Illinois 2023-2024 Regular Session

Illinois House Bill HB2070 Compare Versions

Only one version of the bill is available at this time.

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1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2070 Introduced , by Rep. Jennifer Gong-Gershowitz SYNOPSIS AS INTRODUCED: New Act 215 ILCS 110/34 from Ch. 32, par. 690.34 Creates the Dental Loss Ratio Act. Sets forth provisions concerning dental loss ratio reporting. Provides that a health insurer or dental plan carrier that issues, sells, renews, or offers a specialized health insurance policy covering dental services shall, beginning July 1, 2023, annually submit to the Department of Insurance a dental loss ratio filing. Provides a formula for calculating minimum dental loss ratios. Sets forth provisions concerning minimum dental loss ratio requirements. Provides that the Department may adopt rules to implement the Act. Provides that the Act does not apply to an insurance policy issued, sold, renewed, or offered for health care services or coverage provided as a function of the State of Illinois Medicaid coverage for children or adults or disability insurance for covered benefits in the single specialized area of dental-only health care that pays benefits on a fixed benefit, cash payment-only basis. Defines terms. Amends the Dental Service Plan Act. Provides that a dental service plan corporation shall not disburse during any one year (rather than shall not disburse during any one year, except upon the approval of the Director of Insurance) a sum greater than 20% of payments received from subscribers during that year as administrative expenses. Effective immediately. LRB103 25065 BMS 51400 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2070 Introduced , by Rep. Jennifer Gong-Gershowitz SYNOPSIS AS INTRODUCED: New Act 215 ILCS 110/34 from Ch. 32, par. 690.34 New Act 215 ILCS 110/34 from Ch. 32, par. 690.34 Creates the Dental Loss Ratio Act. Sets forth provisions concerning dental loss ratio reporting. Provides that a health insurer or dental plan carrier that issues, sells, renews, or offers a specialized health insurance policy covering dental services shall, beginning July 1, 2023, annually submit to the Department of Insurance a dental loss ratio filing. Provides a formula for calculating minimum dental loss ratios. Sets forth provisions concerning minimum dental loss ratio requirements. Provides that the Department may adopt rules to implement the Act. Provides that the Act does not apply to an insurance policy issued, sold, renewed, or offered for health care services or coverage provided as a function of the State of Illinois Medicaid coverage for children or adults or disability insurance for covered benefits in the single specialized area of dental-only health care that pays benefits on a fixed benefit, cash payment-only basis. Defines terms. Amends the Dental Service Plan Act. Provides that a dental service plan corporation shall not disburse during any one year (rather than shall not disburse during any one year, except upon the approval of the Director of Insurance) a sum greater than 20% of payments received from subscribers during that year as administrative expenses. Effective immediately. LRB103 25065 BMS 51400 b LRB103 25065 BMS 51400 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2070 Introduced , by Rep. Jennifer Gong-Gershowitz SYNOPSIS AS INTRODUCED:
3	3	New Act 215 ILCS 110/34 from Ch. 32, par. 690.34 New Act 215 ILCS 110/34 from Ch. 32, par. 690.34
4	4	New Act
5	5	215 ILCS 110/34 from Ch. 32, par. 690.34
6	6	Creates the Dental Loss Ratio Act. Sets forth provisions concerning dental loss ratio reporting. Provides that a health insurer or dental plan carrier that issues, sells, renews, or offers a specialized health insurance policy covering dental services shall, beginning July 1, 2023, annually submit to the Department of Insurance a dental loss ratio filing. Provides a formula for calculating minimum dental loss ratios. Sets forth provisions concerning minimum dental loss ratio requirements. Provides that the Department may adopt rules to implement the Act. Provides that the Act does not apply to an insurance policy issued, sold, renewed, or offered for health care services or coverage provided as a function of the State of Illinois Medicaid coverage for children or adults or disability insurance for covered benefits in the single specialized area of dental-only health care that pays benefits on a fixed benefit, cash payment-only basis. Defines terms. Amends the Dental Service Plan Act. Provides that a dental service plan corporation shall not disburse during any one year (rather than shall not disburse during any one year, except upon the approval of the Director of Insurance) a sum greater than 20% of payments received from subscribers during that year as administrative expenses. Effective immediately.
7	7	LRB103 25065 BMS 51400 b LRB103 25065 BMS 51400 b
8	8	LRB103 25065 BMS 51400 b
9	9	A BILL FOR
10	10	HB2070LRB103 25065 BMS 51400 b HB2070 LRB103 25065 BMS 51400 b
11	11	HB2070 LRB103 25065 BMS 51400 b
12	12	1 AN ACT concerning regulation.
13	13	2 Be it enacted by the People of the State of Illinois,
14	14	3 represented in the General Assembly:
15	15	4 Section 1. Short title. This Act may be referred to as the
16	16	5 Dental Loss Ratio Act.
17	17	6 Section 5. Definitions. As used in this Act:
18	18	7 "Dental care provider" means a dentist who bills for
19	19	8 services in Illinois.
20	20	9 "Dental loss ratio" means the ratio of incurred claims to
21	21	10 earned premiums as calculated using the formula under Section
22	22	11 10 of this Act.
23	23	12 "Dental plan carrier" means an entity subject to the
24	24	13 insurance laws, rules, and regulations of this State or
25	25	14 subject to the jurisdiction of the Director that contracts or
26	26	15 offers to contract to provide, deliver, arrange for, pay for,
27	27	16 or reimburse any of the costs of dental care services,
28	28	17 including an accident and health insurance company, a health
29	29	18 maintenance organization, a limited health service
30	30	19 organization, a dental service plan corporation, a health
31	31	20 services plan corporation, a voluntary health services plan,
32	32	21 or any other entity providing a plan of dental insurance,
33	33	22 dental benefits, or dental health care services.
34	34	23 "Department" means the Department of Insurance.
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38	38	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2070 Introduced , by Rep. Jennifer Gong-Gershowitz SYNOPSIS AS INTRODUCED:
39	39	New Act 215 ILCS 110/34 from Ch. 32, par. 690.34 New Act 215 ILCS 110/34 from Ch. 32, par. 690.34
40	40	New Act
41	41	215 ILCS 110/34 from Ch. 32, par. 690.34
42	42	Creates the Dental Loss Ratio Act. Sets forth provisions concerning dental loss ratio reporting. Provides that a health insurer or dental plan carrier that issues, sells, renews, or offers a specialized health insurance policy covering dental services shall, beginning July 1, 2023, annually submit to the Department of Insurance a dental loss ratio filing. Provides a formula for calculating minimum dental loss ratios. Sets forth provisions concerning minimum dental loss ratio requirements. Provides that the Department may adopt rules to implement the Act. Provides that the Act does not apply to an insurance policy issued, sold, renewed, or offered for health care services or coverage provided as a function of the State of Illinois Medicaid coverage for children or adults or disability insurance for covered benefits in the single specialized area of dental-only health care that pays benefits on a fixed benefit, cash payment-only basis. Defines terms. Amends the Dental Service Plan Act. Provides that a dental service plan corporation shall not disburse during any one year (rather than shall not disburse during any one year, except upon the approval of the Director of Insurance) a sum greater than 20% of payments received from subscribers during that year as administrative expenses. Effective immediately.
43	43	LRB103 25065 BMS 51400 b LRB103 25065 BMS 51400 b
44	44	LRB103 25065 BMS 51400 b
45	45	A BILL FOR
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51	51	New Act
52	52	215 ILCS 110/34 from Ch. 32, par. 690.34
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71	71	1 "Director" means the Director of Insurance.
72	72	2 "Earned premiums" means the portion of the premium paid in
73	73	3 the reporting year that is intended to provide coverage during
74	74	4 that reporting period.
75	75	5 "Incurred claims" means the claims for which services were
76	76	6 provided in that reporting year. "Incurred claims" includes
77	77	7 claims that were paid in the reporting year plus unpaid claim
78	78	8 reserves for claims paid after the reporting year.
79	79	9 Section 10. Dental loss ratio reporting.
80	80	10 (a) A health insurer or dental plan carrier that issues,
81	81	11 sells, renews, or offers a specialized health insurance policy
82	82	12 covering dental services shall, beginning July 1, 2023,
83	83	13 annually submit to the Department the dental loss ratio
84	84	14 calculated in accordance with subsection (c). The annual
85	85	15 filing shall, at a minimum, include rates, rating schedules,
86	86	16 and supporting documentation, including ratios of incurred
87	87	17 claims to earned premiums for each calendar year since the
88	88	18 plan's issuance. The required information shall be in the form
89	89	19 established by the Department and shall demonstrate that each
90	90	20 plan complies with the minimum dental loss ratio standards.
91	91	21 (b) The annual filing shall be made publicly available on
92	92	22 the Department's website.
93	93	23 (c) Minimum dental loss ratios are calculated by the
94	94	24 following formula: the numerator is equal to the incurred
95	95	25 claims for the dental loss ratio reporting year; and the
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106	106	1 denominator is equal to the earned premiums for the dental
107	107	2 loss ratio reporting year minus taxes and licensing and
108	108	3 regulatory fees.
109	109	4 (d) If the Director decides to conduct an examination
110	110	5 because the Director finds it necessary to verify a health
111	111	6 insurer's or dental plan carrier's representation in a dental
112	112	7 loss ratio report, then the Department shall provide the
113	113	8 health insurer or dental plan carrier with a notification 30
114	114	9 days before the commencement of the examination.
115	115	10 (e) The health insurer or dental plan carrier shall have
116	116	11 30 days after the date of notification to electronically
117	117	12 submit to the Department all requested records specified by
118	118	13 the Department. The Director may extend the time for a health
119	119	14 insurer or dental plan carrier to comply with this examination
120	120	15 upon a finding of good cause.
121	121	16 Section 15. Dental loss ratio requirement.
122	122	17 (a) A health insurer or dental plan carrier that issues,
123	123	18 sells, renews, or offers a specialized health insurance policy
124	124	19 covering dental services shall meet a minimum dental loss
125	125	20 ratio requirement of 80%.
126	126	21 (b) If the minimum dental loss ratio is not met, then the
127	127	22 Department shall require a corrective action plan from the
128	128	23 carrier to return excess premiums.
129	129	24 Section 20. Rulemaking. The Department may adopt rules to
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140	140	1 implement this Act.
141	141	2 Section 25. Exemptions. This Act does not apply to an
142	142	3 insurance policy issued, sold, renewed, or offered for health
143	143	4 care services or coverage provided as a function of the State
144	144	5 of Illinois Medicaid coverage for children or adults or
145	145	6 disability insurance for covered benefits in the single
146	146	7 specialized area of dental-only health care that pays benefits
147	147	8 on a fixed benefit, cash payment-only basis.
148	148	9 Section 90. The Dental Service Plan Act is amended by
149	149	10 changing Section 34 as follows:
150	150	11 (215 ILCS 110/34) (from Ch. 32, par. 690.34)
151	151	12 Sec. 34. No such corporation shall disburse during any one
152	152	13 year, except upon the approval of the Director, a sum greater
153	153	14 than 20% of payments received from subscribers during that
154	154	15 year, as administrative expenses.
155	155	16 The term "administrative expense" as used in this Section
156	156	17 section includes all expenditures for nonprofessional services
157	157	18 and in general all expenses not directly connected with the
158	158	19 payment for dental services, but does not include expenses of
159	159	20 soliciting subscriptions.
160	160	21 (Source: Laws 1965, p. 2179.)
161	161	22 Section 99. Effective date. This Act takes effect upon
162	162	23 becoming law.
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