DOI Pat Quinn Governor Andrew Boron, Director

Review Requirements Checklists

The Affordable Care Act (ACA) requires all health plans offered in an Exchange to be certified as a Qualified Health Plan (QHP). As a Plan Management partner in plan year 2014, the Department of Insurance (DOI) with the assistance of the Illinois Department of Public Health (DPH) will review QHP applications and recommend applicants that meet the application standards to CCIIO for QHP Certification. DOI issued Company Bulletin #2013-04 on March 20, 2013 relating to Qualified Health Plan Fees and is issuing Company Bulletin #2013-06 providing the Illinois Qualified Health Plan Guidelines and the Illinois QHP Application Checklist. The Guidelines and the Application Checklist provide links to Review Requirements Checklists; and the currently available checklists are listed below. The Individual and Small Group Health Maintenance Organization, Catastrophic and Stand Alone Dental checklists will be made available soon.

  • Individual Accident and Health Checklist — PDF | Word
  • Small Group Accident and Health Checklist — PDF | Word
  • PPO Network Adequacy Checklist — PDF | Word
  • Health Rate Review Checklist — PDF | Word
  • ACA Group Health Maintenance Review Requirements Checklist — PDF | Word
  • ACA Individual HMO Policies Review requirements Checklist — PDF | Word
  • ACA Catastophic Plans Review requirements Checklist — PDF | Word
  • ACA Individual & Small Group Stand alone Dental Review requirements Checklist — PDF | Word

On November 1, 2010 the Illinois Department of Insurance released Company Bulletin 2010-08, Required Submission and Approval of Actuarial Memorandum and Justification Review Standards for New and Renewal Health Rates. The bulletin established a premium reporting and review process which must be followed on and after December 1, 2010. Two documents accompanied the bulletin. The first was a Rate Filing Actuarial Memorandum, explaining the sections and content required for each rate filing. The second document is the Rate Data Collection Form. This form is an Excel spreadsheet which must be completed and filed through SERFF.

  • Company Bulletin 2010-08 Required Submission and Approval of Actuarial Memorandum and Justification Review Standards for New and Renewal Health Rates - PDF
  • Interactive Version of Rate Filing Actuarial Memorandum (No longer used effective March 31, 2013) - Word
  • Rate Data Collection Form - Excel

The Federal Patient Protection and Affordable Care Act (PPACA) has established premium reporting and review processes for all health insurance issuers. The Actuarial Memorandum is required and is to contain complete justification for the submitted rates, including background information and an explanation of the rationale for the requested rate action, as well as other relevant information. The small group or individual Actuarial Memorandum requirements checklist must be completed for each filing. Also, the Actuarial Certification must be completed for all rate filings.

On June 10, 2010, the Illinois Department of Insurance released Company Bulletin 2010-04 - Directions For Certified PPACA Compliance Filings, in which the Department provided directions to companies on how to make PPACA-compliant changes to existing policies. Effective August 9, 2010, the Department has provided updated guidance with Company Bulletin 2010-04A. The Department's objective is to ensure Illinois consumers have access to health coverage policies containing the PPACA required mandates.

Effective March 1, 2009, the Illinois Department of Insurance is requesting all filers to submit the applicable Review Requirements Checklist in every filing submitted for review and approval. This requirement is already in place for filings submitted under Company Bulletin 2007-01 (Certification Process), but will be required in all form filings. All citations are hyperlink text and will open with a mouse click.

Effective March 1, 2007, the Department of Insurance has released a speed to market Bulletin directed to all insurance companies licensed to write Class 1 Clause (a) Life Insurance & Annuity policies. The Department of Insurance has reviewed and analyzed existing policy form filing requirements under Illinois law, specifically 215 ILCS 5/143, as well as the Department’s filing procedures, and has assessed alternative ways in which the Department can continue to emphasize protection of Illinois consumers while increasing the efficiency in processing such filings.

Checklists may need to be printed in landscape format.

EXCESS RISK/STOP LOSS FILINGS ARE DONE ON AN INFORMATIONAL BASIS