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1 | AN ACT concerning insurance.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Insurance Code is amended by | |||||||||||||||||||
5 | changing Section 352 as follows:
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6 | (215 ILCS 5/352) (from Ch. 73, par. 964)
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7 | Sec. 352. Scope of Article.
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8 | (a) Except as provided in subsections (b), (c), (d), and | |||||||||||||||||||
9 | (e),
this
this Article shall
apply to all companies transacting | |||||||||||||||||||
10 | in this State the kinds of business
enumerated in clause (b) of | |||||||||||||||||||
11 | Class 1 and clause (a) of Class 2 of section 4.
Nothing in this | |||||||||||||||||||
12 | Article shall apply to, or in any way affect policies or
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13 | contracts described in clause (a) of Class 1 of Section 4; | |||||||||||||||||||
14 | however, this
Article shall apply to policies and contracts | |||||||||||||||||||
15 | which contain benefits
providing reimbursement for the | |||||||||||||||||||
16 | expenses of long term health care which are
certified or | |||||||||||||||||||
17 | ordered by a physician including but not limited to
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18 | professional nursing care, custodial nursing care, and | |||||||||||||||||||
19 | non-nursing
custodial care provided in a nursing home or at a | |||||||||||||||||||
20 | residence of the insured.
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21 | (b) This Article does not apply to policies of accident and | |||||||||||||||||||
22 | health
insurance issued in compliance with Article XIXB of this | |||||||||||||||||||
23 | Code.
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1 | (c) A policy issued and delivered in this State
that | ||||||
2 | provides coverage under that policy for
certificate holders who | ||||||
3 | are neither residents of nor employed in this State
does not | ||||||
4 | need to provide to those nonresident
certificate holders who | ||||||
5 | are not employed in this State the coverages or
services | ||||||
6 | mandated by this Article.
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7 | (d) Stop-loss insurance is exempt from all Sections
of this | ||||||
8 | Article, except this Section and Sections 353a, 354, 357.30, | ||||||
9 | and
370. For purposes of this exemption, stop-loss insurance is | ||||||
10 | further defined as
follows:
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11 | (1) The policy must be issued to and insure an | ||||||
12 | employer, trustee, or other
sponsor of the plan, or the | ||||||
13 | plan itself, but not employees, members, or
participants.
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14 | (2) Payments by the insurer must be made to the | ||||||
15 | employer, trustee, or
other sponsors of the plan, or the | ||||||
16 | plan itself, but not to the employees,
members, | ||||||
17 | participants, or health care providers.
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18 | (e) A policy issued or delivered in this State to the | ||||||
19 | Department of Healthcare and Family Services (formerly
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20 | Illinois Department
of Public Aid ) and providing coverage, | ||||||
21 | under clause (b) of Class 1 or clause (a)
of Class 2 as | ||||||
22 | described in Section 4, to persons who are enrolled under | ||||||
23 | Article V of the Illinois
Public Aid Code or under the | ||||||
24 | Children's Health Insurance Program Act is
exempt from all | ||||||
25 | restrictions, limitations,
standards, rules, or regulations | ||||||
26 | respecting benefits imposed by or under
authority of this Code, |
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1 | except those specified by subsection (1) of Section
143. | ||||||
2 | Nothing in this subsection, however, affects the total medical | ||||||
3 | services
available to persons eligible for medical assistance | ||||||
4 | under the Illinois Public
Aid Code.
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5 | (Source: P.A. 92-370, eff. 8-15-01; revised 12-15-05.)
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