pool for reasons that he | ||
considers good and sufficient. The admitted assets
shall be | ||
shown in the
statement at the actual values as of the last day | ||
of the preceding year, in
accordance with Section
126.7 of | ||
this Code. The statement shall be verified by oaths of a | ||
majority of
the trustees
or directors of the
pool. In | ||
addition, when the Director considers it to be necessary and
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appropriate for the
protection of policyholders, creditors, | ||
shareholders, or claimants, the
Director may require the
pool | ||
to file, within 60 days after mailing to the pool a notice that | ||
a
supplemental summary
statement is required, a supplemental | ||
summary statement, as of the last day of
any calendar
month | ||
occurring during the 100 days next preceding the mailing of | ||
the notice,
designated by him
or her on forms prescribed and | ||
furnished by the Director. The Director may
require | ||
supplemental
summary statements to be certified by an | ||
independent actuary deemed competent
by the Director
or by an | ||
independent certified public accountant.
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(c) On or before June 1 of each year, a pool shall file | ||
with the Director an
audited financial
statement reporting the | ||
financial condition of the pool as of the end of the
most | ||
recent calendar year
and changes in the surplus funds for the | ||
year then ending. The annual audited
financial report shall
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include the following:
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(1) a report of an independent certified public | ||
accountant;
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(2) a balance sheet reporting assets, as defined in | ||
this Article,
liabilities, and surplus funds;
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(3) a statement of gain and loss from operations;
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(4) a statement of changes in financial position;
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(5) a statement of changes in surplus funds; and
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(6) the notes to financial statements.
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(d) The Director shall require a pool to file an | ||
independent actuarial
opinion
as to the
sufficiency of the | ||
loss and loss adjustment expense reserves. This opinion
shall | ||
be due on March June 1 of
each year.
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(Source: P.A. 91-757, eff. 1-1-01.)
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(215 ILCS 5/130.4) | ||
Sec. 130.4. Disclosure requirement. | ||
(a) An insurer, or the insurance group of which the | ||
insurer is a member, shall, no later than June 1 of each | ||
calendar year, submit to the Director a corporate governance | ||
annual disclosure that contains the information described in | ||
subsection (b) of Section 130.5. Notwithstanding any request | ||
from the Director made pursuant to subsection (c), if the | ||
insurer is a member of an insurance group, the insurer shall | ||
submit the report required by this Section to the Director of | ||
the lead state for the insurance group, in accordance with the | ||
laws of the lead state, as determined by the procedures |
outlined in the most recent Financial Analysis Handbook | ||
adopted by the National Association of Insurance | ||
Commissioners. | ||
(b) The corporate governance annual disclosure must | ||
include a signature of the insurer's or insurance group's | ||
chief executive officer or corporate secretary attesting to | ||
the best of that individual's belief and knowledge that the | ||
insurer has implemented the corporate governance practices | ||
required by this Section and that a copy of the disclosure has | ||
been provided to the insurer's board of directors or the | ||
appropriate committee thereof. | ||
(c) An insurer not required to submit a corporate | ||
governance annual disclosure under this Section shall do so | ||
upon the Director's request. | ||
(d) For purposes of completing the corporate governance | ||
annual disclosure, the insurer or insurance group may provide | ||
information regarding corporate governance at the ultimate | ||
controlling parent level, an intermediate holding company | ||
level, or the individual legal entity level, depending upon | ||
how the insurer or insurance group has structured its system | ||
of corporate governance. The insurer or insurance group is | ||
encouraged to make the corporate governance annual disclosure | ||
at the level at which the insurer's or insurance group's risk | ||
appetite is determined, the level at which the earnings, | ||
capital, liquidity, operations, and reputation of the insurer | ||
are overseen collectively and at which the supervision of |
those factors is coordinated and exercised, or the level at | ||
which legal liability for failure of general corporate | ||
governance duties would be placed. If the insurer or insurance | ||
group determines the level of reporting based on these | ||
criteria, it shall indicate which of the 3 criteria was used to | ||
determine the level of reporting and explain any subsequent | ||
changes in the level of reporting. | ||
(e) The review of the corporate governance annual | ||
disclosure and any additional requests for information shall | ||
be made through the lead state as determined by the procedures | ||
within the most recent Financial Analysis Handbook adopted by | ||
the National Association of Insurance Commissioners. | ||
(f) Insurers providing information substantially similar | ||
to the information required by this Article in other documents | ||
provided to the Director, including proxy statements filed in | ||
conjunction with the requirements of Section 131.13 or other | ||
State or federal filings provided to the Department, are not | ||
required to duplicate that information in the corporate | ||
governance annual disclosure but are only required to | ||
cross-reference the document in which the information is | ||
included.
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(Source: P.A. 101-600, eff. 12-6-19.) | ||
(215 ILCS 5/370c.1) | ||
Sec. 370c.1. Mental, emotional, nervous, or substance use | ||
disorder or condition parity. |
(a) On and after the effective date of this amendatory Act | ||
of the 102nd General Assembly this amendatory Act of the 99th | ||
General Assembly , every insurer that amends, delivers, issues, | ||
or renews a group or individual policy of accident and health | ||
insurance or a qualified health plan offered through the | ||
Health Insurance Marketplace in this State providing coverage | ||
for hospital or medical treatment and for the treatment of | ||
mental, emotional, nervous, or substance use disorders or | ||
conditions shall ensure prior to policy issuance that: | ||
(1) the financial requirements applicable to such | ||
mental, emotional, nervous, or substance use disorder or | ||
condition benefits are no more restrictive than the | ||
predominant financial requirements applied to | ||
substantially all hospital and medical benefits covered by | ||
the policy and that there are no separate cost-sharing | ||
requirements that are applicable only with respect to | ||
mental, emotional, nervous, or substance use disorder or | ||
condition benefits; and | ||
(2) the treatment limitations applicable to such | ||
mental, emotional, nervous, or substance use disorder or | ||
condition benefits are no more restrictive than the | ||
predominant treatment limitations applied to substantially | ||
all hospital and medical benefits covered by the policy | ||
and that there are no separate treatment limitations that | ||
are applicable only with respect to mental, emotional, | ||
nervous, or substance use disorder or condition benefits. |
(b) The following provisions shall apply concerning | ||
aggregate lifetime limits: | ||
(1) In the case of a group or individual policy of | ||
accident and health insurance or a qualified health plan | ||
offered through the Health Insurance Marketplace amended, | ||
delivered, issued, or renewed in this State on or after | ||
the effective date of this amendatory Act of the 99th | ||
General Assembly that provides coverage for hospital or | ||
medical treatment and for the treatment of mental, | ||
emotional, nervous, or substance use disorders or | ||
conditions the following provisions shall apply: | ||
(A) if the policy does not include an aggregate | ||
lifetime limit on substantially all hospital and | ||
medical benefits, then the policy may not impose any | ||
aggregate lifetime limit on mental, emotional, | ||
nervous, or substance use disorder or condition | ||
benefits; or | ||
(B) if the policy includes an aggregate lifetime | ||
limit on substantially all hospital and medical | ||
benefits (in this subsection referred to as the | ||
"applicable lifetime limit"), then the policy shall | ||
either: | ||
(i) apply the applicable lifetime limit both | ||
to the hospital and medical benefits to which it | ||
otherwise would apply and to mental, emotional, | ||
nervous, or substance use disorder or condition |
benefits and not distinguish in the application of | ||
the limit between the hospital and medical | ||
benefits and mental, emotional, nervous, or | ||
substance use disorder or condition benefits; or | ||
(ii) not include any aggregate lifetime limit | ||
on mental, emotional, nervous, or substance use | ||
disorder or condition benefits that is less than | ||
the applicable lifetime limit. | ||
(2) In the case of a policy that is not described in | ||
paragraph (1) of subsection (b) of this Section and that | ||
includes no or different aggregate lifetime limits on | ||
different categories of hospital and medical benefits, the | ||
Director shall establish rules under which subparagraph | ||
(B) of paragraph (1) of subsection (b) of this Section is | ||
applied to such policy with respect to mental, emotional, | ||
nervous, or substance use disorder or condition benefits | ||
by substituting for the applicable lifetime limit an | ||
average aggregate lifetime limit that is computed taking | ||
into account the weighted average of the aggregate | ||
lifetime limits applicable to such categories. | ||
(c) The following provisions shall apply concerning annual | ||
limits: | ||
(1) In the case of a group or individual policy of | ||
accident and health insurance or a qualified health plan | ||
offered through the Health Insurance Marketplace amended, | ||
delivered, issued, or renewed in this State on or after |
the effective date of this amendatory Act of the 99th | ||
General Assembly that provides coverage for hospital or | ||
medical treatment and for the treatment of mental, | ||
emotional, nervous, or substance use disorders or | ||
conditions the following provisions shall apply: | ||
(A) if the policy does not include an annual limit | ||
on substantially all hospital and medical benefits, | ||
then the policy may not impose any annual limits on | ||
mental, emotional, nervous, or substance use disorder | ||
or condition benefits; or | ||
(B) if the policy includes an annual limit on | ||
substantially all hospital and medical benefits (in | ||
this subsection referred to as the "applicable annual | ||
limit"), then the policy shall either: | ||
(i) apply the applicable annual limit both to | ||
the hospital and medical benefits to which it | ||
otherwise would apply and to mental, emotional, | ||
nervous, or substance use disorder or condition | ||
benefits and not distinguish in the application of | ||
the limit between the hospital and medical | ||
benefits and mental, emotional, nervous, or | ||
substance use disorder or condition benefits; or | ||
(ii) not include any annual limit on mental, | ||
emotional, nervous, or substance use disorder or | ||
condition benefits that is less than the | ||
applicable annual limit. |
(2) In the case of a policy that is not described in | ||
paragraph (1) of subsection (c) of this Section and that | ||
includes no or different annual limits on different | ||
categories of hospital and medical benefits, the Director | ||
shall establish rules under which subparagraph (B) of | ||
paragraph (1) of subsection (c) of this Section is applied | ||
to such policy with respect to mental, emotional, nervous, | ||
or substance use disorder or condition benefits by | ||
substituting for the applicable annual limit an average | ||
annual limit that is computed taking into account the | ||
weighted average of the annual limits applicable to such | ||
categories. | ||
(d) With respect to mental, emotional, nervous, or | ||
substance use disorders or conditions, an insurer shall use | ||
policies and procedures for the election and placement of | ||
mental, emotional, nervous, or substance use disorder or | ||
condition treatment drugs on their formulary that are no less | ||
favorable to the insured as those policies and procedures the | ||
insurer uses for the selection and placement of drugs for | ||
medical or surgical conditions and shall follow the expedited | ||
coverage determination requirements for substance abuse | ||
treatment drugs set forth in Section 45.2 of the Managed Care | ||
Reform and Patient Rights Act. | ||
(e) This Section shall be interpreted in a manner | ||
consistent with all applicable federal parity regulations | ||
including, but not limited to, the Paul Wellstone and Pete |
Domenici Mental Health Parity and Addiction Equity Act of | ||
2008, final regulations issued under the Paul Wellstone and | ||
Pete Domenici Mental Health Parity and Addiction Equity Act of | ||
2008 and final regulations applying the Paul Wellstone and | ||
Pete Domenici Mental Health Parity and Addiction Equity Act of | ||
2008 to Medicaid managed care organizations, the Children's | ||
Health Insurance Program, and alternative benefit plans. | ||
(f) The provisions of subsections (b) and (c) of this | ||
Section shall not be interpreted to allow the use of lifetime | ||
or annual limits otherwise prohibited by State or federal law. | ||
(g) As used in this Section: | ||
"Financial requirement" includes deductibles, copayments, | ||
coinsurance, and out-of-pocket maximums, but does not include | ||
an aggregate lifetime limit or an annual limit subject to | ||
subsections (b) and (c). | ||
"Mental, emotional, nervous, or substance use disorder or | ||
condition" means a condition or disorder that involves a | ||
mental health condition or substance use disorder that falls | ||
under any of the diagnostic categories listed in the mental | ||
and behavioral disorders chapter of the current edition of the | ||
International Classification of Disease or that is listed in | ||
the most recent version of the Diagnostic and Statistical | ||
Manual of Mental Disorders. | ||
"Treatment limitation" includes limits on benefits based | ||
on the frequency of treatment, number of visits, days of | ||
coverage, days in a waiting period, or other similar limits on |
the scope or duration of treatment. "Treatment limitation" | ||
includes both quantitative treatment limitations, which are | ||
expressed numerically (such as 50 outpatient visits per year), | ||
and nonquantitative treatment limitations, which otherwise | ||
limit the scope or duration of treatment. A permanent | ||
exclusion of all benefits for a particular condition or | ||
disorder shall not be considered a treatment limitation. | ||
"Nonquantitative treatment" means those limitations as | ||
described under federal regulations (26 CFR 54.9812-1). | ||
"Nonquantitative treatment limitations" include, but are not | ||
limited to, those limitations described under federal | ||
regulations 26 CFR 54.9812-1, 29 CFR 2590.712, and 45 CFR | ||
146.136.
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(h) The Department of Insurance shall implement the | ||
following education initiatives: | ||
(1) By January 1, 2016, the Department shall develop a | ||
plan for a Consumer Education Campaign on parity. The | ||
Consumer Education Campaign shall focus its efforts | ||
throughout the State and include trainings in the | ||
northern, southern, and central regions of the State, as | ||
defined by the Department, as well as each of the 5 managed | ||
care regions of the State as identified by the Department | ||
of Healthcare and Family Services. Under this Consumer | ||
Education Campaign, the Department shall: (1) by January | ||
1, 2017, provide at least one live training in each region | ||
on parity for consumers and providers and one webinar |
training to be posted on the Department website and (2) | ||
establish a consumer hotline to assist consumers in | ||
navigating the parity process by March 1, 2017. By January | ||
1, 2018 the Department shall issue a report to the General | ||
Assembly on the success of the Consumer Education | ||
Campaign, which shall indicate whether additional training | ||
is necessary or would be recommended. | ||
(2) The Department, in coordination with the | ||
Department of Human Services and the Department of | ||
Healthcare and Family Services, shall convene a working | ||
group of health care insurance carriers, mental health | ||
advocacy groups, substance abuse patient advocacy groups, | ||
and mental health physician groups for the purpose of | ||
discussing issues related to the treatment and coverage of | ||
mental, emotional, nervous, or substance use disorders or | ||
conditions and compliance with parity obligations under | ||
State and federal law. Compliance shall be measured, | ||
tracked, and shared during the meetings of the working | ||
group. The working group shall meet once before January 1, | ||
2016 and shall meet semiannually thereafter. The | ||
Department shall issue an annual report to the General | ||
Assembly that includes a list of the health care insurance | ||
carriers, mental health advocacy groups, substance abuse | ||
patient advocacy groups, and mental health physician | ||
groups that participated in the working group meetings, | ||
details on the issues and topics covered, and any |
legislative recommendations developed by the working | ||
group. | ||
(3) Not later than August 1 of each year, the | ||
Department, in conjunction with the Department of | ||
Healthcare and Family Services, shall issue a joint report | ||
to the General Assembly and provide an educational | ||
presentation to the General Assembly. The report and | ||
presentation shall: | ||
(A) Cover the methodology the Departments use to | ||
check for compliance with the federal Paul Wellstone | ||
and Pete Domenici Mental Health Parity and Addiction | ||
Equity Act of 2008, 42 U.S.C. 18031(j), and any | ||
federal regulations or guidance relating to the | ||
compliance and oversight of the federal Paul Wellstone | ||
and Pete Domenici Mental Health Parity and Addiction | ||
Equity Act of 2008 and 42 U.S.C. 18031(j). | ||
(B) Cover the methodology the Departments use to | ||
check for compliance with this Section and Sections | ||
356z.23 and 370c of this Code. | ||
(C) Identify market conduct examinations or, in | ||
the case of the Department of Healthcare and Family | ||
Services, audits conducted or completed during the | ||
preceding 12-month period regarding compliance with | ||
parity in mental, emotional, nervous, and substance | ||
use disorder or condition benefits under State and | ||
federal laws and summarize the results of such market |
conduct examinations and audits. This shall include: | ||
(i) the number of market conduct examinations | ||
and audits initiated and completed; | ||
(ii) the benefit classifications examined by | ||
each market conduct examination and audit; | ||
(iii) the subject matter of each market | ||
conduct examination and audit, including | ||
quantitative and nonquantitative treatment | ||
limitations; and | ||
(iv) a summary of the basis for the final | ||
decision rendered in each market conduct | ||
examination and audit. | ||
Individually identifiable information shall be | ||
excluded from the reports consistent with federal | ||
privacy protections. | ||
(D) Detail any educational or corrective actions | ||
the Departments have taken to ensure compliance with | ||
the federal Paul Wellstone and Pete Domenici Mental | ||
Health Parity and Addiction Equity Act of 2008, 42 | ||
U.S.C. 18031(j), this Section, and Sections 356z.23 | ||
and 370c of this Code. | ||
(E) The report must be written in non-technical, | ||
readily understandable language and shall be made | ||
available to the public by, among such other means as | ||
the Departments find appropriate, posting the report | ||
on the Departments' websites. |
(i) The Parity Advancement Fund is created as a special | ||
fund in the State treasury. Moneys from fines and penalties | ||
collected from insurers for violations of this Section shall | ||
be deposited into the Fund. Moneys deposited into the Fund for | ||
appropriation by the General Assembly to the Department shall | ||
be used for the purpose of providing financial support of the | ||
Consumer Education Campaign, parity compliance advocacy, and | ||
other initiatives that support parity implementation and | ||
enforcement on behalf of consumers. | ||
(j) The Department of Insurance and the Department of | ||
Healthcare and Family Services shall convene and provide | ||
technical support to a workgroup of 11 members that shall be | ||
comprised of 3 mental health parity experts recommended by an | ||
organization advocating on behalf of mental health parity | ||
appointed by the President of the Senate; 3 behavioral health | ||
providers recommended by an organization that represents | ||
behavioral health providers appointed by the Speaker of the | ||
House of Representatives; 2 representing Medicaid managed care | ||
organizations recommended by an organization that represents | ||
Medicaid managed care plans appointed by the Minority Leader | ||
of the House of Representatives; 2 representing commercial | ||
insurers recommended by an organization that represents | ||
insurers appointed by the Minority Leader of the Senate; and a | ||
representative of an organization that represents Medicaid | ||
managed care plans appointed by the Governor. | ||
The workgroup shall provide recommendations to the General |
Assembly on health plan data reporting requirements that | ||
separately break out data on mental, emotional, nervous, or | ||
substance use disorder or condition benefits and data on other | ||
medical benefits, including physical health and related health | ||
services no later than December 31, 2019. The recommendations | ||
to the General Assembly shall be filed with the Clerk of the | ||
House of Representatives and the Secretary of the Senate in | ||
electronic form only, in the manner that the Clerk and the | ||
Secretary shall direct. This workgroup shall take into account | ||
federal requirements and recommendations on mental health | ||
parity reporting for the Medicaid program. This workgroup | ||
shall also develop the format and provide any needed | ||
definitions for reporting requirements in subsection (k). The | ||
research and evaluation of the working group shall include, | ||
but not be limited to: | ||
(1) claims denials due to benefit limits, if | ||
applicable; | ||
(2) administrative denials for no prior authorization; | ||
(3) denials due to not meeting medical necessity; | ||
(4) denials that went to external review and whether | ||
they were upheld or overturned for medical necessity; | ||
(5) out-of-network claims; | ||
(6) emergency care claims; | ||
(7) network directory providers in the outpatient | ||
benefits classification who filed no claims in the last 6 | ||
months, if applicable; |
(8) the impact of existing and pertinent limitations | ||
and restrictions related to approved services, licensed | ||
providers, reimbursement levels, and reimbursement | ||
methodologies within the Division of Mental Health, the | ||
Division of Substance Use Prevention and Recovery | ||
programs, the Department of Healthcare and Family | ||
Services, and, to the extent possible, federal regulations | ||
and law; and | ||
(9) when reporting and publishing should begin. | ||
Representatives from the Department of Healthcare and | ||
Family Services, representatives from the Division of Mental | ||
Health, and representatives from the Division of Substance Use | ||
Prevention and Recovery shall provide technical advice to the | ||
workgroup. | ||
(k) An insurer that amends, delivers, issues, or renews a | ||
group or individual policy of accident and health insurance or | ||
a qualified health plan offered through the health insurance | ||
marketplace in this State providing coverage for hospital or | ||
medical treatment and for the treatment of mental, emotional, | ||
nervous, or substance use disorders or conditions shall submit | ||
an annual report, the format and definitions for which will be | ||
developed by the workgroup in subsection (j), to the | ||
Department, or, with respect to medical assistance, the | ||
Department of Healthcare and Family Services starting on or | ||
before July 1, 2020 that contains the following information | ||
separately for inpatient in-network benefits, inpatient |
out-of-network benefits, outpatient in-network benefits, | ||
outpatient out-of-network benefits, emergency care benefits, | ||
and prescription drug benefits in the case of accident and | ||
health insurance or qualified health plans, or inpatient, | ||
outpatient, emergency care, and prescription drug benefits in | ||
the case of medical assistance: | ||
(1) A summary of the plan's pharmacy management | ||
processes for mental, emotional, nervous, or substance use | ||
disorder or condition benefits compared to those for other | ||
medical benefits. | ||
(2) A summary of the internal processes of review for | ||
experimental benefits and unproven technology for mental, | ||
emotional, nervous, or substance use disorder or condition | ||
benefits and those for
other medical benefits. | ||
(3) A summary of how the plan's policies and | ||
procedures for utilization management for mental, | ||
emotional, nervous, or substance use disorder or condition | ||
benefits compare to those for other medical benefits. | ||
(4) A description of the process used to develop or | ||
select the medical necessity criteria for mental, | ||
emotional, nervous, or substance use disorder or condition | ||
benefits and the process used to develop or select the | ||
medical necessity criteria for medical and surgical | ||
benefits. | ||
(5) Identification of all nonquantitative treatment | ||
limitations that are applied to both mental, emotional, |
nervous, or substance use disorder or condition benefits | ||
and medical and surgical benefits within each | ||
classification of benefits. | ||
(6) The results of an analysis that demonstrates that | ||
for the medical necessity criteria described in | ||
subparagraph (A) and for each nonquantitative treatment | ||
limitation identified in subparagraph (B), as written and | ||
in operation, the processes, strategies, evidentiary | ||
standards, or other factors used in applying the medical | ||
necessity criteria and each nonquantitative treatment | ||
limitation to mental, emotional, nervous, or substance use | ||
disorder or condition benefits within each classification | ||
of benefits are comparable to, and are applied no more | ||
stringently than, the processes, strategies, evidentiary | ||
standards, or other factors used in applying the medical | ||
necessity criteria and each nonquantitative treatment | ||
limitation to medical and surgical benefits within the | ||
corresponding classification of benefits; at a minimum, | ||
the results of the analysis shall: | ||
(A) identify the factors used to determine that a | ||
nonquantitative treatment limitation applies to a | ||
benefit, including factors that were considered but | ||
rejected; | ||
(B) identify and define the specific evidentiary | ||
standards used to define the factors and any other | ||
evidence relied upon in designing each nonquantitative |
treatment limitation; | ||
(C) provide the comparative analyses, including | ||
the results of the analyses, performed to determine | ||
that the processes and strategies used to design each | ||
nonquantitative treatment limitation, as written, for | ||
mental, emotional, nervous, or substance use disorder | ||
or condition benefits are comparable to, and are | ||
applied no more stringently than, the processes and | ||
strategies used to design each nonquantitative | ||
treatment limitation, as written, for medical and | ||
surgical benefits; | ||
(D) provide the comparative analyses, including | ||
the results of the analyses, performed to determine | ||
that the processes and strategies used to apply each | ||
nonquantitative treatment limitation, in operation, | ||
for mental, emotional, nervous, or substance use | ||
disorder or condition benefits are comparable to, and | ||
applied no more stringently than, the processes or | ||
strategies used to apply each nonquantitative | ||
treatment limitation, in operation, for medical and | ||
surgical benefits; and | ||
(E) disclose the specific findings and conclusions | ||
reached by the insurer that the results of the | ||
analyses described in subparagraphs (C) and (D) | ||
indicate that the insurer is in compliance with this | ||
Section and the Mental Health Parity and Addiction |
Equity Act of 2008 and its implementing regulations, | ||
which includes 42 CFR Parts 438, 440, and 457 and 45 | ||
CFR 146.136 and any other related federal regulations | ||
found in the Code of Federal Regulations. | ||
(7) Any other information necessary to clarify data | ||
provided in accordance with this Section requested by the | ||
Director, including information that may be proprietary or | ||
have commercial value, under the requirements of Section | ||
30 of the Viatical Settlements Act of 2009. | ||
(l) An insurer that amends, delivers, issues, or renews a | ||
group or individual policy of accident and health insurance or | ||
a qualified health plan offered through the health insurance | ||
marketplace in this State providing coverage for hospital or | ||
medical treatment and for the treatment of mental, emotional, | ||
nervous, or substance use disorders or conditions on or after | ||
the effective date of this amendatory Act of the 100th General | ||
Assembly shall, in advance of the plan year, make available to | ||
the Department or, with respect to medical assistance, the | ||
Department of Healthcare and Family Services and to all plan | ||
participants and beneficiaries the information required in | ||
subparagraphs (C) through (E) of paragraph (6) of subsection | ||
(k). For plan participants and medical assistance | ||
beneficiaries, the information required in subparagraphs (C) | ||
through (E) of paragraph (6) of subsection (k) shall be made | ||
available on a publicly-available website whose web address is | ||
prominently displayed in plan and managed care organization |
informational and marketing materials. | ||
(m) In conjunction with its compliance examination program | ||
conducted in accordance with the Illinois State Auditing Act, | ||
the Auditor General shall undertake a review of
compliance by | ||
the Department and the Department of Healthcare and Family | ||
Services with Section 370c and this Section. Any
findings | ||
resulting from the review conducted under this Section shall | ||
be included in the applicable State agency's compliance | ||
examination report. Each compliance examination report shall | ||
be issued in accordance with Section 3-14 of the Illinois | ||
State
Auditing Act. A copy of each report shall also be | ||
delivered to
the head of the applicable State agency and | ||
posted on the Auditor General's website. | ||
(Source: P.A. 99-480, eff. 9-9-15; 100-1024, eff. 1-1-19 .)
| ||
(215 ILCS 5/500-30)
| ||
(Section scheduled to be repealed on January 1, 2027)
| ||
Sec. 500-30. Application for license.
| ||
(a) An individual applying for a resident insurance | ||
producer license must
make
application on a form specified by | ||
the Director and declare under penalty of
refusal, suspension,
| ||
or revocation of the license that the statements made in the | ||
application are
true, correct, and
complete to the best of the | ||
individual's knowledge and belief. Before
approving the | ||
application,
the Director must find that the individual:
| ||
(1) is at least 18 years of age;
|
(2) is sufficiently rehabilitated in cases in which | ||||||
the applicant has committed any act that is a ground for | ||||||
denial, suspension, or
revocation set forth in Section | ||||||
500-70, other than convictions set forth in paragraph (6) | ||||||
of subsection (a) of Section 500-70; with respect to | ||||||
applicants with convictions set forth in paragraph (6) of | ||||||
subsection (a) of Section 500-70, the Director shall | ||||||
determine in accordance with Section 500-76 that the | ||||||
conviction will not impair the ability of the applicant to | ||||||
engage in the position for which a license is sought;
| ||||||
(3) has completed, if required by the Director, a | ||||||
pre-licensing course
of
study before the insurance exam | ||||||
for the lines of authority for which the individual has | ||||||
applied (an
individual who
successfully completes the Fire | ||||||
and Casualty pre-licensing courses also meets
the
| ||||||
requirements for Personal Lines-Property and Casualty);
| ||||||
(4) has paid the fees set forth in Section 500-135; | ||||||
and
| ||||||
(5) has successfully passed the examinations for the | ||||||
lines of authority
for
which the person has applied.
| ||||||
(b) A pre-licensing course of study for each class of | ||||||
insurance for which
an insurance
producer license is requested | ||||||
must be established in accordance with rules
prescribed by the
| ||||||
Director and must consist of the following minimum hours:
| ||||||
|
| ||||||||||||||
7.5 hours of each pre-licensing course must be completed | ||||||||||||||
in a classroom or webinar setting, except Motor Vehicle, which | ||||||||||||||
would require 5 hours in a classroom or webinar setting. | ||||||||||||||
(c) A business entity acting as an insurance producer must | ||||||||||||||
obtain an
insurance
producer license. Application must be made | ||||||||||||||
using the Uniform Business Entity
Application.
Before | ||||||||||||||
approving the application, the Director must find that:
| ||||||||||||||
(1) the business entity has paid the fees set forth in | ||||||||||||||
Section 500-135;
and
| ||||||||||||||
(2) the business entity has designated a licensed | ||||||||||||||
producer responsible for
the
business entity's compliance | ||||||||||||||
with the insurance laws and rules of this State.
| ||||||||||||||
(d) The Director may require any documents reasonably | ||||||||||||||
necessary to verify
the
information contained in an | ||||||||||||||
application.
| ||||||||||||||
(Source: P.A. 100-286, eff. 1-1-18 .)
| ||||||||||||||
(215 ILCS 5/500-130)
| ||||||||||||||
(Section scheduled to be repealed on January 1, 2027)
| ||||||||||||||
Sec. 500-130. Bond required of insurance producers.
|
(a) An insurance producer who places insurance either | ||
directly or indirectly
with an
insurer with which the | ||
insurance producer does not have an agency contract agent | ||
contact must
maintain in force
while licensed a bond in favor | ||
of the people of the
State of Illinois executed by an | ||
authorized
surety company and payable to any party injured | ||
under
the terms of the bond. The bond shall be
continuous in | ||
form and in the amount of $2,500 or 5% of
the premiums brokered | ||
in the previous
calendar year, whichever is greater, but not | ||
to exceed
$50,000 total aggregate liability. The bond
shall be | ||
conditioned upon full accounting and due payment
to the person | ||
or company entitled
thereto, of funds coming into the | ||
insurance producer's
possession as an incident to insurance
| ||
transactions under the license or surplus line insurance
| ||
transactions under the license as a surplus
line producer.
| ||
(b) Authorized insurance producers of a business entity | ||
may
meet the requirements of this
Section with a bond in the | ||
name of the business entity,
continuous in form, and in the | ||
amounts
set forth in subsection (a) of this Section. Insurance
| ||
producers may meet the requirements of this
Section with a | ||
bond in the name of an association. An
individual producer | ||
remains responsible
for assuring that a producer bond is in | ||
effect and is for
the correct amount. The association must
| ||
have been in existence for 5 years, have common membership,
| ||
and been formed for a purpose
other than obtaining a bond.
| ||
(c) The surety may cancel the bond and be released from |
further
liability thereunder upon
30 days' written notice in | ||
advance to the principal. The
cancellation does not affect any | ||
liability
incurred or accrued under the bond before the | ||
termination
of the 30-day period.
| ||
(d) The producer's license may be revoked if the producer | ||
acts without a
bond that is
required under this Section.
| ||
(e) If a party injured under the terms of the bond requests | ||
the producer to
provide the
name of the surety and the bond | ||
number, the producer must provide the
information within 3
| ||
working days after receiving the request.
| ||
(f) An association may meet the requirements of this | ||
Section for all of its
members with a
bond in the name of the | ||
association that is continuous in form and in the
amounts set | ||
forth in
subsection (a) of this Section.
| ||
(Source: P.A. 92-386, eff. 1-1-02 .)
| ||
(215 ILCS 5/1510)
| ||
Sec. 1510. Definitions. In this Article: | ||
"Adjusting a claim for loss or damage covered by an | ||
insurance contract" means negotiating values, damages, or | ||
depreciation or applying the loss circumstances to insurance | ||
policy provisions. | ||
"Business entity" means a corporation, association, | ||
partnership, limited liability company, limited liability | ||
partnership, or other legal entity. | ||
"Department" means the Department of Insurance. |
"Director" means the Director of Insurance. | ||
"Fingerprints" means an impression of the lines on the | ||
finger taken for the purpose of identification. The impression | ||
may be electronic or in ink converted to electronic format. | ||
"Home state" means the District of Columbia and any state | ||
or territory of the United States where the public adjuster's | ||
principal place of residence or principal place of business is | ||
located. If neither the state in which the public adjuster | ||
maintains the principal place of residence nor the state in | ||
which the public adjuster maintains the principal place of | ||
business has a substantially similar law governing public | ||
adjusters, the public adjuster may declare another state in | ||
which it becomes licensed and acts as a public adjuster to be | ||
the home state. | ||
"Individual" means a natural person. | ||
"Person" means an individual or a business entity. | ||
"Public adjuster" means any person who, for compensation | ||
or any other thing of value on behalf of the insured: | ||
(i) acts or aids, solely in relation to first party | ||
claims arising under insurance contracts that insure the | ||
real or personal property of the insured, on behalf of an | ||
insured in adjusting a claim for loss or damage covered by | ||
an insurance contract; | ||
(ii) advertises for employment as a public adjuster of | ||
insurance claims or solicits business or represents | ||
himself or herself to the public as a public adjuster of |
first party insurance claims for losses or damages arising | ||
out of policies of insurance that insure real or personal | ||
property; or | ||
(iii) directly or indirectly solicits business, | ||
investigates or adjusts losses, or advises an insured | ||
about first party claims for losses or damages arising out | ||
of policies of insurance that insure real or personal | ||
property for another person engaged in the business of | ||
adjusting losses or damages covered by an insurance policy | ||
for the insured. | ||
"Uniform individual application" means the current version | ||
of the National Association of Directors (NAIC) Uniform | ||
Individual Application for resident and nonresident | ||
individuals. | ||
"Uniform business entity application" means the current | ||
version of the National Association of Insurance Commissioners | ||
(NAIC) Uniform Business Entity Application for resident and | ||
nonresident business entities.
| ||
"Webinar" means an online educational presentation during | ||
which a live and participating instructor and participating | ||
viewers, whose attendance is periodically verified throughout | ||
the presentation, actively engage in discussion and in the | ||
submission and answering of questions. | ||
(Source: P.A. 96-1332, eff. 1-1-11.) | ||
(215 ILCS 5/1565)
|
Sec. 1565. Continuing education. | ||
(a) An individual who holds a public adjuster license and | ||
who is not exempt under subsection (b) of this Section shall | ||
satisfactorily complete a minimum of 24 hours of continuing | ||
education courses, including 3 hours of classroom or webinar | ||
ethics instruction, reported on a biennial basis in | ||
conjunction with the license renewal cycle. | ||
The Director may not approve a course of study unless the | ||
course provides for
classroom, seminar, or self-study | ||
instruction methods. A course
given in a combination | ||
instruction method of classroom or seminar
and self-study | ||
shall be deemed to be a self-study course unless the
classroom | ||
or seminar certified hours meets or exceeds two-thirds of
the | ||
total hours certified for the course. The self-study material | ||
used
in the combination course must be directly related to and | ||
complement
the classroom portion of the course in order to be | ||
considered for
credit. An instruction method other than | ||
classroom or seminar shall
be considered as self-study | ||
methodology. Self-study credit hours
require the successful | ||
completion of an examination covering the
self-study material. | ||
The examination may not be self-evaluated.
However, if the | ||
self-study material is completed through the use of
an | ||
approved computerized interactive format whereby the computer
| ||
validates the successful completion of the self-study | ||
material, no
additional examination is required. The | ||
self-study credit hours
contained in a certified course shall |
be considered classroom hours
when at least two-thirds of the | ||
hours are given as classroom or
seminar instruction. | ||
The public adjuster must complete the course in advance of | ||
the renewal date to
allow the education provider time to | ||
report the credit to the
Department. | ||
(b) This Section shall not apply to: | ||
(1) licensees not licensed for one full year prior to | ||
the end of the applicable continuing education biennium; | ||
or | ||
(2) licensees holding nonresident public adjuster | ||
licenses who have met the continuing education | ||
requirements of their home state and whose home state | ||
gives credit to residents of this State on the same basis. | ||
(c) Only continuing education courses approved by the | ||
Director shall be used to satisfy the continuing education | ||
requirement of subsection (a) of this Section.
| ||
(Source: P.A. 96-1332, eff. 1-1-11.) | ||
(215 ILCS 5/Art. XXXI.75 rep.) | ||
Section 10. The Illinois Insurance Code is amended by | ||
repealing Article XXXI 3/4.
| ||
Section 99. Effective date. This Act takes effect upon | ||
becoming law, except that the changes to Section 107a.12 of | ||
the Illinois Insurance Code take effect January 1, 2022.
|