IL
Illinois Senate Bill SB0324

Illinois 2023-2024 Regular Session

Illinois Senate Bill SB0324 Compare Versions

Only one version of the bill is available at this time.
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11 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB0324 Introduced 2/2/2023, by Sen. Laura Fine SYNOPSIS AS INTRODUCED: 215 ILCS 5/355 from Ch. 73, par. 967 215 ILCS 125/4-12 from Ch. 111 1/2, par. 1409.5 Amends the Illinois Insurance Code and the Health Maintenance Organization Act. Provides that all individual and small group accident and health policies written subject to certain federal standards must file rates with the Department of Insurance for approval. Provides that unreasonable rate increases or inadequate rates shall be disapproved. Provides that when an insurer files a schedule or table of premium rates for individual or small employer health benefit plans, the Department of Insurance shall post notice of the premium rate filings, rate filing summaries, and other information about the rate increase or decrease online on the Department's website. Provides that the Department shall open a 30-day public comment period on the date that a rate filing is posted on the website. Provides that after the close of the public comment period, the Department shall issue a decision to approve, disapprove, or modify a rate filing, and post the decision on the Department's website. Provides that the Department shall adopt rules implementing specified procedures. Defines "inadequate rate" and "unreasonable rate increase". LRB103 26156 BMS 52514 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB0324 Introduced 2/2/2023, by Sen. Laura Fine SYNOPSIS AS INTRODUCED: 215 ILCS 5/355 from Ch. 73, par. 967 215 ILCS 125/4-12 from Ch. 111 1/2, par. 1409.5 215 ILCS 5/355 from Ch. 73, par. 967 215 ILCS 125/4-12 from Ch. 111 1/2, par. 1409.5 Amends the Illinois Insurance Code and the Health Maintenance Organization Act. Provides that all individual and small group accident and health policies written subject to certain federal standards must file rates with the Department of Insurance for approval. Provides that unreasonable rate increases or inadequate rates shall be disapproved. Provides that when an insurer files a schedule or table of premium rates for individual or small employer health benefit plans, the Department of Insurance shall post notice of the premium rate filings, rate filing summaries, and other information about the rate increase or decrease online on the Department's website. Provides that the Department shall open a 30-day public comment period on the date that a rate filing is posted on the website. Provides that after the close of the public comment period, the Department shall issue a decision to approve, disapprove, or modify a rate filing, and post the decision on the Department's website. Provides that the Department shall adopt rules implementing specified procedures. Defines "inadequate rate" and "unreasonable rate increase". LRB103 26156 BMS 52514 b LRB103 26156 BMS 52514 b A BILL FOR
22 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB0324 Introduced 2/2/2023, by Sen. Laura Fine SYNOPSIS AS INTRODUCED:
33 215 ILCS 5/355 from Ch. 73, par. 967 215 ILCS 125/4-12 from Ch. 111 1/2, par. 1409.5 215 ILCS 5/355 from Ch. 73, par. 967 215 ILCS 125/4-12 from Ch. 111 1/2, par. 1409.5
44 215 ILCS 5/355 from Ch. 73, par. 967
55 215 ILCS 125/4-12 from Ch. 111 1/2, par. 1409.5
66 Amends the Illinois Insurance Code and the Health Maintenance Organization Act. Provides that all individual and small group accident and health policies written subject to certain federal standards must file rates with the Department of Insurance for approval. Provides that unreasonable rate increases or inadequate rates shall be disapproved. Provides that when an insurer files a schedule or table of premium rates for individual or small employer health benefit plans, the Department of Insurance shall post notice of the premium rate filings, rate filing summaries, and other information about the rate increase or decrease online on the Department's website. Provides that the Department shall open a 30-day public comment period on the date that a rate filing is posted on the website. Provides that after the close of the public comment period, the Department shall issue a decision to approve, disapprove, or modify a rate filing, and post the decision on the Department's website. Provides that the Department shall adopt rules implementing specified procedures. Defines "inadequate rate" and "unreasonable rate increase".
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1212 1 AN ACT concerning regulation.
1313 2 Be it enacted by the People of the State of Illinois,
1414 3 represented in the General Assembly:
1515 4 Section 5. The Illinois Insurance Code is amended by
1616 5 changing Section 355 as follows:
1717 6 (215 ILCS 5/355) (from Ch. 73, par. 967)
1818 7 Sec. 355. Accident and health policies; provisions.
1919 8 policies-Provisions.)
2020 9 (a) As used in this Section:
2121 10 "Inadequate rate" means a rate:
2222 11 (1) that is insufficient to sustain projected losses
2323 12 and expenses to which the rate applies; and
2424 13 (2) the continued use of which endangers the solvency
2525 14 of an insurer using that rate.
2626 15 "Unreasonable rate increase" means a rate increase that
2727 16 the Director determines to be excessive, unjustified, or
2828 17 unfairly discriminatory in accordance with 45 CFR 154.205.
2929 18 (b) No policy of insurance against loss or damage from the
3030 19 sickness, or from the bodily injury or death of the insured by
3131 20 accident shall be issued or delivered to any person in this
3232 21 State until a copy of the form thereof and of the
3333 22 classification of risks and the premium rates pertaining
3434 23 thereto have been filed with the Director; nor shall it be so
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3838 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB0324 Introduced 2/2/2023, by Sen. Laura Fine SYNOPSIS AS INTRODUCED:
3939 215 ILCS 5/355 from Ch. 73, par. 967 215 ILCS 125/4-12 from Ch. 111 1/2, par. 1409.5 215 ILCS 5/355 from Ch. 73, par. 967 215 ILCS 125/4-12 from Ch. 111 1/2, par. 1409.5
4040 215 ILCS 5/355 from Ch. 73, par. 967
4141 215 ILCS 125/4-12 from Ch. 111 1/2, par. 1409.5
4242 Amends the Illinois Insurance Code and the Health Maintenance Organization Act. Provides that all individual and small group accident and health policies written subject to certain federal standards must file rates with the Department of Insurance for approval. Provides that unreasonable rate increases or inadequate rates shall be disapproved. Provides that when an insurer files a schedule or table of premium rates for individual or small employer health benefit plans, the Department of Insurance shall post notice of the premium rate filings, rate filing summaries, and other information about the rate increase or decrease online on the Department's website. Provides that the Department shall open a 30-day public comment period on the date that a rate filing is posted on the website. Provides that after the close of the public comment period, the Department shall issue a decision to approve, disapprove, or modify a rate filing, and post the decision on the Department's website. Provides that the Department shall adopt rules implementing specified procedures. Defines "inadequate rate" and "unreasonable rate increase".
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7171 1 issued or delivered until the Director shall have approved
7272 2 such policy pursuant to the provisions of Section 143. If the
7373 3 Director disapproves the policy form he shall make a written
7474 4 decision stating the respects in which such form does not
7575 5 comply with the requirements of law and shall deliver a copy
7676 6 thereof to the company and it shall be unlawful thereafter for
7777 7 any such company to issue any policy in such form.
7878 8 (c) Rate increases for all individual and small group
7979 9 accident and health insurance policies subject to the
8080 10 standards of 45 CFR Part 154 must be filed with the Department
8181 11 for approval. Unreasonable rate increases or inadequate rates
8282 12 shall be disapproved.
8383 13 (d) When an insurer files a schedule or table of premium
8484 14 rates for individual or small employer health benefit plans,
8585 15 the Department shall post notice of the rate filings, rate
8686 16 filing summaries, and other information about the rate
8787 17 increase or decrease online on the Department's website. The
8888 18 Department shall open a 30-day public comment period on the
8989 19 rate filing beginning on the date that the rate filing is
9090 20 posted on the website. The Department shall post all of the
9191 21 comments received to the Department's website within 5
9292 22 business days after the comment period ends.
9393 23 (e) After the close of the public comment period described
9494 24 in subsection (d), the Department shall issue a decision to
9595 25 approve, disapprove, or modify a rate filing. The Department
9696 26 shall notify the insurer of the decision, and make the
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107107 1 decision available to the public by posting it on the
108108 2 Department's website, and include the following information:
109109 3 (1) an explanation of the findings and rationale that
110110 4 are the basis for the decision; and
111111 5 (2) any actuarial or other analyses, calculations, or
112112 6 evaluations relied upon by the Department in arriving at
113113 7 the decision.
114114 8 (f) If, following the issuance of a decision but before
115115 9 the effective date of the premium rates approved by the
116116 10 decision, an event occurs that materially affects the
117117 11 Director's decision to approve, deny, or modify the rates, the
118118 12 Director may consider supplemental facts or data reasonably
119119 13 related to the event.
120120 14 (g) The Department shall adopt rules implementing the
121121 15 procedures described in subsections (d) through (f).
122122 16 (Source: P.A. 79-777.)
123123 17 Section 10. The Health Maintenance Organization Act is
124124 18 amended by changing Section 4-12 as follows:
125125 19 (215 ILCS 125/4-12) (from Ch. 111 1/2, par. 1409.5)
126126 20 Sec. 4-12. Changes in Rate Methodology and Benefits,
127127 21 Material Modifications. A health maintenance organization
128128 22 shall file with the Director, prior to use, a notice of any
129129 23 change in rate methodology, or benefits and of any material
130130 24 modification of any matter or document furnished pursuant to
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141141 1 Section 2-1, together with such supporting documents as are
142142 2 necessary to fully explain the change or modification.
143143 3 (a) Contract modifications described in subsections
144144 4 (c)(5), (c)(6) and (c)(7) of Section 2-1 shall include all
145145 5 form agreements between the organization and enrollees,
146146 6 providers, administrators of services and insurers of health
147147 7 maintenance organizations.
148148 8 (b) Material transactions or series of transactions other
149149 9 than those described in subsection (a) of this Section, the
150150 10 total annual value of which exceeds the greater of $100,000 or
151151 11 5% of net earned subscription revenue for the most current
152152 12 twelve month period as determined from filed financial
153153 13 statements.
154154 14 (c) Any agreement between the organization and an insurer
155155 15 shall be subject to the provisions of the laws of this State
156156 16 regarding reinsurance as provided in Article XI of the
157157 17 Illinois Insurance Code. All reinsurance agreements must be
158158 18 filed. Approval of the Director is required for all agreements
159159 19 except the following: individual stop loss, aggregate excess,
160160 20 hospitalization benefits or out-of-area of the participating
161161 21 providers unless 20% or more of the organization's total risk
162162 22 is reinsured, in which case all reinsurance agreements require
163163 23 approval.
164164 24 (d) Rate increases for all individual and small group
165165 25 health care plans subject to the standards of 45 CFR Part 154
166166 26 must be filed with the Department for approval. Unreasonable
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177177 1 rate increases in relation to benefits under the policy
178178 2 provided or inadequate rates shall be disapproved.
179179 3 (e) When a health maintenance organization files a
180180 4 schedule or table of premium rates for individual or small
181181 5 employer health benefit plans, the Department shall post
182182 6 notice of the rate filings, rate filing summaries, and other
183183 7 information about the rate increase or decrease online on the
184184 8 Department's website. The Department shall open a 30-day
185185 9 public comment period on the rate filing beginning on the date
186186 10 that the rate filing is posted on the website. The Department
187187 11 shall post all of the comments received to the Department's
188188 12 website within 5 business days after the comment period ends.
189189 13 (f) After the close of the public comment period described
190190 14 in subsection (e), the Department shall issue a decision to
191191 15 approve, disapprove, or modify a rate filing. The Department
192192 16 shall notify the health maintenance organization of the
193193 17 decision, and make the decision available to the public by
194194 18 posting it on the Department's website, and include the
195195 19 following information:
196196 20 (1) an explanation of the findings and rationale that
197197 21 are the basis for the decision; and
198198 22 (2) any actuarial or other analyses, calculations, or
199199 23 evaluations relied upon by the Department in arriving at
200200 24 the decision.
201201 25 (g) If, following the issuance of a decision but before
202202 26 the effective date of the premium rates approved by the
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213213 1 decision, an event occurs that materially affects the
214214 2 Director's decision to approve, deny, or modify the rates, the
215215 3 Director may consider supplemental facts or data reasonably
216216 4 related to the event.
217217 5 (h) The Department shall adopt rules implementing the
218218 6 procedures described in subsections (e) through (g).
219219 7 (i) As used in this Section:
220220 8 "Inadequate rate" means a rate:
221221 9 (1) that is insufficient to sustain projected losses
222222 10 and expenses to which the rate applies; and
223223 11 (2) the continued use of which endangers the solvency
224224 12 of an insurer using that rate.
225225 13 "Unreasonable rate increase" means a rate increase that
226226 14 the Director determines to be excessive, unjustified, or
227227 15 unfairly discriminatory in accordance with 45 CFR 154.205.
228228 16 (Source: P.A. 86-620.)
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