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.