(215 ILCS 123/30)
Sec. 30.
Insurance policy requirements.
(a) No health insurance contract may be issued or delivered
pursuant to this Act unless a copy of the form of the contract has been
filed with the Director and approved in accordance with Section
355 of the Illinois Insurance Code. It must also
contain, in substance, those provisions contained in Sections
357.1 through 357.30 of the Illinois Insurance Code
as may be applicable and contain all other
provisions applicable to group accident and health insurance policies
as provided in Article XX of the Illinois Insurance Code, except as provided in
Section 50 of this Act. This subsection (a) does not apply to health
maintenance organizations.
(b) No health maintenance organization contract may be
issued or delivered under this Act unless a copy of the form
of the contract has been filed with the Director and approved in
accordance with Section 4-13 of the Health Maintenance
Organization Act. It must also provide or
arrange for and pay for or reimburse the cost of basic health
care services as defined in Section 1-2 of the Health Maintenance Organization
Act and provide the benefits specified in the Health Maintenance Organization
Act for group contracts.
(c) In the event that the enrollee has moved outside of the
service area of the health maintenance organization, the HMO
must make available conversion coverage through a contract with
a licensed insurance carrier. The conversion coverage must be similar to
that which is provided through the HMO. Coverage shall be
considered "similar" if it provides
a comprehensive medical benefit plan for at least 18 months and is provided
without
imposing any preexisting condition limitation or exclusion,
other than those remaining unexpired under the contract from
which conversion is exercised.
(d) Nothing in this Act shall preclude a risk-bearer and an
HPG or employer from entering into a contract that contains
provisions whereby each party agrees to continue the contract in
force for a prescribed period of time.
(e) Nothing in this Act shall preclude a risk-bearer from
offering health insurance contracts that contain benefits in
addition to those required in subsection (a).
(f) No HPG may purchase insurance providing for a
deductible or an aggregate limit unless the deductible or
aggregate limit applies separately to each individual insured person
of the purchasing group.
(Source: P.A. 90-337, eff. 1-1-98.)
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