Company Bulletin 2025-21

Illinois Department of Insurance

JB PRITZKER ANN GILLESPIE Governor Director

TO: All Insurance Companies Writing Individual Comprehensive Major Medical Insurance in Illinois

FROM: Ann Gillespie, Director

DATE: December 19, 2025

RE: Company Bulletin 2025-21 – Data Call for Trend Report

The following data request is being required by the Illinois Department of Insurance (DOI) for the annual Health Insurance Coverage, Affordability and Cost Transparency Report as authorized at 20 ILCS 1405/1405-51.

Risk and Regulatory Consulting, LLC (RRC) is assisting the Department in the collection of this data call. The due date of this request is January 23, 2025.

Files can be sent securely through RRC’s file exchange platform or through your company’s own secure file exchange platform. If a company desires to use RRC’s platform, please provide a Name and Email address to one of the RRC contacts listed below to receive an invite for data upload. All files will be stored and analyzed on a secured drive by the DOI or their contracted consultants. All information provided by the company will be kept confidential with the exception that aggregated and anonymized data may be made publicly available as part of the Department’s analysis.

For each request #1 through #5 below, please populate the referenced tab name in the attached workbook:

IL Trend Report - Data Call Template.xls

Request Notes • Please provide a separate excel file for each line of business listed below and where your organization offers fully-insured policies. o Commercial – Individual  On-Exchange  Off-Exchange Springfield Office Chicago Office 320 W. Washington Street 115 S. LaSalle St., 13th Floor Springfield, Illinois 62767 Chicago, Illinois 60603 (217) 782-4515 (312) 814-2420 o Commercial – Small Group o Commercial – Large Group o Medicare Supplement

• Please provide enrollment, claims, and encounter data based on experience through June 30, 2025 and with runout through November 30, 2025.

• Please provide all experience data gross of reinsurance.

Requests

1. Enrollment – Please provide enrollment values (including both subscribers and dependents) for the period January 2022 to June 2025 for each of the following breakouts: A. Aggregate B. County C. Age – Please use the member’s age at the start of the year. D. Plan Type

2. Premium – Please provide the revenue, member premium, or other premium received by month for the period January 2022 to June 2025 for each of the following breakouts: A. Aggregate B. Plan Type

3. Medical Claims (Allowed and Paid) – Please provide the total allowed and paid medical claims dollars for the period January 2022 to June 2025 for each of the following breakouts: A. Aggregate B. County C. Age – Please use the member’s age at the start of the year. D. Plan Type

4. Pharmacy Claims (Allowed and Paid) – Please provide the total allowed and paid pharmacy claims dollars and (where applicable) the pharmacy claim offsets (i.e., pharmacy rebates, low- income cost sharing, coverage gap discounts, reinsurance, and other direct and indirect remuneration) for the period January 2022 to June 2025 for each of the following breakouts: A. Aggregate B. County C. Age – Please use the member’s age at the start of the year. D. Plan Type Springfield Office Chicago Office 320 W. Washington Street 115 S. LaSalle St., 13th Floor Springfield, Illinois 62767 Chicago, Illinois 60603 (217) 782-4515 (312) 814-2420 5. Utilization – Please provide the following count and cost values for the following utilization categories: Medical and Surgical Inpatient Admissions, Behavioral Health Inpatient Admissions, Emergency Room Visits, Primary Care Physician (PCP) Office Visits, Behavioral Health Office Visits, Ambulatory Services, All Other (Non-PCP) Office Visits, Urgent Care Visits, Generic Pharmacy Scripts (Adjusted to per 30 days), Brand Pharmacy Scripts (Adjusted to per 30 days), and Specialty Pharmacy Scripts (Adjusted to per 30 days) A. Count – Please provide the count of services by month for each service category for the period January 2022 to June 2025. B. Cost – Please provide the cost of services by month for each service category for the period January 2022 to June 2025.

6. Benefits Breakdown – Please provide the breakdown of the allowed and paid medical and pharmacy claims by month and by essential health benefits category, including claims for services that are not essential health benefits. A. Ambulatory patient services B. Emergency services C. Hospitalization D. Pregnancy, maternity, and newborn care E. Mental health and substance use disorder services F. Prescription drugs G. Rehabilitative and habilitative services and devices H. Laboratory services I. Preventive and wellness services J. Pediatric services

All inquiries related to this data call should be directed to Becky Sheppard at Becky.Sheppard@riskreg.com and Andrew Larocque at Andrew.Larocque@riskreg.com.

Springfield Office Chicago Office 320 W. Washington Street 115 S. LaSalle St., 13th Floor Springfield, Illinois 62767 Chicago, Illinois 60603 (217) 782-4515 (312) 814-2420