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Public Act 103-0718 | ||||
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AN ACT concerning regulation. | ||||
Be it enacted by the People of the State of Illinois, | ||||
represented in the General Assembly: | ||||
Section 5. The State Employees Group Insurance Act of 1971 | ||||
is amended by changing Sections 6.7 and 6.11 as follows: | ||||
(5 ILCS 375/6.7) | ||||
Sec. 6.7. Access to obstetrical and gynecological care | ||||
Woman's health care provider . The program of health benefits | ||||
is subject to the provisions of Section 356r of the Illinois | ||||
Insurance Code. | ||||
(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.) | ||||
(5 ILCS 375/6.11) | ||||
Sec. 6.11. Required health benefits; Illinois Insurance | ||||
Code requirements. The program of health benefits shall | ||||
provide the post-mastectomy care benefits required to be | ||||
covered by a policy of accident and health insurance under | ||||
Section 356t of the Illinois Insurance Code. The program of | ||||
health benefits shall provide the coverage required under | ||||
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, | ||||
356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | ||||
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, | ||||
356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, |
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, | ||
356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, | ||
356z.60, and 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, | ||
and 356z.70 of the Illinois Insurance Code. The program of | ||
health benefits must comply with Sections 155.22a, 155.37, | ||
355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the | ||
Illinois Insurance Code. The program of health benefits shall | ||
provide the coverage required under Section 356m of the | ||
Illinois Insurance Code and, for the employees of the State | ||
Employee Group Insurance Program only, the coverage as also | ||
provided in Section 6.11B of this Act. The Department of | ||
Insurance shall enforce the requirements of this Section with | ||
respect to Sections 370c and 370c.1 of the Illinois Insurance | ||
Code; all other requirements of this Section shall be enforced | ||
by the Department of Central Management Services. | ||
Rulemaking authority to implement Public Act 95-1045, if | ||
any, is conditioned on the rules being adopted in accordance | ||
with all provisions of the Illinois Administrative Procedure | ||
Act and all rules and procedures of the Joint Committee on | ||
Administrative Rules; any purported rule not so adopted, for | ||
whatever reason, is unauthorized. | ||
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. | ||
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768, | ||
eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | ||
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. |
1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84, | ||
eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24; | ||
103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff. | ||
8-11-23; revised 8-29-23.) | ||
Section 10. The Counties Code is amended by changing | ||
Sections 5-1069.3 and 5-1069.5 as follows: | ||
(55 ILCS 5/5-1069.3) | ||
Sec. 5-1069.3. Required health benefits. If a county, | ||
including a home rule county, is a self-insurer for purposes | ||
of providing health insurance coverage for its employees, the | ||
coverage shall include coverage for the post-mastectomy care | ||
benefits required to be covered by a policy of accident and | ||
health insurance under Section 356t and the coverage required | ||
under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x, | ||
356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, | ||
356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, | ||
356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 356z.36, | ||
356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, | ||
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and | ||
356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, and 356z.70 | ||
of the Illinois Insurance Code. The coverage shall comply with | ||
Sections 155.22a, 355b, 356z.19, and 370c of the Illinois | ||
Insurance Code. The Department of Insurance shall enforce the | ||
requirements of this Section. The requirement that health |
benefits be covered as provided in this Section is an | ||
exclusive power and function of the State and is a denial and | ||
limitation under Article VII, Section 6, subsection (h) of the | ||
Illinois Constitution. A home rule county to which this | ||
Section applies must comply with every provision of this | ||
Section. | ||
Rulemaking authority to implement Public Act 95-1045, if | ||
any, is conditioned on the rules being adopted in accordance | ||
with all provisions of the Illinois Administrative Procedure | ||
Act and all rules and procedures of the Joint Committee on | ||
Administrative Rules; any purported rule not so adopted, for | ||
whatever reason, is unauthorized. | ||
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||
1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, | ||
eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | ||
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | ||
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | ||
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | ||
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised | ||
8-29-23.) | ||
(55 ILCS 5/5-1069.5) | ||
Sec. 5-1069.5. Access to obstetrical and gynecological | ||
care Woman's health care provider . All counties, including | ||
home rule counties, are subject to the provisions of Section |
356r of the Illinois Insurance Code. The requirement under | ||
this Section that health care benefits provided by counties | ||
comply with Section 356r of the Illinois Insurance Code is an | ||
exclusive power and function of the State and is a denial and | ||
limitation of home rule county powers under Article VII, | ||
Section 6, subsection (h) of the Illinois Constitution. | ||
(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.) | ||
Section 15. The Illinois Municipal Code is amended by | ||
changing Sections 10-4-2.3 and 10-4-2.5 as follows: | ||
(65 ILCS 5/10-4-2.3) | ||
Sec. 10-4-2.3. Required health benefits. If a | ||
municipality, including a home rule municipality, is a | ||
self-insurer for purposes of providing health insurance | ||
coverage for its employees, the coverage shall include | ||
coverage for the post-mastectomy care benefits required to be | ||
covered by a policy of accident and health insurance under | ||
Section 356t and the coverage required under Sections 356g, | ||
356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, | ||
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||
356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, | ||
356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, | ||
356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, | ||
356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62 , | ||
356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois |
Insurance Code. The coverage shall comply with Sections | ||
155.22a, 355b, 356z.19, and 370c of the Illinois Insurance | ||
Code. The Department of Insurance shall enforce the | ||
requirements of this Section. The requirement that health | ||
benefits be covered as provided in this is an exclusive power | ||
and function of the State and is a denial and limitation under | ||
Article VII, Section 6, subsection (h) of the Illinois | ||
Constitution. A home rule municipality to which this Section | ||
applies must comply with every provision of this Section. | ||
Rulemaking authority to implement Public Act 95-1045, if | ||
any, is conditioned on the rules being adopted in accordance | ||
with all provisions of the Illinois Administrative Procedure | ||
Act and all rules and procedures of the Joint Committee on | ||
Administrative Rules; any purported rule not so adopted, for | ||
whatever reason, is unauthorized. | ||
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||
1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, | ||
eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | ||
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | ||
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | ||
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | ||
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised | ||
8-29-23.) | ||
(65 ILCS 5/10-4-2.5) |
Sec. 10-4-2.5. Access to obstetrical and gynecological | ||
care Woman's health care provider . The corporate authorities | ||
of all municipalities are subject to the provisions of Section | ||
356r of the Illinois Insurance Code. The requirement under | ||
this Section that health care benefits provided by | ||
municipalities comply with Section 356r of the Illinois | ||
Insurance Code is an exclusive power and function of the State | ||
and is a denial and limitation of home rule municipality | ||
powers under Article VII, Section 6, subsection (h) of the | ||
Illinois Constitution. | ||
(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.) | ||
Section 20. The School Code is amended by changing | ||
Sections 10-22.3d and 10-22.3f as follows: | ||
(105 ILCS 5/10-22.3d) | ||
Sec. 10-22.3d. Access to obstetrical and gynecological | ||
care Woman's health care provider . Insurance protection and | ||
benefits for employees are subject to the provisions of | ||
Section 356r of the Illinois Insurance Code. | ||
(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.) | ||
(105 ILCS 5/10-22.3f) | ||
Sec. 10-22.3f. Required health benefits. Insurance | ||
protection and benefits for employees shall provide the | ||
post-mastectomy care benefits required to be covered by a |
policy of accident and health insurance under Section 356t and | ||
the coverage required under Sections 356g, 356g.5, 356g.5-1, | ||
356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, | ||
356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, | ||
356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, | ||
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, | ||
356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, | ||
and 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, and | ||
356z.70 of the Illinois Insurance Code. Insurance policies | ||
shall comply with Section 356z.19 of the Illinois Insurance | ||
Code. The coverage shall comply with Sections 155.22a, 355b, | ||
and 370c of the Illinois Insurance Code. The Department of | ||
Insurance shall enforce the requirements of this Section. | ||
Rulemaking authority to implement Public Act 95-1045, if | ||
any, is conditioned on the rules being adopted in accordance | ||
with all provisions of the Illinois Administrative Procedure | ||
Act and all rules and procedures of the Joint Committee on | ||
Administrative Rules; any purported rule not so adopted, for | ||
whatever reason, is unauthorized. | ||
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. | ||
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, | ||
eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; | ||
102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. | ||
1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, | ||
eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; |
103-551, eff. 8-11-23; revised 8-29-23.) | ||
Section 25. The Illinois Insurance Code is amended by | ||
changing Sections 4, 352, 352b, 356a, 356b, 356d, 356e, 356f, | ||
356K, 356L, 356r, 356s, 356z.3, 356z.33, 367a, 370e, 370i, | ||
408, 412, and 531.03 as follows: | ||
(215 ILCS 5/4) (from Ch. 73, par. 616) | ||
Sec. 4. Classes of insurance. Insurance and insurance | ||
business shall be classified as follows: | ||
Class 1. Life, Accident and Health. | ||
(a) Life. Insurance on the lives of persons and every | ||
insurance appertaining thereto or connected therewith and | ||
granting, purchasing or disposing of annuities. Policies of | ||
life or endowment insurance or annuity contracts or contracts | ||
supplemental thereto which contain provisions for additional | ||
benefits in case of death by accidental means and provisions | ||
operating to safeguard such policies or contracts against | ||
lapse, to give a special surrender value, or special benefit, | ||
or an annuity, in the event, that the insured or annuitant | ||
shall become a person with a total and permanent disability as | ||
defined by the policy or contract, or which contain benefits | ||
providing acceleration of life or endowment or annuity | ||
benefits in advance of the time they would otherwise be | ||
payable, as an indemnity for long term care which is certified | ||
or ordered by a physician, including but not limited to, |
professional nursing care, medical care expenses, custodial | ||
nursing care, non-nursing custodial care provided in a nursing | ||
home or at a residence of the insured, or which contain | ||
benefits providing acceleration of life or endowment or | ||
annuity benefits in advance of the time they would otherwise | ||
be payable, at any time during the insured's lifetime, as an | ||
indemnity for a terminal illness shall be deemed to be | ||
policies of life or endowment insurance or annuity contracts | ||
within the intent of this clause. | ||
Also to be deemed as policies of life or endowment | ||
insurance or annuity contracts within the intent of this | ||
clause shall be those policies or riders that provide for the | ||
payment of up to 75% of the face amount of benefits in advance | ||
of the time they would otherwise be payable upon a diagnosis by | ||
a physician licensed to practice medicine in all of its | ||
branches that the insured has incurred a covered condition | ||
listed in the policy or rider. | ||
"Covered condition", as used in this clause, means: heart | ||
attack, stroke, coronary artery surgery, life-threatening life | ||
threatening cancer, renal failure, Alzheimer's disease, | ||
paraplegia, major organ transplantation, total and permanent | ||
disability, and any other medical condition that the | ||
Department may approve for any particular filing. | ||
The Director may issue rules that specify prohibited | ||
policy provisions, not otherwise specifically prohibited by | ||
law, which in the opinion of the Director are unjust, unfair, |
or unfairly discriminatory to the policyholder, any person | ||
insured under the policy, or beneficiary. | ||
(b) Accident and health. Insurance against bodily injury, | ||
disablement or death by accident and against disablement | ||
resulting from sickness or old age and every insurance | ||
appertaining thereto, including stop-loss insurance. In this | ||
clause, "stop-loss Stop-loss insurance " means is insurance | ||
against the risk of economic loss issued to or for the benefit | ||
of a single employer self-funded employee disability benefit | ||
plan or an employee welfare benefit plan as described in 29 | ||
U.S.C. 1001 100 et seq. , where (i) the policy is issued to and | ||
insures an employer, trustee, or other sponsor of the plan, or | ||
the plan itself, but not employees, members, or participants; | ||
and (ii) payments by the insurer are made to the employer, | ||
trustee, or other sponsors of the plan, or the plan itself, but | ||
not to the employees, members, participants, or health care | ||
providers. The insurance laws of this State, including this | ||
Code, do not apply to arrangements between a religious | ||
organization and the organization's members or participants | ||
when the arrangement and organization meet all of the | ||
following criteria: | ||
(i) the organization is described in Section 501(c)(3) | ||
of the Internal Revenue Code and is exempt from taxation | ||
under Section 501(a) of the Internal Revenue Code; | ||
(ii) members of the organization share a common set of | ||
ethical or religious beliefs and share medical expenses |
among members in accordance with those beliefs and without | ||
regard to the state in which a member resides or is | ||
employed; | ||
(iii) no funds that have been given for the purpose of | ||
the sharing of medical expenses among members described in | ||
paragraph (ii) of this subsection (b) are held by the | ||
organization in an off-shore trust or bank account; | ||
(iv) the organization provides at least monthly to all | ||
of its members a written statement listing the dollar | ||
amount of qualified medical expenses that members have | ||
submitted for sharing, as well as the amount of expenses | ||
actually shared among the members; | ||
(v) members of the organization retain membership even | ||
after they develop a medical condition; | ||
(vi) the organization or a predecessor organization | ||
has been in existence at all times since December 31, | ||
1999, and medical expenses of its members have been shared | ||
continuously and without interruption since at least | ||
December 31, 1999; | ||
(vii) the organization conducts an annual audit that | ||
is performed by an independent certified public accounting | ||
firm in accordance with generally accepted accounting | ||
principles and is made available to the public upon | ||
request; | ||
(viii) the organization includes the following | ||
statement, in writing, on or accompanying all applications |
and guideline materials: | ||
"Notice: The organization facilitating the sharing of | ||
medical expenses is not an insurance company, and | ||
neither its guidelines nor plan of operation | ||
constitute or create an insurance policy. Any | ||
assistance you receive with your medical bills will be | ||
totally voluntary. As such, participation in the | ||
organization or a subscription to any of its documents | ||
should never be considered to be insurance. Whether or | ||
not you receive any payments for medical expenses and | ||
whether or not this organization continues to operate, | ||
you are always personally responsible for the payment | ||
of your own medical bills."; | ||
(ix) any membership card or similar document issued by | ||
the organization and any written communication sent by the | ||
organization to a hospital, physician, or other health | ||
care provider shall include a statement that the | ||
organization does not issue health insurance and that the | ||
member or participant is personally liable for payment of | ||
his or her medical bills; | ||
(x) the organization provides to a participant, within | ||
30 days after the participant joins, a complete set of its | ||
rules for the sharing of medical expenses, appeals of | ||
decisions made by the organization, and the filing of | ||
complaints; | ||
(xi) the organization does not offer any other |
services that are regulated under any provision of the | ||
Illinois Insurance Code or other insurance laws of this | ||
State; and | ||
(xii) the organization does not amass funds as | ||
reserves intended for payment of medical services, rather | ||
the organization facilitates the payments provided for in | ||
this subsection (b) through payments made directly from | ||
one participant to another. | ||
(c) Legal Expense Insurance. Insurance which involves the | ||
assumption of a contractual obligation to reimburse the | ||
beneficiary against or pay on behalf of the beneficiary, all | ||
or a portion of his fees, costs, or expenses related to or | ||
arising out of services performed by or under the supervision | ||
of an attorney licensed to practice in the jurisdiction | ||
wherein the services are performed, regardless of whether the | ||
payment is made by the beneficiaries individually or by a | ||
third person for them, but does not include the provision of or | ||
reimbursement for legal services incidental to other insurance | ||
coverages. The insurance laws of this State, including this | ||
Act do not apply to: | ||
(i) retainer contracts made by attorneys at law with | ||
individual clients with fees based on estimates of the | ||
nature and amount of services to be provided to the | ||
specific client, and similar contracts made with a group | ||
of clients involved in the same or closely related legal | ||
matters; |
(ii) plans owned or operated by attorneys who are the | ||
providers of legal services to the plan; | ||
(iii) plans providing legal service benefits to groups | ||
where such plans are owned or operated by authority of a | ||
state, county, local or other bar association; | ||
(iv) any lawyer referral service authorized or | ||
operated by a state, county, local or other bar | ||
association; | ||
(v) the furnishing of legal assistance by labor unions | ||
and other employee organizations to their members in | ||
matters relating to employment or occupation; | ||
(vi) the furnishing of legal assistance to members or | ||
dependents, by churches, consumer organizations, | ||
cooperatives, educational institutions, credit unions, or | ||
organizations of employees, where such organizations | ||
contract directly with lawyers or law firms for the | ||
provision of legal services, and the administration and | ||
marketing of such legal services is wholly conducted by | ||
the organization or its subsidiary; | ||
(vii) legal services provided by an employee welfare | ||
benefit plan defined by the Employee Retirement Income | ||
Security Act of 1974; | ||
(viii) any collectively bargained plan for legal | ||
services between a labor union and an employer negotiated | ||
pursuant to Section 302 of the Labor Management Relations | ||
Act as now or hereafter amended, under which plan legal |
services will be provided for employees of the employer | ||
whether or not payments for such services are funded to or | ||
through an insurance company. | ||
Class 2. Casualty, Fidelity and Surety. | ||
(a) Accident and health. Insurance against bodily injury, | ||
disablement or death by accident and against disablement | ||
resulting from sickness or old age and every insurance | ||
appertaining thereto, including stop-loss insurance. In this | ||
clause, "stop-loss Stop-loss insurance " has meaning given to | ||
that term in clause (b) of Class 1 is insurance against the | ||
risk of economic loss issued to a single employer self-funded | ||
employee disability benefit plan or an employee welfare | ||
benefit plan as described in 29 U.S.C. 1001 et seq . | ||
(b) Vehicle. Insurance against any loss or liability | ||
resulting from or incident to the ownership, maintenance or | ||
use of any vehicle (motor or otherwise), draft animal or | ||
aircraft. Any policy insuring against any loss or liability on | ||
account of the bodily injury or death of any person may contain | ||
a provision for payment of disability benefits to injured | ||
persons and death benefits to dependents, beneficiaries or | ||
personal representatives of persons who are killed, including | ||
the named insured, irrespective of legal liability of the | ||
insured, if the injury or death for which benefits are | ||
provided is caused by accident and sustained while in or upon | ||
or while entering into or alighting from or through being | ||
struck by a vehicle (motor or otherwise), draft animal or |
aircraft, and such provision shall not be deemed to be | ||
accident insurance. | ||
(c) Liability. Insurance against the liability of the | ||
insured for the death, injury or disability of an employee or | ||
other person, and insurance against the liability of the | ||
insured for damage to or destruction of another person's | ||
property. | ||
(d) Workers' compensation. Insurance of the obligations | ||
accepted by or imposed upon employers under laws for workers' | ||
compensation. | ||
(e) Burglary and forgery. Insurance against loss or damage | ||
by burglary, theft, larceny, robbery, forgery, fraud or | ||
otherwise; including all householders' personal property | ||
floater risks. | ||
(f) Glass. Insurance against loss or damage to glass | ||
including lettering, ornamentation and fittings from any | ||
cause. | ||
(g) Fidelity and surety. Become surety or guarantor for | ||
any person, copartnership or corporation in any position or | ||
place of trust or as custodian of money or property, public or | ||
private; or, becoming a surety or guarantor for the | ||
performance of any person, copartnership or corporation of any | ||
lawful obligation, undertaking, agreement or contract of any | ||
kind, except contracts or policies of insurance; and | ||
underwriting blanket bonds. Such obligations shall be known | ||
and treated as suretyship obligations and such business shall |
be known as surety business. | ||
(h) Miscellaneous. Insurance against loss or damage to | ||
property and any liability of the insured caused by accidents | ||
to boilers, pipes, pressure containers, machinery and | ||
apparatus of any kind and any apparatus connected thereto, or | ||
used for creating, transmitting or applying power, light, | ||
heat, steam or refrigeration, making inspection of and issuing | ||
certificates of inspection upon elevators, boilers, machinery | ||
and apparatus of any kind and all mechanical apparatus and | ||
appliances appertaining thereto; insurance against loss or | ||
damage by water entering through leaks or openings in | ||
buildings, or from the breakage or leakage of a sprinkler, | ||
pumps, water pipes, plumbing and all tanks, apparatus, | ||
conduits and containers designed to bring water into buildings | ||
or for its storage or utilization therein, or caused by the | ||
falling of a tank, tank platform or supports, or against loss | ||
or damage from any cause (other than causes specifically | ||
enumerated under Class 3 of this Section) to such sprinkler, | ||
pumps, water pipes, plumbing, tanks, apparatus, conduits or | ||
containers; insurance against loss or damage which may result | ||
from the failure of debtors to pay their obligations to the | ||
insured; and insurance of the payment of money for personal | ||
services under contracts of hiring. | ||
(i) Other casualty risks. Insurance against any other | ||
casualty risk not otherwise specified under Classes 1 or 3, | ||
which may lawfully be the subject of insurance and may |
properly be classified under Class 2. | ||
(j) Contingent losses. Contingent, consequential and | ||
indirect coverages wherein the proximate cause of the loss is | ||
attributable to any one of the causes enumerated under Class | ||
2. Such coverages shall, for the purpose of classification, be | ||
included in the specific grouping of the kinds of insurance | ||
wherein such cause is specified. | ||
(k) Livestock and domestic animals. Insurance against | ||
mortality, accident and health of livestock and domestic | ||
animals. | ||
(l) Legal expense insurance. Insurance against risk | ||
resulting from the cost of legal services as defined under | ||
Class 1(c). | ||
Class 3. Fire and Marine, etc. | ||
(a) Fire. Insurance against loss or damage by fire, smoke | ||
and smudge, lightning or other electrical disturbances. | ||
(b) Elements. Insurance against loss or damage by | ||
earthquake, windstorms, cyclone, tornado, tempests, hail, | ||
frost, snow, ice, sleet, flood, rain, drought or other weather | ||
or climatic conditions including excess or deficiency of | ||
moisture, rising of the waters of the ocean or its | ||
tributaries. | ||
(c) War, riot and explosion. Insurance against loss or | ||
damage by bombardment, invasion, insurrection, riot, strikes, | ||
civil war or commotion, military or usurped power, or | ||
explosion (other than explosion of steam boilers and the |
breaking of fly wheels on premises owned, controlled, managed, | ||
or maintained by the insured). | ||
(d) Marine and transportation. Insurance against loss or | ||
damage to vessels, craft, aircraft, vehicles of every kind, | ||
(excluding vehicles operating under their own power or while | ||
in storage not incidental to transportation) as well as all | ||
goods, freights, cargoes, merchandise, effects, disbursements, | ||
profits, moneys, bullion, precious stones, securities, choses | ||
in action, evidences of debt, valuable papers, bottomry and | ||
respondentia interests and all other kinds of property and | ||
interests therein, in respect to, appertaining to or in | ||
connection with any or all risks or perils of navigation, | ||
transit, or transportation, including war risks, on or under | ||
any seas or other waters, on land or in the air, or while being | ||
assembled, packed, crated, baled, compressed or similarly | ||
prepared for shipment or while awaiting the same or during any | ||
delays, storage, transshipment, or reshipment incident | ||
thereto, including marine builder's risks and all personal | ||
property floater risks; and for loss or damage to persons or | ||
property in connection with or appertaining to marine, inland | ||
marine, transit or transportation insurance, including | ||
liability for loss of or damage to either arising out of or in | ||
connection with the construction, repair, operation, | ||
maintenance, or use of the subject matter of such insurance, | ||
(but not including life insurance or surety bonds); but, | ||
except as herein specified, shall not mean insurances against |
loss by reason of bodily injury to the person; and insurance | ||
against loss or damage to precious stones, jewels, jewelry, | ||
gold, silver and other precious metals whether used in | ||
business or trade or otherwise and whether the same be in | ||
course of transportation or otherwise, which shall include | ||
jewelers' block insurance; and insurance against loss or | ||
damage to bridges, tunnels and other instrumentalities of | ||
transportation and communication (excluding buildings, their | ||
furniture and furnishings, fixed contents and supplies held in | ||
storage) unless fire, tornado, sprinkler leakage, hail, | ||
explosion, earthquake, riot and civil commotion are the only | ||
hazards to be covered; and to piers, wharves, docks and slips, | ||
excluding the risks of fire, tornado, sprinkler leakage, hail, | ||
explosion, earthquake, riot and civil commotion; and to other | ||
aids to navigation and transportation, including dry docks and | ||
marine railways, against all risk. | ||
(e) Vehicle. Insurance against loss or liability resulting | ||
from or incident to the ownership, maintenance or use of any | ||
vehicle (motor or otherwise), draft animal or aircraft, | ||
excluding the liability of the insured for the death, injury | ||
or disability of another person. | ||
(f) Property damage, sprinkler leakage and crop. Insurance | ||
against the liability of the insured for loss or damage to | ||
another person's property or property interests from any cause | ||
enumerated in this class; insurance against loss or damage by | ||
water entering through leaks or openings in buildings, or from |
the breakage or leakage of a sprinkler, pumps, water pipes, | ||
plumbing and all tanks, apparatus, conduits and containers | ||
designed to bring water into buildings or for its storage or | ||
utilization therein, or caused by the falling of a tank, tank | ||
platform or supports or against loss or damage from any cause | ||
to such sprinklers, pumps, water pipes, plumbing, tanks, | ||
apparatus, conduits or containers; insurance against loss or | ||
damage from insects, diseases or other causes to trees, crops | ||
or other products of the soil. | ||
(g) Other fire and marine risks. Insurance against any | ||
other property risk not otherwise specified under Classes 1 or | ||
2, which may lawfully be the subject of insurance and may | ||
properly be classified under Class 3. | ||
(h) Contingent losses. Contingent, consequential and | ||
indirect coverages wherein the proximate cause of the loss is | ||
attributable to any of the causes enumerated under Class 3. | ||
Such coverages shall, for the purpose of classification, be | ||
included in the specific grouping of the kinds of insurance | ||
wherein such cause is specified. | ||
(i) Legal expense insurance. Insurance against risk | ||
resulting from the cost of legal services as defined under | ||
Class 1(c). | ||
(Source: P.A. 101-81, eff. 7-12-19.) | ||
(215 ILCS 5/352) (from Ch. 73, par. 964) | ||
Sec. 352. Scope of Article. |
(a) Except as provided in subsections (b), (c), (d), and | ||
(e) , and (g) , this Article shall apply to all companies | ||
transacting in this State the kinds of business enumerated in | ||
clause (b) of Class 1 and clause (a) of Class 2 of Section 4 | ||
and to all policies, contracts, and certificates of insurance | ||
issued in connection therewith that are not otherwise excluded | ||
under Article VII of this Code . Nothing in this Article shall | ||
apply to, or in any way affect policies or contracts described | ||
in clause (a) of Class 1 of Section 4; however, this Article | ||
shall apply to policies and contracts which contain benefits | ||
providing reimbursement for the expenses of long term health | ||
care which are certified or ordered by a physician including | ||
but not limited to professional nursing care, custodial | ||
nursing care, and non-nursing custodial care provided in a | ||
nursing home or at a residence of the insured. | ||
(b) (Blank). | ||
(c) A policy issued and delivered in this State that | ||
provides coverage under that policy for certificate holders | ||
who are neither residents of nor employed in this State does | ||
not need to provide to those nonresident certificate holders | ||
who are not employed in this State the coverages or services | ||
mandated by this Article. | ||
(d) Stop-loss insurance , as defined in clause (b) of Class | ||
1 or clause (a) of Class 2 of Section 4, is exempt from all | ||
Sections of this Article, except this Section and Sections | ||
353a, 354, 357.30, and 370. For purposes of this exemption, |
stop-loss insurance is further defined as follows: | ||
(1) The policy must be issued to and insure an | ||
employer, trustee, or other sponsor of the plan, or the | ||
plan itself, but not employees, members, or participants. | ||
(2) Payments by the insurer must be made to the | ||
employer, trustee, or other sponsors of the plan, or the | ||
plan itself, but not to the employees, members, | ||
participants, or health care providers. | ||
(e) A policy issued or delivered in this State to the | ||
Department of Healthcare and Family Services (formerly | ||
Illinois Department of Public Aid) and providing coverage, | ||
under clause (b) of Class 1 or clause (a) of Class 2 as | ||
described in Section 4, to persons who are enrolled under | ||
Article V of the Illinois Public Aid Code or under the | ||
Children's Health Insurance Program Act is exempt from all | ||
restrictions, limitations, standards, rules, or regulations | ||
respecting benefits imposed by or under authority of this | ||
Code, except those specified by subsection (1) of Section 143, | ||
Section 370c, and Section 370c.1. Nothing in this subsection, | ||
however, affects the total medical services available to | ||
persons eligible for medical assistance under the Illinois | ||
Public Aid Code. | ||
(f) An in-office membership care agreement provided under | ||
the In-Office Membership Care Act is not insurance for the | ||
purposes of this Code. | ||
(g) The provisions of Sections 356a through 359a, both |
inclusive, shall not apply to or affect: | ||
(1) any policy or contract of reinsurance; or | ||
(2) life insurance, endowment or annuity contracts, or | ||
contracts supplemental thereto that contain only such | ||
provisions relating to accident and sickness insurance | ||
that (A) provide additional benefits in case of death or | ||
dismemberment or loss of sight by accident, or (B) operate | ||
to safeguard such contracts against lapse, or to give a | ||
special surrender value or special benefit or an annuity | ||
if the insured or annuitant becomes a person with a total | ||
and permanent disability, as defined by the contract or | ||
supplemental contract. | ||
(Source: P.A. 101-190, eff. 8-2-19.) | ||
(215 ILCS 5/352b) | ||
Sec. 352b. Excepted benefits exempted Policy of individual | ||
or group accident and health insurance . | ||
(a) Unless specified otherwise and when used in context of | ||
accident and health insurance policy benefits, coverage, | ||
terms, or conditions required to be provided under this | ||
Article, references to any " policy of individual or group | ||
accident and health insurance " , or both, as used in this | ||
Article, do does not include any coverage or policy that | ||
provides an excepted benefit, as that term is defined in | ||
Section 2791(c) of the federal Public Health Service Act (42 | ||
U.S.C. 300gg-91). Nothing in this subsection amendatory Act of |
the 101st General Assembly applies to a policy of liability, | ||
workers' compensation, automobile medical payment, or limited | ||
scope dental or vision benefits insurance issued under this | ||
Code. Nothing in this subsection shall be construed to subject | ||
excepted benefits outside the scope of Section 352 to any | ||
requirements of this Article. | ||
(b) Nothing in this Article shall require a policy of | ||
excepted benefits to provide benefits, coverage, terms, or | ||
conditions in such a manner as to disqualify it from being | ||
classified under federal law as the type of excepted benefit | ||
for which its policy forms are filed under Sections 143 and 355 | ||
of this Code. | ||
(Source: P.A. 101-456, eff. 8-23-19.) | ||
(215 ILCS 5/356a) (from Ch. 73, par. 968a) | ||
Sec. 356a. Form of policy. | ||
(1) No individual policy of accident and health insurance | ||
shall be delivered or issued for delivery to any person in this | ||
State state unless: | ||
(a) the entire money and other considerations therefor | ||
are expressed therein; and | ||
(b) the time at which the insurance takes effect and | ||
terminates is expressed therein; and | ||
(c) it purports to insure only one person, except that | ||
a policy may insure, originally or by subsequent | ||
amendment, upon the application of an adult member of a |
family who shall be deemed the policyholder, any 2 two or | ||
more eligible members of that family, including husband, | ||
wife, dependent children or any children under a specified | ||
age which shall not exceed 19 years and any other person | ||
dependent upon the policyholder; and | ||
(d) the style, arrangement and over-all appearance of | ||
the policy give no undue prominence to any portion of the | ||
text, and unless every printed portion of the text of the | ||
policy and of any endorsements or attached papers is | ||
plainly printed in light-faced type of a style in general | ||
use, the size of which shall be uniform and not less than | ||
ten-point with a lower-case unspaced alphabet length not | ||
less than one hundred and twenty-point (the "text" shall | ||
include all printed matter except the name and address of | ||
the insurer, name or title of the policy, the brief | ||
description if any, and captions and subcaptions); and | ||
(e) the exceptions and reductions of indemnity are set | ||
forth in the policy and, except those which are set forth | ||
in Sections 357.1 through 357.30 of this act, are printed, | ||
at the insurer's option, either included with the benefit | ||
provision to which they apply, or under an appropriate | ||
caption such as "EXCEPTIONS", or "EXCEPTIONS AND | ||
REDUCTIONS", provided that if an exception or reduction | ||
specifically applies only to a particular benefit of the | ||
policy, a statement of such exception or reduction shall | ||
be included with the benefit provision to which it |
applies; and | ||
(f) each such form, including riders and endorsements, | ||
shall be identified by a form number in the lower | ||
left-hand corner of the first page thereof; and | ||
(g) it contains no provision purporting to make any | ||
portion of the charter, rules, constitution, or by-laws of | ||
the insurer a part of the policy unless such portion is set | ||
forth in full in the policy, except in the case of the | ||
incorporation of, or reference to, a statement of rates or | ||
classification of risks, or short-rate table filed with | ||
the Director. | ||
(2) If any policy is issued by an insurer domiciled in this | ||
state for delivery to a person residing in another state, and | ||
if the official having responsibility for the administration | ||
of the insurance laws of such other state shall have advised | ||
the Director that any such policy is not subject to approval or | ||
disapproval by such official, the Director may by ruling | ||
require that such policy meet the standards set forth in | ||
subsection (1) of this section and in Sections 357.1 through | ||
357.30. | ||
(Source: P.A. 76-860.) | ||
(215 ILCS 5/356b) (from Ch. 73, par. 968b) | ||
Sec. 356b. (a) This Section applies to the hospital and | ||
medical expense provisions of an individual accident or health | ||
insurance policy. |
(b) If a policy provides that coverage of a dependent | ||
person terminates upon attainment of the limiting age for | ||
dependent persons specified in the policy, the attainment of | ||
such limiting age does not operate to terminate the hospital | ||
and medical coverage of a person who, because of a disabling | ||
condition that occurred before attainment of the limiting age, | ||
is incapable of self-sustaining employment and is dependent on | ||
his or her parents or other care providers for lifetime care | ||
and supervision. | ||
(c) For purposes of subsection (b), "dependent on other | ||
care providers" is defined as requiring a Community Integrated | ||
Living Arrangement, group home, supervised apartment, or other | ||
residential services licensed or certified by the Department | ||
of Human Services (as successor to the Department of Mental | ||
Health and Developmental Disabilities), the Department of | ||
Public Health, or the Department of Healthcare and Family | ||
Services (formerly Department of Public Aid). | ||
(d) The insurer may inquire of the policyholder 2 months | ||
prior to attainment by a dependent of the limiting age set | ||
forth in the policy, or at any reasonable time thereafter, | ||
whether such dependent is in fact a person who has a disability | ||
and is dependent and, in the absence of proof submitted within | ||
60 days of such inquiry that such dependent is a person who has | ||
a disability and is dependent may terminate coverage of such | ||
person at or after attainment of the limiting age. In the | ||
absence of such inquiry, coverage of any person who has a |
disability and is dependent shall continue through the term of | ||
such policy or any extension or renewal thereof. | ||
(e) This amendatory Act of 1969 is applicable to policies | ||
issued or renewed more than 60 days after the effective date of | ||
this amendatory Act of 1969. | ||
(Source: P.A. 99-143, eff. 7-27-15.) | ||
(215 ILCS 5/356d) (from Ch. 73, par. 968d) | ||
Sec. 356d. Conversion privileges for insured former | ||
spouses. (1) No individual policy of accident and health | ||
insurance providing coverage of hospital and/or medical | ||
expense on either an expense incurred basis or other than an | ||
expense incurred basis, which in addition to covering the | ||
insured also provides coverage to the spouse of the insured | ||
shall contain a provision for termination of coverage for a | ||
spouse covered under the policy solely as a result of a break | ||
in the marital relationship except by reason of an entry of a | ||
valid judgment of dissolution of marriage between the parties. | ||
(2) Every policy which contains a provision for | ||
termination of coverage of the spouse upon dissolution of | ||
marriage shall contain a provision to the effect that upon the | ||
entry of a valid judgment of dissolution of marriage between | ||
the insured parties the spouse whose marriage was dissolved | ||
shall be entitled to have issued to him or her, without | ||
evidence of insurability, upon application made to the company | ||
within 60 days following the entry of such judgment, and upon |
the payment of the appropriate premium, an individual policy | ||
of accident and health insurance. Such policy shall provide | ||
the coverage then being issued by the insurer which is most | ||
nearly similar to, but not greater than, such terminated | ||
coverages. Any and all probationary and/or waiting periods set | ||
forth in such policy shall be considered as being met to the | ||
extent coverage was in force under the prior policy. | ||
(3) The requirements of this Section shall apply to all | ||
policies delivered or issued for delivery on or after the 60th | ||
day following the effective date of this Section. | ||
(Source: P.A. 84-545.) | ||
(215 ILCS 5/356e) (from Ch. 73, par. 968e) | ||
Sec. 356e. Victims of certain offenses. | ||
(1) No individual policy of accident and health insurance, | ||
which provides benefits for hospital or medical expenses based | ||
upon the actual expenses incurred, delivered or issued for | ||
delivery to any person in this State shall contain any | ||
specific exception to coverage which would preclude the | ||
payment under that policy of actual expenses incurred in the | ||
examination and testing of a victim of an offense defined in | ||
Sections 11-1.20 through 11-1.60 or 12-13 through 12-16 of the | ||
Criminal Code of 1961 or the Criminal Code of 2012, or an | ||
attempt to commit such offense to establish that sexual | ||
contact did occur or did not occur, and to establish the | ||
presence or absence of sexually transmitted disease or |
infection, and examination and treatment of injuries and | ||
trauma sustained by a victim of such offense arising out of the | ||
offense. Every policy of accident and health insurance which | ||
specifically provides benefits for routine physical | ||
examinations shall provide full coverage for expenses incurred | ||
in the examination and testing of a victim of an offense | ||
defined in Sections 11-1.20 through 11-1.60 or 12-13 through | ||
12-16 of the Criminal Code of 1961 or the Criminal Code of | ||
2012, or an attempt to commit such offense as set forth in this | ||
Section. This Section shall not apply to a policy which covers | ||
hospital and medical expenses for specified illnesses or | ||
injuries only. | ||
(2) For purposes of enabling the recovery of State funds, | ||
any insurance carrier subject to this Section shall upon | ||
reasonable demand by the Department of Public Health disclose | ||
the names and identities of its insureds entitled to benefits | ||
under this provision to the Department of Public Health | ||
whenever the Department of Public Health has determined that | ||
it has paid, or is about to pay, hospital or medical expenses | ||
for which an insurance carrier is liable under this Section. | ||
All information received by the Department of Public Health | ||
under this provision shall be held on a confidential basis and | ||
shall not be subject to subpoena and shall not be made public | ||
by the Department of Public Health or used for any purpose | ||
other than that authorized by this Section. | ||
(3) Whenever the Department of Public Health finds that it |
has paid all or part of any hospital or medical expenses which | ||
an insurance carrier is obligated to pay under this Section, | ||
the Department of Public Health shall be entitled to receive | ||
reimbursement for its payments from such insurance carrier | ||
provided that the Department of Public Health has notified the | ||
insurance carrier of its claims before the carrier has paid | ||
such benefits to its insureds or in behalf of its insureds. | ||
(Source: P.A. 96-1551, eff. 7-1-11; 97-1150, eff. 1-25-13.) | ||
(215 ILCS 5/356f) (from Ch. 73, par. 968f) | ||
Sec. 356f. No individual policy of accident or health | ||
insurance or any renewal thereof shall be denied or cancelled | ||
by the insurer, nor shall any such policy contain any | ||
exception or exclusion of benefits, solely because the mother | ||
of the insured has taken diethylstilbestrol, commonly referred | ||
to as DES. | ||
(Source: P.A. 81-656.) | ||
(215 ILCS 5/356K) (from Ch. 73, par. 968K) | ||
Sec. 356K. Coverage for Organ Transplantation Procedures. | ||
No accident and health insurer providing individual accident | ||
and health insurance coverage under this Act for hospital or | ||
medical expenses shall deny reimbursement for an otherwise | ||
covered expense incurred for any organ transplantation | ||
procedure solely on the basis that such procedure is deemed | ||
experimental or investigational unless supported by the |
determination of the Office of Health Care Technology | ||
Assessment within the Agency for Health Care Policy and | ||
Research within the federal Department of Health and Human | ||
Services that such procedure is either experimental or | ||
investigational or that there is insufficient data or | ||
experience to determine whether an organ transplantation | ||
procedure is clinically acceptable. If an accident and health | ||
insurer has made written request, or had one made on its behalf | ||
by a national organization, for determination by the Office of | ||
Health Care Technology Assessment within the Agency for Health | ||
Care Policy and Research within the federal Department of | ||
Health and Human Services as to whether a specific organ | ||
transplantation procedure is clinically acceptable and said | ||
organization fails to respond to such a request within a | ||
period of 90 days, the failure to act may be deemed a | ||
determination that the procedure is deemed to be experimental | ||
or investigational. | ||
(Source: P.A. 87-218.) | ||
(215 ILCS 5/356L) (from Ch. 73, par. 968L) | ||
Sec. 356L. No individual policy of accident or health | ||
insurance shall include any provision which shall have the | ||
effect of denying coverage to or on behalf of an insured under | ||
such policy on the basis of a failure by the insured to file a | ||
notice of claim within the time period required by the policy, | ||
provided such failure is caused solely by the physical |
inability or mental incapacity of the insured to file such | ||
notice of claim because of a period of emergency | ||
hospitalization. | ||
(Source: P.A. 86-784.) | ||
(215 ILCS 5/356r) | ||
Sec. 356r. Access to obstetrical and gynecological care | ||
Woman's principal health care provider . | ||
(a) An individual or group policy of accident and health | ||
insurance or a managed care plan amended, delivered, issued, | ||
or renewed in this State must not require authorization or | ||
referral by the plan, issuer, or any person, including a | ||
primary care provider, for any covered individual who seeks | ||
coverage for obstetrical or gynecological care provided by any | ||
licensed or certified participating health care professional | ||
who specializes in obstetrics or gynecology. after November | ||
14, 1996 that requires an insured or enrollee to designate an | ||
individual to coordinate care or to control access to health | ||
care services shall also permit a female insured or enrollee | ||
to designate a participating woman's principal health care | ||
provider, and the insurer or managed care plan shall provide | ||
the following written notice to all female insureds or | ||
enrollees no later than 120 days after the effective date of | ||
this amendatory Act of 1998; to all new enrollees at the time | ||
of enrollment; and thereafter to all existing enrollees at | ||
least annually, as a part of a regular publication or |
informational mailing: | ||
"NOTICE TO ALL FEMALE PLAN MEMBERS: | ||
YOUR RIGHT TO SELECT A WOMAN'S PRINCIPAL | ||
HEALTH CARE PROVIDER. | ||
Illinois law allows you to select "a woman's principal | ||
health care provider" in addition to your selection of a | ||
primary care physician. A woman's principal health care | ||
provider is a physician licensed to practice medicine in | ||
all its branches specializing in obstetrics or gynecology | ||
or specializing in family practice. A woman's principal | ||
health care provider may be seen for care without | ||
referrals from your primary care physician. If you have | ||
not already selected a woman's principal health care | ||
provider, you may do so now or at any other time. You are | ||
not required to have or to select a woman's principal | ||
health care provider. | ||
Your woman's principal health care provider must be a | ||
part of your plan. You may get the list of participating | ||
obstetricians, gynecologists, and family practice | ||
specialists from your employer's employee benefits | ||
coordinator, or for your own copy of the current list, you | ||
may call [insert plan's toll free number]. The list will | ||
be sent to you within 10 days after your call. To designate | ||
a woman's principal health care provider from the list, | ||
call [insert plan's toll free number] and tell our staff | ||
the name of the physician you have selected.". |
If the insurer or managed care plan exercises the option set | ||
forth in subsection (a-5), the notice shall also state: | ||
"Your plan requires that your primary care physician | ||
and your woman's principal health care provider have a | ||
referral arrangement with one another. If the woman's | ||
principal health care provider that you select does not | ||
have a referral arrangement with your primary care | ||
physician, you will have to select a new primary care | ||
physician who has a referral arrangement with your woman's | ||
principal health care provider or you may select a woman's | ||
principal health care provider who has a referral | ||
arrangement with your primary care physician. The list of | ||
woman's principal health care providers will also have the | ||
names of the primary care physicians and their referral | ||
arrangements.". | ||
No later than 120 days after the effective date of this | ||
amendatory Act of 1998, the insurer or managed care plan shall | ||
provide each employer who has a policy of insurance or a | ||
managed care plan with the insurer or managed care plan with a | ||
list of physicians licensed to practice medicine in all its | ||
branches specializing in obstetrics or gynecology or | ||
specializing in family practice who have contracted with the | ||
plan. At the time of enrollment and thereafter within 10 days | ||
after a request by an insured or enrollee, the insurer or | ||
managed care plan also shall provide this list directly to the | ||
insured or enrollee. The list shall include each physician's |
address, telephone number, and specialty. No insurer or plan | ||
formal or informal policy may restrict a female insured's or | ||
enrollee's right to designate a woman's principal health care | ||
provider, except as set forth in subsection (a-5). If the | ||
female enrollee is an enrollee of a managed care plan under | ||
contract with the Department of Healthcare and Family | ||
Services, the physician chosen by the enrollee as her woman's | ||
principal health care provider must be a Medicaid-enrolled | ||
provider. This requirement does not require a female insured | ||
or enrollee to make a selection of a woman's principal health | ||
care provider. The female insured or enrollee may designate a | ||
physician licensed to practice medicine in all its branches | ||
specializing in family practice as her woman's principal | ||
health care provider. | ||
(a-5) If a policy, contract, or certificate requires or | ||
allows a covered individual to designate a primary care | ||
provider and provides coverage for any obstetrical or | ||
gynecological care, the insurer shall provide the notice | ||
required under 45 CFR 147.138(a)(4) and 149.310(a)(4) in all | ||
circumstances required under that provision. The insured or | ||
enrollee may be required by the insurer or managed care plan to | ||
select a woman's principal health care provider who has a | ||
referral arrangement with the insured's or enrollee's | ||
individual who coordinates care or controls access to health | ||
care services if such referral arrangement exists or to select | ||
a new individual to coordinate care or to control access to |
health care services who has a referral arrangement with the | ||
woman's principal health care provider chosen by the insured | ||
or enrollee, if such referral arrangement exists. If an | ||
insurer or a managed care plan requires an insured or enrollee | ||
to select a new physician under this subsection (a-5), the | ||
insurer or managed care plan must provide the insured or | ||
enrollee with both options to select a new physician provided | ||
in this subsection (a-5). | ||
Notwithstanding a plan's restrictions of the frequency or | ||
timing of making designations of primary care providers, a | ||
female enrollee or insured who is subject to the selection | ||
requirements of this subsection, may, at any time, effect a | ||
change in primary care physicians in order to make a selection | ||
of a woman's principal health care provider. | ||
(a-6) The requirements of this Section shall be construed | ||
in a manner consistent with the requirements for access to and | ||
notice of obstetrical and gynecological care in 45 CFR 147.138 | ||
and 45 CFR 149.310. If an insurer or managed care plan | ||
exercises the option in subsection (a-5), the list to be | ||
provided under subsection (a) shall identify the referral | ||
arrangements that exist between the individual who coordinates | ||
care or controls access to health care services and the | ||
woman's principal health care provider in order to assist the | ||
female insured or enrollee to make a selection within the | ||
insurer's or managed care plan's requirement. | ||
(b) Nothing in this Section prevents a health insurance |
issuer from requiring a participating obstetrical or | ||
gynecological health care professional to agree, with respect | ||
to individuals covered under a policy of accident and health | ||
insurance, to otherwise adhere to the health insurance | ||
issuer's policies and procedures, including procedures | ||
regarding referrals and obtaining prior authorization and | ||
providing services pursuant to a treatment plan, if any, | ||
approved by the issuer. If a female insured or enrollee has | ||
designated a woman's principal health care provider, then the | ||
insured or enrollee must be given direct access to the woman's | ||
principal health care provider for services covered by the | ||
policy or plan without the need for a referral or prior | ||
approval. Nothing shall prohibit the insurer or managed care | ||
plan from requiring prior authorization or approval from | ||
either a primary care provider or the woman's principal health | ||
care provider for referrals for additional care or services. | ||
(c) (Blank). For the purposes of this Section the | ||
following terms are defined: | ||
(1) "Woman's principal health care provider" means a | ||
physician licensed to practice medicine in all of its | ||
branches specializing in obstetrics or gynecology or | ||
specializing in family practice. | ||
(2) "Managed care entity" means any entity including a | ||
licensed insurance company, hospital or medical service | ||
plan, health maintenance organization, limited health | ||
service organization, preferred provider organization, |
third party administrator, an employer or employee | ||
organization, or any person or entity that establishes, | ||
operates, or maintains a network of participating | ||
providers. | ||
(3) "Managed care plan" means a plan operated by a | ||
managed care entity that provides for the financing of | ||
health care services to persons enrolled in the plan | ||
through: | ||
(A) organizational arrangements for ongoing | ||
quality assurance, utilization review programs, or | ||
dispute resolution; or | ||
(B) financial incentives for persons enrolled in | ||
the plan to use the participating providers and | ||
procedures covered by the plan. | ||
(4) "Participating provider" means a physician who has | ||
contracted with an insurer or managed care plan to provide | ||
services to insureds or enrollees as defined by the | ||
contract. | ||
(d) Nothing in this Section shall be construed to preclude | ||
a health insurance issuer from requiring that a participating | ||
obstetrical or gynecological health care professional notify | ||
the covered individual's primary care physician or the issuer | ||
of treatment decisions or update centralized medical records. | ||
The original provisions of this Section became law on July 17, | ||
1996 and took effect November 14, 1996, which is 120 days after | ||
becoming law. |
(Source: P.A. 95-331, eff. 8-21-07.) | ||
(215 ILCS 5/356s) | ||
Sec. 356s. Post-parturition care. An individual or group | ||
policy of accident and health insurance that provides | ||
maternity coverage and is amended, delivered, issued, or | ||
renewed after the effective date of this amendatory Act of | ||
1996 shall provide coverage for the following: | ||
(1) a minimum of 48 hours of inpatient care following | ||
a vaginal delivery for the mother and the newborn, except | ||
as otherwise provided in this Section; or | ||
(2) a minimum of 96 hours of inpatient care following | ||
a delivery by caesarian section for the mother and | ||
newborn, except as otherwise provided in this Section. | ||
Coverage may be limited to a A shorter length of hospital | ||
inpatient care stay for services related to maternity and | ||
newborn care may be provided if the attending physician | ||
licensed to practice medicine in all of its branches | ||
determines, in accordance with the protocols and guidelines | ||
developed by the American College of Obstetricians and | ||
Gynecologists or the American Academy of Pediatrics, that the | ||
mother and the newborn meet the appropriate guidelines for | ||
that length of stay based upon evaluation of the mother and | ||
newborn and the coverage and availability of a post-discharge | ||
physician office visit or in-home nurse visit to verify the | ||
condition of the infant in the first 48 hours after discharge. |
(Source: P.A. 89-513, eff. 9-15-96; 90-14, eff. 7-1-97.) | ||
(215 ILCS 5/356z.3) | ||
Sec. 356z.3. Disclosure of limited benefit. An insurer | ||
that issues, delivers, amends, or renews an individual or | ||
group policy of accident and health insurance in this State | ||
after the effective date of this amendatory Act of the 92nd | ||
General Assembly and arranges, contracts with, or administers | ||
contracts with a provider whereby beneficiaries are provided | ||
an incentive to use the services of such provider must include | ||
the following disclosure on its contracts and evidences of | ||
coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN | ||
NON-PARTICIPATING PROVIDERS ARE USED. YOU CAN EXPECT TO PAY | ||
MORE THAN THE COST-SHARING AMOUNT DEFINED IN THE POLICY IN | ||
NON-EMERGENCY SITUATIONS. Except in limited situations | ||
governed by the federal No Surprises Act or Section 356z.3a of | ||
the Illinois Insurance Code (215 ILCS 5/356z.3a), | ||
non-participating providers furnishing non-emergency services | ||
may bill members for any amount up to the billed charge after | ||
the plan has paid its portion of the bill. If you elect to use | ||
a non-participating provider, plan benefit payments will be | ||
determined according to your policy's fee schedule, usual and | ||
customary charge (which is determined by comparing charges for | ||
similar services adjusted to the geographical area where the | ||
services are performed), or other method as defined by the | ||
policy. Participating providers have agreed to ONLY bill |
members the cost-sharing amounts. You should be aware that | ||
when you elect to utilize the services of a non-participating | ||
provider for a covered service in non-emergency situations, | ||
benefit payments to such non-participating provider are not | ||
based upon the amount billed. The basis of your benefit | ||
payment will be determined according to your policy's fee | ||
schedule, usual and customary charge (which is determined by | ||
comparing charges for similar services adjusted to the | ||
geographical area where the services are performed), or other | ||
method as defined by the policy. YOU CAN EXPECT TO PAY MORE | ||
THAN THE COINSURANCE AMOUNT DEFINED IN THE POLICY AFTER THE | ||
PLAN HAS PAID ITS REQUIRED PORTION. Non-participating | ||
providers may bill members for any amount up to the billed | ||
charge after the plan has paid its portion of the bill, except | ||
as provided in Section 356z.3a of the Illinois Insurance Code | ||
for covered services received at a participating health care | ||
facility from a nonparticipating provider that are: (a) | ||
ancillary services, (b) items or services furnished as a | ||
result of unforeseen, urgent medical needs that arise at the | ||
time the item or service is furnished, or (c) items or services | ||
received when the facility or the non-participating provider | ||
fails to satisfy the notice and consent criteria specified | ||
under Section 356z.3a. Participating providers have agreed to | ||
accept discounted payments for services with no additional | ||
billing to the member other than co-insurance and deductible | ||
amounts. You may obtain further information about the |
participating status of professional providers and information | ||
on out-of-pocket expenses by calling the toll-free toll free | ||
telephone number on your identification card.". | ||
(Source: P.A. 102-901, eff. 1-1-23 .) | ||
(215 ILCS 5/356z.33) | ||
(Text of Section before amendment by P.A. 103-454 ) | ||
Sec. 356z.33. Coverage for epinephrine injectors. A group | ||
or individual policy of accident and health insurance or a | ||
managed care plan that is amended, delivered, issued, or | ||
renewed on or after January 1, 2020 (the effective date of | ||
Public Act 101-281) shall provide coverage for medically | ||
necessary epinephrine injectors for persons 18 years of age or | ||
under. As used in this Section, "epinephrine injector" has the | ||
meaning given to that term in Section 5 of the Epinephrine | ||
Injector Act. | ||
(Source: P.A. 101-281, eff. 1-1-20; 102-558, eff. 8-20-21.) | ||
(Text of Section after amendment by P.A. 103-454 ) | ||
Sec. 356z.33. Coverage for epinephrine injectors. | ||
(a) A group or individual policy of accident and health | ||
insurance or a managed care plan that is amended, delivered, | ||
issued, or renewed on or after January 1, 2020 (the effective | ||
date of Public Act 101-281) shall provide coverage for | ||
medically necessary epinephrine injectors for persons 18 years | ||
of age or under. As used in this Section, "epinephrine |
injector" has the meaning given to that term in Section 5 of | ||
the Epinephrine Injector Act. | ||
(b) An insurer that provides coverage for medically | ||
necessary epinephrine injectors shall limit the total amount | ||
that an insured is required to pay for a twin-pack of medically | ||
necessary epinephrine injectors at an amount not to exceed | ||
$60, regardless of the type of epinephrine injector ; except | ||
that this provision does not apply to the extent such coverage | ||
would disqualify a high-deductible health plan from | ||
eligibility for a health savings account pursuant to Section | ||
223 of the Internal Revenue Code (26 U.S.C. 223) . | ||
(c) Nothing in this Section prevents an insurer from | ||
reducing an insured's cost sharing by an amount greater than | ||
the amount specified in subsection (b). | ||
(d) The Department may adopt rules as necessary to | ||
implement and administer this Section. | ||
(Source: P.A. 102-558, eff. 8-20-21; 103-454, eff. 1-1-25.) | ||
(215 ILCS 5/367a) (from Ch. 73, par. 979a) | ||
Sec. 367a. Blanket accident and health insurance. | ||
(1) Blanket accident and health insurance is that form of | ||
accident and health insurance covering special groups of | ||
persons as enumerated in one of the following paragraphs (a) | ||
to (g), inclusive: | ||
(a) Under a policy or contract issued to any carrier | ||
for hire, which shall be deemed the policyholder, covering |
a group defined as all persons who may become passengers | ||
on such carrier. | ||
(b) Under a policy or contract issued to an employer, | ||
who shall be deemed the policyholder, covering all | ||
employees or any group of employees defined by reference | ||
to exceptional hazards incident to such employment. | ||
(c) Under a policy or contract issued to a college, | ||
school, or other institution of learning or to the head or | ||
principal thereof, who or which shall be deemed the | ||
policyholder, covering students or teachers. However, | ||
student health insurance coverage, as defined in 45 CFR | ||
147.145, shall remain subject to the standards and | ||
requirements for individual health insurance coverage | ||
except where inconsistent with that regulation. Student | ||
health insurance coverage shall not be subject to the | ||
Short-Term, Limited-Duration Health Insurance Coverage | ||
Act. An insurer providing student health insurance | ||
coverage or a policy or contract covering students for | ||
limited-scope dental or vision under 45 CFR 148.220 shall | ||
require an individual application or enrollment form and | ||
shall furnish each insured individual a certificate, which | ||
shall have been approved by the Director under Section | ||
355. | ||
(d) Under a policy or contract issued in the name of | ||
any volunteer fire department, first aid, or other such | ||
volunteer group, which shall be deemed the policyholder, |
covering all of the members of such department or group. | ||
(e) Under a policy or contract issued to a creditor, | ||
who shall be deemed the policyholder, to insure debtors of | ||
the creditors; Provided, however, that in the case of a | ||
loan which is subject to the Small Loans Act, no insurance | ||
premium or other cost shall be directly or indirectly | ||
charged or assessed against, or collected or received from | ||
the borrower. | ||
(f) Under a policy or contract issued to a sports team | ||
or to a camp, which team or camp sponsor shall be deemed | ||
the policyholder, covering members or campers. | ||
(g) Under a policy or contract issued to any other | ||
substantially similar group which, in the discretion of | ||
the Director, may be subject to the issuance of a blanket | ||
accident and health policy or contract. | ||
(2) Any insurance company authorized to write accident and | ||
health insurance in this state shall have the power to issue | ||
blanket accident and health insurance. No such blanket policy | ||
may be issued or delivered in this State unless a copy of the | ||
form thereof shall have been filed in accordance with Section | ||
355, and it contains in substance such of those provisions | ||
contained in Sections 357.1 through 357.30 as may be | ||
applicable to blanket accident and health insurance and the | ||
following provisions: | ||
(a) A provision that the policy and the application | ||
shall constitute the entire contract between the parties, |
and that all statements made by the policyholder shall, in | ||
absence of fraud, be deemed representations and not | ||
warranties, and that no such statements shall be used in | ||
defense to a claim under the policy, unless it is | ||
contained in a written application. | ||
(b) A provision that to the group or class thereof | ||
originally insured shall be added from time to time all | ||
new persons or individuals eligible for coverage. | ||
(3) An individual application shall not be required from a | ||
person covered under a blanket accident or health policy or | ||
contract, nor shall it be necessary for the insurer to furnish | ||
each person a certificate. | ||
(3.5) Subsection (3) does not apply to major medical | ||
insurance, or to any excepted benefits or short-term, | ||
limited-duration health insurance coverage for which an | ||
insured individual pays premiums or contributions. In those | ||
cases, the insurer shall require an individual application or | ||
enrollment form and shall furnish each insured individual a | ||
certificate, which shall have been approved by the Director | ||
under Section 355 of this Code. | ||
(4) All benefits under any blanket accident and health | ||
policy shall be payable to the person insured, or to his | ||
designated beneficiary or beneficiaries, or to his or her | ||
estate, except that if the person insured be a minor or person | ||
under legal disability, such benefits may be made payable to | ||
his or her parent, guardian, or other person actually |
supporting him or her. Provided further, however, that the | ||
policy may provide that all or any portion of any indemnities | ||
provided by any such policy on account of hospital, nursing, | ||
medical or surgical services may, at the insurer's option, be | ||
paid directly to the hospital or person rendering such | ||
services; but the policy may not require that the service be | ||
rendered by a particular hospital or person. Payment so made | ||
shall discharge the insurer's obligation with respect to the | ||
amount of insurance so paid. | ||
(5) Nothing contained in this section shall be deemed to | ||
affect the legal liability of policyholders for the death of | ||
or injury to, any such member of such group. | ||
(Source: P.A. 83-1362.) | ||
(215 ILCS 5/370e) (from Ch. 73, par. 982e) | ||
Sec. 370e. Companies which issue group accident and health | ||
policies or blanket accident and health plans to employer | ||
groups in this State shall provide the employer with notice of | ||
termination of a group or blanket accident and health plan | ||
because of the employer's failure to pay the premium when due. | ||
The insurance company shall file send a copy of such notice | ||
with to the Department in an electronic format either through | ||
the System for Electronic Rate and Form Filing (SERFF) or as | ||
otherwise prescribed by the Director . | ||
(Source: P.A. 83-1006.) |
(215 ILCS 5/370i) (from Ch. 73, par. 982i) | ||
Sec. 370i. Policies, agreements or arrangements with | ||
incentives or limits on reimbursement authorized. | ||
(a) Policies, agreements or arrangements issued under this | ||
Article may not contain terms or conditions that would operate | ||
unreasonably to restrict the access and availability of health | ||
care services for the insured. | ||
(b) An insurer or administrator may: | ||
(1) enter into agreements with certain providers of | ||
its choice relating to health care services which may be | ||
rendered to insureds or beneficiaries of the insurer or | ||
administrator, including agreements relating to the | ||
amounts to be charged the insureds or beneficiaries for | ||
services rendered; | ||
(2) issue or administer programs, policies or | ||
subscriber contracts in this State that include incentives | ||
for the insured or beneficiary to utilize the services of | ||
a provider which has entered into an agreement with the | ||
insurer or administrator pursuant to paragraph (1) above. | ||
(c) (Blank). After the effective date of this amendatory | ||
Act of the 92nd General Assembly, any insurer that arranges, | ||
contracts with, or administers contracts with a provider | ||
whereby beneficiaries are provided an incentive to use the | ||
services of such provider must include the following | ||
disclosure on its contracts and evidences of coverage: | ||
"WARNING, LIMITED BENEFITS WILL BE PAID WHEN NON-PARTICIPATING |
PROVIDERS ARE USED. You should be aware that when you elect to | ||
utilize the services of a non-participating provider for a | ||
covered service in non-emergency situations, benefit payments | ||
to such non-participating provider are not based upon the | ||
amount billed. The basis of your benefit payment will be | ||
determined according to your policy's fee schedule, usual and | ||
customary charge (which is determined by comparing charges for | ||
similar services adjusted to the geographical area where the | ||
services are performed), or other method as defined by the | ||
policy. YOU CAN EXPECT TO PAY MORE THAN THE COINSURANCE AMOUNT | ||
DEFINED IN THE POLICY AFTER THE PLAN HAS PAID ITS REQUIRED | ||
PORTION. Non-participating providers may bill members for any | ||
amount up to the billed charge after the plan has paid its | ||
portion of the bill. Participating providers have agreed to | ||
accept discounted payments for services with no additional | ||
billing to the member other than co-insurance and deductible | ||
amounts. You may obtain further information about the | ||
participating status of professional providers and information | ||
on out-of-pocket expenses by calling the toll free telephone | ||
number on your identification card.". | ||
(Source: P.A. 92-579, eff. 1-1-03.) | ||
(215 ILCS 5/408) (from Ch. 73, par. 1020) | ||
(Text of Section before amendment by P.A. 103-75 ) | ||
Sec. 408. Fees and charges. | ||
(1) The Director shall charge, collect and give proper |
acquittances for the payment of the following fees and | ||
charges: | ||
(a) For filing all documents submitted for the | ||
incorporation or organization or certification of a | ||
domestic company, except for a fraternal benefit society, | ||
$2,000. | ||
(b) For filing all documents submitted for the | ||
incorporation or organization of a fraternal benefit | ||
society, $500. | ||
(c) For filing amendments to articles of incorporation | ||
and amendments to declaration of organization, except for | ||
a fraternal benefit society, a mutual benefit association, | ||
a burial society or a farm mutual, $200. | ||
(d) For filing amendments to articles of incorporation | ||
of a fraternal benefit society, a mutual benefit | ||
association or a burial society, $100. | ||
(e) For filing amendments to articles of incorporation | ||
of a farm mutual, $50. | ||
(f) For filing bylaws or amendments thereto, $50. | ||
(g) For filing agreement of merger or consolidation: | ||
(i) for a domestic company, except for a fraternal | ||
benefit society, a mutual benefit association, a | ||
burial society, or a farm mutual, $2,000. | ||
(ii) for a foreign or alien company, except for a | ||
fraternal benefit society, $600. | ||
(iii) for a fraternal benefit society, a mutual |
benefit association, a burial society, or a farm | ||
mutual, $200. | ||
(h) For filing agreements of reinsurance by a domestic | ||
company, $200. | ||
(i) For filing all documents submitted by a foreign or | ||
alien company to be admitted to transact business or | ||
accredited as a reinsurer in this State, except for a | ||
fraternal benefit society, $5,000. | ||
(j) For filing all documents submitted by a foreign or | ||
alien fraternal benefit society to be admitted to transact | ||
business in this State, $500. | ||
(k) For filing declaration of withdrawal of a foreign | ||
or alien company, $50. | ||
(l) For filing annual statement by a domestic company, | ||
except a fraternal benefit society, a mutual benefit | ||
association, a burial society, or a farm mutual, $200. | ||
(m) For filing annual statement by a domestic | ||
fraternal benefit society, $100. | ||
(n) For filing annual statement by a farm mutual, a | ||
mutual benefit association, or a burial society, $50. | ||
(o) For issuing a certificate of authority or renewal | ||
thereof except to a foreign fraternal benefit society, | ||
$400. | ||
(p) For issuing a certificate of authority or renewal | ||
thereof to a foreign fraternal benefit society, $200. | ||
(q) For issuing an amended certificate of authority, |
$50. | ||
(r) For each certified copy of certificate of | ||
authority, $20. | ||
(s) For each certificate of deposit, or valuation, or | ||
compliance or surety certificate, $20. | ||
(t) For copies of papers or records per page, $1. | ||
(u) For each certification to copies of papers or | ||
records, $10. | ||
(v) For multiple copies of documents or certificates | ||
listed in subparagraphs (r), (s), and (u) of paragraph (1) | ||
of this Section, $10 for the first copy of a certificate of | ||
any type and $5 for each additional copy of the same | ||
certificate requested at the same time, unless, pursuant | ||
to paragraph (2) of this Section, the Director finds these | ||
additional fees excessive. | ||
(w) For issuing a permit to sell shares or increase | ||
paid-up capital: | ||
(i) in connection with a public stock offering, | ||
$300; | ||
(ii) in any other case, $100. | ||
(x) For issuing any other certificate required or | ||
permissible under the law, $50. | ||
(y) For filing a plan of exchange of the stock of a | ||
domestic stock insurance company, a plan of | ||
demutualization of a domestic mutual company, or a plan of | ||
reorganization under Article XII, $2,000. |
(z) For filing a statement of acquisition of a | ||
domestic company as defined in Section 131.4 of this Code, | ||
$2,000. | ||
(aa) For filing an agreement to purchase the business | ||
of an organization authorized under the Dental Service | ||
Plan Act or the Voluntary Health Services Plans Act or of a | ||
health maintenance organization or a limited health | ||
service organization, $2,000. | ||
(bb) For filing a statement of acquisition of a | ||
foreign or alien insurance company as defined in Section | ||
131.12a of this Code, $1,000. | ||
(cc) For filing a registration statement as required | ||
in Sections 131.13 and 131.14, the notification as | ||
required by Sections 131.16, 131.20a, or 141.4, or an | ||
agreement or transaction required by Sections 124.2(2), | ||
141, 141a, or 141.1, $200. | ||
(dd) For filing an application for licensing of: | ||
(i) a religious or charitable risk pooling trust | ||
or a workers' compensation pool, $1,000; | ||
(ii) a workers' compensation service company, | ||
$500; | ||
(iii) a self-insured automobile fleet, $200; or | ||
(iv) a renewal of or amendment of any license | ||
issued pursuant to (i), (ii), or (iii) above, $100. | ||
(ee) For filing articles of incorporation for a | ||
syndicate to engage in the business of insurance through |
the Illinois Insurance Exchange, $2,000. | ||
(ff) For filing amended articles of incorporation for | ||
a syndicate engaged in the business of insurance through | ||
the Illinois Insurance Exchange, $100. | ||
(gg) For filing articles of incorporation for a | ||
limited syndicate to join with other subscribers or | ||
limited syndicates to do business through the Illinois | ||
Insurance Exchange, $1,000. | ||
(hh) For filing amended articles of incorporation for | ||
a limited syndicate to do business through the Illinois | ||
Insurance Exchange, $100. | ||
(ii) For a permit to solicit subscriptions to a | ||
syndicate or limited syndicate, $100. | ||
(jj) For the filing of each form as required in | ||
Section 143 of this Code, $50 per form. Informational and | ||
advertising filings shall be $25 per filing. The fee for | ||
advisory and rating organizations shall be $200 per form. | ||
(i) For the purposes of the form filing fee, | ||
filings made on insert page basis will be considered | ||
one form at the time of its original submission. | ||
Changes made to a form subsequent to its approval | ||
shall be considered a new filing. | ||
(ii) Only one fee shall be charged for a form, | ||
regardless of the number of other forms or policies | ||
with which it will be used. | ||
(iii) Fees charged for a policy filed as it will be |
issued regardless of the number of forms comprising | ||
that policy shall not exceed $1,500. For advisory or | ||
rating organizations, fees charged for a policy filed | ||
as it will be issued regardless of the number of forms | ||
comprising that policy shall not exceed $2,500. | ||
(iv) The Director may by rule exempt forms from | ||
such fees. | ||
(kk) For filing an application for licensing of a | ||
reinsurance intermediary, $500. | ||
(ll) For filing an application for renewal of a | ||
license of a reinsurance intermediary, $200. | ||
(mm) For filing a plan of division of a domestic stock | ||
company under Article IIB, $100,000 $10,000 . | ||
(nn) For filing all documents submitted by a foreign | ||
or alien company to be a certified reinsurer in this | ||
State, except for a fraternal benefit society, $1,000. | ||
(oo) For filing a renewal by a foreign or alien | ||
company to be a certified reinsurer in this State, except | ||
for a fraternal benefit society, $400. | ||
(pp) For filing all documents submitted by a reinsurer | ||
domiciled in a reciprocal jurisdiction, $1,000. | ||
(qq) For filing a renewal by a reinsurer domiciled in | ||
a reciprocal jurisdiction, $400. | ||
(rr) For registering a captive management company or | ||
renewal thereof, $50. | ||
(2) When printed copies or numerous copies of the same |
paper or records are furnished or certified, the Director may | ||
reduce such fees for copies if he finds them excessive. He may, | ||
when he considers it in the public interest, furnish without | ||
charge to state insurance departments and persons other than | ||
companies, copies or certified copies of reports of | ||
examinations and of other papers and records. | ||
(3) The expenses incurred in any performance examination | ||
authorized by law shall be paid by the company or person being | ||
examined. The charge shall be reasonably related to the cost | ||
of the examination including but not limited to compensation | ||
of examiners, electronic data processing costs, supervision | ||
and preparation of an examination report and lodging and | ||
travel expenses. All lodging and travel expenses shall be in | ||
accord with the applicable travel regulations as published by | ||
the Department of Central Management Services and approved by | ||
the Governor's Travel Control Board, except that out-of-state | ||
lodging and travel expenses related to examinations authorized | ||
under Section 132 shall be in accordance with travel rates | ||
prescribed under paragraph 301-7.2 of the Federal Travel | ||
Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement of | ||
subsistence expenses incurred during official travel. All | ||
lodging and travel expenses may be reimbursed directly upon | ||
authorization of the Director. With the exception of the | ||
direct reimbursements authorized by the Director, all | ||
performance examination charges collected by the Department | ||
shall be paid to the Insurance Producer Administration Fund, |
however, the electronic data processing costs incurred by the | ||
Department in the performance of any examination shall be | ||
billed directly to the company being examined for payment to | ||
the Technology Management Revolving Fund. | ||
(4) At the time of any service of process on the Director | ||
as attorney for such service, the Director shall charge and | ||
collect the sum of $40, which may be recovered as taxable costs | ||
by the party to the suit or action causing such service to be | ||
made if he prevails in such suit or action. | ||
(5) (a) The costs incurred by the Department of Insurance | ||
in conducting any hearing authorized by law shall be assessed | ||
against the parties to the hearing in such proportion as the | ||
Director of Insurance may determine upon consideration of all | ||
relevant circumstances including: (1) the nature of the | ||
hearing; (2) whether the hearing was instigated by, or for the | ||
benefit of a particular party or parties; (3) whether there is | ||
a successful party on the merits of the proceeding; and (4) the | ||
relative levels of participation by the parties. | ||
(b) For purposes of this subsection (5) costs incurred | ||
shall mean the hearing officer fees, court reporter fees, and | ||
travel expenses of Department of Insurance officers and | ||
employees; provided however, that costs incurred shall not | ||
include hearing officer fees or court reporter fees unless the | ||
Department has retained the services of independent | ||
contractors or outside experts to perform such functions. | ||
(c) The Director shall make the assessment of costs |
incurred as part of the final order or decision arising out of | ||
the proceeding; provided, however, that such order or decision | ||
shall include findings and conclusions in support of the | ||
assessment of costs. This subsection (5) shall not be | ||
construed as permitting the payment of travel expenses unless | ||
calculated in accordance with the applicable travel | ||
regulations of the Department of Central Management Services, | ||
as approved by the Governor's Travel Control Board. The | ||
Director as part of such order or decision shall require all | ||
assessments for hearing officer fees and court reporter fees, | ||
if any, to be paid directly to the hearing officer or court | ||
reporter by the party(s) assessed for such costs. The | ||
assessments for travel expenses of Department officers and | ||
employees shall be reimbursable to the Director of Insurance | ||
for deposit to the fund out of which those expenses had been | ||
paid. | ||
(d) The provisions of this subsection (5) shall apply in | ||
the case of any hearing conducted by the Director of Insurance | ||
not otherwise specifically provided for by law. | ||
(6) The Director shall charge and collect an annual | ||
financial regulation fee from every domestic company for | ||
examination and analysis of its financial condition and to | ||
fund the internal costs and expenses of the Interstate | ||
Insurance Receivership Commission as may be allocated to the | ||
State of Illinois and companies doing an insurance business in | ||
this State pursuant to Article X of the Interstate Insurance |
Receivership Compact. The fee shall be the greater fixed | ||
amount based upon the combination of nationwide direct premium | ||
income and nationwide reinsurance assumed premium income or | ||
upon admitted assets calculated under this subsection as | ||
follows: | ||
(a) Combination of nationwide direct premium income | ||
and nationwide reinsurance assumed premium. | ||
(i) $150, if the premium is less than $500,000 and | ||
there is no reinsurance assumed premium; | ||
(ii) $750, if the premium is $500,000 or more, but | ||
less than $5,000,000 and there is no reinsurance | ||
assumed premium; or if the premium is less than | ||
$5,000,000 and the reinsurance assumed premium is less | ||
than $10,000,000; | ||
(iii) $3,750, if the premium is less than | ||
$5,000,000 and the reinsurance assumed premium is | ||
$10,000,000 or more; | ||
(iv) $7,500, if the premium is $5,000,000 or more, | ||
but less than $10,000,000; | ||
(v) $18,000, if the premium is $10,000,000 or | ||
more, but less than $25,000,000; | ||
(vi) $22,500, if the premium is $25,000,000 or | ||
more, but less than $50,000,000; | ||
(vii) $30,000, if the premium is $50,000,000 or | ||
more, but less than $100,000,000; | ||
(viii) $37,500, if the premium is $100,000,000 or |
more. | ||
(b) Admitted assets. | ||
(i) $150, if admitted assets are less than | ||
$1,000,000; | ||
(ii) $750, if admitted assets are $1,000,000 or | ||
more, but less than $5,000,000; | ||
(iii) $3,750, if admitted assets are $5,000,000 or | ||
more, but less than $25,000,000; | ||
(iv) $7,500, if admitted assets are $25,000,000 or | ||
more, but less than $50,000,000; | ||
(v) $18,000, if admitted assets are $50,000,000 or | ||
more, but less than $100,000,000; | ||
(vi) $22,500, if admitted assets are $100,000,000 | ||
or more, but less than $500,000,000; | ||
(vii) $30,000, if admitted assets are $500,000,000 | ||
or more, but less than $1,000,000,000; | ||
(viii) $37,500, if admitted assets are | ||
$1,000,000,000 or more. | ||
(c) The sum of financial regulation fees charged to | ||
the domestic companies of the same affiliated group shall | ||
not exceed $250,000 in the aggregate in any single year | ||
and shall be billed by the Director to the member company | ||
designated by the group. | ||
(7) The Director shall charge and collect an annual | ||
financial regulation fee from every foreign or alien company, | ||
except fraternal benefit societies, for the examination and |
analysis of its financial condition and to fund the internal | ||
costs and expenses of the Interstate Insurance Receivership | ||
Commission as may be allocated to the State of Illinois and | ||
companies doing an insurance business in this State pursuant | ||
to Article X of the Interstate Insurance Receivership Compact. | ||
The fee shall be a fixed amount based upon Illinois direct | ||
premium income and nationwide reinsurance assumed premium | ||
income in accordance with the following schedule: | ||
(a) $150, if the premium is less than $500,000 and | ||
there is no reinsurance assumed premium; | ||
(b) $750, if the premium is $500,000 or more, but less | ||
than $5,000,000 and there is no reinsurance assumed | ||
premium; or if the premium is less than $5,000,000 and the | ||
reinsurance assumed premium is less than $10,000,000; | ||
(c) $3,750, if the premium is less than $5,000,000 and | ||
the reinsurance assumed premium is $10,000,000 or more; | ||
(d) $7,500, if the premium is $5,000,000 or more, but | ||
less than $10,000,000; | ||
(e) $18,000, if the premium is $10,000,000 or more, | ||
but less than $25,000,000; | ||
(f) $22,500, if the premium is $25,000,000 or more, | ||
but less than $50,000,000; | ||
(g) $30,000, if the premium is $50,000,000 or more, | ||
but less than $100,000,000; | ||
(h) $37,500, if the premium is $100,000,000 or more. | ||
The sum of financial regulation fees under this subsection |
(7) charged to the foreign or alien companies within the same | ||
affiliated group shall not exceed $250,000 in the aggregate in | ||
any single year and shall be billed by the Director to the | ||
member company designated by the group. | ||
(8) Beginning January 1, 1992, the financial regulation | ||
fees imposed under subsections (6) and (7) of this Section | ||
shall be paid by each company or domestic affiliated group | ||
annually. After January 1, 1994, the fee shall be billed by | ||
Department invoice based upon the company's premium income or | ||
admitted assets as shown in its annual statement for the | ||
preceding calendar year. The invoice is due upon receipt and | ||
must be paid no later than June 30 of each calendar year. All | ||
financial regulation fees collected by the Department shall be | ||
paid to the Insurance Financial Regulation Fund. The | ||
Department may not collect financial examiner per diem charges | ||
from companies subject to subsections (6) and (7) of this | ||
Section undergoing financial examination after June 30, 1992. | ||
(9) In addition to the financial regulation fee required | ||
by this Section, a company undergoing any financial | ||
examination authorized by law shall pay the following costs | ||
and expenses incurred by the Department: electronic data | ||
processing costs, the expenses authorized under Section 131.21 | ||
and subsection (d) of Section 132.4 of this Code, and lodging | ||
and travel expenses. | ||
Electronic data processing costs incurred by the | ||
Department in the performance of any examination shall be |
billed directly to the company undergoing examination for | ||
payment to the Technology Management Revolving Fund. Except | ||
for direct reimbursements authorized by the Director or direct | ||
payments made under Section 131.21 or subsection (d) of | ||
Section 132.4 of this Code, all financial regulation fees and | ||
all financial examination charges collected by the Department | ||
shall be paid to the Insurance Financial Regulation Fund. | ||
All lodging and travel expenses shall be in accordance | ||
with applicable travel regulations published by the Department | ||
of Central Management Services and approved by the Governor's | ||
Travel Control Board, except that out-of-state lodging and | ||
travel expenses related to examinations authorized under | ||
Sections 132.1 through 132.7 shall be in accordance with | ||
travel rates prescribed under paragraph 301-7.2 of the Federal | ||
Travel Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement | ||
of subsistence expenses incurred during official travel. All | ||
lodging and travel expenses may be reimbursed directly upon | ||
the authorization of the Director. | ||
In the case of an organization or person not subject to the | ||
financial regulation fee, the expenses incurred in any | ||
financial examination authorized by law shall be paid by the | ||
organization or person being examined. The charge shall be | ||
reasonably related to the cost of the examination including, | ||
but not limited to, compensation of examiners and other costs | ||
described in this subsection. | ||
(10) Any company, person, or entity failing to make any |
payment of $150 or more as required under this Section shall be | ||
subject to the penalty and interest provisions provided for in | ||
subsections (4) and (7) of Section 412. | ||
(11) Unless otherwise specified, all of the fees collected | ||
under this Section shall be paid into the Insurance Financial | ||
Regulation Fund. | ||
(12) For purposes of this Section: | ||
(a) "Domestic company" means a company as defined in | ||
Section 2 of this Code which is incorporated or organized | ||
under the laws of this State, and in addition includes a | ||
not-for-profit corporation authorized under the Dental | ||
Service Plan Act or the Voluntary Health Services Plans | ||
Act, a health maintenance organization, and a limited | ||
health service organization. | ||
(b) "Foreign company" means a company as defined in | ||
Section 2 of this Code which is incorporated or organized | ||
under the laws of any state of the United States other than | ||
this State and in addition includes a health maintenance | ||
organization and a limited health service organization | ||
which is incorporated or organized under the laws of any | ||
state of the United States other than this State. | ||
(c) "Alien company" means a company as defined in | ||
Section 2 of this Code which is incorporated or organized | ||
under the laws of any country other than the United | ||
States. | ||
(d) "Fraternal benefit society" means a corporation, |
society, order, lodge or voluntary association as defined | ||
in Section 282.1 of this Code. | ||
(e) "Mutual benefit association" means a company, | ||
association or corporation authorized by the Director to | ||
do business in this State under the provisions of Article | ||
XVIII of this Code. | ||
(f) "Burial society" means a person, firm, | ||
corporation, society or association of individuals | ||
authorized by the Director to do business in this State | ||
under the provisions of Article XIX of this Code. | ||
(g) "Farm mutual" means a district, county and | ||
township mutual insurance company authorized by the | ||
Director to do business in this State under the provisions | ||
of the Farm Mutual Insurance Company Act of 1986. | ||
(Source: P.A. 102-775, eff. 5-13-22.) | ||
(Text of Section after amendment by P.A. 103-75 ) | ||
Sec. 408. Fees and charges. | ||
(1) The Director shall charge, collect and give proper | ||
acquittances for the payment of the following fees and | ||
charges: | ||
(a) For filing all documents submitted for the | ||
incorporation or organization or certification of a | ||
domestic company, except for a fraternal benefit society, | ||
$2,000. | ||
(b) For filing all documents submitted for the |
incorporation or organization of a fraternal benefit | ||
society, $500. | ||
(c) For filing amendments to articles of incorporation | ||
and amendments to declaration of organization, except for | ||
a fraternal benefit society, a mutual benefit association, | ||
a burial society or a farm mutual, $200. | ||
(d) For filing amendments to articles of incorporation | ||
of a fraternal benefit society, a mutual benefit | ||
association or a burial society, $100. | ||
(e) For filing amendments to articles of incorporation | ||
of a farm mutual, $50. | ||
(f) For filing bylaws or amendments thereto, $50. | ||
(g) For filing agreement of merger or consolidation: | ||
(i) for a domestic company, except for a fraternal | ||
benefit society, a mutual benefit association, a | ||
burial society, or a farm mutual, $2,000. | ||
(ii) for a foreign or alien company, except for a | ||
fraternal benefit society, $600. | ||
(iii) for a fraternal benefit society, a mutual | ||
benefit association, a burial society, or a farm | ||
mutual, $200. | ||
(h) For filing agreements of reinsurance by a domestic | ||
company, $200. | ||
(i) For filing all documents submitted by a foreign or | ||
alien company to be admitted to transact business or | ||
accredited as a reinsurer in this State, except for a |
fraternal benefit society, $5,000. | ||
(j) For filing all documents submitted by a foreign or | ||
alien fraternal benefit society to be admitted to transact | ||
business in this State, $500. | ||
(k) For filing declaration of withdrawal of a foreign | ||
or alien company, $50. | ||
(l) For filing annual statement by a domestic company, | ||
except a fraternal benefit society, a mutual benefit | ||
association, a burial society, or a farm mutual, $200. | ||
(m) For filing annual statement by a domestic | ||
fraternal benefit society, $100. | ||
(n) For filing annual statement by a farm mutual, a | ||
mutual benefit association, or a burial society, $50. | ||
(o) For issuing a certificate of authority or renewal | ||
thereof except to a foreign fraternal benefit society, | ||
$400. | ||
(p) For issuing a certificate of authority or renewal | ||
thereof to a foreign fraternal benefit society, $200. | ||
(q) For issuing an amended certificate of authority, | ||
$50. | ||
(r) For each certified copy of certificate of | ||
authority, $20. | ||
(s) For each certificate of deposit, or valuation, or | ||
compliance or surety certificate, $20. | ||
(t) For copies of papers or records per page, $1. | ||
(u) For each certification to copies of papers or |
records, $10. | ||
(v) For multiple copies of documents or certificates | ||
listed in subparagraphs (r), (s), and (u) of paragraph (1) | ||
of this Section, $10 for the first copy of a certificate of | ||
any type and $5 for each additional copy of the same | ||
certificate requested at the same time, unless, pursuant | ||
to paragraph (2) of this Section, the Director finds these | ||
additional fees excessive. | ||
(w) For issuing a permit to sell shares or increase | ||
paid-up capital: | ||
(i) in connection with a public stock offering, | ||
$300; | ||
(ii) in any other case, $100. | ||
(x) For issuing any other certificate required or | ||
permissible under the law, $50. | ||
(y) For filing a plan of exchange of the stock of a | ||
domestic stock insurance company, a plan of | ||
demutualization of a domestic mutual company, or a plan of | ||
reorganization under Article XII, $2,000. | ||
(z) For filing a statement of acquisition of a | ||
domestic company as defined in Section 131.4 of this Code, | ||
$2,000. | ||
(aa) For filing an agreement to purchase the business | ||
of an organization authorized under the Dental Service | ||
Plan Act or the Voluntary Health Services Plans Act or of a | ||
health maintenance organization or a limited health |
service organization, $2,000. | ||
(bb) For filing a statement of acquisition of a | ||
foreign or alien insurance company as defined in Section | ||
131.12a of this Code, $1,000. | ||
(cc) For filing a registration statement as required | ||
in Sections 131.13 and 131.14, the notification as | ||
required by Sections 131.16, 131.20a, or 141.4, or an | ||
agreement or transaction required by Sections 124.2(2), | ||
141, 141a, or 141.1, $200. | ||
(dd) For filing an application for licensing of: | ||
(i) a religious or charitable risk pooling trust | ||
or a workers' compensation pool, $1,000; | ||
(ii) a workers' compensation service company, | ||
$500; | ||
(iii) a self-insured automobile fleet, $200; or | ||
(iv) a renewal of or amendment of any license | ||
issued pursuant to (i), (ii), or (iii) above, $100. | ||
(ee) For filing articles of incorporation for a | ||
syndicate to engage in the business of insurance through | ||
the Illinois Insurance Exchange, $2,000. | ||
(ff) For filing amended articles of incorporation for | ||
a syndicate engaged in the business of insurance through | ||
the Illinois Insurance Exchange, $100. | ||
(gg) For filing articles of incorporation for a | ||
limited syndicate to join with other subscribers or | ||
limited syndicates to do business through the Illinois |
Insurance Exchange, $1,000. | ||
(hh) For filing amended articles of incorporation for | ||
a limited syndicate to do business through the Illinois | ||
Insurance Exchange, $100. | ||
(ii) For a permit to solicit subscriptions to a | ||
syndicate or limited syndicate, $100. | ||
(jj) For the filing of each form as required in | ||
Section 143 of this Code, $50 per form. Informational and | ||
advertising filings shall be $25 per filing. The fee for | ||
advisory and rating organizations shall be $200 per form. | ||
(i) For the purposes of the form filing fee, | ||
filings made on insert page basis will be considered | ||
one form at the time of its original submission. | ||
Changes made to a form subsequent to its approval | ||
shall be considered a new filing. | ||
(ii) Only one fee shall be charged for a form, | ||
regardless of the number of other forms or policies | ||
with which it will be used. | ||
(iii) Fees charged for a policy filed as it will be | ||
issued regardless of the number of forms comprising | ||
that policy shall not exceed $1,500. For advisory or | ||
rating organizations, fees charged for a policy filed | ||
as it will be issued regardless of the number of forms | ||
comprising that policy shall not exceed $2,500. | ||
(iv) The Director may by rule exempt forms from | ||
such fees. |
(kk) For filing an application for licensing of a | ||
reinsurance intermediary, $500. | ||
(ll) For filing an application for renewal of a | ||
license of a reinsurance intermediary, $200. | ||
(mm) For filing a plan of division of a domestic stock | ||
company under Article IIB, $100,000 $10,000 . | ||
(nn) For filing all documents submitted by a foreign | ||
or alien company to be a certified reinsurer in this | ||
State, except for a fraternal benefit society, $1,000. | ||
(oo) For filing a renewal by a foreign or alien | ||
company to be a certified reinsurer in this State, except | ||
for a fraternal benefit society, $400. | ||
(pp) For filing all documents submitted by a reinsurer | ||
domiciled in a reciprocal jurisdiction, $1,000. | ||
(qq) For filing a renewal by a reinsurer domiciled in | ||
a reciprocal jurisdiction, $400. | ||
(rr) For registering a captive management company or | ||
renewal thereof, $50. | ||
(ss) For filing an insurance business transfer plan | ||
under Article XLVII, $100,000 $25,000 . | ||
(2) When printed copies or numerous copies of the same | ||
paper or records are furnished or certified, the Director may | ||
reduce such fees for copies if he finds them excessive. He may, | ||
when he considers it in the public interest, furnish without | ||
charge to state insurance departments and persons other than | ||
companies, copies or certified copies of reports of |
examinations and of other papers and records. | ||
(3) The expenses incurred in any performance examination | ||
authorized by law shall be paid by the company or person being | ||
examined. The charge shall be reasonably related to the cost | ||
of the examination including but not limited to compensation | ||
of examiners, electronic data processing costs, supervision | ||
and preparation of an examination report and lodging and | ||
travel expenses. All lodging and travel expenses shall be in | ||
accord with the applicable travel regulations as published by | ||
the Department of Central Management Services and approved by | ||
the Governor's Travel Control Board, except that out-of-state | ||
lodging and travel expenses related to examinations authorized | ||
under Section 132 shall be in accordance with travel rates | ||
prescribed under paragraph 301-7.2 of the Federal Travel | ||
Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement of | ||
subsistence expenses incurred during official travel. All | ||
lodging and travel expenses may be reimbursed directly upon | ||
authorization of the Director. With the exception of the | ||
direct reimbursements authorized by the Director, all | ||
performance examination charges collected by the Department | ||
shall be paid to the Insurance Producer Administration Fund, | ||
however, the electronic data processing costs incurred by the | ||
Department in the performance of any examination shall be | ||
billed directly to the company being examined for payment to | ||
the Technology Management Revolving Fund. | ||
(4) At the time of any service of process on the Director |
as attorney for such service, the Director shall charge and | ||
collect the sum of $40, which may be recovered as taxable costs | ||
by the party to the suit or action causing such service to be | ||
made if he prevails in such suit or action. | ||
(5) (a) The costs incurred by the Department of Insurance | ||
in conducting any hearing authorized by law shall be assessed | ||
against the parties to the hearing in such proportion as the | ||
Director of Insurance may determine upon consideration of all | ||
relevant circumstances including: (1) the nature of the | ||
hearing; (2) whether the hearing was instigated by, or for the | ||
benefit of a particular party or parties; (3) whether there is | ||
a successful party on the merits of the proceeding; and (4) the | ||
relative levels of participation by the parties. | ||
(b) For purposes of this subsection (5) costs incurred | ||
shall mean the hearing officer fees, court reporter fees, and | ||
travel expenses of Department of Insurance officers and | ||
employees; provided however, that costs incurred shall not | ||
include hearing officer fees or court reporter fees unless the | ||
Department has retained the services of independent | ||
contractors or outside experts to perform such functions. | ||
(c) The Director shall make the assessment of costs | ||
incurred as part of the final order or decision arising out of | ||
the proceeding; provided, however, that such order or decision | ||
shall include findings and conclusions in support of the | ||
assessment of costs. This subsection (5) shall not be | ||
construed as permitting the payment of travel expenses unless |
calculated in accordance with the applicable travel | ||
regulations of the Department of Central Management Services, | ||
as approved by the Governor's Travel Control Board. The | ||
Director as part of such order or decision shall require all | ||
assessments for hearing officer fees and court reporter fees, | ||
if any, to be paid directly to the hearing officer or court | ||
reporter by the party(s) assessed for such costs. The | ||
assessments for travel expenses of Department officers and | ||
employees shall be reimbursable to the Director of Insurance | ||
for deposit to the fund out of which those expenses had been | ||
paid. | ||
(d) The provisions of this subsection (5) shall apply in | ||
the case of any hearing conducted by the Director of Insurance | ||
not otherwise specifically provided for by law. | ||
(6) The Director shall charge and collect an annual | ||
financial regulation fee from every domestic company for | ||
examination and analysis of its financial condition and to | ||
fund the internal costs and expenses of the Interstate | ||
Insurance Receivership Commission as may be allocated to the | ||
State of Illinois and companies doing an insurance business in | ||
this State pursuant to Article X of the Interstate Insurance | ||
Receivership Compact. The fee shall be the greater fixed | ||
amount based upon the combination of nationwide direct premium | ||
income and nationwide reinsurance assumed premium income or | ||
upon admitted assets calculated under this subsection as | ||
follows: |
(a) Combination of nationwide direct premium income | ||
and nationwide reinsurance assumed premium. | ||
(i) $150, if the premium is less than $500,000 and | ||
there is no reinsurance assumed premium; | ||
(ii) $750, if the premium is $500,000 or more, but | ||
less than $5,000,000 and there is no reinsurance | ||
assumed premium; or if the premium is less than | ||
$5,000,000 and the reinsurance assumed premium is less | ||
than $10,000,000; | ||
(iii) $3,750, if the premium is less than | ||
$5,000,000 and the reinsurance assumed premium is | ||
$10,000,000 or more; | ||
(iv) $7,500, if the premium is $5,000,000 or more, | ||
but less than $10,000,000; | ||
(v) $18,000, if the premium is $10,000,000 or | ||
more, but less than $25,000,000; | ||
(vi) $22,500, if the premium is $25,000,000 or | ||
more, but less than $50,000,000; | ||
(vii) $30,000, if the premium is $50,000,000 or | ||
more, but less than $100,000,000; | ||
(viii) $37,500, if the premium is $100,000,000 or | ||
more. | ||
(b) Admitted assets. | ||
(i) $150, if admitted assets are less than | ||
$1,000,000; | ||
(ii) $750, if admitted assets are $1,000,000 or |
more, but less than $5,000,000; | ||
(iii) $3,750, if admitted assets are $5,000,000 or | ||
more, but less than $25,000,000; | ||
(iv) $7,500, if admitted assets are $25,000,000 or | ||
more, but less than $50,000,000; | ||
(v) $18,000, if admitted assets are $50,000,000 or | ||
more, but less than $100,000,000; | ||
(vi) $22,500, if admitted assets are $100,000,000 | ||
or more, but less than $500,000,000; | ||
(vii) $30,000, if admitted assets are $500,000,000 | ||
or more, but less than $1,000,000,000; | ||
(viii) $37,500, if admitted assets are | ||
$1,000,000,000 or more. | ||
(c) The sum of financial regulation fees charged to | ||
the domestic companies of the same affiliated group shall | ||
not exceed $250,000 in the aggregate in any single year | ||
and shall be billed by the Director to the member company | ||
designated by the group. | ||
(7) The Director shall charge and collect an annual | ||
financial regulation fee from every foreign or alien company, | ||
except fraternal benefit societies, for the examination and | ||
analysis of its financial condition and to fund the internal | ||
costs and expenses of the Interstate Insurance Receivership | ||
Commission as may be allocated to the State of Illinois and | ||
companies doing an insurance business in this State pursuant | ||
to Article X of the Interstate Insurance Receivership Compact. |
The fee shall be a fixed amount based upon Illinois direct | ||
premium income and nationwide reinsurance assumed premium | ||
income in accordance with the following schedule: | ||
(a) $150, if the premium is less than $500,000 and | ||
there is no reinsurance assumed premium; | ||
(b) $750, if the premium is $500,000 or more, but less | ||
than $5,000,000 and there is no reinsurance assumed | ||
premium; or if the premium is less than $5,000,000 and the | ||
reinsurance assumed premium is less than $10,000,000; | ||
(c) $3,750, if the premium is less than $5,000,000 and | ||
the reinsurance assumed premium is $10,000,000 or more; | ||
(d) $7,500, if the premium is $5,000,000 or more, but | ||
less than $10,000,000; | ||
(e) $18,000, if the premium is $10,000,000 or more, | ||
but less than $25,000,000; | ||
(f) $22,500, if the premium is $25,000,000 or more, | ||
but less than $50,000,000; | ||
(g) $30,000, if the premium is $50,000,000 or more, | ||
but less than $100,000,000; | ||
(h) $37,500, if the premium is $100,000,000 or more. | ||
The sum of financial regulation fees under this subsection | ||
(7) charged to the foreign or alien companies within the same | ||
affiliated group shall not exceed $250,000 in the aggregate in | ||
any single year and shall be billed by the Director to the | ||
member company designated by the group. | ||
(8) Beginning January 1, 1992, the financial regulation |
fees imposed under subsections (6) and (7) of this Section | ||
shall be paid by each company or domestic affiliated group | ||
annually. After January 1, 1994, the fee shall be billed by | ||
Department invoice based upon the company's premium income or | ||
admitted assets as shown in its annual statement for the | ||
preceding calendar year. The invoice is due upon receipt and | ||
must be paid no later than June 30 of each calendar year. All | ||
financial regulation fees collected by the Department shall be | ||
paid to the Insurance Financial Regulation Fund. The | ||
Department may not collect financial examiner per diem charges | ||
from companies subject to subsections (6) and (7) of this | ||
Section undergoing financial examination after June 30, 1992. | ||
(9) In addition to the financial regulation fee required | ||
by this Section, a company undergoing any financial | ||
examination authorized by law shall pay the following costs | ||
and expenses incurred by the Department: electronic data | ||
processing costs, the expenses authorized under Section 131.21 | ||
and subsection (d) of Section 132.4 of this Code, and lodging | ||
and travel expenses. | ||
Electronic data processing costs incurred by the | ||
Department in the performance of any examination shall be | ||
billed directly to the company undergoing examination for | ||
payment to the Technology Management Revolving Fund. Except | ||
for direct reimbursements authorized by the Director or direct | ||
payments made under Section 131.21 or subsection (d) of | ||
Section 132.4 of this Code, all financial regulation fees and |
all financial examination charges collected by the Department | ||
shall be paid to the Insurance Financial Regulation Fund. | ||
All lodging and travel expenses shall be in accordance | ||
with applicable travel regulations published by the Department | ||
of Central Management Services and approved by the Governor's | ||
Travel Control Board, except that out-of-state lodging and | ||
travel expenses related to examinations authorized under | ||
Sections 132.1 through 132.7 shall be in accordance with | ||
travel rates prescribed under paragraph 301-7.2 of the Federal | ||
Travel Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement | ||
of subsistence expenses incurred during official travel. All | ||
lodging and travel expenses may be reimbursed directly upon | ||
the authorization of the Director. | ||
In the case of an organization or person not subject to the | ||
financial regulation fee, the expenses incurred in any | ||
financial examination authorized by law shall be paid by the | ||
organization or person being examined. The charge shall be | ||
reasonably related to the cost of the examination including, | ||
but not limited to, compensation of examiners and other costs | ||
described in this subsection. | ||
(10) Any company, person, or entity failing to make any | ||
payment of $150 or more as required under this Section shall be | ||
subject to the penalty and interest provisions provided for in | ||
subsections (4) and (7) of Section 412. | ||
(11) Unless otherwise specified, all of the fees collected | ||
under this Section shall be paid into the Insurance Financial |
Regulation Fund. | ||
(12) For purposes of this Section: | ||
(a) "Domestic company" means a company as defined in | ||
Section 2 of this Code which is incorporated or organized | ||
under the laws of this State, and in addition includes a | ||
not-for-profit corporation authorized under the Dental | ||
Service Plan Act or the Voluntary Health Services Plans | ||
Act, a health maintenance organization, and a limited | ||
health service organization. | ||
(b) "Foreign company" means a company as defined in | ||
Section 2 of this Code which is incorporated or organized | ||
under the laws of any state of the United States other than | ||
this State and in addition includes a health maintenance | ||
organization and a limited health service organization | ||
which is incorporated or organized under the laws of any | ||
state of the United States other than this State. | ||
(c) "Alien company" means a company as defined in | ||
Section 2 of this Code which is incorporated or organized | ||
under the laws of any country other than the United | ||
States. | ||
(d) "Fraternal benefit society" means a corporation, | ||
society, order, lodge or voluntary association as defined | ||
in Section 282.1 of this Code. | ||
(e) "Mutual benefit association" means a company, | ||
association or corporation authorized by the Director to | ||
do business in this State under the provisions of Article |
XVIII of this Code. | ||
(f) "Burial society" means a person, firm, | ||
corporation, society or association of individuals | ||
authorized by the Director to do business in this State | ||
under the provisions of Article XIX of this Code. | ||
(g) "Farm mutual" means a district, county and | ||
township mutual insurance company authorized by the | ||
Director to do business in this State under the provisions | ||
of the Farm Mutual Insurance Company Act of 1986. | ||
(Source: P.A. 102-775, eff. 5-13-22; 103-75, eff. 1-1-25.) | ||
(215 ILCS 5/412) (from Ch. 73, par. 1024) | ||
Sec. 412. Refunds; penalties; collection. | ||
(1)(a) Whenever it appears to the satisfaction of the | ||
Director that because of some mistake of fact, error in | ||
calculation, or erroneous interpretation of a statute of this | ||
or any other state, any authorized company, surplus line | ||
producer, or industrial insured has paid to him, pursuant to | ||
any provision of law, taxes, fees, or other charges in excess | ||
of the amount legally chargeable against it, during the 6-year | ||
6 year period immediately preceding the discovery of such | ||
overpayment, he shall have power to refund to such company, | ||
surplus line producer, or industrial insured the amount of the | ||
excess or excesses by applying the amount or amounts thereof | ||
toward the payment of taxes, fees, or other charges already | ||
due, or which may thereafter become due from that company |
until such excess or excesses have been fully refunded, or | ||
upon a written request from the authorized company, surplus | ||
line producer, or industrial insured, the Director shall | ||
provide a cash refund within 120 days after receipt of the | ||
written request if all necessary information has been filed | ||
with the Department in order for it to perform an audit of the | ||
tax report for the transaction or period or annual return for | ||
the year in which the overpayment occurred or within 120 days | ||
after the date the Department receives all the necessary | ||
information to perform such audit. The Director shall not | ||
provide a cash refund if there are insufficient funds in the | ||
Insurance Premium Tax Refund Fund to provide a cash refund, if | ||
the amount of the overpayment is less than $100, or if the | ||
amount of the overpayment can be fully offset against the | ||
taxpayer's estimated liability for the year following the year | ||
of the cash refund request. Any cash refund shall be paid from | ||
the Insurance Premium Tax Refund Fund, a special fund hereby | ||
created in the State treasury. | ||
(b) As determined by the Director pursuant to paragraph | ||
(a) of this subsection, the Department shall deposit an amount | ||
of cash refunds approved by the Director for payment as a | ||
result of overpayment of tax liability collected under | ||
Sections 121-2.08, 409, 444, 444.1, and 445 of this Code into | ||
the Insurance Premium Tax Refund Fund. | ||
(c) Beginning July 1, 1999, moneys in the Insurance | ||
Premium Tax Refund Fund shall be expended exclusively for the |
purpose of paying cash refunds resulting from overpayment of | ||
tax liability under Sections 121-2.08, 409, 444, 444.1, and | ||
445 of this Code as determined by the Director pursuant to | ||
subsection 1(a) of this Section. Cash refunds made in | ||
accordance with this Section may be made from the Insurance | ||
Premium Tax Refund Fund only to the extent that amounts have | ||
been deposited and retained in the Insurance Premium Tax | ||
Refund Fund. | ||
(d) This Section shall constitute an irrevocable and | ||
continuing appropriation from the Insurance Premium Tax Refund | ||
Fund for the purpose of paying cash refunds pursuant to the | ||
provisions of this Section. | ||
(2)(a) When any insurance company fails to file any tax | ||
return required under Sections 408.1, 409, 444, and 444.1 of | ||
this Code or Section 12 of the Fire Investigation Act on the | ||
date prescribed, including any extensions, there shall be | ||
added as a penalty $400 or 10% of the amount of such tax, | ||
whichever is greater, for each month or part of a month of | ||
failure to file, the entire penalty not to exceed $2,000 or 50% | ||
of the tax due, whichever is greater. In this paragraph, "tax | ||
due" means the full amount due for the applicable tax period | ||
under Section 408.1, 409, 444, or 444.1 of this Code or Section | ||
12 of the Fire Investigation Act. | ||
(b) When any industrial insured or surplus line producer | ||
fails to file any tax return or report required under Sections | ||
121-2.08 and 445 of this Code or Section 12 of the Fire |
Investigation Act on the date prescribed, including any | ||
extensions, there shall be added: | ||
(i) as a late fee, if the return or report is received | ||
at least one day but not more than 15 days after the | ||
prescribed due date, $50 or 5% of the tax due, whichever is | ||
greater, the entire fee not to exceed $1,000; | ||
(ii) as a late fee, if the return or report is received | ||
at least 16 days but not more than 30 days after the | ||
prescribed due date, $100 or 5% of the tax due, whichever | ||
is greater, the entire fee not to exceed $2,000; or | ||
(iii) as a penalty, if the return or report is | ||
received more than 30 days after the prescribed due date, | ||
$100 or 5% of the tax due, whichever is greater, for each | ||
month or part of a month of failure to file, the entire | ||
penalty not to exceed $500 or 30% of the tax due, whichever | ||
is greater. | ||
In this paragraph, "tax due" means the full amount due for | ||
the applicable tax period under Section 121-2.08 or 445 of | ||
this Code or Section 12 of the Fire Investigation Act. A tax | ||
return or report shall be deemed received as of the date mailed | ||
as evidenced by a postmark, proof of mailing on a recognized | ||
United States Postal Service form or a form acceptable to the | ||
United States Postal Service or other commercial mail delivery | ||
service, or other evidence acceptable to the Director. | ||
(3)(a) When any insurance company fails to pay the full | ||
amount due under the provisions of this Section, Sections |
408.1, 409, 444, or 444.1 of this Code, or Section 12 of the | ||
Fire Investigation Act, there shall be added to the amount due | ||
as a penalty an amount equal to 10% of the deficiency. | ||
(a-5) When any industrial insured or surplus line producer | ||
fails to pay the full amount due under the provisions of this | ||
Section, Sections 121-2.08 or 445 of this Code, or Section 12 | ||
of the Fire Investigation Act on the date prescribed, there | ||
shall be added: | ||
(i) as a late fee, if the payment is received at least | ||
one day but not more than 7 days after the prescribed due | ||
date, 10% of the tax due, the entire fee not to exceed | ||
$1,000; | ||
(ii) as a late fee, if the payment is received at least | ||
8 days but not more than 14 days after the prescribed due | ||
date, 10% of the tax due, the entire fee not to exceed | ||
$1,500; | ||
(iii) as a late fee, if the payment is received at | ||
least 15 days but not more than 21 days after the | ||
prescribed due date, 10% of the tax due, the entire fee not | ||
to exceed $2,000; or | ||
(iv) as a penalty, if the return or report is received | ||
more than 21 days after the prescribed due date, 10% of the | ||
tax due. | ||
In this paragraph, "tax due" means the full amount due for | ||
the applicable tax period under this Section, Section 121-2.08 | ||
or 445 of this Code, or Section 12 of the Fire Investigation |
Act. A tax payment shall be deemed received as of the date | ||
mailed as evidenced by a postmark, proof of mailing on a | ||
recognized United States Postal Service form or a form | ||
acceptable to the United States Postal Service or other | ||
commercial mail delivery service, or other evidence acceptable | ||
to the Director. | ||
(b) If such failure to pay is determined by the Director to | ||
be willful wilful , after a hearing under Sections 402 and 403, | ||
there shall be added to the tax as a penalty an amount equal to | ||
the greater of 50% of the deficiency or 10% of the amount due | ||
and unpaid for each month or part of a month that the | ||
deficiency remains unpaid commencing with the date that the | ||
amount becomes due. Such amount shall be in lieu of any | ||
determined under paragraph (a) or (a-5). | ||
(4) Any insurance company, industrial insured, or surplus | ||
line producer that fails to pay the full amount due under this | ||
Section or Sections 121-2.08, 408.1, 409, 444, 444.1, or 445 | ||
of this Code, or Section 12 of the Fire Investigation Act is | ||
liable, in addition to the tax and any late fees and penalties, | ||
for interest on such deficiency at the rate of 12% per annum, | ||
or at such higher adjusted rates as are or may be established | ||
under subsection (b) of Section 6621 of the Internal Revenue | ||
Code, from the date that payment of any such tax was due, | ||
determined without regard to any extensions, to the date of | ||
payment of such amount. | ||
(5) The Director, through the Attorney General, may |
institute an action in the name of the People of the State of | ||
Illinois, in any court of competent jurisdiction, for the | ||
recovery of the amount of such taxes, fees, and penalties due, | ||
and prosecute the same to final judgment, and take such steps | ||
as are necessary to collect the same. | ||
(6) In the event that the certificate of authority of a | ||
foreign or alien company is revoked for any cause or the | ||
company withdraws from this State prior to the renewal date of | ||
the certificate of authority as provided in Section 114, the | ||
company may recover the amount of any such tax paid in advance. | ||
Except as provided in this subsection, no revocation or | ||
withdrawal excuses payment of or constitutes grounds for the | ||
recovery of any taxes or penalties imposed by this Code. | ||
(7) When an insurance company or domestic affiliated group | ||
fails to pay the full amount of any fee of $200 or more due | ||
under Section 408 of this Code, there shall be added to the | ||
amount due as a penalty the greater of $100 or an amount equal | ||
to 10% of the deficiency for each month or part of a month that | ||
the deficiency remains unpaid. | ||
(8) The Department shall have a lien for the taxes, fees, | ||
charges, fines, penalties, interest, other charges, or any | ||
portion thereof, imposed or assessed pursuant to this Code, | ||
upon all the real and personal property of any company or | ||
person to whom the assessment or final order has been issued or | ||
whenever a tax return is filed without payment of the tax or | ||
penalty shown therein to be due, including all such property |
of the company or person acquired after receipt of the | ||
assessment, issuance of the order, or filing of the return. | ||
The company or person is liable for the filing fee incurred by | ||
the Department for filing the lien and the filing fee incurred | ||
by the Department to file the release of that lien. The filing | ||
fees shall be paid to the Department in addition to payment of | ||
the tax, fee, charge, fine, penalty, interest, other charges, | ||
or any portion thereof, included in the amount of the lien. | ||
However, where the lien arises because of the issuance of a | ||
final order of the Director or tax assessment by the | ||
Department, the lien shall not attach and the notice referred | ||
to in this Section shall not be filed until all administrative | ||
proceedings or proceedings in court for review of the final | ||
order or assessment have terminated or the time for the taking | ||
thereof has expired without such proceedings being instituted. | ||
Upon the granting of Department review after a lien has | ||
attached, the lien shall remain in full force except to the | ||
extent to which the final assessment may be reduced by a | ||
revised final assessment following the rehearing or review. | ||
The lien created by the issuance of a final assessment shall | ||
terminate, unless a notice of lien is filed, within 3 years | ||
after the date all proceedings in court for the review of the | ||
final assessment have terminated or the time for the taking | ||
thereof has expired without such proceedings being instituted, | ||
or (in the case of a revised final assessment issued pursuant | ||
to a rehearing or review by the Department) within 3 years |
after the date all proceedings in court for the review of such | ||
revised final assessment have terminated or the time for the | ||
taking thereof has expired without such proceedings being | ||
instituted. Where the lien results from the filing of a tax | ||
return without payment of the tax or penalty shown therein to | ||
be due, the lien shall terminate, unless a notice of lien is | ||
filed, within 3 years after the date when the return is filed | ||
with the Department. | ||
The time limitation period on the Department's right to | ||
file a notice of lien shall not run during any period of time | ||
in which the order of any court has the effect of enjoining or | ||
restraining the Department from filing such notice of lien. If | ||
the Department finds that a company or person is about to | ||
depart from the State, to conceal himself or his property, or | ||
to do any other act tending to prejudice or to render wholly or | ||
partly ineffectual proceedings to collect the amount due and | ||
owing to the Department unless such proceedings are brought | ||
without delay, or if the Department finds that the collection | ||
of the amount due from any company or person will be | ||
jeopardized by delay, the Department shall give the company or | ||
person notice of such findings and shall make demand for | ||
immediate return and payment of the amount, whereupon the | ||
amount shall become immediately due and payable. If the | ||
company or person, within 5 days after the notice (or within | ||
such extension of time as the Department may grant), does not | ||
comply with the notice or show to the Department that the |
findings in the notice are erroneous, the Department may file | ||
a notice of jeopardy assessment lien in the office of the | ||
recorder of the county in which any property of the company or | ||
person may be located and shall notify the company or person of | ||
the filing. The jeopardy assessment lien shall have the same | ||
scope and effect as the statutory lien provided for in this | ||
Section. If the company or person believes that the company or | ||
person does not owe some or all of the tax for which the | ||
jeopardy assessment lien against the company or person has | ||
been filed, or that no jeopardy to the revenue in fact exists, | ||
the company or person may protest within 20 days after being | ||
notified by the Department of the filing of the jeopardy | ||
assessment lien and request a hearing, whereupon the | ||
Department shall hold a hearing in conformity with the | ||
provisions of this Code and, pursuant thereto, shall notify | ||
the company or person of its findings as to whether or not the | ||
jeopardy assessment lien will be released. If not, and if the | ||
company or person is aggrieved by this decision, the company | ||
or person may file an action for judicial review of the final | ||
determination of the Department in accordance with the | ||
Administrative Review Law. If, pursuant to such hearing (or | ||
after an independent determination of the facts by the | ||
Department without a hearing), the Department determines that | ||
some or all of the amount due covered by the jeopardy | ||
assessment lien is not owed by the company or person, or that | ||
no jeopardy to the revenue exists, or if on judicial review the |
final judgment of the court is that the company or person does | ||
not owe some or all of the amount due covered by the jeopardy | ||
assessment lien against them, or that no jeopardy to the | ||
revenue exists, the Department shall release its jeopardy | ||
assessment lien to the extent of such finding of nonliability | ||
for the amount, or to the extent of such finding of no jeopardy | ||
to the revenue. The Department shall also release its jeopardy | ||
assessment lien against the company or person whenever the | ||
amount due and owing covered by the lien, plus any interest | ||
which may be due, are paid and the company or person has paid | ||
the Department in cash or by guaranteed remittance an amount | ||
representing the filing fee for the lien and the filing fee for | ||
the release of that lien. The Department shall file that | ||
release of lien with the recorder of the county where that lien | ||
was filed. | ||
Nothing in this Section shall be construed to give the | ||
Department a preference over the rights of any bona fide | ||
purchaser, holder of a security interest, mechanics | ||
lienholder, mortgagee, or judgment lien creditor arising prior | ||
to the filing of a regular notice of lien or a notice of | ||
jeopardy assessment lien in the office of the recorder in the | ||
county in which the property subject to the lien is located. | ||
For purposes of this Section, "bona fide" shall not include | ||
any mortgage of real or personal property or any other credit | ||
transaction that results in the mortgagee or the holder of the | ||
security acting as trustee for unsecured creditors of the |
company or person mentioned in the notice of lien who executed | ||
such chattel or real property mortgage or the document | ||
evidencing such credit transaction. The lien shall be inferior | ||
to the lien of general taxes, special assessments, and special | ||
taxes levied by any political subdivision of this State. In | ||
case title to land to be affected by the notice of lien or | ||
notice of jeopardy assessment lien is registered under the | ||
provisions of the Registered Titles (Torrens) Act, such notice | ||
shall be filed in the office of the Registrar of Titles of the | ||
county within which the property subject to the lien is | ||
situated and shall be entered upon the register of titles as a | ||
memorial or charge upon each folium of the register of titles | ||
affected by such notice, and the Department shall not have a | ||
preference over the rights of any bona fide purchaser, | ||
mortgagee, judgment creditor, or other lienholder arising | ||
prior to the registration of such notice. The regular lien or | ||
jeopardy assessment lien shall not be effective against any | ||
purchaser with respect to any item in a retailer's stock in | ||
trade purchased from the retailer in the usual course of the | ||
retailer's business. | ||
(Source: P.A. 102-775, eff. 5-13-22; 103-426, eff. 8-4-23.) | ||
(215 ILCS 5/531.03) (from Ch. 73, par. 1065.80-3) | ||
Sec. 531.03. Coverage and limitations. | ||
(1) This Article shall provide coverage for the policies | ||
and contracts specified in subsection (2) of this Section: |
(a) to persons who, regardless of where they reside | ||
(except for non-resident certificate holders under group | ||
policies or contracts), are the beneficiaries, assignees | ||
or payees, including health care providers rendering | ||
services covered under a health insurance policy or | ||
certificate, of the persons covered under paragraph (b) of | ||
this subsection, and | ||
(b) to persons who are owners of or certificate | ||
holders or enrollees under the policies or contracts | ||
(other than unallocated annuity contracts and structured | ||
settlement annuities) and in each case who: | ||
(i) are residents; or | ||
(ii) are not residents, but only under all of the | ||
following conditions: | ||
(A) the member insurer that issued the | ||
policies or contracts is domiciled in this State; | ||
(B) the states in which the persons reside | ||
have associations similar to the Association | ||
created by this Article; | ||
(C) the persons are not eligible for coverage | ||
by an association in any other state due to the | ||
fact that the insurer or health maintenance | ||
organization was not licensed in that state at the | ||
time specified in that state's guaranty | ||
association law. | ||
(c) For unallocated annuity contracts specified in |
subsection (2), paragraphs (a) and (b) of this subsection | ||
(1) shall not apply and this Article shall (except as | ||
provided in paragraphs (e) and (f) of this subsection) | ||
provide coverage to: | ||
(i) persons who are the owners of the unallocated | ||
annuity contracts if the contracts are issued to or in | ||
connection with a specific benefit plan whose plan | ||
sponsor has its principal place of business in this | ||
State; and | ||
(ii) persons who are owners of unallocated annuity | ||
contracts issued to or in connection with government | ||
lotteries if the owners are residents. | ||
(d) For structured settlement annuities specified in | ||
subsection (2), paragraphs (a) and (b) of this subsection | ||
(1) shall not apply and this Article shall (except as | ||
provided in paragraphs (e) and (f) of this subsection) | ||
provide coverage to a person who is a payee under a | ||
structured settlement annuity (or beneficiary of a payee | ||
if the payee is deceased), if the payee: | ||
(i) is a resident, regardless of where the | ||
contract owner resides; or | ||
(ii) is not a resident, but only under both of the | ||
following conditions: | ||
(A) with regard to residency: | ||
(I) the contract owner of the structured | ||
settlement annuity is a resident; or |
(II) the contract owner of the structured | ||
settlement annuity is not a resident but the | ||
insurer that issued the structured settlement | ||
annuity is domiciled in this State and the | ||
state in which the contract owner resides has | ||
an association similar to the Association | ||
created by this Article; and | ||
(B) neither the payee or beneficiary nor the | ||
contract owner is eligible for coverage by the | ||
association of the state in which the payee or | ||
contract owner resides. | ||
(e) This Article shall not provide coverage to: | ||
(i) a person who is a payee or beneficiary of a | ||
contract owner resident of this State if the payee or | ||
beneficiary is afforded any coverage by the | ||
association of another state; or | ||
(ii) a person covered under paragraph (c) of this | ||
subsection (1), if any coverage is provided by the | ||
association of another state to that person. | ||
(f) This Article is intended to provide coverage to a | ||
person who is a resident of this State and, in special | ||
circumstances, to a nonresident. In order to avoid | ||
duplicate coverage, if a person who would otherwise | ||
receive coverage under this Article is provided coverage | ||
under the laws of any other state, then the person shall | ||
not be provided coverage under this Article. In |
determining the application of the provisions of this | ||
paragraph in situations where a person could be covered by | ||
the association of more than one state, whether as an | ||
owner, payee, enrollee, beneficiary, or assignee, this | ||
Article shall be construed in conjunction with other state | ||
laws to result in coverage by only one association. | ||
(2)(a) This Article shall provide coverage to the persons | ||
specified in subsection (1) of this Section for policies or | ||
contracts of direct, (i) nongroup life insurance, health | ||
insurance (that, for the purposes of this Article, includes | ||
health maintenance organization subscriber contracts and | ||
certificates), annuities and supplemental contracts to any of | ||
these, (ii) for certificates under direct group policies or | ||
contracts, (iii) for unallocated annuity contracts and (iv) | ||
for contracts to furnish health care services and subscription | ||
certificates for medical or health care services issued by | ||
persons licensed to transact insurance business in this State | ||
under this Code. Annuity contracts and certificates under | ||
group annuity contracts include but are not limited to | ||
guaranteed investment contracts, deposit administration | ||
contracts, unallocated funding agreements, allocated funding | ||
agreements, structured settlement agreements, lottery | ||
contracts and any immediate or deferred annuity contracts. | ||
(b) Except as otherwise provided in paragraph (c) of this | ||
subsection, this Article shall not provide coverage for: | ||
(i) that portion of a policy or contract not |
guaranteed by the member insurer, or under which the risk | ||
is borne by the policy or contract owner; | ||
(ii) any such policy or contract or part thereof | ||
assumed by the impaired or insolvent insurer under a | ||
contract of reinsurance, other than reinsurance for which | ||
assumption certificates have been issued; | ||
(iii) any portion of a policy or contract to the | ||
extent that the rate of interest on which it is based or | ||
the interest rate, crediting rate, or similar factor is | ||
determined by use of an index or other external reference | ||
stated in the policy or contract employed in calculating | ||
returns or changes in value: | ||
(A) averaged over the period of 4 years prior to | ||
the date on which the member insurer becomes an | ||
impaired or insolvent insurer under this Article, | ||
whichever is earlier, exceeds the rate of interest | ||
determined by subtracting 2 percentage points from | ||
Moody's Corporate Bond Yield Average averaged for that | ||
same 4-year period or for such lesser period if the | ||
policy or contract was issued less than 4 years before | ||
the member insurer becomes an impaired or insolvent | ||
insurer under this Article, whichever is earlier; and | ||
(B) on and after the date on which the member | ||
insurer becomes an impaired or insolvent insurer under | ||
this Article, whichever is earlier, exceeds the rate | ||
of interest determined by subtracting 3 percentage |
points from Moody's Corporate Bond Yield Average as | ||
most recently available; | ||
(iv) any unallocated annuity contract issued to or in | ||
connection with a benefit plan protected under the federal | ||
Pension Benefit Guaranty Corporation, regardless of | ||
whether the federal Pension Benefit Guaranty Corporation | ||
has yet become liable to make any payments with respect to | ||
the benefit plan; | ||
(v) any portion of any unallocated annuity contract | ||
which is not issued to or in connection with a specific | ||
employee, union or association of natural persons benefit | ||
plan or a government lottery; | ||
(vi) an obligation that does not arise under the | ||
express written terms of the policy or contract issued by | ||
the member insurer to the enrollee, certificate holder, | ||
contract owner, or policy owner, including without | ||
limitation: | ||
(A) a claim based on marketing materials; | ||
(B) a claim based on side letters, riders, or | ||
other documents that were issued by the member insurer | ||
without meeting applicable policy or contract form | ||
filing or approval requirements; | ||
(C) a misrepresentation of or regarding policy or | ||
contract benefits; | ||
(D) an extra-contractual claim; or | ||
(E) a claim for penalties or consequential or |
incidental damages; | ||
(vii) any stop-loss insurance, as defined in clause | ||
(b) of Class 1 or clause (a) of Class 2 of Section 4 , and | ||
further defined in subsection (d) of Section 352 ; | ||
(viii) any policy or contract providing any hospital, | ||
medical, prescription drug, or other health care benefits | ||
pursuant to Part C or Part D of Subchapter XVIII, Chapter 7 | ||
of Title 42 of the United States Code (commonly known as | ||
Medicare Part C & D), Subchapter XIX, Chapter 7 of Title 42 | ||
of the United States Code (commonly known as Medicaid), or | ||
any regulations issued pursuant thereto; | ||
(ix) any portion of a policy or contract to the extent | ||
that the assessments required by Section 531.09 of this | ||
Code with respect to the policy or contract are preempted | ||
or otherwise not permitted by federal or State law; | ||
(x) any portion of a policy or contract issued to a | ||
plan or program of an employer, association, or other | ||
person to provide life, health, or annuity benefits to its | ||
employees, members, or others to the extent that the plan | ||
or program is self-funded or uninsured, including, but not | ||
limited to, benefits payable by an employer, association, | ||
or other person under: | ||
(A) a multiple employer welfare arrangement as | ||
defined in 29 U.S.C. Section 1002; | ||
(B) a minimum premium group insurance plan; | ||
(C) a stop-loss group insurance plan; or |
(D) an administrative services only contract; | ||
(xi) any portion of a policy or contract to the extent | ||
that it provides for: | ||
(A) dividends or experience rating credits; | ||
(B) voting rights; or | ||
(C) payment of any fees or allowances to any | ||
person, including the policy or contract owner, in | ||
connection with the service to or administration of | ||
the policy or contract; | ||
(xii) any policy or contract issued in this State by a | ||
member insurer at a time when it was not licensed or did | ||
not have a certificate of authority to issue the policy or | ||
contract in this State; | ||
(xiii) any contractual agreement that establishes the | ||
member insurer's obligations to provide a book value | ||
accounting guaranty for defined contribution benefit plan | ||
participants by reference to a portfolio of assets that is | ||
owned by the benefit plan or its trustee, which in each | ||
case is not an affiliate of the member insurer; | ||
(xiv) any portion of a policy or contract to the | ||
extent that it provides for interest or other changes in | ||
value to be determined by the use of an index or other | ||
external reference stated in the policy or contract, but | ||
which have not been credited to the policy or contract, or | ||
as to which the policy or contract owner's rights are | ||
subject to forfeiture, as of the date the member insurer |
becomes an impaired or insolvent insurer under this Code, | ||
whichever is earlier. If a policy's or contract's interest | ||
or changes in value are credited less frequently than | ||
annually, then for purposes of determining the values that | ||
have been credited and are not subject to forfeiture under | ||
this Section, the interest or change in value determined | ||
by using the procedures defined in the policy or contract | ||
will be credited as if the contractual date of crediting | ||
interest or changing values was the date of impairment or | ||
insolvency, whichever is earlier, and will not be subject | ||
to forfeiture; or | ||
(xv) that portion or part of a variable life insurance | ||
or variable annuity contract not guaranteed by a member | ||
insurer. | ||
(c) The exclusion from coverage referenced in subdivision | ||
(iii) of paragraph (b) of this subsection shall not apply to | ||
any portion of a policy or contract, including a rider, that | ||
provides long-term care or other health insurance benefits. | ||
(3) The benefits for which the Association may become | ||
liable shall in no event exceed the lesser of: | ||
(a) the contractual obligations for which the member | ||
insurer is liable or would have been liable if it were not | ||
an impaired or insolvent insurer, or | ||
(b)(i) with respect to any one life, regardless of the | ||
number of policies or contracts: | ||
(A) $300,000 in life insurance death benefits, but |
not more than $100,000 in net cash surrender and net | ||
cash withdrawal values for life insurance; | ||
(B) for health insurance benefits: | ||
(I) $100,000 for coverages not defined as | ||
disability income insurance or health benefit | ||
plans or long-term care insurance, including any | ||
net cash surrender and net cash withdrawal values; | ||
(II) $300,000 for disability income insurance | ||
and $300,000 for long-term care insurance; and | ||
(III) $500,000 for health benefit plans; | ||
(C) $250,000 in the present value of annuity | ||
benefits, including net cash surrender and net cash | ||
withdrawal values; | ||
(ii) with respect to each individual participating in | ||
a governmental retirement benefit plan established under | ||
Section 401, 403(b), or 457 of the U.S. Internal Revenue | ||
Code covered by an unallocated annuity contract or the | ||
beneficiaries of each such individual if deceased, in the | ||
aggregate, $250,000 in present value annuity benefits, | ||
including net cash surrender and net cash withdrawal | ||
values; | ||
(iii) with respect to each payee of a structured | ||
settlement annuity or beneficiary or beneficiaries of the | ||
payee if deceased, $250,000 in present value annuity | ||
benefits, in the aggregate, including net cash surrender | ||
and net cash withdrawal values, if any; or |
(iv) with respect to either (1) one contract owner | ||
provided coverage under subparagraph (ii) of paragraph (c) | ||
of subsection (1) of this Section or (2) one plan sponsor | ||
whose plans own directly or in trust one or more | ||
unallocated annuity contracts not included in subparagraph | ||
(ii) of paragraph (b) of this subsection, $5,000,000 in | ||
benefits, irrespective of the number of contracts with | ||
respect to the contract owner or plan sponsor. However, in | ||
the case where one or more unallocated annuity contracts | ||
are covered contracts under this Article and are owned by | ||
a trust or other entity for the benefit of 2 or more plan | ||
sponsors, coverage shall be afforded by the Association if | ||
the largest interest in the trust or entity owning the | ||
contract or contracts is held by a plan sponsor whose | ||
principal place of business is in this State. In no event | ||
shall the Association be obligated to cover more than | ||
$5,000,000 in benefits with respect to all these | ||
unallocated contracts. | ||
In no event shall the Association be obligated to cover | ||
more than (1) an aggregate of $300,000 in benefits with | ||
respect to any one life under subparagraphs (i), (ii), and | ||
(iii) of this paragraph (b) except with respect to benefits | ||
for health benefit plans under item (B) of subparagraph (i) of | ||
this paragraph (b), in which case the aggregate liability of | ||
the Association shall not exceed $500,000 with respect to any | ||
one individual or (2) with respect to one owner of multiple |
nongroup policies of life insurance, whether the policy or | ||
contract owner is an individual, firm, corporation, or other | ||
person and whether the persons insured are officers, managers, | ||
employees, or other persons, $5,000,000 in benefits, | ||
regardless of the number of policies and contracts held by the | ||
owner. | ||
The limitations set forth in this subsection are | ||
limitations on the benefits for which the Association is | ||
obligated before taking into account either its subrogation | ||
and assignment rights or the extent to which those benefits | ||
could be provided out of the assets of the impaired or | ||
insolvent insurer attributable to covered policies. The costs | ||
of the Association's obligations under this Article may be met | ||
by the use of assets attributable to covered policies or | ||
reimbursed to the Association pursuant to its subrogation and | ||
assignment rights. | ||
For purposes of this Article, benefits provided by a | ||
long-term care rider to a life insurance policy or annuity | ||
contract shall be considered the same type of benefits as the | ||
base life insurance policy or annuity contract to which it | ||
relates. | ||
(4) In performing its obligations to provide coverage | ||
under Section 531.08 of this Code, the Association shall not | ||
be required to guarantee, assume, reinsure, reissue, or | ||
perform or cause to be guaranteed, assumed, reinsured, | ||
reissued, or performed the contractual obligations of the |
insolvent or impaired insurer under a covered policy or | ||
contract that do not materially affect the economic values or | ||
economic benefits of the covered policy or contract. | ||
(Source: P.A. 100-687, eff. 8-3-18; 100-863, eff. 8-14-18.) | ||
(215 ILCS 5/356z.30a rep.) | ||
(215 ILCS 5/362a rep.) | ||
Section 26. The Illinois Insurance Code is amended by | ||
repealing Sections 356z.30a and 362a. | ||
Section 30. The Network Adequacy and Transparency Act is | ||
amended by changing Sections 5 and 10 as follows: | ||
(215 ILCS 124/5) | ||
Sec. 5. Definitions. In this Act: | ||
"Authorized representative" means a person to whom a | ||
beneficiary has given express written consent to represent the | ||
beneficiary; a person authorized by law to provide substituted | ||
consent for a beneficiary; or the beneficiary's treating | ||
provider only when the beneficiary or his or her family member | ||
is unable to provide consent. | ||
"Beneficiary" means an individual, an enrollee, an | ||
insured, a participant, or any other person entitled to | ||
reimbursement for covered expenses of or the discounting of | ||
provider fees for health care services under a program in | ||
which the beneficiary has an incentive to utilize the services |
of a provider that has entered into an agreement or | ||
arrangement with an insurer. | ||
"Department" means the Department of Insurance. | ||
"Director" means the Director of Insurance. | ||
"Family caregiver" means a relative, partner, friend, or | ||
neighbor who has a significant relationship with the patient | ||
and administers or assists the patient with activities of | ||
daily living, instrumental activities of daily living, or | ||
other medical or nursing tasks for the quality and welfare of | ||
that patient. | ||
"Insurer" means any entity that offers individual or group | ||
accident and health insurance, including, but not limited to, | ||
health maintenance organizations, preferred provider | ||
organizations, exclusive provider organizations, and other | ||
plan structures requiring network participation, excluding the | ||
medical assistance program under the Illinois Public Aid Code, | ||
the State employees group health insurance program, workers | ||
compensation insurance, and pharmacy benefit managers. | ||
"Material change" means a significant reduction in the | ||
number of providers available in a network plan, including, | ||
but not limited to, a reduction of 10% or more in a specific | ||
type of providers, the removal of a major health system that | ||
causes a network to be significantly different from the | ||
network when the beneficiary purchased the network plan, or | ||
any change that would cause the network to no longer satisfy | ||
the requirements of this Act or the Department's rules for |
network adequacy and transparency. | ||
"Network" means the group or groups of preferred providers | ||
providing services to a network plan. | ||
"Network plan" means an individual or group policy of | ||
accident and health insurance that either requires a covered | ||
person to use or creates incentives, including financial | ||
incentives, for a covered person to use providers managed, | ||
owned, under contract with, or employed by the insurer. | ||
"Ongoing course of treatment" means (1) treatment for a | ||
life-threatening condition, which is a disease or condition | ||
for which likelihood of death is probable unless the course of | ||
the disease or condition is interrupted; (2) treatment for a | ||
serious acute condition, defined as a disease or condition | ||
requiring complex ongoing care that the covered person is | ||
currently receiving, such as chemotherapy, radiation therapy, | ||
or post-operative visits; (3) a course of treatment for a | ||
health condition that a treating provider attests that | ||
discontinuing care by that provider would worsen the condition | ||
or interfere with anticipated outcomes; or (4) the third | ||
trimester of pregnancy through the post-partum period. | ||
"Preferred provider" means any provider who has entered, | ||
either directly or indirectly, into an agreement with an | ||
employer or risk-bearing entity relating to health care | ||
services that may be rendered to beneficiaries under a network | ||
plan. | ||
"Providers" means physicians licensed to practice medicine |
in all its branches, other health care professionals, | ||
hospitals, or other health care institutions that provide | ||
health care services. | ||
"Telehealth" has the meaning given to that term in Section | ||
356z.22 of the Illinois Insurance Code. | ||
"Telemedicine" has the meaning given to that term in | ||
Section 49.5 of the Medical Practice Act of 1987. | ||
"Tiered network" means a network that identifies and | ||
groups some or all types of provider and facilities into | ||
specific groups to which different provider reimbursement, | ||
covered person cost-sharing or provider access requirements, | ||
or any combination thereof, apply for the same services. | ||
"Woman's principal health care provider" means a physician | ||
licensed to practice medicine in all of its branches | ||
specializing in obstetrics, gynecology, or family practice. | ||
(Source: P.A. 102-92, eff. 7-9-21; 102-813, eff. 5-13-22.) | ||
(215 ILCS 124/10) | ||
Sec. 10. Network adequacy. | ||
(a) An insurer providing a network plan shall file a | ||
description of all of the following with the Director: | ||
(1) The written policies and procedures for adding | ||
providers to meet patient needs based on increases in the | ||
number of beneficiaries, changes in the | ||
patient-to-provider ratio, changes in medical and health | ||
care capabilities, and increased demand for services. |
(2) The written policies and procedures for making | ||
referrals within and outside the network. | ||
(3) The written policies and procedures on how the | ||
network plan will provide 24-hour, 7-day per week access | ||
to network-affiliated primary care, emergency services, | ||
and obstetrical and gynecological health care | ||
professionals women's principal health care providers . | ||
An insurer shall not prohibit a preferred provider from | ||
discussing any specific or all treatment options with | ||
beneficiaries irrespective of the insurer's position on those | ||
treatment options or from advocating on behalf of | ||
beneficiaries within the utilization review, grievance, or | ||
appeals processes established by the insurer in accordance | ||
with any rights or remedies available under applicable State | ||
or federal law. | ||
(b) Insurers must file for review a description of the | ||
services to be offered through a network plan. The description | ||
shall include all of the following: | ||
(1) A geographic map of the area proposed to be served | ||
by the plan by county service area and zip code, including | ||
marked locations for preferred providers. | ||
(2) As deemed necessary by the Department, the names, | ||
addresses, phone numbers, and specialties of the providers | ||
who have entered into preferred provider agreements under | ||
the network plan. | ||
(3) The number of beneficiaries anticipated to be |
covered by the network plan. | ||
(4) An Internet website and toll-free telephone number | ||
for beneficiaries and prospective beneficiaries to access | ||
current and accurate lists of preferred providers, | ||
additional information about the plan, as well as any | ||
other information required by Department rule. | ||
(5) A description of how health care services to be | ||
rendered under the network plan are reasonably accessible | ||
and available to beneficiaries. The description shall | ||
address all of the following: | ||
(A) the type of health care services to be | ||
provided by the network plan; | ||
(B) the ratio of physicians and other providers to | ||
beneficiaries, by specialty and including primary care | ||
physicians and facility-based physicians when | ||
applicable under the contract, necessary to meet the | ||
health care needs and service demands of the currently | ||
enrolled population; | ||
(C) the travel and distance standards for plan | ||
beneficiaries in county service areas; and | ||
(D) a description of how the use of telemedicine, | ||
telehealth, or mobile care services may be used to | ||
partially meet the network adequacy standards, if | ||
applicable. | ||
(6) A provision ensuring that whenever a beneficiary | ||
has made a good faith effort, as evidenced by accessing |
the provider directory, calling the network plan, and | ||
calling the provider, to utilize preferred providers for a | ||
covered service and it is determined the insurer does not | ||
have the appropriate preferred providers due to | ||
insufficient number, type, unreasonable travel distance or | ||
delay, or preferred providers refusing to provide a | ||
covered service because it is contrary to the conscience | ||
of the preferred providers, as protected by the Health | ||
Care Right of Conscience Act, the insurer shall ensure, | ||
directly or indirectly, by terms contained in the payer | ||
contract, that the beneficiary will be provided the | ||
covered service at no greater cost to the beneficiary than | ||
if the service had been provided by a preferred provider. | ||
This paragraph (6) does not apply to: (A) a beneficiary | ||
who willfully chooses to access a non-preferred provider | ||
for health care services available through the panel of | ||
preferred providers, or (B) a beneficiary enrolled in a | ||
health maintenance organization. In these circumstances, | ||
the contractual requirements for non-preferred provider | ||
reimbursements shall apply unless Section 356z.3a of the | ||
Illinois Insurance Code requires otherwise. In no event | ||
shall a beneficiary who receives care at a participating | ||
health care facility be required to search for | ||
participating providers under the circumstances described | ||
in subsection (b) or (b-5) of Section 356z.3a of the | ||
Illinois Insurance Code except under the circumstances |
described in paragraph (2) of subsection (b-5). | ||
(7) A provision that the beneficiary shall receive | ||
emergency care coverage such that payment for this | ||
coverage is not dependent upon whether the emergency | ||
services are performed by a preferred or non-preferred | ||
provider and the coverage shall be at the same benefit | ||
level as if the service or treatment had been rendered by a | ||
preferred provider. For purposes of this paragraph (7), | ||
"the same benefit level" means that the beneficiary is | ||
provided the covered service at no greater cost to the | ||
beneficiary than if the service had been provided by a | ||
preferred provider. This provision shall be consistent | ||
with Section 356z.3a of the Illinois Insurance Code. | ||
(8) A limitation that, if the plan provides that the | ||
beneficiary will incur a penalty for failing to | ||
pre-certify inpatient hospital treatment, the penalty may | ||
not exceed $1,000 per occurrence in addition to the plan | ||
cost-sharing cost sharing provisions. | ||
(c) The network plan shall demonstrate to the Director a | ||
minimum ratio of providers to plan beneficiaries as required | ||
by the Department. | ||
(1) The ratio of physicians or other providers to plan | ||
beneficiaries shall be established annually by the | ||
Department in consultation with the Department of Public | ||
Health based upon the guidance from the federal Centers | ||
for Medicare and Medicaid Services. The Department shall |
not establish ratios for vision or dental providers who | ||
provide services under dental-specific or vision-specific | ||
benefits. The Department shall consider establishing | ||
ratios for the following physicians or other providers: | ||
(A) Primary Care; | ||
(B) Pediatrics; | ||
(C) Cardiology; | ||
(D) Gastroenterology; | ||
(E) General Surgery; | ||
(F) Neurology; | ||
(G) OB/GYN; | ||
(H) Oncology/Radiation; | ||
(I) Ophthalmology; | ||
(J) Urology; | ||
(K) Behavioral Health; | ||
(L) Allergy/Immunology; | ||
(M) Chiropractic; | ||
(N) Dermatology; | ||
(O) Endocrinology; | ||
(P) Ears, Nose, and Throat (ENT)/Otolaryngology; | ||
(Q) Infectious Disease; | ||
(R) Nephrology; | ||
(S) Neurosurgery; | ||
(T) Orthopedic Surgery; | ||
(U) Physiatry/Rehabilitative; | ||
(V) Plastic Surgery; |
(W) Pulmonary; | ||
(X) Rheumatology; | ||
(Y) Anesthesiology; | ||
(Z) Pain Medicine; | ||
(AA) Pediatric Specialty Services; | ||
(BB) Outpatient Dialysis; and | ||
(CC) HIV. | ||
(2) The Director shall establish a process for the | ||
review of the adequacy of these standards, along with an | ||
assessment of additional specialties to be included in the | ||
list under this subsection (c). | ||
(d) The network plan shall demonstrate to the Director | ||
maximum travel and distance standards for plan beneficiaries, | ||
which shall be established annually by the Department in | ||
consultation with the Department of Public Health based upon | ||
the guidance from the federal Centers for Medicare and | ||
Medicaid Services. These standards shall consist of the | ||
maximum minutes or miles to be traveled by a plan beneficiary | ||
for each county type, such as large counties, metro counties, | ||
or rural counties as defined by Department rule. | ||
The maximum travel time and distance standards must | ||
include standards for each physician and other provider | ||
category listed for which ratios have been established. | ||
The Director shall establish a process for the review of | ||
the adequacy of these standards along with an assessment of | ||
additional specialties to be included in the list under this |
subsection (d). | ||
(d-5)(1) Every insurer shall ensure that beneficiaries | ||
have timely and proximate access to treatment for mental, | ||
emotional, nervous, or substance use disorders or conditions | ||
in accordance with the provisions of paragraph (4) of | ||
subsection (a) of Section 370c of the Illinois Insurance Code. | ||
Insurers shall use a comparable process, strategy, evidentiary | ||
standard, and other factors in the development and application | ||
of the network adequacy standards for timely and proximate | ||
access to treatment for mental, emotional, nervous, or | ||
substance use disorders or conditions and those for the access | ||
to treatment for medical and surgical conditions. As such, the | ||
network adequacy standards for timely and proximate access | ||
shall equally be applied to treatment facilities and providers | ||
for mental, emotional, nervous, or substance use disorders or | ||
conditions and specialists providing medical or surgical | ||
benefits pursuant to the parity requirements of Section 370c.1 | ||
of the Illinois Insurance Code and the federal Paul Wellstone | ||
and Pete Domenici Mental Health Parity and Addiction Equity | ||
Act of 2008. Notwithstanding the foregoing, the network | ||
adequacy standards for timely and proximate access to | ||
treatment for mental, emotional, nervous, or substance use | ||
disorders or conditions shall, at a minimum, satisfy the | ||
following requirements: | ||
(A) For beneficiaries residing in the metropolitan | ||
counties of Cook, DuPage, Kane, Lake, McHenry, and Will, |
network adequacy standards for timely and proximate access | ||
to treatment for mental, emotional, nervous, or substance | ||
use disorders or conditions means a beneficiary shall not | ||
have to travel longer than 30 minutes or 30 miles from the | ||
beneficiary's residence to receive outpatient treatment | ||
for mental, emotional, nervous, or substance use disorders | ||
or conditions. Beneficiaries shall not be required to wait | ||
longer than 10 business days between requesting an initial | ||
appointment and being seen by the facility or provider of | ||
mental, emotional, nervous, or substance use disorders or | ||
conditions for outpatient treatment or to wait longer than | ||
20 business days between requesting a repeat or follow-up | ||
appointment and being seen by the facility or provider of | ||
mental, emotional, nervous, or substance use disorders or | ||
conditions for outpatient treatment; however, subject to | ||
the protections of paragraph (3) of this subsection, a | ||
network plan shall not be held responsible if the | ||
beneficiary or provider voluntarily chooses to schedule an | ||
appointment outside of these required time frames. | ||
(B) For beneficiaries residing in Illinois counties | ||
other than those counties listed in subparagraph (A) of | ||
this paragraph, network adequacy standards for timely and | ||
proximate access to treatment for mental, emotional, | ||
nervous, or substance use disorders or conditions means a | ||
beneficiary shall not have to travel longer than 60 | ||
minutes or 60 miles from the beneficiary's residence to |
receive outpatient treatment for mental, emotional, | ||
nervous, or substance use disorders or conditions. | ||
Beneficiaries shall not be required to wait longer than 10 | ||
business days between requesting an initial appointment | ||
and being seen by the facility or provider of mental, | ||
emotional, nervous, or substance use disorders or | ||
conditions for outpatient treatment or to wait longer than | ||
20 business days between requesting a repeat or follow-up | ||
appointment and being seen by the facility or provider of | ||
mental, emotional, nervous, or substance use disorders or | ||
conditions for outpatient treatment; however, subject to | ||
the protections of paragraph (3) of this subsection, a | ||
network plan shall not be held responsible if the | ||
beneficiary or provider voluntarily chooses to schedule an | ||
appointment outside of these required time frames. | ||
(2) For beneficiaries residing in all Illinois counties, | ||
network adequacy standards for timely and proximate access to | ||
treatment for mental, emotional, nervous, or substance use | ||
disorders or conditions means a beneficiary shall not have to | ||
travel longer than 60 minutes or 60 miles from the | ||
beneficiary's residence to receive inpatient or residential | ||
treatment for mental, emotional, nervous, or substance use | ||
disorders or conditions. | ||
(3) If there is no in-network facility or provider | ||
available for a beneficiary to receive timely and proximate | ||
access to treatment for mental, emotional, nervous, or |
substance use disorders or conditions in accordance with the | ||
network adequacy standards outlined in this subsection, the | ||
insurer shall provide necessary exceptions to its network to | ||
ensure admission and treatment with a provider or at a | ||
treatment facility in accordance with the network adequacy | ||
standards in this subsection. | ||
(e) Except for network plans solely offered as a group | ||
health plan, these ratio and time and distance standards apply | ||
to the lowest cost-sharing tier of any tiered network. | ||
(f) The network plan may consider use of other health care | ||
service delivery options, such as telemedicine or telehealth, | ||
mobile clinics, and centers of excellence, or other ways of | ||
delivering care to partially meet the requirements set under | ||
this Section. | ||
(g) Except for the requirements set forth in subsection | ||
(d-5), insurers who are not able to comply with the provider | ||
ratios and time and distance standards established by the | ||
Department may request an exception to these requirements from | ||
the Department. The Department may grant an exception in the | ||
following circumstances: | ||
(1) if no providers or facilities meet the specific | ||
time and distance standard in a specific service area and | ||
the insurer (i) discloses information on the distance and | ||
travel time points that beneficiaries would have to travel | ||
beyond the required criterion to reach the next closest | ||
contracted provider outside of the service area and (ii) |
provides contact information, including names, addresses, | ||
and phone numbers for the next closest contracted provider | ||
or facility; | ||
(2) if patterns of care in the service area do not | ||
support the need for the requested number of provider or | ||
facility type and the insurer provides data on local | ||
patterns of care, such as claims data, referral patterns, | ||
or local provider interviews, indicating where the | ||
beneficiaries currently seek this type of care or where | ||
the physicians currently refer beneficiaries, or both; or | ||
(3) other circumstances deemed appropriate by the | ||
Department consistent with the requirements of this Act. | ||
(h) Insurers are required to report to the Director any | ||
material change to an approved network plan within 15 days | ||
after the change occurs and any change that would result in | ||
failure to meet the requirements of this Act. Upon notice from | ||
the insurer, the Director shall reevaluate the network plan's | ||
compliance with the network adequacy and transparency | ||
standards of this Act. | ||
(Source: P.A. 102-144, eff. 1-1-22; 102-901, eff. 7-1-22; | ||
102-1117, eff. 1-13-23.) | ||
Section 35. The Health Maintenance Organization Act is | ||
amended by changing Sections 4.5-1, 5-3, and 5-3.1 as follows: | ||
(215 ILCS 125/4.5-1) |
Sec. 4.5-1. Point-of-service health service contracts. | ||
(a) A health maintenance organization that offers a | ||
point-of-service contract: | ||
(1) must include as in-plan covered services all | ||
services required by law to be provided by a health | ||
maintenance organization; | ||
(2) must provide incentives, which shall include | ||
financial incentives, for enrollees to use in-plan covered | ||
services; | ||
(3) may not offer services out-of-plan without | ||
providing those services on an in-plan basis; | ||
(4) may include annual out-of-pocket limits and | ||
lifetime maximum benefits allowances for out-of-plan | ||
services that are separate from any limits or allowances | ||
applied to in-plan services; | ||
(5) may not consider emergency services, authorized | ||
referral services, or non-routine services obtained out of | ||
the service area to be point-of-service services; | ||
(6) may treat as out-of-plan services those services | ||
that an enrollee obtains from a participating provider, | ||
but for which the proper authorization was not given by | ||
the health maintenance organization; and | ||
(7) after January 1, 2003 (the effective date of | ||
Public Act 92-579), must include the following disclosure | ||
on its point-of-service contracts and evidences of | ||
coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN |
NON-PARTICIPATING PROVIDERS ARE USED. YOU CAN EXPECT TO | ||
PAY MORE THAN THE COST-SHARING AMOUNT DEFINED IN THE | ||
POLICY IN NON-EMERGENCY SITUATIONS. Except in limited | ||
situations governed by the federal No Surprises Act or | ||
Section 356z.3a of the Illinois Insurance Code (215 ILCS | ||
5/356z.3a), non-participating providers furnishing | ||
non-emergency services may bill members for any amount up | ||
to the billed charge after the plan has paid its portion of | ||
the bill. If you elect to use a non-participating | ||
provider, plan benefit payments will be determined | ||
according to your policy's fee schedule, usual and | ||
customary charge (which is determined by comparing charges | ||
for similar services adjusted to the geographical area | ||
where the services are performed), or other method as | ||
defined by the policy. Participating providers have agreed | ||
to ONLY bill members the cost-sharing amounts. You should | ||
be aware that when you elect to utilize the services of a | ||
non-participating provider for a covered service in | ||
non-emergency situations, benefit payments to such | ||
non-participating provider are not based upon the amount | ||
billed. The basis of your benefit payment will be | ||
determined according to your policy's fee schedule, usual | ||
and customary charge (which is determined by comparing | ||
charges for similar services adjusted to the geographical | ||
area where the services are performed), or other method as | ||
defined by the policy. YOU CAN EXPECT TO PAY MORE THAN THE |
COINSURANCE AMOUNT DEFINED IN THE POLICY AFTER THE PLAN | ||
HAS PAID ITS REQUIRED PORTION. Non-participating providers | ||
may bill members for any amount up to the billed charge | ||
after the plan has paid its portion of the bill, except as | ||
provided in Section 356z.3a of the Illinois Insurance Code | ||
for covered services received at a participating health | ||
care facility from a non-participating provider that are: | ||
(a) ancillary services, (b) items or services furnished as | ||
a result of unforeseen, urgent medical needs that arise at | ||
the time the item or service is furnished, or (c) items or | ||
services received when the facility or the | ||
non-participating provider fails to satisfy the notice and | ||
consent criteria specified under Section 356z.3a. | ||
Participating providers have agreed to accept discounted | ||
payments for services with no additional billing to the | ||
member other than co-insurance and deductible amounts. You | ||
may obtain further information about the participating | ||
status of professional providers and information on | ||
out-of-pocket expenses by calling the toll-free toll free | ||
telephone number on your identification card.". | ||
(b) A health maintenance organization offering a | ||
point-of-service contract is subject to all of the following | ||
limitations: | ||
(1) The health maintenance organization may not expend | ||
in any calendar quarter more than 20% of its total | ||
expenditures for all its members for out-of-plan covered |
services. | ||
(2) If the amount specified in item (1) of this | ||
subsection is exceeded by 2% in a quarter, the health | ||
maintenance organization must effect compliance with item | ||
(1) of this subsection by the end of the following | ||
quarter. | ||
(3) If compliance with the amount specified in item | ||
(1) of this subsection is not demonstrated in the health | ||
maintenance organization's next quarterly report, the | ||
health maintenance organization may not offer the | ||
point-of-service contract to new groups or include the | ||
point-of-service option in the renewal of an existing | ||
group until compliance with the amount specified in item | ||
(1) of this subsection is demonstrated or until otherwise | ||
allowed by the Director. | ||
(4) A health maintenance organization failing, without | ||
just cause, to comply with the provisions of this | ||
subsection shall be required, after notice and hearing, to | ||
pay a penalty of $250 for each day out of compliance, to be | ||
recovered by the Director. Any penalty recovered shall be | ||
paid into the General Revenue Fund. The Director may | ||
reduce the penalty if the health maintenance organization | ||
demonstrates to the Director that the imposition of the | ||
penalty would constitute a financial hardship to the | ||
health maintenance organization. | ||
(c) A health maintenance organization that offers a |
point-of-service product must do all of the following: | ||
(1) File a quarterly financial statement detailing | ||
compliance with the requirements of subsection (b). | ||
(2) Track out-of-plan, point-of-service utilization | ||
separately from in-plan or non-point-of-service, | ||
out-of-plan emergency care, referral care, and urgent care | ||
out of the service area utilization. | ||
(3) Record out-of-plan utilization in a manner that | ||
will permit such utilization and cost reporting as the | ||
Director may, by rule, require. | ||
(4) Demonstrate to the Director's satisfaction that | ||
the health maintenance organization has the fiscal, | ||
administrative, and marketing capacity to control its | ||
point-of-service enrollment, utilization, and costs so as | ||
not to jeopardize the financial security of the health | ||
maintenance organization. | ||
(5) Maintain, in addition to any other deposit | ||
required under this Act, the deposit required by Section | ||
2-6. | ||
(6) Maintain cash and cash equivalents of sufficient | ||
amount to fully liquidate 10 days' average claim payments, | ||
subject to review by the Director. | ||
(7) Maintain and file with the Director, reinsurance | ||
coverage protecting against catastrophic losses on | ||
out-of-network point-of-service services. Deductibles may | ||
not exceed $100,000 per covered life per year, and the |
portion of risk retained by the health maintenance | ||
organization once deductibles have been satisfied may not | ||
exceed 20%. Reinsurance must be placed with licensed | ||
authorized reinsurers qualified to do business in this | ||
State. | ||
(d) A health maintenance organization may not issue a | ||
point-of-service contract until it has filed and had approved | ||
by the Director a plan to comply with the provisions of this | ||
Section. The compliance plan must, at a minimum, include | ||
provisions demonstrating that the health maintenance | ||
organization will do all of the following: | ||
(1) Design the benefit levels and conditions of | ||
coverage for in-plan covered services and out-of-plan | ||
covered services as required by this Article. | ||
(2) Provide or arrange for the provision of adequate | ||
systems to: | ||
(A) process and pay claims for all out-of-plan | ||
covered services; | ||
(B) meet the requirements for point-of-service | ||
contracts set forth in this Section and any additional | ||
requirements that may be set forth by the Director; | ||
and | ||
(C) generate accurate data and financial and | ||
regulatory reports on a timely basis so that the | ||
Department of Insurance can evaluate the health | ||
maintenance organization's experience with the |
point-of-service contract and monitor compliance with | ||
point-of-service contract provisions. | ||
(3) Comply with the requirements of subsections (b) | ||
and (c). | ||
(Source: P.A. 102-901, eff. 1-1-23; 103-154, eff. 6-30-23.) | ||
(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) | ||
Sec. 5-3. Insurance Code provisions. | ||
(a) Health Maintenance Organizations shall be subject to | ||
the provisions of Sections 133, 134, 136, 137, 139, 140, | ||
141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, | ||
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49, | ||
355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v, | ||
356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, | ||
356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, | ||
356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, | ||
356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, | ||
356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35, | ||
356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44, | ||
356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, | ||
356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, | ||
356z.60, 356z.61, 356z.62, 356z.63, 356z.64, 356z.65, 356z.66, | ||
356z.67, 356z.68, 356z.69, 356z.70, 364, 364.01, 364.3, 367.2, | ||
367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, | ||
401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and | ||
444.1, paragraph (c) of subsection (2) of Section 367, and |
Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, | ||
XXVI, and XXXIIB of the Illinois Insurance Code. | ||
(b) For purposes of the Illinois Insurance Code, except | ||
for Sections 444 and 444.1 and Articles XIII and XIII 1/2, | ||
Health Maintenance Organizations in the following categories | ||
are deemed to be "domestic companies": | ||
(1) a corporation authorized under the Dental Service | ||
Plan Act or the Voluntary Health Services Plans Act; | ||
(2) a corporation organized under the laws of this | ||
State; or | ||
(3) a corporation organized under the laws of another | ||
state, 30% or more of the enrollees of which are residents | ||
of this State, except a corporation subject to | ||
substantially the same requirements in its state of | ||
organization as is a "domestic company" under Article VIII | ||
1/2 of the Illinois Insurance Code. | ||
(c) In considering the merger, consolidation, or other | ||
acquisition of control of a Health Maintenance Organization | ||
pursuant to Article VIII 1/2 of the Illinois Insurance Code, | ||
(1) the Director shall give primary consideration to | ||
the continuation of benefits to enrollees and the | ||
financial conditions of the acquired Health Maintenance | ||
Organization after the merger, consolidation, or other | ||
acquisition of control takes effect; | ||
(2)(i) the criteria specified in subsection (1)(b) of | ||
Section 131.8 of the Illinois Insurance Code shall not |
apply and (ii) the Director, in making his determination | ||
with respect to the merger, consolidation, or other | ||
acquisition of control, need not take into account the | ||
effect on competition of the merger, consolidation, or | ||
other acquisition of control; | ||
(3) the Director shall have the power to require the | ||
following information: | ||
(A) certification by an independent actuary of the | ||
adequacy of the reserves of the Health Maintenance | ||
Organization sought to be acquired; | ||
(B) pro forma financial statements reflecting the | ||
combined balance sheets of the acquiring company and | ||
the Health Maintenance Organization sought to be | ||
acquired as of the end of the preceding year and as of | ||
a date 90 days prior to the acquisition, as well as pro | ||
forma financial statements reflecting projected | ||
combined operation for a period of 2 years; | ||
(C) a pro forma business plan detailing an | ||
acquiring party's plans with respect to the operation | ||
of the Health Maintenance Organization sought to be | ||
acquired for a period of not less than 3 years; and | ||
(D) such other information as the Director shall | ||
require. | ||
(d) The provisions of Article VIII 1/2 of the Illinois | ||
Insurance Code and this Section 5-3 shall apply to the sale by | ||
any health maintenance organization of greater than 10% of its |
enrollee population (including , without limitation , the health | ||
maintenance organization's right, title, and interest in and | ||
to its health care certificates). | ||
(e) In considering any management contract or service | ||
agreement subject to Section 141.1 of the Illinois Insurance | ||
Code, the Director (i) shall, in addition to the criteria | ||
specified in Section 141.2 of the Illinois Insurance Code, | ||
take into account the effect of the management contract or | ||
service agreement on the continuation of benefits to enrollees | ||
and the financial condition of the health maintenance | ||
organization to be managed or serviced, and (ii) need not take | ||
into account the effect of the management contract or service | ||
agreement on competition. | ||
(f) Except for small employer groups as defined in the | ||
Small Employer Rating, Renewability and Portability Health | ||
Insurance Act and except for medicare supplement policies as | ||
defined in Section 363 of the Illinois Insurance Code, a | ||
Health Maintenance Organization may by contract agree with a | ||
group or other enrollment unit to effect refunds or charge | ||
additional premiums under the following terms and conditions: | ||
(i) the amount of, and other terms and conditions with | ||
respect to, the refund or additional premium are set forth | ||
in the group or enrollment unit contract agreed in advance | ||
of the period for which a refund is to be paid or | ||
additional premium is to be charged (which period shall | ||
not be less than one year); and |
(ii) the amount of the refund or additional premium | ||
shall not exceed 20% of the Health Maintenance | ||
Organization's profitable or unprofitable experience with | ||
respect to the group or other enrollment unit for the | ||
period (and, for purposes of a refund or additional | ||
premium, the profitable or unprofitable experience shall | ||
be calculated taking into account a pro rata share of the | ||
Health Maintenance Organization's administrative and | ||
marketing expenses, but shall not include any refund to be | ||
made or additional premium to be paid pursuant to this | ||
subsection (f)). The Health Maintenance Organization and | ||
the group or enrollment unit may agree that the profitable | ||
or unprofitable experience may be calculated taking into | ||
account the refund period and the immediately preceding 2 | ||
plan years. | ||
The Health Maintenance Organization shall include a | ||
statement in the evidence of coverage issued to each enrollee | ||
describing the possibility of a refund or additional premium, | ||
and upon request of any group or enrollment unit, provide to | ||
the group or enrollment unit a description of the method used | ||
to calculate (1) the Health Maintenance Organization's | ||
profitable experience with respect to the group or enrollment | ||
unit and the resulting refund to the group or enrollment unit | ||
or (2) the Health Maintenance Organization's unprofitable | ||
experience with respect to the group or enrollment unit and | ||
the resulting additional premium to be paid by the group or |
enrollment unit. | ||
In no event shall the Illinois Health Maintenance | ||
Organization Guaranty Association be liable to pay any | ||
contractual obligation of an insolvent organization to pay any | ||
refund authorized under this Section. | ||
(g) Rulemaking authority to implement Public Act 95-1045, | ||
if any, is conditioned on the rules being adopted in | ||
accordance with all provisions of the Illinois Administrative | ||
Procedure Act and all rules and procedures of the Joint | ||
Committee on Administrative Rules; any purported rule not so | ||
adopted, for whatever reason, is unauthorized. | ||
(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; | ||
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||
1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, | ||
eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; | ||
102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. | ||
1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, | ||
eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; | ||
103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff. | ||
6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, | ||
eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.) | ||
(215 ILCS 125/5-3.1) | ||
Sec. 5-3.1. Access to obstetrical and gynecological care | ||
Woman's health care provider . Health maintenance organizations | ||
are subject to the provisions of Section 356r of the Illinois |
Insurance Code. | ||
(Source: P.A. 89-514, eff. 7-17-96.) | ||
Section 40. The Limited Health Service Organization Act is | ||
amended by changing Sections 4002.1 and 4003 as follows: | ||
(215 ILCS 130/4002.1) | ||
Sec. 4002.1. Access to obstetrical and gynecological care | ||
Woman's health care provider . Limited health service | ||
organizations are subject to the provisions of Section 356r of | ||
the Illinois Insurance Code. | ||
(Source: P.A. 89-514, eff. 7-17-96.) | ||
(215 ILCS 130/4003) (from Ch. 73, par. 1504-3) | ||
Sec. 4003. Illinois Insurance Code provisions. Limited | ||
health service organizations shall be subject to the | ||
provisions of Sections 133, 134, 136, 137, 139, 140, 141.1, | ||
141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, | ||
154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2, | ||
355.3, 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, | ||
356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, | ||
356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, | ||
356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 364.3, | ||
368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, | ||
and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII | ||
1/2, XXV, and XXVI of the Illinois Insurance Code. Nothing in |
this Section shall require a limited health care plan to cover | ||
any service that is not a limited health service. For purposes | ||
of the Illinois Insurance Code, except for Sections 444 and | ||
444.1 and Articles XIII and XIII 1/2, limited health service | ||
organizations in the following categories are deemed to be | ||
domestic companies: | ||
(1) a corporation under the laws of this State; or | ||
(2) a corporation organized under the laws of another | ||
state, 30% or more of the enrollees of which are residents | ||
of this State, except a corporation subject to | ||
substantially the same requirements in its state of | ||
organization as is a domestic company under Article VIII | ||
1/2 of the Illinois Insurance Code. | ||
(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; | ||
102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff. | ||
1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816, | ||
eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; | ||
102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. | ||
1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, | ||
eff. 1-1-24; revised 8-29-23.) | ||
Section 43. The Voluntary Health Services Plans Act is | ||
amended by changing Section 10 as follows: | ||
(215 ILCS 165/10) (from Ch. 32, par. 604) | ||
Sec. 10. Application of Insurance Code provisions. Health |
services plan corporations and all persons interested therein | ||
or dealing therewith shall be subject to the provisions of | ||
Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140, | ||
143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, | ||
356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w, | ||
356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, | ||
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||
356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, | ||
356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, | ||
356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, | ||
356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, | ||
356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401, 401.1, 402, | ||
403, 403A, 408, 408.2, and 412, and paragraphs (7) and (15) of | ||
Section 367 of the Illinois Insurance Code. | ||
Rulemaking authority to implement Public Act 95-1045, if | ||
any, is conditioned on the rules being adopted in accordance | ||
with all provisions of the Illinois Administrative Procedure | ||
Act and all rules and procedures of the Joint Committee on | ||
Administrative Rules; any purported rule not so adopted, for | ||
whatever reason, is unauthorized. | ||
(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; | ||
102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. | ||
10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, | ||
eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; | ||
102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. | ||
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, |
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | ||
103-551, eff. 8-11-23; revised 8-29-23.) | ||
Section 45. The Illinois Public Aid Code is amended by | ||
changing Section 5-16.9 as follows: | ||
(305 ILCS 5/5-16.9) | ||
Sec. 5-16.9. Access to obstetrical and gynecological care | ||
Woman's health care provider . The medical assistance program | ||
is subject to the provisions of Section 356r of the Illinois | ||
Insurance Code. The Illinois Department shall adopt rules to | ||
implement the requirements of Section 356r of the Illinois | ||
Insurance Code in the medical assistance program including | ||
managed care components. | ||
On and after July 1, 2012, the Department shall reduce any | ||
rate of reimbursement for services or other payments or alter | ||
any methodologies authorized by this Code to reduce any rate | ||
of reimbursement for services or other payments in accordance | ||
with Section 5-5e. | ||
(Source: P.A. 97-689, eff. 6-14-12.) | ||
Section 95. No acceleration or delay. Where this Act makes | ||
changes in a statute that is represented in this Act by text | ||
that is not yet or no longer in effect (for example, a Section | ||
represented by multiple versions), the use of that text does | ||
not accelerate or delay the taking effect of (i) the changes |
made by this Act or (ii) provisions derived from any other | ||
Public Act. | ||
Section 99. Effective date. This Act takes effect upon | ||
becoming law, except that the changes to Sections 356r, 356s, | ||
356z.3, and 367a of the Illinois Insurance Code and Section | ||
4.5-1 of the Health Maintenance Organization Act take effect | ||
January 1, 2025. |