All Domestic HMOs, LHSOs, Insurance Companies Possessing an Illinois HMO Certificate of Authority or an Illinois LHSO Certificat of Authority : HMO and LHSO Provider Agreements/Provider Contracts: 215 ILCS 125/2-8; 215 ILCS 125/2-1(c)(5); 215 ILCS 130/2002(a)(7); 215 ILCS 130/2008; 215 ILCS 5/131.20a; and 50Ill. Adm. Code 4521

[LOGO] Illinois Department of Insurance JB PRITZKER Governor ROBERT H. MURIEL Director TO: ALL DOMESTIC HEALTH MAINTENANCE ORGANIZATIONS ("HMOs"); ALL DOMESTIC LIMITED HEALTH SERVICE ORGANIZATIONS ("LHSOs"); ALL DOMESTIC INSURANCE COMPANIES POSSESSING AN ILLINOIS HMO CERTIFICATE OF AUTHORITY OR AN ILLINOIS LHSO CERTIFICATE OF AUTHORITY FROM: Robert H. Muriel, Director of Insurance Rm DATE: July 10, 2019 RE: Company Bulletin # 2019-06: HMO and LHSO Provider Agreements/Provider Contracts: 215 ILCS 125/2-8; 215 ILCS 125/2-1(c)(5); 215 ILCS 130/2002(a)(7); 215 ILCS 130/2008; 215 ILCS 5/131.20a; and 50 Ill. Adm. Code 4521 This Company Bulletin is intended to provide an update and clarification to domestic corporations or domestic insurance companies possessing an HMO or LHSO Certificate of Authority in Illinois, about the content of the provider agreements/provider contracts related to Illinois HMO health care plans/Illinois HMO business, or related to Illinois LHSO limited health care plans/Illinois LHSO business, respectively. This Company Bulletin is also intended to provide guidance on the submission of these HMO or LHSO provider agreements/provider contracts to the Illinois Department of Insurance ("Department"), on a going-forward basis. Please note, the Department is no longer requiring or accepting HMO or LHSO provider agreements/provider contracts through SERFF. All domestic corporations or domestic insurance companies possessing an HMO Certificate of Authority in Illinois under the Health Maintenance Organization Act (215 ILCS 125/1-1 et. seq) must submit all HMO sample/template agreements or sample/template contracts with providers under 215 ILCS 125/2- 1(c)(5) and 50 Ill. Adm. Code 4521 and must comply with the contract language requirements set forth in 215 ILCS 125/2-8 and 50 Ill. Adm. Code 4521 regarding all HMO sample/template agreements or contracts with providers. Such sample/template provider agreements/provider contracts should have variable language bracketed in the templates. Sample/template provider agreements/provider contracts related to HMO commercial business or to HMO government business (i.e., Medicare, Medicaid, Federal Employees Health Benefit Plans) should be submitted to the Department. All domestic corporations or domestic insurance companies possessing an LHSO Certificate of Authority in Illinois under the Limited Health Service Organization Act (215 ILCS 130/1001 et. seq) must submit all LHSO sample/template agreements or contracts with providers under 215 ILCS 130/2002(a)(7) and must comply with the contract language requirements set forth in 215 ILCS 130/2008 regarding all contracts with providers or subcontractors. LHSO Sample/template provider agreements/provider contracts should have variable language bracketed in the templates. Sample/template provider agreements/provider contracts related to LHSO commercial business or to LHSO government business (i.e., Medicare, Medicaid, Federal Employees Health Benefit Plans) should be submitted to the Department. 320 W. Washington Street Springfield, Illinois 62767 (217) 782-4515 http://insurance.illinois.gov All sample/template or executed HMO or LHSO provider agreements/provider contracts submitted to the Department should clearly set forth, within the agreement or contract, the full legal name of the insurance company, HMO, or LHSO licensed in Illinois which is a party to the HMO or LHSO provider agreement/provider contract. Executed HMO or LHSO provider agreements/provider contracts, including modifications and amendments, with any specific affiliated person or affiliated entity within the domestic HMO's, domestic LHSO's, or domestic insurance company's holding company system, are also required to be submitted to the Department as a Form D filing, under 215 ILCS 5/131.20a(1)(a)(iv). HMO or LHSO provider agreements/provider contracts and related Form D filings mentioned above, as well as those which have not already been provided to the Department, should be submitted to the Department in hard copy format to the following address: Illinois Department of Insurance Attn: Paul Ebelherr Supervisor, LAH Financial Analysis Unit 320 W. Washington Street, Springfield, IL 62767. Questions about this bulletin may be directed to Paul Ebelherr, Supervisor, LAH Financial Analysis Unit via email at Paul.Ebelherr@illinois.gov. # # # 2 | Page