"Affordable Care Act" or "ACA" means the Patient Protection and
Affordable Care Act (
42
USC 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 Illinois Department of
Insurance.
"CMMS" means the Centers for Medicare and Medicaid
Services.
"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.
"Health Insurance Coverage" has the meaning given that term in
PHS Act section 2791(b)(1).
"Health Insurance Issuer" has the meaning given that term in
PHS Act section 2791(b)(2).
"Individual Market" has the meaning given in PHS Act section
2791(e)(1)(A). Coverage that would be regulated as individual market coverage,
as defined in PHS Act section 2791(e)(1)(A), if it were not sold through an
association, is subject to rate review as individual market coverage.
"PHS Act" means the Public Health Service Act (
42
USC 201 et seq.).
"Product" means a package of health insurance coverage benefits
with a discrete set of rating and pricing methodologies that a health insurance
issuer offers in a state.
"Rate Increase" means any increase of the rates for a specific
product offered in the individual or small group market.
"Rate Increase Subject to Review" means a rate increase that
meets the criteria set forth in Section
2026.30.
"Secretary" means the Secretary of the Department of Health and
Human Services.
"Small Group Market" has the meaning ascribed in PHS Act
section 2791(e)(5); provided, however, that for the purpose of this definition,
"50" employees applies in place of "100" employees in the definition of "small
employer" in section 2791(e)(4). "Coverage" that would be regulated as small
group market coverage (as defined in section 2791(e)(5)) if it were not sold
through an association is subject to rate review as small group market
coverage.
"Unreasonable Rate Increase" means a rate increase that the
Director determines under Section
2026.40
to be excessive, unjustified or unfairly discriminatory.