Illinois Administrative Code › Title 50 - INSURANCE › Part 2026 - HEALTH INSURANCE RATE REVIEW › Section 2026.10 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
"Affordable Care Act" or "ACA" means the Patient Protection and
				Affordable Care Act (42
				U.S.C. 18001 et seq.).
"Code" means the Illinois Insurance Code [215 ILCS 5].
"Department" means the Illinois Department of Insurance.
"Director" means the Director of the Department.
"CMMS" means the Centers for Medicare and Medicaid
				Services.
"Excepted benefits" has the meaning ascribed in
				42 U.S.C.
				300gg-91(c).
"Federal medical loss ratio standard" means the applicable
				medical loss ratio standard for the State and market segment involved,
				determined under subpart B of 45 CFR 158.
"Grandfathered health plan" has the meaning ascribed in
				45 CFR
				147.140 (Dec. 15, 2020) (no later editions or
				amendments).
"Health insurance coverage" has the meaning ascribed in
				42 U.S.C.
				300gg-91(b)(1).
"Health insurance issuer" has the meaning ascribed in
				42 U.S.C.
				300gg-91(b)(2).
"Inadequate rate" means a rate:
that is insufficient to sustain projected losses and
				expenses to which the rate applies; and
the continued use of which endangers the solvency of
				a
health insurance issuer
using that rate
. (Section
				355(a) of the Code)
"Individual market" has the meaning ascribed in
				42 U.S.C.
				300gg-91(e)(1)(A).
				Coverage that would be regulated as individual market coverage under that
				definition, if it were not sold through an association, is subject to rate
				review as individual market coverage.
"Plain language"
or "plain writing"
has the meaning provided
for "plain writing"
in the
				federal Plain Writing Act of 2010
(Pub. Law 111-274)
and
				subsequent guidance documents, including the "Federal Plain Language
				Guidelines"
published by the Plain Language Action and Information
				Network with support from the United States General Services Administration,
				1800 F Street, NW, Washington, DC 20405 (rev. 1, May 2011) (no later editions
				or amendments), available online at:
https://www.plainlanguage.gov/media/FederalPLGuidelines.pdf
.
				(Section 355(a) of the Code)
"Product" has the meaning ascribed in
				45 CFR
				144.103 (May 6, 2022) (no later editions or
				amendments).
"Rate increase" means any increase of the premium rates for a
				specific product.
"Secretary" means the Secretary of the United States Department
				of Health and Human Services.
"Short-term, limited-duration health insurance coverage" has
				the meaning ascribed in Section 5 of the Short-Term, Limited-Duration Health
				Insurance Coverage Act [215 ILCS 190].
"Small group market" has the meaning ascribed in
				42 U.S.C.
				300gg-91(e)(5).
				Coverage that would be regulated as small group market coverage under that
				definition, if it were not sold through an association, is subject to rate
				review as small group market coverage.
"Student health insurance coverage" has the meaning ascribed in
				45 CFR
				147.145 (March 8, 2016) (no later editions or
				amendments).
"
Unreasonable rate increase
"
means a
				rate increase that the Director determines
t
o be excessive,
				unjustified, or unfairly discriminatory in accordance with
				45 CFR
				154.205
(May 23, 2011) (no later
				editions or amendments). (Section 355(a) of the Code)