Full Text of HB0471 101st General Assembly
HB0471ham002 101ST GENERAL ASSEMBLY | Rep. Bob Morgan Filed: 4/5/2019
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| 1 | | AMENDMENT TO HOUSE BILL 471
| 2 | | AMENDMENT NO. ______. Amend House Bill 471 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Insurance Code is amended by | 5 | | changing Section 355 as follows:
| 6 | | (215 ILCS 5/355) (from Ch. 73, par. 967)
| 7 | | Sec. 355. Accident
and health policies; provisions. | 8 | | policies-Provisions.)
| 9 | | (a) As used in this Section, "unreasonable rate increase" | 10 | | means a rate increase that the Director determines to be | 11 | | excessive, unjustified, or unfairly discriminatory in | 12 | | accordance with 45 CFR 154.205. | 13 | | (b) No policy of insurance against loss or damage from the | 14 | | sickness, or from
the bodily injury or death of the insured by | 15 | | accident shall be issued or
delivered to any person in this | 16 | | State until a copy of the form thereof and
of the |
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| 1 | | classification of risks and the premium rates pertaining | 2 | | thereto
have been filed with the Director; nor shall it be so | 3 | | issued or delivered
until the Director shall have approved such | 4 | | policy pursuant to the provisions
of Section 143. If the | 5 | | Director
disapproves the policy form he shall make a written | 6 | | decision stating the
respects in which such form does not | 7 | | comply with the requirements of law
and shall deliver a copy | 8 | | thereof to the company and it shall be unlawful
thereafter for | 9 | | any such company to issue any policy in such form. | 10 | | (c) All individual and small group accident and health | 11 | | policies written in compliance with the Patient Protection and | 12 | | Affordable Care Act must file rates with the Department for | 13 | | approval. Rate increases found to be unreasonable rate | 14 | | increases in relation to benefits under the policy provided | 15 | | shall be disapproved. The Department shall provide a report to | 16 | | the General Assembly on or after January 1, 2021, regarding | 17 | | both on and off exchange individual and small group rates in | 18 | | the Illinois market.
| 19 | | (d) A rate increase filed under this Section must be | 20 | | approved or denied within 60 calendar days after the date the | 21 | | rate increase is filed with the Department. Any rate increase | 22 | | that is not approved or denied by the Department shall | 23 | | automatically be approved on the 61st calendar day. | 24 | | (e) No less than 30 days after the federal Centers for | 25 | | Medicare and Medicaid Services has certified the policies | 26 | | described in this Section for the upcoming plan year, the |
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| 1 | | Department shall publish on its website a report explaining the | 2 | | rates for the subsequent calendar year's certified policies. | 3 | | (Source: P.A. 79-777.)
| 4 | | Section 10. The Health Maintenance Organization Act is | 5 | | amended by changing Section 4-12 as follows:
| 6 | | (215 ILCS 125/4-12) (from Ch. 111 1/2, par. 1409.5)
| 7 | | Sec. 4-12. Changes in Rate Methodology and Benefits, | 8 | | Material
Modifications. A health maintenance organization | 9 | | shall file with the
Director, prior to use, a notice of any | 10 | | change in rate methodology, or
benefits and of any material | 11 | | modification of any matter or document
furnished pursuant to | 12 | | Section 2-1, together with such supporting documents
as are | 13 | | necessary to fully explain the change or modification.
| 14 | | (a) Contract modifications described in subsections | 15 | | (c)(5), (c)(6) and
(c)(7) of Section 2-1 shall include all form | 16 | | agreements between the
organization and enrollees, providers, | 17 | | administrators of services and
insurers of health maintenance | 18 | | organizations.
| 19 | | (b) Material transactions or series of transactions other | 20 | | than those
described in subsection (a) of this Section, the | 21 | | total annual value of
which exceeds the greater of $100,000 or | 22 | | 5% of net earned subscription
revenue for the most current | 23 | | twelve month period as determined from filed
financial | 24 | | statements.
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| 1 | | (c) Any agreement between the organization and an insurer | 2 | | shall be
subject to the provisions of the laws of this State | 3 | | regarding reinsurance
as provided in Article XI of the Illinois | 4 | | Insurance Code. All reinsurance
agreements must be filed. | 5 | | Approval of the Director is required for all
agreements except | 6 | | the following: individual stop loss, aggregate excess,
| 7 | | hospitalization benefits or out-of-area of the participating | 8 | | providers
unless 20% or more of the organization's total risk | 9 | | is reinsured, in which
case all reinsurance agreements require | 10 | | approval. | 11 | | (d) All individual and small group accident and health | 12 | | policies written in compliance with the Patient Protection and | 13 | | Affordable Care Act must file rates with the Department for | 14 | | approval. Rate increases found to be unreasonable rate | 15 | | increases in relation to benefits under the policy provided | 16 | | shall be disapproved. The Department shall provide a report to | 17 | | the General Assembly on or after January 1, 2021, regarding | 18 | | both on and off exchange individual and small group rates in | 19 | | the Illinois market.
| 20 | | (e) A rate increase filed under this Section must be | 21 | | approved or denied within 60 calendar days after the date the | 22 | | rate increase is filed with the Department. Any rate increase | 23 | | that is not approved or denied by the Department shall | 24 | | automatically be approved on the 61st calendar day. | 25 | | (f) No less than 30 days after the federal Centers for | 26 | | Medicare and Medicaid Services has certified the policies |
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| 1 | | described in this Section for the upcoming plan year, the | 2 | | Department shall publish on its website a report explaining the | 3 | | rates for the subsequent calendar year's certified policies. | 4 | | (g) As used in this Section, "unreasonable rate increase" | 5 | | means a rate increase that the Director determines to be | 6 | | excessive, unjustified, or unfairly discriminatory in | 7 | | accordance with 45 CFR 154.205. | 8 | | (Source: P.A. 86-620.)".
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