Full Text of SB1912 103rd General Assembly
SB1912sam001 103RD GENERAL ASSEMBLY | Sen. Laura Fine Filed: 3/21/2023
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| 1 | | AMENDMENT TO SENATE BILL 1912
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 1912 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Department of Insurance Law is amended by | 5 | | adding Section 1405-26 as follows: | 6 | | (20 ILCS 1405/1405-26 new) | 7 | | Sec. 1405-26. Office of the Healthcare Advocate. | 8 | | (a) The Department of Insurance shall establish the Office | 9 | | of the Healthcare Advocate within the State health benefits | 10 | | exchange established by the State of Illinois in accordance | 11 | | with Section 1311 of the federal Patient Protection and | 12 | | Affordable Care Act. The Office shall be administered by the | 13 | | Chief Health Care Advocate, who shall report to the Director. | 14 | | The Advocate shall be an individual with expertise and | 15 | | experience in the fields of health insurance and consumer | 16 | | advocacy. The Advocate may employ legal counsel, independent |
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| 1 | | actuaries, and other employees and contractors as needed to | 2 | | carry out the duties of the Office. | 3 | | (b) The Advocate shall evaluate data, in consultation with | 4 | | an actuary, to assess individual and small group health | 5 | | benefit plan rate filings, networks, and affordability; and | 6 | | represent the interests of individuals and small business | 7 | | owners in public hearings held pursuant to subsection (e) of | 8 | | Section 355 of the Illinois Insurance Code and subsection (f) | 9 | | of Section 4-12 of the Health Maintenance Organization Act. | 10 | | (c) The Advocate shall have access to the unredacted | 11 | | actuarial memos that insurers send to the Department as part | 12 | | of the rate filings. | 13 | | (d) The Advocate shall develop and recommend affordability | 14 | | standards that must be considered by the Director in any | 15 | | decision to approve, disapprove, or modify rates. These | 16 | | affordability standards include, but are not limited to, the | 17 | | following: | 18 | | (1) trends, including historical rates for existing | 19 | | products and national and regional medical and health | 20 | | insurance trends; | 21 | | (2) inflation; | 22 | | (3) price comparisons to other market rates for | 23 | | similar products; | 24 | | (4) the ability of low-income individuals to pay for | 25 | | health insurance; | 26 | | (5) the ability of small businesses to pay for health |
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| 1 | | insurance; | 2 | | (6) health insurers' efforts to control administrative | 3 | | costs; and | 4 | | (7) effective strategies implemented by health | 5 | | insurers to increase affordability, including payment | 6 | | reform across the delivery system. | 7 | | (e) In the performance of the Advocate's duties, the | 8 | | Advocate shall act independently of the Department. Any | 9 | | recommendations made or positions taken by the Advocate do not | 10 | | reflect those of the Department. | 11 | | (f) The Department may adopt reasonable rules necessary to | 12 | | implement this Section. | 13 | | Section 10. The Illinois Insurance Code is amended by | 14 | | changing Section 355 as follows:
| 15 | | (215 ILCS 5/355) (from Ch. 73, par. 967)
| 16 | | Sec. 355. Accident
and health policies; provisions. | 17 | | policies-Provisions.)
| 18 | | (a) As used in this Section: | 19 | | "Inadequate rate" means a rate: | 20 | | (1) that is insufficient to sustain projected losses | 21 | | and expenses to which the rate applies; and | 22 | | (2) the continued use of which endangers the solvency | 23 | | of an insurer using that rate. | 24 | | "Plain language" shall have the same meaning as "plain |
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| 1 | | writing" as used in the federal Plain Writing Act of 2010, and | 2 | | subsequent guidance documents, including the Federal Plain | 3 | | Language Guidelines. | 4 | | "Unreasonable rate increase" means a rate increase that | 5 | | the Director determines to be excessive, unjustified, or | 6 | | unfairly discriminatory in accordance with 45 CFR 154.205. | 7 | | (b) No policy of insurance against loss or damage from the | 8 | | sickness, or from
the bodily injury or death of the insured by | 9 | | accident shall be issued or
delivered to any person in this | 10 | | State until a copy of the form thereof and
of the | 11 | | classification of risks and the premium rates pertaining | 12 | | thereto
have been filed with the Director; nor shall it be so | 13 | | issued or delivered
until the Director shall have approved | 14 | | such policy pursuant to the provisions
of Section 143. If the | 15 | | Director
disapproves the policy form he shall make a written | 16 | | decision stating the
respects in which such form does not | 17 | | comply with the requirements of law
and shall deliver a copy | 18 | | thereof to the company and it shall be unlawful
thereafter for | 19 | | any such company to issue any policy in such form. | 20 | | (c) Beginning for plan year 2026, rate increases for all | 21 | | individual and small group accident and health insurance | 22 | | policies subject to the standards of 45 CFR Part 154 must be | 23 | | filed with the Department for approval. Unreasonable rate | 24 | | increases or inadequate rates shall be modified or | 25 | | disapproved.
| 26 | | (d) Beginning for plan year 2025, when an insurer files a |
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| 1 | | schedule or table of premium rates for individual or small | 2 | | group health benefit plans, the insurer shall post notice of | 3 | | the rate filing and a filing summary in plain language on the | 4 | | insurer's website. The Department shall post all insurers' | 5 | | rate filings and summaries on the Department's website. All | 6 | | summaries shall include a brief justification of any rate | 7 | | increase or decrease requested, including the number of | 8 | | individual members, the medical loss ratio, medical trend, | 9 | | administrative costs, and any other information requested by | 10 | | the Director. The plain language summary shall include | 11 | | notification of the public comment period established in | 12 | | subsection (e). | 13 | | (e) The Department shall open a 30-day public comment | 14 | | period on the rate filings beginning on the date that all of | 15 | | the rate filings are posted on the website. The Department | 16 | | shall post all of the comments received to the Department's | 17 | | website within 5 business days after the comment period ends. | 18 | | (f) The Department shall hold a public hearing within 10 | 19 | | days after the public comments are posted on the Department's | 20 | | website. All insurers and health maintenance organizations | 21 | | selling plans in the individual and small group markets shall | 22 | | appear at the public hearing to explain their rate filings and | 23 | | justifications. | 24 | | (g) After the close of the public comment period described | 25 | | in subsection (e), the Department shall issue a decision to | 26 | | approve, disapprove, or modify a rate filing. The Department |
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| 1 | | shall notify the insurer of the decision, make the decision | 2 | | available to the public by posting it on the Department's | 3 | | website, and include an explanation of the findings and | 4 | | rationale that are the basis for the decision. | 5 | | (h) If, following the issuance of a decision but before | 6 | | the effective date of the premium rates approved by the | 7 | | decision, an event occurs that materially affects the | 8 | | Director's decision to approve, deny, or modify the rates, the | 9 | | Director may consider supplemental facts or data reasonably | 10 | | related to the event. | 11 | | (i) The Department shall adopt rules implementing the | 12 | | procedures described in subsections (d) through (h). | 13 | | (Source: P.A. 79-777.)
| 14 | | Section 15. The Health Maintenance Organization Act is | 15 | | amended by changing Section 4-12 as follows:
| 16 | | (215 ILCS 125/4-12) (from Ch. 111 1/2, par. 1409.5)
| 17 | | Sec. 4-12. Changes in Rate Methodology and Benefits, | 18 | | Material
Modifications. A health maintenance organization | 19 | | shall file with the
Director, prior to use, a notice of any | 20 | | change in rate methodology, or
benefits and of any material | 21 | | modification of any matter or document
furnished pursuant to | 22 | | Section 2-1, together with such supporting documents
as are | 23 | | necessary to fully explain the change or modification.
| 24 | | (a) Contract modifications described in subsections |
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| 1 | | (c)(5), (c)(6) and
(c)(7) of Section 2-1 shall include all | 2 | | form agreements between the
organization and enrollees, | 3 | | providers, administrators of services and
insurers of health | 4 | | maintenance organizations.
| 5 | | (b) Material transactions or series of transactions other | 6 | | than those
described in subsection (a) of this Section, the | 7 | | total annual value of
which exceeds the greater of $100,000 or | 8 | | 5% of net earned subscription
revenue for the most current | 9 | | twelve month period as determined from filed
financial | 10 | | statements.
| 11 | | (c) Any agreement between the organization and an insurer | 12 | | shall be
subject to the provisions of the laws of this State | 13 | | regarding reinsurance
as provided in Article XI of the | 14 | | Illinois Insurance Code. All reinsurance
agreements must be | 15 | | filed. Approval of the Director is required for all
agreements | 16 | | except the following: individual stop loss, aggregate excess,
| 17 | | hospitalization benefits or out-of-area of the participating | 18 | | providers
unless 20% or more of the organization's total risk | 19 | | is reinsured, in which
case all reinsurance agreements require | 20 | | approval. | 21 | | (d) Beginning for plan year 2026, rate increases for all | 22 | | individual and small group accident and health insurance | 23 | | policies subject to the standards of 45 CFR Part 154 must be | 24 | | filed with the Department for approval. Unreasonable rate | 25 | | increases in relation to benefits under the policy provided or | 26 | | inadequate rates shall be modified or disapproved.
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| 1 | | (e) Beginning for plan year 2025, when a health | 2 | | maintenance organization files a schedule or table of premium | 3 | | rates for individual or small group health benefit plans, the | 4 | | health maintenance organization shall post notice of the rate | 5 | | filing and a filing summary in plain language on the | 6 | | organization's website. The Department shall post all | 7 | | insurers' rate filings and summaries on the Department's | 8 | | website. All summaries shall include a brief justification of | 9 | | any rate increase or decrease requested, including the number | 10 | | of individual members, the medical loss ratio, medical trend, | 11 | | administrative costs, and any other information requested by | 12 | | the Director. The plain language summary shall include | 13 | | notification of the public comment period established in | 14 | | subsection (f). | 15 | | (f) The Department shall open a 30-day public comment | 16 | | period on the rate filings beginning on the date that all of | 17 | | the rate filings are posted on the website. The Department | 18 | | shall post all of the comments received to the Department's | 19 | | website within 5 business days after the comment period ends. | 20 | | (g) The Department shall hold a public hearing within 10 | 21 | | days after the public comments are posted on the Department's | 22 | | website. All insurers and health maintenance organizations | 23 | | selling plans in the individual and small group markets shall | 24 | | appear at the public hearing to explain their rate filings and | 25 | | justifications. | 26 | | (h) After the close of the public comment period described |
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| 1 | | in subsection (f), the Department shall issue a decision to | 2 | | approve, disapprove, or modify a rate filing. The Department | 3 | | shall notify the health maintenance organization of the | 4 | | decision, make the decision available to the public by posting | 5 | | it on the Department's website, and include an explanation of | 6 | | the findings and rationale that are the basis for the | 7 | | decision. | 8 | | (i) If, following the issuance of a decision but before | 9 | | the effective date of the premium rates approved by the | 10 | | decision, an event occurs that materially affects the | 11 | | Director's decision to approve, deny, or modify the rates, the | 12 | | Director may consider supplemental facts or data reasonably | 13 | | related to the event. | 14 | | (j) The Department shall adopt rules implementing the | 15 | | procedures described in subsections (e) through (i). | 16 | | (k) As used in this Section: | 17 | | "Inadequate rate" means a rate: | 18 | | (1) that is insufficient to sustain projected losses | 19 | | and expenses to which the rate applies; and | 20 | | (2) the continued use of which endangers the solvency | 21 | | of an insurer using that rate. | 22 | | "Plain language" shall have the same meaning as "plain | 23 | | writing" as used in the federal Plain Writing Act of 2010, and | 24 | | subsequent guidance documents, including the Federal Plain | 25 | | Language Guidelines. | 26 | | "Unreasonable rate increase" means a rate increase that |
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| 1 | | the Director determines to be excessive, unjustified, or | 2 | | unfairly discriminatory in accordance with 45 CFR 154.205. | 3 | | (Source: P.A. 86-620.)".
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