Illinois Health Insurance Enforcement and Consumer Protections Grant Award
Cycle I Grant Application Summary
Illinois Grantee: Illinois Department of Insurance
Award Date: October 31, 2016
Total Award: $1,377,567.36
Baseline Award: $476,998
Selected Market Reforms Amount: $600,000
Workload Award Amount: $300,569.36
- Section 2707 - The Illinois Department of Insurance will develop standard operating procedures and best practices to identify discriminatory benefit design. The Department of Insurance will work with Navigators, consumers, advocates, and other government agencies to ensure communication and transparency throughout the process.
- Section 2713 - The Illinois Department of Insurance will conduct educational campaigns to increase knowledge of preventative health services without cost sharing. The Department of Insurance will work with health insurance issuers to standardize the internal appeals process for preventative services so consumers can appeal denied services for preventative health services. Illinois will also draft and publish step-by-step instructions for appeals to increase consumer literacy and awareness.
- Section 2718 - The Illinois Department of Insurance will bring down the cost of health care through transparency initiatives in connection with the claims data that goes into calculating Medical Loss Ratio (MLR) with the goal of improving consumer literacy regarding not only the percent of premium a health insurance issuer spends on claims and expenses that improve health care quality, but the actual costs, including prescription drugs, associated with healthcare delivery.
- Section 2719 - The Illinois Department of Insurance will create a full time Consumer Health Protection Community Affairs Liaison position which will provide education, outreach and technical assistance to consumers. The Liaison will coordinate between the Illinois Department of Insurance, providers, and health insurance issuers in complicated disputes. Additionally, the Liaison will coordinate efforts with other State agencies’ appeals divisions including the Illinois Department of Healthcare and Family Services and the Illinois Attorney General’s Health Care Bureau, which addresses consumers health care concerns and complaints through mediation and dispute resolution and law enforcement actions. The Liaison will organize consumer and provider stakeholder groups to regularly meet with the Illinois Department of Insurance to discuss parity, appeals, coverage of preventive health services, and nondiscrimination issues and concerns. Finally, the Department of Insurance will better publicize the external appeals process and make the process more understandable and visible on the website.
- Section 2726 - The Illinois Department of Insurance will require all health insurance issuers to complete a parity compliance worksheet for State certification. The Department of Insurance will continue to ensure plan compliance through form review and regulatory oversight. The Department of Insurance will examine consumer and provider complaint trends in connection with behavioral health and substance use disorder benefits parity. Moreover, the complaint data analysis will form a basis for operational direction to better serve consumers. The Department of Insurance will also create a consumer-friendly outreach campaign including in-person presentations, webinars, and educational material in various languages in order to raise awareness. Finally, the Department’s website will be updated to provide easy access to information for consumers, providers, and health insurance issuers and will be enhanced to receive comments, questions, and complaints from consumers.
- March 5, 2020 Information Related to COVID–19 Individual and Small Group Market Insurance Coverage
- March 12, 2020 FAQs on Essential Health Benefits Coverage and the Coronavirus (COVID-19)
- March 18, 2020 FAQs on Catastrophic Plan Coverage and the Coronavirus Disease 2019 (COVID-19)
- March 24, 2020 FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019 (COVID-19)
- March 24, 2020 Payment and Grace Period Flexibilities Associated with the COVID-19 National Emergency
- March 24, 2020 FAQs on Prescription Drugs and the Coronavirus Disease 2019 (COVID-19) for Issuers Offering Health Insurance Coverage in the Individual and Small Group Markets
- April 11, 2020 FAQs about Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act Implementation
*This document was updated on April 15, 2020, to correct an error in footnote 10 regarding the current end date of the public health emergency related to COVID 19.
- April 13, 2020 Postponement of 2019 Benefit Year HHS-operated Risk Adjustment Data Validation (HHS-RADV)