Bill Amendment: IL SB0665 | 2019-2020 | 101st General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: REGULATION-TECH
Status: 2021-01-13 - Session Sine Die [SB0665 Detail]
Download: Illinois-2019-SB0665-Senate_Amendment_001.html
Bill Title: REGULATION-TECH
Status: 2021-01-13 - Session Sine Die [SB0665 Detail]
Download: Illinois-2019-SB0665-Senate_Amendment_001.html
| |||||||
| |||||||
| |||||||
1 | AMENDMENT TO SENATE BILL 665
| ||||||
2 | AMENDMENT NO. ______. Amend Senate Bill 665 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: | ||||||
10 | "Inadequate rate" means a rate: | ||||||
11 | (1) that is insufficient to sustain projected losses | ||||||
12 | and expenses to which the rate applies; and | ||||||
13 | (2) the continued use of which endangers the solvency | ||||||
14 | of an insurer using that rate. | ||||||
15 | "Unreasonable rate increase" means a rate increase that the | ||||||
16 | Director determines to be excessive, unjustified, or unfairly |
| |||||||
| |||||||
1 | discriminatory in accordance with 45 CFR 154.205. | ||||||
2 | (b) No policy of insurance against loss or damage from the | ||||||
3 | sickness, or from
the bodily injury or death of the insured by | ||||||
4 | accident shall be issued or
delivered to any person in this | ||||||
5 | State until a copy of the form thereof and
of the | ||||||
6 | classification of risks and the premium rates pertaining | ||||||
7 | thereto
have been filed with the Director; nor shall it be so | ||||||
8 | issued or delivered
until the Director shall have approved such | ||||||
9 | policy pursuant to the provisions
of Section 143. If the | ||||||
10 | Director
disapproves the policy form he shall make a written | ||||||
11 | decision stating the
respects in which such form does not | ||||||
12 | comply with the requirements of law
and shall deliver a copy | ||||||
13 | thereof to the company and it shall be unlawful
thereafter for | ||||||
14 | any such company to issue any policy in such form. | ||||||
15 | (c) Rate increases for all individual and small group | ||||||
16 | accident and health insurance policies subject to the standards | ||||||
17 | of 45 CFR Part 154 must be filed with the Department for | ||||||
18 | approval. Unreasonable rate increases or inadequate rates | ||||||
19 | shall be disapproved. The Department shall provide a report to | ||||||
20 | the General Assembly on or after January 1, 2021 regarding both | ||||||
21 | on and off exchange individual and small group rates in the | ||||||
22 | Illinois market.
| ||||||
23 | (d) In all cases the Director shall approve or disapprove a | ||||||
24 | rate filing under subsection (c) within 45 calendar days of | ||||||
25 | submission unless the Director extends, by not more than an | ||||||
26 | additional 30 days, the period within which he or she shall |
| |||||||
| |||||||
1 | approve or disapprove any such filing by giving written notice | ||||||
2 | to the insurer of such extension before expiration of the | ||||||
3 | initial 45-day period. Rates not approved or disapproved by the | ||||||
4 | applicable deadline shall be deemed approved on the following | ||||||
5 | calendar day. | ||||||
6 | (e) No less than 30 days after the federal Centers for | ||||||
7 | Medicare and Medicaid Services has certified the policies | ||||||
8 | described in subsection (c) for the upcoming plan year, the | ||||||
9 | Department shall publish on its website a report explaining the | ||||||
10 | rates for that plan year's certified policies. | ||||||
11 | (Source: P.A. 79-777.)
| ||||||
12 | Section 10. The Health Maintenance Organization Act is | ||||||
13 | amended by changing Section 4-12 as follows:
| ||||||
14 | (215 ILCS 125/4-12) (from Ch. 111 1/2, par. 1409.5)
| ||||||
15 | Sec. 4-12. Changes in Rate Methodology and Benefits, | ||||||
16 | Material
Modifications. A health maintenance organization | ||||||
17 | shall file with the
Director, prior to use, a notice of any | ||||||
18 | change in rate methodology, or
benefits and of any material | ||||||
19 | modification of any matter or document
furnished pursuant to | ||||||
20 | Section 2-1, together with such supporting documents
as are | ||||||
21 | necessary to fully explain the change or modification.
| ||||||
22 | (a) Contract modifications described in subsections | ||||||
23 | (c)(5), (c)(6) and
(c)(7) of Section 2-1 shall include all form | ||||||
24 | agreements between the
organization and enrollees, providers, |
| |||||||
| |||||||
1 | administrators of services and
insurers of health maintenance | ||||||
2 | organizations.
| ||||||
3 | (b) Material transactions or series of transactions other | ||||||
4 | than those
described in subsection (a) of this Section, the | ||||||
5 | total annual value of
which exceeds the greater of $100,000 or | ||||||
6 | 5% of net earned subscription
revenue for the most current | ||||||
7 | twelve month period as determined from filed
financial | ||||||
8 | statements.
| ||||||
9 | (c) Any agreement between the organization and an insurer | ||||||
10 | shall be
subject to the provisions of the laws of this State | ||||||
11 | regarding reinsurance
as provided in Article XI of the Illinois | ||||||
12 | Insurance Code. All reinsurance
agreements must be filed. | ||||||
13 | Approval of the Director is required for all
agreements except | ||||||
14 | the following: individual stop loss, aggregate excess,
| ||||||
15 | hospitalization benefits or out-of-area of the participating | ||||||
16 | providers
unless 20% or more of the organization's total risk | ||||||
17 | is reinsured, in which
case all reinsurance agreements require | ||||||
18 | approval. | ||||||
19 | (d) Rate increases for all individual and small group | ||||||
20 | health care plans subject to the standards of 45 CFR Part 154 | ||||||
21 | must be filed with the Department for approval. Unreasonable | ||||||
22 | rate increases in relation to benefits under the policy | ||||||
23 | provided or inadequate rates shall be disapproved. The | ||||||
24 | Department shall provide a report to the General Assembly on or | ||||||
25 | after January 1, 2021 regarding both on and off exchange | ||||||
26 | individual and small group rates in the Illinois market.
|
| |||||||
| |||||||
1 | (e) In all cases the Director shall approve or disapprove a | ||||||
2 | rate filing under subsection (d) within 45 calendar days of | ||||||
3 | submission unless the Director extends, by not more than an | ||||||
4 | additional 30 days, the period within which he or she shall | ||||||
5 | approve or disapprove any such filing by giving written notice | ||||||
6 | to the insurer of such extension before expiration of the | ||||||
7 | initial 45-day period. Rates not approved or disapproved by the | ||||||
8 | applicable deadline shall be deemed approved on the following | ||||||
9 | calendar day. | ||||||
10 | (f) No less than 30 days after the federal Centers for | ||||||
11 | Medicare and Medicaid Services has certified the health care | ||||||
12 | plans described in subsection (d) for the upcoming plan year, | ||||||
13 | the Department shall publish on its website a report explaining | ||||||
14 | the rates for that plan year's certified health care plans. | ||||||
15 | (g) As used in this Section: | ||||||
16 | "Inadequate rate" means a rate: | ||||||
17 | (1) that is insufficient to sustain projected losses | ||||||
18 | and expenses to which the rate applies; and | ||||||
19 | (2) the continued use of which endangers the solvency | ||||||
20 | of an insurer using that rate. | ||||||
21 | "Unreasonable rate increase" means a rate increase that the | ||||||
22 | Director determines to be excessive, unjustified, or unfairly | ||||||
23 | discriminatory in accordance with 45 CFR 154.205. | ||||||
24 | (Source: P.A. 86-620.)".
|