98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
SB2344

 

Introduced 2/15/2013, by Sen. Heather A. Steans

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/355  from Ch. 73, par. 967
215 ILCS 5/355.01 new
215 ILCS 5/367  from Ch. 73, par. 979
215 ILCS 125/2-11.1 new
215 ILCS 125/5-3  from Ch. 111 1/2, par. 1411.2

    Amends the Illinois Insurance Code. Sets forth provisions concerning the filing of premium rates with respect to health insurance coverage offered by a health insurance issuer and premium rate changes. Provides that in addition to filing premium rates, a company shall notify the Director of Insurance whenever a policy form has been closed for sale. Sets forth provisions concerning health insurance premium rates and prior approval of the Director. Contains provisions concerning appeal and requests for actuarial reasoning and data. Makes changes to the provision concerning group accident and health insurance. Amends the Health Maintenance Organization Act. Sets forth provisions concerning premium rates and filing and prior approval. Requires that the schedule of base rates for a group or individual contract or evidence of coverage to be used in conjunction with the contract or evidence of coverage be filed with the Director. Further amends the Act to comport with the provisions of the Illinois Insurance Code concerning health insurance premium rates and prior approval. Effective on January 1, 2014.


LRB098 09547 RPM 39691 b

 

 

A BILL FOR

 

SB2344LRB098 09547 RPM 39691 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 1. This Act may be cited as the Health Insurance
5Rate Fairness and Affordability Act.
 
6    Section 5. The Illinois Insurance Code is amended by
7changing Sections 355 and 367 and by adding Section 355.01 as
8follows:
 
9    (215 ILCS 5/355)  (from Ch. 73, par. 967)
10    Sec. 355. Accident and health policies-Provisions.)
11    (a) No individual or group policy of insurance against loss
12or damage from the sickness, or from the bodily injury or death
13of the insured by accident shall be issued or delivered to any
14person in this State until a copy of the form thereof and of
15the classification of risks and the premium rates pertaining
16thereto have been filed with the Director; nor shall it be so
17issued or delivered until the Director shall have approved such
18policy pursuant to the provisions of Section 143. If the
19Director disapproves the policy form he shall make a written
20decision stating the respects in which such form does not
21comply with the requirements of law and shall deliver a copy
22thereof to the company and it shall be unlawful thereafter for

 

 

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1any such company to issue any policy in such form.
2    (b) With respect to health insurance coverage offered by a
3health insurance issuer, a filing of premium rates pursuant to
4subsection (a) of this Section shall not be complete unless it
5contains all information necessary to justify the premium rate
6and such other information as the Director may require to
7determine the rate's compliance with Section 355.01 of this
8Code. Each rate filing must also include a certification by a
9qualified actuary that to the best of the actuary's knowledge
10and judgment the rate filing is in compliance with applicable
11laws and regulations and that the benefits are reasonable in
12relation to premiums.
13    (c) With respect to premium rate changes, the filing under
14subsection (a) of this Section shall clearly indicate the
15percentage change from the previously filed rate and the
16percentage change from the rate that was in effect 12 months
17prior to the proposed effective date of such rate.
18    (d) In addition to filing premium rates, a company shall
19notify the Director whenever a policy form subject to this
20Section has been closed for sale.
21    (e) As used in this Section, the terms "health insurance
22coverage" and "health insurance issuer" have the meanings given
23those terms in the Illinois Health Insurance Portability and
24Accountability Act.
25(Source: P.A. 79-777.)
 

 

 

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1    (215 ILCS 5/355.01 new)
2    Sec. 355.01. Health insurance premium rates; prior
3approval.
4    (a) With respect to health insurance coverage offered by a
5health insurance issuer, no such policy, plan, or contract
6shall be issued or delivered to any person in this State until
7the classification of risks and the premium rates pertaining
8thereto have been approved by the Director under this Section.
9Any subsequent addition to or change in premium rates shall
10also be subject to the Director's approval under this Section.
11In all cases the Director shall approve or disapprove a premium
12rate within 60 days after submission unless the Director
13extends by not more than an additional 60 days the period
14within which the Director shall approve or disapprove such
15premium rate by giving written notice to the health insurance
16issuer of the extension before expiration of the initial 60-day
17period.
18    (b) The Director shall disapprove a premium rate under this
19Section if:
20        (1) the benefits provided are not reasonable in
21    relation to the premium charged; or
22        (2) the proposed premium rate is excessive,
23    inadequate, unjustified, or unfairly discriminatory.
24    The party proposing a rate has the burden of proving by
25clear and convincing evidence that the rate does not violate
26this Section.

 

 

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1    (c) With respect to premium rate changes, the Director's
2review of a proposed rate change shall include an examination
3of the factors set forth in regulation promulgated by the
4Secretary of the U.S. Department of Health and Human Services
5pursuant to Section 2794 of the Public Health Service Act, as
6added by the Patient Protection and Affordable Care Act (Pub.
7L. 111-148), for the purpose of determining whether a State has
8an effective rate review program.
9    (d) The Director shall notify a health insurance issuer in
10writing of the approval or disapproval of a premium rate under
11this Section, and the notice shall be posted on the
12Department's website. If the Director disapproves the premium
13rate, then the written notice shall clearly state the respects
14in which the premium rate does not comply with the requirements
15of law and it shall be unlawful thereafter for any such health
16insurance issuer to use the premium rate. The written notice of
17disapproval shall also advise the health insurance issuer of
18the right to a hearing under subsection (f) of this Section.
19    (e) With respect to a rate change approved under this
20Section, the rate change shall take effect no sooner than 30
21days after the written approval is mailed by the Director. The
22rate change shall be stayed if within the 30-day period a
23written request for a hearing is filed with the Director under
24subsection (f) of this Section. A health insurance issuer shall
25notify in writing all policyholders to which such rate change
26applies at least 30 days prior to the effective date of the

 

 

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1rate change. The written notice shall also advise the
2policyholders of the right to a hearing under subsection (d) of
3this Section.
4    (f) A health insurance issuer may appeal a decision by the
5Director under this Section by making a written request for a
6hearing before the Director within 30 days after receiving the
7written notice under subsections (d) or (g) of this Section.
8One percent or 25 of the covered lives (whichever is greater)
9to which such rate change applies may appeal a decision by the
10Director under this Section by submitting a written request to
11the Department for a hearing before the Director within 30 days
12after the Department posts public notice under subsection (d)
13of this Section.
14    (g) The Director may request actuarial reasons and data, as
15well as other information, needed to determine if a previously
16approved rate continues to satisfy the requirements of this
17Section. The Director may withdraw approval of any rate that
18has been previously approved on any of the grounds stated in
19subsection (b) of this Section. The Director shall notify a
20health insurance issuer in writing of the withdrawal of
21approval. The written notice shall clearly state the respects
22in which the premium rate ceases to comply with the
23requirements of law and shall advise the health insurance
24issuer of the right to a hearing under subsection (f) of this
25Section. The written withdrawal of approval shall take effect
2630 days after the date of mailing but shall be stayed if within

 

 

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1the 30-day period a written request for hearing is filed with
2the Director under subsection (f) of this Section.
3    (h) As used in this Section, the terms "health insurance
4coverage" and "health insurance issuer" have the meanings given
5those terms in the Illinois Health Insurance Portability and
6Accountability Act.
 
7    (215 ILCS 5/367)  (from Ch. 73, par. 979)
8    Sec. 367. Group accident and health insurance.
9    (1) Group accident and health insurance is hereby declared
10to be that form of accident and health insurance covering not
11less than 2 employees, members, or employees of members,
12written under a master policy issued to any governmental
13corporation, unit, agency or department thereof, or to any
14corporation, copartnership, individual employer, or to any
15association upon application of an executive officer or trustee
16of such association having a constitution or bylaws and formed
17in good faith for purposes other than that of obtaining
18insurance, where officers, members, employees, employees of
19members or classes or department thereof, may be insured for
20their individual benefit. In addition a group accident and
21health policy may be written to insure any group which may be
22insured under a group life insurance policy. The term
23"employees" shall include the officers, managers and employees
24of subsidiary or affiliated corporations, and the individual
25proprietors, partners and employees of affiliated individuals

 

 

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1and firms, when the business of such subsidiary or affiliated
2corporations, firms or individuals, is controlled by a common
3employer through stock ownership, contract or otherwise.
4    (2) Any insurance company authorized to write accident and
5health insurance in this State shall have power to issue group
6accident and health policies. No policy of group accident and
7health insurance may be issued or delivered in this State
8unless a copy of the form thereof and of the classification of
9risks and the premium rates pertaining thereto shall have been
10filed with the department and approved by it in accordance with
11Section 355 and Section 355.01, and it contains in substance
12those provisions contained in Sections 357.1 through 357.30 as
13may be applicable to group accident and health insurance and
14the following provisions:
15        (a) A provision that the policy, the application of the
16    employer, or executive officer or trustee of any
17    association, and the individual applications, if any, of
18    the employees, members or employees of members insured
19    shall constitute the entire contract between the parties,
20    and that all statements made by the employer, or the
21    executive officer or trustee, or by the individual
22    employees, members or employees of members shall (in the
23    absence of fraud) be deemed representations and not
24    warranties, and that no such statement shall be used in
25    defense to a claim under the policy, unless it is contained
26    in a written application.

 

 

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1        (b) A provision that the insurer will issue to the
2    employer, or to the executive officer or trustee of the
3    association, for delivery to the employee, member or
4    employee of a member, who is insured under such policy, an
5    individual certificate setting forth a statement as to the
6    insurance protection to which he is entitled and to whom
7    payable.
8        (c) A provision that to the group or class thereof
9    originally insured shall be added from time to time all new
10    employees of the employer, members of the association or
11    employees of members eligible to and applying for insurance
12    in such group or class.
13    (3) Anything in this code to the contrary notwithstanding,
14any group accident and health policy may provide that all or
15any portion of any indemnities provided by any such policy on
16account of hospital, nursing, medical or surgical services,
17may, at the insurer's option, be paid directly to the hospital
18or person rendering such services; but the policy may not
19require that the service be rendered by a particular hospital
20or person. Payment so made shall discharge the insurer's
21obligation with respect to the amount of insurance so paid.
22Nothing in this subsection (3) shall prohibit an insurer from
23providing incentives for insureds to utilize the services of a
24particular hospital or person.
25    (4) Special group policies may be issued to school
26districts providing medical or hospital service, or both, for

 

 

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1pupils of the district injured while participating in any
2athletic activity under the jurisdiction of or sponsored or
3controlled by the district or the authorities of any school
4thereof. The provisions of this Section governing the issuance
5of group accident and health insurance shall, insofar as
6applicable, control the issuance of such policies issued to
7schools.
8    (5) No policy of group accident and health insurance may be
9issued or delivered in this State unless it provides that upon
10the death of the insured employee or group member the
11dependents' coverage, if any, continues for a period of at
12least 90 days subject to any other policy provisions relating
13to termination of dependents' coverage.
14    (6) No group hospital policy covering miscellaneous
15hospital expenses issued or delivered in this State shall
16contain any exception or exclusion from coverage which would
17preclude the payment of expenses incurred for the processing
18and administration of blood and its components.
19    (7) No policy of group accident and health insurance,
20delivered in this State more than 120 days after the effective
21day of the Section, which provides inpatient hospital coverage
22for sicknesses shall exclude from such coverage the treatment
23of alcoholism. This subsection shall not apply to a policy
24which covers only specified sicknesses.
25    (8) No policy of group accident and health insurance, which
26provides benefits for hospital or medical expenses based upon

 

 

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1the actual expenses incurred, issued or delivered in this State
2shall contain any specific exception to coverage which would
3preclude the payment of actual expenses incurred in the
4examination and testing of a victim of an offense defined in
5Sections 11-1.20 through 11-1.60 or 12-13 through 12-16 of the
6Criminal Code of 1961 or the Criminal Code of 2012, or an
7attempt to commit such offense, to establish that sexual
8contact did occur or did not occur, and to establish the
9presence or absence of sexually transmitted disease or
10infection, and examination and treatment of injuries and trauma
11sustained by the victim of such offense, arising out of the
12offense. Every group policy of accident and health insurance
13which specifically provides benefits for routine physical
14examinations shall provide full coverage for expenses incurred
15in the examination and testing of a victim of an offense
16defined in Sections 11-1.20 through 11-1.60 or 12-13 through
1712-16 of the Criminal Code of 1961 or the Criminal Code of
182012, or an attempt to commit such offense, as set forth in
19this Section. This subsection shall not apply to a policy which
20covers hospital and medical expenses for specified illnesses
21and injuries only.
22    (9) For purposes of enabling the recovery of State funds,
23any insurance carrier subject to this Section shall upon
24reasonable demand by the Department of Public Health disclose
25the names and identities of its insureds entitled to benefits
26under this provision to the Department of Public Health

 

 

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1whenever the Department of Public Health has determined that it
2has paid, or is about to pay, hospital or medical expenses for
3which an insurance carrier is liable under this Section. All
4information received by the Department of Public Health under
5this provision shall be held on a confidential basis and shall
6not be subject to subpoena and shall not be made public by the
7Department of Public Health or used for any purpose other than
8that authorized by this Section.
9    (10) Whenever the Department of Public Health finds that it
10has paid all or part of any hospital or medical expenses which
11an insurance carrier is obligated to pay under this Section,
12the Department of Public Health shall be entitled to receive
13reimbursement for its payments from such insurance carrier
14provided that the Department of Public Health has notified the
15insurance carrier of its claim before the carrier has paid the
16benefits to its insureds or the insureds' assignees.
17    (11) (a) No group hospital, medical or surgical expense
18    policy shall contain any provision whereby benefits
19    otherwise payable thereunder are subject to reduction
20    solely on account of the existence of similar benefits
21    provided under other group or group-type accident and
22    sickness insurance policies where such reduction would
23    operate to reduce total benefits payable under these
24    policies below an amount equal to 100% of total allowable
25    expenses provided under these policies.
26        (b) When dependents of insureds are covered under 2

 

 

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1    policies, both of which contain coordination of benefits
2    provisions, benefits of the policy of the insured whose
3    birthday falls earlier in the year are determined before
4    those of the policy of the insured whose birthday falls
5    later in the year. Birthday, as used herein, refers only to
6    the month and day in a calendar year, not the year in which
7    the person was born. The Department of Insurance shall
8    promulgate rules defining the order of benefit
9    determination pursuant to this paragraph (b).
10    (12) Every group policy under this Section shall be subject
11to the provisions of Sections 356g and 356n of this Code.
12    (13) No accident and health insurer providing coverage for
13hospital or medical expenses on an expense incurred basis shall
14deny reimbursement for an otherwise covered expense incurred
15for any organ transplantation procedure solely on the basis
16that such procedure is deemed experimental or investigational
17unless supported by the determination of the Office of Health
18Care Technology Assessment within the Agency for Health Care
19Policy and Research within the federal Department of Health and
20Human Services that such procedure is either experimental or
21investigational or that there is insufficient data or
22experience to determine whether an organ transplantation
23procedure is clinically acceptable. If an accident and health
24insurer has made written request, or had one made on its behalf
25by a national organization, for determination by the Office of
26Health Care Technology Assessment within the Agency for Health

 

 

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1Care Policy and Research within the federal Department of
2Health and Human Services as to whether a specific organ
3transplantation procedure is clinically acceptable and said
4organization fails to respond to such a request within a period
5of 90 days, the failure to act may be deemed a determination
6that the procedure is deemed to be experimental or
7investigational.
8    (14) Whenever a claim for benefits by an insured under a
9dental prepayment program is denied or reduced, based on the
10review of x-ray films, such review must be performed by a
11dentist.
12(Source: P.A. 96-1551, eff. 7-1-11; 97-1150, eff. 1-25-13.)
 
13    Section 10. The Health Maintenance Organization Act is
14amended by changing Section 5-3 and by adding Section 2-11.1 as
15follows:
 
16    (215 ILCS 125/2-11.1 new)
17    Sec. 2-11.1. Premium rates; filing and prior approval.
18    (a) Notwithstanding any other provision of law, no group or
19individual contract or evidence of coverage shall be issued or
20delivered in this State until the schedule of base rates to be
21used in conjunction with the contract or evidence of coverage
22has been filed with the Director; nor shall it be issued or
23delivered until the Director shall have approved such base
24rates pursuant to the provisions of Section 355.01 of the

 

 

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1Illinois Insurance Code. Any subsequent addition to or change
2in rates is also subject to this Section.
3    (b) A filing of rates under this Section shall not be
4complete unless it contains all information necessary to
5justify the premium rate and such other information as the
6Director may require to determine the rate's compliance with
7Section 355.01 of the Illinois Insurance Code. Each rate filing
8must also include a certification by a qualified actuary that
9to the best of the actuary's knowledge and judgment the rate
10filing is in compliance with the applicable laws and
11regulations of this State and that the benefits are reasonable
12in relation to premiums.
13    (c) With respect to rate changes, the filing under this
14Section shall clearly indicate the percentage change from the
15previously filed rate and the percentage change from the rate
16that was in effect 12 months prior to the proposed effective
17date of such rate.
18    (d) In addition to filing premium rates, a health
19maintenance organization shall notify the Director whenever a
20plan subject to this Section has been closed for sale.
 
21    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
22    Sec. 5-3. Insurance Code provisions.
23    (a) Health Maintenance Organizations shall be subject to
24the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
25141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,

 

 

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1154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.01, 355.2,
2355.3, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
3356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
4356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
5364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e,
6370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
7444, and 444.1, paragraph (c) of subsection (2) of Section 367,
8and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
9and XXVI of the Illinois Insurance Code.
10    (b) For purposes of the Illinois Insurance Code, except for
11Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
12Maintenance Organizations in the following categories are
13deemed to be "domestic companies":
14        (1) a corporation authorized under the Dental Service
15    Plan Act or the Voluntary Health Services Plans Act;
16        (2) a corporation organized under the laws of this
17    State; or
18        (3) a corporation organized under the laws of another
19    state, 30% or more of the enrollees of which are residents
20    of this State, except a corporation subject to
21    substantially the same requirements in its state of
22    organization as is a "domestic company" under Article VIII
23    1/2 of the Illinois Insurance Code.
24    (c) In considering the merger, consolidation, or other
25acquisition of control of a Health Maintenance Organization
26pursuant to Article VIII 1/2 of the Illinois Insurance Code,

 

 

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1        (1) the Director shall give primary consideration to
2    the continuation of benefits to enrollees and the financial
3    conditions of the acquired Health Maintenance Organization
4    after the merger, consolidation, or other acquisition of
5    control takes effect;
6        (2)(i) the criteria specified in subsection (1)(b) of
7    Section 131.8 of the Illinois Insurance Code shall not
8    apply and (ii) the Director, in making his determination
9    with respect to the merger, consolidation, or other
10    acquisition of control, need not take into account the
11    effect on competition of the merger, consolidation, or
12    other acquisition of control;
13        (3) the Director shall have the power to require the
14    following information:
15            (A) certification by an independent actuary of the
16        adequacy of the reserves of the Health Maintenance
17        Organization sought to be acquired;
18            (B) pro forma financial statements reflecting the
19        combined balance sheets of the acquiring company and
20        the Health Maintenance Organization sought to be
21        acquired as of the end of the preceding year and as of
22        a date 90 days prior to the acquisition, as well as pro
23        forma financial statements reflecting projected
24        combined operation for a period of 2 years;
25            (C) a pro forma business plan detailing an
26        acquiring party's plans with respect to the operation

 

 

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1        of the Health Maintenance Organization sought to be
2        acquired for a period of not less than 3 years; and
3            (D) such other information as the Director shall
4        require.
5    (d) The provisions of Article VIII 1/2 of the Illinois
6Insurance Code and this Section 5-3 shall apply to the sale by
7any health maintenance organization of greater than 10% of its
8enrollee population (including without limitation the health
9maintenance organization's right, title, and interest in and to
10its health care certificates).
11    (e) In considering any management contract or service
12agreement subject to Section 141.1 of the Illinois Insurance
13Code, the Director (i) shall, in addition to the criteria
14specified in Section 141.2 of the Illinois Insurance Code, take
15into account the effect of the management contract or service
16agreement on the continuation of benefits to enrollees and the
17financial condition of the health maintenance organization to
18be managed or serviced, and (ii) need not take into account the
19effect of the management contract or service agreement on
20competition.
21    (f) Except for small employer groups as defined in the
22Small Employer Rating, Renewability and Portability Health
23Insurance Act and except for medicare supplement policies as
24defined in Section 363 of the Illinois Insurance Code, a Health
25Maintenance Organization may by contract agree with a group or
26other enrollment unit to effect refunds or charge additional

 

 

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1premiums under the following terms and conditions:
2        (i) the amount of, and other terms and conditions with
3    respect to, the refund or additional premium are set forth
4    in the group or enrollment unit contract agreed in advance
5    of the period for which a refund is to be paid or
6    additional premium is to be charged (which period shall not
7    be less than one year); and
8        (ii) the amount of the refund or additional premium
9    shall not exceed 20% of the Health Maintenance
10    Organization's profitable or unprofitable experience with
11    respect to the group or other enrollment unit for the
12    period (and, for purposes of a refund or additional
13    premium, the profitable or unprofitable experience shall
14    be calculated taking into account a pro rata share of the
15    Health Maintenance Organization's administrative and
16    marketing expenses, but shall not include any refund to be
17    made or additional premium to be paid pursuant to this
18    subsection (f)). The Health Maintenance Organization and
19    the group or enrollment unit may agree that the profitable
20    or unprofitable experience may be calculated taking into
21    account the refund period and the immediately preceding 2
22    plan years.
23    The Health Maintenance Organization shall include a
24statement in the evidence of coverage issued to each enrollee
25describing the possibility of a refund or additional premium,
26and upon request of any group or enrollment unit, provide to

 

 

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1the group or enrollment unit a description of the method used
2to calculate (1) the Health Maintenance Organization's
3profitable experience with respect to the group or enrollment
4unit and the resulting refund to the group or enrollment unit
5or (2) the Health Maintenance Organization's unprofitable
6experience with respect to the group or enrollment unit and the
7resulting additional premium to be paid by the group or
8enrollment unit.
9    In no event shall the Illinois Health Maintenance
10Organization Guaranty Association be liable to pay any
11contractual obligation of an insolvent organization to pay any
12refund authorized under this Section.
13    (g) Rulemaking authority to implement Public Act 95-1045,
14if any, is conditioned on the rules being adopted in accordance
15with all provisions of the Illinois Administrative Procedure
16Act and all rules and procedures of the Joint Committee on
17Administrative Rules; any purported rule not so adopted, for
18whatever reason, is unauthorized.
19(Source: P.A. 96-328, eff. 8-11-09; 96-639, eff. 1-1-10;
2096-833, eff. 6-1-10; 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11;
2197-343, eff. 1-1-12; 97-437, eff. 8-18-11; 97-486, eff. 1-1-12;
2297-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813, eff.
237-13-12.)
 
24    Section 99. Effective date. This Act takes effect January
251, 2014.