Section 2026.10  Definitions

"Affordable Care Act" or "ACA" means the Patient Protection and Affordable Care Act (42 USC 18001 et seq.).

                        "Code" means the Illinois Insurance Code [215 ILCS 5].

"Department" means the Illinois Department of Insurance.

"Director" means the Director of the Illinois Department of Insurance.

"CMMS" means the Centers for Medicare and Medicaid Services.

"Federal Medical Loss Ratio Standard" means the applicable medical loss ratio standard for the State and market segment involved, determined under subpart B of 45 CFR 158.

"Health Insurance Coverage" has the meaning given that term in PHS Act section 2791(b)(1).

"Health Insurance Issuer" has the meaning given that term in PHS Act section 2791(b)(2).

"Individual Market" has the meaning given in PHS Act section 2791(e)(1)(A).  Coverage that would be regulated as individual market coverage, as defined in PHS Act section 2791(e)(1)(A), if it were not sold through an association, is subject to rate review as individual market coverage.

"PHS Act" means the Public Health Service Act (42 USC 201 et seq.).

"Product" means a package of health insurance coverage benefits with a discrete set of rating and pricing methodologies that a health insurance issuer offers in a state.

"Rate Increase" means any increase of the rates for a specific product offered in the individual or small group market.

"Rate Increase Subject to Review" means a rate increase that meets the criteria set forth in Section 2026.30.

"Secretary" means the Secretary of the Department of Health and Human Services.

"Small Group Market" has the meaning ascribed in PHS Act section 2791(e)(5); provided, however, that for the purpose of this definition, "50" employees applies in place of "100" employees in the definition of "small employer" in section 2791(e)(4).  "Coverage" that would be regulated as small group market coverage (as defined in section 2791(e)(5)) if it were not sold through an association is subject to rate review as small group market coverage.

"Unreasonable Rate Increase" means a rate increase that the Director determines under Section 2026.40 to be excessive, unjustified or unfairly discriminatory.