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Public Act 102-0135 |
HB1957 Enrolled | LRB102 10644 BMS 15973 b |
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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 |
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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 |
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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 |
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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. |
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(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. |
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(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 |
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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 |
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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. |
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(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 |
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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 |
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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 |
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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 |
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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 |
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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. |
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(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 |
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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; |
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(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 |
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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, |
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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 |
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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 |
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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 |
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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 .)
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(215 ILCS 5/500-30)
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(Section scheduled to be repealed on January 1, 2027)
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Sec. 500-30. Application for license.
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(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,
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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:
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(1) is at least 18 years of age;
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(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:
|
|
Class of Insurance |
Number of |
|
|
Hours |
|
|
|
Life (Class 1(a)) |
20 |
|
Accident and Health (Class 1(b) or 2(a)) |
20 |
|
Fire (Class 3) |
20 |
|
Casualty (Class 2) |
20 |
|
Personal Lines-Property Casualty |
20 |
|
Motor Vehicle (Class 2(b) or 3(e)) |
12.5 |
|
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.
|