Full Text of HB0815 101st General Assembly
HB0815ham002 101ST GENERAL ASSEMBLY | Rep. Bob Morgan Filed: 3/21/2019
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| 1 | | AMENDMENT TO HOUSE BILL 815
| 2 | | AMENDMENT NO. ______. Amend House Bill 815 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 and by adding Section 351A-7.5 as follows: | 6 | | (215 ILCS 5/351A-7.5 new) | 7 | | Sec. 351A-7.5. Rate approval; rate transparency. | 8 | | (a) All long-term care policies issued, amended, renewed, | 9 | | or delivered on or after the effective date of this amendatory | 10 | | Act of the 101st General Assembly must submit for Director | 11 | | approval of all proposed rate changes. Rate increases not found | 12 | | to be reasonable in relation to benefits under the policy | 13 | | provided shall be disapproved. Additionally, all rates are | 14 | | subject to all minimum loss ratio requirements as outlined in | 15 | | the Illinois Administrative Code pursuant to Section 351A-11 of | 16 | | this Code. |
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| 1 | | (b) The Department shall accept comments on all rates as | 2 | | defined in this Code and shall deliver an annual report to the | 3 | | General Assembly beginning on or after January 1, 2021, | 4 | | regarding long-term rate changes in the Illinois market.
| 5 | | (215 ILCS 5/355) (from Ch. 73, par. 967)
| 6 | | Sec. 355. Accident
and health policies-Provisions.)
| 7 | | (a) No policy of insurance against loss or damage from the | 8 | | sickness, or from
the bodily injury or death of the insured by | 9 | | accident shall be issued or
delivered to any person in this | 10 | | State until a copy of the form thereof and
of the | 11 | | classification of risks and the premium rates pertaining | 12 | | thereto
have been filed with the Director; nor shall it be so | 13 | | issued or delivered
until the Director shall have approved such | 14 | | policy pursuant to the provisions
of Section 143. If the | 15 | | Director
disapproves the policy form he shall make a written | 16 | | decision stating the
respects in which such form does not | 17 | | comply with the requirements of law
and shall deliver a copy | 18 | | thereof to the company and it shall be unlawful
thereafter for | 19 | | any such company to issue any policy in such form. | 20 | | (b) All individual and small group accident and health | 21 | | policies written in compliance with the Patient Protection and | 22 | | Affordable Care Act must file rates for approval. Rate | 23 | | increases not found to be reasonable in relation to benefits | 24 | | under the policy provided shall be disapproved. The Department | 25 | | shall provide a report to the General Assembly on or after |
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| 1 | | January 1, 2021, regarding both on and off exchange individual | 2 | | and small group rates in the Illinois market.
| 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 health plans written in | 12 | | compliance with the Patient Protection and Affordable Care Act | 13 | | must file rates for approval. Rate increases not found to be | 14 | | reasonable 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 | | (Source: P.A. 86-620.)".
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