Full Text of HB5582 100th General Assembly
HB5582 100TH GENERAL ASSEMBLY |
| | 100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018 HB5582 Introduced , by Rep. Norine K. Hammond SYNOPSIS AS INTRODUCED: |
| 215 ILCS 5/131.22 | from Ch. 73, par. 743.22 | 215 ILCS 5/353a | from Ch. 73, par. 965a | 215 ILCS 5/404 | from Ch. 73, par. 1016 | 215 ILCS 5/141.2 rep. | | 215 ILCS 5/155.25 rep. | | 215 ILCS 5/233 rep. | | 215 ILCS 5/Art. XIX rep. | | 215 ILCS 125/1-2 | from Ch. 111 1/2, par. 1402 |
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Amends the Illinois Insurance Code. In provisions concerning confidential treatment, provides that specified information shall remain confidential and privileged with the exception of information submitted pursuant to provisions concerning acquisition of control or merger with domestic companies that is not personal financial information. In provisions concerning accident and health reserves, removes language requiring the Director of Insurance from time to time to adopt rules requiring the use of appropriate tables of morbidity, mortality, interest rates, and valuation methods for such reserves. Provides that the Director may to enter into written agreements to share confidential insurer records or information with the International Association of Insurance Supervisors. Repeals provisions concerning grounds for disapproval of a management contract or service agreement, reports by certain property and casualty insurers, participating and non-participating policies, and burial societies. Amends the Health Maintenance Organization Act. Changes the definition of "organization" to mean any domestic insurance company (rather than any insurance company). Effective immediately.
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| | A BILL FOR |
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| 1 | | AN ACT concerning regulation.
| 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 | 5 | | changing Sections 131.22, 125.1a, 125.2a, 353a, and 404 as | 6 | | follows:
| 7 | | (215 ILCS 5/131.22) (from Ch. 73, par. 743.22)
| 8 | | Sec. 131.22. Confidential treatment. | 9 | | (a) Documents, materials, or other information in the | 10 | | possession or control of the Department that are obtained by or | 11 | | disclosed to the Director or any other person in the course of | 12 | | an examination or investigation made pursuant to this Article | 13 | | and all information reported pursuant to this Article , with the | 14 | | exception of information submitted pursuant to Sections 131.5 | 15 | | through 131.10 that is not personal financial information, | 16 | | shall be confidential by law and privileged, shall not be | 17 | | subject to the Illinois Freedom of Information Act, shall not | 18 | | be subject to subpoena, and shall not be subject to discovery | 19 | | or admissible in evidence in any private civil action. However, | 20 | | the Director is authorized to use the documents, materials, or | 21 | | other information in the furtherance of any regulatory or legal | 22 | | action brought as a part of the Director's official duties. The | 23 | | Director shall not otherwise make the documents, materials, or |
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| 1 | | other information public without the prior written consent of | 2 | | the company to which it pertains unless the Director, after | 3 | | giving the company and its affiliates who would be affected | 4 | | thereby prior written notice and an opportunity to be heard, | 5 | | determines that the interest of policyholders, shareholders, | 6 | | or the public shall be served by the publication thereof, in | 7 | | which event the Director may publish all or any part in such | 8 | | manner as may be deemed appropriate. | 9 | | (b) Neither the Director nor any person who received | 10 | | documents, materials, or other information while acting under | 11 | | the authority of the Director or with whom such documents, | 12 | | materials, or other information are shared pursuant to this | 13 | | Article shall be permitted or required to testify in any | 14 | | private civil action concerning any confidential documents, | 15 | | materials, or information subject to subsection (a) of this | 16 | | Section. | 17 | | (c) In order to assist in the performance of the Director's | 18 | | duties, the Director: | 19 | | (1) may share documents, materials, or other | 20 | | information, including the confidential and privileged | 21 | | documents, materials, or information subject to subsection | 22 | | (a) of this Section, with other state, federal, and | 23 | | international regulatory agencies, with the NAIC and its | 24 | | affiliates and subsidiaries, and with state, federal, and | 25 | | international law enforcement authorities, including | 26 | | members of any supervisory college allowed by this Article, |
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| 1 | | provided that the recipient agrees in writing to maintain | 2 | | the confidentiality and privileged status of the document, | 3 | | material, or other information, and has verified in writing | 4 | | the legal authority to maintain confidentiality; | 5 | | (1.5) notwithstanding paragraph (1) of this subsection | 6 | | (c), may only share confidential and privileged documents, | 7 | | material, or information reported pursuant to Section | 8 | | 131.14b with commissioners of states having statutes or | 9 | | regulations substantially similar to subsection (a) of | 10 | | this Section and who have agreed in writing not to disclose | 11 | | such information; | 12 | | (2) may receive documents, materials, or information, | 13 | | including otherwise confidential and privileged documents, | 14 | | materials, or information from the NAIC and its affiliates | 15 | | and subsidiaries and from regulatory and law enforcement | 16 | | officials of other foreign or domestic jurisdictions, and | 17 | | shall maintain as confidential or privileged any document, | 18 | | material, or information received with notice or the | 19 | | understanding that it is confidential or privileged under | 20 | | the laws of the jurisdiction that is the source of the | 21 | | document, material, or information; any such documents,
| 22 | | materials, or information, while in the Director's | 23 | | possession, shall not be subject to the
Illinois Freedom of | 24 | | Information Act and shall not be subject to subpoena; and | 25 | | (3) shall enter into written agreements with the NAIC | 26 | | governing sharing and use of information provided pursuant |
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| 1 | | to this Article consistent with this subsection (c) that | 2 | | shall
(i)
specify procedures and protocols regarding the | 3 | | confidentiality and security of information shared with | 4 | | the NAIC and its affiliates and subsidiaries pursuant to | 5 | | this Article, including procedures and protocols for | 6 | | sharing by the NAIC with other state, federal, or | 7 | | international regulators;
(ii)
specify that ownership of | 8 | | information shared with the NAIC and its affiliates and | 9 | | subsidiaries pursuant to this Article remains with the | 10 | | Director and the NAIC's use of the information is subject | 11 | | to the direction of the Director;
(iii)
require prompt | 12 | | notice to be given to a company whose confidential | 13 | | information in the possession of the NAIC pursuant to this | 14 | | Article is subject to a request or subpoena to the NAIC for | 15 | | disclosure or production; and
(iv)
require the NAIC and its | 16 | | affiliates and subsidiaries to consent to intervention by a | 17 | | company in any judicial or administrative action in which | 18 | | the NAIC and its affiliates and subsidiaries may be | 19 | | required to disclose confidential information about the | 20 | | company shared with the NAIC and its affiliates and | 21 | | subsidiaries pursuant to this Article. | 22 | | (d) The sharing of documents, materials, or information by | 23 | | the Director pursuant to this Article shall not constitute a | 24 | | delegation of regulatory authority or rulemaking, and the | 25 | | Director is solely responsible for the administration, | 26 | | execution, and enforcement of the provisions of this Article. |
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| 1 | | (e) No waiver of any applicable privilege or claim of | 2 | | confidentiality in the documents, materials, or information | 3 | | shall occur as a result of disclosure to the Director under | 4 | | this Section or as a result of sharing as authorized in | 5 | | subsection (c) of this Section. | 6 | | (f) Documents, materials, or other information in the | 7 | | possession or control of the NAIC pursuant to this Article | 8 | | shall be confidential by law and privileged, shall not be | 9 | | subject to the Illinois Freedom of Information Act, shall not | 10 | | be subject to subpoena, and shall not be subject to discovery | 11 | | or admissible in evidence in any private civil action.
| 12 | | (Source: P.A. 98-609, eff. 1-1-14.)
| 13 | | (215 ILCS 5/353a) (from Ch. 73, par. 965a)
| 14 | | Sec. 353a. Accident
and health reserves. The reserves for | 15 | | all accident and health policies issued after the
operative | 16 | | date of this section shall be computed and maintained on a | 17 | | basis
which shall place an actuarially sound value on the | 18 | | liabilities under such
policies. To provide a basis for the | 19 | | determination of such actuarially
sound value, the Director | 20 | | from time to time shall adopt rules requiring the
use of | 21 | | appropriate tables of morbidity, mortality, interest rates and
| 22 | | valuation methods for such reserves. In no event shall such | 23 | | reserves be
less than the pro rata gross unearned premium | 24 | | reserve for such policies.
| 25 | | The company shall give the notice required in section 234 |
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| 1 | | on all
non-cancellable accident and health policies.
| 2 | | After this section becomes effective, any company may file | 3 | | with the
Director written notice of its election to comply with | 4 | | the provisions of
this section after a specified date before | 5 | | January 1, 1967. After the
filing of such notice, then upon | 6 | | such specified date (which shall be the
operative date of this | 7 | | section for such company), this section shall become
operative | 8 | | with respect to the accident and health policies thereafter
| 9 | | issued by such company. If a company makes no such election, | 10 | | the operative
date of this section for such company shall be | 11 | | January 1, 1967.
| 12 | | After this section becomes effective, any company may file | 13 | | with the
Director written notice of its election to establish | 14 | | and maintain reserves
upon its accident and health policies | 15 | | issued prior to the operative date of
this section in | 16 | | accordance with the standards for reserves established by
this | 17 | | section, and thereafter the reserve standards prescribed | 18 | | pursuant to
this section shall be effective with respect to | 19 | | said accident and health
policies issued prior to the operative | 20 | | date of this section.
| 21 | | (Source: Laws 1965, p. 740.)
| 22 | | (215 ILCS 5/404) (from Ch. 73, par. 1016)
| 23 | | Sec. 404. Office of Director; a public office; destruction | 24 | | or
disposal of records, papers, documents, and memoranda. | 25 | | (1)(a) The office of the Director shall be a public office |
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| 1 | | and the
records,
books, and papers thereof on file
therein, | 2 | | except those records
or documents containing or disclosing any | 3 | | analysis, opinion, calculation,
ratio, recommendation, advice, | 4 | | viewpoint, or estimation by any Department staff
regarding the | 5 | | financial or market condition of an insurer not otherwise made
| 6 | | part of the public record by the Director,
shall be accessible | 7 | | to the
inspection of the public, except as the Director, for | 8 | | good reason, may
decide otherwise, or except as may be | 9 | | otherwise provided in this Code or as otherwise provided in | 10 | | Section 7 of the Freedom of Information Act.
| 11 | | (b) Except where another provision of this Code expressly | 12 | | prohibits a
disclosure of confidential information to the | 13 | | specific officials or
organizations described in this | 14 | | subsection, the Director may disclose or share
any confidential | 15 | | records or information in his custody and control with any
| 16 | | insurance regulatory officials of any state or country, with | 17 | | the law
enforcement officials of this State, any other state, | 18 | | or the federal
government, or with the National Association of | 19 | | Insurance Commissioners, upon
the written agreement of the | 20 | | official or organization receiving the information
to hold the | 21 | | information or records confidential and in a manner consistent | 22 | | with
this Code.
| 23 | | (c) The Director shall maintain as confidential any records | 24 | | or
information received from the National Association of | 25 | | Insurance Commissioners
or insurance regulatory officials of | 26 | | other states which is confidential in that
other jurisdiction.
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| 1 | | (2) Upon the filing of the examination to which they | 2 | | relate, the Director
is authorized to destroy or otherwise | 3 | | dispose of all working papers relative
to any company which has | 4 | | been examined at any time prior to that last
examination by the | 5 | | Department, so that in such circumstances only current
working | 6 | | papers of that last examination may be retained by the | 7 | | Department.
| 8 | | (3) Five years after the conclusion of the transactions to
| 9 | | which they relate, the Director is authorized to destroy or | 10 | | otherwise
dispose of all books, records, papers, memoranda and | 11 | | correspondence
directly related to consumer complaints or | 12 | | inquiries.
| 13 | | (4) Two years after the conclusion of the transactions to | 14 | | which they
relate, the Director is authorized to destroy or | 15 | | otherwise dispose of all
books, records, papers, memoranda, and | 16 | | correspondence directly related to
all void, obsolete, or | 17 | | superseded rate filings and schedules required to be
filed by | 18 | | statute; and all individual company rating experience data and | 19 | | all
records, papers, documents and memoranda in the possession | 20 | | of the Director
relating thereto.
| 21 | | (5) Five years after the conclusion of the transactions to | 22 | | which
they relate, the Director is authorized to destroy or | 23 | | otherwise dispose
of all examination reports of companies made | 24 | | by the insurance supervisory
officials of states other than | 25 | | Illinois; applications, requisitions, and
requests for | 26 | | licenses; all records of hearings; and all similar records,
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| 1 | | papers, documents, and memoranda in the possession of the | 2 | | Director.
| 3 | | (6) Ten years after the conclusion of the transactions to | 4 | | which they
relate, the Director is authorized to destroy or | 5 | | otherwise dispose of all
official correspondence of foreign and | 6 | | alien companies, all foreign
companies' and alien companies' | 7 | | annual statements, valuation reports, tax
reports, and all | 8 | | similar records, papers, documents and memoranda in the
| 9 | | possession of the Director.
| 10 | | (7) Whenever any records, papers, documents or memoranda | 11 | | are
destroyed or otherwise disposed of pursuant to the | 12 | | provisions of this
section, the Director shall execute and file | 13 | | in a separate, permanent
office file a certificate listing and | 14 | | setting forth by summary
description the records, papers, | 15 | | documents or memoranda so destroyed or
otherwise disposed of, | 16 | | and the Director may, in his discretion, preserve
copies of any | 17 | | such records, papers, documents or memoranda by means of
| 18 | | microfilming or photographing the same.
| 19 | | (8) This Section shall apply to records, papers, documents, | 20 | | and
memoranda presently in the possession of the Director as | 21 | | well as to
records, papers, documents, and memoranda hereafter | 22 | | coming into his
possession.
| 23 | | (9) The Director may enter into written agreements to share | 24 | | confidential insurer records or information with the | 25 | | International Association of Insurance Supervisors. | 26 | | (Source: P.A. 97-1004, eff. 8-17-12.)
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| 1 | | (215 ILCS 5/141.2 rep.)
| 2 | | (215 ILCS 5/155.25 rep.)
| 3 | | (215 ILCS 5/233 rep.)
| 4 | | (215 ILCS 5/Art. XIX rep.) | 5 | | Section 10. The Illinois Insurance Code is amended by | 6 | | repealing Sections 141.2, 155.25, and 233 and Article XIX. | 7 | | Section 15. The Health Maintenance Organization Act is | 8 | | amended by changing Section 1-2 as follows:
| 9 | | (215 ILCS 125/1-2) (from Ch. 111 1/2, par. 1402)
| 10 | | Sec. 1-2. Definitions. As used in this Act, unless the | 11 | | context otherwise
requires, the following terms shall have the | 12 | | meanings ascribed to them:
| 13 | | (1) "Advertisement" means any printed or published | 14 | | material,
audiovisual material and descriptive literature of | 15 | | the health care plan
used in direct mail, newspapers, | 16 | | magazines, radio scripts, television
scripts, billboards and | 17 | | similar displays; and any descriptive literature or
sales aids | 18 | | of all kinds disseminated by a representative of the health | 19 | | care
plan for presentation to the public including, but not | 20 | | limited to, circulars,
leaflets, booklets, depictions, | 21 | | illustrations, form letters and prepared
sales presentations.
| 22 | | (2) "Director" means the Director of Insurance.
| 23 | | (3) "Basic health care services" means emergency care, and |
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| 1 | | inpatient
hospital and physician care, outpatient medical | 2 | | services, mental
health services and care for alcohol and drug | 3 | | abuse, including any
reasonable deductibles and co-payments, | 4 | | all of which are subject to the
limitations described in | 5 | | Section 4-20 of this Act and as determined by the Director | 6 | | pursuant to rule.
| 7 | | (4) "Enrollee" means an individual who has been enrolled in | 8 | | a health
care plan.
| 9 | | (5) "Evidence of coverage" means any certificate, | 10 | | agreement,
or contract issued to an enrollee setting out the | 11 | | coverage to which he is
entitled in exchange for a per capita | 12 | | prepaid sum.
| 13 | | (6) "Group contract" means a contract for health care | 14 | | services which
by its terms limits eligibility to members of a | 15 | | specified group.
| 16 | | (7) "Health care plan" means any arrangement whereby any | 17 | | organization
undertakes to provide or arrange for and pay for | 18 | | or reimburse the
cost of basic health care services, excluding | 19 | | any reasonable deductibles and copayments, from providers | 20 | | selected by
the Health Maintenance Organization and such | 21 | | arrangement
consists of arranging for or the provision of such | 22 | | health care services, as
distinguished from mere | 23 | | indemnification against the cost of such services,
except as | 24 | | otherwise authorized by Section 2-3 of this Act,
on a per | 25 | | capita prepaid basis, through insurance or otherwise. A "health
| 26 | | care plan" also includes any arrangement whereby an |
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| 1 | | organization undertakes to
provide or arrange for or pay for or | 2 | | reimburse the cost of any health care
service for persons who | 3 | | are enrolled under Article V of the Illinois Public Aid
Code or | 4 | | under the Children's Health Insurance Program Act through
| 5 | | providers selected by the organization and the arrangement | 6 | | consists of making
provision for the delivery of health care | 7 | | services, as distinguished from mere
indemnification. A | 8 | | "health care plan" also includes any arrangement pursuant
to | 9 | | Section 4-17. Nothing in this definition, however, affects the | 10 | | total
medical services available to persons eligible for | 11 | | medical assistance under the
Illinois Public Aid Code.
| 12 | | (8) "Health care services" means any services included in | 13 | | the furnishing
to any individual of medical or dental care, or | 14 | | the hospitalization or
incident to the furnishing of such care | 15 | | or hospitalization as well as the
furnishing to any person of | 16 | | any and all other services for the purpose of
preventing, | 17 | | alleviating, curing or healing human illness or injury.
| 18 | | (9) "Health Maintenance Organization" means any | 19 | | organization formed
under the laws of this or another state to | 20 | | provide or arrange for one or
more health care plans under a | 21 | | system which causes any part of the risk of
health care | 22 | | delivery to be borne by the organization or its providers.
| 23 | | (10) "Net worth" means admitted assets, as defined in | 24 | | Section 1-3 of
this Act, minus liabilities.
| 25 | | (11) "Organization" means any domestic insurance company, | 26 | | a nonprofit
corporation authorized under the Dental
Service |
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| 1 | | Plan Act or the Voluntary
Health Services Plans Act,
or a | 2 | | corporation organized under the laws of this or another state | 3 | | for the
purpose of operating one or more health care plans and | 4 | | doing no business other
than that of a Health Maintenance | 5 | | Organization or an insurance company.
"Organization" shall | 6 | | also mean the University of Illinois Hospital as
defined in the | 7 | | University of Illinois Hospital Act or a unit of local | 8 | | government health system operating within a county with a | 9 | | population of 3,000,000 or more.
| 10 | | (12) "Provider" means any physician, hospital facility,
| 11 | | facility licensed under the Nursing Home Care Act, or facility | 12 | | or long-term care facility as those terms are defined in the | 13 | | Nursing Home Care Act or other person which is licensed or | 14 | | otherwise authorized
to furnish health care services and also | 15 | | includes any other entity that
arranges for the delivery or | 16 | | furnishing of health care service.
| 17 | | (13) "Producer" means a person directly or indirectly | 18 | | associated with a
health care plan who engages in solicitation | 19 | | or enrollment.
| 20 | | (14) "Per capita prepaid" means a basis of prepayment by | 21 | | which a fixed
amount of money is prepaid per individual or any | 22 | | other enrollment unit to
the Health Maintenance Organization or | 23 | | for health care services which are
provided during a definite | 24 | | time period regardless of the frequency or
extent of the | 25 | | services rendered
by the Health Maintenance Organization, | 26 | | except for copayments and deductibles
and except as provided in |
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| 1 | | subsection (f) of Section 5-3 of this Act.
| 2 | | (15) "Subscriber" means a person who has entered into a | 3 | | contractual
relationship with the Health Maintenance | 4 | | Organization for the provision of
or arrangement of at least | 5 | | basic health care services to the beneficiaries
of such | 6 | | contract.
| 7 | | (Source: P.A. 98-651, eff. 6-16-14; 98-841, eff. 8-1-14; 99-78, | 8 | | eff. 7-20-15.)
| 9 | | Section 99. Effective date. This Act takes effect upon | 10 | | becoming law.
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