Bill Amendment: IL SB0665 | 2019-2020 | 101st General Assembly

NOTE: For additional amemendments please see the Bill Drafting List

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Bill Title: REGULATION-TECH

Status: 2021-01-13 - Session Sine Die [SB0665 Detail]

Download: Illinois-2019-SB0665-Senate_Amendment_001.html

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Sen. Laura Fine

Filed: 5/29/2019

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AMENDMENT TO SENATE BILL 665
AMENDMENT NO. ______. Amend Senate Bill 665 by replacing
everything after the enacting clause with the following:
"Section 5. The Illinois Insurance Code is amended by
changing Section 355 as follows:
(215 ILCS 5/355) (from Ch. 73, par. 967)
Sec. 355. Accident and health policies; provisions.
policies-Provisions.)
(a) As used in this Section:
"Inadequate rate" means a rate:
(1) that is insufficient to sustain projected losses
and expenses to which the rate applies; and
(2) the continued use of which endangers the solvency
of an insurer using that rate.
"Unreasonable rate increase" means a rate increase that the
Director determines to be excessive, unjustified, or unfairly

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discriminatory in accordance with 45 CFR 154.205.
(b) No policy of insurance against loss or damage from the
sickness, or from the bodily injury or death of the insured by
accident shall be issued or delivered to any person in this
State until a copy of the form thereof and of the
classification of risks and the premium rates pertaining
thereto have been filed with the Director; nor shall it be so
issued or delivered until the Director shall have approved such
policy pursuant to the provisions of Section 143. If the
Director disapproves the policy form he shall make a written
decision stating the respects in which such form does not
comply with the requirements of law and shall deliver a copy
thereof to the company and it shall be unlawful thereafter for
any such company to issue any policy in such form.
(c) Rate increases for all individual and small group
accident and health insurance policies subject to the standards
of 45 CFR Part 154 must be filed with the Department for
approval. Unreasonable rate increases or inadequate rates
shall be disapproved. The Department shall provide a report to
the General Assembly on or after January 1, 2021 regarding both
on and off exchange individual and small group rates in the
Illinois market.
(d) In all cases the Director shall approve or disapprove a
rate filing under subsection (c) within 45 calendar days of
submission unless the Director extends, by not more than an
additional 30 days, the period within which he or she shall

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approve or disapprove any such filing by giving written notice
to the insurer of such extension before expiration of the
initial 45-day period. Rates not approved or disapproved by the
applicable deadline shall be deemed approved on the following
calendar day.
(e) No less than 30 days after the federal Centers for
Medicare and Medicaid Services has certified the policies
described in subsection (c) for the upcoming plan year, the
Department shall publish on its website a report explaining the
rates for that plan year's certified policies.
(Source: P.A. 79-777.)
Section 10. The Health Maintenance Organization Act is
amended by changing Section 4-12 as follows:
(215 ILCS 125/4-12) (from Ch. 111 1/2, par. 1409.5)
Sec. 4-12. Changes in Rate Methodology and Benefits,
Material Modifications. A health maintenance organization
shall file with the Director, prior to use, a notice of any
change in rate methodology, or benefits and of any material
modification of any matter or document furnished pursuant to
Section 2-1, together with such supporting documents as are
necessary to fully explain the change or modification.
(a) Contract modifications described in subsections
(c)(5), (c)(6) and (c)(7) of Section 2-1 shall include all form
agreements between the organization and enrollees, providers,

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administrators of services and insurers of health maintenance
organizations.
(b) Material transactions or series of transactions other
than those described in subsection (a) of this Section, the
total annual value of which exceeds the greater of $100,000 or
5% of net earned subscription revenue for the most current
twelve month period as determined from filed financial
statements.
(c) Any agreement between the organization and an insurer
shall be subject to the provisions of the laws of this State
regarding reinsurance as provided in Article XI of the Illinois
Insurance Code. All reinsurance agreements must be filed.
Approval of the Director is required for all agreements except
the following: individual stop loss, aggregate excess,
hospitalization benefits or out-of-area of the participating
providers unless 20% or more of the organization's total risk
is reinsured, in which case all reinsurance agreements require
approval.
(d) Rate increases for all individual and small group
health care plans subject to the standards of 45 CFR Part 154
must be filed with the Department for approval. Unreasonable
rate increases in relation to benefits under the policy
provided or inadequate rates shall be disapproved. The
Department shall provide a report to the General Assembly on or
after January 1, 2021 regarding both on and off exchange
individual and small group rates in the Illinois market.

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(e) In all cases the Director shall approve or disapprove a
rate filing under subsection (d) within 45 calendar days of
submission unless the Director extends, by not more than an
additional 30 days, the period within which he or she shall
approve or disapprove any such filing by giving written notice
to the insurer of such extension before expiration of the
initial 45-day period. Rates not approved or disapproved by the
applicable deadline shall be deemed approved on the following
calendar day.
(f) No less than 30 days after the federal Centers for
Medicare and Medicaid Services has certified the health care
plans described in subsection (d) for the upcoming plan year,
the Department shall publish on its website a report explaining
the rates for that plan year's certified health care plans.
(g) As used in this Section:
"Inadequate rate" means a rate:
(1) that is insufficient to sustain projected losses
and expenses to which the rate applies; and
(2) the continued use of which endangers the solvency
of an insurer using that rate.
"Unreasonable rate increase" means a rate increase that the
Director determines to be excessive, unjustified, or unfairly
discriminatory in accordance with 45 CFR 154.205.
(Source: P.A. 86-620.)".