Full Text of HB0471 101st General Assembly
HB0471sam001 101ST GENERAL ASSEMBLY | Sen. Laura Fine Filed: 5/17/2019
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| 1 | | AMENDMENT TO HOUSE BILL 471
| 2 | | AMENDMENT NO. ______. Amend House Bill 471 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Insurance Code is amended by | 5 | | changing Section 355 as follows:
| 6 | | (215 ILCS 5/355) (from Ch. 73, par. 967)
| 7 | | Sec. 355. Accident
and health policies; provisions. | 8 | | policies-Provisions.)
| 9 | | (a) As used in this Section, "unreasonable rate increase" | 10 | | means a rate increase that the Director determines to be | 11 | | excessive, unjustified, or unfairly discriminatory in | 12 | | accordance with 45 CFR 154.205. | 13 | | (b) No policy of insurance against loss or damage from the | 14 | | sickness, or from
the bodily injury or death of the insured by | 15 | | accident shall be issued or
delivered to any person in this | 16 | | State until a copy of the form thereof and
of the |
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| 1 | | classification of risks and the premium rates pertaining | 2 | | thereto
have been filed with the Director; nor shall it be so | 3 | | issued or delivered
until the Director shall have approved such | 4 | | policy pursuant to the provisions
of Section 143. If the | 5 | | Director
disapproves the policy form he shall make a written | 6 | | decision stating the
respects in which such form does not | 7 | | comply with the requirements of law
and shall deliver a copy | 8 | | thereof to the company and it shall be unlawful
thereafter for | 9 | | any such company to issue any policy in such form. | 10 | | (c) Rate increases for all individual and small group | 11 | | accident and health insurance policies subject to the standards | 12 | | of 45 CFR Part 154 must be filed with the Department for | 13 | | approval. Unreasonable rate increases shall be disapproved. | 14 | | The Department shall provide a report to the General Assembly | 15 | | on or after January 1, 2021, regarding both on and off exchange | 16 | | individual and small group rates in the Illinois market.
| 17 | | (d) In all cases the Director shall approve or disapprove a | 18 | | rate filing under subsection (c) within 60 calendar days of | 19 | | submission unless the Director extends, by not more than an | 20 | | additional 30 days, the period within which he or she shall | 21 | | approve or disapprove any such filing by giving written notice | 22 | | to the insurer of such extension before expiration of the | 23 | | initial 60-day period. Rates not approved or disapproved by the | 24 | | applicable deadline shall be deemed approved on the following | 25 | | calendar day. | 26 | | (e) No less than 30 days after the federal Centers for |
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| 1 | | Medicare and Medicaid Services has certified the policies | 2 | | described in subsection (c) for the upcoming plan year, the | 3 | | Department shall publish on its website a report explaining the | 4 | | rates for that plan year's certified policies. | 5 | | (Source: P.A. 79-777.)
| 6 | | Section 10. The Health Maintenance Organization Act is | 7 | | amended by changing Section 4-12 as follows:
| 8 | | (215 ILCS 125/4-12) (from Ch. 111 1/2, par. 1409.5)
| 9 | | Sec. 4-12. Changes in Rate Methodology and Benefits, | 10 | | Material
Modifications. A health maintenance organization | 11 | | shall file with the
Director, prior to use, a notice of any | 12 | | change in rate methodology, or
benefits and of any material | 13 | | modification of any matter or document
furnished pursuant to | 14 | | Section 2-1, together with such supporting documents
as are | 15 | | necessary to fully explain the change or modification.
| 16 | | (a) Contract modifications described in subsections | 17 | | (c)(5), (c)(6) and
(c)(7) of Section 2-1 shall include all form | 18 | | agreements between the
organization and enrollees, providers, | 19 | | administrators of services and
insurers of health maintenance | 20 | | organizations.
| 21 | | (b) Material transactions or series of transactions other | 22 | | than those
described in subsection (a) of this Section, the | 23 | | total annual value of
which exceeds the greater of $100,000 or | 24 | | 5% of net earned subscription
revenue for the most current |
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| 1 | | twelve month period as determined from filed
financial | 2 | | statements.
| 3 | | (c) Any agreement between the organization and an insurer | 4 | | shall be
subject to the provisions of the laws of this State | 5 | | regarding reinsurance
as provided in Article XI of the Illinois | 6 | | Insurance Code. All reinsurance
agreements must be filed. | 7 | | Approval of the Director is required for all
agreements except | 8 | | the following: individual stop loss, aggregate excess,
| 9 | | hospitalization benefits or out-of-area of the participating | 10 | | providers
unless 20% or more of the organization's total risk | 11 | | is reinsured, in which
case all reinsurance agreements require | 12 | | approval. | 13 | | (d) Rate increases for all individual and small group | 14 | | health care plans subject to the standards of 45 CFR Part 154 | 15 | | must be filed with the Department for approval. Unreasonable | 16 | | rate increases in relation to benefits under the policy | 17 | | provided shall be disapproved. The Department shall provide a | 18 | | report to the General Assembly on or after January 1, 2021, | 19 | | regarding both on and off exchange individual and small group | 20 | | rates in the Illinois market.
| 21 | | (e) In all cases the Director shall approve or disapprove a | 22 | | rate filing under subsection (d) within 60 calendar days of | 23 | | submission unless the Director extends, by not more than an | 24 | | additional 30 days, the period within which he or she shall | 25 | | approve or disapprove any such filing by giving written notice | 26 | | to the insurer of such extension before expiration of the |
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| 1 | | initial 60-day period. Rates not approved or disapproved by the | 2 | | applicable deadline shall be deemed approved on the following | 3 | | calendar day. | 4 | | (f) No less than 30 days after the federal Centers for | 5 | | Medicare and Medicaid Services has certified the health care | 6 | | plans described in subsection (d) for the upcoming plan year, | 7 | | the Department shall publish on its website a report explaining | 8 | | the rates for that plan year's certified health care plans. | 9 | | (g) As used in this Section, "unreasonable rate increase" | 10 | | means a rate increase that the Director determines to be | 11 | | excessive, unjustified, or unfairly discriminatory in | 12 | | accordance with 45 CFR 154.205. | 13 | | (Source: P.A. 86-620.)".
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