IL
Illinois Senate Bill SB1912

Illinois 2023-2024 Regular Session

Illinois Senate Bill SB1912 Compare Versions

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11 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1912 Introduced 2/9/2023, by Sen. Laura Fine SYNOPSIS AS INTRODUCED: 20 ILCS 1405/1405-26 new 215 ILCS 5/355 from Ch. 73, par. 967 215 ILCS 125/4-12 from Ch. 111 1/2, par. 1409.5 Amends the Department of Insurance Law. Provides that the Department of Insurance shall establish the Office of the Healthcare Advocate. Provides that the Office shall be administered by the Chief Health Care Advocate, who shall report to the Director of Insurance. 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 for approval. Provides that unreasonable rate increases or inadequate rates shall be modified or disapproved. Provides that when an insurer files a schedule or table of premium rates for individual or small group health benefit plans, the insurer shall post notice of the premium rate filings and a filing summary in plain language on the insurer's website. Provides that the Department shall post all insurers' rate filings and summaries 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 the Department shall hold a public hearing during the 30-day comment period. Provides that the Director shall adopt affordability standards that must be considered in any decision to approve, disapprove, or modify rate filings. 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", "plain language", and "unreasonable rate increase". LRB103 25851 BMS 57008 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1912 Introduced 2/9/2023, by Sen. Laura Fine SYNOPSIS AS INTRODUCED: 20 ILCS 1405/1405-26 new 215 ILCS 5/355 from Ch. 73, par. 967 215 ILCS 125/4-12 from Ch. 111 1/2, par. 1409.5 20 ILCS 1405/1405-26 new 215 ILCS 5/355 from Ch. 73, par. 967 215 ILCS 125/4-12 from Ch. 111 1/2, par. 1409.5 Amends the Department of Insurance Law. Provides that the Department of Insurance shall establish the Office of the Healthcare Advocate. Provides that the Office shall be administered by the Chief Health Care Advocate, who shall report to the Director of Insurance. 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 for approval. Provides that unreasonable rate increases or inadequate rates shall be modified or disapproved. Provides that when an insurer files a schedule or table of premium rates for individual or small group health benefit plans, the insurer shall post notice of the premium rate filings and a filing summary in plain language on the insurer's website. Provides that the Department shall post all insurers' rate filings and summaries 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 the Department shall hold a public hearing during the 30-day comment period. Provides that the Director shall adopt affordability standards that must be considered in any decision to approve, disapprove, or modify rate filings. 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", "plain language", and "unreasonable rate increase". LRB103 25851 BMS 57008 b LRB103 25851 BMS 57008 b A BILL FOR
22 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1912 Introduced 2/9/2023, by Sen. Laura Fine SYNOPSIS AS INTRODUCED:
33 20 ILCS 1405/1405-26 new 215 ILCS 5/355 from Ch. 73, par. 967 215 ILCS 125/4-12 from Ch. 111 1/2, par. 1409.5 20 ILCS 1405/1405-26 new 215 ILCS 5/355 from Ch. 73, par. 967 215 ILCS 125/4-12 from Ch. 111 1/2, par. 1409.5
44 20 ILCS 1405/1405-26 new
55 215 ILCS 5/355 from Ch. 73, par. 967
66 215 ILCS 125/4-12 from Ch. 111 1/2, par. 1409.5
77 Amends the Department of Insurance Law. Provides that the Department of Insurance shall establish the Office of the Healthcare Advocate. Provides that the Office shall be administered by the Chief Health Care Advocate, who shall report to the Director of Insurance. 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 for approval. Provides that unreasonable rate increases or inadequate rates shall be modified or disapproved. Provides that when an insurer files a schedule or table of premium rates for individual or small group health benefit plans, the insurer shall post notice of the premium rate filings and a filing summary in plain language on the insurer's website. Provides that the Department shall post all insurers' rate filings and summaries 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 the Department shall hold a public hearing during the 30-day comment period. Provides that the Director shall adopt affordability standards that must be considered in any decision to approve, disapprove, or modify rate filings. 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", "plain language", and "unreasonable rate increase".
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1313 1 AN ACT concerning regulation.
1414 2 Be it enacted by the People of the State of Illinois,
1515 3 represented in the General Assembly:
1616 4 Section 5. The Department of Insurance Law is amended by
1717 5 adding Section 1405-26 as follows:
1818 6 (20 ILCS 1405/1405-26 new)
1919 7 Sec. 1405-26. Office of the Healthcare Advocate.
2020 8 (a) The Department of Insurance shall establish the Office
2121 9 of the Healthcare Advocate. The Office shall be administered
2222 10 by the Chief Health Care Advocate, who shall report to the
2323 11 Director. The Advocate shall be an individual with expertise
2424 12 and experience in the fields of health insurance and consumer
2525 13 advocacy. The Advocate may employ legal counsel, independent
2626 14 actuaries, and other employees and contractors as needed to
2727 15 carry out the duties of the Office.
2828 16 (b) The Advocate shall evaluate data, in consultation with
2929 17 an actuary, to assess individual and small group health
3030 18 benefit plan rate filings, networks, and affordability; and
3131 19 represent the interests of individuals and small business
3232 20 owners in public hearings held pursuant to subsection (e) of
3333 21 Section 355 of the Illinois Insurance Code and subsection (f)
3434 22 of Section 4-12 of the Health Maintenance Organization Act.
3535 23 (c) The Advocate shall have access to the unredacted
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3939 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1912 Introduced 2/9/2023, by Sen. Laura Fine SYNOPSIS AS INTRODUCED:
4040 20 ILCS 1405/1405-26 new 215 ILCS 5/355 from Ch. 73, par. 967 215 ILCS 125/4-12 from Ch. 111 1/2, par. 1409.5 20 ILCS 1405/1405-26 new 215 ILCS 5/355 from Ch. 73, par. 967 215 ILCS 125/4-12 from Ch. 111 1/2, par. 1409.5
4141 20 ILCS 1405/1405-26 new
4242 215 ILCS 5/355 from Ch. 73, par. 967
4343 215 ILCS 125/4-12 from Ch. 111 1/2, par. 1409.5
4444 Amends the Department of Insurance Law. Provides that the Department of Insurance shall establish the Office of the Healthcare Advocate. Provides that the Office shall be administered by the Chief Health Care Advocate, who shall report to the Director of Insurance. 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 for approval. Provides that unreasonable rate increases or inadequate rates shall be modified or disapproved. Provides that when an insurer files a schedule or table of premium rates for individual or small group health benefit plans, the insurer shall post notice of the premium rate filings and a filing summary in plain language on the insurer's website. Provides that the Department shall post all insurers' rate filings and summaries 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 the Department shall hold a public hearing during the 30-day comment period. Provides that the Director shall adopt affordability standards that must be considered in any decision to approve, disapprove, or modify rate filings. 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", "plain language", and "unreasonable rate increase".
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7474 1 actuarial memos that insurers send to the Department as part
7575 2 of the rate filings.
7676 3 (d) In the performance of the Advocate's duties, the
7777 4 Advocate shall act independently of the Department. Any
7878 5 recommendations made or positions taken by the Advocate do not
7979 6 reflect those of the Department.
8080 7 (e) The Department may adopt reasonable rules necessary to
8181 8 implement this Section.
8282 9 Section 10. The Illinois Insurance Code is amended by
8383 10 changing Section 355 as follows:
8484 11 (215 ILCS 5/355) (from Ch. 73, par. 967)
8585 12 Sec. 355. Accident and health policies; provisions.
8686 13 policies-Provisions.)
8787 14 (a) As used in this Section:
8888 15 "Inadequate rate" means a rate:
8989 16 (1) that is insufficient to sustain projected losses
9090 17 and expenses to which the rate applies; and
9191 18 (2) the continued use of which endangers the solvency
9292 19 of an insurer using that rate.
9393 20 "Plain language" shall have the same meaning as "plain
9494 21 writing" as used in the federal Plain Writing Act of 2010, and
9595 22 subsequent guidance documents, including the Federal Plain
9696 23 Language Guidelines.
9797 24 "Unreasonable rate increase" means a rate increase that
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108108 1 the Director determines to be excessive, unjustified, or
109109 2 unfairly discriminatory in accordance with 45 CFR 154.205.
110110 3 (b) No policy of insurance against loss or damage from the
111111 4 sickness, or from the bodily injury or death of the insured by
112112 5 accident shall be issued or delivered to any person in this
113113 6 State until a copy of the form thereof and of the
114114 7 classification of risks and the premium rates pertaining
115115 8 thereto have been filed with the Director; nor shall it be so
116116 9 issued or delivered until the Director shall have approved
117117 10 such policy pursuant to the provisions of Section 143. If the
118118 11 Director disapproves the policy form he shall make a written
119119 12 decision stating the respects in which such form does not
120120 13 comply with the requirements of law and shall deliver a copy
121121 14 thereof to the company and it shall be unlawful thereafter for
122122 15 any such company to issue any policy in such form.
123123 16 (c) Rate increases for all individual and small group
124124 17 accident and health insurance policies subject to the
125125 18 standards of 45 CFR Part 154 must be filed with the Department
126126 19 for approval. Unreasonable rate increases or inadequate rates
127127 20 shall be modified or disapproved.
128128 21 (d) When an insurer files a schedule or table of premium
129129 22 rates for individual or small group health benefit plans, the
130130 23 insurer shall post notice of the rate filing and a filing
131131 24 summary in plain language on the insurer's website. The
132132 25 Department shall post all insurers' rate filings and summaries
133133 26 on the Department's website. All summaries shall include a
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144144 1 brief justification of any rate increase or decrease
145145 2 requested, including the number of individual members, the
146146 3 medical loss ratio, medical trend, administrative costs, and
147147 4 any other information requested by the Director. The plain
148148 5 language summary shall include notification of the public
149149 6 comment period established in subsection (e).
150150 7 (e) The Department shall open a 30-day public comment
151151 8 period on the rate filing beginning on the date that the rate
152152 9 filing is posted on the website. The Department shall post all
153153 10 of the comments received to the Department's website within 5
154154 11 business days after the comment period ends. The Department
155155 12 shall hold a public hearing during the 30-day comment period.
156156 13 (f) The Director shall adopt affordability standards that
157157 14 must be considered in any decision to approve, disapprove, or
158158 15 modify rate filings. These affordability standards include,
159159 16 but are not limited to, the following:
160160 17 (1) trends, including historical rates for existing
161161 18 products and national and regional medical and health
162162 19 insurance trends;
163163 20 (2) inflation;
164164 21 (3) price comparisons to other market rates for
165165 22 similar products;
166166 23 (4) the ability of low-income individuals to pay for
167167 24 health insurance;
168168 25 (5) the ability of small businesses to pay for health
169169 26 insurance;
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180180 1 (6) health insurers' efforts to control administrative
181181 2 costs; and
182182 3 (7) effective strategies implemented by health
183183 4 insurers to increase affordability, including payment
184184 5 reform across the delivery system.
185185 6 (g) After the close of the public comment period described
186186 7 in subsection (e), the Department shall issue a decision to
187187 8 approve, disapprove, or modify a rate filing. The Department
188188 9 shall notify the insurer of the decision, and make the
189189 10 decision available to the public by posting it on the
190190 11 Department's website, and include the following information:
191191 12 (1) an explanation of the findings and rationale that
192192 13 are the basis for the decision; and
193193 14 (2) any actuarial or other analyses, calculations, or
194194 15 evaluations relied upon by the Department in arriving at
195195 16 the decision.
196196 17 (h) If, following the issuance of a decision but before
197197 18 the effective date of the premium rates approved by the
198198 19 decision, an event occurs that materially affects the
199199 20 Director's decision to approve, deny, or modify the rates, the
200200 21 Director may consider supplemental facts or data reasonably
201201 22 related to the event.
202202 23 (i) The Department shall adopt rules implementing the
203203 24 procedures described in subsections (d) through (h).
204204 25 (Source: P.A. 79-777.)
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215215 1 Section 15. The Health Maintenance Organization Act is
216216 2 amended by changing Section 4-12 as follows:
217217 3 (215 ILCS 125/4-12) (from Ch. 111 1/2, par. 1409.5)
218218 4 Sec. 4-12. Changes in Rate Methodology and Benefits,
219219 5 Material Modifications. A health maintenance organization
220220 6 shall file with the Director, prior to use, a notice of any
221221 7 change in rate methodology, or benefits and of any material
222222 8 modification of any matter or document furnished pursuant to
223223 9 Section 2-1, together with such supporting documents as are
224224 10 necessary to fully explain the change or modification.
225225 11 (a) Contract modifications described in subsections
226226 12 (c)(5), (c)(6) and (c)(7) of Section 2-1 shall include all
227227 13 form agreements between the organization and enrollees,
228228 14 providers, administrators of services and insurers of health
229229 15 maintenance organizations.
230230 16 (b) Material transactions or series of transactions other
231231 17 than those described in subsection (a) of this Section, the
232232 18 total annual value of which exceeds the greater of $100,000 or
233233 19 5% of net earned subscription revenue for the most current
234234 20 twelve month period as determined from filed financial
235235 21 statements.
236236 22 (c) Any agreement between the organization and an insurer
237237 23 shall be subject to the provisions of the laws of this State
238238 24 regarding reinsurance as provided in Article XI of the
239239 25 Illinois Insurance Code. All reinsurance agreements must be
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250250 1 filed. Approval of the Director is required for all agreements
251251 2 except the following: individual stop loss, aggregate excess,
252252 3 hospitalization benefits or out-of-area of the participating
253253 4 providers unless 20% or more of the organization's total risk
254254 5 is reinsured, in which case all reinsurance agreements require
255255 6 approval.
256256 7 (d) Rate increases for all individual and small group
257257 8 accident and health insurance policies subject to the
258258 9 standards of 45 CFR Part 154 must be filed with the Department
259259 10 for approval. Unreasonable rate increases in relation to
260260 11 benefits under the policy provided or inadequate rates shall
261261 12 be modified or disapproved.
262262 13 (e) When a health maintenance organization files a
263263 14 schedule or table of premium rates for individual or small
264264 15 group health benefit plans, the health maintenance
265265 16 organization shall post notice of the rate filing and a filing
266266 17 summary in plain language on the organization's website. The
267267 18 Department shall post all insurers' rate filings and summaries
268268 19 on the Department's website. All summaries shall include a
269269 20 brief justification of any rate increase or decrease
270270 21 requested, including the number of individual members, the
271271 22 medical loss ratio, medical trend, administrative costs, and
272272 23 any other information requested by the Director. The plain
273273 24 language summary shall include notification of the public
274274 25 comment period established in subsection (f).
275275 26 (f) The Department shall open a 30-day public comment
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286286 1 period on the rate filing beginning on the date that the rate
287287 2 filing is posted on the website. The Department shall post all
288288 3 of the comments received to the Department's website within 5
289289 4 business days after the comment period ends. The Department
290290 5 shall hold a public hearing during the 30-day comment period.
291291 6 (g) The Director shall adopt affordability standards that
292292 7 must be considered in any decision to approve, disapprove, or
293293 8 modify rate filings. These affordability standards include,
294294 9 but are not limited to, the following:
295295 10 (1) trends, including historical rates for existing
296296 11 products and national and regional medical and health
297297 12 insurance trends;
298298 13 (2) inflation;
299299 14 (3) price comparisons to other market rates for
300300 15 similar products;
301301 16 (4) the ability of low-income individuals to pay for
302302 17 health insurance;
303303 18 (5) the ability of small businesses to pay for health
304304 19 insurance;
305305 20 (6) health insurers' efforts to control administrative
306306 21 costs; and
307307 22 (7) effective strategies implemented by health
308308 23 insurers to increase affordability, including payment
309309 24 reform across the delivery system.
310310 25 (h) After the close of the public comment period described
311311 26 in subsection (f), the Department shall issue a decision to
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322322 1 approve, disapprove, or modify a rate filing. The Department
323323 2 shall notify the health maintenance organization of the
324324 3 decision, and make the decision available to the public by
325325 4 posting it on the Department's website, and include the
326326 5 following information:
327327 6 (1) an explanation of the findings and rationale that
328328 7 are the basis for the decision; and
329329 8 (2) any actuarial or other analyses, calculations, or
330330 9 evaluations relied upon by the Department in arriving at
331331 10 the decision.
332332 11 (i) If, following the issuance of a decision but before
333333 12 the effective date of the premium rates approved by the
334334 13 decision, an event occurs that materially affects the
335335 14 Director's decision to approve, deny, or modify the rates, the
336336 15 Director may consider supplemental facts or data reasonably
337337 16 related to the event.
338338 17 (j) The Department shall adopt rules implementing the
339339 18 procedures described in subsections (e) through (i).
340340 19 (k) As used in this Section:
341341 20 "Inadequate rate" means a rate:
342342 21 (1) that is insufficient to sustain projected losses
343343 22 and expenses to which the rate applies; and
344344 23 (2) the continued use of which endangers the solvency
345345 24 of an insurer using that rate.
346346 25 "Plain language" shall have the same meaning as "plain
347347 26 writing" as used in the federal Plain Writing Act of 2010, and
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358358 1 subsequent guidance documents, including the Federal Plain
359359 2 Language Guidelines.
360360 3 "Unreasonable rate increase" means a rate increase that
361361 4 the Director determines to be excessive, unjustified, or
362362 5 unfairly discriminatory in accordance with 45 CFR 154.205.
363363 6 (Source: P.A. 86-620.)
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