(215 ILCS 5/356z.70) Sec. 356z.70. Coverage of no-cost mental health prevention and wellness visits. (a) A group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 shall provide coverage for one annual mental health prevention and wellness visit for children and for adults. (b) Mental health prevention and wellness visits shall include any age-appropriate screening recommended by the United States Preventive Services Task Force or by the American Academy of Pediatrics' Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents for purposes of identifying a mental health issue, condition, or disorder; discussing mental health symptoms that might be present, including symptoms of a previously diagnosed mental health condition or disorder; performing an evaluation of adverse childhood experiences; and discussing mental health and wellness. (c) A mental health prevention and wellness visit shall be covered for up to 60 minutes and may be performed by a physician licensed to practice medicine in all of its branches, a licensed clinical psychologist, a licensed clinical social worker, a licensed clinical professional counselor, a licensed marriage and family therapist, a licensed social worker, or a licensed professional counselor. (d) A policy subject to this Section shall not impose a deductible, coinsurance, copayment, or other cost-sharing requirement for mental health prevention and wellness visits. The cost-sharing prohibition in this subsection (d) does not apply to coverage of mental health prevention and wellness visits 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. (e) A mental health prevention and wellness visit shall be in addition to an annual physical examination and shall not replace a well-child visit or a general health or medical visit. (f) A mental health prevention and wellness visit shall be reimbursed through the following American Medical Association current procedural terminology codes and at the same rate that current procedural terminology codes are reimbursed for the provision of other medical care: 99381-99387 and 99391-99397. The Department shall update the current procedural terminology codes through adoption of rules if the codes listed in this subsection are altered, amended, changed, deleted, or supplemented. (g) Reimbursement of any of the current procedural terminology codes listed in this Section shall comply with the following: (1) reimbursement may be adjusted for payment of | ||
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(2) for a mental health prevention and wellness visit | ||
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(h) A mental health prevention and wellness visit may be incorporated into and reimbursed within any type of integrated primary care service delivery method, including, but not limited to, a psychiatric collaborative care model as provided for under this Code. (i) The Department shall adopt any rules necessary to implement this Section by no later than October 31, 2024. (Source: P.A. 103-535, eff. 8-11-23; 103-605, eff. 7-1-24.) |
(215 ILCS 5/357.1) (from Ch. 73, par. 969.1)
Sec. 357.1.
Accident and health policy provisions required.
Except as provided in section 357.26 of this article each accident
and health policy delivered or issued for delivery to any person in this
State shall contain the provisions set forth in sections 357.2 through
357.13 in the words in which the same appear in the specified sections;
provided, however, that the company may, at its option, substitute for
one or more of such provisions corresponding provisions of different
wording approved by the Director which are in each instance not less
favorable in any respect to the insured or the beneficiary. Such
provisions shall be preceded individually by the caption appearing at
the beginning of each such section or, at the option of the company, by
such appropriate individual or group captions or subcaptions as the
Director may approve.
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.2) (from Ch. 73, par. 969.2)
Sec. 357.2.
"ENTIRE CONTRACT; CHANGES:
This policy, including the
endorsements and the attached papers, if any, constitutes the entire
contract of insurance. No change in this policy shall be valid until
approved by an executive officer of the company and unless such approval
be endorsed hereon or attached hereto. No agent has authority to change
this policy or to waive any of its provisions."
(1) Premium Notice Required. No policy of accident and health
insurance, as enumerated in class 1(b) or 2(a) of Section 4, shall be
declared forfeited or lapsed within 6 months after default in payment of
any premium installment or interest or any portion thereof, nor shall
any such policy be forfeited or lapsed by reason of nonpayment when due
of any premium, installment or interest, or any portion thereof,
required by the terms of the policy to be paid, within 6 months from the
default in payment of such premium, installment or interest, unless a
written or printed notice stating the amount of such premium,
installment, interest or portion thereof due on such policy, the place
where it shall be paid and the person to whom the same is payable, shall
have been duly addressed and mailed with the required postage affixed,
to the person insured or to the premium payor if other than the insured
at the last known post office address of the insured or premium payor,
at least 15 days and not more than 45 days prior to the day when same is
due and payable before the beginning of the grace period.
Such notice shall also state that unless such premium or other sum
due shall be paid to the company or its agent the policy and all
payments thereon will become forfeited and void, except as to any right
to a surrender value or paid up policy as provided for by the policy.
The affidavit of any officer, clerk or agent of the company or of anyone
authorized to mail such notice that the notice required by this Section
bearing the required postage has been duly addressed and mailed shall be
presumptive evidence that such notice has been duly given.
If the notice is given in a manner other than mailing, then
physical proof of the receipt of such notice by the proper recipient
shall be maintained by the insurer.
(2) Paragraph (1) of this Section shall not apply
to cancellable policies which are renewable at the option of the company
nor shall it apply to group policies, industrial policies, or any
policies upon which premiums are payable monthly or at shorter intervals.
(Source: P.A. 91-357, eff. 7-29-99.)
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(215 ILCS 5/357.3) (from Ch. 73, par. 969.3)
Sec. 357.3. "TIME LIMIT ON CERTAIN DEFENSES: (1) After 2 years from the
date of issue of this policy no misstatements, except fraudulent
misstatements, made by the applicant in the application for such policy
shall be used to void the policy or to deny a claim for loss incurred or
disability (as defined in the policy) commencing after the expiration of
such 2 year period."
(The foregoing policy provision shall not be so construed as to affect
any legal requirement for avoidance of a policy or denial of a claim during
such initial 2 year period, nor to limit the application of section 357.15
through section 357.19 in the event of misstatement with respect to age
or occupation or other insurance.)
A policy which the insured has the right to continue in force subject to
its terms by the timely payment of premium (1) until at least age 50 or,
(2) in the case of a policy issued after age 44, for at least 5 years from
its date of issue, may contain in lieu of the foregoing the following
provisions (from which the clause in parentheses may be omitted at the
company's option) under the caption "INCONTESTABLE":
"After this policy has been in force for a period of 2 years during the
lifetime of the insured (excluding any period during which the insured is
a person with a disability), it shall become incontestable as to the statements contained in
the application."
(2) "No claim for loss incurred or disability (as defined in the policy)
commencing after 2 years from the date of issue of this policy shall be
reduced or denied on the ground that a disease or physical condition not
excluded from coverage by name or specific description effective on the
date of loss had existed prior to the effective date of coverage of this
policy."
(Source: P.A. 99-143, eff. 7-27-15.)
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(215 ILCS 5/357.4) (from Ch. 73, par. 969.4)
Sec. 357.4.
"GRACE PERIOD:
A grace period of ....(insert a number not less
than "7" for weekly premium policies, "10" for monthly premium policies and
"31" for all other policies) days will be granted for the payment of each
premium falling due after the first premium, during which grace period the
policy shall continue in force."
(A policy which contains a cancellation provision may add, at the end of
the above provision: "Subject to the right of the company to cancel in
accordance with the cancellation provision hereof."
A policy in which the company reserves the right to refuse any renewal
shall have, at the beginning of the above provision:
"Unless not less than 30 days prior to the premium due date the company
has delivered to the insured or has mailed to his last address as shown by
the records of the company written notice of its intention not to renew
this policy beyond the period for which the premium has been accepted.")
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.5) (from Ch. 73, par. 969.5)
Sec. 357.5.
"REINSTATEMENT:
If any renewal premium be not paid within
the time granted the insured for payment, a subsequent acceptance of
premium by the company or by any agent duly authorized by the company to
accept such premium, without requiring in connection therewith an
application for reinstatement, shall reinstate the policy; provided,
however, that if the company or such agent requires an application for
reinstatement and issues a conditional receipt for the premium tendered,
the policy will be reinstated upon approval of such application by the
company or, lacking such approval, upon the 45th day following the date
of such conditional receipt unless the company has previously notified
the insured in writing of its disapproval of such application. The
reinstated policy shall cover only loss resulting from such accidental
injury as may be sustained after the date of reinstatement and loss due
to such sickness as may begin more than 10 days after such date. In all
other respects the insured and company shall have the same rights
thereunder as they had under the policy immediately before the due date
of the defaulted premium, subject to any provisions endorsed hereon or
attached hereto in connection with the reinstatement. Any premium
accepted in connection with a reinstatement shall be applied to a period
for which premium has not been previously paid, but not to any period
more than 60 days prior to the date of reinstatement."
The last sentence of the above provision may be omitted from any
policy which the insured has the right to continue in force subject to
its terms by the timely payment of premiums (1) until at least age 50
or, (2) in the case of a policy issued after age 44, for at least 5
years from its date of issue.
For the purpose of this Section, the phrase "loss resulting from such
accidental injury as may be sustained after the date of reinstatement and
loss due to such sickness as may begin more than 10 days
after such date" shall mean that the reinstated policy shall not cover a
loss resulting from accidental injury sustained after the date of lapse
of the policy and prior to the date of reinstatement or a loss resulting
from sickness which is first manifested after the date of lapse of the policy
but not after a date more than 10 days after the date of
reinstatement. An accidental injury and a sickness as described in this
Section shall be subject to the requirements of Section 357.3 with the
exception that references to date of issue and application shall mean date
of reinstatement and reinstatement application. All other accidental
injuries and sicknesses will be subject to the requirements of 357.3.
Provisions endorsed or attached to the policy in connection with the
reinstatement shall relate to a disease or physical condition of an insured
under the policy.
(Source: P.A. 84-1308.)
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(215 ILCS 5/357.6) (from Ch. 73, par. 969.6)
Sec. 357.6.
"NOTICE OF CLAIM:
Written notice of claim must be given to the
company within 20 days after the occurrence or commencement of any loss
covered by the policy, or as soon thereafter as is reasonably possible.
Notice given by or on behalf of the insured or the beneficiary to the
company at ....(insert the location of such office as the company may
designate for the purpose), or to any authorized agent of the company, with
information sufficient to identify the insured, shall be deemed notice to
the company."
In a policy providing a loss-of-time benefit which may be payable for at
least 2 years, a company may at its option insert the following between the
first and second sentences of the above provision:
"Subject to the qualifications set forth below, if the insured suffers
loss of time on account of disability for which indemnity may be payable
for at least 2 years, he shall, at least once in every 6 months after
having given notice of claim, give to the company notice of continuance of
said disability, except in the event of legal incapacity. The period of 6
months following any filing of proof by the insured or any payment by the
company on account of such claim or any denial of liability in whole or in
part by the company shall be excluded in applying this provision. Delay in
the giving of such notice shall not impair the insured's right to any
indemnity which would otherwise have accrued during the period of 6 months
preceding the date on which such notice is actually given."
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.7) (from Ch. 73, par. 969.7)
Sec. 357.7.
"CLAIM FORMS:
The company, upon receipt of a notice of claim,
will furnish to the claimant such forms as are usually furnished by it for
filing proofs of loss. If such forms are not furnished within 15 days after
the giving of such notice the claimant shall be deemed to have complied
with the requirements of this policy as to proof of loss upon submitting,
within the time fixed in the policy for filing proofs of loss, written
proof covering the occurrence, the character and the extent of the loss for
which claim is made."
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.8) (from Ch. 73, par. 969.8)
Sec. 357.8.
"PROOFS OF LOSS:
Written proof of loss must be furnished to the
company at its said office in case of claim for loss for which this policy
provides any periodic payment contingent upon continuing loss within 90
days after the termination of the period for which the company is liable
and in case of claim for any other loss within 90 days after the date of
such loss. Failure to furnish such proof within the time required shall not
invalidate nor reduce any claim if it was not reasonably possible to give
proof within such time, provided such proof is furnished as soon as
reasonably possible and in no event, except in the absence of legal
capacity, later than one year from the time proof is otherwise required."
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.9) (from Ch. 73, par. 969.9)
Sec. 357.9.
"TIME OF PAYMENT OF CLAIMS:
Indemnities
payable under
this policy for any loss other than loss for which this policy provides
any periodic payment will be paid immediately upon receipt of due
written proof of such loss.
Subject
to due written proof of loss, all
accrued indemnities for loss for which this policy provides periodic
payment will be paid ....
(insert period for payment which must not be
less frequently than monthly) and any balance remaining unpaid upon the
termination of liability, will be paid immediately upon receipt of due
written proof."
All claims and indemnities payable under the terms of
a policy of accident and health insurance shall be paid within 30 days
following receipt by the insurer of due proof of loss.
Failure to pay
within such period shall entitle the insured
to interest at the rate of 9
per cent per annum from the 30th day after receipt of such proof of loss to
the date of late payment, provided that interest amounting to less than one
dollar need not be paid.
An insured or an insured's assignee shall be
notified by the insurer, health maintenance organization, managed care plan,
health care plan, preferred provider organization, or third party administrator
of any known failure to provide sufficient documentation for a
due proof of
loss within 30 days after receipt of the claim.
Any
required interest payments shall be made within 30 days after the payment.
The requirements of this Section shall apply to any policy of accident
and health insurance delivered, issued for delivery, renewed or amended on
or after 180 days following the effective date of this amendatory Act of 1985.
The requirements of this Section also shall specifically apply to
any group policy of dental insurance only, delivered, issued for
delivery, renewed or amended on or after 180 days following the effective
date of this amendatory Act of 1987.
(Source: P.A. 91-605, eff. 12-14-99.)
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(215 ILCS 5/357.9a) (from Ch. 73, par. 969.9a)
Sec. 357.9a.
Delay in payment of claims.
Periodic payments
of accrued indemnities for loss-of-time coverage under accident
and health policies shall commence not later than 30 days after
the receipt by the company of the required written proofs of loss.
An insurer which violates this Section if liable under said policy, shall
pay to the insured, in addition to any other penalty provided for in this Code,
interest at the rate of 9% per annum from the 30th day after
receipt of such proofs of loss to the date of late payment of the
accrued indemnities, provided that interest amounting to less than
one dollar need not be paid.
(Source: P.A. 92-139, eff. 7-24-01.)
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(215 ILCS 5/357.10) (from Ch. 73, par. 969.10)
Sec. 357.10.
"PAYMENT OF CLAIMS:
Indemnity for loss of life will be payable
in accordance with the beneficiary designation and the provisions
respecting such payment which may be prescribed herein and effective at the
time of payment. If no such designation or provision is then effective,
such indemnity shall be payable to the estate of the insured. Any other
accrued indemnities unpaid at the insured's death may, at the option of the
company, be paid either to such beneficiary or to such estate. All other
indemnities will be payable to the insured."
The following provisions, or either of them, may be included with the
foregoing provision at the option of the company:
"If any indemnity of this policy shall be payable to the estate of the
insured, or to an insured or beneficiary who is a minor or otherwise not
competent to give a valid release, the company may pay such indemnity, up
to an amount not exceeding $....(insert an amount which shall not exceed
$1000), to any relative by blood or connection by marriage of the insured
or beneficiary who is deemed by the company to be equitably entitled
thereto. Any payment made by the company in good faith pursuant to this
provision shall fully discharge the company to the extent of such payment.
"Subject to any written direction of the insured in the application or
otherwise all or a portion of any indemnities provided by this policy on
account of hospital, nursing, medical, or surgical services may, at the
company's option and unless the insured requests otherwise in writing not
later than the time of filing proofs of such loss, be paid directly to the
hospital or person rendering such services; but it is not required that the
service be rendered by a particular hospital or person. Nothing in this
provision shall prohibit an insurer from providing incentives for insureds
to utilize the services of a particular hospital or person."
(Source: P.A. 84-618.)
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(215 ILCS 5/357.11) (from Ch. 73, par. 969.11)
Sec. 357.11.
"PHYSICAL EXAMINATIONS AND AUTOPSY:
The company at its own
expense shall have the right and opportunity to examine the person of the
insured when and as often as it may reasonably require during the pendency
of a claim hereunder and to make an autopsy in case of death where it is
not forbidden by law."
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.12) (from Ch. 73, par. 969.12)
Sec. 357.12.
"LEGAL ACTIONS:
No civil action shall be brought
to recover on this policy prior to the expiration of 60 days after written
proof of loss has been furnished in accordance with the requirements of
this policy. No such action shall be brought after the expiration of 3
years after the time written proof of loss is required to be furnished."
(Source: P.A. 79-1362.)
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(215 ILCS 5/357.13) (from Ch. 73, par. 969.13)
Sec. 357.13.
"CHANGE OF BENEFICIARY:
Unless the insured makes an
irrevocable designation of beneficiary, the right to change of beneficiary
is reserved to the insured and the consent of the beneficiary or
beneficiaries shall not be requisite to surrender or assignment of this
policy or to any change of beneficiary or beneficiaries, or to any other
changes in this policy."
(The first clause of this provision, relating to the irrevocable
designation of beneficiary, may be omitted at the company's option.)
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.14) (from Ch. 73, par. 969.14)
Sec. 357.14. Except as provided in section 357.26, no such policy delivered
or issued for delivery to any person in this State shall contain provisions
respecting the matters set forth in sections 357.15 through 357.24 unless
such provisions are in the words in which the same appear in this article;
provided, however, that the company may, at its option, use in lieu of any
such provision a corresponding provision of different wording approved by
the Director which is not less favorable in any respect to the insured or
the beneficiary. Any such provision contained in the policy shall be
preceded individually by the appropriate caption appearing in the following
sections or, at the option of the company, by such appropriate individual
or group captions or subcaptions as the Director may approve.
(Source: P.A. 95-230, eff. 1-1-08.)
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