97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB3968

 

Introduced 1/10/2012, by Rep. Monique D. Davis

 

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. Provides that a filing of premium rates with the Director of Insurance shall not be complete unless it contains all information necessary to justify the premium rate and such other information as the Director may require to determine the rate's compliance with the provision concerning health insurance premium rates and prior approval. Provides that the filing shall clearly indicate the percentage change from certain prior rates. Sets forth provisions concerning health insurance premium rates and prior approval of the Director. Prohibits policies, plans, and contracts of health insurance coverage offered by a health insurance issuer from being issued or delivered until the classification of risks and the premium rates pertaining thereto have been approved by the Director. Contains provisions concerning approvals, appeals, 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, 2013.


LRB097 16042 RPM 61195 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB3968LRB097 16042 RPM 61195 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 5. The Illinois Insurance Code is amended by
5changing Sections 355 and 367 and by adding Section 355.01 as
6follows:
 
7    (215 ILCS 5/355)  (from Ch. 73, par. 967)
8    Sec. 355. Accident and health policies-Provisions.)
9    (a) No individual or group policy of insurance against loss
10or damage from the sickness, or from the bodily injury or death
11of the insured by accident shall be issued or delivered to any
12person in this State until a copy of the form thereof and of
13the classification 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
17Director disapproves the policy form he shall make a written
18decision stating the respects in which such form does not
19comply with the requirements of law and shall deliver a copy
20thereof to the company and it shall be unlawful thereafter for
21any such company to issue any policy in such form.
22    (b) With respect to health insurance coverage offered by a
23health insurance issuer, a filing of premium rates pursuant to

 

 

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1subsection (a) of this Section shall not be complete unless it
2contains all information necessary to justify the premium rate
3and such other information as the Director may require to
4determine the rate's compliance with Section 355.01 of this
5Code. Each rate filing must also include a certification by a
6qualified actuary that to the best of the actuary's knowledge
7and judgment the rate filing is in compliance with applicable
8laws and regulations and that the benefits are reasonable in
9relation to premiums.
10    (c) With respect to premium rate changes, the filing under
11subsection (a) of this Section shall clearly indicate the
12percentage change from the previously filed rate and the
13percentage change from the rate that was in effect 12 months
14prior to the proposed effective date of such rate.
15    (d) In addition to filing premium rates, a company shall
16notify the Director whenever a policy form subject to this
17Section has been closed for sale.
18    (e) As used in this Section, the terms "health insurance
19coverage" and "health insurance issuer" have the meanings given
20those terms in the Illinois Health Insurance Portability and
21Accountability Act.
22(Source: P.A. 79-777.)
 
23    (215 ILCS 5/355.01 new)
24    Sec. 355.01. Health insurance premium rates; prior
25approval.

 

 

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

 

 

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

 

 

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1    (f) A health insurance issuer may appeal a decision by the
2Director under this Section by making a written request for a
3hearing before the Director within 30 days after receiving the
4written notice under subsections (d) or (g) of this Section.
5One percent or 25 of the covered lives (whichever is greater)
6to which such rate change applies may appeal a decision by the
7Director under this Section by submitting a written request to
8the Department for a hearing before the Director within 30 days
9after the Department posts public notice under subsection (d)
10of this Section.
11    (g) The Director may request actuarial reasons and data, as
12well as other information, needed to determine if a previously
13approved rate continues to satisfy the requirements of this
14Section. The Director may withdraw approval of any rate that
15has been previously approved on any of the grounds stated in
16subsection (b) of this Section. The Director shall notify a
17health insurance issuer in writing of the withdrawal of
18approval. The written notice shall clearly state the respects
19in which the premium rate ceases to comply with the
20requirements of law and shall advise the health insurance
21issuer of the right to a hearing under subsection (f) of this
22Section. The written withdrawal of approval shall take effect
2330 days after the date of mailing but shall be stayed if within
24the 30-day period a written request for hearing is filed with
25the Director under subsection (f) of this Section.
26    (h) As used in this Section, the terms "health insurance

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1examination and testing of a victim of an offense defined in
2Sections 11-1.20 through 11-1.60 or 12-13 through 12-16 of the
3Criminal Code of 1961, or an attempt to commit such offense, to
4establish that sexual contact did occur or did not occur, and
5to establish the presence or absence of sexually transmitted
6disease or infection, and examination and treatment of injuries
7and trauma sustained by the victim of such offense, arising out
8of the offense. Every group policy of accident and health
9insurance which specifically provides benefits for routine
10physical examinations shall provide full coverage for expenses
11incurred in the examination and testing of a victim of an
12offense defined in Sections 11-1.20 through 11-1.60 or 12-13
13through 12-16 of the Criminal Code of 1961, or an attempt to
14commit such offense, as set forth in this Section. This
15subsection shall not apply to a policy which covers hospital
16and medical expenses for specified illnesses and injuries only.
17    (9) For purposes of enabling the recovery of State funds,
18any insurance carrier subject to this Section shall upon
19reasonable demand by the Department of Public Health disclose
20the names and identities of its insureds entitled to benefits
21under this provision to the Department of Public Health
22whenever the Department of Public Health has determined that it
23has paid, or is about to pay, hospital or medical expenses for
24which an insurance carrier is liable under this Section. All
25information received by the Department of Public Health under
26this provision shall be held on a confidential basis and shall

 

 

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

 

 

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1    the month and day in a calendar year, not the year in which
2    the person was born. The Department of Insurance shall
3    promulgate rules defining the order of benefit
4    determination pursuant to this paragraph (b).
5    (12) Every group policy under this Section shall be subject
6to the provisions of Sections 356g and 356n of this Code.
7    (13) No accident and health insurer providing coverage for
8hospital or medical expenses on an expense incurred basis shall
9deny reimbursement for an otherwise covered expense incurred
10for any organ transplantation procedure solely on the basis
11that such procedure is deemed experimental or investigational
12unless supported by the determination of the Office of Health
13Care Technology Assessment within the Agency for Health Care
14Policy and Research within the federal Department of Health and
15Human Services that such procedure is either experimental or
16investigational or that there is insufficient data or
17experience to determine whether an organ transplantation
18procedure is clinically acceptable. If an accident and health
19insurer has made written request, or had one made on its behalf
20by a national organization, for determination by the Office of
21Health Care Technology Assessment within the Agency for Health
22Care Policy and Research within the federal Department of
23Health and Human Services as to whether a specific organ
24transplantation procedure is clinically acceptable and said
25organization fails to respond to such a request within a period
26of 90 days, the failure to act may be deemed a determination

 

 

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1that the procedure is deemed to be experimental or
2investigational.
3    (14) Whenever a claim for benefits by an insured under a
4dental prepayment program is denied or reduced, based on the
5review of x-ray films, such review must be performed by a
6dentist.
7(Source: P.A. 96-1551, eff. 7-1-11.)
 
8    Section 10. The Health Maintenance Organization Act is
9amended by changing Section 5-3 and by adding Section 2-11.1 as
10follows:
 
11    (215 ILCS 125/2-11.1 new)
12    Sec. 2-11.1. Premium rates; filing and prior approval.
13    (a) Notwithstanding any other provision of law, no group or
14individual contract or evidence of coverage shall be issued or
15delivered in this State until the schedule of base rates to be
16used in conjunction with the contract or evidence of coverage
17has been filed with the Director; nor shall it be issued or
18delivered until the Director shall have approved such base
19rates pursuant to the provisions of Section 355.01 of the
20Illinois Insurance Code. Any subsequent addition to or change
21in rates is also subject to this Section.
22    (b) A filing of rates under this Section shall not be
23complete unless it contains all information necessary to
24justify the premium rate and such other information as the

 

 

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1Director may require to determine the rate's compliance with
2Section 355.01 of the Illinois Insurance Code. Each rate filing
3must also include a certification by a qualified actuary that
4to the best of the actuary's knowledge and judgment the rate
5filing is in compliance with the applicable laws and
6regulations of this State and that the benefits are reasonable
7in relation to premiums.
8    (c) With respect to rate changes, the filing under this
9Section shall clearly indicate the percentage change from the
10previously filed rate and the percentage change from the rate
11that was in effect 12 months prior to the proposed effective
12date of such rate.
13    (d) In addition to filing premium rates, a health
14maintenance organization shall notify the Director whenever a
15plan subject to this Section has been closed for sale.
 
16    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
17    Sec. 5-3. Insurance Code provisions.
18    (a) Health Maintenance Organizations shall be subject to
19the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
20141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
21154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.01, 355.2,
22356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4, 356z.5,
23356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
24356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21 356z.19,
25364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e,

 

 

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1370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
2444, and 444.1, paragraph (c) of subsection (2) of Section 367,
3and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
4and XXVI of the Illinois Insurance Code.
5    (b) For purposes of the Illinois Insurance Code, except for
6Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
7Maintenance Organizations in the following categories are
8deemed to be "domestic companies":
9        (1) a corporation authorized under the Dental Service
10    Plan Act or the Voluntary Health Services Plans Act;
11        (2) a corporation organized under the laws of this
12    State; or
13        (3) a corporation organized under the laws of another
14    state, 30% or more of the enrollees of which are residents
15    of this State, except a corporation subject to
16    substantially the same requirements in its state of
17    organization as is a "domestic company" under Article VIII
18    1/2 of the Illinois Insurance Code.
19    (c) In considering the merger, consolidation, or other
20acquisition of control of a Health Maintenance Organization
21pursuant to Article VIII 1/2 of the Illinois Insurance Code,
22        (1) the Director shall give primary consideration to
23    the continuation of benefits to enrollees and the financial
24    conditions of the acquired Health Maintenance Organization
25    after the merger, consolidation, or other acquisition of
26    control takes effect;

 

 

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

 

 

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

 

 

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

 

 

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1experience with respect to the group or enrollment unit and the
2resulting additional premium to be paid by the group or
3enrollment unit.
4    In no event shall the Illinois Health Maintenance
5Organization Guaranty Association be liable to pay any
6contractual obligation of an insolvent organization to pay any
7refund authorized under this Section.
8    (g) Rulemaking authority to implement Public Act 95-1045,
9if any, is conditioned on the rules being adopted in accordance
10with all provisions of the Illinois Administrative Procedure
11Act and all rules and procedures of the Joint Committee on
12Administrative Rules; any purported rule not so adopted, for
13whatever reason, is unauthorized.
14(Source: P.A. 96-328, eff. 8-11-09; 96-639, eff. 1-1-10;
1596-833, eff. 6-1-10; 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11;
1697-343, eff. 1-1-12; 97-437, eff. 8-18-11; 97-486, eff. 1-1-12;
1797-592, eff. 1-1-12; revised 10-13-11.)
 
18    Section 99. Effective date. This Act takes effect January
191, 2013.