Illinois General Assembly - Bill Status for HB4059

Amends the Illinois Insurance Code, the Health Care Purchasing Group Act, the Health Maintenance Organization Act, the Limited Health Service Organization Act, and the Voluntary Health Services Plans Act. Provides that upon the written request of a sponsor of a group health plan, the health insurance issuer providing health insurance coverage under the plan must report to the sponsor information from the 12 months preceding the date of the report regarding: (1) the total amount of charges submitted to the health insurance issuer for persons covered under the plan; (2) the total amount of payments made by the health insurance issuer to health care providers for persons covered under the plan; (3) to the extent available, information on claims paid by type of health care provider; and (4) the diagnosis codes for payment of claims that exceed $25,000. Provides that the plan sponsor may use the information only for purposes relating to obtaining and maintaining health insurance coverage for the sponsor's employees (if the sponsor is an employer) or members (if the sponsor is an employee organization).

Provides that a plan sponsor may not use information obtained from a health insurance issuer for any purpose other than obtaining and maintaining health insurance coverage for the sponsor's employees or members. Provides that a plan sponsor may not discriminate against an employee or member or take any retaliatory action against an employee or member based on any information obtained by the sponsor from a health insurance issuer.

Replaces the substantive provisions added to the Illinois Insurance Code by the bill. Provides a definition of "summary health information". Provides requirements for group health plans in relation to the disclosure of summary health information, including a requirement that a group health plan, or health insurance issuer or HMO with respect to the group health plan, disclose summary health information to the plan sponsor if the plan sponsor requests the information for the purpose of obtaining premium bids from health plans or modifying or terminating the group health plan. Provides other requirements relating to the uses and disclosures of protected health information, including requirements for the de-identification of protected health information.

Deletes everything after the enacting clause and reinserts the provisions of House Bill 4059 as introduced, except replaces provisions amending the Illinois Insurance Code concerning the disclosure of information to a group health plan sponsor and the time limits for making such a disclosure with the following: (1) adds a definition of "summary health information", and requires that a group health plan, of a health insurance issuer or HMO with respect to such a plan, disclose summary health information to the plan sponsor if the sponsor requests the information for the purpose of (i) obtaining premium bids from health plans for providing health insurance coverage under the plan or (ii) modifying, amending, or terminating the plan; and (2) provides that the group health plan documents must be amended to incorporate certain provisions, including provisions that establish the permitted and required uses of disclosed information by the plan sponsor.

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