Illinois General Assembly - Full Text of HB1957
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Full Text of HB1957  102nd General Assembly

HB1957enr 102ND GENERAL ASSEMBLY

  
  
  

 


 
HB1957 EnrolledLRB102 10644 BMS 15973 b

1    AN ACT concerning regulation.
 
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 107a.12, 130.4, 370c.1, 500-30, 500-130,
61510, and 1565 as follows:
 
7    (215 ILCS 5/107a.12)
8    Sec. 107a.12. Annual statement.
9    (a) A pool authorized to do business in this State shall
10file with the Director by March 1st in each year 2 copies of
11its financial statement for the year ending December 31st
12immediately preceding on forms prescribed by the Director,
13which shall conform substantially to the form of statement
14adopted by the National Association of Insurance
15Commissioners. Unless the Director provides otherwise, the
16annual statement is to be prepared in accordance with the
17annual statement instructions and the Accounting Practices and
18Procedures Manual adopted by the National Association of
19Insurance Commissioners. The Director may promulgate rules for
20determining which portions of the annual statement
21instructions and Accounting Practices and Procedures Manual
22adopted by the National Association of Insurance Commissioners
23are germane for the purpose of ascertaining the condition and

 

 

HB1957 Enrolled- 2 -LRB102 10644 BMS 15973 b

1affairs of a pool.
2    (b) The Director shall have authority to extend the time
3for filing any statement by any pool for reasons that he
4considers good and sufficient. The admitted assets shall be
5shown in the statement at the actual values as of the last day
6of the preceding year, in accordance with Section 126.7 of
7this Code. The statement shall be verified by oaths of a
8majority of the trustees or directors of the pool. In
9addition, when the Director considers it to be necessary and
10appropriate for the protection of policyholders, creditors,
11shareholders, or claimants, the Director may require the pool
12to file, within 60 days after mailing to the pool a notice that
13a supplemental summary statement is required, a supplemental
14summary statement, as of the last day of any calendar month
15occurring during the 100 days next preceding the mailing of
16the notice, designated by him or her on forms prescribed and
17furnished by the Director. The Director may require
18supplemental summary statements to be certified by an
19independent actuary deemed competent by the Director or by an
20independent certified public accountant.
21    (c) On or before June 1 of each year, a pool shall file
22with the Director an audited financial statement reporting the
23financial condition of the pool as of the end of the most
24recent calendar year and changes in the surplus funds for the
25year then ending. The annual audited financial report shall
26include the following:

 

 

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1        (1) a report of an independent certified public
2    accountant;
3        (2) a balance sheet reporting assets, as defined in
4    this Article, liabilities, and surplus funds;
5        (3) a statement of gain and loss from operations;
6        (4) a statement of changes in financial position;
7        (5) a statement of changes in surplus funds; and
8        (6) the notes to financial statements.
9    (d) The Director shall require a pool to file an
10independent actuarial opinion as to the sufficiency of the
11loss and loss adjustment expense reserves. This opinion shall
12be due on March June 1 of each year.
13(Source: P.A. 91-757, eff. 1-1-01.)
 
14    (215 ILCS 5/130.4)
15    Sec. 130.4. Disclosure requirement.
16    (a) An insurer, or the insurance group of which the
17insurer is a member, shall, no later than June 1 of each
18calendar year, submit to the Director a corporate governance
19annual disclosure that contains the information described in
20subsection (b) of Section 130.5. Notwithstanding any request
21from the Director made pursuant to subsection (c), if the
22insurer is a member of an insurance group, the insurer shall
23submit the report required by this Section to the Director of
24the lead state for the insurance group, in accordance with the
25laws of the lead state, as determined by the procedures

 

 

HB1957 Enrolled- 4 -LRB102 10644 BMS 15973 b

1outlined in the most recent Financial Analysis Handbook
2adopted by the National Association of Insurance
3Commissioners.
4    (b) The corporate governance annual disclosure must
5include a signature of the insurer's or insurance group's
6chief executive officer or corporate secretary attesting to
7the best of that individual's belief and knowledge that the
8insurer has implemented the corporate governance practices
9required by this Section and that a copy of the disclosure has
10been provided to the insurer's board of directors or the
11appropriate committee thereof.
12    (c) An insurer not required to submit a corporate
13governance annual disclosure under this Section shall do so
14upon the Director's request.
15    (d) For purposes of completing the corporate governance
16annual disclosure, the insurer or insurance group may provide
17information regarding corporate governance at the ultimate
18controlling parent level, an intermediate holding company
19level, or the individual legal entity level, depending upon
20how the insurer or insurance group has structured its system
21of corporate governance. The insurer or insurance group is
22encouraged to make the corporate governance annual disclosure
23at the level at which the insurer's or insurance group's risk
24appetite is determined, the level at which the earnings,
25capital, liquidity, operations, and reputation of the insurer
26are overseen collectively and at which the supervision of

 

 

HB1957 Enrolled- 5 -LRB102 10644 BMS 15973 b

1those factors is coordinated and exercised, or the level at
2which legal liability for failure of general corporate
3governance duties would be placed. If the insurer or insurance
4group determines the level of reporting based on these
5criteria, it shall indicate which of the 3 criteria was used to
6determine the level of reporting and explain any subsequent
7changes in the level of reporting.
8    (e) The review of the corporate governance annual
9disclosure and any additional requests for information shall
10be made through the lead state as determined by the procedures
11within the most recent Financial Analysis Handbook adopted by
12the National Association of Insurance Commissioners.
13    (f) Insurers providing information substantially similar
14to the information required by this Article in other documents
15provided to the Director, including proxy statements filed in
16conjunction with the requirements of Section 131.13 or other
17State or federal filings provided to the Department, are not
18required to duplicate that information in the corporate
19governance annual disclosure but are only required to
20cross-reference the document in which the information is
21included.
22(Source: P.A. 101-600, eff. 12-6-19.)
 
23    (215 ILCS 5/370c.1)
24    Sec. 370c.1. Mental, emotional, nervous, or substance use
25disorder or condition parity.

 

 

HB1957 Enrolled- 6 -LRB102 10644 BMS 15973 b

1    (a) On and after the effective date of this amendatory Act
2of the 102nd General Assembly this amendatory Act of the 99th
3General Assembly, every insurer that amends, delivers, issues,
4or renews a group or individual policy of accident and health
5insurance or a qualified health plan offered through the
6Health Insurance Marketplace in this State providing coverage
7for hospital or medical treatment and for the treatment of
8mental, emotional, nervous, or substance use disorders or
9conditions shall ensure prior to policy issuance that:
10        (1) the financial requirements applicable to such
11    mental, emotional, nervous, or substance use disorder or
12    condition benefits are no more restrictive than the
13    predominant financial requirements applied to
14    substantially all hospital and medical benefits covered by
15    the policy and that there are no separate cost-sharing
16    requirements that are applicable only with respect to
17    mental, emotional, nervous, or substance use disorder or
18    condition benefits; and
19        (2) the treatment limitations applicable to such
20    mental, emotional, nervous, or substance use disorder or
21    condition benefits are no more restrictive than the
22    predominant treatment limitations applied to substantially
23    all hospital and medical benefits covered by the policy
24    and that there are no separate treatment limitations that
25    are applicable only with respect to mental, emotional,
26    nervous, or substance use disorder or condition benefits.

 

 

HB1957 Enrolled- 7 -LRB102 10644 BMS 15973 b

1    (b) The following provisions shall apply concerning
2aggregate lifetime limits:
3        (1) In the case of a group or individual policy of
4    accident and health insurance or a qualified health plan
5    offered through the Health Insurance Marketplace amended,
6    delivered, issued, or renewed in this State on or after
7    the effective date of this amendatory Act of the 99th
8    General Assembly that provides coverage for hospital or
9    medical treatment and for the treatment of mental,
10    emotional, nervous, or substance use disorders or
11    conditions the following provisions shall apply:
12            (A) if the policy does not include an aggregate
13        lifetime limit on substantially all hospital and
14        medical benefits, then the policy may not impose any
15        aggregate lifetime limit on mental, emotional,
16        nervous, or substance use disorder or condition
17        benefits; or
18            (B) if the policy includes an aggregate lifetime
19        limit on substantially all hospital and medical
20        benefits (in this subsection referred to as the
21        "applicable lifetime limit"), then the policy shall
22        either:
23                (i) apply the applicable lifetime limit both
24            to the hospital and medical benefits to which it
25            otherwise would apply and to mental, emotional,
26            nervous, or substance use disorder or condition

 

 

HB1957 Enrolled- 8 -LRB102 10644 BMS 15973 b

1            benefits and not distinguish in the application of
2            the limit between the hospital and medical
3            benefits and mental, emotional, nervous, or
4            substance use disorder or condition benefits; or
5                (ii) not include any aggregate lifetime limit
6            on mental, emotional, nervous, or substance use
7            disorder or condition benefits that is less than
8            the applicable lifetime limit.
9        (2) In the case of a policy that is not described in
10    paragraph (1) of subsection (b) of this Section and that
11    includes no or different aggregate lifetime limits on
12    different categories of hospital and medical benefits, the
13    Director shall establish rules under which subparagraph
14    (B) of paragraph (1) of subsection (b) of this Section is
15    applied to such policy with respect to mental, emotional,
16    nervous, or substance use disorder or condition benefits
17    by substituting for the applicable lifetime limit an
18    average aggregate lifetime limit that is computed taking
19    into account the weighted average of the aggregate
20    lifetime limits applicable to such categories.
21    (c) The following provisions shall apply concerning annual
22limits:
23        (1) In the case of a group or individual policy of
24    accident and health insurance or a qualified health plan
25    offered through the Health Insurance Marketplace amended,
26    delivered, issued, or renewed in this State on or after

 

 

HB1957 Enrolled- 9 -LRB102 10644 BMS 15973 b

1    the effective date of this amendatory Act of the 99th
2    General Assembly that provides coverage for hospital or
3    medical treatment and for the treatment of mental,
4    emotional, nervous, or substance use disorders or
5    conditions the following provisions shall apply:
6            (A) if the policy does not include an annual limit
7        on substantially all hospital and medical benefits,
8        then the policy may not impose any annual limits on
9        mental, emotional, nervous, or substance use disorder
10        or condition benefits; or
11            (B) if the policy includes an annual limit on
12        substantially all hospital and medical benefits (in
13        this subsection referred to as the "applicable annual
14        limit"), then the policy shall either:
15                (i) apply the applicable annual limit both to
16            the hospital and medical benefits to which it
17            otherwise would apply and to mental, emotional,
18            nervous, or substance use disorder or condition
19            benefits and not distinguish in the application of
20            the limit between the hospital and medical
21            benefits and mental, emotional, nervous, or
22            substance use disorder or condition benefits; or
23                (ii) not include any annual limit on mental,
24            emotional, nervous, or substance use disorder or
25            condition benefits that is less than the
26            applicable annual limit.

 

 

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1        (2) In the case of a policy that is not described in
2    paragraph (1) of subsection (c) of this Section and that
3    includes no or different annual limits on different
4    categories of hospital and medical benefits, the Director
5    shall establish rules under which subparagraph (B) of
6    paragraph (1) of subsection (c) of this Section is applied
7    to such policy with respect to mental, emotional, nervous,
8    or substance use disorder or condition benefits by
9    substituting for the applicable annual limit an average
10    annual limit that is computed taking into account the
11    weighted average of the annual limits applicable to such
12    categories.
13    (d) With respect to mental, emotional, nervous, or
14substance use disorders or conditions, an insurer shall use
15policies and procedures for the election and placement of
16mental, emotional, nervous, or substance use disorder or
17condition treatment drugs on their formulary that are no less
18favorable to the insured as those policies and procedures the
19insurer uses for the selection and placement of drugs for
20medical or surgical conditions and shall follow the expedited
21coverage determination requirements for substance abuse
22treatment drugs set forth in Section 45.2 of the Managed Care
23Reform and Patient Rights Act.
24    (e) This Section shall be interpreted in a manner
25consistent with all applicable federal parity regulations
26including, but not limited to, the Paul Wellstone and Pete

 

 

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1Domenici Mental Health Parity and Addiction Equity Act of
22008, final regulations issued under the Paul Wellstone and
3Pete Domenici Mental Health Parity and Addiction Equity Act of
42008 and final regulations applying the Paul Wellstone and
5Pete Domenici Mental Health Parity and Addiction Equity Act of
62008 to Medicaid managed care organizations, the Children's
7Health Insurance Program, and alternative benefit plans.
8    (f) The provisions of subsections (b) and (c) of this
9Section shall not be interpreted to allow the use of lifetime
10or annual limits otherwise prohibited by State or federal law.
11    (g) As used in this Section:
12    "Financial requirement" includes deductibles, copayments,
13coinsurance, and out-of-pocket maximums, but does not include
14an aggregate lifetime limit or an annual limit subject to
15subsections (b) and (c).
16    "Mental, emotional, nervous, or substance use disorder or
17condition" means a condition or disorder that involves a
18mental health condition or substance use disorder that falls
19under any of the diagnostic categories listed in the mental
20and behavioral disorders chapter of the current edition of the
21International Classification of Disease or that is listed in
22the most recent version of the Diagnostic and Statistical
23Manual of Mental Disorders.
24    "Treatment limitation" includes limits on benefits based
25on the frequency of treatment, number of visits, days of
26coverage, days in a waiting period, or other similar limits on

 

 

HB1957 Enrolled- 12 -LRB102 10644 BMS 15973 b

1the scope or duration of treatment. "Treatment limitation"
2includes both quantitative treatment limitations, which are
3expressed numerically (such as 50 outpatient visits per year),
4and nonquantitative treatment limitations, which otherwise
5limit the scope or duration of treatment. A permanent
6exclusion of all benefits for a particular condition or
7disorder shall not be considered a treatment limitation.
8"Nonquantitative treatment" means those limitations as
9described under federal regulations (26 CFR 54.9812-1).
10"Nonquantitative treatment limitations" include, but are not
11limited to, those limitations described under federal
12regulations 26 CFR 54.9812-1, 29 CFR 2590.712, and 45 CFR
13146.136.
14    (h) The Department of Insurance shall implement the
15following education initiatives:
16        (1) By January 1, 2016, the Department shall develop a
17    plan for a Consumer Education Campaign on parity. The
18    Consumer Education Campaign shall focus its efforts
19    throughout the State and include trainings in the
20    northern, southern, and central regions of the State, as
21    defined by the Department, as well as each of the 5 managed
22    care regions of the State as identified by the Department
23    of Healthcare and Family Services. Under this Consumer
24    Education Campaign, the Department shall: (1) by January
25    1, 2017, provide at least one live training in each region
26    on parity for consumers and providers and one webinar

 

 

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1    training to be posted on the Department website and (2)
2    establish a consumer hotline to assist consumers in
3    navigating the parity process by March 1, 2017. By January
4    1, 2018 the Department shall issue a report to the General
5    Assembly on the success of the Consumer Education
6    Campaign, which shall indicate whether additional training
7    is necessary or would be recommended.
8        (2) The Department, in coordination with the
9    Department of Human Services and the Department of
10    Healthcare and Family Services, shall convene a working
11    group of health care insurance carriers, mental health
12    advocacy groups, substance abuse patient advocacy groups,
13    and mental health physician groups for the purpose of
14    discussing issues related to the treatment and coverage of
15    mental, emotional, nervous, or substance use disorders or
16    conditions and compliance with parity obligations under
17    State and federal law. Compliance shall be measured,
18    tracked, and shared during the meetings of the working
19    group. The working group shall meet once before January 1,
20    2016 and shall meet semiannually thereafter. The
21    Department shall issue an annual report to the General
22    Assembly that includes a list of the health care insurance
23    carriers, mental health advocacy groups, substance abuse
24    patient advocacy groups, and mental health physician
25    groups that participated in the working group meetings,
26    details on the issues and topics covered, and any

 

 

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1    legislative recommendations developed by the working
2    group.
3        (3) Not later than August 1 of each year, the
4    Department, in conjunction with the Department of
5    Healthcare and Family Services, shall issue a joint report
6    to the General Assembly and provide an educational
7    presentation to the General Assembly. The report and
8    presentation shall:
9            (A) Cover the methodology the Departments use to
10        check for compliance with the federal Paul Wellstone
11        and Pete Domenici Mental Health Parity and Addiction
12        Equity Act of 2008, 42 U.S.C. 18031(j), and any
13        federal regulations or guidance relating to the
14        compliance and oversight of the federal Paul Wellstone
15        and Pete Domenici Mental Health Parity and Addiction
16        Equity Act of 2008 and 42 U.S.C. 18031(j).
17            (B) Cover the methodology the Departments use to
18        check for compliance with this Section and Sections
19        356z.23 and 370c of this Code.
20            (C) Identify market conduct examinations or, in
21        the case of the Department of Healthcare and Family
22        Services, audits conducted or completed during the
23        preceding 12-month period regarding compliance with
24        parity in mental, emotional, nervous, and substance
25        use disorder or condition benefits under State and
26        federal laws and summarize the results of such market

 

 

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1        conduct examinations and audits. This shall include:
2                (i) the number of market conduct examinations
3            and audits initiated and completed;
4                (ii) the benefit classifications examined by
5            each market conduct examination and audit;
6                (iii) the subject matter of each market
7            conduct examination and audit, including
8            quantitative and nonquantitative treatment
9            limitations; and
10                (iv) a summary of the basis for the final
11            decision rendered in each market conduct
12            examination and audit.
13            Individually identifiable information shall be
14        excluded from the reports consistent with federal
15        privacy protections.
16            (D) Detail any educational or corrective actions
17        the Departments have taken to ensure compliance with
18        the federal Paul Wellstone and Pete Domenici Mental
19        Health Parity and Addiction Equity Act of 2008, 42
20        U.S.C. 18031(j), this Section, and Sections 356z.23
21        and 370c of this Code.
22            (E) The report must be written in non-technical,
23        readily understandable language and shall be made
24        available to the public by, among such other means as
25        the Departments find appropriate, posting the report
26        on the Departments' websites.

 

 

HB1957 Enrolled- 16 -LRB102 10644 BMS 15973 b

1    (i) The Parity Advancement Fund is created as a special
2fund in the State treasury. Moneys from fines and penalties
3collected from insurers for violations of this Section shall
4be deposited into the Fund. Moneys deposited into the Fund for
5appropriation by the General Assembly to the Department shall
6be used for the purpose of providing financial support of the
7Consumer Education Campaign, parity compliance advocacy, and
8other initiatives that support parity implementation and
9enforcement on behalf of consumers.
10    (j) The Department of Insurance and the Department of
11Healthcare and Family Services shall convene and provide
12technical support to a workgroup of 11 members that shall be
13comprised of 3 mental health parity experts recommended by an
14organization advocating on behalf of mental health parity
15appointed by the President of the Senate; 3 behavioral health
16providers recommended by an organization that represents
17behavioral health providers appointed by the Speaker of the
18House of Representatives; 2 representing Medicaid managed care
19organizations recommended by an organization that represents
20Medicaid managed care plans appointed by the Minority Leader
21of the House of Representatives; 2 representing commercial
22insurers recommended by an organization that represents
23insurers appointed by the Minority Leader of the Senate; and a
24representative of an organization that represents Medicaid
25managed care plans appointed by the Governor.
26    The workgroup shall provide recommendations to the General

 

 

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1Assembly on health plan data reporting requirements that
2separately break out data on mental, emotional, nervous, or
3substance use disorder or condition benefits and data on other
4medical benefits, including physical health and related health
5services no later than December 31, 2019. The recommendations
6to the General Assembly shall be filed with the Clerk of the
7House of Representatives and the Secretary of the Senate in
8electronic form only, in the manner that the Clerk and the
9Secretary shall direct. This workgroup shall take into account
10federal requirements and recommendations on mental health
11parity reporting for the Medicaid program. This workgroup
12shall also develop the format and provide any needed
13definitions for reporting requirements in subsection (k). The
14research and evaluation of the working group shall include,
15but not be limited to:
16        (1) claims denials due to benefit limits, if
17    applicable;
18        (2) administrative denials for no prior authorization;
19        (3) denials due to not meeting medical necessity;
20        (4) denials that went to external review and whether
21    they were upheld or overturned for medical necessity;
22        (5) out-of-network claims;
23        (6) emergency care claims;
24        (7) network directory providers in the outpatient
25    benefits classification who filed no claims in the last 6
26    months, if applicable;

 

 

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1        (8) the impact of existing and pertinent limitations
2    and restrictions related to approved services, licensed
3    providers, reimbursement levels, and reimbursement
4    methodologies within the Division of Mental Health, the
5    Division of Substance Use Prevention and Recovery
6    programs, the Department of Healthcare and Family
7    Services, and, to the extent possible, federal regulations
8    and law; and
9        (9) when reporting and publishing should begin.
10    Representatives from the Department of Healthcare and
11Family Services, representatives from the Division of Mental
12Health, and representatives from the Division of Substance Use
13Prevention and Recovery shall provide technical advice to the
14workgroup.
15    (k) An insurer that amends, delivers, issues, or renews a
16group or individual policy of accident and health insurance or
17a qualified health plan offered through the health insurance
18marketplace in this State providing coverage for hospital or
19medical treatment and for the treatment of mental, emotional,
20nervous, or substance use disorders or conditions shall submit
21an annual report, the format and definitions for which will be
22developed by the workgroup in subsection (j), to the
23Department, or, with respect to medical assistance, the
24Department of Healthcare and Family Services starting on or
25before July 1, 2020 that contains the following information
26separately for inpatient in-network benefits, inpatient

 

 

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1out-of-network benefits, outpatient in-network benefits,
2outpatient out-of-network benefits, emergency care benefits,
3and prescription drug benefits in the case of accident and
4health insurance or qualified health plans, or inpatient,
5outpatient, emergency care, and prescription drug benefits in
6the case of medical assistance:
7        (1) A summary of the plan's pharmacy management
8    processes for mental, emotional, nervous, or substance use
9    disorder or condition benefits compared to those for other
10    medical benefits.
11        (2) A summary of the internal processes of review for
12    experimental benefits and unproven technology for mental,
13    emotional, nervous, or substance use disorder or condition
14    benefits and those for other medical benefits.
15        (3) A summary of how the plan's policies and
16    procedures for utilization management for mental,
17    emotional, nervous, or substance use disorder or condition
18    benefits compare to those for other medical benefits.
19        (4) A description of the process used to develop or
20    select the medical necessity criteria for mental,
21    emotional, nervous, or substance use disorder or condition
22    benefits and the process used to develop or select the
23    medical necessity criteria for medical and surgical
24    benefits.
25        (5) Identification of all nonquantitative treatment
26    limitations that are applied to both mental, emotional,

 

 

HB1957 Enrolled- 20 -LRB102 10644 BMS 15973 b

1    nervous, or substance use disorder or condition benefits
2    and medical and surgical benefits within each
3    classification of benefits.
4        (6) The results of an analysis that demonstrates that
5    for the medical necessity criteria described in
6    subparagraph (A) and for each nonquantitative treatment
7    limitation identified in subparagraph (B), as written and
8    in operation, the processes, strategies, evidentiary
9    standards, or other factors used in applying the medical
10    necessity criteria and each nonquantitative treatment
11    limitation to mental, emotional, nervous, or substance use
12    disorder or condition benefits within each classification
13    of benefits are comparable to, and are applied no more
14    stringently than, the processes, strategies, evidentiary
15    standards, or other factors used in applying the medical
16    necessity criteria and each nonquantitative treatment
17    limitation to medical and surgical benefits within the
18    corresponding classification of benefits; at a minimum,
19    the results of the analysis shall:
20            (A) identify the factors used to determine that a
21        nonquantitative treatment limitation applies to a
22        benefit, including factors that were considered but
23        rejected;
24            (B) identify and define the specific evidentiary
25        standards used to define the factors and any other
26        evidence relied upon in designing each nonquantitative

 

 

HB1957 Enrolled- 21 -LRB102 10644 BMS 15973 b

1        treatment limitation;
2            (C) provide the comparative analyses, including
3        the results of the analyses, performed to determine
4        that the processes and strategies used to design each
5        nonquantitative treatment limitation, as written, for
6        mental, emotional, nervous, or substance use disorder
7        or condition benefits are comparable to, and are
8        applied no more stringently than, the processes and
9        strategies used to design each nonquantitative
10        treatment limitation, as written, for medical and
11        surgical benefits;
12            (D) provide the comparative analyses, including
13        the results of the analyses, performed to determine
14        that the processes and strategies used to apply each
15        nonquantitative treatment limitation, in operation,
16        for mental, emotional, nervous, or substance use
17        disorder or condition benefits are comparable to, and
18        applied no more stringently than, the processes or
19        strategies used to apply each nonquantitative
20        treatment limitation, in operation, for medical and
21        surgical benefits; and
22            (E) disclose the specific findings and conclusions
23        reached by the insurer that the results of the
24        analyses described in subparagraphs (C) and (D)
25        indicate that the insurer is in compliance with this
26        Section and the Mental Health Parity and Addiction

 

 

HB1957 Enrolled- 22 -LRB102 10644 BMS 15973 b

1        Equity Act of 2008 and its implementing regulations,
2        which includes 42 CFR Parts 438, 440, and 457 and 45
3        CFR 146.136 and any other related federal regulations
4        found in the Code of Federal Regulations.
5        (7) Any other information necessary to clarify data
6    provided in accordance with this Section requested by the
7    Director, including information that may be proprietary or
8    have commercial value, under the requirements of Section
9    30 of the Viatical Settlements Act of 2009.
10    (l) An insurer that amends, delivers, issues, or renews a
11group or individual policy of accident and health insurance or
12a qualified health plan offered through the health insurance
13marketplace in this State providing coverage for hospital or
14medical treatment and for the treatment of mental, emotional,
15nervous, or substance use disorders or conditions on or after
16the effective date of this amendatory Act of the 100th General
17Assembly shall, in advance of the plan year, make available to
18the Department or, with respect to medical assistance, the
19Department of Healthcare and Family Services and to all plan
20participants and beneficiaries the information required in
21subparagraphs (C) through (E) of paragraph (6) of subsection
22(k). For plan participants and medical assistance
23beneficiaries, the information required in subparagraphs (C)
24through (E) of paragraph (6) of subsection (k) shall be made
25available on a publicly-available website whose web address is
26prominently displayed in plan and managed care organization

 

 

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1informational and marketing materials.
2    (m) In conjunction with its compliance examination program
3conducted in accordance with the Illinois State Auditing Act,
4the Auditor General shall undertake a review of compliance by
5the Department and the Department of Healthcare and Family
6Services with Section 370c and this Section. Any findings
7resulting from the review conducted under this Section shall
8be included in the applicable State agency's compliance
9examination report. Each compliance examination report shall
10be issued in accordance with Section 3-14 of the Illinois
11State Auditing Act. A copy of each report shall also be
12delivered to the head of the applicable State agency and
13posted on the Auditor General's website.
14(Source: P.A. 99-480, eff. 9-9-15; 100-1024, eff. 1-1-19.)
 
15    (215 ILCS 5/500-30)
16    (Section scheduled to be repealed on January 1, 2027)
17    Sec. 500-30. Application for license.
18    (a) An individual applying for a resident insurance
19producer license must make application on a form specified by
20the Director and declare under penalty of refusal, suspension,
21or revocation of the license that the statements made in the
22application are true, correct, and complete to the best of the
23individual's knowledge and belief. Before approving the
24application, the Director must find that the individual:
25        (1) is at least 18 years of age;

 

 

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1        (2) is sufficiently rehabilitated in cases in which
2    the applicant has committed any act that is a ground for
3    denial, suspension, or revocation set forth in Section
4    500-70, other than convictions set forth in paragraph (6)
5    of subsection (a) of Section 500-70; with respect to
6    applicants with convictions set forth in paragraph (6) of
7    subsection (a) of Section 500-70, the Director shall
8    determine in accordance with Section 500-76 that the
9    conviction will not impair the ability of the applicant to
10    engage in the position for which a license is sought;
11        (3) has completed, if required by the Director, a
12    pre-licensing course of study before the insurance exam
13    for the lines of authority for which the individual has
14    applied (an individual who successfully completes the Fire
15    and Casualty pre-licensing courses also meets the
16    requirements for Personal Lines-Property and Casualty);
17        (4) has paid the fees set forth in Section 500-135;
18    and
19        (5) has successfully passed the examinations for the
20    lines of authority for which the person has applied.
21    (b) A pre-licensing course of study for each class of
22insurance for which an insurance producer license is requested
23must be established in accordance with rules prescribed by the
24Director and must consist of the following minimum hours:
25Class of InsuranceNumber of
26Hours

 

 

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1Life (Class 1(a))20
2Accident and Health (Class 1(b) or 2(a))20
3Fire (Class 3)20
4Casualty (Class 2)20
5Personal Lines-Property Casualty20
6Motor Vehicle (Class 2(b) or 3(e))12.5
7    7.5 hours of each pre-licensing course must be completed
8in a classroom or webinar setting, except Motor Vehicle, which
9would require 5 hours in a classroom or webinar setting.
10    (c) A business entity acting as an insurance producer must
11obtain an insurance producer license. Application must be made
12using the Uniform Business Entity Application. Before
13approving the application, the Director must find that:
14        (1) the business entity has paid the fees set forth in
15    Section 500-135; and
16        (2) the business entity has designated a licensed
17    producer responsible for the business entity's compliance
18    with the insurance laws and rules of this State.
19    (d) The Director may require any documents reasonably
20necessary to verify the information contained in an
21application.
22(Source: P.A. 100-286, eff. 1-1-18.)
 
23    (215 ILCS 5/500-130)
24    (Section scheduled to be repealed on January 1, 2027)
25    Sec. 500-130. Bond required of insurance producers.

 

 

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1    (a) An insurance producer who places insurance either
2directly or indirectly with an insurer with which the
3insurance producer does not have an agency contract agent
4contact must maintain in force while licensed a bond in favor
5of the people of the State of Illinois executed by an
6authorized surety company and payable to any party injured
7under the terms of the bond. The bond shall be continuous in
8form and in the amount of $2,500 or 5% of the premiums brokered
9in the previous calendar year, whichever is greater, but not
10to exceed $50,000 total aggregate liability. The bond shall be
11conditioned upon full accounting and due payment to the person
12or company entitled thereto, of funds coming into the
13insurance producer's possession as an incident to insurance
14transactions under the license or surplus line insurance
15transactions under the license as a surplus line producer.
16    (b) Authorized insurance producers of a business entity
17may meet the requirements of this Section with a bond in the
18name of the business entity, continuous in form, and in the
19amounts set forth in subsection (a) of this Section. Insurance
20producers may meet the requirements of this Section with a
21bond in the name of an association. An individual producer
22remains responsible for assuring that a producer bond is in
23effect and is for the correct amount. The association must
24have been in existence for 5 years, have common membership,
25and been formed for a purpose other than obtaining a bond.
26    (c) The surety may cancel the bond and be released from

 

 

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1further liability thereunder upon 30 days' written notice in
2advance to the principal. The cancellation does not affect any
3liability incurred or accrued under the bond before the
4termination of the 30-day period.
5    (d) The producer's license may be revoked if the producer
6acts without a bond that is required under this Section.
7    (e) If a party injured under the terms of the bond requests
8the producer to provide the name of the surety and the bond
9number, the producer must provide the information within 3
10working days after receiving the request.
11    (f) An association may meet the requirements of this
12Section for all of its members with a bond in the name of the
13association that is continuous in form and in the amounts set
14forth in subsection (a) of this Section.
15(Source: P.A. 92-386, eff. 1-1-02.)
 
16    (215 ILCS 5/1510)
17    Sec. 1510. Definitions. In this Article:
18    "Adjusting a claim for loss or damage covered by an
19insurance contract" means negotiating values, damages, or
20depreciation or applying the loss circumstances to insurance
21policy provisions.
22    "Business entity" means a corporation, association,
23partnership, limited liability company, limited liability
24partnership, or other legal entity.
25    "Department" means the Department of Insurance.

 

 

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1    "Director" means the Director of Insurance.
2    "Fingerprints" means an impression of the lines on the
3finger taken for the purpose of identification. The impression
4may be electronic or in ink converted to electronic format.
5    "Home state" means the District of Columbia and any state
6or territory of the United States where the public adjuster's
7principal place of residence or principal place of business is
8located. If neither the state in which the public adjuster
9maintains the principal place of residence nor the state in
10which the public adjuster maintains the principal place of
11business has a substantially similar law governing public
12adjusters, the public adjuster may declare another state in
13which it becomes licensed and acts as a public adjuster to be
14the home state.
15    "Individual" means a natural person.
16    "Person" means an individual or a business entity.
17    "Public adjuster" means any person who, for compensation
18or any other thing of value on behalf of the insured:
19        (i) acts or aids, solely in relation to first party
20    claims arising under insurance contracts that insure the
21    real or personal property of the insured, on behalf of an
22    insured in adjusting a claim for loss or damage covered by
23    an insurance contract;
24        (ii) advertises for employment as a public adjuster of
25    insurance claims or solicits business or represents
26    himself or herself to the public as a public adjuster of

 

 

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1    first party insurance claims for losses or damages arising
2    out of policies of insurance that insure real or personal
3    property; or
4        (iii) directly or indirectly solicits business,
5    investigates or adjusts losses, or advises an insured
6    about first party claims for losses or damages arising out
7    of policies of insurance that insure real or personal
8    property for another person engaged in the business of
9    adjusting losses or damages covered by an insurance policy
10    for the insured.
11    "Uniform individual application" means the current version
12of the National Association of Directors (NAIC) Uniform
13Individual Application for resident and nonresident
14individuals.
15    "Uniform business entity application" means the current
16version of the National Association of Insurance Commissioners
17(NAIC) Uniform Business Entity Application for resident and
18nonresident business entities.
19    "Webinar" means an online educational presentation during
20which a live and participating instructor and participating
21viewers, whose attendance is periodically verified throughout
22the presentation, actively engage in discussion and in the
23submission and answering of questions.
24(Source: P.A. 96-1332, eff. 1-1-11.)
 
25    (215 ILCS 5/1565)

 

 

HB1957 Enrolled- 30 -LRB102 10644 BMS 15973 b

1    Sec. 1565. Continuing education.
2    (a) An individual who holds a public adjuster license and
3who is not exempt under subsection (b) of this Section shall
4satisfactorily complete a minimum of 24 hours of continuing
5education courses, including 3 hours of classroom or webinar
6ethics instruction, reported on a biennial basis in
7conjunction with the license renewal cycle.
8    The Director may not approve a course of study unless the
9course provides for classroom, seminar, or self-study
10instruction methods. A course given in a combination
11instruction method of classroom or seminar and self-study
12shall be deemed to be a self-study course unless the classroom
13or seminar certified hours meets or exceeds two-thirds of the
14total hours certified for the course. The self-study material
15used in the combination course must be directly related to and
16complement the classroom portion of the course in order to be
17considered for credit. An instruction method other than
18classroom or seminar shall be considered as self-study
19methodology. Self-study credit hours require the successful
20completion of an examination covering the self-study material.
21The examination may not be self-evaluated. However, if the
22self-study material is completed through the use of an
23approved computerized interactive format whereby the computer
24validates the successful completion of the self-study
25material, no additional examination is required. The
26self-study credit hours contained in a certified course shall

 

 

HB1957 Enrolled- 31 -LRB102 10644 BMS 15973 b

1be considered classroom hours when at least two-thirds of the
2hours are given as classroom or seminar instruction.
3    The public adjuster must complete the course in advance of
4the renewal date to allow the education provider time to
5report the credit to the Department.
6    (b) This Section shall not apply to:
7        (1) licensees not licensed for one full year prior to
8    the end of the applicable continuing education biennium;
9    or
10        (2) licensees holding nonresident public adjuster
11    licenses who have met the continuing education
12    requirements of their home state and whose home state
13    gives credit to residents of this State on the same basis.
14    (c) Only continuing education courses approved by the
15Director shall be used to satisfy the continuing education
16requirement of subsection (a) of this Section.
17(Source: P.A. 96-1332, eff. 1-1-11.)
 
18    (215 ILCS 5/Art. XXXI.75 rep.)
19    Section 10. The Illinois Insurance Code is amended by
20repealing Article XXXI 3/4.
 
21    Section 99. Effective date. This Act takes effect upon
22becoming law, except that the changes to Section 107a.12 of
23the Illinois Insurance Code take effect January 1, 2022.