Section 4540.80 Confidentiality

Section 4540.80

Confidentiality

a)         All records in the custody or possession of the Department

are presumed to be open to public inspection or copying unless exempt from

disclosure by Section 7 or 7.5 of the Freedom of Information Act [5 ILCS 140].

Except as otherwise provided in this Section or under other applicable law, the

filings required under the Act and this Part and communications between the

Department and an insurer in connection with those filings are open to public

inspection or copying.

b)         The following information shall not be considered

confidential:

1)         actual or projected ratios of providers to beneficiaries,

and whether a network plan has satisfied the Act’s requirements for these

ratios;

2)         actual or projected time or distance between preferred

providers and beneficiaries;

3)         actual or projected appointment waiting times for a

beneficiary to see a preferred provider;

4)         geographic maps of preferred providers;

5)         provider directories and provider lists;

6)         exceptions to compliance with Section 10 of the Act, except

with respect to any explicit discussion of ongoing or planned contractual

negotiations with preferred providers that the insurer expressly asks to be

treated as confidential; and

7)         insurer or Department statements of determination as to

whether a network plan has satisfied the Act’s requirements regarding the

information described in subsections (b)(1) through (b)(6).

c)         An insurer’s workpapers and reports under Section 4540.60

shall remain confidential unless the insurer expressly waives confidentiality

or unless all or some of the workpaper or report is considered public

information under federal law or the Freedom of Information Act [5 ILCS 140]

sfied the Act’s requirements regarding the

information described in subsections (b)(1) through (b)(6).

c)         An insurer’s workpapers and reports under Section 4540.60

shall remain confidential unless the insurer expressly waives confidentiality

or unless all or some of the workpaper or report is considered public

information under federal law or the Freedom of Information Act [5 ILCS 140].

d)         Except when contrary to other applicable law, a filing

required under Section 10 of this Act and the related communications between

the Department and the insurer will be treated as confidential while the filing

remains under the Department’s review but will become open to public inspection

and copying upon the completion of the Department review.

e)         If an insurer wishes to assert that any information filed

under the Act or this Part, other than the information specified in subsection

(b), should be withheld from public disclosure based on a claim that the

information is a trade secret or confidential commercial or financial

information, the insurer shall:

1)         include a cover letter in its filing that identifies all

documents containing confidential information and specifies the types of

information that are trade secrets or confidential commercial or financial

information that the insurer considers proprietary, privileged, or

confidential, as well as a brief factual explanation as to how the disclosure

of each type of information would cause competitive harm to the insurer;

2)         if a document is confidential in its entirety, include a

cover page, a note on the first page, or a note in the margins that the

document is confidential; and

3)         if the document contains both confidential information and

public information, include both an unredacted and a redacted copy of that

document in the filing. The redactions shall only extend to the confidential

information identified in the cover letter

l in its entirety, include a

cover page, a note on the first page, or a note in the margins that the

document is confidential; and

3)         if the document contains both confidential information and

public information, include both an unredacted and a redacted copy of that

document in the filing. The redactions shall only extend to the confidential

information identified in the cover letter.

f)         Documents filed and communications exchanged with the

insurer under the Act will not be deemed examination materials unless requested

by the Department’s examination staff or a duly appointed examiner and

transmitted outside of SERFF. Nothing in this Section shall be construed to

override the statutory requirement that workpapers that the Department obtains or

creates during a market conduct examination remain confidential.