Rep. Bob Morgan

Filed: 4/2/2019

 

 


 

 


 
10100HB0471ham001LRB101 03392 AMC 59018 a

1
AMENDMENT TO HOUSE BILL 471

2    AMENDMENT NO. ______. Amend House Bill 471 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Insurance Code is amended by
5changing Section 355 as follows:
 
6    (215 ILCS 5/355)  (from Ch. 73, par. 967)
7    Sec. 355. Accident and health policies; provisions.
8policies-Provisions.)
9    (a) No policy of insurance against loss or damage from the
10sickness, or from the bodily injury or death of the insured by
11accident shall be issued or delivered to any person in this
12State until a copy of the form thereof and of the
13classification of risks and the premium rates pertaining
14thereto have been filed with the Director; nor shall it be so
15issued or delivered until the Director shall have approved such
16policy pursuant to the provisions of Section 143. If the

 

 

10100HB0471ham001- 2 -LRB101 03392 AMC 59018 a

1Director disapproves the policy form he shall make a written
2decision stating the respects in which such form does not
3comply with the requirements of law and shall deliver a copy
4thereof to the company and it shall be unlawful thereafter for
5any such company to issue any policy in such form.
6    (b) All individual and small group accident and health
7policies written in compliance with the Patient Protection and
8Affordable Care Act must file rates for approval. Rate
9increases not found to be reasonable in relation to benefits
10under the policy provided shall be disapproved. The Department
11shall provide a report to the General Assembly on or after
12January 1, 2021, regarding both on and off exchange individual
13and small group rates in the Illinois market.
14(Source: P.A. 79-777.)
 
15    Section 10. The Health Maintenance Organization Act is
16amended by changing Section 4-12 as follows:
 
17    (215 ILCS 125/4-12)  (from Ch. 111 1/2, par. 1409.5)
18    Sec. 4-12. Changes in Rate Methodology and Benefits,
19Material Modifications. A health maintenance organization
20shall file with the Director, prior to use, a notice of any
21change in rate methodology, or benefits and of any material
22modification of any matter or document furnished pursuant to
23Section 2-1, together with such supporting documents as are
24necessary to fully explain the change or modification.

 

 

10100HB0471ham001- 3 -LRB101 03392 AMC 59018 a

1    (a) Contract modifications described in subsections
2(c)(5), (c)(6) and (c)(7) of Section 2-1 shall include all form
3agreements between the organization and enrollees, providers,
4administrators of services and insurers of health maintenance
5organizations.
6    (b) Material transactions or series of transactions other
7than those described in subsection (a) of this Section, the
8total annual value of which exceeds the greater of $100,000 or
95% of net earned subscription revenue for the most current
10twelve month period as determined from filed financial
11statements.
12    (c) Any agreement between the organization and an insurer
13shall be subject to the provisions of the laws of this State
14regarding reinsurance as provided in Article XI of the Illinois
15Insurance Code. All reinsurance agreements must be filed.
16Approval of the Director is required for all agreements except
17the following: individual stop loss, aggregate excess,
18hospitalization benefits or out-of-area of the participating
19providers unless 20% or more of the organization's total risk
20is reinsured, in which case all reinsurance agreements require
21approval.
22    (d) All individual and small group health plans written in
23compliance with the Patient Protection and Affordable Care Act
24must file rates for approval. Rate increases not found to be
25reasonable in relation to benefits under the policy provided
26shall be disapproved. The Department shall provide a report to

 

 

10100HB0471ham001- 4 -LRB101 03392 AMC 59018 a

1the General Assembly on or after January 1, 2021, regarding
2both on and off exchange individual and small group rates in
3the Illinois market.
4(Source: P.A. 86-620.)".