Sen. Laura Fine

Filed: 5/29/2019

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 665

2    AMENDMENT NO. ______. Amend Senate Bill 665 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Insurance Code is amended by
5changing Section 355 as follows:
 
6    (215 ILCS 5/355)  (from Ch. 73, par. 967)
7    Sec. 355. Accident and health policies; provisions.
8policies-Provisions.)
9    (a) As used in this Section:
10    "Inadequate rate" means a rate:
11        (1) that is insufficient to sustain projected losses
12    and expenses to which the rate applies; and
13        (2) the continued use of which endangers the solvency
14    of an insurer using that rate.
15    "Unreasonable rate increase" means a rate increase that the
16Director determines to be excessive, unjustified, or unfairly

 

 

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1discriminatory in accordance with 45 CFR 154.205.
2    (b) No policy of insurance against loss or damage from the
3sickness, or from the bodily injury or death of the insured by
4accident shall be issued or delivered to any person in this
5State until a copy of the form thereof and of the
6classification of risks and the premium rates pertaining
7thereto have been filed with the Director; nor shall it be so
8issued or delivered until the Director shall have approved such
9policy pursuant to the provisions of Section 143. If the
10Director disapproves the policy form he shall make a written
11decision stating the respects in which such form does not
12comply with the requirements of law and shall deliver a copy
13thereof to the company and it shall be unlawful thereafter for
14any such company to issue any policy in such form.
15    (c) Rate increases for all individual and small group
16accident and health insurance policies subject to the standards
17of 45 CFR Part 154 must be filed with the Department for
18approval. Unreasonable rate increases or inadequate rates
19shall be disapproved. The Department shall provide a report to
20the General Assembly on or after January 1, 2021 regarding both
21on and off exchange individual and small group rates in the
22Illinois market.
23    (d) In all cases the Director shall approve or disapprove a
24rate filing under subsection (c) within 45 calendar days of
25submission unless the Director extends, by not more than an
26additional 30 days, the period within which he or she shall

 

 

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1approve or disapprove any such filing by giving written notice
2to the insurer of such extension before expiration of the
3initial 45-day period. Rates not approved or disapproved by the
4applicable deadline shall be deemed approved on the following
5calendar day.
6    (e) No less than 30 days after the federal Centers for
7Medicare and Medicaid Services has certified the policies
8described in subsection (c) for the upcoming plan year, the
9Department shall publish on its website a report explaining the
10rates for that plan year's certified policies.
11(Source: P.A. 79-777.)
 
12    Section 10. The Health Maintenance Organization Act is
13amended by changing Section 4-12 as follows:
 
14    (215 ILCS 125/4-12)  (from Ch. 111 1/2, par. 1409.5)
15    Sec. 4-12. Changes in Rate Methodology and Benefits,
16Material Modifications. A health maintenance organization
17shall file with the Director, prior to use, a notice of any
18change in rate methodology, or benefits and of any material
19modification of any matter or document furnished pursuant to
20Section 2-1, together with such supporting documents as are
21necessary to fully explain the change or modification.
22    (a) Contract modifications described in subsections
23(c)(5), (c)(6) and (c)(7) of Section 2-1 shall include all form
24agreements between the organization and enrollees, providers,

 

 

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1administrators of services and insurers of health maintenance
2organizations.
3    (b) Material transactions or series of transactions other
4than those described in subsection (a) of this Section, the
5total annual value of which exceeds the greater of $100,000 or
65% of net earned subscription revenue for the most current
7twelve month period as determined from filed financial
8statements.
9    (c) Any agreement between the organization and an insurer
10shall be subject to the provisions of the laws of this State
11regarding reinsurance as provided in Article XI of the Illinois
12Insurance Code. All reinsurance agreements must be filed.
13Approval of the Director is required for all agreements except
14the following: individual stop loss, aggregate excess,
15hospitalization benefits or out-of-area of the participating
16providers unless 20% or more of the organization's total risk
17is reinsured, in which case all reinsurance agreements require
18approval.
19    (d) Rate increases for all individual and small group
20health care plans subject to the standards of 45 CFR Part 154
21must be filed with the Department for approval. Unreasonable
22rate increases in relation to benefits under the policy
23provided or inadequate rates shall be disapproved. The
24Department shall provide a report to the General Assembly on or
25after January 1, 2021 regarding both on and off exchange
26individual and small group rates in the Illinois market.

 

 

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1    (e) In all cases the Director shall approve or disapprove a
2rate filing under subsection (d) within 45 calendar days of
3submission unless the Director extends, by not more than an
4additional 30 days, the period within which he or she shall
5approve or disapprove any such filing by giving written notice
6to the insurer of such extension before expiration of the
7initial 45-day period. Rates not approved or disapproved by the
8applicable deadline shall be deemed approved on the following
9calendar day.
10    (f) No less than 30 days after the federal Centers for
11Medicare and Medicaid Services has certified the health care
12plans described in subsection (d) for the upcoming plan year,
13the Department shall publish on its website a report explaining
14the rates for that plan year's certified health care plans.
15    (g) As used in this Section:
16    "Inadequate rate" means a rate:
17        (1) that is insufficient to sustain projected losses
18    and expenses to which the rate applies; and
19        (2) the continued use of which endangers the solvency
20    of an insurer using that rate.
21    "Unreasonable rate increase" means a rate increase that the
22Director determines to be excessive, unjustified, or unfairly
23discriminatory in accordance with 45 CFR 154.205.
24(Source: P.A. 86-620.)".