Full Text of SB1618 97th General Assembly
SB1618 97TH GENERAL ASSEMBLY |
| | 97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012 SB1618 Introduced 2/9/2011, by Sen. Heather A. Steans SYNOPSIS AS INTRODUCED: |
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Amends the Illinois Insurance Code. Provides that a health insurance issuer offering group or individual health insurance coverage shall, with respect to each plan year, provide an annual rebate to each enrollee under such coverage, on a pro rata basis, if the medical loss ratio for the plan year meets specified criteria. Sets forth guidelines for calculating the medical loss ratio. Effective immediately.
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| | A BILL FOR |
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| | | SB1618 | | LRB097 09360 RPM 49495 b |
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| 1 | | AN ACT concerning insurance.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Insurance Code is amended by adding | 5 | | Section 356Z.26 as follows: | 6 | | (215 ILCS 5/356Z.26 new) | 7 | | Sec. 356Z.26. Requirement to provide value for premium | 8 | | payments. | 9 | | (a) Beginning January 1, 2011, except as provided in | 10 | | subsection (c) of this Section, a health insurance issuer | 11 | | offering group or individual health insurance coverage shall, | 12 | | with respect to each plan year, provide an annual rebate to | 13 | | each enrollee under such coverage, on a pro rata basis, if the | 14 | | medical loss ratio for the plan year is: | 15 | | (1) with respect to a health insurance issuer offering | 16 | | coverage in the large group market, less than 85% or such | 17 | | higher percentage as established by the Department; or | 18 | | (2) with respect to a health insurance issuer offering | 19 | | coverage in the small group market or in the individual | 20 | | market, less than 80% or such higher percentage as | 21 | | established by the Department. The Director may request an | 22 | | adjustment to the 80% standard in this paragraph (2) from | 23 | | the Secretary of the U.S. Department of Health and Human |
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| 1 | | Services if the Director determines that requiring | 2 | | insurers to meet the 80% standard has a likelihood of | 3 | | destabilizing the individual market and could result in | 4 | | fewer choices for consumers. | 5 | | (b) The total amount of an annual rebate required under | 6 | | this Section shall be in an amount equal to the product of the | 7 | | amount by which the percentage described in paragraph (1) or | 8 | | (2) of subsection (a) of this Section exceeds the ratio | 9 | | described in such paragraph and the total amount of premium | 10 | | revenue for such plan year. | 11 | | (c) Beginning on January 1, 2014, the determination made | 12 | | under subsection (a) of this Section for the year involved | 13 | | shall be based on the averages of the premiums expended on the | 14 | | costs described in such subsection and total premium revenue | 15 | | for each of the previous 3 years for the plan. | 16 | | (d) In determining the percentages under subsection (a) of | 17 | | this Section, the Department shall seek to ensure adequate | 18 | | participation by health insurance issuers, competition in the | 19 | | Illinois health insurance market, and value for consumers so | 20 | | that premiums are used for clinical services and quality | 21 | | improvements. | 22 | | (e) The medical loss ratio described in subsection (a) of | 23 | | this Section shall be calculated pursuant to the NAIC Patient | 24 | | Protection and Affordable Care Act Medical Loss Ratio | 25 | | Regulation as certified by the Secretary of the U.S. Department | 26 | | of Health and Human Services under subsection (c) of Section |
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| 1 | | 2718 of the federal Public Health Service Act, as amended by | 2 | | the Patient Protection and Affordable Care Act. | 3 | | (f) A health insurance issuer offering group or individual | 4 | | health insurance coverage shall provide to the Department any | 5 | | information required to be submitted to the Secretary of the | 6 | | U.S. Department of Health and Human Services under Section 2718 | 7 | | of the Public Health Service Act, as amended by the Patient | 8 | | Protection and Affordable Care Act, or under regulations | 9 | | promulgated pursuant thereto. | 10 | | (g) As used in this Section "health insurance issuer", | 11 | | "health insurance coverage", "group health insurance", and | 12 | | "individual health insurance" shall have the same meaning given | 13 | | those terms in the Illinois Health Insurance Portability and | 14 | | Accountability Act.
| 15 | | Section 99. Effective date. This Act takes effect upon | 16 | | becoming law.
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