Bill Amendment: IL HB5493 | 2023-2024 | 103rd General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: INSURANCE-VARIOUS
Status: 2024-05-16 - Passed Both Houses [HB5493 Detail]
Download: Illinois-2023-HB5493-House_Amendment_001.html
Bill Title: INSURANCE-VARIOUS
Status: 2024-05-16 - Passed Both Houses [HB5493 Detail]
Download: Illinois-2023-HB5493-House_Amendment_001.html
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1 | AMENDMENT TO HOUSE BILL 5493 | ||||||
2 | AMENDMENT NO. ______. Amend House Bill 5493 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The State Employees Group Insurance Act of | ||||||
5 | 1971 is amended by changing Sections 6.7 and 6.11 and by adding | ||||||
6 | Section 6.11D as follows:
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7 | (5 ILCS 375/6.7) | ||||||
8 | Sec. 6.7. Access to obstetrical and gynecological care | ||||||
9 | Woman's health care provider . The program of health benefits | ||||||
10 | is subject to the provisions of Section 356r of the Illinois | ||||||
11 | Insurance Code. | ||||||
12 | (Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
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13 | (5 ILCS 375/6.11) | ||||||
14 | Sec. 6.11. Required health benefits; Illinois Insurance | ||||||
15 | Code requirements. The program of health benefits shall |
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1 | provide the post-mastectomy care benefits required to be | ||||||
2 | covered by a policy of accident and health insurance under | ||||||
3 | Section 356t of the Illinois Insurance Code. The program of | ||||||
4 | health benefits shall provide the coverage required under | ||||||
5 | Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, | ||||||
6 | 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | ||||||
7 | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, | ||||||
8 | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | ||||||
9 | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | ||||||
10 | 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, 356z.60, | ||||||
11 | and 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, and | ||||||
12 | 356z.70 of the Illinois Insurance Code. The program of health | ||||||
13 | benefits must comply with Sections 155.22a, 155.37, 355b, | ||||||
14 | 356z.19, 370c, and 370c.1 and Article XXXIIB of the Illinois | ||||||
15 | Insurance Code. The program of health benefits shall provide | ||||||
16 | the coverage required under Section 356m of the Illinois | ||||||
17 | Insurance Code and, for the employees of the State Employee | ||||||
18 | Group Insurance Program only, the coverage as also provided in | ||||||
19 | Section 6.11B of this Act. The Department of Insurance shall | ||||||
20 | enforce the requirements of this Section with respect to | ||||||
21 | Sections 370c and 370c.1 of the Illinois Insurance Code; all | ||||||
22 | other requirements of this Section shall be enforced by the | ||||||
23 | Department of Central Management Services. | ||||||
24 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
25 | any, is conditioned on the rules being adopted in accordance | ||||||
26 | with all provisions of the Illinois Administrative Procedure |
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1 | Act and all rules and procedures of the Joint Committee on | ||||||
2 | Administrative Rules; any purported rule not so adopted, for | ||||||
3 | whatever reason, is unauthorized. | ||||||
4 | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||||||
5 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. | ||||||
6 | 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768, | ||||||
7 | eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | ||||||
8 | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | ||||||
9 | 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84, | ||||||
10 | eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24; | ||||||
11 | 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff. | ||||||
12 | 8-11-23; revised 8-29-23.)
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13 | (5 ILCS 375/6.11D new) | ||||||
14 | Sec. 6.11D. Coverage for hearing instruments. | ||||||
15 | (a) As used in this Section: | ||||||
16 | "Hearing care professional" means a person who is a | ||||||
17 | licensed hearing instrument dispenser, licensed audiologist, | ||||||
18 | or a licensed physician. | ||||||
19 | "Hearing instrument" means any wearable non-disposable | ||||||
20 | instrument or device designed to aid or compensate for | ||||||
21 | impaired human hearing and any parts, attachments, or | ||||||
22 | accessories for the instrument or device, including an ear | ||||||
23 | mold but excluding batteries and cords. | ||||||
24 | "Related services" means those services necessary to | ||||||
25 | assess, select, and adjust or fit the hearing instrument to |
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1 | ensure optimal performance, including, but not limited to, | ||||||
2 | audiological exams, replacement ear molds, and repairs to the | ||||||
3 | hearing instrument. | ||||||
4 | (b) The program of health benefits shall offer coverage or | ||||||
5 | reimbursement for hearing instruments and related services for | ||||||
6 | all members and dependents enrolled in any major medical or | ||||||
7 | managed care health plan when a hearing care professional | ||||||
8 | prescribes a hearing instrument to augment communication. The | ||||||
9 | program of health benefits may offer this coverage on an | ||||||
10 | optional basis for an additional premium or contribution | ||||||
11 | beyond the underlying health plan or as an integrated benefit | ||||||
12 | in the health plan. | ||||||
13 | (c) This coverage shall be subject to all applicable | ||||||
14 | copayments, coinsurance, deductibles, and out-of-pocket limits | ||||||
15 | for the cost of a hearing instrument for each ear, as needed, | ||||||
16 | as well as related services, with a maximum for the hearing | ||||||
17 | instrument and related services of no more than $2,500 per | ||||||
18 | hearing instrument every 24 months. | ||||||
19 | (d) Nothing in this Section precludes a covered member or | ||||||
20 | dependent from selecting a hearing instrument that costs more | ||||||
21 | than the amount covered by the program of health benefits and | ||||||
22 | paying the uncovered cost at the member or dependent's own | ||||||
23 | expense.
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24 | Section 10. The Counties Code is amended by changing | ||||||
25 | Sections 5-1069.3 and 5-1069.5 and by adding Section 5-1069.4 |
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1 | as follows:
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2 | (55 ILCS 5/5-1069.3) | ||||||
3 | Sec. 5-1069.3. Required health benefits. If a county, | ||||||
4 | including a home rule county, is a self-insurer for purposes | ||||||
5 | of providing health insurance coverage for its employees, the | ||||||
6 | coverage shall include coverage for the post-mastectomy care | ||||||
7 | benefits required to be covered by a policy of accident and | ||||||
8 | health insurance under Section 356t and the coverage required | ||||||
9 | under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x, | ||||||
10 | 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, | ||||||
11 | 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, | ||||||
12 | 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, | ||||||
13 | 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, | ||||||
14 | 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and | ||||||
15 | 356z.62 , 356z.64, 356z.67, 356z.68, and 356z.70 of the | ||||||
16 | Illinois Insurance Code. The coverage shall comply with | ||||||
17 | Sections 155.22a, 355b, 356z.19, and 370c of the Illinois | ||||||
18 | Insurance Code. The Department of Insurance shall enforce the | ||||||
19 | requirements of this Section. The requirement that health | ||||||
20 | benefits be covered as provided in this Section is an | ||||||
21 | exclusive power and function of the State and is a denial and | ||||||
22 | limitation under Article VII, Section 6, subsection (h) of the | ||||||
23 | Illinois Constitution. A home rule county to which this | ||||||
24 | Section applies must comply with every provision of this | ||||||
25 | Section. |
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1 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
2 | any, is conditioned on the rules being adopted in accordance | ||||||
3 | with all provisions of the Illinois Administrative Procedure | ||||||
4 | Act and all rules and procedures of the Joint Committee on | ||||||
5 | Administrative Rules; any purported rule not so adopted, for | ||||||
6 | whatever reason, is unauthorized. | ||||||
7 | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||||||
8 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||||||
9 | 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, | ||||||
10 | eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | ||||||
11 | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | ||||||
12 | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | ||||||
13 | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | ||||||
14 | 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised | ||||||
15 | 8-29-23.)
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16 | (55 ILCS 5/5-1069.4 new) | ||||||
17 | Sec. 5-1069.4. Coverage for hearing instruments. | ||||||
18 | (a) As used in this Section: | ||||||
19 | "Hearing care professional" means a person who is a | ||||||
20 | licensed hearing instrument dispenser, licensed audiologist, | ||||||
21 | or a licensed physician. | ||||||
22 | "Hearing instrument" means any wearable non-disposable | ||||||
23 | instrument or device designed to aid or compensate for | ||||||
24 | impaired human hearing and any parts, attachments, or | ||||||
25 | accessories for the instrument or device, including an ear |
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1 | mold but excluding batteries and cords. | ||||||
2 | "Related services" means those services necessary to | ||||||
3 | assess, select, and adjust or fit the hearing instrument to | ||||||
4 | ensure optimal performance, including, but not limited to, | ||||||
5 | audiological exams, replacement ear molds, and repairs to the | ||||||
6 | hearing instrument. | ||||||
7 | (b) If a county, including a home rule county, is a | ||||||
8 | self-insurer for purposes of providing health insurance | ||||||
9 | coverage for its employees, the county shall offer coverage or | ||||||
10 | reimbursement for hearing instruments and related services for | ||||||
11 | all individuals enrolled under any major medical or managed | ||||||
12 | care health plan when a hearing care professional prescribes a | ||||||
13 | hearing instrument to augment communication. The county may | ||||||
14 | offer this coverage on an optional basis for an additional | ||||||
15 | premium or contribution beyond the underlying health plan or | ||||||
16 | as an integrated benefit in the health plan. | ||||||
17 | (c) This coverage shall be subject to all applicable | ||||||
18 | copayments, coinsurance, deductibles, and out-of-pocket limits | ||||||
19 | for the cost of a hearing instrument for each ear, as needed, | ||||||
20 | as well as related services, with a maximum for the hearing | ||||||
21 | instrument and related services of no more than $2,500 per | ||||||
22 | hearing instrument every 24 months. | ||||||
23 | (d) Nothing in this Section precludes a covered individual | ||||||
24 | from selecting a hearing instrument that costs more than the | ||||||
25 | amount covered by the county and paying the uncovered cost at | ||||||
26 | the individual's own expense. |
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1 | (e) The requirement that health benefits be covered as | ||||||
2 | provided in this Section is an exclusive power and function of | ||||||
3 | the State and is a denial and limitation under Article VII, | ||||||
4 | Section 6, subsection (h) of the Illinois Constitution. A home | ||||||
5 | rule county to which this Section applies must comply with | ||||||
6 | every provision of this Section.
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7 | (55 ILCS 5/5-1069.5) | ||||||
8 | Sec. 5-1069.5. Access to obstetrical and gynecological | ||||||
9 | care Woman's health care provider . All counties, including | ||||||
10 | home rule counties, are subject to the provisions of Section | ||||||
11 | 356r of the Illinois Insurance Code. The requirement under | ||||||
12 | this Section that health care benefits provided by counties | ||||||
13 | comply with Section 356r of the Illinois Insurance Code is an | ||||||
14 | exclusive power and function of the State and is a denial and | ||||||
15 | limitation of home rule county powers under Article VII, | ||||||
16 | Section 6, subsection (h) of the Illinois Constitution. | ||||||
17 | (Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
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18 | Section 15. The Illinois Municipal Code is amended by | ||||||
19 | changing Sections 10-4-2.3 and 10-4-2.5 and by adding Section | ||||||
20 | 10-4-2.4 as follows:
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21 | (65 ILCS 5/10-4-2.3) | ||||||
22 | Sec. 10-4-2.3. Required health benefits. If a | ||||||
23 | municipality, including a home rule municipality, is a |
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1 | self-insurer for purposes of providing health insurance | ||||||
2 | coverage for its employees, the coverage shall include | ||||||
3 | coverage for the post-mastectomy care benefits required to be | ||||||
4 | covered by a policy of accident and health insurance under | ||||||
5 | Section 356t and the coverage required under Sections 356g, | ||||||
6 | 356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, | ||||||
7 | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||||||
8 | 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | ||||||
9 | 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, | ||||||
10 | 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, | ||||||
11 | 356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62 , | ||||||
12 | 356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois | ||||||
13 | Insurance Code. The coverage shall comply with Sections | ||||||
14 | 155.22a, 355b, 356z.19, and 370c of the Illinois Insurance | ||||||
15 | Code. The Department of Insurance shall enforce the | ||||||
16 | requirements of this Section. The requirement that health | ||||||
17 | benefits be covered as provided in this is an exclusive power | ||||||
18 | and function of the State and is a denial and limitation under | ||||||
19 | Article VII, Section 6, subsection (h) of the Illinois | ||||||
20 | Constitution. A home rule municipality to which this Section | ||||||
21 | applies must comply with every provision of this Section. | ||||||
22 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
23 | any, is conditioned on the rules being adopted in accordance | ||||||
24 | with all provisions of the Illinois Administrative Procedure | ||||||
25 | Act and all rules and procedures of the Joint Committee on | ||||||
26 | Administrative Rules; any purported rule not so adopted, for |
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1 | whatever reason, is unauthorized. | ||||||
2 | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||||||
3 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||||||
4 | 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, | ||||||
5 | eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | ||||||
6 | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | ||||||
7 | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | ||||||
8 | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | ||||||
9 | 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised | ||||||
10 | 8-29-23.)
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11 | (65 ILCS 5/10-4-2.4 new) | ||||||
12 | Sec. 10-4-2.4. Coverage for hearing instruments. | ||||||
13 | (a) As used in this Section: | ||||||
14 | "Hearing care professional" means a person who is a | ||||||
15 | licensed hearing instrument dispenser, licensed audiologist, | ||||||
16 | or a licensed physician. | ||||||
17 | "Hearing instrument" means any wearable non-disposable | ||||||
18 | instrument or device designed to aid or compensate for | ||||||
19 | impaired human hearing and any parts, attachments, or | ||||||
20 | accessories for the instrument or device, including an ear | ||||||
21 | mold but excluding batteries and cords. | ||||||
22 | "Related services" means those services necessary to | ||||||
23 | assess, select, and adjust or fit the hearing instrument to | ||||||
24 | ensure optimal performance, including, but not limited to, | ||||||
25 | audiological exams, replacement ear molds, and repairs to the |
| |||||||
| |||||||
1 | hearing instrument. | ||||||
2 | (b) If a municipality, including a home rule municipality, | ||||||
3 | is a self-insurer for purposes of providing health insurance | ||||||
4 | coverage for its employees, the municipality shall offer | ||||||
5 | coverage or reimbursement for hearing instruments and related | ||||||
6 | services for all individuals enrolled under any major medical | ||||||
7 | or managed care health plan when a hearing care professional | ||||||
8 | prescribes a hearing instrument to augment communication. The | ||||||
9 | municipality may offer this coverage on an optional basis for | ||||||
10 | an additional premium or contribution beyond the underlying | ||||||
11 | health plan or as an integrated benefit in the health plan. | ||||||
12 | (c) This coverage shall be subject to all applicable | ||||||
13 | copayments, coinsurance, deductibles, and out-of-pocket limits | ||||||
14 | for the cost of a hearing instrument for each ear, as needed, | ||||||
15 | as well as related services, with a maximum for the hearing | ||||||
16 | instrument and related services of no more than $2,500 per | ||||||
17 | hearing instrument every 24 months. | ||||||
18 | (d) Nothing in this Section precludes a covered individual | ||||||
19 | from selecting a hearing instrument that costs more than the | ||||||
20 | amount covered by the municipality and paying the uncovered | ||||||
21 | cost at the individual's own expense. | ||||||
22 | (e) The requirement that health benefits be covered as | ||||||
23 | provided in this Section is an exclusive power and function of | ||||||
24 | the State and is a denial and limitation under Article VII, | ||||||
25 | Section 6, subsection (h) of the Illinois Constitution. A home | ||||||
26 | rule municipality to which this Section applies must comply |
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1 | with every provision of this Section.
| ||||||
2 | (65 ILCS 5/10-4-2.5) | ||||||
3 | Sec. 10-4-2.5. Access to obstetrical and gynecological | ||||||
4 | care Woman's health care provider . The corporate authorities | ||||||
5 | of all municipalities are subject to the provisions of Section | ||||||
6 | 356r of the Illinois Insurance Code. The requirement under | ||||||
7 | this Section that health care benefits provided by | ||||||
8 | municipalities comply with Section 356r of the Illinois | ||||||
9 | Insurance Code is an exclusive power and function of the State | ||||||
10 | and is a denial and limitation of home rule municipality | ||||||
11 | powers under Article VII, Section 6, subsection (h) of the | ||||||
12 | Illinois Constitution. | ||||||
13 | (Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
| ||||||
14 | Section 20. The School Code is amended by changing | ||||||
15 | Sections 10-22.3d and 10-22.3f and by adding Section 10-22.3g | ||||||
16 | as follows:
| ||||||
17 | (105 ILCS 5/10-22.3d) | ||||||
18 | Sec. 10-22.3d. Access to obstetrical and gynecological | ||||||
19 | care Woman's health care provider . Insurance protection and | ||||||
20 | benefits for employees are subject to the provisions of | ||||||
21 | Section 356r of the Illinois Insurance Code. | ||||||
22 | (Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
|
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| |||||||
1 | (105 ILCS 5/10-22.3f) | ||||||
2 | Sec. 10-22.3f. Required health benefits. Insurance | ||||||
3 | protection and benefits for employees shall provide the | ||||||
4 | post-mastectomy care benefits required to be covered by a | ||||||
5 | policy of accident and health insurance under Section 356t and | ||||||
6 | the coverage required under Sections 356g, 356g.5, 356g.5-1, | ||||||
7 | 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, | ||||||
8 | 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, | ||||||
9 | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | ||||||
10 | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | ||||||
11 | 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and | ||||||
12 | 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, and 356z.70 | ||||||
13 | of the Illinois Insurance Code. Insurance policies shall | ||||||
14 | comply with Section 356z.19 of the Illinois Insurance Code. | ||||||
15 | The coverage shall comply with Sections 155.22a, 355b, and | ||||||
16 | 370c of the Illinois Insurance Code. The Department of | ||||||
17 | Insurance shall enforce the requirements of this Section. | ||||||
18 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
19 | any, is conditioned on the rules being adopted in accordance | ||||||
20 | with all provisions of the Illinois Administrative Procedure | ||||||
21 | Act and all rules and procedures of the Joint Committee on | ||||||
22 | Administrative Rules; any purported rule not so adopted, for | ||||||
23 | whatever reason, is unauthorized. | ||||||
24 | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||||||
25 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. | ||||||
26 | 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, |
| |||||||
| |||||||
1 | eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; | ||||||
2 | 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. | ||||||
3 | 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, | ||||||
4 | eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; | ||||||
5 | 103-551, eff. 8-11-23; revised 8-29-23.)
| ||||||
6 | (105 ILCS 5/10-22.3g new) | ||||||
7 | Sec. 10-22.3g. Coverage for hearing instruments. | ||||||
8 | (a) As used in this Section: | ||||||
9 | "Hearing care professional" means a person who is a | ||||||
10 | licensed hearing instrument dispenser, licensed audiologist, | ||||||
11 | or a licensed physician. | ||||||
12 | "Hearing instrument" means any wearable non-disposable | ||||||
13 | instrument or device designed to aid or compensate for | ||||||
14 | impaired human hearing and any parts, attachments, or | ||||||
15 | accessories for the instrument or device, including an ear | ||||||
16 | mold but excluding batteries and cords. | ||||||
17 | "Related services" means those services necessary to | ||||||
18 | assess, select, and adjust or fit the hearing instrument to | ||||||
19 | ensure optimal performance, including, but not limited to, | ||||||
20 | audiological exams, replacement ear molds, and repairs to the | ||||||
21 | hearing instrument. | ||||||
22 | (b) Insurance protection and benefits for employees shall | ||||||
23 | include the offering of coverage or reimbursement for hearing | ||||||
24 | instruments and related services for all individuals enrolled | ||||||
25 | under any major medical or managed care health plan when a |
| |||||||
| |||||||
1 | hearing care professional prescribes a hearing instrument to | ||||||
2 | augment communication. The board may offer this coverage on an | ||||||
3 | optional basis for an additional premium or contribution | ||||||
4 | beyond the underlying health plan or as an integrated benefit | ||||||
5 | in the health plan. | ||||||
6 | (c) This coverage shall be subject to all applicable | ||||||
7 | copayments, coinsurance, deductibles, and out-of-pocket limits | ||||||
8 | for the cost of a hearing instrument for each ear, as needed, | ||||||
9 | as well as related services, with a maximum for the hearing | ||||||
10 | instrument and related services of no more than $2,500 per | ||||||
11 | hearing instrument every 24 months. | ||||||
12 | (d) Nothing in this Section precludes a covered individual | ||||||
13 | from selecting a hearing instrument that costs more than the | ||||||
14 | amount covered by the insurance benefits and paying the | ||||||
15 | uncovered cost at the individual's own expense.
| ||||||
16 | Section 25. The Illinois Insurance Code is amended by | ||||||
17 | changing Sections 4, 352, 352b, 356a, 356b, 356d, 356e, 356f, | ||||||
18 | 356K, 356L, 356r, 356s, 356z.3, 356z.33, 367a, 370e, 370i, | ||||||
19 | 408, 412, and 531.03 as follows:
| ||||||
20 | (215 ILCS 5/4) (from Ch. 73, par. 616) | ||||||
21 | Sec. 4. Classes of insurance. Insurance and insurance | ||||||
22 | business shall be classified as follows: | ||||||
23 | Class 1. Life, Accident and Health. | ||||||
24 | (a) Life. Insurance on the lives of persons and every |
| |||||||
| |||||||
1 | insurance appertaining thereto or connected therewith and | ||||||
2 | granting, purchasing or disposing of annuities. Policies of | ||||||
3 | life or endowment insurance or annuity contracts or contracts | ||||||
4 | supplemental thereto which contain provisions for additional | ||||||
5 | benefits in case of death by accidental means and provisions | ||||||
6 | operating to safeguard such policies or contracts against | ||||||
7 | lapse, to give a special surrender value, or special benefit, | ||||||
8 | or an annuity, in the event, that the insured or annuitant | ||||||
9 | shall become a person with a total and permanent disability as | ||||||
10 | defined by the policy or contract, or which contain benefits | ||||||
11 | providing acceleration of life or endowment or annuity | ||||||
12 | benefits in advance of the time they would otherwise be | ||||||
13 | payable, as an indemnity for long term care which is certified | ||||||
14 | or ordered by a physician, including but not limited to, | ||||||
15 | professional nursing care, medical care expenses, custodial | ||||||
16 | nursing care, non-nursing custodial care provided in a nursing | ||||||
17 | home or at a residence of the insured, or which contain | ||||||
18 | benefits providing acceleration of life or endowment or | ||||||
19 | annuity benefits in advance of the time they would otherwise | ||||||
20 | be payable, at any time during the insured's lifetime, as an | ||||||
21 | indemnity for a terminal illness shall be deemed to be | ||||||
22 | policies of life or endowment insurance or annuity contracts | ||||||
23 | within the intent of this clause. | ||||||
24 | Also to be deemed as policies of life or endowment | ||||||
25 | insurance or annuity contracts within the intent of this | ||||||
26 | clause shall be those policies or riders that provide for the |
| |||||||
| |||||||
1 | payment of up to 75% of the face amount of benefits in advance | ||||||
2 | of the time they would otherwise be payable upon a diagnosis by | ||||||
3 | a physician licensed to practice medicine in all of its | ||||||
4 | branches that the insured has incurred a covered condition | ||||||
5 | listed in the policy or rider. | ||||||
6 | "Covered condition", as used in this clause, means: heart | ||||||
7 | attack, stroke, coronary artery surgery, life-threatening life | ||||||
8 | threatening cancer, renal failure, Alzheimer's disease, | ||||||
9 | paraplegia, major organ transplantation, total and permanent | ||||||
10 | disability, and any other medical condition that the | ||||||
11 | Department may approve for any particular filing. | ||||||
12 | The Director may issue rules that specify prohibited | ||||||
13 | policy provisions, not otherwise specifically prohibited by | ||||||
14 | law, which in the opinion of the Director are unjust, unfair, | ||||||
15 | or unfairly discriminatory to the policyholder, any person | ||||||
16 | insured under the policy, or beneficiary. | ||||||
17 | (b) Accident and health. Insurance against bodily injury, | ||||||
18 | disablement or death by accident and against disablement | ||||||
19 | resulting from sickness or old age and every insurance | ||||||
20 | appertaining thereto, including stop-loss insurance. In this | ||||||
21 | clause, "stop-loss Stop-loss insurance " means is insurance | ||||||
22 | against the risk of economic loss issued to or for the benefit | ||||||
23 | of a single employer self-funded employee disability benefit | ||||||
24 | plan or an employee welfare benefit plan as described in 29 | ||||||
25 | U.S.C. 1001 100 et seq. , where (i) the policy is issued to and | ||||||
26 | insures an employer, trustee, or other sponsor of the plan, or |
| |||||||
| |||||||
1 | the plan itself, but not employees, members, or participants; | ||||||
2 | and (ii) payments by the insurer are made to the employer, | ||||||
3 | trustee, or other sponsors of the plan, or the plan itself, but | ||||||
4 | not to the employees, members, participants, or health care | ||||||
5 | providers. The insurance laws of this State, including this | ||||||
6 | Code, do not apply to arrangements between a religious | ||||||
7 | organization and the organization's members or participants | ||||||
8 | when the arrangement and organization meet all of the | ||||||
9 | following criteria: | ||||||
10 | (i) the organization is described in Section 501(c)(3) | ||||||
11 | of the Internal Revenue Code and is exempt from taxation | ||||||
12 | under Section 501(a) of the Internal Revenue Code; | ||||||
13 | (ii) members of the organization share a common set of | ||||||
14 | ethical or religious beliefs and share medical expenses | ||||||
15 | among members in accordance with those beliefs and without | ||||||
16 | regard to the state in which a member resides or is | ||||||
17 | employed; | ||||||
18 | (iii) no funds that have been given for the purpose of | ||||||
19 | the sharing of medical expenses among members described in | ||||||
20 | paragraph (ii) of this subsection (b) are held by the | ||||||
21 | organization in an off-shore trust or bank account; | ||||||
22 | (iv) the organization provides at least monthly to all | ||||||
23 | of its members a written statement listing the dollar | ||||||
24 | amount of qualified medical expenses that members have | ||||||
25 | submitted for sharing, as well as the amount of expenses | ||||||
26 | actually shared among the members; |
| |||||||
| |||||||
1 | (v) members of the organization retain membership even | ||||||
2 | after they develop a medical condition; | ||||||
3 | (vi) the organization or a predecessor organization | ||||||
4 | has been in existence at all times since December 31, | ||||||
5 | 1999, and medical expenses of its members have been shared | ||||||
6 | continuously and without interruption since at least | ||||||
7 | December 31, 1999; | ||||||
8 | (vii) the organization conducts an annual audit that | ||||||
9 | is performed by an independent certified public accounting | ||||||
10 | firm in accordance with generally accepted accounting | ||||||
11 | principles and is made available to the public upon | ||||||
12 | request; | ||||||
13 | (viii) the organization includes the following | ||||||
14 | statement, in writing, on or accompanying all applications | ||||||
15 | and guideline materials: | ||||||
16 | "Notice: The organization facilitating the sharing of | ||||||
17 | medical expenses is not an insurance company, and | ||||||
18 | neither its guidelines nor plan of operation | ||||||
19 | constitute or create an insurance policy. Any | ||||||
20 | assistance you receive with your medical bills will be | ||||||
21 | totally voluntary. As such, participation in the | ||||||
22 | organization or a subscription to any of its documents | ||||||
23 | should never be considered to be insurance. Whether or | ||||||
24 | not you receive any payments for medical expenses and | ||||||
25 | whether or not this organization continues to operate, | ||||||
26 | you are always personally responsible for the payment |
| |||||||
| |||||||
1 | of your own medical bills."; | ||||||
2 | (ix) any membership card or similar document issued by | ||||||
3 | the organization and any written communication sent by the | ||||||
4 | organization to a hospital, physician, or other health | ||||||
5 | care provider shall include a statement that the | ||||||
6 | organization does not issue health insurance and that the | ||||||
7 | member or participant is personally liable for payment of | ||||||
8 | his or her medical bills; | ||||||
9 | (x) the organization provides to a participant, within | ||||||
10 | 30 days after the participant joins, a complete set of its | ||||||
11 | rules for the sharing of medical expenses, appeals of | ||||||
12 | decisions made by the organization, and the filing of | ||||||
13 | complaints; | ||||||
14 | (xi) the organization does not offer any other | ||||||
15 | services that are regulated under any provision of the | ||||||
16 | Illinois Insurance Code or other insurance laws of this | ||||||
17 | State; and | ||||||
18 | (xii) the organization does not amass funds as | ||||||
19 | reserves intended for payment of medical services, rather | ||||||
20 | the organization facilitates the payments provided for in | ||||||
21 | this subsection (b) through payments made directly from | ||||||
22 | one participant to another. | ||||||
23 | (c) Legal Expense Insurance. Insurance which involves the | ||||||
24 | assumption of a contractual obligation to reimburse the | ||||||
25 | beneficiary against or pay on behalf of the beneficiary, all | ||||||
26 | or a portion of his fees, costs, or expenses related to or |
| |||||||
| |||||||
1 | arising out of services performed by or under the supervision | ||||||
2 | of an attorney licensed to practice in the jurisdiction | ||||||
3 | wherein the services are performed, regardless of whether the | ||||||
4 | payment is made by the beneficiaries individually or by a | ||||||
5 | third person for them, but does not include the provision of or | ||||||
6 | reimbursement for legal services incidental to other insurance | ||||||
7 | coverages. The insurance laws of this State, including this | ||||||
8 | Act do not apply to: | ||||||
9 | (i) retainer contracts made by attorneys at law with | ||||||
10 | individual clients with fees based on estimates of the | ||||||
11 | nature and amount of services to be provided to the | ||||||
12 | specific client, and similar contracts made with a group | ||||||
13 | of clients involved in the same or closely related legal | ||||||
14 | matters; | ||||||
15 | (ii) plans owned or operated by attorneys who are the | ||||||
16 | providers of legal services to the plan; | ||||||
17 | (iii) plans providing legal service benefits to groups | ||||||
18 | where such plans are owned or operated by authority of a | ||||||
19 | state, county, local or other bar association; | ||||||
20 | (iv) any lawyer referral service authorized or | ||||||
21 | operated by a state, county, local or other bar | ||||||
22 | association; | ||||||
23 | (v) the furnishing of legal assistance by labor unions | ||||||
24 | and other employee organizations to their members in | ||||||
25 | matters relating to employment or occupation; | ||||||
26 | (vi) the furnishing of legal assistance to members or |
| |||||||
| |||||||
1 | dependents, by churches, consumer organizations, | ||||||
2 | cooperatives, educational institutions, credit unions, or | ||||||
3 | organizations of employees, where such organizations | ||||||
4 | contract directly with lawyers or law firms for the | ||||||
5 | provision of legal services, and the administration and | ||||||
6 | marketing of such legal services is wholly conducted by | ||||||
7 | the organization or its subsidiary; | ||||||
8 | (vii) legal services provided by an employee welfare | ||||||
9 | benefit plan defined by the Employee Retirement Income | ||||||
10 | Security Act of 1974; | ||||||
11 | (viii) any collectively bargained plan for legal | ||||||
12 | services between a labor union and an employer negotiated | ||||||
13 | pursuant to Section 302 of the Labor Management Relations | ||||||
14 | Act as now or hereafter amended, under which plan legal | ||||||
15 | services will be provided for employees of the employer | ||||||
16 | whether or not payments for such services are funded to or | ||||||
17 | through an insurance company. | ||||||
18 | Class 2. Casualty, Fidelity and Surety. | ||||||
19 | (a) Accident and health. Insurance against bodily injury, | ||||||
20 | disablement or death by accident and against disablement | ||||||
21 | resulting from sickness or old age and every insurance | ||||||
22 | appertaining thereto, including stop-loss insurance. In this | ||||||
23 | clause, "stop-loss Stop-loss insurance " has meaning given to | ||||||
24 | that term in clause (b) of Class 1 is insurance against the | ||||||
25 | risk of economic loss issued to a single employer self-funded | ||||||
26 | employee disability benefit plan or an employee welfare |
| |||||||
| |||||||
1 | benefit plan as described in 29 U.S.C. 1001 et seq . | ||||||
2 | (b) Vehicle. Insurance against any loss or liability | ||||||
3 | resulting from or incident to the ownership, maintenance or | ||||||
4 | use of any vehicle (motor or otherwise), draft animal or | ||||||
5 | aircraft. Any policy insuring against any loss or liability on | ||||||
6 | account of the bodily injury or death of any person may contain | ||||||
7 | a provision for payment of disability benefits to injured | ||||||
8 | persons and death benefits to dependents, beneficiaries or | ||||||
9 | personal representatives of persons who are killed, including | ||||||
10 | the named insured, irrespective of legal liability of the | ||||||
11 | insured, if the injury or death for which benefits are | ||||||
12 | provided is caused by accident and sustained while in or upon | ||||||
13 | or while entering into or alighting from or through being | ||||||
14 | struck by a vehicle (motor or otherwise), draft animal or | ||||||
15 | aircraft, and such provision shall not be deemed to be | ||||||
16 | accident insurance. | ||||||
17 | (c) Liability. Insurance against the liability of the | ||||||
18 | insured for the death, injury or disability of an employee or | ||||||
19 | other person, and insurance against the liability of the | ||||||
20 | insured for damage to or destruction of another person's | ||||||
21 | property. | ||||||
22 | (d) Workers' compensation. Insurance of the obligations | ||||||
23 | accepted by or imposed upon employers under laws for workers' | ||||||
24 | compensation. | ||||||
25 | (e) Burglary and forgery. Insurance against loss or damage | ||||||
26 | by burglary, theft, larceny, robbery, forgery, fraud or |
| |||||||
| |||||||
1 | otherwise; including all householders' personal property | ||||||
2 | floater risks. | ||||||
3 | (f) Glass. Insurance against loss or damage to glass | ||||||
4 | including lettering, ornamentation and fittings from any | ||||||
5 | cause. | ||||||
6 | (g) Fidelity and surety. Become surety or guarantor for | ||||||
7 | any person, copartnership or corporation in any position or | ||||||
8 | place of trust or as custodian of money or property, public or | ||||||
9 | private; or, becoming a surety or guarantor for the | ||||||
10 | performance of any person, copartnership or corporation of any | ||||||
11 | lawful obligation, undertaking, agreement or contract of any | ||||||
12 | kind, except contracts or policies of insurance; and | ||||||
13 | underwriting blanket bonds. Such obligations shall be known | ||||||
14 | and treated as suretyship obligations and such business shall | ||||||
15 | be known as surety business. | ||||||
16 | (h) Miscellaneous. Insurance against loss or damage to | ||||||
17 | property and any liability of the insured caused by accidents | ||||||
18 | to boilers, pipes, pressure containers, machinery and | ||||||
19 | apparatus of any kind and any apparatus connected thereto, or | ||||||
20 | used for creating, transmitting or applying power, light, | ||||||
21 | heat, steam or refrigeration, making inspection of and issuing | ||||||
22 | certificates of inspection upon elevators, boilers, machinery | ||||||
23 | and apparatus of any kind and all mechanical apparatus and | ||||||
24 | appliances appertaining thereto; insurance against loss or | ||||||
25 | damage by water entering through leaks or openings in | ||||||
26 | buildings, or from the breakage or leakage of a sprinkler, |
| |||||||
| |||||||
1 | pumps, water pipes, plumbing and all tanks, apparatus, | ||||||
2 | conduits and containers designed to bring water into buildings | ||||||
3 | or for its storage or utilization therein, or caused by the | ||||||
4 | falling of a tank, tank platform or supports, or against loss | ||||||
5 | or damage from any cause (other than causes specifically | ||||||
6 | enumerated under Class 3 of this Section) to such sprinkler, | ||||||
7 | pumps, water pipes, plumbing, tanks, apparatus, conduits or | ||||||
8 | containers; insurance against loss or damage which may result | ||||||
9 | from the failure of debtors to pay their obligations to the | ||||||
10 | insured; and insurance of the payment of money for personal | ||||||
11 | services under contracts of hiring. | ||||||
12 | (i) Other casualty risks. Insurance against any other | ||||||
13 | casualty risk not otherwise specified under Classes 1 or 3, | ||||||
14 | which may lawfully be the subject of insurance and may | ||||||
15 | properly be classified under Class 2. | ||||||
16 | (j) Contingent losses. Contingent, consequential and | ||||||
17 | indirect coverages wherein the proximate cause of the loss is | ||||||
18 | attributable to any one of the causes enumerated under Class | ||||||
19 | 2. Such coverages shall, for the purpose of classification, be | ||||||
20 | included in the specific grouping of the kinds of insurance | ||||||
21 | wherein such cause is specified. | ||||||
22 | (k) Livestock and domestic animals. Insurance against | ||||||
23 | mortality, accident and health of livestock and domestic | ||||||
24 | animals. | ||||||
25 | (l) Legal expense insurance. Insurance against risk | ||||||
26 | resulting from the cost of legal services as defined under |
| |||||||
| |||||||
1 | Class 1(c). | ||||||
2 | Class 3. Fire and Marine, etc. | ||||||
3 | (a) Fire. Insurance against loss or damage by fire, smoke | ||||||
4 | and smudge, lightning or other electrical disturbances. | ||||||
5 | (b) Elements. Insurance against loss or damage by | ||||||
6 | earthquake, windstorms, cyclone, tornado, tempests, hail, | ||||||
7 | frost, snow, ice, sleet, flood, rain, drought or other weather | ||||||
8 | or climatic conditions including excess or deficiency of | ||||||
9 | moisture, rising of the waters of the ocean or its | ||||||
10 | tributaries. | ||||||
11 | (c) War, riot and explosion. Insurance against loss or | ||||||
12 | damage by bombardment, invasion, insurrection, riot, strikes, | ||||||
13 | civil war or commotion, military or usurped power, or | ||||||
14 | explosion (other than explosion of steam boilers and the | ||||||
15 | breaking of fly wheels on premises owned, controlled, managed, | ||||||
16 | or maintained by the insured). | ||||||
17 | (d) Marine and transportation. Insurance against loss or | ||||||
18 | damage to vessels, craft, aircraft, vehicles of every kind, | ||||||
19 | (excluding vehicles operating under their own power or while | ||||||
20 | in storage not incidental to transportation) as well as all | ||||||
21 | goods, freights, cargoes, merchandise, effects, disbursements, | ||||||
22 | profits, moneys, bullion, precious stones, securities, choses | ||||||
23 | in action, evidences of debt, valuable papers, bottomry and | ||||||
24 | respondentia interests and all other kinds of property and | ||||||
25 | interests therein, in respect to, appertaining to or in | ||||||
26 | connection with any or all risks or perils of navigation, |
| |||||||
| |||||||
1 | transit, or transportation, including war risks, on or under | ||||||
2 | any seas or other waters, on land or in the air, or while being | ||||||
3 | assembled, packed, crated, baled, compressed or similarly | ||||||
4 | prepared for shipment or while awaiting the same or during any | ||||||
5 | delays, storage, transshipment, or reshipment incident | ||||||
6 | thereto, including marine builder's risks and all personal | ||||||
7 | property floater risks; and for loss or damage to persons or | ||||||
8 | property in connection with or appertaining to marine, inland | ||||||
9 | marine, transit or transportation insurance, including | ||||||
10 | liability for loss of or damage to either arising out of or in | ||||||
11 | connection with the construction, repair, operation, | ||||||
12 | maintenance, or use of the subject matter of such insurance, | ||||||
13 | (but not including life insurance or surety bonds); but, | ||||||
14 | except as herein specified, shall not mean insurances against | ||||||
15 | loss by reason of bodily injury to the person; and insurance | ||||||
16 | against loss or damage to precious stones, jewels, jewelry, | ||||||
17 | gold, silver and other precious metals whether used in | ||||||
18 | business or trade or otherwise and whether the same be in | ||||||
19 | course of transportation or otherwise, which shall include | ||||||
20 | jewelers' block insurance; and insurance against loss or | ||||||
21 | damage to bridges, tunnels and other instrumentalities of | ||||||
22 | transportation and communication (excluding buildings, their | ||||||
23 | furniture and furnishings, fixed contents and supplies held in | ||||||
24 | storage) unless fire, tornado, sprinkler leakage, hail, | ||||||
25 | explosion, earthquake, riot and civil commotion are the only | ||||||
26 | hazards to be covered; and to piers, wharves, docks and slips, |
| |||||||
| |||||||
1 | excluding the risks of fire, tornado, sprinkler leakage, hail, | ||||||
2 | explosion, earthquake, riot and civil commotion; and to other | ||||||
3 | aids to navigation and transportation, including dry docks and | ||||||
4 | marine railways, against all risk. | ||||||
5 | (e) Vehicle. Insurance against loss or liability resulting | ||||||
6 | from or incident to the ownership, maintenance or use of any | ||||||
7 | vehicle (motor or otherwise), draft animal or aircraft, | ||||||
8 | excluding the liability of the insured for the death, injury | ||||||
9 | or disability of another person. | ||||||
10 | (f) Property damage, sprinkler leakage and crop. Insurance | ||||||
11 | against the liability of the insured for loss or damage to | ||||||
12 | another person's property or property interests from any cause | ||||||
13 | enumerated in this class; insurance against loss or damage by | ||||||
14 | water entering through leaks or openings in buildings, or from | ||||||
15 | the breakage or leakage of a sprinkler, pumps, water pipes, | ||||||
16 | plumbing and all tanks, apparatus, conduits and containers | ||||||
17 | designed to bring water into buildings or for its storage or | ||||||
18 | utilization therein, or caused by the falling of a tank, tank | ||||||
19 | platform or supports or against loss or damage from any cause | ||||||
20 | to such sprinklers, pumps, water pipes, plumbing, tanks, | ||||||
21 | apparatus, conduits or containers; insurance against loss or | ||||||
22 | damage from insects, diseases or other causes to trees, crops | ||||||
23 | or other products of the soil. | ||||||
24 | (g) Other fire and marine risks. Insurance against any | ||||||
25 | other property risk not otherwise specified under Classes 1 or | ||||||
26 | 2, which may lawfully be the subject of insurance and may |
| |||||||
| |||||||
1 | properly be classified under Class 3. | ||||||
2 | (h) Contingent losses. Contingent, consequential and | ||||||
3 | indirect coverages wherein the proximate cause of the loss is | ||||||
4 | attributable to any of the causes enumerated under Class 3. | ||||||
5 | Such coverages shall, for the purpose of classification, be | ||||||
6 | included in the specific grouping of the kinds of insurance | ||||||
7 | wherein such cause is specified. | ||||||
8 | (i) Legal expense insurance. Insurance against risk | ||||||
9 | resulting from the cost of legal services as defined under | ||||||
10 | Class 1(c). | ||||||
11 | (Source: P.A. 101-81, eff. 7-12-19.)
| ||||||
12 | (215 ILCS 5/352) (from Ch. 73, par. 964) | ||||||
13 | Sec. 352. Scope of Article. | ||||||
14 | (a) Except as provided in subsections (b), (c), (d), and | ||||||
15 | (e) , and (g) , this Article shall apply to all companies | ||||||
16 | transacting in this State the kinds of business enumerated in | ||||||
17 | clause (b) of Class 1 and clause (a) of Class 2 of Section 4 | ||||||
18 | and to all policies, contracts, and certificates of insurance | ||||||
19 | issued in connection therewith that are not otherwise excluded | ||||||
20 | under Article VII of this Code . Nothing in this Article shall | ||||||
21 | apply to, or in any way affect policies or contracts described | ||||||
22 | in clause (a) of Class 1 of Section 4; however, this Article | ||||||
23 | shall apply to policies and contracts which contain benefits | ||||||
24 | providing reimbursement for the expenses of long term health | ||||||
25 | care which are certified or ordered by a physician including |
| |||||||
| |||||||
1 | but not limited to professional nursing care, custodial | ||||||
2 | nursing care, and non-nursing custodial care provided in a | ||||||
3 | nursing home or at a residence of the insured. | ||||||
4 | (b) (Blank). | ||||||
5 | (c) A policy issued and delivered in this State that | ||||||
6 | provides coverage under that policy for certificate holders | ||||||
7 | who are neither residents of nor employed in this State does | ||||||
8 | not need to provide to those nonresident certificate holders | ||||||
9 | who are not employed in this State the coverages or services | ||||||
10 | mandated by this Article. | ||||||
11 | (d) Stop-loss insurance , as defined in clause (b) of Class | ||||||
12 | 1 or clause (a) of Class 2 of Section 4, is exempt from all | ||||||
13 | Sections of this Article, except this Section and Sections | ||||||
14 | 353a, 354, 357.30, and 370. For purposes of this exemption, | ||||||
15 | stop-loss insurance is further defined as follows: | ||||||
16 | (1) The policy must be issued to and insure an | ||||||
17 | employer, trustee, or other sponsor of the plan, or the | ||||||
18 | plan itself, but not employees, members, or participants. | ||||||
19 | (2) Payments by the insurer must be made to the | ||||||
20 | employer, trustee, or other sponsors of the plan, or the | ||||||
21 | plan itself, but not to the employees, members, | ||||||
22 | participants, or health care providers. | ||||||
23 | (e) A policy issued or delivered in this State to the | ||||||
24 | Department of Healthcare and Family Services (formerly | ||||||
25 | Illinois Department of Public Aid) and providing coverage, | ||||||
26 | under clause (b) of Class 1 or clause (a) of Class 2 as |
| |||||||
| |||||||
1 | described in Section 4, to persons who are enrolled under | ||||||
2 | Article V of the Illinois Public Aid Code or under the | ||||||
3 | Children's Health Insurance Program Act is exempt from all | ||||||
4 | restrictions, limitations, standards, rules, or regulations | ||||||
5 | respecting benefits imposed by or under authority of this | ||||||
6 | Code, except those specified by subsection (1) of Section 143, | ||||||
7 | Section 370c, and Section 370c.1. Nothing in this subsection, | ||||||
8 | however, affects the total medical services available to | ||||||
9 | persons eligible for medical assistance under the Illinois | ||||||
10 | Public Aid Code. | ||||||
11 | (f) An in-office membership care agreement provided under | ||||||
12 | the In-Office Membership Care Act is not insurance for the | ||||||
13 | purposes of this Code. | ||||||
14 | (g) The provisions of Sections 356a through 359a, both | ||||||
15 | inclusive, shall not apply to or affect: | ||||||
16 | (1) any policy or contract of reinsurance; or | ||||||
17 | (2) life insurance, endowment or annuity contracts, or | ||||||
18 | contracts supplemental thereto, that contain only such | ||||||
19 | provisions relating to accident and sickness insurance | ||||||
20 | that (A) provide additional benefits in case of death or | ||||||
21 | dismemberment or loss of sight by accident, or (B) operate | ||||||
22 | to safeguard such contracts against lapse, or to give a | ||||||
23 | special surrender value or special benefit or an annuity | ||||||
24 | if the insured or annuitant becomes a person with a total | ||||||
25 | and permanent disability, as defined by the contract or | ||||||
26 | supplemental contract. |
| |||||||
| |||||||
1 | (Source: P.A. 101-190, eff. 8-2-19.)
| ||||||
2 | (215 ILCS 5/352b) | ||||||
3 | Sec. 352b. Excepted benefits exempted Policy of individual | ||||||
4 | or group accident and health insurance . | ||||||
5 | (a) Unless specified otherwise and when used in context of | ||||||
6 | accident and health insurance policy benefits, coverage, | ||||||
7 | terms, or conditions required to be provided under this | ||||||
8 | Article, references to any " policy of individual or group | ||||||
9 | accident and health insurance " , or both, as used in this | ||||||
10 | Article, do does not include any coverage or policy that | ||||||
11 | provides an excepted benefit, as that term is defined in | ||||||
12 | Section 2791(c) of the federal Public Health Service Act (42 | ||||||
13 | U.S.C. 300gg-91). Nothing in this subsection amendatory Act of | ||||||
14 | the 101st General Assembly applies to a policy of liability, | ||||||
15 | workers' compensation, automobile medical payment, or limited | ||||||
16 | scope dental or vision benefits insurance issued under this | ||||||
17 | Code. Nothing in this subsection shall be construed to subject | ||||||
18 | excepted benefits outside the scope of Section 352 to any | ||||||
19 | requirements of this Article. | ||||||
20 | (b) Nothing in this Article shall require a policy of | ||||||
21 | excepted benefits to provide benefits, coverage, terms, or | ||||||
22 | conditions in such a manner as to disqualify it from being | ||||||
23 | classified under federal law as the type of excepted benefit | ||||||
24 | for which its policy forms are filed under Sections 143 and 355 | ||||||
25 | of this Code. |
| |||||||
| |||||||
1 | (Source: P.A. 101-456, eff. 8-23-19.)
| ||||||
2 | (215 ILCS 5/356a) (from Ch. 73, par. 968a) | ||||||
3 | Sec. 356a. Form of policy. | ||||||
4 | (1) No individual policy of accident and health insurance | ||||||
5 | shall be delivered or issued for delivery to any person in this | ||||||
6 | State state unless: | ||||||
7 | (a) the entire money and other considerations therefor | ||||||
8 | are expressed therein; and | ||||||
9 | (b) the time at which the insurance takes effect and | ||||||
10 | terminates is expressed therein; and | ||||||
11 | (c) it purports to insure only one person, except that | ||||||
12 | a policy may insure, originally or by subsequent | ||||||
13 | amendment, upon the application of an adult member of a | ||||||
14 | family who shall be deemed the policyholder, any 2 two or | ||||||
15 | more eligible members of that family, including husband, | ||||||
16 | wife, dependent children or any children under a specified | ||||||
17 | age which shall not exceed 19 years and any other person | ||||||
18 | dependent upon the policyholder; and | ||||||
19 | (d) the style, arrangement and over-all appearance of | ||||||
20 | the policy give no undue prominence to any portion of the | ||||||
21 | text, and unless every printed portion of the text of the | ||||||
22 | policy and of any endorsements or attached papers is | ||||||
23 | plainly printed in light-faced type of a style in general | ||||||
24 | use, the size of which shall be uniform and not less than | ||||||
25 | ten-point with a lower-case unspaced alphabet length not |
| |||||||
| |||||||
1 | less than one hundred and twenty-point (the "text" shall | ||||||
2 | include all printed matter except the name and address of | ||||||
3 | the insurer, name or title of the policy, the brief | ||||||
4 | description if any, and captions and subcaptions); and | ||||||
5 | (e) the exceptions and reductions of indemnity are set | ||||||
6 | forth in the policy and, except those which are set forth | ||||||
7 | in Sections 357.1 through 357.30 of this act, are printed, | ||||||
8 | at the insurer's option, either included with the benefit | ||||||
9 | provision to which they apply, or under an appropriate | ||||||
10 | caption such as "EXCEPTIONS", or "EXCEPTIONS AND | ||||||
11 | REDUCTIONS", provided that if an exception or reduction | ||||||
12 | specifically applies only to a particular benefit of the | ||||||
13 | policy, a statement of such exception or reduction shall | ||||||
14 | be included with the benefit provision to which it | ||||||
15 | applies; and | ||||||
16 | (f) each such form, including riders and endorsements, | ||||||
17 | shall be identified by a form number in the lower | ||||||
18 | left-hand corner of the first page thereof; and | ||||||
19 | (g) it contains no provision purporting to make any | ||||||
20 | portion of the charter, rules, constitution, or by-laws of | ||||||
21 | the insurer a part of the policy unless such portion is set | ||||||
22 | forth in full in the policy, except in the case of the | ||||||
23 | incorporation of, or reference to, a statement of rates or | ||||||
24 | classification of risks, or short-rate table filed with | ||||||
25 | the Director. | ||||||
26 | (2) If any policy is issued by an insurer domiciled in this |
| |||||||
| |||||||
1 | state for delivery to a person residing in another state, and | ||||||
2 | if the official having responsibility for the administration | ||||||
3 | of the insurance laws of such other state shall have advised | ||||||
4 | the Director that any such policy is not subject to approval or | ||||||
5 | disapproval by such official, the Director may by ruling | ||||||
6 | require that such policy meet the standards set forth in | ||||||
7 | subsection (1) of this section and in Sections 357.1 through | ||||||
8 | 357.30. | ||||||
9 | (Source: P.A. 76-860.)
| ||||||
10 | (215 ILCS 5/356b) (from Ch. 73, par. 968b) | ||||||
11 | Sec. 356b. (a) This Section applies to the hospital and | ||||||
12 | medical expense provisions of an individual accident or health | ||||||
13 | insurance policy. | ||||||
14 | (b) If a policy provides that coverage of a dependent | ||||||
15 | person terminates upon attainment of the limiting age for | ||||||
16 | dependent persons specified in the policy, the attainment of | ||||||
17 | such limiting age does not operate to terminate the hospital | ||||||
18 | and medical coverage of a person who, because of a disabling | ||||||
19 | condition that occurred before attainment of the limiting age, | ||||||
20 | is incapable of self-sustaining employment and is dependent on | ||||||
21 | his or her parents or other care providers for lifetime care | ||||||
22 | and supervision. | ||||||
23 | (c) For purposes of subsection (b), "dependent on other | ||||||
24 | care providers" is defined as requiring a Community Integrated | ||||||
25 | Living Arrangement, group home, supervised apartment, or other |
| |||||||
| |||||||
1 | residential services licensed or certified by the Department | ||||||
2 | of Human Services (as successor to the Department of Mental | ||||||
3 | Health and Developmental Disabilities), the Department of | ||||||
4 | Public Health, or the Department of Healthcare and Family | ||||||
5 | Services (formerly Department of Public Aid). | ||||||
6 | (d) The insurer may inquire of the policyholder 2 months | ||||||
7 | prior to attainment by a dependent of the limiting age set | ||||||
8 | forth in the policy, or at any reasonable time thereafter, | ||||||
9 | whether such dependent is in fact a person who has a disability | ||||||
10 | and is dependent and, in the absence of proof submitted within | ||||||
11 | 60 days of such inquiry that such dependent is a person who has | ||||||
12 | a disability and is dependent may terminate coverage of such | ||||||
13 | person at or after attainment of the limiting age. In the | ||||||
14 | absence of such inquiry, coverage of any person who has a | ||||||
15 | disability and is dependent shall continue through the term of | ||||||
16 | such policy or any extension or renewal thereof. | ||||||
17 | (e) This amendatory Act of 1969 is applicable to policies | ||||||
18 | issued or renewed more than 60 days after the effective date of | ||||||
19 | this amendatory Act of 1969. | ||||||
20 | (Source: P.A. 99-143, eff. 7-27-15.)
| ||||||
21 | (215 ILCS 5/356d) (from Ch. 73, par. 968d) | ||||||
22 | Sec. 356d. Conversion privileges for insured former | ||||||
23 | spouses. (1) No individual policy of accident and health | ||||||
24 | insurance providing coverage of hospital and/or medical | ||||||
25 | expense on either an expense incurred basis or other than an |
| |||||||
| |||||||
1 | expense incurred basis, which in addition to covering the | ||||||
2 | insured also provides coverage to the spouse of the insured | ||||||
3 | shall contain a provision for termination of coverage for a | ||||||
4 | spouse covered under the policy solely as a result of a break | ||||||
5 | in the marital relationship except by reason of an entry of a | ||||||
6 | valid judgment of dissolution of marriage between the parties. | ||||||
7 | (2) Every policy which contains a provision for | ||||||
8 | termination of coverage of the spouse upon dissolution of | ||||||
9 | marriage shall contain a provision to the effect that upon the | ||||||
10 | entry of a valid judgment of dissolution of marriage between | ||||||
11 | the insured parties the spouse whose marriage was dissolved | ||||||
12 | shall be entitled to have issued to him or her, without | ||||||
13 | evidence of insurability, upon application made to the company | ||||||
14 | within 60 days following the entry of such judgment, and upon | ||||||
15 | the payment of the appropriate premium, an individual policy | ||||||
16 | of accident and health insurance. Such policy shall provide | ||||||
17 | the coverage then being issued by the insurer which is most | ||||||
18 | nearly similar to, but not greater than, such terminated | ||||||
19 | coverages. Any and all probationary and/or waiting periods set | ||||||
20 | forth in such policy shall be considered as being met to the | ||||||
21 | extent coverage was in force under the prior policy. | ||||||
22 | (3) The requirements of this Section shall apply to all | ||||||
23 | policies delivered or issued for delivery on or after the 60th | ||||||
24 | day following the effective date of this Section. | ||||||
25 | (Source: P.A. 84-545.)
|
| |||||||
| |||||||
1 | (215 ILCS 5/356e) (from Ch. 73, par. 968e) | ||||||
2 | Sec. 356e. Victims of certain offenses. | ||||||
3 | (1) No individual policy of accident and health insurance, | ||||||
4 | which provides benefits for hospital or medical expenses based | ||||||
5 | upon the actual expenses incurred, delivered or issued for | ||||||
6 | delivery to any person in this State shall contain any | ||||||
7 | specific exception to coverage which would preclude the | ||||||
8 | payment under that policy of actual expenses incurred in the | ||||||
9 | examination and testing of a victim of an offense defined in | ||||||
10 | Sections 11-1.20 through 11-1.60 or 12-13 through 12-16 of the | ||||||
11 | Criminal Code of 1961 or the Criminal Code of 2012, or an | ||||||
12 | attempt to commit such offense to establish that sexual | ||||||
13 | contact did occur or did not occur, and to establish the | ||||||
14 | presence or absence of sexually transmitted disease or | ||||||
15 | infection, and examination and treatment of injuries and | ||||||
16 | trauma sustained by a victim of such offense arising out of the | ||||||
17 | offense. Every policy of accident and health insurance which | ||||||
18 | specifically provides benefits for routine physical | ||||||
19 | examinations shall provide full coverage for expenses incurred | ||||||
20 | in the examination and testing of a victim of an offense | ||||||
21 | defined in Sections 11-1.20 through 11-1.60 or 12-13 through | ||||||
22 | 12-16 of the Criminal Code of 1961 or the Criminal Code of | ||||||
23 | 2012, or an attempt to commit such offense as set forth in this | ||||||
24 | Section. This Section shall not apply to a policy which covers | ||||||
25 | hospital and medical expenses for specified illnesses or | ||||||
26 | injuries only. |
| |||||||
| |||||||
1 | (2) For purposes of enabling the recovery of State funds, | ||||||
2 | any insurance carrier subject to this Section shall upon | ||||||
3 | reasonable demand by the Department of Public Health disclose | ||||||
4 | the names and identities of its insureds entitled to benefits | ||||||
5 | under this provision to the Department of Public Health | ||||||
6 | whenever the Department of Public Health has determined that | ||||||
7 | it has paid, or is about to pay, hospital or medical expenses | ||||||
8 | for which an insurance carrier is liable under this Section. | ||||||
9 | All information received by the Department of Public Health | ||||||
10 | under this provision shall be held on a confidential basis and | ||||||
11 | shall not be subject to subpoena and shall not be made public | ||||||
12 | by the Department of Public Health or used for any purpose | ||||||
13 | other than that authorized by this Section. | ||||||
14 | (3) Whenever the Department of Public Health finds that it | ||||||
15 | has paid all or part of any hospital or medical expenses which | ||||||
16 | an insurance carrier is obligated to pay under this Section, | ||||||
17 | the Department of Public Health shall be entitled to receive | ||||||
18 | reimbursement for its payments from such insurance carrier | ||||||
19 | provided that the Department of Public Health has notified the | ||||||
20 | insurance carrier of its claims before the carrier has paid | ||||||
21 | such benefits to its insureds or in behalf of its insureds. | ||||||
22 | (Source: P.A. 96-1551, eff. 7-1-11; 97-1150, eff. 1-25-13.)
| ||||||
23 | (215 ILCS 5/356f) (from Ch. 73, par. 968f) | ||||||
24 | Sec. 356f. No individual policy of accident or health | ||||||
25 | insurance or any renewal thereof shall be denied or cancelled |
| |||||||
| |||||||
1 | by the insurer, nor shall any such policy contain any | ||||||
2 | exception or exclusion of benefits, solely because the mother | ||||||
3 | of the insured has taken diethylstilbestrol, commonly referred | ||||||
4 | to as DES. | ||||||
5 | (Source: P.A. 81-656.)
| ||||||
6 | (215 ILCS 5/356K) (from Ch. 73, par. 968K) | ||||||
7 | Sec. 356K. Coverage for Organ Transplantation Procedures. | ||||||
8 | No accident and health insurer providing individual accident | ||||||
9 | and health insurance coverage under this Act for hospital or | ||||||
10 | medical expenses shall deny reimbursement for an otherwise | ||||||
11 | covered expense incurred for any organ transplantation | ||||||
12 | procedure solely on the basis that such procedure is deemed | ||||||
13 | experimental or investigational unless supported by the | ||||||
14 | determination of the Office of Health Care Technology | ||||||
15 | Assessment within the Agency for Health Care Policy and | ||||||
16 | Research within the federal Department of Health and Human | ||||||
17 | Services that such procedure is either experimental or | ||||||
18 | investigational or that there is insufficient data or | ||||||
19 | experience to determine whether an organ transplantation | ||||||
20 | procedure is clinically acceptable. If an accident and health | ||||||
21 | insurer has made written request, or had one made on its behalf | ||||||
22 | by a national organization, for determination by the Office of | ||||||
23 | Health Care Technology Assessment within the Agency for Health | ||||||
24 | Care Policy and Research within the federal Department of | ||||||
25 | Health and Human Services as to whether a specific organ |
| |||||||
| |||||||
1 | transplantation procedure is clinically acceptable and said | ||||||
2 | organization fails to respond to such a request within a | ||||||
3 | period of 90 days, the failure to act may be deemed a | ||||||
4 | determination that the procedure is deemed to be experimental | ||||||
5 | or investigational. | ||||||
6 | (Source: P.A. 87-218.)
| ||||||
7 | (215 ILCS 5/356L) (from Ch. 73, par. 968L) | ||||||
8 | Sec. 356L. No individual policy of accident or health | ||||||
9 | insurance shall include any provision which shall have the | ||||||
10 | effect of denying coverage to or on behalf of an insured under | ||||||
11 | such policy on the basis of a failure by the insured to file a | ||||||
12 | notice of claim within the time period required by the policy, | ||||||
13 | provided such failure is caused solely by the physical | ||||||
14 | inability or mental incapacity of the insured to file such | ||||||
15 | notice of claim because of a period of emergency | ||||||
16 | hospitalization. | ||||||
17 | (Source: P.A. 86-784.)
| ||||||
18 | (215 ILCS 5/356r) | ||||||
19 | Sec. 356r. Access to obstetrical and gynecological care | ||||||
20 | Woman's principal health care provider . | ||||||
21 | (a) An individual or group policy of accident and health | ||||||
22 | insurance or a managed care plan amended, delivered, issued, | ||||||
23 | or renewed in this State must not require authorization or | ||||||
24 | referral by the plan, issuer, or any person, including a |
| |||||||
| |||||||
1 | primary care provider, for any covered individual who seeks | ||||||
2 | coverage for obstetrical or gynecological care provided by any | ||||||
3 | licensed or certified participating health care professional | ||||||
4 | who specializes in obstetrics or gynecology. after November | ||||||
5 | 14, 1996 that requires an insured or enrollee to designate an | ||||||
6 | individual to coordinate care or to control access to health | ||||||
7 | care services shall also permit a female insured or enrollee | ||||||
8 | to designate a participating woman's principal health care | ||||||
9 | provider, and the insurer or managed care plan shall provide | ||||||
10 | the following written notice to all female insureds or | ||||||
11 | enrollees no later than 120 days after the effective date of | ||||||
12 | this amendatory Act of 1998; to all new enrollees at the time | ||||||
13 | of enrollment; and thereafter to all existing enrollees at | ||||||
14 | least annually, as a part of a regular publication or | ||||||
15 | informational mailing: | ||||||
16 | "NOTICE TO ALL FEMALE PLAN MEMBERS: | ||||||
17 | YOUR RIGHT TO SELECT A WOMAN'S PRINCIPAL | ||||||
18 | HEALTH CARE PROVIDER. | ||||||
19 | Illinois law allows you to select "a woman's principal | ||||||
20 | health care provider" in addition to your selection of a | ||||||
21 | primary care physician. A woman's principal health care | ||||||
22 | provider is a physician licensed to practice medicine in | ||||||
23 | all its branches specializing in obstetrics or gynecology | ||||||
24 | or specializing in family practice. A woman's principal | ||||||
25 | health care provider may be seen for care without | ||||||
26 | referrals from your primary care physician. If you have |
| |||||||
| |||||||
1 | not already selected a woman's principal health care | ||||||
2 | provider, you may do so now or at any other time. You are | ||||||
3 | not required to have or to select a woman's principal | ||||||
4 | health care provider. | ||||||
5 | Your woman's principal health care provider must be a | ||||||
6 | part of your plan. You may get the list of participating | ||||||
7 | obstetricians, gynecologists, and family practice | ||||||
8 | specialists from your employer's employee benefits | ||||||
9 | coordinator, or for your own copy of the current list, you | ||||||
10 | may call [insert plan's toll free number]. The list will | ||||||
11 | be sent to you within 10 days after your call. To designate | ||||||
12 | a woman's principal health care provider from the list, | ||||||
13 | call [insert plan's toll free number] and tell our staff | ||||||
14 | the name of the physician you have selected.". | ||||||
15 | If the insurer or managed care plan exercises the option set | ||||||
16 | forth in subsection (a-5), the notice shall also state: | ||||||
17 | "Your plan requires that your primary care physician | ||||||
18 | and your woman's principal health care provider have a | ||||||
19 | referral arrangement with one another. If the woman's | ||||||
20 | principal health care provider that you select does not | ||||||
21 | have a referral arrangement with your primary care | ||||||
22 | physician, you will have to select a new primary care | ||||||
23 | physician who has a referral arrangement with your woman's | ||||||
24 | principal health care provider or you may select a woman's | ||||||
25 | principal health care provider who has a referral | ||||||
26 | arrangement with your primary care physician. The list of |
| |||||||
| |||||||
1 | woman's principal health care providers will also have the | ||||||
2 | names of the primary care physicians and their referral | ||||||
3 | arrangements.". | ||||||
4 | No later than 120 days after the effective date of this | ||||||
5 | amendatory Act of 1998, the insurer or managed care plan shall | ||||||
6 | provide each employer who has a policy of insurance or a | ||||||
7 | managed care plan with the insurer or managed care plan with a | ||||||
8 | list of physicians licensed to practice medicine in all its | ||||||
9 | branches specializing in obstetrics or gynecology or | ||||||
10 | specializing in family practice who have contracted with the | ||||||
11 | plan. At the time of enrollment and thereafter within 10 days | ||||||
12 | after a request by an insured or enrollee, the insurer or | ||||||
13 | managed care plan also shall provide this list directly to the | ||||||
14 | insured or enrollee. The list shall include each physician's | ||||||
15 | address, telephone number, and specialty. No insurer or plan | ||||||
16 | formal or informal policy may restrict a female insured's or | ||||||
17 | enrollee's right to designate a woman's principal health care | ||||||
18 | provider, except as set forth in subsection (a-5). If the | ||||||
19 | female enrollee is an enrollee of a managed care plan under | ||||||
20 | contract with the Department of Healthcare and Family | ||||||
21 | Services, the physician chosen by the enrollee as her woman's | ||||||
22 | principal health care provider must be a Medicaid-enrolled | ||||||
23 | provider. This requirement does not require a female insured | ||||||
24 | or enrollee to make a selection of a woman's principal health | ||||||
25 | care provider. The female insured or enrollee may designate a | ||||||
26 | physician licensed to practice medicine in all its branches |
| |||||||
| |||||||
1 | specializing in family practice as her woman's principal | ||||||
2 | health care provider. | ||||||
3 | (a-5) If a policy, contract, or certificate requires or | ||||||
4 | allows a covered individual to designate a primary care | ||||||
5 | provider and provides coverage for any obstetrical or | ||||||
6 | gynecological care, the insurer shall provide the notice | ||||||
7 | required under 45 CFR 147.138(a)(4) and 149.310(a)(4) in all | ||||||
8 | circumstances required under that provision. The insured or | ||||||
9 | enrollee may be required by the insurer or managed care plan to | ||||||
10 | select a woman's principal health care provider who has a | ||||||
11 | referral arrangement with the insured's or enrollee's | ||||||
12 | individual who coordinates care or controls access to health | ||||||
13 | care services if such referral arrangement exists or to select | ||||||
14 | a new individual to coordinate care or to control access to | ||||||
15 | health care services who has a referral arrangement with the | ||||||
16 | woman's principal health care provider chosen by the insured | ||||||
17 | or enrollee, if such referral arrangement exists. If an | ||||||
18 | insurer or a managed care plan requires an insured or enrollee | ||||||
19 | to select a new physician under this subsection (a-5), the | ||||||
20 | insurer or managed care plan must provide the insured or | ||||||
21 | enrollee with both options to select a new physician provided | ||||||
22 | in this subsection (a-5). | ||||||
23 | Notwithstanding a plan's restrictions of the frequency or | ||||||
24 | timing of making designations of primary care providers, a | ||||||
25 | female enrollee or insured who is subject to the selection | ||||||
26 | requirements of this subsection, may, at any time, effect a |
| |||||||
| |||||||
1 | change in primary care physicians in order to make a selection | ||||||
2 | of a woman's principal health care provider. | ||||||
3 | (a-6) The requirements of this Section shall be construed | ||||||
4 | in a manner consistent with the requirements for access to and | ||||||
5 | notice of obstetrical and gynecological care in 45 CFR 147.138 | ||||||
6 | and 45 CFR 149.310. If an insurer or managed care plan | ||||||
7 | exercises the option in subsection (a-5), the list to be | ||||||
8 | provided under subsection (a) shall identify the referral | ||||||
9 | arrangements that exist between the individual who coordinates | ||||||
10 | care or controls access to health care services and the | ||||||
11 | woman's principal health care provider in order to assist the | ||||||
12 | female insured or enrollee to make a selection within the | ||||||
13 | insurer's or managed care plan's requirement. | ||||||
14 | (b) Nothing in this Section prevents a health insurance | ||||||
15 | issuer from requiring a participating obstetrical or | ||||||
16 | gynecological health care professional to agree, with respect | ||||||
17 | to individuals covered under a policy of accident and health | ||||||
18 | insurance, to otherwise adhere to the health insurance | ||||||
19 | issuer's policies and procedures, including procedures | ||||||
20 | regarding referrals and obtaining prior authorization and | ||||||
21 | providing services pursuant to a treatment plan, if any, | ||||||
22 | approved by the issuer. If a female insured or enrollee has | ||||||
23 | designated a woman's principal health care provider, then the | ||||||
24 | insured or enrollee must be given direct access to the woman's | ||||||
25 | principal health care provider for services covered by the | ||||||
26 | policy or plan without the need for a referral or prior |
| |||||||
| |||||||
1 | approval. Nothing shall prohibit the insurer or managed care | ||||||
2 | plan from requiring prior authorization or approval from | ||||||
3 | either a primary care provider or the woman's principal health | ||||||
4 | care provider for referrals for additional care or services. | ||||||
5 | (c) (Blank). For the purposes of this Section the | ||||||
6 | following terms are defined: | ||||||
7 | (1) "Woman's principal health care provider" means a | ||||||
8 | physician licensed to practice medicine in all of its | ||||||
9 | branches specializing in obstetrics or gynecology or | ||||||
10 | specializing in family practice. | ||||||
11 | (2) "Managed care entity" means any entity including a | ||||||
12 | licensed insurance company, hospital or medical service | ||||||
13 | plan, health maintenance organization, limited health | ||||||
14 | service organization, preferred provider organization, | ||||||
15 | third party administrator, an employer or employee | ||||||
16 | organization, or any person or entity that establishes, | ||||||
17 | operates, or maintains a network of participating | ||||||
18 | providers. | ||||||
19 | (3) "Managed care plan" means a plan operated by a | ||||||
20 | managed care entity that provides for the financing of | ||||||
21 | health care services to persons enrolled in the plan | ||||||
22 | through: | ||||||
23 | (A) organizational arrangements for ongoing | ||||||
24 | quality assurance, utilization review programs, or | ||||||
25 | dispute resolution; or | ||||||
26 | (B) financial incentives for persons enrolled in |
| |||||||
| |||||||
1 | the plan to use the participating providers and | ||||||
2 | procedures covered by the plan. | ||||||
3 | (4) "Participating provider" means a physician who has | ||||||
4 | contracted with an insurer or managed care plan to provide | ||||||
5 | services to insureds or enrollees as defined by the | ||||||
6 | contract. | ||||||
7 | (d) Nothing in this Section shall be construed to preclude | ||||||
8 | a health insurance issuer from requiring that a participating | ||||||
9 | obstetrical or gynecological health care professional notify | ||||||
10 | the covered individual's primary care physician or the issuer | ||||||
11 | of treatment decisions or update centralized medical records. | ||||||
12 | The original provisions of this Section became law on July 17, | ||||||
13 | 1996 and took effect November 14, 1996, which is 120 days after | ||||||
14 | becoming law. | ||||||
15 | (Source: P.A. 95-331, eff. 8-21-07.)
| ||||||
16 | (215 ILCS 5/356s) | ||||||
17 | Sec. 356s. Post-parturition care. An individual or group | ||||||
18 | policy of accident and health insurance that provides | ||||||
19 | maternity coverage and is amended, delivered, issued, or | ||||||
20 | renewed after the effective date of this amendatory Act of | ||||||
21 | 1996 shall provide coverage for the following: | ||||||
22 | (1) a minimum of 48 hours of inpatient care following | ||||||
23 | a vaginal delivery for the mother and the newborn, except | ||||||
24 | as otherwise provided in this Section; or | ||||||
25 | (2) a minimum of 96 hours of inpatient care following |
| |||||||
| |||||||
1 | a delivery by caesarian section for the mother and | ||||||
2 | newborn, except as otherwise provided in this Section. | ||||||
3 | Coverage may be limited to a A shorter length of hospital | ||||||
4 | inpatient care stay for services related to maternity and | ||||||
5 | newborn care may be provided if the attending physician | ||||||
6 | licensed to practice medicine in all of its branches | ||||||
7 | determines, in accordance with the protocols and guidelines | ||||||
8 | developed by the American College of Obstetricians and | ||||||
9 | Gynecologists or the American Academy of Pediatrics, that the | ||||||
10 | mother and the newborn meet the appropriate guidelines for | ||||||
11 | that length of stay based upon evaluation of the mother and | ||||||
12 | newborn and the coverage and availability of a post-discharge | ||||||
13 | physician office visit or in-home nurse visit to verify the | ||||||
14 | condition of the infant in the first 48 hours after discharge. | ||||||
15 | (Source: P.A. 89-513, eff. 9-15-96; 90-14, eff. 7-1-97.)
| ||||||
16 | (215 ILCS 5/356z.3) | ||||||
17 | Sec. 356z.3. Disclosure of limited benefit. An insurer | ||||||
18 | that issues, delivers, amends, or renews an individual or | ||||||
19 | group policy of accident and health insurance in this State | ||||||
20 | after the effective date of this amendatory Act of the 92nd | ||||||
21 | General Assembly and arranges, contracts with, or administers | ||||||
22 | contracts with a provider whereby beneficiaries are provided | ||||||
23 | an incentive to use the services of such provider must include | ||||||
24 | the following disclosure on its contracts and evidences of | ||||||
25 | coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN |
| |||||||
| |||||||
1 | NON-PARTICIPATING PROVIDERS ARE USED. YOU CAN EXPECT TO PAY | ||||||
2 | MORE THAN THE COST-SHARING AMOUNT DEFINED IN THE POLICY IN | ||||||
3 | NON-EMERGENCY SITUATIONS. Except in limited situations | ||||||
4 | governed by the federal No Surprises Act or Section 356z.3a of | ||||||
5 | the Illinois Insurance Code (215 ILCS 5/356z.3a), | ||||||
6 | non-participating providers furnishing non-emergency services | ||||||
7 | may bill members for any amount up to the billed charge after | ||||||
8 | the plan has paid its portion of the bill. If you elect to use | ||||||
9 | a non-participating provider, plan benefit payments will be | ||||||
10 | determined according to your policy's fee schedule, usual and | ||||||
11 | customary charge (which is determined by comparing charges for | ||||||
12 | similar services adjusted to the geographical area where the | ||||||
13 | services are performed), or other method as defined by the | ||||||
14 | policy. Participating providers have agreed to ONLY bill | ||||||
15 | members the cost-sharing amounts. You should be aware that | ||||||
16 | when you elect to utilize the services of a non-participating | ||||||
17 | provider for a covered service in non-emergency situations, | ||||||
18 | benefit payments to such non-participating provider are not | ||||||
19 | based upon the amount billed. The basis of your benefit | ||||||
20 | payment will be determined according to your policy's fee | ||||||
21 | schedule, usual and customary charge (which is determined by | ||||||
22 | comparing charges for similar services adjusted to the | ||||||
23 | geographical area where the services are performed), or other | ||||||
24 | method as defined by the policy. YOU CAN EXPECT TO PAY MORE | ||||||
25 | THAN THE COINSURANCE AMOUNT DEFINED IN THE POLICY AFTER THE | ||||||
26 | PLAN HAS PAID ITS REQUIRED PORTION. Non-participating |
| |||||||
| |||||||
1 | providers may bill members for any amount up to the billed | ||||||
2 | charge after the plan has paid its portion of the bill, except | ||||||
3 | as provided in Section 356z.3a of the Illinois Insurance Code | ||||||
4 | for covered services received at a participating health care | ||||||
5 | facility from a nonparticipating provider that are: (a) | ||||||
6 | ancillary services, (b) items or services furnished as a | ||||||
7 | result of unforeseen, urgent medical needs that arise at the | ||||||
8 | time the item or service is furnished, or (c) items or services | ||||||
9 | received when the facility or the non-participating provider | ||||||
10 | fails to satisfy the notice and consent criteria specified | ||||||
11 | under Section 356z.3a. Participating providers have agreed to | ||||||
12 | accept discounted payments for services with no additional | ||||||
13 | billing to the member other than co-insurance and deductible | ||||||
14 | amounts. You may obtain further information about the | ||||||
15 | participating status of professional providers and information | ||||||
16 | on out-of-pocket expenses by calling the toll-free toll free | ||||||
17 | telephone number on your identification card.". | ||||||
18 | (Source: P.A. 102-901, eff. 1-1-23 .)
| ||||||
19 | (215 ILCS 5/356z.33) | ||||||
20 | (Text of Section before amendment by P.A. 103-454 ) | ||||||
21 | Sec. 356z.33. Coverage for epinephrine injectors. A group | ||||||
22 | or individual policy of accident and health insurance or a | ||||||
23 | managed care plan that is amended, delivered, issued, or | ||||||
24 | renewed on or after January 1, 2020 (the effective date of | ||||||
25 | Public Act 101-281) shall provide coverage for medically |
| |||||||
| |||||||
1 | necessary epinephrine injectors for persons 18 years of age or | ||||||
2 | under. As used in this Section, "epinephrine injector" has the | ||||||
3 | meaning given to that term in Section 5 of the Epinephrine | ||||||
4 | Injector Act. | ||||||
5 | (Source: P.A. 101-281, eff. 1-1-20; 102-558, eff. 8-20-21.)
| ||||||
6 | (Text of Section after amendment by P.A. 103-454 ) | ||||||
7 | Sec. 356z.33. Coverage for epinephrine injectors. | ||||||
8 | (a) A group or individual policy of accident and health | ||||||
9 | insurance or a managed care plan that is amended, delivered, | ||||||
10 | issued, or renewed on or after January 1, 2020 (the effective | ||||||
11 | date of Public Act 101-281) shall provide coverage for | ||||||
12 | medically necessary epinephrine injectors for persons 18 years | ||||||
13 | of age or under. As used in this Section, "epinephrine | ||||||
14 | injector" has the meaning given to that term in Section 5 of | ||||||
15 | the Epinephrine Injector Act. | ||||||
16 | (b) An insurer that provides coverage for medically | ||||||
17 | necessary epinephrine injectors shall limit the total amount | ||||||
18 | that an insured is required to pay for a twin-pack of medically | ||||||
19 | necessary epinephrine injectors at an amount not to exceed | ||||||
20 | $60, regardless of the type of epinephrine injector ; except | ||||||
21 | that this provision does not apply to the extent such coverage | ||||||
22 | would disqualify a high-deductible health plan from | ||||||
23 | eligibility for a health savings account pursuant to Section | ||||||
24 | 223 of the Internal Revenue Code (26 U.S.C. 223) . | ||||||
25 | (c) Nothing in this Section prevents an insurer from |
| |||||||
| |||||||
1 | reducing an insured's cost sharing by an amount greater than | ||||||
2 | the amount specified in subsection (b). | ||||||
3 | (d) The Department may adopt rules as necessary to | ||||||
4 | implement and administer this Section. | ||||||
5 | (Source: P.A. 102-558, eff. 8-20-21; 103-454, eff. 1-1-25.)
| ||||||
6 | (215 ILCS 5/367a) (from Ch. 73, par. 979a) | ||||||
7 | Sec. 367a. Blanket accident and health insurance. | ||||||
8 | (1) Blanket accident and health insurance is that form of | ||||||
9 | accident and health insurance covering special groups of | ||||||
10 | persons as enumerated in one of the following paragraphs (a) | ||||||
11 | to (g), inclusive: | ||||||
12 | (a) Under a policy or contract issued to any carrier | ||||||
13 | for hire, which shall be deemed the policyholder, covering | ||||||
14 | a group defined as all persons who may become passengers | ||||||
15 | on such carrier. | ||||||
16 | (b) Under a policy or contract issued to an employer, | ||||||
17 | who shall be deemed the policyholder, covering all | ||||||
18 | employees or any group of employees defined by reference | ||||||
19 | to exceptional hazards incident to such employment. | ||||||
20 | (c) Under a policy or contract issued to a college, | ||||||
21 | school, or other institution of learning or to the head or | ||||||
22 | principal thereof, who or which shall be deemed the | ||||||
23 | policyholder, covering students or teachers. However, | ||||||
24 | student health insurance coverage, as defined in 45 CFR | ||||||
25 | 147.145, shall remain subject to the standards and |
| |||||||
| |||||||
1 | requirements for individual health insurance coverage | ||||||
2 | except where inconsistent with that regulation. Student | ||||||
3 | health insurance coverage shall not be subject to the | ||||||
4 | Short-Term, Limited-Duration Health Insurance Coverage | ||||||
5 | Act. An insurer providing student health insurance | ||||||
6 | coverage or a policy or contract covering students for | ||||||
7 | limited-scope dental or vision under 45 CFR 148.220 shall | ||||||
8 | require an individual application or enrollment form and | ||||||
9 | shall furnish each insured individual a certificate, which | ||||||
10 | shall have been approved by the Director under Section | ||||||
11 | 355. | ||||||
12 | (d) Under a policy or contract issued in the name of | ||||||
13 | any volunteer fire department, first aid, or other such | ||||||
14 | volunteer group, which shall be deemed the policyholder, | ||||||
15 | covering all of the members of such department or group. | ||||||
16 | (e) Under a policy or contract issued to a creditor, | ||||||
17 | who shall be deemed the policyholder, to insure debtors of | ||||||
18 | the creditors; Provided, however, that in the case of a | ||||||
19 | loan which is subject to the Small Loans Act, no insurance | ||||||
20 | premium or other cost shall be directly or indirectly | ||||||
21 | charged or assessed against, or collected or received from | ||||||
22 | the borrower. | ||||||
23 | (f) Under a policy or contract issued to a sports team | ||||||
24 | or to a camp, which team or camp sponsor shall be deemed | ||||||
25 | the policyholder, covering members or campers. | ||||||
26 | (g) Under a policy or contract issued to any other |
| |||||||
| |||||||
1 | substantially similar group which, in the discretion of | ||||||
2 | the Director, may be subject to the issuance of a blanket | ||||||
3 | accident and health policy or contract. | ||||||
4 | (2) Any insurance company authorized to write accident and | ||||||
5 | health insurance in this state shall have the power to issue | ||||||
6 | blanket accident and health insurance. No such blanket policy | ||||||
7 | may be issued or delivered in this State unless a copy of the | ||||||
8 | form thereof shall have been filed in accordance with Section | ||||||
9 | 355, and it contains in substance such of those provisions | ||||||
10 | contained in Sections 357.1 through 357.30 as may be | ||||||
11 | applicable to blanket accident and health insurance and the | ||||||
12 | following provisions: | ||||||
13 | (a) A provision that the policy and the application | ||||||
14 | shall constitute the entire contract between the parties, | ||||||
15 | and that all statements made by the policyholder shall, in | ||||||
16 | absence of fraud, be deemed representations and not | ||||||
17 | warranties, and that no such statements shall be used in | ||||||
18 | defense to a claim under the policy, unless it is | ||||||
19 | contained in a written application. | ||||||
20 | (b) A provision that to the group or class thereof | ||||||
21 | originally insured shall be added from time to time all | ||||||
22 | new persons or individuals eligible for coverage. | ||||||
23 | (3) An individual application shall not be required from a | ||||||
24 | person covered under a blanket accident or health policy or | ||||||
25 | contract, nor shall it be necessary for the insurer to furnish | ||||||
26 | each person a certificate. |
| |||||||
| |||||||
1 | (3.5) Subsection (3) does not apply to major medical | ||||||
2 | insurance, or to any excepted benefits or short-term, | ||||||
3 | limited-duration health insurance coverage for which an | ||||||
4 | insured individual pays premiums or contributions. In those | ||||||
5 | cases, the insurer shall require an individual application or | ||||||
6 | enrollment form and shall furnish each insured individual a | ||||||
7 | certificate, which shall have been approved by the Director | ||||||
8 | under Section 355 of this Code. | ||||||
9 | (4) All benefits under any blanket accident and health | ||||||
10 | policy shall be payable to the person insured, or to his | ||||||
11 | designated beneficiary or beneficiaries, or to his or her | ||||||
12 | estate, except that if the person insured be a minor or person | ||||||
13 | under legal disability, such benefits may be made payable to | ||||||
14 | his or her parent, guardian, or other person actually | ||||||
15 | supporting him or her. Provided further, however, that the | ||||||
16 | policy may provide that all or any portion of any indemnities | ||||||
17 | provided by any such policy on account of hospital, nursing, | ||||||
18 | medical or surgical services may, at the insurer's option, be | ||||||
19 | paid directly to the hospital or person rendering such | ||||||
20 | services; but the policy may not require that the service be | ||||||
21 | rendered by a particular hospital or person. Payment so made | ||||||
22 | shall discharge the insurer's obligation with respect to the | ||||||
23 | amount of insurance so paid. | ||||||
24 | (5) Nothing contained in this section shall be deemed to | ||||||
25 | affect the legal liability of policyholders for the death of | ||||||
26 | or injury to, any such member of such group. |
| |||||||
| |||||||
1 | (Source: P.A. 83-1362.)
| ||||||
2 | (215 ILCS 5/370e) (from Ch. 73, par. 982e) | ||||||
3 | Sec. 370e. Companies which issue group accident and health | ||||||
4 | policies or blanket accident and health plans to employer | ||||||
5 | groups in this State shall provide the employer with notice of | ||||||
6 | termination of a group or blanket accident and health plan | ||||||
7 | because of the employer's failure to pay the premium when due. | ||||||
8 | The insurance company shall file send a copy of such notice | ||||||
9 | with to the Department in an electronic format either through | ||||||
10 | the System for Electronic Rate and Form Filing (SERFF) or as | ||||||
11 | otherwise prescribed by the Director . | ||||||
12 | (Source: P.A. 83-1006.)
| ||||||
13 | (215 ILCS 5/370i) (from Ch. 73, par. 982i) | ||||||
14 | Sec. 370i. Policies, agreements or arrangements with | ||||||
15 | incentives or limits on reimbursement authorized. | ||||||
16 | (a) Policies, agreements or arrangements issued under this | ||||||
17 | Article may not contain terms or conditions that would operate | ||||||
18 | unreasonably to restrict the access and availability of health | ||||||
19 | care services for the insured. | ||||||
20 | (b) An insurer or administrator may: | ||||||
21 | (1) enter into agreements with certain providers of | ||||||
22 | its choice relating to health care services which may be | ||||||
23 | rendered to insureds or beneficiaries of the insurer or | ||||||
24 | administrator, including agreements relating to the |
| |||||||
| |||||||
1 | amounts to be charged the insureds or beneficiaries for | ||||||
2 | services rendered; | ||||||
3 | (2) issue or administer programs, policies or | ||||||
4 | subscriber contracts in this State that include incentives | ||||||
5 | for the insured or beneficiary to utilize the services of | ||||||
6 | a provider which has entered into an agreement with the | ||||||
7 | insurer or administrator pursuant to paragraph (1) above. | ||||||
8 | (c) (Blank). After the effective date of this amendatory | ||||||
9 | Act of the 92nd General Assembly, any insurer that arranges, | ||||||
10 | contracts with, or administers contracts with a provider | ||||||
11 | whereby beneficiaries are provided an incentive to use the | ||||||
12 | services of such provider must include the following | ||||||
13 | disclosure on its contracts and evidences of coverage: | ||||||
14 | "WARNING, LIMITED BENEFITS WILL BE PAID WHEN NON-PARTICIPATING | ||||||
15 | PROVIDERS ARE USED. You should be aware that when you elect to | ||||||
16 | utilize the services of a non-participating provider for a | ||||||
17 | covered service in non-emergency situations, benefit payments | ||||||
18 | to such non-participating provider are not based upon the | ||||||
19 | amount billed. The basis of your benefit payment will be | ||||||
20 | determined according to your policy's fee schedule, usual and | ||||||
21 | customary charge (which is determined by comparing charges for | ||||||
22 | similar services adjusted to the geographical area where the | ||||||
23 | services are performed), or other method as defined by the | ||||||
24 | policy. YOU CAN EXPECT TO PAY MORE THAN THE COINSURANCE AMOUNT | ||||||
25 | DEFINED IN THE POLICY AFTER THE PLAN HAS PAID ITS REQUIRED | ||||||
26 | PORTION. Non-participating providers may bill members for any |
| |||||||
| |||||||
1 | amount up to the billed charge after the plan has paid its | ||||||
2 | portion of the bill. Participating providers have agreed to | ||||||
3 | accept discounted payments for services with no additional | ||||||
4 | billing to the member other than co-insurance and deductible | ||||||
5 | amounts. You may obtain further information about the | ||||||
6 | participating status of professional providers and information | ||||||
7 | on out-of-pocket expenses by calling the toll free telephone | ||||||
8 | number on your identification card.". | ||||||
9 | (Source: P.A. 92-579, eff. 1-1-03.)
| ||||||
10 | (215 ILCS 5/408) (from Ch. 73, par. 1020) | ||||||
11 | (Text of Section before amendment by P.A. 103-75 ) | ||||||
12 | Sec. 408. Fees and charges. | ||||||
13 | (1) The Director shall charge, collect and give proper | ||||||
14 | acquittances for the payment of the following fees and | ||||||
15 | charges: | ||||||
16 | (a) For filing all documents submitted for the | ||||||
17 | incorporation or organization or certification of a | ||||||
18 | domestic company, except for a fraternal benefit society, | ||||||
19 | $2,000. | ||||||
20 | (b) For filing all documents submitted for the | ||||||
21 | incorporation or organization of a fraternal benefit | ||||||
22 | society, $500. | ||||||
23 | (c) For filing amendments to articles of incorporation | ||||||
24 | and amendments to declaration of organization, except for | ||||||
25 | a fraternal benefit society, a mutual benefit association, |
| |||||||
| |||||||
1 | a burial society or a farm mutual, $200. | ||||||
2 | (d) For filing amendments to articles of incorporation | ||||||
3 | of a fraternal benefit society, a mutual benefit | ||||||
4 | association or a burial society, $100. | ||||||
5 | (e) For filing amendments to articles of incorporation | ||||||
6 | of a farm mutual, $50. | ||||||
7 | (f) For filing bylaws or amendments thereto, $50. | ||||||
8 | (g) For filing agreement of merger or consolidation: | ||||||
9 | (i) for a domestic company, except for a fraternal | ||||||
10 | benefit society, a mutual benefit association, a | ||||||
11 | burial society, or a farm mutual, $2,000. | ||||||
12 | (ii) for a foreign or alien company, except for a | ||||||
13 | fraternal benefit society, $600. | ||||||
14 | (iii) for a fraternal benefit society, a mutual | ||||||
15 | benefit association, a burial society, or a farm | ||||||
16 | mutual, $200. | ||||||
17 | (h) For filing agreements of reinsurance by a domestic | ||||||
18 | company, $200. | ||||||
19 | (i) For filing all documents submitted by a foreign or | ||||||
20 | alien company to be admitted to transact business or | ||||||
21 | accredited as a reinsurer in this State, except for a | ||||||
22 | fraternal benefit society, $5,000. | ||||||
23 | (j) For filing all documents submitted by a foreign or | ||||||
24 | alien fraternal benefit society to be admitted to transact | ||||||
25 | business in this State, $500. | ||||||
26 | (k) For filing declaration of withdrawal of a foreign |
| |||||||
| |||||||
1 | or alien company, $50. | ||||||
2 | (l) For filing annual statement by a domestic company, | ||||||
3 | except a fraternal benefit society, a mutual benefit | ||||||
4 | association, a burial society, or a farm mutual, $200. | ||||||
5 | (m) For filing annual statement by a domestic | ||||||
6 | fraternal benefit society, $100. | ||||||
7 | (n) For filing annual statement by a farm mutual, a | ||||||
8 | mutual benefit association, or a burial society, $50. | ||||||
9 | (o) For issuing a certificate of authority or renewal | ||||||
10 | thereof except to a foreign fraternal benefit society, | ||||||
11 | $400. | ||||||
12 | (p) For issuing a certificate of authority or renewal | ||||||
13 | thereof to a foreign fraternal benefit society, $200. | ||||||
14 | (q) For issuing an amended certificate of authority, | ||||||
15 | $50. | ||||||
16 | (r) For each certified copy of certificate of | ||||||
17 | authority, $20. | ||||||
18 | (s) For each certificate of deposit, or valuation, or | ||||||
19 | compliance or surety certificate, $20. | ||||||
20 | (t) For copies of papers or records per page, $1. | ||||||
21 | (u) For each certification to copies of papers or | ||||||
22 | records, $10. | ||||||
23 | (v) For multiple copies of documents or certificates | ||||||
24 | listed in subparagraphs (r), (s), and (u) of paragraph (1) | ||||||
25 | of this Section, $10 for the first copy of a certificate of | ||||||
26 | any type and $5 for each additional copy of the same |
| |||||||
| |||||||
1 | certificate requested at the same time, unless, pursuant | ||||||
2 | to paragraph (2) of this Section, the Director finds these | ||||||
3 | additional fees excessive. | ||||||
4 | (w) For issuing a permit to sell shares or increase | ||||||
5 | paid-up capital: | ||||||
6 | (i) in connection with a public stock offering, | ||||||
7 | $300; | ||||||
8 | (ii) in any other case, $100. | ||||||
9 | (x) For issuing any other certificate required or | ||||||
10 | permissible under the law, $50. | ||||||
11 | (y) For filing a plan of exchange of the stock of a | ||||||
12 | domestic stock insurance company, a plan of | ||||||
13 | demutualization of a domestic mutual company, or a plan of | ||||||
14 | reorganization under Article XII, $2,000. | ||||||
15 | (z) For filing a statement of acquisition of a | ||||||
16 | domestic company as defined in Section 131.4 of this Code, | ||||||
17 | $2,000. | ||||||
18 | (aa) For filing an agreement to purchase the business | ||||||
19 | of an organization authorized under the Dental Service | ||||||
20 | Plan Act or the Voluntary Health Services Plans Act or of a | ||||||
21 | health maintenance organization or a limited health | ||||||
22 | service organization, $2,000. | ||||||
23 | (bb) For filing a statement of acquisition of a | ||||||
24 | foreign or alien insurance company as defined in Section | ||||||
25 | 131.12a of this Code, $1,000. | ||||||
26 | (cc) For filing a registration statement as required |
| |||||||
| |||||||
1 | in Sections 131.13 and 131.14, the notification as | ||||||
2 | required by Sections 131.16, 131.20a, or 141.4, or an | ||||||
3 | agreement or transaction required by Sections 124.2(2), | ||||||
4 | 141, 141a, or 141.1, $200. | ||||||
5 | (dd) For filing an application for licensing of: | ||||||
6 | (i) a religious or charitable risk pooling trust | ||||||
7 | or a workers' compensation pool, $1,000; | ||||||
8 | (ii) a workers' compensation service company, | ||||||
9 | $500; | ||||||
10 | (iii) a self-insured automobile fleet, $200; or | ||||||
11 | (iv) a renewal of or amendment of any license | ||||||
12 | issued pursuant to (i), (ii), or (iii) above, $100. | ||||||
13 | (ee) For filing articles of incorporation for a | ||||||
14 | syndicate to engage in the business of insurance through | ||||||
15 | the Illinois Insurance Exchange, $2,000. | ||||||
16 | (ff) For filing amended articles of incorporation for | ||||||
17 | a syndicate engaged in the business of insurance through | ||||||
18 | the Illinois Insurance Exchange, $100. | ||||||
19 | (gg) For filing articles of incorporation for a | ||||||
20 | limited syndicate to join with other subscribers or | ||||||
21 | limited syndicates to do business through the Illinois | ||||||
22 | Insurance Exchange, $1,000. | ||||||
23 | (hh) For filing amended articles of incorporation for | ||||||
24 | a limited syndicate to do business through the Illinois | ||||||
25 | Insurance Exchange, $100. | ||||||
26 | (ii) For a permit to solicit subscriptions to a |
| |||||||
| |||||||
1 | syndicate or limited syndicate, $100. | ||||||
2 | (jj) For the filing of each form as required in | ||||||
3 | Section 143 of this Code, $50 per form. Informational and | ||||||
4 | advertising filings shall be $25 per filing. The fee for | ||||||
5 | advisory and rating organizations shall be $200 per form. | ||||||
6 | (i) For the purposes of the form filing fee, | ||||||
7 | filings made on insert page basis will be considered | ||||||
8 | one form at the time of its original submission. | ||||||
9 | Changes made to a form subsequent to its approval | ||||||
10 | shall be considered a new filing. | ||||||
11 | (ii) Only one fee shall be charged for a form, | ||||||
12 | regardless of the number of other forms or policies | ||||||
13 | with which it will be used. | ||||||
14 | (iii) Fees charged for a policy filed as it will be | ||||||
15 | issued regardless of the number of forms comprising | ||||||
16 | that policy shall not exceed $1,500. For advisory or | ||||||
17 | rating organizations, fees charged for a policy filed | ||||||
18 | as it will be issued regardless of the number of forms | ||||||
19 | comprising that policy shall not exceed $2,500. | ||||||
20 | (iv) The Director may by rule exempt forms from | ||||||
21 | such fees. | ||||||
22 | (kk) For filing an application for licensing of a | ||||||
23 | reinsurance intermediary, $500. | ||||||
24 | (ll) For filing an application for renewal of a | ||||||
25 | license of a reinsurance intermediary, $200. | ||||||
26 | (mm) For filing a plan of division of a domestic stock |
| |||||||
| |||||||
1 | company under Article IIB, $100,000 $10,000 . | ||||||
2 | (nn) For filing all documents submitted by a foreign | ||||||
3 | or alien company to be a certified reinsurer in this | ||||||
4 | State, except for a fraternal benefit society, $1,000. | ||||||
5 | (oo) For filing a renewal by a foreign or alien | ||||||
6 | company to be a certified reinsurer in this State, except | ||||||
7 | for a fraternal benefit society, $400. | ||||||
8 | (pp) For filing all documents submitted by a reinsurer | ||||||
9 | domiciled in a reciprocal jurisdiction, $1,000. | ||||||
10 | (qq) For filing a renewal by a reinsurer domiciled in | ||||||
11 | a reciprocal jurisdiction, $400. | ||||||
12 | (rr) For registering a captive management company or | ||||||
13 | renewal thereof, $50. | ||||||
14 | (2) When printed copies or numerous copies of the same | ||||||
15 | paper or records are furnished or certified, the Director may | ||||||
16 | reduce such fees for copies if he finds them excessive. He may, | ||||||
17 | when he considers it in the public interest, furnish without | ||||||
18 | charge to state insurance departments and persons other than | ||||||
19 | companies, copies or certified copies of reports of | ||||||
20 | examinations and of other papers and records. | ||||||
21 | (3) The expenses incurred in any performance examination | ||||||
22 | authorized by law shall be paid by the company or person being | ||||||
23 | examined. The charge shall be reasonably related to the cost | ||||||
24 | of the examination including but not limited to compensation | ||||||
25 | of examiners, electronic data processing costs, supervision | ||||||
26 | and preparation of an examination report and lodging and |
| |||||||
| |||||||
1 | travel expenses. All lodging and travel expenses shall be in | ||||||
2 | accord with the applicable travel regulations as published by | ||||||
3 | the Department of Central Management Services and approved by | ||||||
4 | the Governor's Travel Control Board, except that out-of-state | ||||||
5 | lodging and travel expenses related to examinations authorized | ||||||
6 | under Section 132 shall be in accordance with travel rates | ||||||
7 | prescribed under paragraph 301-7.2 of the Federal Travel | ||||||
8 | Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement of | ||||||
9 | subsistence expenses incurred during official travel. All | ||||||
10 | lodging and travel expenses may be reimbursed directly upon | ||||||
11 | authorization of the Director. With the exception of the | ||||||
12 | direct reimbursements authorized by the Director, all | ||||||
13 | performance examination charges collected by the Department | ||||||
14 | shall be paid to the Insurance Producer Administration Fund, | ||||||
15 | however, the electronic data processing costs incurred by the | ||||||
16 | Department in the performance of any examination shall be | ||||||
17 | billed directly to the company being examined for payment to | ||||||
18 | the Technology Management Revolving Fund. | ||||||
19 | (4) At the time of any service of process on the Director | ||||||
20 | as attorney for such service, the Director shall charge and | ||||||
21 | collect the sum of $40, which may be recovered as taxable costs | ||||||
22 | by the party to the suit or action causing such service to be | ||||||
23 | made if he prevails in such suit or action. | ||||||
24 | (5) (a) The costs incurred by the Department of Insurance | ||||||
25 | in conducting any hearing authorized by law shall be assessed | ||||||
26 | against the parties to the hearing in such proportion as the |
| |||||||
| |||||||
1 | Director of Insurance may determine upon consideration of all | ||||||
2 | relevant circumstances including: (1) the nature of the | ||||||
3 | hearing; (2) whether the hearing was instigated by, or for the | ||||||
4 | benefit of a particular party or parties; (3) whether there is | ||||||
5 | a successful party on the merits of the proceeding; and (4) the | ||||||
6 | relative levels of participation by the parties. | ||||||
7 | (b) For purposes of this subsection (5) costs incurred | ||||||
8 | shall mean the hearing officer fees, court reporter fees, and | ||||||
9 | travel expenses of Department of Insurance officers and | ||||||
10 | employees; provided however, that costs incurred shall not | ||||||
11 | include hearing officer fees or court reporter fees unless the | ||||||
12 | Department has retained the services of independent | ||||||
13 | contractors or outside experts to perform such functions. | ||||||
14 | (c) The Director shall make the assessment of costs | ||||||
15 | incurred as part of the final order or decision arising out of | ||||||
16 | the proceeding; provided, however, that such order or decision | ||||||
17 | shall include findings and conclusions in support of the | ||||||
18 | assessment of costs. This subsection (5) shall not be | ||||||
19 | construed as permitting the payment of travel expenses unless | ||||||
20 | calculated in accordance with the applicable travel | ||||||
21 | regulations of the Department of Central Management Services, | ||||||
22 | as approved by the Governor's Travel Control Board. The | ||||||
23 | Director as part of such order or decision shall require all | ||||||
24 | assessments for hearing officer fees and court reporter fees, | ||||||
25 | if any, to be paid directly to the hearing officer or court | ||||||
26 | reporter by the party(s) assessed for such costs. The |
| |||||||
| |||||||
1 | assessments for travel expenses of Department officers and | ||||||
2 | employees shall be reimbursable to the Director of Insurance | ||||||
3 | for deposit to the fund out of which those expenses had been | ||||||
4 | paid. | ||||||
5 | (d) The provisions of this subsection (5) shall apply in | ||||||
6 | the case of any hearing conducted by the Director of Insurance | ||||||
7 | not otherwise specifically provided for by law. | ||||||
8 | (6) The Director shall charge and collect an annual | ||||||
9 | financial regulation fee from every domestic company for | ||||||
10 | examination and analysis of its financial condition and to | ||||||
11 | fund the internal costs and expenses of the Interstate | ||||||
12 | Insurance Receivership Commission as may be allocated to the | ||||||
13 | State of Illinois and companies doing an insurance business in | ||||||
14 | this State pursuant to Article X of the Interstate Insurance | ||||||
15 | Receivership Compact. The fee shall be the greater fixed | ||||||
16 | amount based upon the combination of nationwide direct premium | ||||||
17 | income and nationwide reinsurance assumed premium income or | ||||||
18 | upon admitted assets calculated under this subsection as | ||||||
19 | follows: | ||||||
20 | (a) Combination of nationwide direct premium income | ||||||
21 | and nationwide reinsurance assumed premium. | ||||||
22 | (i) $150, if the premium is less than $500,000 and | ||||||
23 | there is no reinsurance assumed premium; | ||||||
24 | (ii) $750, if the premium is $500,000 or more, but | ||||||
25 | less than $5,000,000 and there is no reinsurance | ||||||
26 | assumed premium; or if the premium is less than |
| |||||||
| |||||||
1 | $5,000,000 and the reinsurance assumed premium is less | ||||||
2 | than $10,000,000; | ||||||
3 | (iii) $3,750, if the premium is less than | ||||||
4 | $5,000,000 and the reinsurance assumed premium is | ||||||
5 | $10,000,000 or more; | ||||||
6 | (iv) $7,500, if the premium is $5,000,000 or more, | ||||||
7 | but less than $10,000,000; | ||||||
8 | (v) $18,000, if the premium is $10,000,000 or | ||||||
9 | more, but less than $25,000,000; | ||||||
10 | (vi) $22,500, if the premium is $25,000,000 or | ||||||
11 | more, but less than $50,000,000; | ||||||
12 | (vii) $30,000, if the premium is $50,000,000 or | ||||||
13 | more, but less than $100,000,000; | ||||||
14 | (viii) $37,500, if the premium is $100,000,000 or | ||||||
15 | more. | ||||||
16 | (b) Admitted assets. | ||||||
17 | (i) $150, if admitted assets are less than | ||||||
18 | $1,000,000; | ||||||
19 | (ii) $750, if admitted assets are $1,000,000 or | ||||||
20 | more, but less than $5,000,000; | ||||||
21 | (iii) $3,750, if admitted assets are $5,000,000 or | ||||||
22 | more, but less than $25,000,000; | ||||||
23 | (iv) $7,500, if admitted assets are $25,000,000 or | ||||||
24 | more, but less than $50,000,000; | ||||||
25 | (v) $18,000, if admitted assets are $50,000,000 or | ||||||
26 | more, but less than $100,000,000; |
| |||||||
| |||||||
1 | (vi) $22,500, if admitted assets are $100,000,000 | ||||||
2 | or more, but less than $500,000,000; | ||||||
3 | (vii) $30,000, if admitted assets are $500,000,000 | ||||||
4 | or more, but less than $1,000,000,000; | ||||||
5 | (viii) $37,500, if admitted assets are | ||||||
6 | $1,000,000,000 or more. | ||||||
7 | (c) The sum of financial regulation fees charged to | ||||||
8 | the domestic companies of the same affiliated group shall | ||||||
9 | not exceed $250,000 in the aggregate in any single year | ||||||
10 | and shall be billed by the Director to the member company | ||||||
11 | designated by the group. | ||||||
12 | (7) The Director shall charge and collect an annual | ||||||
13 | financial regulation fee from every foreign or alien company, | ||||||
14 | except fraternal benefit societies, for the examination and | ||||||
15 | analysis of its financial condition and to fund the internal | ||||||
16 | costs and expenses of the Interstate Insurance Receivership | ||||||
17 | Commission as may be allocated to the State of Illinois and | ||||||
18 | companies doing an insurance business in this State pursuant | ||||||
19 | to Article X of the Interstate Insurance Receivership Compact. | ||||||
20 | The fee shall be a fixed amount based upon Illinois direct | ||||||
21 | premium income and nationwide reinsurance assumed premium | ||||||
22 | income in accordance with the following schedule: | ||||||
23 | (a) $150, if the premium is less than $500,000 and | ||||||
24 | there is no reinsurance assumed premium; | ||||||
25 | (b) $750, if the premium is $500,000 or more, but less | ||||||
26 | than $5,000,000 and there is no reinsurance assumed |
| |||||||
| |||||||
1 | premium; or if the premium is less than $5,000,000 and the | ||||||
2 | reinsurance assumed premium is less than $10,000,000; | ||||||
3 | (c) $3,750, if the premium is less than $5,000,000 and | ||||||
4 | the reinsurance assumed premium is $10,000,000 or more; | ||||||
5 | (d) $7,500, if the premium is $5,000,000 or more, but | ||||||
6 | less than $10,000,000; | ||||||
7 | (e) $18,000, if the premium is $10,000,000 or more, | ||||||
8 | but less than $25,000,000; | ||||||
9 | (f) $22,500, if the premium is $25,000,000 or more, | ||||||
10 | but less than $50,000,000; | ||||||
11 | (g) $30,000, if the premium is $50,000,000 or more, | ||||||
12 | but less than $100,000,000; | ||||||
13 | (h) $37,500, if the premium is $100,000,000 or more. | ||||||
14 | The sum of financial regulation fees under this subsection | ||||||
15 | (7) charged to the foreign or alien companies within the same | ||||||
16 | affiliated group shall not exceed $250,000 in the aggregate in | ||||||
17 | any single year and shall be billed by the Director to the | ||||||
18 | member company designated by the group. | ||||||
19 | (8) Beginning January 1, 1992, the financial regulation | ||||||
20 | fees imposed under subsections (6) and (7) of this Section | ||||||
21 | shall be paid by each company or domestic affiliated group | ||||||
22 | annually. After January 1, 1994, the fee shall be billed by | ||||||
23 | Department invoice based upon the company's premium income or | ||||||
24 | admitted assets as shown in its annual statement for the | ||||||
25 | preceding calendar year. The invoice is due upon receipt and | ||||||
26 | must be paid no later than June 30 of each calendar year. All |
| |||||||
| |||||||
1 | financial regulation fees collected by the Department shall be | ||||||
2 | paid to the Insurance Financial Regulation Fund. The | ||||||
3 | Department may not collect financial examiner per diem charges | ||||||
4 | from companies subject to subsections (6) and (7) of this | ||||||
5 | Section undergoing financial examination after June 30, 1992. | ||||||
6 | (9) In addition to the financial regulation fee required | ||||||
7 | by this Section, a company undergoing any financial | ||||||
8 | examination authorized by law shall pay the following costs | ||||||
9 | and expenses incurred by the Department: electronic data | ||||||
10 | processing costs, the expenses authorized under Section 131.21 | ||||||
11 | and subsection (d) of Section 132.4 of this Code, and lodging | ||||||
12 | and travel expenses. | ||||||
13 | Electronic data processing costs incurred by the | ||||||
14 | Department in the performance of any examination shall be | ||||||
15 | billed directly to the company undergoing examination for | ||||||
16 | payment to the Technology Management Revolving Fund. Except | ||||||
17 | for direct reimbursements authorized by the Director or direct | ||||||
18 | payments made under Section 131.21 or subsection (d) of | ||||||
19 | Section 132.4 of this Code, all financial regulation fees and | ||||||
20 | all financial examination charges collected by the Department | ||||||
21 | shall be paid to the Insurance Financial Regulation Fund. | ||||||
22 | All lodging and travel expenses shall be in accordance | ||||||
23 | with applicable travel regulations published by the Department | ||||||
24 | of Central Management Services and approved by the Governor's | ||||||
25 | Travel Control Board, except that out-of-state lodging and | ||||||
26 | travel expenses related to examinations authorized under |
| |||||||
| |||||||
1 | Sections 132.1 through 132.7 shall be in accordance with | ||||||
2 | travel rates prescribed under paragraph 301-7.2 of the Federal | ||||||
3 | Travel Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement | ||||||
4 | of subsistence expenses incurred during official travel. All | ||||||
5 | lodging and travel expenses may be reimbursed directly upon | ||||||
6 | the authorization of the Director. | ||||||
7 | In the case of an organization or person not subject to the | ||||||
8 | financial regulation fee, the expenses incurred in any | ||||||
9 | financial examination authorized by law shall be paid by the | ||||||
10 | organization or person being examined. The charge shall be | ||||||
11 | reasonably related to the cost of the examination including, | ||||||
12 | but not limited to, compensation of examiners and other costs | ||||||
13 | described in this subsection. | ||||||
14 | (10) Any company, person, or entity failing to make any | ||||||
15 | payment of $150 or more as required under this Section shall be | ||||||
16 | subject to the penalty and interest provisions provided for in | ||||||
17 | subsections (4) and (7) of Section 412. | ||||||
18 | (11) Unless otherwise specified, all of the fees collected | ||||||
19 | under this Section shall be paid into the Insurance Financial | ||||||
20 | Regulation Fund. | ||||||
21 | (12) For purposes of this Section: | ||||||
22 | (a) "Domestic company" means a company as defined in | ||||||
23 | Section 2 of this Code which is incorporated or organized | ||||||
24 | under the laws of this State, and in addition includes a | ||||||
25 | not-for-profit corporation authorized under the Dental | ||||||
26 | Service Plan Act or the Voluntary Health Services Plans |
| |||||||
| |||||||
1 | Act, a health maintenance organization, and a limited | ||||||
2 | health service organization. | ||||||
3 | (b) "Foreign company" means a company as defined in | ||||||
4 | Section 2 of this Code which is incorporated or organized | ||||||
5 | under the laws of any state of the United States other than | ||||||
6 | this State and in addition includes a health maintenance | ||||||
7 | organization and a limited health service organization | ||||||
8 | which is incorporated or organized under the laws of any | ||||||
9 | state of the United States other than this State. | ||||||
10 | (c) "Alien company" means a company as defined in | ||||||
11 | Section 2 of this Code which is incorporated or organized | ||||||
12 | under the laws of any country other than the United | ||||||
13 | States. | ||||||
14 | (d) "Fraternal benefit society" means a corporation, | ||||||
15 | society, order, lodge or voluntary association as defined | ||||||
16 | in Section 282.1 of this Code. | ||||||
17 | (e) "Mutual benefit association" means a company, | ||||||
18 | association or corporation authorized by the Director to | ||||||
19 | do business in this State under the provisions of Article | ||||||
20 | XVIII of this Code. | ||||||
21 | (f) "Burial society" means a person, firm, | ||||||
22 | corporation, society or association of individuals | ||||||
23 | authorized by the Director to do business in this State | ||||||
24 | under the provisions of Article XIX of this Code. | ||||||
25 | (g) "Farm mutual" means a district, county and | ||||||
26 | township mutual insurance company authorized by the |
| |||||||
| |||||||
1 | Director to do business in this State under the provisions | ||||||
2 | of the Farm Mutual Insurance Company Act of 1986. | ||||||
3 | (Source: P.A. 102-775, eff. 5-13-22.)
| ||||||
4 | (Text of Section after amendment by P.A. 103-75 ) | ||||||
5 | Sec. 408. Fees and charges. | ||||||
6 | (1) The Director shall charge, collect and give proper | ||||||
7 | acquittances for the payment of the following fees and | ||||||
8 | charges: | ||||||
9 | (a) For filing all documents submitted for the | ||||||
10 | incorporation or organization or certification of a | ||||||
11 | domestic company, except for a fraternal benefit society, | ||||||
12 | $2,000. | ||||||
13 | (b) For filing all documents submitted for the | ||||||
14 | incorporation or organization of a fraternal benefit | ||||||
15 | society, $500. | ||||||
16 | (c) For filing amendments to articles of incorporation | ||||||
17 | and amendments to declaration of organization, except for | ||||||
18 | a fraternal benefit society, a mutual benefit association, | ||||||
19 | a burial society or a farm mutual, $200. | ||||||
20 | (d) For filing amendments to articles of incorporation | ||||||
21 | of a fraternal benefit society, a mutual benefit | ||||||
22 | association or a burial society, $100. | ||||||
23 | (e) For filing amendments to articles of incorporation | ||||||
24 | of a farm mutual, $50. | ||||||
25 | (f) For filing bylaws or amendments thereto, $50. |
| |||||||
| |||||||
1 | (g) For filing agreement of merger or consolidation: | ||||||
2 | (i) for a domestic company, except for a fraternal | ||||||
3 | benefit society, a mutual benefit association, a | ||||||
4 | burial society, or a farm mutual, $2,000. | ||||||
5 | (ii) for a foreign or alien company, except for a | ||||||
6 | fraternal benefit society, $600. | ||||||
7 | (iii) for a fraternal benefit society, a mutual | ||||||
8 | benefit association, a burial society, or a farm | ||||||
9 | mutual, $200. | ||||||
10 | (h) For filing agreements of reinsurance by a domestic | ||||||
11 | company, $200. | ||||||
12 | (i) For filing all documents submitted by a foreign or | ||||||
13 | alien company to be admitted to transact business or | ||||||
14 | accredited as a reinsurer in this State, except for a | ||||||
15 | fraternal benefit society, $5,000. | ||||||
16 | (j) For filing all documents submitted by a foreign or | ||||||
17 | alien fraternal benefit society to be admitted to transact | ||||||
18 | business in this State, $500. | ||||||
19 | (k) For filing declaration of withdrawal of a foreign | ||||||
20 | or alien company, $50. | ||||||
21 | (l) For filing annual statement by a domestic company, | ||||||
22 | except a fraternal benefit society, a mutual benefit | ||||||
23 | association, a burial society, or a farm mutual, $200. | ||||||
24 | (m) For filing annual statement by a domestic | ||||||
25 | fraternal benefit society, $100. | ||||||
26 | (n) For filing annual statement by a farm mutual, a |
| |||||||
| |||||||
1 | mutual benefit association, or a burial society, $50. | ||||||
2 | (o) For issuing a certificate of authority or renewal | ||||||
3 | thereof except to a foreign fraternal benefit society, | ||||||
4 | $400. | ||||||
5 | (p) For issuing a certificate of authority or renewal | ||||||
6 | thereof to a foreign fraternal benefit society, $200. | ||||||
7 | (q) For issuing an amended certificate of authority, | ||||||
8 | $50. | ||||||
9 | (r) For each certified copy of certificate of | ||||||
10 | authority, $20. | ||||||
11 | (s) For each certificate of deposit, or valuation, or | ||||||
12 | compliance or surety certificate, $20. | ||||||
13 | (t) For copies of papers or records per page, $1. | ||||||
14 | (u) For each certification to copies of papers or | ||||||
15 | records, $10. | ||||||
16 | (v) For multiple copies of documents or certificates | ||||||
17 | listed in subparagraphs (r), (s), and (u) of paragraph (1) | ||||||
18 | of this Section, $10 for the first copy of a certificate of | ||||||
19 | any type and $5 for each additional copy of the same | ||||||
20 | certificate requested at the same time, unless, pursuant | ||||||
21 | to paragraph (2) of this Section, the Director finds these | ||||||
22 | additional fees excessive. | ||||||
23 | (w) For issuing a permit to sell shares or increase | ||||||
24 | paid-up capital: | ||||||
25 | (i) in connection with a public stock offering, | ||||||
26 | $300; |
| |||||||
| |||||||
1 | (ii) in any other case, $100. | ||||||
2 | (x) For issuing any other certificate required or | ||||||
3 | permissible under the law, $50. | ||||||
4 | (y) For filing a plan of exchange of the stock of a | ||||||
5 | domestic stock insurance company, a plan of | ||||||
6 | demutualization of a domestic mutual company, or a plan of | ||||||
7 | reorganization under Article XII, $2,000. | ||||||
8 | (z) For filing a statement of acquisition of a | ||||||
9 | domestic company as defined in Section 131.4 of this Code, | ||||||
10 | $2,000. | ||||||
11 | (aa) For filing an agreement to purchase the business | ||||||
12 | of an organization authorized under the Dental Service | ||||||
13 | Plan Act or the Voluntary Health Services Plans Act or of a | ||||||
14 | health maintenance organization or a limited health | ||||||
15 | service organization, $2,000. | ||||||
16 | (bb) For filing a statement of acquisition of a | ||||||
17 | foreign or alien insurance company as defined in Section | ||||||
18 | 131.12a of this Code, $1,000. | ||||||
19 | (cc) For filing a registration statement as required | ||||||
20 | in Sections 131.13 and 131.14, the notification as | ||||||
21 | required by Sections 131.16, 131.20a, or 141.4, or an | ||||||
22 | agreement or transaction required by Sections 124.2(2), | ||||||
23 | 141, 141a, or 141.1, $200. | ||||||
24 | (dd) For filing an application for licensing of: | ||||||
25 | (i) a religious or charitable risk pooling trust | ||||||
26 | or a workers' compensation pool, $1,000; |
| |||||||
| |||||||
1 | (ii) a workers' compensation service company, | ||||||
2 | $500; | ||||||
3 | (iii) a self-insured automobile fleet, $200; or | ||||||
4 | (iv) a renewal of or amendment of any license | ||||||
5 | issued pursuant to (i), (ii), or (iii) above, $100. | ||||||
6 | (ee) For filing articles of incorporation for a | ||||||
7 | syndicate to engage in the business of insurance through | ||||||
8 | the Illinois Insurance Exchange, $2,000. | ||||||
9 | (ff) For filing amended articles of incorporation for | ||||||
10 | a syndicate engaged in the business of insurance through | ||||||
11 | the Illinois Insurance Exchange, $100. | ||||||
12 | (gg) For filing articles of incorporation for a | ||||||
13 | limited syndicate to join with other subscribers or | ||||||
14 | limited syndicates to do business through the Illinois | ||||||
15 | Insurance Exchange, $1,000. | ||||||
16 | (hh) For filing amended articles of incorporation for | ||||||
17 | a limited syndicate to do business through the Illinois | ||||||
18 | Insurance Exchange, $100. | ||||||
19 | (ii) For a permit to solicit subscriptions to a | ||||||
20 | syndicate or limited syndicate, $100. | ||||||
21 | (jj) For the filing of each form as required in | ||||||
22 | Section 143 of this Code, $50 per form. Informational and | ||||||
23 | advertising filings shall be $25 per filing. The fee for | ||||||
24 | advisory and rating organizations shall be $200 per form. | ||||||
25 | (i) For the purposes of the form filing fee, | ||||||
26 | filings made on insert page basis will be considered |
| |||||||
| |||||||
1 | one form at the time of its original submission. | ||||||
2 | Changes made to a form subsequent to its approval | ||||||
3 | shall be considered a new filing. | ||||||
4 | (ii) Only one fee shall be charged for a form, | ||||||
5 | regardless of the number of other forms or policies | ||||||
6 | with which it will be used. | ||||||
7 | (iii) Fees charged for a policy filed as it will be | ||||||
8 | issued regardless of the number of forms comprising | ||||||
9 | that policy shall not exceed $1,500. For advisory or | ||||||
10 | rating organizations, fees charged for a policy filed | ||||||
11 | as it will be issued regardless of the number of forms | ||||||
12 | comprising that policy shall not exceed $2,500. | ||||||
13 | (iv) The Director may by rule exempt forms from | ||||||
14 | such fees. | ||||||
15 | (kk) For filing an application for licensing of a | ||||||
16 | reinsurance intermediary, $500. | ||||||
17 | (ll) For filing an application for renewal of a | ||||||
18 | license of a reinsurance intermediary, $200. | ||||||
19 | (mm) For filing a plan of division of a domestic stock | ||||||
20 | company under Article IIB, $100,000 $10,000 . | ||||||
21 | (nn) For filing all documents submitted by a foreign | ||||||
22 | or alien company to be a certified reinsurer in this | ||||||
23 | State, except for a fraternal benefit society, $1,000. | ||||||
24 | (oo) For filing a renewal by a foreign or alien | ||||||
25 | company to be a certified reinsurer in this State, except | ||||||
26 | for a fraternal benefit society, $400. |
| |||||||
| |||||||
1 | (pp) For filing all documents submitted by a reinsurer | ||||||
2 | domiciled in a reciprocal jurisdiction, $1,000. | ||||||
3 | (qq) For filing a renewal by a reinsurer domiciled in | ||||||
4 | a reciprocal jurisdiction, $400. | ||||||
5 | (rr) For registering a captive management company or | ||||||
6 | renewal thereof, $50. | ||||||
7 | (ss) For filing an insurance business transfer plan | ||||||
8 | under Article XLVII, $100,000 $25,000 . | ||||||
9 | (2) When printed copies or numerous copies of the same | ||||||
10 | paper or records are furnished or certified, the Director may | ||||||
11 | reduce such fees for copies if he finds them excessive. He may, | ||||||
12 | when he considers it in the public interest, furnish without | ||||||
13 | charge to state insurance departments and persons other than | ||||||
14 | companies, copies or certified copies of reports of | ||||||
15 | examinations and of other papers and records. | ||||||
16 | (3) The expenses incurred in any performance examination | ||||||
17 | authorized by law shall be paid by the company or person being | ||||||
18 | examined. The charge shall be reasonably related to the cost | ||||||
19 | of the examination including but not limited to compensation | ||||||
20 | of examiners, electronic data processing costs, supervision | ||||||
21 | and preparation of an examination report and lodging and | ||||||
22 | travel expenses. All lodging and travel expenses shall be in | ||||||
23 | accord with the applicable travel regulations as published by | ||||||
24 | the Department of Central Management Services and approved by | ||||||
25 | the Governor's Travel Control Board, except that out-of-state | ||||||
26 | lodging and travel expenses related to examinations authorized |
| |||||||
| |||||||
1 | under Section 132 shall be in accordance with travel rates | ||||||
2 | prescribed under paragraph 301-7.2 of the Federal Travel | ||||||
3 | Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement of | ||||||
4 | subsistence expenses incurred during official travel. All | ||||||
5 | lodging and travel expenses may be reimbursed directly upon | ||||||
6 | authorization of the Director. With the exception of the | ||||||
7 | direct reimbursements authorized by the Director, all | ||||||
8 | performance examination charges collected by the Department | ||||||
9 | shall be paid to the Insurance Producer Administration Fund, | ||||||
10 | however, the electronic data processing costs incurred by the | ||||||
11 | Department in the performance of any examination shall be | ||||||
12 | billed directly to the company being examined for payment to | ||||||
13 | the Technology Management Revolving Fund. | ||||||
14 | (4) At the time of any service of process on the Director | ||||||
15 | as attorney for such service, the Director shall charge and | ||||||
16 | collect the sum of $40, which may be recovered as taxable costs | ||||||
17 | by the party to the suit or action causing such service to be | ||||||
18 | made if he prevails in such suit or action. | ||||||
19 | (5) (a) The costs incurred by the Department of Insurance | ||||||
20 | in conducting any hearing authorized by law shall be assessed | ||||||
21 | against the parties to the hearing in such proportion as the | ||||||
22 | Director of Insurance may determine upon consideration of all | ||||||
23 | relevant circumstances including: (1) the nature of the | ||||||
24 | hearing; (2) whether the hearing was instigated by, or for the | ||||||
25 | benefit of a particular party or parties; (3) whether there is | ||||||
26 | a successful party on the merits of the proceeding; and (4) the |
| |||||||
| |||||||
1 | relative levels of participation by the parties. | ||||||
2 | (b) For purposes of this subsection (5) costs incurred | ||||||
3 | shall mean the hearing officer fees, court reporter fees, and | ||||||
4 | travel expenses of Department of Insurance officers and | ||||||
5 | employees; provided however, that costs incurred shall not | ||||||
6 | include hearing officer fees or court reporter fees unless the | ||||||
7 | Department has retained the services of independent | ||||||
8 | contractors or outside experts to perform such functions. | ||||||
9 | (c) The Director shall make the assessment of costs | ||||||
10 | incurred as part of the final order or decision arising out of | ||||||
11 | the proceeding; provided, however, that such order or decision | ||||||
12 | shall include findings and conclusions in support of the | ||||||
13 | assessment of costs. This subsection (5) shall not be | ||||||
14 | construed as permitting the payment of travel expenses unless | ||||||
15 | calculated in accordance with the applicable travel | ||||||
16 | regulations of the Department of Central Management Services, | ||||||
17 | as approved by the Governor's Travel Control Board. The | ||||||
18 | Director as part of such order or decision shall require all | ||||||
19 | assessments for hearing officer fees and court reporter fees, | ||||||
20 | if any, to be paid directly to the hearing officer or court | ||||||
21 | reporter by the party(s) assessed for such costs. The | ||||||
22 | assessments for travel expenses of Department officers and | ||||||
23 | employees shall be reimbursable to the Director of Insurance | ||||||
24 | for deposit to the fund out of which those expenses had been | ||||||
25 | paid. | ||||||
26 | (d) The provisions of this subsection (5) shall apply in |
| |||||||
| |||||||
1 | the case of any hearing conducted by the Director of Insurance | ||||||
2 | not otherwise specifically provided for by law. | ||||||
3 | (6) The Director shall charge and collect an annual | ||||||
4 | financial regulation fee from every domestic company for | ||||||
5 | examination and analysis of its financial condition and to | ||||||
6 | fund the internal costs and expenses of the Interstate | ||||||
7 | Insurance Receivership Commission as may be allocated to the | ||||||
8 | State of Illinois and companies doing an insurance business in | ||||||
9 | this State pursuant to Article X of the Interstate Insurance | ||||||
10 | Receivership Compact. The fee shall be the greater fixed | ||||||
11 | amount based upon the combination of nationwide direct premium | ||||||
12 | income and nationwide reinsurance assumed premium income or | ||||||
13 | upon admitted assets calculated under this subsection as | ||||||
14 | follows: | ||||||
15 | (a) Combination of nationwide direct premium income | ||||||
16 | and nationwide reinsurance assumed premium. | ||||||
17 | (i) $150, if the premium is less than $500,000 and | ||||||
18 | there is no reinsurance assumed premium; | ||||||
19 | (ii) $750, if the premium is $500,000 or more, but | ||||||
20 | less than $5,000,000 and there is no reinsurance | ||||||
21 | assumed premium; or if the premium is less than | ||||||
22 | $5,000,000 and the reinsurance assumed premium is less | ||||||
23 | than $10,000,000; | ||||||
24 | (iii) $3,750, if the premium is less than | ||||||
25 | $5,000,000 and the reinsurance assumed premium is | ||||||
26 | $10,000,000 or more; |
| |||||||
| |||||||
1 | (iv) $7,500, if the premium is $5,000,000 or more, | ||||||
2 | but less than $10,000,000; | ||||||
3 | (v) $18,000, if the premium is $10,000,000 or | ||||||
4 | more, but less than $25,000,000; | ||||||
5 | (vi) $22,500, if the premium is $25,000,000 or | ||||||
6 | more, but less than $50,000,000; | ||||||
7 | (vii) $30,000, if the premium is $50,000,000 or | ||||||
8 | more, but less than $100,000,000; | ||||||
9 | (viii) $37,500, if the premium is $100,000,000 or | ||||||
10 | more. | ||||||
11 | (b) Admitted assets. | ||||||
12 | (i) $150, if admitted assets are less than | ||||||
13 | $1,000,000; | ||||||
14 | (ii) $750, if admitted assets are $1,000,000 or | ||||||
15 | more, but less than $5,000,000; | ||||||
16 | (iii) $3,750, if admitted assets are $5,000,000 or | ||||||
17 | more, but less than $25,000,000; | ||||||
18 | (iv) $7,500, if admitted assets are $25,000,000 or | ||||||
19 | more, but less than $50,000,000; | ||||||
20 | (v) $18,000, if admitted assets are $50,000,000 or | ||||||
21 | more, but less than $100,000,000; | ||||||
22 | (vi) $22,500, if admitted assets are $100,000,000 | ||||||
23 | or more, but less than $500,000,000; | ||||||
24 | (vii) $30,000, if admitted assets are $500,000,000 | ||||||
25 | or more, but less than $1,000,000,000; | ||||||
26 | (viii) $37,500, if admitted assets are |
| |||||||
| |||||||
1 | $1,000,000,000 or more. | ||||||
2 | (c) The sum of financial regulation fees charged to | ||||||
3 | the domestic companies of the same affiliated group shall | ||||||
4 | not exceed $250,000 in the aggregate in any single year | ||||||
5 | and shall be billed by the Director to the member company | ||||||
6 | designated by the group. | ||||||
7 | (7) The Director shall charge and collect an annual | ||||||
8 | financial regulation fee from every foreign or alien company, | ||||||
9 | except fraternal benefit societies, for the examination and | ||||||
10 | analysis of its financial condition and to fund the internal | ||||||
11 | costs and expenses of the Interstate Insurance Receivership | ||||||
12 | Commission as may be allocated to the State of Illinois and | ||||||
13 | companies doing an insurance business in this State pursuant | ||||||
14 | to Article X of the Interstate Insurance Receivership Compact. | ||||||
15 | The fee shall be a fixed amount based upon Illinois direct | ||||||
16 | premium income and nationwide reinsurance assumed premium | ||||||
17 | income in accordance with the following schedule: | ||||||
18 | (a) $150, if the premium is less than $500,000 and | ||||||
19 | there is no reinsurance assumed premium; | ||||||
20 | (b) $750, if the premium is $500,000 or more, but less | ||||||
21 | than $5,000,000 and there is no reinsurance assumed | ||||||
22 | premium; or if the premium is less than $5,000,000 and the | ||||||
23 | reinsurance assumed premium is less than $10,000,000; | ||||||
24 | (c) $3,750, if the premium is less than $5,000,000 and | ||||||
25 | the reinsurance assumed premium is $10,000,000 or more; | ||||||
26 | (d) $7,500, if the premium is $5,000,000 or more, but |
| |||||||
| |||||||
1 | less than $10,000,000; | ||||||
2 | (e) $18,000, if the premium is $10,000,000 or more, | ||||||
3 | but less than $25,000,000; | ||||||
4 | (f) $22,500, if the premium is $25,000,000 or more, | ||||||
5 | but less than $50,000,000; | ||||||
6 | (g) $30,000, if the premium is $50,000,000 or more, | ||||||
7 | but less than $100,000,000; | ||||||
8 | (h) $37,500, if the premium is $100,000,000 or more. | ||||||
9 | The sum of financial regulation fees under this subsection | ||||||
10 | (7) charged to the foreign or alien companies within the same | ||||||
11 | affiliated group shall not exceed $250,000 in the aggregate in | ||||||
12 | any single year and shall be billed by the Director to the | ||||||
13 | member company designated by the group. | ||||||
14 | (8) Beginning January 1, 1992, the financial regulation | ||||||
15 | fees imposed under subsections (6) and (7) of this Section | ||||||
16 | shall be paid by each company or domestic affiliated group | ||||||
17 | annually. After January 1, 1994, the fee shall be billed by | ||||||
18 | Department invoice based upon the company's premium income or | ||||||
19 | admitted assets as shown in its annual statement for the | ||||||
20 | preceding calendar year. The invoice is due upon receipt and | ||||||
21 | must be paid no later than June 30 of each calendar year. All | ||||||
22 | financial regulation fees collected by the Department shall be | ||||||
23 | paid to the Insurance Financial Regulation Fund. The | ||||||
24 | Department may not collect financial examiner per diem charges | ||||||
25 | from companies subject to subsections (6) and (7) of this | ||||||
26 | Section undergoing financial examination after June 30, 1992. |
| |||||||
| |||||||
1 | (9) In addition to the financial regulation fee required | ||||||
2 | by this Section, a company undergoing any financial | ||||||
3 | examination authorized by law shall pay the following costs | ||||||
4 | and expenses incurred by the Department: electronic data | ||||||
5 | processing costs, the expenses authorized under Section 131.21 | ||||||
6 | and subsection (d) of Section 132.4 of this Code, and lodging | ||||||
7 | and travel expenses. | ||||||
8 | Electronic data processing costs incurred by the | ||||||
9 | Department in the performance of any examination shall be | ||||||
10 | billed directly to the company undergoing examination for | ||||||
11 | payment to the Technology Management Revolving Fund. Except | ||||||
12 | for direct reimbursements authorized by the Director or direct | ||||||
13 | payments made under Section 131.21 or subsection (d) of | ||||||
14 | Section 132.4 of this Code, all financial regulation fees and | ||||||
15 | all financial examination charges collected by the Department | ||||||
16 | shall be paid to the Insurance Financial Regulation Fund. | ||||||
17 | All lodging and travel expenses shall be in accordance | ||||||
18 | with applicable travel regulations published by the Department | ||||||
19 | of Central Management Services and approved by the Governor's | ||||||
20 | Travel Control Board, except that out-of-state lodging and | ||||||
21 | travel expenses related to examinations authorized under | ||||||
22 | Sections 132.1 through 132.7 shall be in accordance with | ||||||
23 | travel rates prescribed under paragraph 301-7.2 of the Federal | ||||||
24 | Travel Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement | ||||||
25 | of subsistence expenses incurred during official travel. All | ||||||
26 | lodging and travel expenses may be reimbursed directly upon |
| |||||||
| |||||||
1 | the authorization of the Director. | ||||||
2 | In the case of an organization or person not subject to the | ||||||
3 | financial regulation fee, the expenses incurred in any | ||||||
4 | financial examination authorized by law shall be paid by the | ||||||
5 | organization or person being examined. The charge shall be | ||||||
6 | reasonably related to the cost of the examination including, | ||||||
7 | but not limited to, compensation of examiners and other costs | ||||||
8 | described in this subsection. | ||||||
9 | (10) Any company, person, or entity failing to make any | ||||||
10 | payment of $150 or more as required under this Section shall be | ||||||
11 | subject to the penalty and interest provisions provided for in | ||||||
12 | subsections (4) and (7) of Section 412. | ||||||
13 | (11) Unless otherwise specified, all of the fees collected | ||||||
14 | under this Section shall be paid into the Insurance Financial | ||||||
15 | Regulation Fund. | ||||||
16 | (12) For purposes of this Section: | ||||||
17 | (a) "Domestic company" means a company as defined in | ||||||
18 | Section 2 of this Code which is incorporated or organized | ||||||
19 | under the laws of this State, and in addition includes a | ||||||
20 | not-for-profit corporation authorized under the Dental | ||||||
21 | Service Plan Act or the Voluntary Health Services Plans | ||||||
22 | Act, a health maintenance organization, and a limited | ||||||
23 | health service organization. | ||||||
24 | (b) "Foreign company" means a company as defined in | ||||||
25 | Section 2 of this Code which is incorporated or organized | ||||||
26 | under the laws of any state of the United States other than |
| |||||||
| |||||||
1 | this State and in addition includes a health maintenance | ||||||
2 | organization and a limited health service organization | ||||||
3 | which is incorporated or organized under the laws of any | ||||||
4 | state of the United States other than this State. | ||||||
5 | (c) "Alien company" means a company as defined in | ||||||
6 | Section 2 of this Code which is incorporated or organized | ||||||
7 | under the laws of any country other than the United | ||||||
8 | States. | ||||||
9 | (d) "Fraternal benefit society" means a corporation, | ||||||
10 | society, order, lodge or voluntary association as defined | ||||||
11 | in Section 282.1 of this Code. | ||||||
12 | (e) "Mutual benefit association" means a company, | ||||||
13 | association or corporation authorized by the Director to | ||||||
14 | do business in this State under the provisions of Article | ||||||
15 | XVIII of this Code. | ||||||
16 | (f) "Burial society" means a person, firm, | ||||||
17 | corporation, society or association of individuals | ||||||
18 | authorized by the Director to do business in this State | ||||||
19 | under the provisions of Article XIX of this Code. | ||||||
20 | (g) "Farm mutual" means a district, county and | ||||||
21 | township mutual insurance company authorized by the | ||||||
22 | Director to do business in this State under the provisions | ||||||
23 | of the Farm Mutual Insurance Company Act of 1986. | ||||||
24 | (Source: P.A. 102-775, eff. 5-13-22; 103-75, eff. 1-1-25.)
| ||||||
25 | (215 ILCS 5/412) (from Ch. 73, par. 1024) |
| |||||||
| |||||||
1 | Sec. 412. Refunds; penalties; collection. | ||||||
2 | (1)(a) Whenever it appears to the satisfaction of the | ||||||
3 | Director that because of some mistake of fact, error in | ||||||
4 | calculation, or erroneous interpretation of a statute of this | ||||||
5 | or any other state, any authorized company, surplus line | ||||||
6 | producer, or industrial insured has paid to him, pursuant to | ||||||
7 | any provision of law, taxes, fees, or other charges in excess | ||||||
8 | of the amount legally chargeable against it, during the 6-year | ||||||
9 | 6 year period immediately preceding the discovery of such | ||||||
10 | overpayment, he shall have power to refund to such company, | ||||||
11 | surplus line producer, or industrial insured the amount of the | ||||||
12 | excess or excesses by applying the amount or amounts thereof | ||||||
13 | toward the payment of taxes, fees, or other charges already | ||||||
14 | due, or which may thereafter become due from that company | ||||||
15 | until such excess or excesses have been fully refunded, or | ||||||
16 | upon a written request from the authorized company, surplus | ||||||
17 | line producer, or industrial insured, the Director shall | ||||||
18 | provide a cash refund within 120 days after receipt of the | ||||||
19 | written request if all necessary information has been filed | ||||||
20 | with the Department in order for it to perform an audit of the | ||||||
21 | tax report for the transaction or period or annual return for | ||||||
22 | the year in which the overpayment occurred or within 120 days | ||||||
23 | after the date the Department receives all the necessary | ||||||
24 | information to perform such audit. The Director shall not | ||||||
25 | provide a cash refund if there are insufficient funds in the | ||||||
26 | Insurance Premium Tax Refund Fund to provide a cash refund, if |
| |||||||
| |||||||
1 | the amount of the overpayment is less than $100, or if the | ||||||
2 | amount of the overpayment can be fully offset against the | ||||||
3 | taxpayer's estimated liability for the year following the year | ||||||
4 | of the cash refund request. Any cash refund shall be paid from | ||||||
5 | the Insurance Premium Tax Refund Fund, a special fund hereby | ||||||
6 | created in the State treasury. | ||||||
7 | (b) As determined by the Director pursuant to paragraph | ||||||
8 | (a) of this subsection, the Department shall deposit an amount | ||||||
9 | of cash refunds approved by the Director for payment as a | ||||||
10 | result of overpayment of tax liability collected under | ||||||
11 | Sections 121-2.08, 409, 444, 444.1, and 445 of this Code into | ||||||
12 | the Insurance Premium Tax Refund Fund. | ||||||
13 | (c) Beginning July 1, 1999, moneys in the Insurance | ||||||
14 | Premium Tax Refund Fund shall be expended exclusively for the | ||||||
15 | purpose of paying cash refunds resulting from overpayment of | ||||||
16 | tax liability under Sections 121-2.08, 409, 444, 444.1, and | ||||||
17 | 445 of this Code as determined by the Director pursuant to | ||||||
18 | subsection 1(a) of this Section. Cash refunds made in | ||||||
19 | accordance with this Section may be made from the Insurance | ||||||
20 | Premium Tax Refund Fund only to the extent that amounts have | ||||||
21 | been deposited and retained in the Insurance Premium Tax | ||||||
22 | Refund Fund. | ||||||
23 | (d) This Section shall constitute an irrevocable and | ||||||
24 | continuing appropriation from the Insurance Premium Tax Refund | ||||||
25 | Fund for the purpose of paying cash refunds pursuant to the | ||||||
26 | provisions of this Section. |
| |||||||
| |||||||
1 | (2)(a) When any insurance company fails to file any tax | ||||||
2 | return required under Sections 408.1, 409, 444, and 444.1 of | ||||||
3 | this Code or Section 12 of the Fire Investigation Act on the | ||||||
4 | date prescribed, including any extensions, there shall be | ||||||
5 | added as a penalty $400 or 10% of the amount of such tax, | ||||||
6 | whichever is greater, for each month or part of a month of | ||||||
7 | failure to file, the entire penalty not to exceed $2,000 or 50% | ||||||
8 | of the tax due, whichever is greater. In this paragraph, "tax | ||||||
9 | due" means the full amount due for that year under Section | ||||||
10 | 408.1, 409, 444, or 444.1 of this Code or Section 12 of the | ||||||
11 | Fire Investigation Act. | ||||||
12 | (b) When any industrial insured or surplus line producer | ||||||
13 | fails to file any tax return or report required under Sections | ||||||
14 | 121-2.08 and 445 of this Code or Section 12 of the Fire | ||||||
15 | Investigation Act on the date prescribed, including any | ||||||
16 | extensions, there shall be added: | ||||||
17 | (i) as a late fee, if the return or report is received | ||||||
18 | at least one day but not more than 15 days after the | ||||||
19 | prescribed due date, $50 or 5% of the tax due, whichever is | ||||||
20 | greater, the entire fee not to exceed $1,000; | ||||||
21 | (ii) as a late fee, if the return or report is received | ||||||
22 | at least 16 days but not more than 30 days after the | ||||||
23 | prescribed due date, $100 or 5% of the tax due, whichever | ||||||
24 | is greater, the entire fee not to exceed $2,000; or | ||||||
25 | (iii) as a penalty, if the return or report is | ||||||
26 | received more than 30 days after the prescribed due date, |
| |||||||
| |||||||
1 | $100 or 5% of the tax due, whichever is greater, for each | ||||||
2 | month or part of a month of failure to file, the entire | ||||||
3 | penalty not to exceed $500 or 30% of the tax due, whichever | ||||||
4 | is greater. | ||||||
5 | In this paragraph, "tax due" means the full amount due for | ||||||
6 | that year under Section 121-2.08 or 445 of this Code or Section | ||||||
7 | 12 of the Fire Investigation Act. A tax return or report shall | ||||||
8 | be deemed received as of the date mailed as evidenced by a | ||||||
9 | postmark, proof of mailing on a recognized United States | ||||||
10 | Postal Service form or a form acceptable to the United States | ||||||
11 | Postal Service or other commercial mail delivery service, or | ||||||
12 | other evidence acceptable to the Director. | ||||||
13 | (3)(a) When any insurance company fails to pay the full | ||||||
14 | amount due under the provisions of this Section, Sections | ||||||
15 | 408.1, 409, 444, or 444.1 of this Code, or Section 12 of the | ||||||
16 | Fire Investigation Act, there shall be added to the amount due | ||||||
17 | as a penalty an amount equal to 10% of the deficiency. | ||||||
18 | (a-5) When any industrial insured or surplus line producer | ||||||
19 | fails to pay the full amount due under the provisions of this | ||||||
20 | Section, Sections 121-2.08 or 445 of this Code, or Section 12 | ||||||
21 | of the Fire Investigation Act on the date prescribed, there | ||||||
22 | shall be added: | ||||||
23 | (i) as a late fee, if the payment is received at least | ||||||
24 | one day but not more than 7 days after the prescribed due | ||||||
25 | date, 10% of the tax due, the entire fee not to exceed | ||||||
26 | $1,000; |
| |||||||
| |||||||
1 | (ii) as a late fee, if the payment is received at least | ||||||
2 | 8 days but not more than 14 days after the prescribed due | ||||||
3 | date, 10% of the tax due, the entire fee not to exceed | ||||||
4 | $1,500; | ||||||
5 | (iii) as a late fee, if the payment is received at | ||||||
6 | least 15 days but not more than 21 days after the | ||||||
7 | prescribed due date, 10% of the tax due, the entire fee not | ||||||
8 | to exceed $2,000; or | ||||||
9 | (iv) as a penalty, if the return or report is received | ||||||
10 | more than 21 days after the prescribed due date, 10% of the | ||||||
11 | tax due. | ||||||
12 | In this paragraph, "tax due" means the full amount due for | ||||||
13 | that year under this Section, Section 121-2.08 or 445 of this | ||||||
14 | Code, or Section 12 of the Fire Investigation Act. A tax | ||||||
15 | payment shall be deemed received as of the date mailed as | ||||||
16 | evidenced by a postmark, proof of mailing on a recognized | ||||||
17 | United States Postal Service form or a form acceptable to the | ||||||
18 | United States Postal Service or other commercial mail delivery | ||||||
19 | service, or other evidence acceptable to the Director. | ||||||
20 | (b) If such failure to pay is determined by the Director to | ||||||
21 | be willful wilful , after a hearing under Sections 402 and 403, | ||||||
22 | there shall be added to the tax as a penalty an amount equal to | ||||||
23 | the greater of 50% of the deficiency or 10% of the amount due | ||||||
24 | and unpaid for each month or part of a month that the | ||||||
25 | deficiency remains unpaid commencing with the date that the | ||||||
26 | amount becomes due. Such amount shall be in lieu of any |
| |||||||
| |||||||
1 | determined under paragraph (a) or (a-5). | ||||||
2 | (4) Any insurance company, industrial insured, or surplus | ||||||
3 | line producer that fails to pay the full amount due under this | ||||||
4 | Section or Sections 121-2.08, 408.1, 409, 444, 444.1, or 445 | ||||||
5 | of this Code, or Section 12 of the Fire Investigation Act is | ||||||
6 | liable, in addition to the tax and any late fees and penalties, | ||||||
7 | for interest on such deficiency at the rate of 12% per annum, | ||||||
8 | or at such higher adjusted rates as are or may be established | ||||||
9 | under subsection (b) of Section 6621 of the Internal Revenue | ||||||
10 | Code, from the date that payment of any such tax was due, | ||||||
11 | determined without regard to any extensions, to the date of | ||||||
12 | payment of such amount. | ||||||
13 | (5) The Director, through the Attorney General, may | ||||||
14 | institute an action in the name of the People of the State of | ||||||
15 | Illinois, in any court of competent jurisdiction, for the | ||||||
16 | recovery of the amount of such taxes, fees, and penalties due, | ||||||
17 | and prosecute the same to final judgment, and take such steps | ||||||
18 | as are necessary to collect the same. | ||||||
19 | (6) In the event that the certificate of authority of a | ||||||
20 | foreign or alien company is revoked for any cause or the | ||||||
21 | company withdraws from this State prior to the renewal date of | ||||||
22 | the certificate of authority as provided in Section 114, the | ||||||
23 | company may recover the amount of any such tax paid in advance. | ||||||
24 | Except as provided in this subsection, no revocation or | ||||||
25 | withdrawal excuses payment of or constitutes grounds for the | ||||||
26 | recovery of any taxes or penalties imposed by this Code. |
| |||||||
| |||||||
1 | (7) When an insurance company or domestic affiliated group | ||||||
2 | fails to pay the full amount of any fee of $200 or more due | ||||||
3 | under Section 408 of this Code, there shall be added to the | ||||||
4 | amount due as a penalty the greater of $100 or an amount equal | ||||||
5 | to 10% of the deficiency for each month or part of a month that | ||||||
6 | the deficiency remains unpaid. | ||||||
7 | (8) The Department shall have a lien for the taxes, fees, | ||||||
8 | charges, fines, penalties, interest, other charges, or any | ||||||
9 | portion thereof, imposed or assessed pursuant to this Code, | ||||||
10 | upon all the real and personal property of any company or | ||||||
11 | person to whom the assessment or final order has been issued or | ||||||
12 | whenever a tax return is filed without payment of the tax or | ||||||
13 | penalty shown therein to be due, including all such property | ||||||
14 | of the company or person acquired after receipt of the | ||||||
15 | assessment, issuance of the order, or filing of the return. | ||||||
16 | The company or person is liable for the filing fee incurred by | ||||||
17 | the Department for filing the lien and the filing fee incurred | ||||||
18 | by the Department to file the release of that lien. The filing | ||||||
19 | fees shall be paid to the Department in addition to payment of | ||||||
20 | the tax, fee, charge, fine, penalty, interest, other charges, | ||||||
21 | or any portion thereof, included in the amount of the lien. | ||||||
22 | However, where the lien arises because of the issuance of a | ||||||
23 | final order of the Director or tax assessment by the | ||||||
24 | Department, the lien shall not attach and the notice referred | ||||||
25 | to in this Section shall not be filed until all administrative | ||||||
26 | proceedings or proceedings in court for review of the final |
| |||||||
| |||||||
1 | order or assessment have terminated or the time for the taking | ||||||
2 | thereof has expired without such proceedings being instituted. | ||||||
3 | Upon the granting of Department review after a lien has | ||||||
4 | attached, the lien shall remain in full force except to the | ||||||
5 | extent to which the final assessment may be reduced by a | ||||||
6 | revised final assessment following the rehearing or review. | ||||||
7 | The lien created by the issuance of a final assessment shall | ||||||
8 | terminate, unless a notice of lien is filed, within 3 years | ||||||
9 | after the date all proceedings in court for the review of the | ||||||
10 | final assessment have terminated or the time for the taking | ||||||
11 | thereof has expired without such proceedings being instituted, | ||||||
12 | or (in the case of a revised final assessment issued pursuant | ||||||
13 | to a rehearing or review by the Department) within 3 years | ||||||
14 | after the date all proceedings in court for the review of such | ||||||
15 | revised final assessment have terminated or the time for the | ||||||
16 | taking thereof has expired without such proceedings being | ||||||
17 | instituted. Where the lien results from the filing of a tax | ||||||
18 | return without payment of the tax or penalty shown therein to | ||||||
19 | be due, the lien shall terminate, unless a notice of lien is | ||||||
20 | filed, within 3 years after the date when the return is filed | ||||||
21 | with the Department. | ||||||
22 | The time limitation period on the Department's right to | ||||||
23 | file a notice of lien shall not run during any period of time | ||||||
24 | in which the order of any court has the effect of enjoining or | ||||||
25 | restraining the Department from filing such notice of lien. If | ||||||
26 | the Department finds that a company or person is about to |
| |||||||
| |||||||
1 | depart from the State, to conceal himself or his property, or | ||||||
2 | to do any other act tending to prejudice or to render wholly or | ||||||
3 | partly ineffectual proceedings to collect the amount due and | ||||||
4 | owing to the Department unless such proceedings are brought | ||||||
5 | without delay, or if the Department finds that the collection | ||||||
6 | of the amount due from any company or person will be | ||||||
7 | jeopardized by delay, the Department shall give the company or | ||||||
8 | person notice of such findings and shall make demand for | ||||||
9 | immediate return and payment of the amount, whereupon the | ||||||
10 | amount shall become immediately due and payable. If the | ||||||
11 | company or person, within 5 days after the notice (or within | ||||||
12 | such extension of time as the Department may grant), does not | ||||||
13 | comply with the notice or show to the Department that the | ||||||
14 | findings in the notice are erroneous, the Department may file | ||||||
15 | a notice of jeopardy assessment lien in the office of the | ||||||
16 | recorder of the county in which any property of the company or | ||||||
17 | person may be located and shall notify the company or person of | ||||||
18 | the filing. The jeopardy assessment lien shall have the same | ||||||
19 | scope and effect as the statutory lien provided for in this | ||||||
20 | Section. If the company or person believes that the company or | ||||||
21 | person does not owe some or all of the tax for which the | ||||||
22 | jeopardy assessment lien against the company or person has | ||||||
23 | been filed, or that no jeopardy to the revenue in fact exists, | ||||||
24 | the company or person may protest within 20 days after being | ||||||
25 | notified by the Department of the filing of the jeopardy | ||||||
26 | assessment lien and request a hearing, whereupon the |
| |||||||
| |||||||
1 | Department shall hold a hearing in conformity with the | ||||||
2 | provisions of this Code and, pursuant thereto, shall notify | ||||||
3 | the company or person of its findings as to whether or not the | ||||||
4 | jeopardy assessment lien will be released. If not, and if the | ||||||
5 | company or person is aggrieved by this decision, the company | ||||||
6 | or person may file an action for judicial review of the final | ||||||
7 | determination of the Department in accordance with the | ||||||
8 | Administrative Review Law. If, pursuant to such hearing (or | ||||||
9 | after an independent determination of the facts by the | ||||||
10 | Department without a hearing), the Department determines that | ||||||
11 | some or all of the amount due covered by the jeopardy | ||||||
12 | assessment lien is not owed by the company or person, or that | ||||||
13 | no jeopardy to the revenue exists, or if on judicial review the | ||||||
14 | final judgment of the court is that the company or person does | ||||||
15 | not owe some or all of the amount due covered by the jeopardy | ||||||
16 | assessment lien against them, or that no jeopardy to the | ||||||
17 | revenue exists, the Department shall release its jeopardy | ||||||
18 | assessment lien to the extent of such finding of nonliability | ||||||
19 | for the amount, or to the extent of such finding of no jeopardy | ||||||
20 | to the revenue. The Department shall also release its jeopardy | ||||||
21 | assessment lien against the company or person whenever the | ||||||
22 | amount due and owing covered by the lien, plus any interest | ||||||
23 | which may be due, are paid and the company or person has paid | ||||||
24 | the Department in cash or by guaranteed remittance an amount | ||||||
25 | representing the filing fee for the lien and the filing fee for | ||||||
26 | the release of that lien. The Department shall file that |
| |||||||
| |||||||
1 | release of lien with the recorder of the county where that lien | ||||||
2 | was filed. | ||||||
3 | Nothing in this Section shall be construed to give the | ||||||
4 | Department a preference over the rights of any bona fide | ||||||
5 | purchaser, holder of a security interest, mechanics | ||||||
6 | lienholder, mortgagee, or judgment lien creditor arising prior | ||||||
7 | to the filing of a regular notice of lien or a notice of | ||||||
8 | jeopardy assessment lien in the office of the recorder in the | ||||||
9 | county in which the property subject to the lien is located. | ||||||
10 | For purposes of this Section, "bona fide" shall not include | ||||||
11 | any mortgage of real or personal property or any other credit | ||||||
12 | transaction that results in the mortgagee or the holder of the | ||||||
13 | security acting as trustee for unsecured creditors of the | ||||||
14 | company or person mentioned in the notice of lien who executed | ||||||
15 | such chattel or real property mortgage or the document | ||||||
16 | evidencing such credit transaction. The lien shall be inferior | ||||||
17 | to the lien of general taxes, special assessments, and special | ||||||
18 | taxes levied by any political subdivision of this State. In | ||||||
19 | case title to land to be affected by the notice of lien or | ||||||
20 | notice of jeopardy assessment lien is registered under the | ||||||
21 | provisions of the Registered Titles (Torrens) Act, such notice | ||||||
22 | shall be filed in the office of the Registrar of Titles of the | ||||||
23 | county within which the property subject to the lien is | ||||||
24 | situated and shall be entered upon the register of titles as a | ||||||
25 | memorial or charge upon each folium of the register of titles | ||||||
26 | affected by such notice, and the Department shall not have a |
| |||||||
| |||||||
1 | preference over the rights of any bona fide purchaser, | ||||||
2 | mortgagee, judgment creditor, or other lienholder arising | ||||||
3 | prior to the registration of such notice. The regular lien or | ||||||
4 | jeopardy assessment lien shall not be effective against any | ||||||
5 | purchaser with respect to any item in a retailer's stock in | ||||||
6 | trade purchased from the retailer in the usual course of the | ||||||
7 | retailer's business. | ||||||
8 | (Source: P.A. 102-775, eff. 5-13-22; 103-426, eff. 8-4-23.)
| ||||||
9 | (215 ILCS 5/531.03) (from Ch. 73, par. 1065.80-3) | ||||||
10 | Sec. 531.03. Coverage and limitations. | ||||||
11 | (1) This Article shall provide coverage for the policies | ||||||
12 | and contracts specified in subsection (2) of this Section: | ||||||
13 | (a) to persons who, regardless of where they reside | ||||||
14 | (except for non-resident certificate holders under group | ||||||
15 | policies or contracts), are the beneficiaries, assignees | ||||||
16 | or payees, including health care providers rendering | ||||||
17 | services covered under a health insurance policy or | ||||||
18 | certificate, of the persons covered under paragraph (b) of | ||||||
19 | this subsection, and | ||||||
20 | (b) to persons who are owners of or certificate | ||||||
21 | holders or enrollees under the policies or contracts | ||||||
22 | (other than unallocated annuity contracts and structured | ||||||
23 | settlement annuities) and in each case who: | ||||||
24 | (i) are residents; or | ||||||
25 | (ii) are not residents, but only under all of the |
| |||||||
| |||||||
1 | following conditions: | ||||||
2 | (A) the member insurer that issued the | ||||||
3 | policies or contracts is domiciled in this State; | ||||||
4 | (B) the states in which the persons reside | ||||||
5 | have associations similar to the Association | ||||||
6 | created by this Article; | ||||||
7 | (C) the persons are not eligible for coverage | ||||||
8 | by an association in any other state due to the | ||||||
9 | fact that the insurer or health maintenance | ||||||
10 | organization was not licensed in that state at the | ||||||
11 | time specified in that state's guaranty | ||||||
12 | association law. | ||||||
13 | (c) For unallocated annuity contracts specified in | ||||||
14 | subsection (2), paragraphs (a) and (b) of this subsection | ||||||
15 | (1) shall not apply and this Article shall (except as | ||||||
16 | provided in paragraphs (e) and (f) of this subsection) | ||||||
17 | provide coverage to: | ||||||
18 | (i) persons who are the owners of the unallocated | ||||||
19 | annuity contracts if the contracts are issued to or in | ||||||
20 | connection with a specific benefit plan whose plan | ||||||
21 | sponsor has its principal place of business in this | ||||||
22 | State; and | ||||||
23 | (ii) persons who are owners of unallocated annuity | ||||||
24 | contracts issued to or in connection with government | ||||||
25 | lotteries if the owners are residents. | ||||||
26 | (d) For structured settlement annuities specified in |
| |||||||
| |||||||
1 | subsection (2), paragraphs (a) and (b) of this subsection | ||||||
2 | (1) shall not apply and this Article shall (except as | ||||||
3 | provided in paragraphs (e) and (f) of this subsection) | ||||||
4 | provide coverage to a person who is a payee under a | ||||||
5 | structured settlement annuity (or beneficiary of a payee | ||||||
6 | if the payee is deceased), if the payee: | ||||||
7 | (i) is a resident, regardless of where the | ||||||
8 | contract owner resides; or | ||||||
9 | (ii) is not a resident, but only under both of the | ||||||
10 | following conditions: | ||||||
11 | (A) with regard to residency: | ||||||
12 | (I) the contract owner of the structured | ||||||
13 | settlement annuity is a resident; or | ||||||
14 | (II) the contract owner of the structured | ||||||
15 | settlement annuity is not a resident but the | ||||||
16 | insurer that issued the structured settlement | ||||||
17 | annuity is domiciled in this State and the | ||||||
18 | state in which the contract owner resides has | ||||||
19 | an association similar to the Association | ||||||
20 | created by this Article; and | ||||||
21 | (B) neither the payee or beneficiary nor the | ||||||
22 | contract owner is eligible for coverage by the | ||||||
23 | association of the state in which the payee or | ||||||
24 | contract owner resides. | ||||||
25 | (e) This Article shall not provide coverage to: | ||||||
26 | (i) a person who is a payee or beneficiary of a |
| |||||||
| |||||||
1 | contract owner resident of this State if the payee or | ||||||
2 | beneficiary is afforded any coverage by the | ||||||
3 | association of another state; or | ||||||
4 | (ii) a person covered under paragraph (c) of this | ||||||
5 | subsection (1), if any coverage is provided by the | ||||||
6 | association of another state to that person. | ||||||
7 | (f) This Article is intended to provide coverage to a | ||||||
8 | person who is a resident of this State and, in special | ||||||
9 | circumstances, to a nonresident. In order to avoid | ||||||
10 | duplicate coverage, if a person who would otherwise | ||||||
11 | receive coverage under this Article is provided coverage | ||||||
12 | under the laws of any other state, then the person shall | ||||||
13 | not be provided coverage under this Article. In | ||||||
14 | determining the application of the provisions of this | ||||||
15 | paragraph in situations where a person could be covered by | ||||||
16 | the association of more than one state, whether as an | ||||||
17 | owner, payee, enrollee, beneficiary, or assignee, this | ||||||
18 | Article shall be construed in conjunction with other state | ||||||
19 | laws to result in coverage by only one association. | ||||||
20 | (2)(a) This Article shall provide coverage to the persons | ||||||
21 | specified in subsection (1) of this Section for policies or | ||||||
22 | contracts of direct, (i) nongroup life insurance, health | ||||||
23 | insurance (that, for the purposes of this Article, includes | ||||||
24 | health maintenance organization subscriber contracts and | ||||||
25 | certificates), annuities and supplemental contracts to any of | ||||||
26 | these, (ii) for certificates under direct group policies or |
| |||||||
| |||||||
1 | contracts, (iii) for unallocated annuity contracts and (iv) | ||||||
2 | for contracts to furnish health care services and subscription | ||||||
3 | certificates for medical or health care services issued by | ||||||
4 | persons licensed to transact insurance business in this State | ||||||
5 | under this Code. Annuity contracts and certificates under | ||||||
6 | group annuity contracts include but are not limited to | ||||||
7 | guaranteed investment contracts, deposit administration | ||||||
8 | contracts, unallocated funding agreements, allocated funding | ||||||
9 | agreements, structured settlement agreements, lottery | ||||||
10 | contracts and any immediate or deferred annuity contracts. | ||||||
11 | (b) Except as otherwise provided in paragraph (c) of this | ||||||
12 | subsection, this Article shall not provide coverage for: | ||||||
13 | (i) that portion of a policy or contract not | ||||||
14 | guaranteed by the member insurer, or under which the risk | ||||||
15 | is borne by the policy or contract owner; | ||||||
16 | (ii) any such policy or contract or part thereof | ||||||
17 | assumed by the impaired or insolvent insurer under a | ||||||
18 | contract of reinsurance, other than reinsurance for which | ||||||
19 | assumption certificates have been issued; | ||||||
20 | (iii) any portion of a policy or contract to the | ||||||
21 | extent that the rate of interest on which it is based or | ||||||
22 | the interest rate, crediting rate, or similar factor is | ||||||
23 | determined by use of an index or other external reference | ||||||
24 | stated in the policy or contract employed in calculating | ||||||
25 | returns or changes in value: | ||||||
26 | (A) averaged over the period of 4 years prior to |
| |||||||
| |||||||
1 | the date on which the member insurer becomes an | ||||||
2 | impaired or insolvent insurer under this Article, | ||||||
3 | whichever is earlier, exceeds the rate of interest | ||||||
4 | determined by subtracting 2 percentage points from | ||||||
5 | Moody's Corporate Bond Yield Average averaged for that | ||||||
6 | same 4-year period or for such lesser period if the | ||||||
7 | policy or contract was issued less than 4 years before | ||||||
8 | the member insurer becomes an impaired or insolvent | ||||||
9 | insurer under this Article, whichever is earlier; and | ||||||
10 | (B) on and after the date on which the member | ||||||
11 | insurer becomes an impaired or insolvent insurer under | ||||||
12 | this Article, whichever is earlier, exceeds the rate | ||||||
13 | of interest determined by subtracting 3 percentage | ||||||
14 | points from Moody's Corporate Bond Yield Average as | ||||||
15 | most recently available; | ||||||
16 | (iv) any unallocated annuity contract issued to or in | ||||||
17 | connection with a benefit plan protected under the federal | ||||||
18 | Pension Benefit Guaranty Corporation, regardless of | ||||||
19 | whether the federal Pension Benefit Guaranty Corporation | ||||||
20 | has yet become liable to make any payments with respect to | ||||||
21 | the benefit plan; | ||||||
22 | (v) any portion of any unallocated annuity contract | ||||||
23 | which is not issued to or in connection with a specific | ||||||
24 | employee, union or association of natural persons benefit | ||||||
25 | plan or a government lottery; | ||||||
26 | (vi) an obligation that does not arise under the |
| |||||||
| |||||||
1 | express written terms of the policy or contract issued by | ||||||
2 | the member insurer to the enrollee, certificate holder, | ||||||
3 | contract owner, or policy owner, including without | ||||||
4 | limitation: | ||||||
5 | (A) a claim based on marketing materials; | ||||||
6 | (B) a claim based on side letters, riders, or | ||||||
7 | other documents that were issued by the member insurer | ||||||
8 | without meeting applicable policy or contract form | ||||||
9 | filing or approval requirements; | ||||||
10 | (C) a misrepresentation of or regarding policy or | ||||||
11 | contract benefits; | ||||||
12 | (D) an extra-contractual claim; or | ||||||
13 | (E) a claim for penalties or consequential or | ||||||
14 | incidental damages; | ||||||
15 | (vii) any stop-loss insurance, as defined in clause | ||||||
16 | (b) of Class 1 or clause (a) of Class 2 of Section 4 , and | ||||||
17 | further defined in subsection (d) of Section 352 ; | ||||||
18 | (viii) any policy or contract providing any hospital, | ||||||
19 | medical, prescription drug, or other health care benefits | ||||||
20 | pursuant to Part C or Part D of Subchapter XVIII, Chapter 7 | ||||||
21 | of Title 42 of the United States Code (commonly known as | ||||||
22 | Medicare Part C & D), Subchapter XIX, Chapter 7 of Title 42 | ||||||
23 | of the United States Code (commonly known as Medicaid), or | ||||||
24 | any regulations issued pursuant thereto; | ||||||
25 | (ix) any portion of a policy or contract to the extent | ||||||
26 | that the assessments required by Section 531.09 of this |
| |||||||
| |||||||
1 | Code with respect to the policy or contract are preempted | ||||||
2 | or otherwise not permitted by federal or State law; | ||||||
3 | (x) any portion of a policy or contract issued to a | ||||||
4 | plan or program of an employer, association, or other | ||||||
5 | person to provide life, health, or annuity benefits to its | ||||||
6 | employees, members, or others to the extent that the plan | ||||||
7 | or program is self-funded or uninsured, including, but not | ||||||
8 | limited to, benefits payable by an employer, association, | ||||||
9 | or other person under: | ||||||
10 | (A) a multiple employer welfare arrangement as | ||||||
11 | defined in 29 U.S.C. Section 1002; | ||||||
12 | (B) a minimum premium group insurance plan; | ||||||
13 | (C) a stop-loss group insurance plan; or | ||||||
14 | (D) an administrative services only contract; | ||||||
15 | (xi) any portion of a policy or contract to the extent | ||||||
16 | that it provides for: | ||||||
17 | (A) dividends or experience rating credits; | ||||||
18 | (B) voting rights; or | ||||||
19 | (C) payment of any fees or allowances to any | ||||||
20 | person, including the policy or contract owner, in | ||||||
21 | connection with the service to or administration of | ||||||
22 | the policy or contract; | ||||||
23 | (xii) any policy or contract issued in this State by a | ||||||
24 | member insurer at a time when it was not licensed or did | ||||||
25 | not have a certificate of authority to issue the policy or | ||||||
26 | contract in this State; |
| |||||||
| |||||||
1 | (xiii) any contractual agreement that establishes the | ||||||
2 | member insurer's obligations to provide a book value | ||||||
3 | accounting guaranty for defined contribution benefit plan | ||||||
4 | participants by reference to a portfolio of assets that is | ||||||
5 | owned by the benefit plan or its trustee, which in each | ||||||
6 | case is not an affiliate of the member insurer; | ||||||
7 | (xiv) any portion of a policy or contract to the | ||||||
8 | extent that it provides for interest or other changes in | ||||||
9 | value to be determined by the use of an index or other | ||||||
10 | external reference stated in the policy or contract, but | ||||||
11 | which have not been credited to the policy or contract, or | ||||||
12 | as to which the policy or contract owner's rights are | ||||||
13 | subject to forfeiture, as of the date the member insurer | ||||||
14 | becomes an impaired or insolvent insurer under this Code, | ||||||
15 | whichever is earlier. If a policy's or contract's interest | ||||||
16 | or changes in value are credited less frequently than | ||||||
17 | annually, then for purposes of determining the values that | ||||||
18 | have been credited and are not subject to forfeiture under | ||||||
19 | this Section, the interest or change in value determined | ||||||
20 | by using the procedures defined in the policy or contract | ||||||
21 | will be credited as if the contractual date of crediting | ||||||
22 | interest or changing values was the date of impairment or | ||||||
23 | insolvency, whichever is earlier, and will not be subject | ||||||
24 | to forfeiture; or | ||||||
25 | (xv) that portion or part of a variable life insurance | ||||||
26 | or variable annuity contract not guaranteed by a member |
| |||||||
| |||||||
1 | insurer. | ||||||
2 | (c) The exclusion from coverage referenced in subdivision | ||||||
3 | (iii) of paragraph (b) of this subsection shall not apply to | ||||||
4 | any portion of a policy or contract, including a rider, that | ||||||
5 | provides long-term care or other health insurance benefits. | ||||||
6 | (3) The benefits for which the Association may become | ||||||
7 | liable shall in no event exceed the lesser of: | ||||||
8 | (a) the contractual obligations for which the member | ||||||
9 | insurer is liable or would have been liable if it were not | ||||||
10 | an impaired or insolvent insurer, or | ||||||
11 | (b)(i) with respect to any one life, regardless of the | ||||||
12 | number of policies or contracts: | ||||||
13 | (A) $300,000 in life insurance death benefits, but | ||||||
14 | not more than $100,000 in net cash surrender and net | ||||||
15 | cash withdrawal values for life insurance; | ||||||
16 | (B) for health insurance benefits: | ||||||
17 | (I) $100,000 for coverages not defined as | ||||||
18 | disability income insurance or health benefit | ||||||
19 | plans or long-term care insurance, including any | ||||||
20 | net cash surrender and net cash withdrawal values; | ||||||
21 | (II) $300,000 for disability income insurance | ||||||
22 | and $300,000 for long-term care insurance; and | ||||||
23 | (III) $500,000 for health benefit plans; | ||||||
24 | (C) $250,000 in the present value of annuity | ||||||
25 | benefits, including net cash surrender and net cash | ||||||
26 | withdrawal values; |
| |||||||
| |||||||
1 | (ii) with respect to each individual participating in | ||||||
2 | a governmental retirement benefit plan established under | ||||||
3 | Section 401, 403(b), or 457 of the U.S. Internal Revenue | ||||||
4 | Code covered by an unallocated annuity contract or the | ||||||
5 | beneficiaries of each such individual if deceased, in the | ||||||
6 | aggregate, $250,000 in present value annuity benefits, | ||||||
7 | including net cash surrender and net cash withdrawal | ||||||
8 | values; | ||||||
9 | (iii) with respect to each payee of a structured | ||||||
10 | settlement annuity or beneficiary or beneficiaries of the | ||||||
11 | payee if deceased, $250,000 in present value annuity | ||||||
12 | benefits, in the aggregate, including net cash surrender | ||||||
13 | and net cash withdrawal values, if any; or | ||||||
14 | (iv) with respect to either (1) one contract owner | ||||||
15 | provided coverage under subparagraph (ii) of paragraph (c) | ||||||
16 | of subsection (1) of this Section or (2) one plan sponsor | ||||||
17 | whose plans own directly or in trust one or more | ||||||
18 | unallocated annuity contracts not included in subparagraph | ||||||
19 | (ii) of paragraph (b) of this subsection, $5,000,000 in | ||||||
20 | benefits, irrespective of the number of contracts with | ||||||
21 | respect to the contract owner or plan sponsor. However, in | ||||||
22 | the case where one or more unallocated annuity contracts | ||||||
23 | are covered contracts under this Article and are owned by | ||||||
24 | a trust or other entity for the benefit of 2 or more plan | ||||||
25 | sponsors, coverage shall be afforded by the Association if | ||||||
26 | the largest interest in the trust or entity owning the |
| |||||||
| |||||||
1 | contract or contracts is held by a plan sponsor whose | ||||||
2 | principal place of business is in this State. In no event | ||||||
3 | shall the Association be obligated to cover more than | ||||||
4 | $5,000,000 in benefits with respect to all these | ||||||
5 | unallocated contracts. | ||||||
6 | In no event shall the Association be obligated to cover | ||||||
7 | more than (1) an aggregate of $300,000 in benefits with | ||||||
8 | respect to any one life under subparagraphs (i), (ii), and | ||||||
9 | (iii) of this paragraph (b) except with respect to benefits | ||||||
10 | for health benefit plans under item (B) of subparagraph (i) of | ||||||
11 | this paragraph (b), in which case the aggregate liability of | ||||||
12 | the Association shall not exceed $500,000 with respect to any | ||||||
13 | one individual or (2) with respect to one owner of multiple | ||||||
14 | nongroup policies of life insurance, whether the policy or | ||||||
15 | contract owner is an individual, firm, corporation, or other | ||||||
16 | person and whether the persons insured are officers, managers, | ||||||
17 | employees, or other persons, $5,000,000 in benefits, | ||||||
18 | regardless of the number of policies and contracts held by the | ||||||
19 | owner. | ||||||
20 | The limitations set forth in this subsection are | ||||||
21 | limitations on the benefits for which the Association is | ||||||
22 | obligated before taking into account either its subrogation | ||||||
23 | and assignment rights or the extent to which those benefits | ||||||
24 | could be provided out of the assets of the impaired or | ||||||
25 | insolvent insurer attributable to covered policies. The costs | ||||||
26 | of the Association's obligations under this Article may be met |
| |||||||
| |||||||
1 | by the use of assets attributable to covered policies or | ||||||
2 | reimbursed to the Association pursuant to its subrogation and | ||||||
3 | assignment rights. | ||||||
4 | For purposes of this Article, benefits provided by a | ||||||
5 | long-term care rider to a life insurance policy or annuity | ||||||
6 | contract shall be considered the same type of benefits as the | ||||||
7 | base life insurance policy or annuity contract to which it | ||||||
8 | relates. | ||||||
9 | (4) In performing its obligations to provide coverage | ||||||
10 | under Section 531.08 of this Code, the Association shall not | ||||||
11 | be required to guarantee, assume, reinsure, reissue, or | ||||||
12 | perform or cause to be guaranteed, assumed, reinsured, | ||||||
13 | reissued, or performed the contractual obligations of the | ||||||
14 | insolvent or impaired insurer under a covered policy or | ||||||
15 | contract that do not materially affect the economic values or | ||||||
16 | economic benefits of the covered policy or contract. | ||||||
17 | (Source: P.A. 100-687, eff. 8-3-18; 100-863, eff. 8-14-18.)
| ||||||
18 | (215 ILCS 5/356z.30a rep.) | ||||||
19 | (215 ILCS 5/362a rep.) | ||||||
20 | Section 26. The Illinois Insurance Code is amended by | ||||||
21 | repealing Sections 356z.30a and 362a.
| ||||||
22 | Section 30. The Network Adequacy and Transparency Act is | ||||||
23 | amended by changing Sections 5 and 10 as follows:
|
| |||||||
| |||||||
1 | (215 ILCS 124/5) | ||||||
2 | Sec. 5. Definitions. In this Act: | ||||||
3 | "Authorized representative" means a person to whom a | ||||||
4 | beneficiary has given express written consent to represent the | ||||||
5 | beneficiary; a person authorized by law to provide substituted | ||||||
6 | consent for a beneficiary; or the beneficiary's treating | ||||||
7 | provider only when the beneficiary or his or her family member | ||||||
8 | is unable to provide consent. | ||||||
9 | "Beneficiary" means an individual, an enrollee, an | ||||||
10 | insured, a participant, or any other person entitled to | ||||||
11 | reimbursement for covered expenses of or the discounting of | ||||||
12 | provider fees for health care services under a program in | ||||||
13 | which the beneficiary has an incentive to utilize the services | ||||||
14 | of a provider that has entered into an agreement or | ||||||
15 | arrangement with an insurer. | ||||||
16 | "Department" means the Department of Insurance. | ||||||
17 | "Director" means the Director of Insurance. | ||||||
18 | "Family caregiver" means a relative, partner, friend, or | ||||||
19 | neighbor who has a significant relationship with the patient | ||||||
20 | and administers or assists the patient with activities of | ||||||
21 | daily living, instrumental activities of daily living, or | ||||||
22 | other medical or nursing tasks for the quality and welfare of | ||||||
23 | that patient. | ||||||
24 | "Insurer" means any entity that offers individual or group | ||||||
25 | accident and health insurance, including, but not limited to, | ||||||
26 | health maintenance organizations, preferred provider |
| |||||||
| |||||||
1 | organizations, exclusive provider organizations, and other | ||||||
2 | plan structures requiring network participation, excluding the | ||||||
3 | medical assistance program under the Illinois Public Aid Code, | ||||||
4 | the State employees group health insurance program, workers | ||||||
5 | compensation insurance, and pharmacy benefit managers. | ||||||
6 | "Material change" means a significant reduction in the | ||||||
7 | number of providers available in a network plan, including, | ||||||
8 | but not limited to, a reduction of 10% or more in a specific | ||||||
9 | type of providers, the removal of a major health system that | ||||||
10 | causes a network to be significantly different from the | ||||||
11 | network when the beneficiary purchased the network plan, or | ||||||
12 | any change that would cause the network to no longer satisfy | ||||||
13 | the requirements of this Act or the Department's rules for | ||||||
14 | network adequacy and transparency. | ||||||
15 | "Network" means the group or groups of preferred providers | ||||||
16 | providing services to a network plan. | ||||||
17 | "Network plan" means an individual or group policy of | ||||||
18 | accident and health insurance that either requires a covered | ||||||
19 | person to use or creates incentives, including financial | ||||||
20 | incentives, for a covered person to use providers managed, | ||||||
21 | owned, under contract with, or employed by the insurer. | ||||||
22 | "Ongoing course of treatment" means (1) treatment for a | ||||||
23 | life-threatening condition, which is a disease or condition | ||||||
24 | for which likelihood of death is probable unless the course of | ||||||
25 | the disease or condition is interrupted; (2) treatment for a | ||||||
26 | serious acute condition, defined as a disease or condition |
| |||||||
| |||||||
1 | requiring complex ongoing care that the covered person is | ||||||
2 | currently receiving, such as chemotherapy, radiation therapy, | ||||||
3 | or post-operative visits; (3) a course of treatment for a | ||||||
4 | health condition that a treating provider attests that | ||||||
5 | discontinuing care by that provider would worsen the condition | ||||||
6 | or interfere with anticipated outcomes; or (4) the third | ||||||
7 | trimester of pregnancy through the post-partum period. | ||||||
8 | "Preferred provider" means any provider who has entered, | ||||||
9 | either directly or indirectly, into an agreement with an | ||||||
10 | employer or risk-bearing entity relating to health care | ||||||
11 | services that may be rendered to beneficiaries under a network | ||||||
12 | plan. | ||||||
13 | "Providers" means physicians licensed to practice medicine | ||||||
14 | in all its branches, other health care professionals, | ||||||
15 | hospitals, or other health care institutions that provide | ||||||
16 | health care services. | ||||||
17 | "Telehealth" has the meaning given to that term in Section | ||||||
18 | 356z.22 of the Illinois Insurance Code. | ||||||
19 | "Telemedicine" has the meaning given to that term in | ||||||
20 | Section 49.5 of the Medical Practice Act of 1987. | ||||||
21 | "Tiered network" means a network that identifies and | ||||||
22 | groups some or all types of provider and facilities into | ||||||
23 | specific groups to which different provider reimbursement, | ||||||
24 | covered person cost-sharing or provider access requirements, | ||||||
25 | or any combination thereof, apply for the same services. | ||||||
26 | "Woman's principal health care provider" means a physician |
| |||||||
| |||||||
1 | licensed to practice medicine in all of its branches | ||||||
2 | specializing in obstetrics, gynecology, or family practice. | ||||||
3 | (Source: P.A. 102-92, eff. 7-9-21; 102-813, eff. 5-13-22.)
| ||||||
4 | (215 ILCS 124/10) | ||||||
5 | Sec. 10. Network adequacy. | ||||||
6 | (a) An insurer providing a network plan shall file a | ||||||
7 | description of all of the following with the Director: | ||||||
8 | (1) The written policies and procedures for adding | ||||||
9 | providers to meet patient needs based on increases in the | ||||||
10 | number of beneficiaries, changes in the | ||||||
11 | patient-to-provider ratio, changes in medical and health | ||||||
12 | care capabilities, and increased demand for services. | ||||||
13 | (2) The written policies and procedures for making | ||||||
14 | referrals within and outside the network. | ||||||
15 | (3) The written policies and procedures on how the | ||||||
16 | network plan will provide 24-hour, 7-day per week access | ||||||
17 | to network-affiliated primary care, emergency services, | ||||||
18 | and obstetrical and gynecological health care | ||||||
19 | professionals women's principal health care providers . | ||||||
20 | An insurer shall not prohibit a preferred provider from | ||||||
21 | discussing any specific or all treatment options with | ||||||
22 | beneficiaries irrespective of the insurer's position on those | ||||||
23 | treatment options or from advocating on behalf of | ||||||
24 | beneficiaries within the utilization review, grievance, or | ||||||
25 | appeals processes established by the insurer in accordance |
| |||||||
| |||||||
1 | with any rights or remedies available under applicable State | ||||||
2 | or federal law. | ||||||
3 | (b) Insurers must file for review a description of the | ||||||
4 | services to be offered through a network plan. The description | ||||||
5 | shall include all of the following: | ||||||
6 | (1) A geographic map of the area proposed to be served | ||||||
7 | by the plan by county service area and zip code, including | ||||||
8 | marked locations for preferred providers. | ||||||
9 | (2) As deemed necessary by the Department, the names, | ||||||
10 | addresses, phone numbers, and specialties of the providers | ||||||
11 | who have entered into preferred provider agreements under | ||||||
12 | the network plan. | ||||||
13 | (3) The number of beneficiaries anticipated to be | ||||||
14 | covered by the network plan. | ||||||
15 | (4) An Internet website and toll-free telephone number | ||||||
16 | for beneficiaries and prospective beneficiaries to access | ||||||
17 | current and accurate lists of preferred providers, | ||||||
18 | additional information about the plan, as well as any | ||||||
19 | other information required by Department rule. | ||||||
20 | (5) A description of how health care services to be | ||||||
21 | rendered under the network plan are reasonably accessible | ||||||
22 | and available to beneficiaries. The description shall | ||||||
23 | address all of the following: | ||||||
24 | (A) the type of health care services to be | ||||||
25 | provided by the network plan; | ||||||
26 | (B) the ratio of physicians and other providers to |
| |||||||
| |||||||
1 | beneficiaries, by specialty and including primary care | ||||||
2 | physicians and facility-based physicians when | ||||||
3 | applicable under the contract, necessary to meet the | ||||||
4 | health care needs and service demands of the currently | ||||||
5 | enrolled population; | ||||||
6 | (C) the travel and distance standards for plan | ||||||
7 | beneficiaries in county service areas; and | ||||||
8 | (D) a description of how the use of telemedicine, | ||||||
9 | telehealth, or mobile care services may be used to | ||||||
10 | partially meet the network adequacy standards, if | ||||||
11 | applicable. | ||||||
12 | (6) A provision ensuring that whenever a beneficiary | ||||||
13 | has made a good faith effort, as evidenced by accessing | ||||||
14 | the provider directory, calling the network plan, and | ||||||
15 | calling the provider, to utilize preferred providers for a | ||||||
16 | covered service and it is determined the insurer does not | ||||||
17 | have the appropriate preferred providers due to | ||||||
18 | insufficient number, type, unreasonable travel distance or | ||||||
19 | delay, or preferred providers refusing to provide a | ||||||
20 | covered service because it is contrary to the conscience | ||||||
21 | of the preferred providers, as protected by the Health | ||||||
22 | Care Right of Conscience Act, the insurer shall ensure, | ||||||
23 | directly or indirectly, by terms contained in the payer | ||||||
24 | contract, that the beneficiary will be provided the | ||||||
25 | covered service at no greater cost to the beneficiary than | ||||||
26 | if the service had been provided by a preferred provider. |
| |||||||
| |||||||
1 | This paragraph (6) does not apply to: (A) a beneficiary | ||||||
2 | who willfully chooses to access a non-preferred provider | ||||||
3 | for health care services available through the panel of | ||||||
4 | preferred providers, or (B) a beneficiary enrolled in a | ||||||
5 | health maintenance organization. In these circumstances, | ||||||
6 | the contractual requirements for non-preferred provider | ||||||
7 | reimbursements shall apply unless Section 356z.3a of the | ||||||
8 | Illinois Insurance Code requires otherwise. In no event | ||||||
9 | shall a beneficiary who receives care at a participating | ||||||
10 | health care facility be required to search for | ||||||
11 | participating providers under the circumstances described | ||||||
12 | in subsection (b) or (b-5) of Section 356z.3a of the | ||||||
13 | Illinois Insurance Code except under the circumstances | ||||||
14 | described in paragraph (2) of subsection (b-5). | ||||||
15 | (7) A provision that the beneficiary shall receive | ||||||
16 | emergency care coverage such that payment for this | ||||||
17 | coverage is not dependent upon whether the emergency | ||||||
18 | services are performed by a preferred or non-preferred | ||||||
19 | provider and the coverage shall be at the same benefit | ||||||
20 | level as if the service or treatment had been rendered by a | ||||||
21 | preferred provider. For purposes of this paragraph (7), | ||||||
22 | "the same benefit level" means that the beneficiary is | ||||||
23 | provided the covered service at no greater cost to the | ||||||
24 | beneficiary than if the service had been provided by a | ||||||
25 | preferred provider. This provision shall be consistent | ||||||
26 | with Section 356z.3a of the Illinois Insurance Code. |
| |||||||
| |||||||
1 | (8) A limitation that, if the plan provides that the | ||||||
2 | beneficiary will incur a penalty for failing to | ||||||
3 | pre-certify inpatient hospital treatment, the penalty may | ||||||
4 | not exceed $1,000 per occurrence in addition to the plan | ||||||
5 | cost-sharing cost sharing provisions. | ||||||
6 | (c) The network plan shall demonstrate to the Director a | ||||||
7 | minimum ratio of providers to plan beneficiaries as required | ||||||
8 | by the Department. | ||||||
9 | (1) The ratio of physicians or other providers to plan | ||||||
10 | beneficiaries shall be established annually by the | ||||||
11 | Department in consultation with the Department of Public | ||||||
12 | Health based upon the guidance from the federal Centers | ||||||
13 | for Medicare and Medicaid Services. The Department shall | ||||||
14 | not establish ratios for vision or dental providers who | ||||||
15 | provide services under dental-specific or vision-specific | ||||||
16 | benefits. The Department shall consider establishing | ||||||
17 | ratios for the following physicians or other providers: | ||||||
18 | (A) Primary Care; | ||||||
19 | (B) Pediatrics; | ||||||
20 | (C) Cardiology; | ||||||
21 | (D) Gastroenterology; | ||||||
22 | (E) General Surgery; | ||||||
23 | (F) Neurology; | ||||||
24 | (G) OB/GYN; | ||||||
25 | (H) Oncology/Radiation; | ||||||
26 | (I) Ophthalmology; |
| |||||||
| |||||||
1 | (J) Urology; | ||||||
2 | (K) Behavioral Health; | ||||||
3 | (L) Allergy/Immunology; | ||||||
4 | (M) Chiropractic; | ||||||
5 | (N) Dermatology; | ||||||
6 | (O) Endocrinology; | ||||||
7 | (P) Ears, Nose, and Throat (ENT)/Otolaryngology; | ||||||
8 | (Q) Infectious Disease; | ||||||
9 | (R) Nephrology; | ||||||
10 | (S) Neurosurgery; | ||||||
11 | (T) Orthopedic Surgery; | ||||||
12 | (U) Physiatry/Rehabilitative; | ||||||
13 | (V) Plastic Surgery; | ||||||
14 | (W) Pulmonary; | ||||||
15 | (X) Rheumatology; | ||||||
16 | (Y) Anesthesiology; | ||||||
17 | (Z) Pain Medicine; | ||||||
18 | (AA) Pediatric Specialty Services; | ||||||
19 | (BB) Outpatient Dialysis; and | ||||||
20 | (CC) HIV. | ||||||
21 | (2) The Director shall establish a process for the | ||||||
22 | review of the adequacy of these standards, along with an | ||||||
23 | assessment of additional specialties to be included in the | ||||||
24 | list under this subsection (c). | ||||||
25 | (d) The network plan shall demonstrate to the Director | ||||||
26 | maximum travel and distance standards for plan beneficiaries, |
| |||||||
| |||||||
1 | which shall be established annually by the Department in | ||||||
2 | consultation with the Department of Public Health based upon | ||||||
3 | the guidance from the federal Centers for Medicare and | ||||||
4 | Medicaid Services. These standards shall consist of the | ||||||
5 | maximum minutes or miles to be traveled by a plan beneficiary | ||||||
6 | for each county type, such as large counties, metro counties, | ||||||
7 | or rural counties as defined by Department rule. | ||||||
8 | The maximum travel time and distance standards must | ||||||
9 | include standards for each physician and other provider | ||||||
10 | category listed for which ratios have been established. | ||||||
11 | The Director shall establish a process for the review of | ||||||
12 | the adequacy of these standards along with an assessment of | ||||||
13 | additional specialties to be included in the list under this | ||||||
14 | subsection (d). | ||||||
15 | (d-5)(1) Every insurer shall ensure that beneficiaries | ||||||
16 | have timely and proximate access to treatment for mental, | ||||||
17 | emotional, nervous, or substance use disorders or conditions | ||||||
18 | in accordance with the provisions of paragraph (4) of | ||||||
19 | subsection (a) of Section 370c of the Illinois Insurance Code. | ||||||
20 | Insurers shall use a comparable process, strategy, evidentiary | ||||||
21 | standard, and other factors in the development and application | ||||||
22 | of the network adequacy standards for timely and proximate | ||||||
23 | access to treatment for mental, emotional, nervous, or | ||||||
24 | substance use disorders or conditions and those for the access | ||||||
25 | to treatment for medical and surgical conditions. As such, the | ||||||
26 | network adequacy standards for timely and proximate access |
| |||||||
| |||||||
1 | shall equally be applied to treatment facilities and providers | ||||||
2 | for mental, emotional, nervous, or substance use disorders or | ||||||
3 | conditions and specialists providing medical or surgical | ||||||
4 | benefits pursuant to the parity requirements of Section 370c.1 | ||||||
5 | of the Illinois Insurance Code and the federal Paul Wellstone | ||||||
6 | and Pete Domenici Mental Health Parity and Addiction Equity | ||||||
7 | Act of 2008. Notwithstanding the foregoing, the network | ||||||
8 | adequacy standards for timely and proximate access to | ||||||
9 | treatment for mental, emotional, nervous, or substance use | ||||||
10 | disorders or conditions shall, at a minimum, satisfy the | ||||||
11 | following requirements: | ||||||
12 | (A) For beneficiaries residing in the metropolitan | ||||||
13 | counties of Cook, DuPage, Kane, Lake, McHenry, and Will, | ||||||
14 | network adequacy standards for timely and proximate access | ||||||
15 | to treatment for mental, emotional, nervous, or substance | ||||||
16 | use disorders or conditions means a beneficiary shall not | ||||||
17 | have to travel longer than 30 minutes or 30 miles from the | ||||||
18 | beneficiary's residence to receive outpatient treatment | ||||||
19 | for mental, emotional, nervous, or substance use disorders | ||||||
20 | or conditions. Beneficiaries shall not be required to wait | ||||||
21 | longer than 10 business days between requesting an initial | ||||||
22 | appointment and being seen by the facility or provider of | ||||||
23 | mental, emotional, nervous, or substance use disorders or | ||||||
24 | conditions for outpatient treatment or to wait longer than | ||||||
25 | 20 business days between requesting a repeat or follow-up | ||||||
26 | appointment and being seen by the facility or provider of |
| |||||||
| |||||||
1 | mental, emotional, nervous, or substance use disorders or | ||||||
2 | conditions for outpatient treatment; however, subject to | ||||||
3 | the protections of paragraph (3) of this subsection, a | ||||||
4 | network plan shall not be held responsible if the | ||||||
5 | beneficiary or provider voluntarily chooses to schedule an | ||||||
6 | appointment outside of these required time frames. | ||||||
7 | (B) For beneficiaries residing in Illinois counties | ||||||
8 | other than those counties listed in subparagraph (A) of | ||||||
9 | this paragraph, network adequacy standards for timely and | ||||||
10 | proximate access to treatment for mental, emotional, | ||||||
11 | nervous, or substance use disorders or conditions means a | ||||||
12 | beneficiary shall not have to travel longer than 60 | ||||||
13 | minutes or 60 miles from the beneficiary's residence to | ||||||
14 | receive outpatient treatment for mental, emotional, | ||||||
15 | nervous, or substance use disorders or conditions. | ||||||
16 | Beneficiaries shall not be required to wait longer than 10 | ||||||
17 | business days between requesting an initial appointment | ||||||
18 | and being seen by the facility or provider of mental, | ||||||
19 | emotional, nervous, or substance use disorders or | ||||||
20 | conditions for outpatient treatment or to wait longer than | ||||||
21 | 20 business days between requesting a repeat or follow-up | ||||||
22 | appointment and being seen by the facility or provider of | ||||||
23 | mental, emotional, nervous, or substance use disorders or | ||||||
24 | conditions for outpatient treatment; however, subject to | ||||||
25 | the protections of paragraph (3) of this subsection, a | ||||||
26 | network plan shall not be held responsible if the |
| |||||||
| |||||||
1 | beneficiary or provider voluntarily chooses to schedule an | ||||||
2 | appointment outside of these required time frames. | ||||||
3 | (2) For beneficiaries residing in all Illinois counties, | ||||||
4 | network adequacy standards for timely and proximate access to | ||||||
5 | treatment for mental, emotional, nervous, or substance use | ||||||
6 | disorders or conditions means a beneficiary shall not have to | ||||||
7 | travel longer than 60 minutes or 60 miles from the | ||||||
8 | beneficiary's residence to receive inpatient or residential | ||||||
9 | treatment for mental, emotional, nervous, or substance use | ||||||
10 | disorders or conditions. | ||||||
11 | (3) If there is no in-network facility or provider | ||||||
12 | available for a beneficiary to receive timely and proximate | ||||||
13 | access to treatment for mental, emotional, nervous, or | ||||||
14 | substance use disorders or conditions in accordance with the | ||||||
15 | network adequacy standards outlined in this subsection, the | ||||||
16 | insurer shall provide necessary exceptions to its network to | ||||||
17 | ensure admission and treatment with a provider or at a | ||||||
18 | treatment facility in accordance with the network adequacy | ||||||
19 | standards in this subsection. | ||||||
20 | (e) Except for network plans solely offered as a group | ||||||
21 | health plan, these ratio and time and distance standards apply | ||||||
22 | to the lowest cost-sharing tier of any tiered network. | ||||||
23 | (f) The network plan may consider use of other health care | ||||||
24 | service delivery options, such as telemedicine or telehealth, | ||||||
25 | mobile clinics, and centers of excellence, or other ways of | ||||||
26 | delivering care to partially meet the requirements set under |
| |||||||
| |||||||
1 | this Section. | ||||||
2 | (g) Except for the requirements set forth in subsection | ||||||
3 | (d-5), insurers who are not able to comply with the provider | ||||||
4 | ratios and time and distance standards established by the | ||||||
5 | Department may request an exception to these requirements from | ||||||
6 | the Department. The Department may grant an exception in the | ||||||
7 | following circumstances: | ||||||
8 | (1) if no providers or facilities meet the specific | ||||||
9 | time and distance standard in a specific service area and | ||||||
10 | the insurer (i) discloses information on the distance and | ||||||
11 | travel time points that beneficiaries would have to travel | ||||||
12 | beyond the required criterion to reach the next closest | ||||||
13 | contracted provider outside of the service area and (ii) | ||||||
14 | provides contact information, including names, addresses, | ||||||
15 | and phone numbers for the next closest contracted provider | ||||||
16 | or facility; | ||||||
17 | (2) if patterns of care in the service area do not | ||||||
18 | support the need for the requested number of provider or | ||||||
19 | facility type and the insurer provides data on local | ||||||
20 | patterns of care, such as claims data, referral patterns, | ||||||
21 | or local provider interviews, indicating where the | ||||||
22 | beneficiaries currently seek this type of care or where | ||||||
23 | the physicians currently refer beneficiaries, or both; or | ||||||
24 | (3) other circumstances deemed appropriate by the | ||||||
25 | Department consistent with the requirements of this Act. | ||||||
26 | (h) Insurers are required to report to the Director any |
| |||||||
| |||||||
1 | material change to an approved network plan within 15 days | ||||||
2 | after the change occurs and any change that would result in | ||||||
3 | failure to meet the requirements of this Act. Upon notice from | ||||||
4 | the insurer, the Director shall reevaluate the network plan's | ||||||
5 | compliance with the network adequacy and transparency | ||||||
6 | standards of this Act. | ||||||
7 | (Source: P.A. 102-144, eff. 1-1-22; 102-901, eff. 7-1-22; | ||||||
8 | 102-1117, eff. 1-13-23.)
| ||||||
9 | Section 35. The Health Maintenance Organization Act is | ||||||
10 | amended by changing Sections 4.5-1, 5-3, and 5-3.1 as follows:
| ||||||
11 | (215 ILCS 125/4.5-1) | ||||||
12 | Sec. 4.5-1. Point-of-service health service contracts. | ||||||
13 | (a) A health maintenance organization that offers a | ||||||
14 | point-of-service contract: | ||||||
15 | (1) must include as in-plan covered services all | ||||||
16 | services required by law to be provided by a health | ||||||
17 | maintenance organization; | ||||||
18 | (2) must provide incentives, which shall include | ||||||
19 | financial incentives, for enrollees to use in-plan covered | ||||||
20 | services; | ||||||
21 | (3) may not offer services out-of-plan without | ||||||
22 | providing those services on an in-plan basis; | ||||||
23 | (4) may include annual out-of-pocket limits and | ||||||
24 | lifetime maximum benefits allowances for out-of-plan |
| |||||||
| |||||||
1 | services that are separate from any limits or allowances | ||||||
2 | applied to in-plan services; | ||||||
3 | (5) may not consider emergency services, authorized | ||||||
4 | referral services, or non-routine services obtained out of | ||||||
5 | the service area to be point-of-service services; | ||||||
6 | (6) may treat as out-of-plan services those services | ||||||
7 | that an enrollee obtains from a participating provider, | ||||||
8 | but for which the proper authorization was not given by | ||||||
9 | the health maintenance organization; and | ||||||
10 | (7) after January 1, 2003 (the effective date of | ||||||
11 | Public Act 92-579), must include the following disclosure | ||||||
12 | on its point-of-service contracts and evidences of | ||||||
13 | coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN | ||||||
14 | NON-PARTICIPATING PROVIDERS ARE USED. YOU CAN EXPECT TO | ||||||
15 | PAY MORE THAN THE COST-SHARING AMOUNT DEFINED IN THE | ||||||
16 | POLICY IN NON-EMERGENCY SITUATIONS. Except in limited | ||||||
17 | situations governed by the federal No Surprises Act or | ||||||
18 | Section 356z.3a of the Illinois Insurance Code (215 ILCS | ||||||
19 | 5/356z.3a), non-participating providers furnishing | ||||||
20 | non-emergency services may bill members for any amount up | ||||||
21 | to the billed charge after the plan has paid its portion of | ||||||
22 | the bill. If you elect to use a non-participating | ||||||
23 | provider, plan benefit payments will be determined | ||||||
24 | according to your policy's fee schedule, usual and | ||||||
25 | customary charge (which is determined by comparing charges | ||||||
26 | for similar services adjusted to the geographical area |
| |||||||
| |||||||
1 | where the services are performed), or other method as | ||||||
2 | defined by the policy. Participating providers have agreed | ||||||
3 | to ONLY bill members the cost-sharing amounts. You should | ||||||
4 | be aware that when you elect to utilize the services of a | ||||||
5 | non-participating provider for a covered service in | ||||||
6 | non-emergency situations, benefit payments to such | ||||||
7 | non-participating provider are not based upon the amount | ||||||
8 | billed. The basis of your benefit payment will be | ||||||
9 | determined according to your policy's fee schedule, usual | ||||||
10 | and customary charge (which is determined by comparing | ||||||
11 | charges for similar services adjusted to the geographical | ||||||
12 | area where the services are performed), or other method as | ||||||
13 | defined by the policy. YOU CAN EXPECT TO PAY MORE THAN THE | ||||||
14 | COINSURANCE AMOUNT DEFINED IN THE POLICY AFTER THE PLAN | ||||||
15 | HAS PAID ITS REQUIRED PORTION. Non-participating providers | ||||||
16 | may bill members for any amount up to the billed charge | ||||||
17 | after the plan has paid its portion of the bill, except as | ||||||
18 | provided in Section 356z.3a of the Illinois Insurance Code | ||||||
19 | for covered services received at a participating health | ||||||
20 | care facility from a non-participating provider that are: | ||||||
21 | (a) ancillary services, (b) items or services furnished as | ||||||
22 | a result of unforeseen, urgent medical needs that arise at | ||||||
23 | the time the item or service is furnished, or (c) items or | ||||||
24 | services received when the facility or the | ||||||
25 | non-participating provider fails to satisfy the notice and | ||||||
26 | consent criteria specified under Section 356z.3a. |
| |||||||
| |||||||
1 | Participating providers have agreed to accept discounted | ||||||
2 | payments for services with no additional billing to the | ||||||
3 | member other than co-insurance and deductible amounts. You | ||||||
4 | may obtain further information about the participating | ||||||
5 | status of professional providers and information on | ||||||
6 | out-of-pocket expenses by calling the toll-free toll free | ||||||
7 | telephone number on your identification card.". | ||||||
8 | (b) A health maintenance organization offering a | ||||||
9 | point-of-service contract is subject to all of the following | ||||||
10 | limitations: | ||||||
11 | (1) The health maintenance organization may not expend | ||||||
12 | in any calendar quarter more than 20% of its total | ||||||
13 | expenditures for all its members for out-of-plan covered | ||||||
14 | services. | ||||||
15 | (2) If the amount specified in item (1) of this | ||||||
16 | subsection is exceeded by 2% in a quarter, the health | ||||||
17 | maintenance organization must effect compliance with item | ||||||
18 | (1) of this subsection by the end of the following | ||||||
19 | quarter. | ||||||
20 | (3) If compliance with the amount specified in item | ||||||
21 | (1) of this subsection is not demonstrated in the health | ||||||
22 | maintenance organization's next quarterly report, the | ||||||
23 | health maintenance organization may not offer the | ||||||
24 | point-of-service contract to new groups or include the | ||||||
25 | point-of-service option in the renewal of an existing | ||||||
26 | group until compliance with the amount specified in item |
| |||||||
| |||||||
1 | (1) of this subsection is demonstrated or until otherwise | ||||||
2 | allowed by the Director. | ||||||
3 | (4) A health maintenance organization failing, without | ||||||
4 | just cause, to comply with the provisions of this | ||||||
5 | subsection shall be required, after notice and hearing, to | ||||||
6 | pay a penalty of $250 for each day out of compliance, to be | ||||||
7 | recovered by the Director. Any penalty recovered shall be | ||||||
8 | paid into the General Revenue Fund. The Director may | ||||||
9 | reduce the penalty if the health maintenance organization | ||||||
10 | demonstrates to the Director that the imposition of the | ||||||
11 | penalty would constitute a financial hardship to the | ||||||
12 | health maintenance organization. | ||||||
13 | (c) A health maintenance organization that offers a | ||||||
14 | point-of-service product must do all of the following: | ||||||
15 | (1) File a quarterly financial statement detailing | ||||||
16 | compliance with the requirements of subsection (b). | ||||||
17 | (2) Track out-of-plan, point-of-service utilization | ||||||
18 | separately from in-plan or non-point-of-service, | ||||||
19 | out-of-plan emergency care, referral care, and urgent care | ||||||
20 | out of the service area utilization. | ||||||
21 | (3) Record out-of-plan utilization in a manner that | ||||||
22 | will permit such utilization and cost reporting as the | ||||||
23 | Director may, by rule, require. | ||||||
24 | (4) Demonstrate to the Director's satisfaction that | ||||||
25 | the health maintenance organization has the fiscal, | ||||||
26 | administrative, and marketing capacity to control its |
| |||||||
| |||||||
1 | point-of-service enrollment, utilization, and costs so as | ||||||
2 | not to jeopardize the financial security of the health | ||||||
3 | maintenance organization. | ||||||
4 | (5) Maintain, in addition to any other deposit | ||||||
5 | required under this Act, the deposit required by Section | ||||||
6 | 2-6. | ||||||
7 | (6) Maintain cash and cash equivalents of sufficient | ||||||
8 | amount to fully liquidate 10 days' average claim payments, | ||||||
9 | subject to review by the Director. | ||||||
10 | (7) Maintain and file with the Director, reinsurance | ||||||
11 | coverage protecting against catastrophic losses on | ||||||
12 | out-of-network point-of-service services. Deductibles may | ||||||
13 | not exceed $100,000 per covered life per year, and the | ||||||
14 | portion of risk retained by the health maintenance | ||||||
15 | organization once deductibles have been satisfied may not | ||||||
16 | exceed 20%. Reinsurance must be placed with licensed | ||||||
17 | authorized reinsurers qualified to do business in this | ||||||
18 | State. | ||||||
19 | (d) A health maintenance organization may not issue a | ||||||
20 | point-of-service contract until it has filed and had approved | ||||||
21 | by the Director a plan to comply with the provisions of this | ||||||
22 | Section. The compliance plan must, at a minimum, include | ||||||
23 | provisions demonstrating that the health maintenance | ||||||
24 | organization will do all of the following: | ||||||
25 | (1) Design the benefit levels and conditions of | ||||||
26 | coverage for in-plan covered services and out-of-plan |
| |||||||
| |||||||
1 | covered services as required by this Article. | ||||||
2 | (2) Provide or arrange for the provision of adequate | ||||||
3 | systems to: | ||||||
4 | (A) process and pay claims for all out-of-plan | ||||||
5 | covered services; | ||||||
6 | (B) meet the requirements for point-of-service | ||||||
7 | contracts set forth in this Section and any additional | ||||||
8 | requirements that may be set forth by the Director; | ||||||
9 | and | ||||||
10 | (C) generate accurate data and financial and | ||||||
11 | regulatory reports on a timely basis so that the | ||||||
12 | Department of Insurance can evaluate the health | ||||||
13 | maintenance organization's experience with the | ||||||
14 | point-of-service contract and monitor compliance with | ||||||
15 | point-of-service contract provisions. | ||||||
16 | (3) Comply with the requirements of subsections (b) | ||||||
17 | and (c). | ||||||
18 | (Source: P.A. 102-901, eff. 1-1-23; 103-154, eff. 6-30-23.)
| ||||||
19 | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) | ||||||
20 | Sec. 5-3. Insurance Code provisions. | ||||||
21 | (a) Health Maintenance Organizations shall be subject to | ||||||
22 | the provisions of Sections 133, 134, 136, 137, 139, 140, | ||||||
23 | 141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, | ||||||
24 | 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49, | ||||||
25 | 355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v, |
| |||||||
| |||||||
1 | 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, | ||||||
2 | 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, | ||||||
3 | 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, | ||||||
4 | 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, | ||||||
5 | 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35, | ||||||
6 | 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44, | ||||||
7 | 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, | ||||||
8 | 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, | ||||||
9 | 356z.60, 356z.61, 356z.62, 356z.63, 356z.64, 356z.65, 356z.66, | ||||||
10 | 356z.67, 356z.68, 356z.69, 356z.70, 364, 364.01, 364.3, 367.2, | ||||||
11 | 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, | ||||||
12 | 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and | ||||||
13 | 444.1, paragraph (c) of subsection (2) of Section 367, and | ||||||
14 | Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, | ||||||
15 | XXVI, and XXXIIB of the Illinois Insurance Code. | ||||||
16 | (b) For purposes of the Illinois Insurance Code, except | ||||||
17 | for Sections 444 and 444.1 and Articles XIII and XIII 1/2, | ||||||
18 | Health Maintenance Organizations in the following categories | ||||||
19 | are deemed to be "domestic companies": | ||||||
20 | (1) a corporation authorized under the Dental Service | ||||||
21 | Plan Act or the Voluntary Health Services Plans Act; | ||||||
22 | (2) a corporation organized under the laws of this | ||||||
23 | State; or | ||||||
24 | (3) a corporation organized under the laws of another | ||||||
25 | state, 30% or more of the enrollees of which are residents | ||||||
26 | of this State, except a corporation subject to |
| |||||||
| |||||||
1 | substantially the same requirements in its state of | ||||||
2 | organization as is a "domestic company" under Article VIII | ||||||
3 | 1/2 of the Illinois Insurance Code. | ||||||
4 | (c) In considering the merger, consolidation, or other | ||||||
5 | acquisition of control of a Health Maintenance Organization | ||||||
6 | pursuant to Article VIII 1/2 of the Illinois Insurance Code, | ||||||
7 | (1) the Director shall give primary consideration to | ||||||
8 | the continuation of benefits to enrollees and the | ||||||
9 | financial conditions of the acquired Health Maintenance | ||||||
10 | Organization after the merger, consolidation, or other | ||||||
11 | acquisition of control takes effect; | ||||||
12 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
13 | Section 131.8 of the Illinois Insurance Code shall not | ||||||
14 | apply and (ii) the Director, in making his determination | ||||||
15 | with respect to the merger, consolidation, or other | ||||||
16 | acquisition of control, need not take into account the | ||||||
17 | effect on competition of the merger, consolidation, or | ||||||
18 | other acquisition of control; | ||||||
19 | (3) the Director shall have the power to require the | ||||||
20 | following information: | ||||||
21 | (A) certification by an independent actuary of the | ||||||
22 | adequacy of the reserves of the Health Maintenance | ||||||
23 | Organization sought to be acquired; | ||||||
24 | (B) pro forma financial statements reflecting the | ||||||
25 | combined balance sheets of the acquiring company and | ||||||
26 | the Health Maintenance Organization sought to be |
| |||||||
| |||||||
1 | acquired as of the end of the preceding year and as of | ||||||
2 | a date 90 days prior to the acquisition, as well as pro | ||||||
3 | forma financial statements reflecting projected | ||||||
4 | combined operation for a period of 2 years; | ||||||
5 | (C) a pro forma business plan detailing an | ||||||
6 | acquiring party's plans with respect to the operation | ||||||
7 | of the Health Maintenance Organization sought to be | ||||||
8 | acquired for a period of not less than 3 years; and | ||||||
9 | (D) such other information as the Director shall | ||||||
10 | require. | ||||||
11 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
12 | Insurance Code and this Section 5-3 shall apply to the sale by | ||||||
13 | any health maintenance organization of greater than 10% of its | ||||||
14 | enrollee population (including , without limitation , the health | ||||||
15 | maintenance organization's right, title, and interest in and | ||||||
16 | to its health care certificates). | ||||||
17 | (e) In considering any management contract or service | ||||||
18 | agreement subject to Section 141.1 of the Illinois Insurance | ||||||
19 | Code, the Director (i) shall, in addition to the criteria | ||||||
20 | specified in Section 141.2 of the Illinois Insurance Code, | ||||||
21 | take into account the effect of the management contract or | ||||||
22 | service agreement on the continuation of benefits to enrollees | ||||||
23 | and the financial condition of the health maintenance | ||||||
24 | organization to be managed or serviced, and (ii) need not take | ||||||
25 | into account the effect of the management contract or service | ||||||
26 | agreement on competition. |
| |||||||
| |||||||
1 | (f) Except for small employer groups as defined in the | ||||||
2 | Small Employer Rating, Renewability and Portability Health | ||||||
3 | Insurance Act and except for medicare supplement policies as | ||||||
4 | defined in Section 363 of the Illinois Insurance Code, a | ||||||
5 | Health Maintenance Organization may by contract agree with a | ||||||
6 | group or other enrollment unit to effect refunds or charge | ||||||
7 | additional premiums under the following terms and conditions: | ||||||
8 | (i) the amount of, and other terms and conditions with | ||||||
9 | respect to, the refund or additional premium are set forth | ||||||
10 | in the group or enrollment unit contract agreed in advance | ||||||
11 | of the period for which a refund is to be paid or | ||||||
12 | additional premium is to be charged (which period shall | ||||||
13 | not be less than one year); and | ||||||
14 | (ii) the amount of the refund or additional premium | ||||||
15 | shall not exceed 20% of the Health Maintenance | ||||||
16 | Organization's profitable or unprofitable experience with | ||||||
17 | respect to the group or other enrollment unit for the | ||||||
18 | period (and, for purposes of a refund or additional | ||||||
19 | premium, the profitable or unprofitable experience shall | ||||||
20 | be calculated taking into account a pro rata share of the | ||||||
21 | Health Maintenance Organization's administrative and | ||||||
22 | marketing expenses, but shall not include any refund to be | ||||||
23 | made or additional premium to be paid pursuant to this | ||||||
24 | subsection (f)). The Health Maintenance Organization and | ||||||
25 | the group or enrollment unit may agree that the profitable | ||||||
26 | or unprofitable experience may be calculated taking into |
| |||||||
| |||||||
1 | account the refund period and the immediately preceding 2 | ||||||
2 | plan years. | ||||||
3 | The Health Maintenance Organization shall include a | ||||||
4 | statement in the evidence of coverage issued to each enrollee | ||||||
5 | describing the possibility of a refund or additional premium, | ||||||
6 | and upon request of any group or enrollment unit, provide to | ||||||
7 | the group or enrollment unit a description of the method used | ||||||
8 | to calculate (1) the Health Maintenance Organization's | ||||||
9 | profitable experience with respect to the group or enrollment | ||||||
10 | unit and the resulting refund to the group or enrollment unit | ||||||
11 | or (2) the Health Maintenance Organization's unprofitable | ||||||
12 | experience with respect to the group or enrollment unit and | ||||||
13 | the resulting additional premium to be paid by the group or | ||||||
14 | enrollment unit. | ||||||
15 | In no event shall the Illinois Health Maintenance | ||||||
16 | Organization Guaranty Association be liable to pay any | ||||||
17 | contractual obligation of an insolvent organization to pay any | ||||||
18 | refund authorized under this Section. | ||||||
19 | (g) Rulemaking authority to implement Public Act 95-1045, | ||||||
20 | if any, is conditioned on the rules being adopted in | ||||||
21 | accordance with all provisions of the Illinois Administrative | ||||||
22 | Procedure Act and all rules and procedures of the Joint | ||||||
23 | Committee on Administrative Rules; any purported rule not so | ||||||
24 | adopted, for whatever reason, is unauthorized. | ||||||
25 | (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; | ||||||
26 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. |
| |||||||
| |||||||
1 | 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, | ||||||
2 | eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; | ||||||
3 | 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. | ||||||
4 | 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, | ||||||
5 | eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; | ||||||
6 | 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff. | ||||||
7 | 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, | ||||||
8 | eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
| ||||||
9 | (215 ILCS 125/5-3.1) | ||||||
10 | Sec. 5-3.1. Access to obstetrical and gynecological care | ||||||
11 | Woman's health care provider . Health maintenance organizations | ||||||
12 | are subject to the provisions of Section 356r of the Illinois | ||||||
13 | Insurance Code. | ||||||
14 | (Source: P.A. 89-514, eff. 7-17-96.)
| ||||||
15 | Section 40. The Limited Health Service Organization Act is | ||||||
16 | amended by changing Section 4002.1 as follows:
| ||||||
17 | (215 ILCS 130/4002.1) | ||||||
18 | Sec. 4002.1. Access to obstetrical and gynecological care | ||||||
19 | Woman's health care provider . Limited health service | ||||||
20 | organizations are subject to the provisions of Section 356r of | ||||||
21 | the Illinois Insurance Code. | ||||||
22 | (Source: P.A. 89-514, eff. 7-17-96.)
|
| |||||||
| |||||||
1 | Section 45. The Illinois Public Aid Code is amended by | ||||||
2 | changing Section 5-16.9 as follows:
| ||||||
3 | (305 ILCS 5/5-16.9) | ||||||
4 | Sec. 5-16.9. Access to obstetrical and gynecological care | ||||||
5 | Woman's health care provider . The medical assistance program | ||||||
6 | is subject to the provisions of Section 356r of the Illinois | ||||||
7 | Insurance Code. The Illinois Department shall adopt rules to | ||||||
8 | implement the requirements of Section 356r of the Illinois | ||||||
9 | Insurance Code in the medical assistance program including | ||||||
10 | managed care components. | ||||||
11 | On and after July 1, 2012, the Department shall reduce any | ||||||
12 | rate of reimbursement for services or other payments or alter | ||||||
13 | any methodologies authorized by this Code to reduce any rate | ||||||
14 | of reimbursement for services or other payments in accordance | ||||||
15 | with Section 5-5e. | ||||||
16 | (Source: P.A. 97-689, eff. 6-14-12.)
| ||||||
17 | Section 95. No acceleration or delay. Where this Act makes | ||||||
18 | changes in a statute that is represented in this Act by text | ||||||
19 | that is not yet or no longer in effect (for example, a Section | ||||||
20 | represented by multiple versions), the use of that text does | ||||||
21 | not accelerate or delay the taking effect of (i) the changes | ||||||
22 | made by this Act or (ii) provisions derived from any other | ||||||
23 | Public Act.
|
| |||||||
| |||||||