Rep. JoAnn D. Osmond

Filed: 5/2/2011

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 1553

2    AMENDMENT NO. ______. Amend Senate Bill 1553 by replacing
3everything after the enacting clause with the following:
 
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

 

 

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1or before April 1 February 1 for the preceding 6-month period
2ending December 31. The statements shall itemize and separately
3detail all of the following information with respect to the
4carrier's accident or health insurance business:
5        (1) the amount of premiums earned by the carrier both
6    before and after any costs related to the carrier's
7    purchase of reinsurance coverage;
8        (2) the total amount of claims for losses paid by the
9    carrier both before and after any reimbursement from
10    reinsurance coverage including any costs incurred related
11    to:
12            (A) disease, case, or chronic care management
13        programs;
14            (B) wellness and health education programs;
15            (C) fraud prevention;
16            (D) maintaining provider networks and provider
17        credentialing;
18            (E) health information technology for personal
19        electronic health records; and
20            (F) utilization review and utilization management;
21        (3) the amount of any losses incurred by the carrier
22    but not reported to the carrier in the current or prior
23    reporting period;
24        (4) the amount of costs incurred by the carrier for
25    State fees and federal and State taxes including:
26            (A) any high risk pool and guaranty fund

 

 

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1        assessments levied on the carrier by the State; and
2            (B) any regulatory compliance costs including
3        State fees for form and rate filings, licensures,
4        market conduct exams, and financial reports;
5        (5) the amount of costs incurred by the carrier for
6    reinsurance coverage;
7        (6) the amount of costs incurred by the carrier that
8    are related to the carrier's payment of marketing expenses
9    including commissions; and
10        (7) any other administrative expenses incurred by the
11    carrier.
12    (b) The information provided pursuant to subsection (a) of
13this Section shall be separately aggregated for the following
14lines of major medical insurance:
15        (1) individually underwritten;
16        (2) groups of 2 to 25 members;
17        (3) groups of 26 to 50 members;
18        (4) groups of 51 or more members.
19    (c) The Department shall make the submitted information
20publicly available on the Department's website or such other
21media as appropriate in a form useful for consumers.
22(Source: P.A. 96-857, eff. 1-5-10.)".