SB 1479

Abstract

Amends the Illinois Insurance Code. Sets forth provisions concerning market conduct and nonfinancial examinations; market analysis and market conduct actions; access to books and records; examination reports; hearings; disclosures; confidentiality; corrective actions; and immunity to liability of market conduct surveillance personnel. Provides that the Director of Insurance shall collect and report market data to the National Association of Insurance Commissioner's market information systems. Provides that if the Director or an examiner finds that an administrator or pharmacy benefit manager has violated insurance-related laws or regulations under specified circumstances, then, unless the health care payer, health insurer, or plan sponsor is included in the examination and has been afforded the same opportunity to request or participate in a hearing on the examination report, the examination report shall not allege a violation by the health care payer, health insurer, or plan sponsor and the Director's order based on the report shall not impose any requirements, prohibitions, or penalties on the health care payer, health insurer, or plan sponsor. Removes various provisions concerning market conduct and nonfinancial examinations. Defines terms. Makes other changes. Effective immediately. Senate Committee Amendment No. 1 Adds reference to: 215 ILCS 5/408 from Ch. 73, par. 1020 Replaces everything after the enacting clause. Reinserts the provisions of the introduced bill with the following changes. Further amends the Illinois Insurance Code. Provides that at a pre-examination conference, the Director of Insurance or authorized market conduct surveillance personnel shall disclose the basis of the examination. Provides that the Director may give a company or person an opportunity to resolve matters that are identified as a result of a market analysis to the Director's satisfaction before undertaking a market conduct action against the company or person. Provides that a failure to produce requested books, records, or documents by a deadline shall not be a violation until the later of specified deadlines. Provides that whenever the Department of Insurance has made substantive changes to a previously shared draft report, unless those changes remove part or all of an alleged violation or were proposed by the examinee, the Department shall deliver the revised version to the examinee as a new draft and shall allow the examinee 30 days to respond before the Department issues a final report. Provides that no corrective action shall be ordered with respect to violations in transactions with consumers or other entities that are isolated occurrences or that occur with such low frequency as to fall below a reasonable margin of error. Provides that the Director may make the results of a data call available for public inspection under certain circumstances. Provides that any failure to respond to an information request in a market conduct action or violation of specified provisions may carry a fine of up to $1,000 per day up to a maximum of $50,000. Authorizes the Director to order a penalty of up $2,000 (rather than $3,000) for each violation of any law, rule, or prior lawful order of the Director. Removes language providing that if an examination report finds a violation by the examinee that the report is unable to quantify such as an operational policy or procedure that conflicts with applicable law, then the Director may order a penalty of up to $10,000 for that violation. Provides that fines and penalties shall be consistent, reasonable, and justifiable, and the Director may consider reasonable criteria including, but not limited to, the examinee's size, consumer harm, the intentionality of any violations, or remedial actions already undertaken by the examinee. Provides that the Director shall communicate to the examinee the basis for any assessed fine or penalty. In a provision requiring examinees to pay for the expenses of a market conduct examination, provides that the costs and fees incurred in a market conduct examination shall be itemized and bills shall be provided to the examinee on a monthly basis for review prior to submission for payment. Makes other changes. Effective January 1, 2025 (rather than effective immediately). Senate Committee Amendment No. 2 Removes the examinee's size from the criteria for ordering certain fines and penalties.