IL HB5471

Allows administrative review under the Code of Civil Procedure for Director determinations upholding external review decisions adverse to enrollees under both the Managed Care Reform and Patient Rights Act and Health Carrier External Review Act.

Requires health carriers to include a written statement of patient rights with every billing request for payment to covered persons.

Establishes Office of Consumer Health Insurance consultation, case management services, and toll-free phone line for covered persons engaged in appeals or external reviews of adverse determinations.

Mandates health carriers spend at least 85% of aggregate dues, fees, and premiums received on health care benefits, with ability to average costs across all health benefit plans including affiliated companies' plans.

Allows health carriers to exclude new health benefit plans from the 85% medical loss ratio requirement for up to the first 2 years if substantially different from existing plans.