SB1553 EnrolledLRB097 09436 RPM 49571 b

1    AN ACT concerning insurance.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by
5changing Section 359c as follows:
 
6    (215 ILCS 5/359c)
7    Sec. 359c. Accident and health expense reporting.
8    (a) Beginning January 1, 2011 and every 6 months
9thereafter, any carrier providing a group or individual major
10medical policy of accident or health insurance shall prepare
11and provide to the Department of Insurance a statement of the
12aggregate administrative expenses of the carrier, based on the
13premiums earned in the immediately preceding 6-month period on
14the accident or health insurance business of the carrier. The
15semi-annual statements shall be filed on or before October 1
16July 31 for the preceding 6-month period ending June 30 and on
17or before April 1 February 1 for the preceding 6-month period
18ending December 31. The statements shall itemize and separately
19detail all of the following information with respect to the
20carrier's accident or health insurance business:
21        (1) the amount of premiums earned by the carrier both
22    before and after any costs related to the carrier's
23    purchase of reinsurance coverage;

 

 

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1        (2) the total amount of claims for losses paid by the
2    carrier both before and after any reimbursement from
3    reinsurance coverage including any costs incurred related
4    to:
5            (A) disease, case, or chronic care management
6        programs;
7            (B) wellness and health education programs;
8            (C) fraud prevention;
9            (D) maintaining provider networks and provider
10        credentialing;
11            (E) health information technology for personal
12        electronic health records; and
13            (F) utilization review and utilization management;
14        (3) the amount of any losses incurred by the carrier
15    but not reported to the carrier in the current or prior
16    reporting period;
17        (4) the amount of costs incurred by the carrier for
18    State fees and federal and State taxes including:
19            (A) any high risk pool and guaranty fund
20        assessments levied on the carrier by the State; and
21            (B) any regulatory compliance costs including
22        State fees for form and rate filings, licensures,
23        market conduct exams, and financial reports;
24        (5) the amount of costs incurred by the carrier for
25    reinsurance coverage;
26        (6) the amount of costs incurred by the carrier that

 

 

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1    are related to the carrier's payment of marketing expenses
2    including commissions; and
3        (7) any other administrative expenses incurred by the
4    carrier.
5    (b) The information provided pursuant to subsection (a) of
6this Section shall be separately aggregated for the following
7lines of major medical insurance:
8        (1) individually underwritten;
9        (2) groups of 2 to 25 members;
10        (3) groups of 26 to 50 members;
11        (4) groups of 51 or more members.
12    (c) The Department shall make the submitted information
13publicly available on the Department's website or such other
14media as appropriate in a form useful for consumers.
15(Source: P.A. 96-857, eff. 1-5-10.)