By Patricia D. King, Megan R. Rooney, and James W. Kim*
June 12, 2009
HB 3923, a bill to institute reform in the small group and individual health insurance market, and to strengthen consumer protection, was passed by the House on April 3, 2009, and by the Senate on May 30, 2009, but was returned to the House for action on Senate amendments. The deadline for House action has been extended to November 30, 2009.
HB 3923 would establish the Minimum Medical Loss Ratio Law, requiring companies selling health benefit plans in the individual or small group market to expend at least 75% of premiums on healthcare benefits, although the Division of Insurance is permitted to exclude new plans from this requirement for the first two years. The bill would also require the Division of Insurance to develop a standard application form for the small group market and a standard health statement for use in applications for individual coverage. HB 3923 also modifies the requirements under the Illinois Insurance Code for coverage of serious mental illness, mandating that coverage after June 1, 2010, may not be denied if the services are "medically necessary."
HB 3923 would also expand the role of the Office of Consumer Health Insurance, authorizing the Office to provide oversight of health insurance companies and plans with respect to claims practice; emergency services; coverage for mental health treatment; underwriting, rating, and rescission; and billing practices, including consumer cost sharing. Consumers would be permitted to appeal adverse, external independent review decisions to the Office, which would have the authority to overturn adverse decisions and require the insurer to pay for the healthcare service or treatment.
*We would like to thank Patricia D. King, Esquire (Swedish Covenant Hospital, Chicago, IL) and Megan R. Rooney, Esquire and James W. Kim, Esquire (McDermott Will & Emery LLP, Chicago, IL) for providing this email alert.
The Healthcare Reform Educational Task Force is a joint endeavor of the Healthcare Liability and Litigation; Hospitals and Health Systems; In-House Counsel; Payors, Plans, and Managed Care; Physician Organizations; Regulation, Accreditation, and Payment; and Teaching Hospitals and Academic Medical Centers Practice Groups.