IL| The Illinois Department of Insurance’s Company Bulletin 2025-07 outlines the filing requirements and timelines for issuers seeking certification or recertification of individual and small group health plans—including stand-alone dental plans—both on and off the ACA Marketplace for Plan Year 2026. The bulletin details key deadlines, documentation standards, and regulatory updates, emphasizing Illinois’ anticipated transition to a State-based Marketplace, network adequacy requirements, and the need for compliance with both state and federal mandates, including pending legislation that may impact coverage.
Key Points:
- Issuers must adhere to a detailed submission calendar for plan and rate applications, network adequacy filings, and certification agreements, with critical deadlines spanning from June to September 2025 and open enrollment beginning November 1, 2025.
- All filings must include comprehensive, standardized documentation—such as checklists, templates, network adequacy data, and redlined comparisons to prior year plans—submitted via SERFF, with special requirements for network adequacy, service area exceptions, and public posting of rate filings for transparency and comment.
- The bulletin highlights new requirements for 2026, such as the Formulary Compliance Template for prescription drugs, and urges issuers to monitor pending state legislation that could affect plan benefits, while also specifying maximum annual cost-sharing limits and rules for high-deductible and HSA-eligible plans.