Full Text of HB2286 95th General Assembly
HB2286ham001 95TH GENERAL ASSEMBLY
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Rep. Mary E. Flowers
Filed: 5/1/2008
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| AMENDMENT TO HOUSE BILL 2286
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| AMENDMENT NO. ______. Amend House Bill 2286 by replacing | 3 |
| everything after the enacting clause with the following:
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| "Section 5. The State Employees Group Insurance Act of 1971 | 5 |
| is amended by changing Section 6.11 as follows:
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| (5 ILCS 375/6.11)
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| Sec. 6.11. Required health benefits; Illinois Insurance | 8 |
| Code
requirements. The program of health
benefits shall provide | 9 |
| the post-mastectomy care benefits required to be covered
by a | 10 |
| policy of accident and health insurance under Section 356t of | 11 |
| the Illinois
Insurance Code. The program of health benefits | 12 |
| shall provide the coverage
required under Sections 356f.1, | 13 |
| 356g.5,
356u, 356w, 356x, 356z.2, 356z.4, 356z.6, and 356z.9, | 14 |
| and 356z.10
356z.9 of the
Illinois Insurance Code.
The program | 15 |
| of health benefits must comply with Section 155.37 of the
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| Illinois Insurance Code.
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| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 2 |
| 95-520, eff. 8-28-07; revised 12-4-07.)
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| Section 10. The Counties Code is amended by changing | 4 |
| Section 5-1069.3 as follows: | 5 |
| (55 ILCS 5/5-1069.3)
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| Sec. 5-1069.3. Required health benefits. If a county, | 7 |
| including a home
rule
county, is a self-insurer for purposes of | 8 |
| providing health insurance coverage
for its employees, the | 9 |
| coverage shall include coverage for the post-mastectomy
care | 10 |
| benefits required to be covered by a policy of accident and | 11 |
| health
insurance under Section 356t and the coverage required | 12 |
| under Sections 356f.1, 356g.5, 356u,
356w, 356x, 356z.6, and | 13 |
| 356z.9, and 356z.10
356z.9 of
the Illinois Insurance Code. The | 14 |
| requirement that health benefits be covered
as provided in this | 15 |
| Section is an
exclusive power and function of the State and is | 16 |
| a denial and limitation under
Article VII, Section 6, | 17 |
| subsection (h) of the Illinois Constitution. A home
rule county | 18 |
| to which this Section applies must comply with every provision | 19 |
| of
this Section.
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| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 21 |
| 95-520, eff. 8-28-07; revised 12-4-07.)
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| Section 15. The Illinois Municipal Code is amended by | 23 |
| changing Section 10-4-2.3 as follows: |
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| (65 ILCS 5/10-4-2.3)
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| Sec. 10-4-2.3. Required health benefits. If a | 3 |
| municipality, including a
home rule municipality, is a | 4 |
| self-insurer for purposes of providing health
insurance | 5 |
| coverage for its employees, the coverage shall include coverage | 6 |
| for
the post-mastectomy care benefits required to be covered by | 7 |
| a policy of
accident and health insurance under Section 356t | 8 |
| and the coverage required
under Sections 356f.1, 356g.5, 356u, | 9 |
| 356w, 356x, 356z.6, and 356z.9, and 356z.10
356z.9 of the | 10 |
| Illinois
Insurance
Code. The requirement that health
benefits | 11 |
| be covered as provided in this is an exclusive power and | 12 |
| function of
the State and is a denial and limitation under | 13 |
| Article VII, Section 6,
subsection (h) of the Illinois | 14 |
| Constitution. A home rule municipality to which
this Section | 15 |
| applies must comply with every provision of this Section.
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| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 17 |
| 95-520, eff. 8-28-07; revised 12-4-07.)
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| Section 20. The School Code is amended by changing Section | 19 |
| 10-22.3f as follows: | 20 |
| (105 ILCS 5/10-22.3f)
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| Sec. 10-22.3f. Required health benefits. Insurance | 22 |
| protection and
benefits
for employees shall provide the | 23 |
| post-mastectomy care benefits required to be
covered by a |
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| policy of accident and health insurance under Section 356t and | 2 |
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coverage required under Sections 356f.1, 356g.5, 356u, | 3 |
| 356w, 356x,
356z.6, and 356z.9 of
the
Illinois Insurance Code.
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| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 5 |
| revised 12-4-07.)
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| Section 25. The Illinois Insurance Code is amended by | 7 |
| adding Section 356f.1 as follows: | 8 |
| (215 ILCS 5/356f.1 new)
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| Sec. 356f.1. Recision, cancellation, or limiting of a plan | 10 |
| contract. | 11 |
| (a) No insurer or health care service plan shall engage in | 12 |
| the practice of postclaims underwriting. For purposes of this | 13 |
| Section, "postclaims underwriting" means the rescinding, | 14 |
| canceling, or limiting of a plan contract due to the plan's | 15 |
| failure to complete medical underwriting and resolve all | 16 |
| reasonable questions arising from written information | 17 |
| submitted on or with an application before issuing the plan | 18 |
| contract. This subsection (a) shall not limit a plan's remedies | 19 |
| upon a showing of willful misrepresentation. | 20 |
| (b) Notwithstanding any other provision of law, a health | 21 |
| care service plan shall seek and receive final approval from | 22 |
| the Division of Insurance prior to rescinding a plan contract | 23 |
| of a subscriber or enrollee. No later than January 1, 2010, the | 24 |
| Department shall contract with one or more appropriately |
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| qualified independent review organizations to conduct the | 2 |
| review required by this subsection (b). The Department shall | 3 |
| ensure that the review organization shall not have any | 4 |
| material, professional, familial, or financial affiliation | 5 |
| with the health care service plan. | 6 |
| (c) Notwithstanding any other rulemaking authority that | 7 |
| may exist, neither the Governor nor any agency or agency head | 8 |
| under the jurisdiction of the Governor has any authority to | 9 |
| make or promulgate rules to implement or enforce the provisions | 10 |
| of this amendatory Act of the 95th General Assembly. If, | 11 |
| however, the Governor believes that rules are necessary to | 12 |
| implement or enforce the provisions of this amendatory Act of | 13 |
| the 95th General Assembly, the Governor may suggest rules to | 14 |
| the General Assembly by filing them with the Clerk of the House | 15 |
| and the Secretary of the Senate and by requesting that the | 16 |
| General Assembly authorize such rulemaking by law, enact those | 17 |
| suggested rules into law, or take any other appropriate action | 18 |
| in the General Assembly's discretion. Nothing contained in this | 19 |
| amendatory Act of the 95th General Assembly shall be | 20 |
| interpreted to grant rulemaking authority under any other | 21 |
| Illinois statute where such authority is not otherwise | 22 |
| explicitly given. For the purposes of this amendatory Act of | 23 |
| the 95th General Assembly, "rules" is given the meaning | 24 |
| contained in Section 1-70 of the Illinois Administrative | 25 |
| Procedure Act, and "agency" and "agency head" are given the | 26 |
| meanings contained in Sections 1-20 and 1-25 of the Illinois |
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| Administrative Procedure Act to the extent that such | 2 |
| definitions apply to agencies or agency heads under the | 3 |
| jurisdiction of the Governor.
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| Section 30. The Health Maintenance Organization Act is | 5 |
| amended by changing Section 5-3 as follows:
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| (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
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| Sec. 5-3. Insurance Code provisions.
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| (a) Health Maintenance Organizations
shall be subject to | 9 |
| the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | 10 |
| 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | 11 |
| 154.6,
154.7, 154.8, 155.04, 355.2, 356f.1, 356m, 356v, 356w, | 12 |
| 356x, 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, | 13 |
| 356z.10
356z.9 , 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, | 14 |
| 368d, 368e, 370c,
401, 401.1, 402, 403, 403A,
408, 408.2, 409, | 15 |
| 412, 444,
and
444.1,
paragraph (c) of subsection (2) of Section | 16 |
| 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, | 17 |
| XXV, and XXVI of the Illinois Insurance Code.
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| (b) For purposes of the Illinois Insurance Code, except for | 19 |
| Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | 20 |
| Maintenance Organizations in
the following categories are | 21 |
| deemed to be "domestic companies":
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| (1) a corporation authorized under the
Dental Service | 23 |
| Plan Act or the Voluntary Health Services Plans Act;
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| (2) a corporation organized under the laws of this |
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| State; or
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| (3) a corporation organized under the laws of another | 3 |
| state, 30% or more
of the enrollees of which are residents | 4 |
| of this State, except a
corporation subject to | 5 |
| substantially the same requirements in its state of
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| organization as is a "domestic company" under Article VIII | 7 |
| 1/2 of the
Illinois Insurance Code.
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| (c) In considering the merger, consolidation, or other | 9 |
| acquisition of
control of a Health Maintenance Organization | 10 |
| pursuant to Article VIII 1/2
of the Illinois Insurance Code,
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| (1) the Director shall give primary consideration to | 12 |
| the continuation of
benefits to enrollees and the financial | 13 |
| conditions of the acquired Health
Maintenance Organization | 14 |
| after the merger, consolidation, or other
acquisition of | 15 |
| control takes effect;
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| (2)(i) the criteria specified in subsection (1)(b) of | 17 |
| Section 131.8 of
the Illinois Insurance Code shall not | 18 |
| apply and (ii) the Director, in making
his determination | 19 |
| with respect to the merger, consolidation, or other
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| acquisition of control, need not take into account the | 21 |
| effect on
competition of the merger, consolidation, or | 22 |
| other acquisition of control;
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| (3) the Director shall have the power to require the | 24 |
| following
information:
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| (A) certification by an independent actuary of the | 26 |
| adequacy
of the reserves of the Health Maintenance |
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| Organization sought to be acquired;
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| (B) pro forma financial statements reflecting the | 3 |
| combined balance
sheets of the acquiring company and | 4 |
| the Health Maintenance Organization sought
to be | 5 |
| acquired as of the end of the preceding year and as of | 6 |
| a date 90 days
prior to the acquisition, as well as pro | 7 |
| forma financial statements
reflecting projected | 8 |
| combined operation for a period of 2 years;
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| (C) a pro forma business plan detailing an | 10 |
| acquiring party's plans with
respect to the operation | 11 |
| of the Health Maintenance Organization sought to
be | 12 |
| acquired for a period of not less than 3 years; and
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| (D) such other information as the Director shall | 14 |
| require.
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| (d) The provisions of Article VIII 1/2 of the Illinois | 16 |
| Insurance Code
and this Section 5-3 shall apply to the sale by | 17 |
| any health maintenance
organization of greater than 10% of its
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| enrollee population (including without limitation the health | 19 |
| maintenance
organization's right, title, and interest in and to | 20 |
| its health care
certificates).
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| (e) In considering any management contract or service | 22 |
| agreement subject
to Section 141.1 of the Illinois Insurance | 23 |
| Code, the Director (i) shall, in
addition to the criteria | 24 |
| specified in Section 141.2 of the Illinois
Insurance Code, take | 25 |
| into account the effect of the management contract or
service | 26 |
| agreement on the continuation of benefits to enrollees and the
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| financial condition of the health maintenance organization to | 2 |
| be managed or
serviced, and (ii) need not take into account the | 3 |
| effect of the management
contract or service agreement on | 4 |
| competition.
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| (f) Except for small employer groups as defined in the | 6 |
| Small Employer
Rating, Renewability and Portability Health | 7 |
| Insurance Act and except for
medicare supplement policies as | 8 |
| defined in Section 363 of the Illinois
Insurance Code, a Health | 9 |
| Maintenance Organization may by contract agree with a
group or | 10 |
| other enrollment unit to effect refunds or charge additional | 11 |
| premiums
under the following terms and conditions:
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| (i) the amount of, and other terms and conditions with | 13 |
| respect to, the
refund or additional premium are set forth | 14 |
| in the group or enrollment unit
contract agreed in advance | 15 |
| of the period for which a refund is to be paid or
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| additional premium is to be charged (which period shall not | 17 |
| be less than one
year); and
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| (ii) the amount of the refund or additional premium | 19 |
| shall not exceed 20%
of the Health Maintenance | 20 |
| Organization's profitable or unprofitable experience
with | 21 |
| respect to the group or other enrollment unit for the | 22 |
| period (and, for
purposes of a refund or additional | 23 |
| premium, the profitable or unprofitable
experience shall | 24 |
| be calculated taking into account a pro rata share of the
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| Health Maintenance Organization's administrative and | 26 |
| marketing expenses, but
shall not include any refund to be |
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| made or additional premium to be paid
pursuant to this | 2 |
| subsection (f)). The Health Maintenance Organization and | 3 |
| the
group or enrollment unit may agree that the profitable | 4 |
| or unprofitable
experience may be calculated taking into | 5 |
| account the refund period and the
immediately preceding 2 | 6 |
| plan years.
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| The Health Maintenance Organization shall include a | 8 |
| statement in the
evidence of coverage issued to each enrollee | 9 |
| describing the possibility of a
refund or additional premium, | 10 |
| and upon request of any group or enrollment unit,
provide to | 11 |
| the group or enrollment unit a description of the method used | 12 |
| to
calculate (1) the Health Maintenance Organization's | 13 |
| profitable experience with
respect to the group or enrollment | 14 |
| unit and the resulting refund to the group
or enrollment unit | 15 |
| or (2) the Health Maintenance Organization's unprofitable
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| experience with respect to the group or enrollment unit and the | 17 |
| resulting
additional premium to be paid by the group or | 18 |
| enrollment unit.
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| In no event shall the Illinois Health Maintenance | 20 |
| Organization
Guaranty Association be liable to pay any | 21 |
| contractual obligation of an
insolvent organization to pay any | 22 |
| refund authorized under this Section.
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| (Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06; | 24 |
| 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; revised 12-4-07.)
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| Section 35. The Limited Health Service Organization Act is |
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| amended by changing Section 4003 as follows:
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| (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
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| Sec. 4003. Illinois Insurance Code provisions. Limited | 4 |
| health service
organizations shall be subject to the provisions | 5 |
| of Sections 133, 134, 137,
140, 141.1, 141.2, 141.3, 143, 143c, | 6 |
| 147, 148, 149, 151, 152, 153, 154, 154.5,
154.6, 154.7, 154.8, | 7 |
| 155.04, 155.37, 355.2, 356f.1, 356v, 356z.10
356z.9 , 368a, 401, | 8 |
| 401.1,
402,
403, 403A, 408,
408.2, 409, 412, 444, and 444.1 and | 9 |
| Articles IIA, VIII 1/2, XII, XII 1/2,
XIII,
XIII 1/2, XXV, and | 10 |
| XXVI of the Illinois Insurance Code. For purposes of the
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| Illinois Insurance Code, except for Sections 444 and 444.1 and | 12 |
| Articles XIII
and XIII 1/2, limited health service | 13 |
| organizations in the following categories
are deemed to be | 14 |
| domestic companies:
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| (1) a corporation under the laws of this State; or
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| (2) a corporation organized under the laws of another | 17 |
| state, 30% of more
of the enrollees of which are residents | 18 |
| of this State, except a corporation
subject to | 19 |
| substantially the same requirements in its state of | 20 |
| organization as
is a domestic company under Article VIII | 21 |
| 1/2 of the Illinois Insurance Code.
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| (Source: P.A. 95-520, eff. 8-28-07; revised 12-5-07.)
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| Section 37. The Managed Care Reform and Patient Rights Act | 24 |
| is amended by changing Section 20 as follows:
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| (215 ILCS 134/20)
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| Sec. 20. Notice of nonrenewal or termination. A health care | 3 |
| plan must
give at least 60
days notice of nonrenewal or | 4 |
| termination of a health
care provider to the health care
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| provider and to the enrollees served by the health care | 6 |
| provider.
The notice shall include a name and address to which | 7 |
| an enrollee or health care
provider may direct
comments and | 8 |
| concerns regarding the nonrenewal or termination.
Immediate | 9 |
| written notice may be provided without 60 days notice when a | 10 |
| health
care provider's license has been disciplined by a State | 11 |
| licensing board. All health care plans shall comply with | 12 |
| Section 356f.1 of the Illinois Insurance Code.
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| (Source: P.A. 91-617, eff. 1-1-00.)
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| Section 40. The Voluntary Health Services Plans Act is | 15 |
| amended by changing Section 10 as follows:
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| (215 ILCS 165/10) (from Ch. 32, par. 604)
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| Sec. 10. Application of Insurance Code provisions. Health | 18 |
| services
plan corporations and all persons interested therein | 19 |
| or dealing therewith
shall be subject to the provisions of | 20 |
| Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | 21 |
| 149, 155.37, 354, 355.2, 356f.1, 356g.5, 356r, 356t, 356u, | 22 |
| 356v,
356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, | 23 |
| 356z.8, 356z.9,
356z.10
356z.9 , 364.01, 367.2, 368a, 401, |
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| 401.1,
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) | 2 |
| and (15) of Section 367 of the Illinois
Insurance Code.
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| (Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07; | 4 |
| 95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff. | 5 |
| 8-28-07; revised 12-5-07.)".
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