Illinois General Assembly - Full Text of Public Act 097-0524
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Public Act 097-0524





Public Act 097-0524
SB1553 EnrolledLRB097 09436 RPM 49571 b

    AN ACT concerning insurance.
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
    Section 5. The Illinois Insurance Code is amended by
changing Section 359c as follows:
    (215 ILCS 5/359c)
    Sec. 359c. Accident and health expense reporting.
    (a) Beginning January 1, 2011 and every 6 months
thereafter, any carrier providing a group or individual major
medical policy of accident or health insurance shall prepare
and provide to the Department of Insurance a statement of the
aggregate administrative expenses of the carrier, based on the
premiums earned in the immediately preceding 6-month period on
the accident or health insurance business of the carrier. The
semi-annual statements shall be filed on or before October 1
July 31 for the preceding 6-month period ending June 30 and on
or before April 1 February 1 for the preceding 6-month period
ending December 31. The statements shall itemize and separately
detail all of the following information with respect to the
carrier's accident or health insurance business:
        (1) the amount of premiums earned by the carrier both
    before and after any costs related to the carrier's
    purchase of reinsurance coverage;
        (2) the total amount of claims for losses paid by the
    carrier both before and after any reimbursement from
    reinsurance coverage including any costs incurred related
            (A) disease, case, or chronic care management
            (B) wellness and health education programs;
            (C) fraud prevention;
            (D) maintaining provider networks and provider
            (E) health information technology for personal
        electronic health records; and
            (F) utilization review and utilization management;
        (3) the amount of any losses incurred by the carrier
    but not reported to the carrier in the current or prior
    reporting period;
        (4) the amount of costs incurred by the carrier for
    State fees and federal and State taxes including:
            (A) any high risk pool and guaranty fund
        assessments levied on the carrier by the State; and
            (B) any regulatory compliance costs including
        State fees for form and rate filings, licensures,
        market conduct exams, and financial reports;
        (5) the amount of costs incurred by the carrier for
    reinsurance coverage;
        (6) the amount of costs incurred by the carrier that
    are related to the carrier's payment of marketing expenses
    including commissions; and
        (7) any other administrative expenses incurred by the
    (b) The information provided pursuant to subsection (a) of
this Section shall be separately aggregated for the following
lines of major medical insurance:
        (1) individually underwritten;
        (2) groups of 2 to 25 members;
        (3) groups of 26 to 50 members;
        (4) groups of 51 or more members.
    (c) The Department shall make the submitted information
publicly available on the Department's website or such other
media as appropriate in a form useful for consumers.
(Source: P.A. 96-857, eff. 1-5-10.)

Effective Date: 1/1/2012