ALL COMPANIES WRITING ACCIDENT AND HEALTH INSURANCE AND MANAGED CARE PLANS IN ILLINOIS

Springfield Office 320 W. Washington Street Springfield, Illinois 62767 (217) 782-4515 Chicago Office 122 S. Michigan Ave., 19th Floor Chicago, Illinois 60603 (312) 814-2420 Illinois Department of Insurance JB PRITZKER Governor DANA POPISH SEVERINGHAUS Director MEMORANDUM TO: ALL COMPANIES WRITING ACCIDENT AND HEALTH INSURANCE AND MANAGED CARE PLANS IN ILLINOIS FROM: Dana Popish Severinghaus, Director of Insurance DATE: July 1, 2023 RE: Company Bulletin 2023-06 Under 215 ILCS 5/370c.1(j) and (k) as amended by Public Act 103-0105, each issuer is required to file annually with the Illinois Department of Insurance (IDOI) specific data and procedures. The format for the collection of this information was created by the IDOI. The required data to be filed is non-quantitative treatment limitation (NQTL) comparative analysis. Due to the original reporting structure prior the amendment of the statute, these NQTLs are due via the following schedule: NQTL for Reimbursement: September 1, 2023 On September 1, 2024, and annually thereafter, the following NQTLs are required: 1. Concurrent Review 2. Experimental Investigational 3. Failure to Complete 4. Formulary Tiering 5. Medical Necessity Criteria 6. Outlier Review 7. Prior Authorization 8. Retrospective Review 9. Step Therapy 10. Reimbursement You may access instructions for completion and the required reporting template for submission of NQTL comparative analysis located on the Department’s website, under Companies, Checklists Life-Accident Health, labeled “MH/SUD NQTL Comparative Analysis”. Note that issuers are required to utilize this format when completing and submitting the respective NQTL comparative analysis. Instructions for Submission: The reporting period will be as of end of 2nd quarter of the current calendar year. Issuers are to submit their analysis under the supporting documentation tab in a SERFF filing using the below Type of Insurance (TOI) with a filing type of “Report”: TOI: NQTL Report Sub-TOI: PA 100-1024 Springfield Office 320 W. Washington Street Springfield, Illinois 62767 (217) 782-4515 Chicago Office 122 S. Michigan Ave., 19th Floor Chicago, Illinois 60603 (312) 814-2420 These requirements are pursuant to the Department’s authority under the Illinois Insurance code, specifically 215 ILCS 5/370c.1(j) & (k), 215 ILCS 5/132 and 215 ILCS 5/401 to receive and examine the non-financial business practices, performance and operations of any insurance company and to administer the insurance laws of Illinois. Confidentiality of the underlying data filed with the Department is preserved under 215 ILCS 5/132.5(f). Please direct questions regarding this Bulletin to the Assistant Deputy Director & Chief Market Conduct Examiner Erica Weyhenmeyer at erica.weyhenmeyer@illinois.gov.