Illinois General Assembly - Full Text of HB0146
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Full Text of HB0146  102nd General Assembly

HB0146 102ND GENERAL ASSEMBLY


 


 
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB0146

 

Introduced 1/14/2021, by Rep. Bob Morgan

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/355  from Ch. 73, par. 967
215 ILCS 125/4-12  from Ch. 111 1/2, par. 1409.5

    Amends the Illinois Insurance Code and the Health Maintenance Organization Act. Provides that all individual and small group accident and health policies written in compliance with the Patient Protection and Affordable Care Act must file rates with the Department of Insurance for approval. Provides that rate increases found to be unreasonable rate increases in relation to benefits under the policy provided shall be disapproved. Requires the Department to provide a report to the General Assembly after January 1, 2023 regarding both on and off exchange individual and small group rates in the Illinois market. Requires that the Department approve or deny rate increases within 60 calendar days after the rate increase is filed with the Department. Provides that a rate increase that is not approved or denied by the Department on the 61st calendar day shall be automatically approved on that day. Provides that no less than 30 days after the federal Centers for Medicare and Medicaid Services has certified the plans described in this Section for the upcoming plan year, the Department shall publish on its website a report explaining the rates for the subsequent calendar year's certified policies. Defines "unreasonable rate increase".


LRB102 04400 BMS 14418 b

 

 

A BILL FOR

 

HB0146LRB102 04400 BMS 14418 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
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, "unreasonable rate increase"
10means a rate increase that the Director determines to be
11excessive, unjustified, or unfairly discriminatory in
12accordance with 45 CFR 154.205.
13    (b) No policy of insurance against loss or damage from the
14sickness, or from the bodily injury or death of the insured by
15accident shall be issued or delivered to any person in this
16State until a copy of the form thereof and of the
17classification of risks and the premium rates pertaining
18thereto have been filed with the Director; nor shall it be so
19issued or delivered until the Director shall have approved
20such policy pursuant to the provisions of Section 143. If the
21Director disapproves the policy form he shall make a written
22decision stating the respects in which such form does not
23comply with the requirements of law and shall deliver a copy

 

 

HB0146- 2 -LRB102 04400 BMS 14418 b

1thereof to the company and it shall be unlawful thereafter for
2any such company to issue any policy in such form.
3    (c) All individual and small group accident and health
4policies written in compliance with the Patient Protection and
5Affordable Care Act must file rates with the Department for
6approval. Rate increases found to be unreasonable rate
7increases in relation to benefits under the policy provided
8shall be disapproved. The Department shall provide a report to
9the General Assembly on or after January 1, 2023, regarding
10both on and off exchange individual and small group rates in
11the Illinois market.
12    (d) A rate increase filed under this Section must be
13approved or denied within 60 calendar days after the date the
14rate increase is filed with the Department. Any rate increase
15that is not approved or denied by the Department shall
16automatically be approved on the 61st calendar day.
17    (e) No less than 30 days after the federal Centers for
18Medicare and Medicaid Services has certified the policies
19described in this Section for the upcoming plan year, the
20Department shall publish on its website a report explaining
21the rates for the subsequent calendar year's certified
22policies.
23(Source: P.A. 79-777.)
 
24    Section 10. The Health Maintenance Organization Act is
25amended by changing Section 4-12 as follows:
 

 

 

HB0146- 3 -LRB102 04400 BMS 14418 b

1    (215 ILCS 125/4-12)  (from Ch. 111 1/2, par. 1409.5)
2    Sec. 4-12. Changes in Rate Methodology and Benefits,
3Material Modifications. A health maintenance organization
4shall file with the Director, prior to use, a notice of any
5change in rate methodology, or benefits and of any material
6modification of any matter or document furnished pursuant to
7Section 2-1, together with such supporting documents as are
8necessary to fully explain the change or modification.
9    (a) Contract modifications described in subsections
10(c)(5), (c)(6) and (c)(7) of Section 2-1 shall include all
11form agreements between the organization and enrollees,
12providers, administrators of services and insurers of health
13maintenance organizations.
14    (b) Material transactions or series of transactions other
15than those described in subsection (a) of this Section, the
16total annual value of which exceeds the greater of $100,000 or
175% of net earned subscription revenue for the most current
18twelve month period as determined from filed financial
19statements.
20    (c) Any agreement between the organization and an insurer
21shall be subject to the provisions of the laws of this State
22regarding reinsurance as provided in Article XI of the
23Illinois Insurance Code. All reinsurance agreements must be
24filed. Approval of the Director is required for all agreements
25except the following: individual stop loss, aggregate excess,

 

 

HB0146- 4 -LRB102 04400 BMS 14418 b

1hospitalization benefits or out-of-area of the participating
2providers unless 20% or more of the organization's total risk
3is reinsured, in which case all reinsurance agreements require
4approval.
5    (d) All individual and small group accident and health
6policies written in compliance with the Patient Protection and
7Affordable Care Act must file rates with the Department for
8approval. Rate increases found to be unreasonable rate
9increases in relation to benefits under the policy provided
10shall be disapproved. The Department shall provide a report to
11the General Assembly on or after January 1, 2023, regarding
12both on and off exchange individual and small group rates in
13the Illinois market.
14    (e) A rate increase filed under this Section must be
15approved or denied within 60 calendar days after the date the
16rate increase is filed with the Department. Any rate increase
17that is not approved or denied by the Department shall
18automatically be approved on the 61st calendar day.
19    (f) No less than 30 days after the federal Centers for
20Medicare and Medicaid Services has certified the policies
21described in this Section for the upcoming plan year, the
22Department shall publish on its website a report explaining
23the rates for the subsequent calendar year's certified
24policies.
25    (g) As used in this Section, "unreasonable rate increase"
26means a rate increase that the Director determines to be

 

 

HB0146- 5 -LRB102 04400 BMS 14418 b

1excessive, unjustified, or unfairly discriminatory in
2accordance with 45 CFR 154.205.
3(Source: P.A. 86-620.)