HB 3923

Abstract

Creates the Individual Market Fairness Reform Law. Provides that a managed care entity shall (1) fairly and affirmatively offer all of its managed care plans that are sold to all individuals in each service area in which the managed care entity provides or arranges for the provision of health care services and (2) may not reject an application for an individual managed care plan if certain requirements are met. Provides that the Division of Insurance of the Department of Financial and Professional Regulation shall develop a system to categorize all managed care plans offered and sold to individuals pursuant to this Law into 5 coverage choice categories. Creates the Minimum Medical Loss Ratio Law. Provides that any company selling a health benefit plan in the individual or small group market shall expend in the form of health care benefits no less than 85 percent of the aggregate dues, fees, and premiums received by the company. Creates the Health Sure Illinois Law to establish a program for the purpose of making managed care plans affordable and accessible to small employers and individuals. Provides that the program is limited to active managed care entities. Amends the Illinois Insurance Code. Creates new Articles in the Code establishing the Office of Patient Protection and the Illinois Health Carrier External Review Law. Amends the Small Employer Health Insurance Rating Act, Illinois Health Insurance Portability and Accountability Act, and Managed Care Reform and Patient Rights Act in provisions concerning small employers, individuals, review, and rates. Repeals a provision of the Small Employer Health Insurance Rating Act concerning establishment of a class of business. Makes other changes.