Consumer Health Insurance Reform

Health Policy Rate Filing Report

In order to better serve the residents of Illinois, the Department of Insurance has implemented a Health Premium Rate Review program. This Program is designed to evaluate premium rate increases proposed by health care plans marketing in Illinois, protect consumers from unreasonable rate increases and educate consumers on the medical and administrative costs driving such increases. The Program covers individual and group major medical policies, hospital/surgical medical expense policies, and student/blanket policies; including any conversion coverage offered through these products.

Consistent with these goals, the Department is making premium rate increase information available to Illinois consumers and policymakers. We are also accepting questions, concerns and comments related to rate filings found on this page. When submitting your comments, please identify both the company and the policy number. The Department cannot respond to submitted comments but will respond to questions consistent with our Comment Policy PDF.

2018 Analysis of Illinois Exchange Plans

Explanations of terms used in the charts PDF.

Individual & Group Health Premium Rate Filings Since 2010

  2010
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2011
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2012
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2013
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2014
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2015
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2016
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Number of Rate Filings 61 145 139 115 149 145 128

HealthCare.gov website - Proposed Rate Increases of 10% or more

Starting September 1, 2011, health insurance companies must inform the public when they want to increase health insurance rates for individual or small group policies by an average of 10% or more. Companies requesting such increases must file them with the federal government in addition to filing them with the Department of Insurance.

These filings must include rating documentation called “Justification”. Justification is a federally-developed form that will enable consumers to see a summary of certain factors underlying a proposed rate increase and an explanation, provided by the insurance company, for the proposed increase.

Through the following links, the Department of Insurance is providing you with a link to access this consumer-friendly summary and disclosure form – HealthCare.gov

Health Insurance Exchanges

An important component of Health Care Reform is the availability of a health insurance exchange. An exchange is a transparent, centralized marketplace that will offer a choice of affordable, high-quality health insurance plans to individuals and small businesses. Plan enrollments are to begin October 1, 2013 with a coverage effective date of January 1, 2014.

Illinois Health Care Reform Implementation Council

The Illinois Healthcare Reform Implementation Council issued its report to Governor Quinn on March 1, 2011. The Council, comprised of directors of state agencies and departments responsible for implementing the Affordable Care Act (ACA), received input from consumers, providers, legislators and organizations throughout Illinois on how best to implement the ACA for the benefit of Illinois residents. Among the key recommendations is the establishment of a health insurance exchange for Illinois.

Illinois Health Benefits Exchange Law

On July 14, 2011, Governor Quinn signed Public Act 97-0142, the Illinois Health Benefits Exchange Law PDF. This legislation, effective immediately, enables Illinois to establish its own health insurance exchange for individuals and businesses with 50 or fewer employees.

An Amendment to the Illinois Health Benefits Exchange Law was introduced during the Illinois General Assembly veto session on October 26, 2011. The Amendment to SB1313 includes provisions on specific aspects of the structure, function and financing of the Exchange.

The Amendment has been referred to the House Insurance Committee. The next meeting of the Committee is scheduled for November 8, 2011 at 2 pm.

Illinois Health Benefits Legislative Study Committee

The recently enacted Illinois Health Benefits Exchange Law (Public Act 97-0142) called for the creation of a 12-member Legislative Study Committee to issue a report to the General Assembly and the Governor on establishment of the Illinois Health Benefits Exchange. The final report PDF of its findings was forwarded to Governor Quinn and the leadership of the General Assembly on October 18, 2011.

For a list of committee members, meeting notices and agendas for future meetings, as well as ongoing developments, visit the Illinois Health Insurance Exchange Legislative Study Committee.

Federal Regulations and Guidance

Proposed Rules

Final Rules

Federal Exchange Planning and Establishment Grants

Illinois has been awarded the following grants by HHS to assist in planning and implementing the health insurance exchange in Illinois.

Reports Funded through Federal Grants

Background Resources

Medical Loss Ratios

The Medical Loss Ratio (MLR) provision of the Affordable Care Act (ACA), released on November 22, 2010 works in conjunction with the Premium Rate Review Program to increase the value that consumers receive for their health care premium dollars.

Medical Loss Ratio (MLR) refers to the portion of insurance premiums an insurer spends on health care and expenses to improve health care quality. The Affordable Care Act requires that a minimum of 80% (in the small group market) and 85% (in the large group market) of each premium dollar is spent on health care services and health care quality improvement and not on company overhead and administrative costs. The MLR regulations are codified as 45 CFR Part 158.

Insurers failing to meet the applicable MLR standard must pay rebates to consumers beginning in August 2012.

Illinois Guidance

Federal Regulations, Guidance and Reports

NAIC Guidance

In 2015, Public Act 99-0480 (The Heroin Crisis Act) created a Working Group to discuss issues related to the treatment and coverage of substance abuse disorders and mental illness. Partnering with the Department of Human Services (DHS), the Department of Healthcare and Family Services (HFS), and the Department of Public Health (DPH), the Illinois Department of Insurance (DOI) hosts the Working Group.

In accordance with the Illinois Open Meetings Act, you can find MHSUD Meeting notices, agendas, approved minutes, and annual reports below.

Premium Rate Review

In order to better serve the residents of Illinois, the Department of Insurance (DOI) has implemented a Health Premium Rate Review program. This Program is designed to access premium rate filings that health care plans marketing in Illinois are required to send to DOI for review, protect consumers from unreasonable rate increases and educate consumers on the medical and administrative costs driving such increases.

Illinois Rate Review Information

Rate Review Webinars/Presentations

Current Premium Rate Filings in Illinois

Federal Regulations and Guidance

Federal Rate Review Reports

Rate Review Grants and Reports

 

Applications

 

Reports

Medical Loss Ratios

The Medical Loss Ratio (MLR) provision of the Affordable Care Act (ACA), released on November 22, 2010 works in conjunction with the Premium Rate Review Program to increase the value that consumers receive for their health care premium dollars.

Medical Loss Ratio (MLR) refers to the portion of insurance premiums an insurer spends on health care and expenses to improve health care quality. The Affordable Care Act requires that a minimum of 80% (in the small group market) and 85% (in the large group market) of each premium dollar is spent on health care services and health care quality improvement and not on company overhead and administrative costs. The MLR regulations are codified as 45 CFR Part 158.

Insurers failing to meet the applicable MLR standard must pay rebates to consumers beginning in August 2012.

 

Illinois Guidance:

 

Federal Regulations, Guidance and Reports:

 

NAIC Guidance:

Other Relevant Links

Small Business Health Options Program

The Affordable Care Act (ACA) requires the establishment of a Small Business Health Options Program (SHOP exchange) in each state. The purpose of the SHOP exchange is to help small businesses find and purchase health insurance for their employees.

Illinois Health Benefits Exchange Small Business Survey & Focus Groups

The Illinois Department of Insurance is studying small business health insurance needs to determine ways that the prospective Illinois Health Insurance Exchange (SHOP) can address those needs. The Department engaged the Survey Research Laboratory of the University of Illinois and the School of Public Health at the University of Illinois at Chicago to survey the Illinois small business community.

Final UIC SHOP Report PDF

Concept & Operational Considerations in Illinois’ SHOP Exchange

Final Wakely Report PDF

Small Business Tax Credit

Tax credits are currently available for employers with 25 or fewer full-time equivalent employees and average annual wages of $50,000 or less. For 2010-2013, the credit is valued at up to 35% of premium costs (25% for tax-exempt organizations). Beginning in 2014, the credit increases to 50% of premium costs (35% for tax-exempt organizations), but employers may only claim the credit for two years and must purchase insurance through the State's SHOP Exchange to qualify. Please see the resources linked below for more information.