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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.

Illinois Rate Review Information

Rate Review Grants and Reports

Medical Loss Ratios

The Medical Loss Ratio (MLR) provision of the Affordable Care Act (ACA) 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 were required to pay rebates to consumers beginning in August 2012.

For more information, please see: