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 Webinars/Presentations

Current Premium Rate Filings in Illinois

Federal Regulations and Guidance
Federal Rate Review Reports
Rate Review Grants and Reports

Applications

Illinois Grant Application for Premium Review | Abstract 

Illinois Grant Application for Premium Review Cycle II 

Reports

2017 Cycle II FFY HHS PDF

2016 Cycle II FFY HHS PDF

Cycle II FFY 2014, Report to HHS 

Cycle II FFY 2013, Report to HHS 

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

Cycle 1 FFY 2012, Report to HHS 

Cycle 1 FFY 2011, Report to HHS  


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