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| Public Act 097-0524 | ||||
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AN ACT concerning insurance.
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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 Section 359c as follows: | ||||
(215 ILCS 5/359c)
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Sec. 359c. Accident and health expense reporting. | ||||
(a) Beginning January 1, 2011 and every 6 months | ||||
thereafter, any carrier providing a group or individual major | ||||
medical policy of accident or health insurance shall prepare | ||||
and provide to the Department of Insurance a statement of the | ||||
aggregate administrative expenses of the carrier, based on the | ||||
premiums earned in the immediately preceding 6-month period on | ||||
the accident or health insurance business of the carrier. The | ||||
semi-annual statements shall be filed on or before October 1 | ||||
July 31 for the preceding 6-month period ending June 30 and on | ||||
or before April 1 February 1 for the preceding 6-month period | ||||
ending December 31. The statements shall itemize and separately | ||||
detail all of the following information with respect to the | ||||
carrier's accident or health insurance business: | ||||
(1) the amount of premiums earned by the carrier both | ||||
before and after any costs related to the carrier's | ||||
purchase of reinsurance coverage; | ||||
(2) the total amount of claims for losses paid by the | ||
carrier both before and after any reimbursement from | ||
reinsurance coverage including any costs incurred related | ||
to: | ||
(A) disease, case, or chronic care management | ||
programs; | ||
(B) wellness and health education programs; | ||
(C) fraud prevention; | ||
(D) maintaining provider networks and provider | ||
credentialing; | ||
(E) health information technology for personal | ||
electronic health records; and | ||
(F) utilization review and utilization management; | ||
(3) the amount of any losses incurred by the carrier | ||
but not reported to the carrier in the current or prior | ||
reporting period; | ||
(4) the amount of costs incurred by the carrier for | ||
State fees and federal and State taxes including: | ||
(A) any high risk pool and guaranty fund | ||
assessments levied on the carrier by the State; and | ||
(B) any regulatory compliance costs including | ||
State fees for form and rate filings, licensures, | ||
market conduct exams, and financial reports; | ||
(5) the amount of costs incurred by the carrier for | ||
reinsurance coverage; | ||
(6) the amount of costs incurred by the carrier that | ||
are related to the carrier's payment of marketing expenses | ||
including commissions; and | ||
(7) any other administrative expenses incurred by the | ||
carrier. | ||
(b) The information provided pursuant to subsection (a) of | ||
this Section shall be separately aggregated for the following | ||
lines of major medical insurance: | ||
(1) individually underwritten; | ||
(2) groups of 2 to 25 members; | ||
(3) groups of 26 to 50 members; | ||
(4) groups of 51 or more members. | ||
(c) The Department shall make the submitted information | ||
publicly available on the Department's website or such other | ||
media as appropriate in a form useful for consumers.
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(Source: P.A. 96-857, eff. 1-5-10.)
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