IL Premium Rate Review

Any insurance company, health maintenance organization or health service plan authorized to offer health insurance coverage, as that term is defined in the Illinois Health Insurance Portability and Accountability Act [215 ILCS 97/1 et.seq.], must file all proposed rate increases with the Department prior to its use. 

The Health Premium Rate Review 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.

How Rate Review in Illinois Works (English) | Español | 명. 한국어 | Polski | (形) 中國的, 中國話的

Rate Review Q&As (English) | Español | 명. 한국어 | Polski | (形) 中國的, 中國話的

Rate Review Webinars/Presentations

• Health Insurance Webinars/Presentations PDF

Current Premium Rate Filings in Illinois

• Current Premium Rate Filings in Illinois PDF

• February 22, 2013 — CMS-9972-F: Patient Protection and Affordable Care Act: Health Insurance Market Rules; Rate Review

• November 26, 2012 — CMS-9972-P: Patient Protection and Affordable Care Act: Health Insurance Market Rules; Rate Review

• September 6, 2011 — CMS-9999-F: Rate Increase Disclosure and Review: Definitions of Individual Market and Small Group Market

May 19, 2011 — CMS-9999-FC: Rate Increase Disclosure and Review; Final Rule

• Cover Letter from Secretary Sebelius PDF
• HHS's Request for Comments PDF
• NAIC Response PDF
• HHS Rate Review/WellPoint Letter PDF
• Illinois Response PDF

Federal Rate Review Reports

• Rate Review Saves Estimated $1 Billion for Consumers PDF
  

• Rate Review Annual Report: 2014  | 2013  | 2012

Applications

Illinois Grant Application for Premium Review | Abstract 

Illinois Grant Application for Premium Review Cycle II 

Reports

2017 Cycle II FFY HHS PDF

Quater 1

Quater 2

Quater 3

Quater 4

2016 Cycle II FFY HHS PDF

• Quarter 3

• Quarter 4
  

• 2016 Cycle II FFY Quarter 4 HHS

• 2016 Cycle II FFY Annual

Cycle II FFY 2015, Report to HHS

• Quarter 1
  

• Quarter 2
  

• Quarter 3
  

• No–Cost Extension Request — Grant No PRPPR120017-01-05
  

• No–Cost Extension Request — Grant No PRPPR120017-01-08

Cycle II FFY 2014, Report to HHS 

• Quarter 1
  

• Quarter 2
  

• Quarter 3
  

• No–Cost Extension Request — Grant No PRPPR120017&aeb
  

• Cycle II Annual Report (October 30, 2014)
  

• Cycle II FFY 2014, Quarter 4 Report to HHS

Cycle II FFY 2013, Report to HHS 

• Quarter 1

• Quarter 2
  

• Quarter 3

• Quarter 4

• Cycle II Annual Report (October 30, 2013) 

Cycle 1 and Cycle II FFY 2012, Quarter 4 Report to HHS 

• Cycle 1 Annual Report (December 30, 2012)
  

• Cycle II Annual Report (October 30, 2012) 

Cycle 1 FFY 2012, Report to HHS 

• Quarter 1

• Quarter 2

• Quarter 3

Cycle 1 FFY 2011, Report to HHS  

• Quarter 1
  

• Quarter 2
  

• Quarter 3
  

• Quarter 4

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:

• Rebates and the MLR Standard in the Individual Market
  English | Español | Korean - 명. 한국어 | Polski | (形) 中國的, 中國話的 
• Rebates and the MLR Standard in the Group Market
  English | Español | Korean - 명. 한국어 | Polski | (形) 中國的, 中國話的  

Federal Regulations, Guidance and Reports:

• Interim Final Rule: MLR Requirements under the ACA (December 2010) PDF
• Final Rule: MLR Requirements under the ACA (May 11, 2011) — Amends Interim Final Rule PDF
• Medical Loss Ratio Requirements under the ACA — Correcting Amendment PDF
• The 80/20 Rule — How Insurers Spend Your Health Insurance Premiums
  
• Consumers Benefitted From 80/20 Rule in 2013 

NAIC Guidance:

• NAIC Model Regulation (October 27, 2010)  
• Summary PDF
  
• Pre-adoption draft with 10/21/10 considered amendments
  
• Combined Comments as of 10/21/10 PDF
• October 13, 2010 Letter to HHS Secretary Sebelius — MLR issues not mandated by PPACA to the NAIC
  
• MLR Reporting Form: NAIC Blanks Proposal (Document adopted by Joint Executive Committee/Plenary 8/17/10) 

Illinois Comments to the NAIC Health Reform Solvency Impact (E) Subgroup 

• July 1, 2010 PDF
  

• June 23, 2010 PDF

Illinois Comments to NAIC Actuarial Subgroup

• June 23, 2010 PDF
  
• Illinois Letter to NAIC (June 3, 2010) PDF
  

• NAIC Response to HHS Request for Comments (May 12, 2010) PDF