Sen. Laura Fine

Filed: 5/17/2019

 

 


 

 


 
10100HB0471sam001LRB101 03392 SMS 60844 a

1
AMENDMENT TO HOUSE BILL 471

2    AMENDMENT NO. ______. Amend House Bill 471 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Insurance Code is amended by
5changing Section 355 as follows:
 
6    (215 ILCS 5/355)  (from Ch. 73, par. 967)
7    Sec. 355. Accident and health policies; provisions.
8policies-Provisions.)
9    (a) As used in this Section, "unreasonable rate increase"
10means a rate increase that the Director determines to be
11excessive, unjustified, or unfairly discriminatory in
12accordance with 45 CFR 154.205.
13    (b) No policy of insurance against loss or damage from the
14sickness, or from the bodily injury or death of the insured by
15accident shall be issued or delivered to any person in this
16State until a copy of the form thereof and of the

 

 

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1classification of risks and the premium rates pertaining
2thereto have been filed with the Director; nor shall it be so
3issued or delivered until the Director shall have approved such
4policy pursuant to the provisions of Section 143. If the
5Director disapproves the policy form he shall make a written
6decision stating the respects in which such form does not
7comply with the requirements of law and shall deliver a copy
8thereof to the company and it shall be unlawful thereafter for
9any such company to issue any policy in such form.
10    (c) Rate increases for all individual and small group
11accident and health insurance policies subject to the standards
12of 45 CFR Part 154 must be filed with the Department for
13approval. Unreasonable rate increases shall be disapproved.
14The Department shall provide a report to the General Assembly
15on or after January 1, 2021, regarding both on and off exchange
16individual and small group rates in the Illinois market.
17    (d) In all cases the Director shall approve or disapprove a
18rate filing under subsection (c) within 60 calendar days of
19submission unless the Director extends, by not more than an
20additional 30 days, the period within which he or she shall
21approve or disapprove any such filing by giving written notice
22to the insurer of such extension before expiration of the
23initial 60-day period. Rates not approved or disapproved by the
24applicable deadline shall be deemed approved on the following
25calendar day.
26    (e) No less than 30 days after the federal Centers for

 

 

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1Medicare and Medicaid Services has certified the policies
2described in subsection (c) for the upcoming plan year, the
3Department shall publish on its website a report explaining the
4rates for that plan year's certified policies.
5(Source: P.A. 79-777.)
 
6    Section 10. The Health Maintenance Organization Act is
7amended by changing Section 4-12 as follows:
 
8    (215 ILCS 125/4-12)  (from Ch. 111 1/2, par. 1409.5)
9    Sec. 4-12. Changes in Rate Methodology and Benefits,
10Material Modifications. A health maintenance organization
11shall file with the Director, prior to use, a notice of any
12change in rate methodology, or benefits and of any material
13modification of any matter or document furnished pursuant to
14Section 2-1, together with such supporting documents as are
15necessary to fully explain the change or modification.
16    (a) Contract modifications described in subsections
17(c)(5), (c)(6) and (c)(7) of Section 2-1 shall include all form
18agreements between the organization and enrollees, providers,
19administrators of services and insurers of health maintenance
20organizations.
21    (b) Material transactions or series of transactions other
22than those described in subsection (a) of this Section, the
23total annual value of which exceeds the greater of $100,000 or
245% of net earned subscription revenue for the most current

 

 

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1twelve month period as determined from filed financial
2statements.
3    (c) Any agreement between the organization and an insurer
4shall be subject to the provisions of the laws of this State
5regarding reinsurance as provided in Article XI of the Illinois
6Insurance Code. All reinsurance agreements must be filed.
7Approval of the Director is required for all agreements except
8the following: individual stop loss, aggregate excess,
9hospitalization benefits or out-of-area of the participating
10providers unless 20% or more of the organization's total risk
11is reinsured, in which case all reinsurance agreements require
12approval.
13    (d) Rate increases for all individual and small group
14health care plans subject to the standards of 45 CFR Part 154
15must be filed with the Department for approval. Unreasonable
16rate increases in relation to benefits under the policy
17provided shall be disapproved. The Department shall provide a
18report to the General Assembly on or after January 1, 2021,
19regarding both on and off exchange individual and small group
20rates in the Illinois market.
21    (e) In all cases the Director shall approve or disapprove a
22rate filing under subsection (d) within 60 calendar days of
23submission unless the Director extends, by not more than an
24additional 30 days, the period within which he or she shall
25approve or disapprove any such filing by giving written notice
26to the insurer of such extension before expiration of the

 

 

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1initial 60-day period. Rates not approved or disapproved by the
2applicable deadline shall be deemed approved on the following
3calendar day.
4    (f) No less than 30 days after the federal Centers for
5Medicare and Medicaid Services has certified the health care
6plans described in subsection (d) for the upcoming plan year,
7the Department shall publish on its website a report explaining
8the rates for that plan year's certified health care plans.
9    (g) As used in this Section, "unreasonable rate increase"
10means a rate increase that the Director determines to be
11excessive, unjustified, or unfairly discriminatory in
12accordance with 45 CFR 154.205.
13(Source: P.A. 86-620.)".