Full Text of SB0665 101st General Assembly
SB0665sam001 101ST GENERAL ASSEMBLY | 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 | 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: | 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 | 16 | | Director determines to be excessive, unjustified, or unfairly |
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| 1 | | discriminatory in accordance with 45 CFR 154.205. | 2 | | (b) No policy of insurance against loss or damage from the | 3 | | sickness, or from
the bodily injury or death of the insured by | 4 | | accident shall be issued or
delivered to any person in this | 5 | | State until a copy of the form thereof and
of the | 6 | | classification of risks and the premium rates pertaining | 7 | | thereto
have been filed with the Director; nor shall it be so | 8 | | issued or delivered
until the Director shall have approved such | 9 | | policy pursuant to the provisions
of Section 143. If the | 10 | | Director
disapproves the policy form he shall make a written | 11 | | decision stating the
respects in which such form does not | 12 | | comply with the requirements of law
and shall deliver a copy | 13 | | thereof to the company and it shall be unlawful
thereafter for | 14 | | any such company to issue any policy in such form. | 15 | | (c) Rate increases for all individual and small group | 16 | | accident and health insurance policies subject to the standards | 17 | | of 45 CFR Part 154 must be filed with the Department for | 18 | | approval. Unreasonable rate increases or inadequate rates | 19 | | shall be disapproved. The Department shall provide a report to | 20 | | the General Assembly on or after January 1, 2021 regarding both | 21 | | on and off exchange individual and small group rates in the | 22 | | Illinois market.
| 23 | | (d) In all cases the Director shall approve or disapprove a | 24 | | rate filing under subsection (c) within 45 calendar days of | 25 | | submission unless the Director extends, by not more than an | 26 | | additional 30 days, the period within which he or she shall |
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| 1 | | approve or disapprove any such filing by giving written notice | 2 | | to the insurer of such extension before expiration of the | 3 | | initial 45-day period. Rates not approved or disapproved by the | 4 | | applicable deadline shall be deemed approved on the following | 5 | | calendar day. | 6 | | (e) No less than 30 days after the federal Centers for | 7 | | Medicare and Medicaid Services has certified the policies | 8 | | described in subsection (c) for the upcoming plan year, the | 9 | | Department shall publish on its website a report explaining the | 10 | | rates for that plan year's certified policies. | 11 | | (Source: P.A. 79-777.)
| 12 | | Section 10. The Health Maintenance Organization Act is | 13 | | amended 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, | 16 | | Material
Modifications. A health maintenance organization | 17 | | shall file with the
Director, prior to use, a notice of any | 18 | | change in rate methodology, or
benefits and of any material | 19 | | modification of any matter or document
furnished pursuant to | 20 | | Section 2-1, together with such supporting documents
as are | 21 | | necessary 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 | 24 | | agreements between the
organization and enrollees, providers, |
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| 1 | | administrators of services and
insurers of health maintenance | 2 | | organizations.
| 3 | | (b) Material transactions or series of transactions other | 4 | | than those
described in subsection (a) of this Section, the | 5 | | total annual value of
which exceeds the greater of $100,000 or | 6 | | 5% of net earned subscription
revenue for the most current | 7 | | twelve month period as determined from filed
financial | 8 | | statements.
| 9 | | (c) Any agreement between the organization and an insurer | 10 | | shall be
subject to the provisions of the laws of this State | 11 | | regarding reinsurance
as provided in Article XI of the Illinois | 12 | | Insurance Code. All reinsurance
agreements must be filed. | 13 | | Approval of the Director is required for all
agreements except | 14 | | the following: individual stop loss, aggregate excess,
| 15 | | hospitalization benefits or out-of-area of the participating | 16 | | providers
unless 20% or more of the organization's total risk | 17 | | is reinsured, in which
case all reinsurance agreements require | 18 | | approval. | 19 | | (d) Rate increases for all individual and small group | 20 | | health care plans subject to the standards of 45 CFR Part 154 | 21 | | must be filed with the Department for approval. Unreasonable | 22 | | rate increases in relation to benefits under the policy | 23 | | provided or inadequate rates shall be disapproved. The | 24 | | Department shall provide a report to the General Assembly on or | 25 | | after January 1, 2021 regarding both on and off exchange | 26 | | individual and small group rates in the Illinois market.
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| 1 | | (e) In all cases the Director shall approve or disapprove a | 2 | | rate filing under subsection (d) within 45 calendar days of | 3 | | submission unless the Director extends, by not more than an | 4 | | additional 30 days, the period within which he or she shall | 5 | | approve or disapprove any such filing by giving written notice | 6 | | to the insurer of such extension before expiration of the | 7 | | initial 45-day period. Rates not approved or disapproved by the | 8 | | applicable deadline shall be deemed approved on the following | 9 | | calendar day. | 10 | | (f) No less than 30 days after the federal Centers for | 11 | | Medicare and Medicaid Services has certified the health care | 12 | | plans described in subsection (d) for the upcoming plan year, | 13 | | the Department shall publish on its website a report explaining | 14 | | the 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 | 22 | | Director determines to be excessive, unjustified, or unfairly | 23 | | discriminatory in accordance with 45 CFR 154.205. | 24 | | (Source: P.A. 86-620.)".
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