(215 ILCS 210/1)
Sec. 1. Short title. This Act may be cited as the Health Insurance Coverage Premium Misalignment Study Act.
(Source: P.A. 102-900, eff. 1-1-23.)
(215 ILCS 210/5)
Sec. 5. Purpose. This Act is intended to enable the State to study possible misalignment in the Illinois health insurance marketplace that would produce increased premium or cost sharing for some consumers and drive some consumers into lower value qualified health plans or out of the marketplace altogether.
(Source: P.A. 102-900, eff. 1-1-23.)
(215 ILCS 210/10)
Sec. 10. Findings. The General Assembly finds that:
(1) Section 1402 of the Patient Protection and Affordable Care Act requires health insurance issuers to provide cost-sharing reductions to low-income marketplace consumers below the 250% federal poverty level who choose a silver level plan; it also requires the United States Department of Health and Human Services to reimburse issuers for cost-sharing reductions. Cost-sharing reductions are important because they help low-income marketplace consumers afford out-of-pocket costs, including deductibles and copayments, and therefore keep them in the marketplace.
(2) On October 12, 2017, the federal government, through executive action, announced that it would be discontinuing cost-sharing reduction payments to issuers in the Patient Protection and Affordable Care Act marketplace. Illinois, like the majority of other states, took action to mitigate the losses that Illinois issuers would endure without the federal cost-sharing reduction payments by adopting a practice called "silver loading" or "cost-sharing reduction uncertainty cost" beginning in the 2018 plan year. Silver loading allows issuers to increase their silver plan baseline premiums to make up the costs lost from the missing federal cost-sharing reduction payments. Most of these premium increases are offset by higher advanced premium tax credits from the federal government.
(3) However, due to silver loading and resulting pricing of silver plans in the Illinois marketplace, it appears that the current metal-level premiums in the Illinois marketplace are misaligned and do not reflect coverage generosity of the plans. The fact that silver plans are now overpriced for enrollees ineligible for generous cost-sharing reductions has driven some of those enrollees into non-silver (mostly bronze) plans with levels of cost sharing that are a worse match for their needs. In other words, Illinois marketplace consumers could be currently paying more than they should for low value plans and less than they should for high value plans.
(Source: P.A. 102-900, eff. 1-1-23.)
(215 ILCS 210/15)
Sec. 15. Premium misalignment study.
(a) The Department of Insurance shall oversee a study to explore rate setting approaches that may yield a misalignment of premiums across different tiers of coverage in Illinois' individual health insurance market. The study shall examine these approaches with a view to attempts to make coverage more affordable for low-income and middle-income residents. The study shall follow the best practices of other states targeted at addressing metal-level premium misalignment and include an Illinois-specific analysis of:
(b) The study shall produce cost estimates for Illinois residents addressing metal-level premium misalignment policy as studied in subsection (a) along with the impact of the policy on health insurance affordability and access and the uninsured rates for low-income and middle-income residents, with break-out data by geography, race, ethnicity, and income level. The study shall evaluate how premium realignment, if implemented, would affect costs and outcomes for Illinoisans.
(c) The Department of Insurance shall develop and submit, no later than January 1, 2024, a report to the General Assembly and the Governor concerning the design, costs, benefits, and implementation of premium realignment to increase affordability and access to health care coverage that leverages existing State infrastructure.
(Source: P.A. 102-900, eff. 1-1-23.)
Structure Illinois Compiled Statutes
215 ILCS 5/ - Illinois Insurance Code.
215 ILCS 93/ - Small Employer Health Insurance Rating Act.
215 ILCS 97/ - Illinois Health Insurance Portability and Accountability Act.
215 ILCS 100/ - Reinsurance Intermediary Act.
215 ILCS 105/ - Comprehensive Health Insurance Plan Act.
215 ILCS 106/ - Childrens Health Insurance Program Act.
215 ILCS 107/ - Producer Controlled Insurer Act.
215 ILCS 109/ - Dental Care Patient Protection Act.
215 ILCS 110/ - Dental Service Plan Act.
215 ILCS 111/ - Uniform Electronic Transactions in Dental Care Billing Act.
215 ILCS 113/ - Employee Leasing Company Act.
215 ILCS 115/ - Employees Dental Freedom of Choice Act.
215 ILCS 120/ - Farm Mutual Insurance Company Act of 1986.
215 ILCS 121/ - Navigator Certification Act.
215 ILCS 122/ - Illinois Health Benefits Exchange Law.
215 ILCS 123/ - Health Care Purchasing Group Act.
215 ILCS 124/ - Network Adequacy and Transparency Act.
215 ILCS 125/ - Health Maintenance Organization Act.
215 ILCS 130/ - Limited Health Service Organization Act.
215 ILCS 132/ - Illinois Long-Term Care Partnership Program Act.
215 ILCS 134/ - Managed Care Reform and Patient Rights Act.
215 ILCS 136/ - Portable Electronics Insurance Act.
215 ILCS 138/ - Uniform Prescription Drug Information Card Act.
215 ILCS 139/ - Uniform Health Care Service Benefits Information Card Act.
215 ILCS 145/ - Property Fire Loss Act.
215 ILCS 150/ - Religious and Charitable Risk Pooling Trust Act.
215 ILCS 152/ - Service Contract Act.
215 ILCS 153/ - Structured Settlement Protection Act.
215 ILCS 155/ - Title Insurance Act.
215 ILCS 156/ - Topical Eye Medication Prescription Act.
215 ILCS 157/ - Use of Credit Information in Personal Insurance Act.
215 ILCS 159/ - Viatical Settlements Act of 2009.
215 ILCS 165/ - Voluntary Health Services Plans Act.
215 ILCS 170/ - Covering ALL KIDS Health Insurance Act.
215 ILCS 175/ - Organ Transplant Medication Notification Act.
215 ILCS 180/ - Health Carrier External Review Act.
215 ILCS 185/ - Unclaimed Life Insurance Benefits Act.
215 ILCS 190/ - Short-Term, Limited-Duration Health Insurance Coverage Act.
215 ILCS 200/ - Prior Authorization Reform Act.
215 ILCS 205/ - Private Primary Residential Flood Insurance Act.
215 ILCS 210/ - Health Insurance Coverage Premium Misalignment Study Act.