Section 2026.100  Review of Rates Not Subject to the Effective Rate Review Program

a)         The Director's review of any rate, classification of risks, or rate-setting methodology described in Section 2026.30(d) is subject to Section 355(i) of the Code in addition to any other law or rule applicable to the type of coverage. Upon the request of the Director, the health insurance issuer must submit actuarial documentation for any submitted rates, classifications of risks, or rate-setting methodologies, including, but not limited to, major cost components, experience, assumptions, and procedures used to develop the submitted rates, classifications, or methodologies.

b)         A large group market rate filing described in Section 2026.30(c) must include enough information for the Director to determine whether the rates are or will be reasonable in relation to the benefits and are or will be calculated in accordance with sound actuarial principles. In addition to the applicable information in Section 2026.30(e), the required information includes, but is not limited to:

1)         the rate manual;

2)         a full description of how final premium rates are determined, including the experience, assumptions, and procedures upon which the health insurance issuer relies;

3)         historical and future expected medical trend rates;

4)         historical and future expected prescription drug trend rates;

5)         commission schedules;

6)         administrative expense ratios;

7)         profit assumptions;

8)         historical and future expected medical loss ratio, as calculated under 45 CFR Part 158; and

9)         the product or products' actual premium rates that went into effect since the prior rate filing. For each product, this information must identify the group or master policyholders, the approximate number of covered lives under each policyholder for each class of benefits, the rate tiers with the premium rates under each policyholder for each class of benefits, and the date the premium rates went into effect for the policyholder.

c)         Discrimination prohibited. If a policy's rates or classifications create differences between applicants or covered individuals within similar risk categories that do not reasonably correspond to differences in expected costs, the Director will deem the rates or classifications not to have been calculated in accordance with sound actuarial principles. Nothing in this subsection prevents the Director from enforcing other prohibitions on discrimination in rates or classifications of risk as provided by the law or regulation applicable to the type of policy, including, but not limited to, Sections 364 and 424(3) of the Code, Section 25(B) of the Illinois Health Insurance Portability and Accountability Act, and 50 Ill. Adm. Code 2603.

d)         Confidentiality requirements.

1)         If a health insurance issuer deems any information contained in its rate filing proprietary, privileged, or confidential such that disclosure of the information would cause competitive harm to the issuer, the health insurance issuer must file both an unredacted version and a version with the deemed confidential information redacted that is separately marked for public access in SERFF. Additionally, to qualify for ongoing exemption from production under Section 7(1)(g) of the Freedom of Information Act [5 ILCS 140], proprietary, privileged, or confidential information must be furnished to the Department with the explicit claim that the disclosure of the information would cause competitive harm to the health insurance issuer. The health insurance issuer must furnish that claim in a separate letter within the SERFF filing to which it pertains.

2)         Without expanding the scope of information for which a health insurance issuer may obtain protection under Section 7(1)(g) of the Freedom of Information Act, the rate, premium, and policyholder information described in Section 2026.30(e)(2) must not be redacted and will not be deemed confidential, proprietary, or privileged by the Department.

3)         Notwithstanding any provision of this Part other than subsection (e)(4), for any policy that is issued in connection with an employee benefit plan, the Department will allow public inspection or copying of information described in 29 U.S.C. 1023(e) starting 210 days after the close of the plan year or policy period.

4)         Notwithstanding any other provision of this subsection, the Department will hold the entirety of a rate filing described in Section 2026.30(c) or (d) confidential while it remains pending the Department's review.

(Source:  Amended at 49 Ill. Reg. 11309, effective August 28, 2025)