Full Text of SB3926 102nd General Assembly
SB3926eng 102ND GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Insurance Code is amended by | 5 | | changing Sections 121-2.05, 356z.18, 367.3, 367a, 368f, 424, | 6 | | 425, and 500-70 as follows:
| 7 | | (215 ILCS 5/121-2.05) (from Ch. 73, par. 733-2.05)
| 8 | | Sec. 121-2.05.
Group insurance policies issued and | 9 | | delivered in other
State-Transactions in this State.
With the
| 10 | | exception of insurance transactions authorized under Sections | 11 | | 230.2 or
367.3 of this Code and transactions subject to the | 12 | | requirements of the Short-Term, Limited-Duration Health | 13 | | Insurance Coverage Act , transactions in this State involving | 14 | | group legal, group
life and
group accident and health or | 15 | | blanket
accident and health insurance or group
annuities where | 16 | | the master policy of such groups was lawfully issued and
| 17 | | delivered in, and under the laws of, a State in which the | 18 | | insurer was
authorized to do an insurance business, to a group | 19 | | properly established
pursuant to law or regulation, and where | 20 | | the
policyholder is domiciled or otherwise has a bona fide | 21 | | situs.
| 22 | | (Source: P.A. 86-753.)
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| 1 | | (215 ILCS 5/356z.18) | 2 | | Sec. 356z.18. Prosthetic and customized orthotic devices. | 3 | | (a) For the purposes of this Section: | 4 | | "Customized orthotic device" means a supportive device for | 5 | | the body or a part of the body, the head, neck, or extremities, | 6 | | and includes the replacement or repair of the device based on | 7 | | the patient's physical condition as medically necessary, | 8 | | excluding foot orthotics defined as an in-shoe device designed | 9 | | to support the structural components of the foot during | 10 | | weight-bearing activities. | 11 | | "Licensed provider" means a prosthetist, orthotist, or | 12 | | pedorthist licensed to practice in this State. | 13 | | "Prosthetic device" means an artificial device to replace, | 14 | | in whole or in part, an arm or leg and includes accessories | 15 | | essential to the effective use of the device and the | 16 | | replacement or repair of the device based on the patient's | 17 | | physical condition as medically necessary. | 18 | | (b) This amendatory Act of the 96th General Assembly shall | 19 | | provide benefits to any person covered thereunder for expenses | 20 | | incurred in obtaining a prosthetic or custom orthotic device | 21 | | from any Illinois licensed prosthetist, licensed orthotist, or | 22 | | licensed pedorthist as required under the Orthotics, | 23 | | Prosthetics, and Pedorthics Practice Act. | 24 | | (c) A group or individual major medical policy of accident | 25 | | or health insurance or managed care plan or medical, health, | 26 | | or hospital service corporation contract that provides |
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| 1 | | coverage for prosthetic or custom orthotic care and is | 2 | | amended, delivered, issued, or renewed 6 months after the | 3 | | effective date of this amendatory Act of the 96th General | 4 | | Assembly must provide coverage for prosthetic and orthotic | 5 | | devices in accordance with this subsection (c). The coverage | 6 | | required under this Section shall be subject to the other | 7 | | general exclusions, limitations, and financial requirements of | 8 | | the policy, including coordination of benefits, participating | 9 | | provider requirements, utilization review of health care | 10 | | services, including review of medical necessity, case | 11 | | management, and experimental and investigational treatments, | 12 | | and other managed care provisions under terms and conditions | 13 | | that are no less favorable than the terms and conditions that | 14 | | apply to substantially all medical and surgical benefits | 15 | | provided under the plan or coverage. | 16 | | (d) The policy or plan or contract may require prior | 17 | | authorization for the prosthetic or orthotic devices in the | 18 | | same manner that prior authorization is required for any other | 19 | | covered benefit. | 20 | | (e) Repairs and replacements of prosthetic and orthotic | 21 | | devices are also covered, subject to the co-payments and | 22 | | deductibles, unless necessitated by misuse or loss. | 23 | | (f) A policy or plan or contract may require that, if | 24 | | coverage is provided through a managed care plan, the benefits | 25 | | mandated pursuant to this Section shall be covered benefits | 26 | | only if the prosthetic or orthotic devices are provided by a |
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| 1 | | licensed provider employed by a provider service who contracts | 2 | | with or is designated by the carrier, to the extent that the | 3 | | carrier provides in-network and out-of-network service, the | 4 | | coverage for the prosthetic or orthotic device shall be | 5 | | offered no less extensively. | 6 | | (g) The policy or plan or contract shall also meet | 7 | | adequacy requirements as established by the Health Care | 8 | | Reimbursement Reform Act of 1985 of the Illinois Insurance | 9 | | Code. | 10 | | (h) This Section shall not apply to accident only, | 11 | | specified disease, short-term travel hospital or medical , | 12 | | hospital confinement indemnity, credit, dental, vision, | 13 | | Medicare supplement, long-term care, basic hospital and | 14 | | medical-surgical expense coverage, disability income insurance | 15 | | coverage, coverage issued as a supplement to liability | 16 | | insurance, workers' compensation insurance, or automobile | 17 | | medical payment insurance.
| 18 | | (Source: P.A. 96-833, eff. 6-1-10 .)
| 19 | | (215 ILCS 5/367.3) (from Ch. 73, par. 979.3)
| 20 | | Sec. 367.3. Group accident and health insurance; | 21 | | discretionary groups.
| 22 | | (a) No group health insurance offered to a resident of | 23 | | this State under
a policy issued to a group, other than one | 24 | | specifically described in
Section 367(1), shall be delivered | 25 | | or issued for delivery in this State
unless the Director |
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| 1 | | determines that:
| 2 | | (1) the issuance of the policy is not contrary to the | 3 | | public interest;
| 4 | | (2) the issuance of the policy will result in | 5 | | economies of
acquisition and administration; and
| 6 | | (3) the benefits under the policy are reasonable in | 7 | | relation to the
premium charged.
| 8 | | (b) No such group health insurance may be offered in this | 9 | | State under a
policy issued in another state unless this State | 10 | | or the state in which the
group policy is issued has made a | 11 | | determination that the requirements of
subsection (a) have | 12 | | been met.
| 13 | | Where insurance is to be offered in this State under a | 14 | | policy described
in this subsection, the insurer shall file | 15 | | for informational review purposes:
| 16 | | (1) a copy of the group master contract;
| 17 | | (2) a copy of the statute authorizing the issuance of | 18 | | the group policy
in the state of situs, which statute has | 19 | | the same or similar requirements as
this State, or in the | 20 | | absence of such statute, a certification by an
officer of | 21 | | the company that the policy meets the Illinois minimum | 22 | | standards
required for individual accident and health | 23 | | policies under authority of
Section 401 of this Code, as | 24 | | now or hereafter amended, as
promulgated by rule at 50 | 25 | | Illinois Administrative Code, Ch. I, Sec. 2007,
et seq., | 26 | | as now or hereafter amended, or under the Short-Term, |
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| 1 | | Limited-Duration Health Insurance Coverage Act and rules | 2 | | thereunder, as applicable, or by a successor rule;
| 3 | | (3) evidence of approval by the state of situs of the | 4 | | group master
policy; and
| 5 | | (4) copies of all supportive material furnished to the | 6 | | state of situs
to satisfy the criteria for approval.
| 7 | | (c) The Director may, at any time after receipt of the | 8 | | information
required under subsection (b) and after finding | 9 | | that the standards of
subsection (a) have not been met, order | 10 | | the insurer to cease the issuance
or marketing of that | 11 | | coverage in this State.
| 12 | | (d) Notwithstanding subsections (a) and (b), group Group | 13 | | accident and health insurance subject to the provisions of
| 14 | | this Section is also subject to the provisions of Section 367i | 15 | | of this Code or the Short-Term, Limited-Duration Health | 16 | | Insurance Coverage Act, as applicable, and rules thereunder | 17 | | that pertain to group accident and health insurance .
| 18 | | (Source: P.A. 90-655, eff. 7-30-98.)
| 19 | | (215 ILCS 5/367a) (from Ch. 73, par. 979a)
| 20 | | Sec. 367a.
Blanket
accident and health insurance.
| 21 | | (1) Blanket accident and health insurance is that form of | 22 | | accident and
health insurance covering special groups of | 23 | | persons as enumerated in one of
the following paragraphs (a) | 24 | | to (g), inclusive:
| 25 | | (a) Under a policy or contract issued to any carrier for |
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| 1 | | hire, which
shall be deemed the policyholder, covering a group | 2 | | defined as all persons
who may become passengers on such | 3 | | carrier.
| 4 | | (b) Under a policy or contract issued to an employer, who | 5 | | shall be
deemed the policyholder, covering all employees or | 6 | | any group of employees
defined by reference to exceptional | 7 | | hazards incident to such employment.
| 8 | | (c) Under a policy or contract issued to a college, | 9 | | school, or other
institution of learning or to the head or | 10 | | principal thereof, who or which
shall be deemed the | 11 | | policyholder, covering students or teachers. However, except | 12 | | where inconsistent with 45 CFR 147.145, student health | 13 | | insurance coverage other than excepted benefits or short-term, | 14 | | limited-duration health insurance coverage that is provided | 15 | | pursuant to a written agreement with an institution of higher | 16 | | education for the benefit of its enrolled students and their | 17 | | dependents shall remain subject to the standards and | 18 | | requirements for individual health insurance coverage.
| 19 | | (d) Under a policy or contract issued in the name of any | 20 | | volunteer fire
department, first aid, or other such volunteer | 21 | | group, which shall be deemed
the policyholder, covering all of | 22 | | the members of such department or group.
| 23 | | (e) Under a policy or contract issued to a creditor, who | 24 | | shall be deemed
the policyholder, to insure debtors of the | 25 | | creditors; Provided, however,
that in the case of a loan which | 26 | | is subject to the Small Loans Act, no
insurance premium or |
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| 1 | | other cost shall be directly or indirectly charged or
assessed | 2 | | against, or collected or received from the borrower.
| 3 | | (f) Under a policy or contract issued to a sports team or | 4 | | to a camp,
which team or camp sponsor shall be deemed the | 5 | | policyholder, covering
members or campers.
| 6 | | (g) Under a policy or contract issued to any other | 7 | | substantially similar
group which, in the discretion of the | 8 | | Director, may be subject to the
issuance of a blanket accident | 9 | | and health policy or contract.
| 10 | | (2) Any insurance company authorized to write accident and | 11 | | health
insurance in this state shall have the power to issue | 12 | | blanket accident and
health insurance. No such blanket policy | 13 | | may be issued or delivered in this
State unless a copy of the | 14 | | form thereof shall have been filed in accordance
with Section | 15 | | 355, and it contains in substance such of those provisions
| 16 | | contained in Sections 357.1 through 357.30 as may be | 17 | | applicable to blanket accident and
health insurance and the | 18 | | following provisions:
| 19 | | (a) A provision that the policy and the application shall | 20 | | constitute the
entire contract between the parties, and that | 21 | | all statements made by the
policyholder shall, in absence of | 22 | | fraud, be deemed representations and not
warranties, and that | 23 | | no such statements shall be used in defense to a claim
under | 24 | | the policy, unless it is contained in a written application.
| 25 | | (b) A provision that to the group or class thereof | 26 | | originally insured
shall be added from time to time all new |
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| 1 | | persons or individuals eligible
for coverage.
| 2 | | (3) An individual application shall not be required from a | 3 | | person
covered under a blanket accident or health policy or | 4 | | contract, nor shall it
be necessary for the insurer to furnish | 5 | | each person a certificate.
| 6 | | (4) All benefits under any blanket accident and health | 7 | | policy shall be
payable to the person insured, or to his | 8 | | designated beneficiary or
beneficiaries, or to his or her | 9 | | estate, except that if the person insured be a
minor or person | 10 | | under legal disability, such
benefits may be made payable to | 11 | | his or her
parent, guardian, or other person actually | 12 | | supporting him or her. Provided
further, however, that the | 13 | | policy may provide that all or any portion of
any indemnities | 14 | | provided by any such policy on account of hospital,
nursing, | 15 | | medical or surgical services may, at the insurer's option, be | 16 | | paid
directly to the hospital or person rendering such | 17 | | services; but the policy
may not require that the service be | 18 | | rendered by a particular hospital or
person. Payment so made | 19 | | shall discharge the insurer's obligation with
respect to the | 20 | | amount of insurance so paid.
| 21 | | (5) Nothing contained in this section shall be deemed to | 22 | | affect the
legal liability of policyholders for the death of | 23 | | or injury to, any such
member of such group.
| 24 | | (Source: P.A. 83-1362.)
| 25 | | (215 ILCS 5/368f) |
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| 1 | | Sec. 368f. Military service member insurance | 2 | | reinstatement. | 3 | | (a) No Illinois resident activated for military service | 4 | | and no spouse or dependent of the resident who becomes | 5 | | eligible for a federal government-sponsored health insurance | 6 | | program, including the TriCare program providing coverage for | 7 | | civilian dependents of military personnel, as a result of the | 8 | | activation shall be denied reinstatement into the same | 9 | | individual health insurance coverage with the health insurer | 10 | | that the resident lapsed as a result of activation or becoming | 11 | | covered by the federal government-sponsored health insurance | 12 | | program. The resident shall have the right to reinstatement in | 13 | | the same individual health insurance coverage without medical | 14 | | underwriting, subject to payment of the current premium | 15 | | charged to other persons of the same age and gender that are | 16 | | covered under the same individual health coverage. Except in | 17 | | the case of birth or adoption that occurs during the period of | 18 | | activation, reinstatement must be into the same coverage type | 19 | | as the resident held prior to lapsing the individual health | 20 | | insurance coverage and at the same or, at the option of the | 21 | | resident, higher deductible level. The reinstatement rights | 22 | | provided under this subsection (a) are not available to a | 23 | | resident or dependents if the activated person is discharged | 24 | | from the military under other than honorable conditions. | 25 | | (b) The health insurer with which the reinstatement is | 26 | | being requested must receive a request for reinstatement no |
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| 1 | | later than 63 days following the later of (i) deactivation or | 2 | | (ii) loss of coverage under the federal government-sponsored | 3 | | health insurance program. The health insurer may request proof | 4 | | of loss of coverage and the timing of the loss of coverage of | 5 | | the government-sponsored coverage in order to determine | 6 | | eligibility for reinstatement into the individual coverage. | 7 | | The effective date of the reinstatement of individual health | 8 | | coverage shall be the first of the month following receipt of | 9 | | the notice requesting reinstatement. | 10 | | (c) All insurers must provide written notice to the | 11 | | policyholder of individual health coverage of the rights | 12 | | described in subsection (a) of this Section. In lieu of the | 13 | | inclusion of the notice in the individual health insurance | 14 | | policy, an insurance company may satisfy the notification | 15 | | requirement by providing a single written notice: | 16 | | (1) in conjunction with the enrollment process for a | 17 | | policyholder initially enrolling in the individual | 18 | | coverage on or after the effective date of this amendatory | 19 | | Act of the 94th General Assembly; or | 20 | | (2) by mailing written notice to policyholders whose | 21 | | coverage was effective prior to the effective date of this | 22 | | amendatory Act of the 94th General Assembly no later than | 23 | | 90 days following the effective date of this amendatory | 24 | | Act of the 94th General Assembly. | 25 | | (d) The provisions of subsection (a) of this Section do | 26 | | not apply to any policy or certificate providing coverage for |
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| 1 | | any specified disease, specified accident or accident-only | 2 | | coverage, credit, dental, disability income, hospital | 3 | | indemnity, long-term care, Medicare supplement, vision care, | 4 | | or short-term travel nonrenewable health policy or other | 5 | | limited-benefit supplemental insurance, or any coverage issued | 6 | | as a supplement to any liability insurance, workers' | 7 | | compensation or similar insurance, or any insurance under | 8 | | which benefits are payable with or without regard to fault, | 9 | | whether written on a group, blanket, or individual basis. | 10 | | (e) Nothing in this Section shall require an insurer to | 11 | | reinstate the resident if the insurer requires residency in an | 12 | | enrollment area and those residency requirements are not met | 13 | | after deactivation or loss of coverage under the | 14 | | government-sponsored health insurance program. | 15 | | (f) All terms, conditions, and limitations of the | 16 | | individual coverage into which reinstatement is made apply | 17 | | equally to all insureds enrolled in the coverage. | 18 | | (g) The Secretary may adopt rules as may be necessary to | 19 | | carry out the provisions of this Section.
| 20 | | (Source: P.A. 94-1037, eff. 7-20-06.)
| 21 | | (215 ILCS 5/424) (from Ch. 73, par. 1031)
| 22 | | Sec. 424. Unfair methods of competition and unfair or | 23 | | deceptive acts or
practices defined. The following are hereby | 24 | | defined as unfair methods of
competition and unfair and | 25 | | deceptive acts or practices in the business of
insurance:
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| 1 | | (1) The commission by any person of any one or more of | 2 | | the acts
defined or prohibited by Sections 134, 143.24c, | 3 | | 147, 148, 149, 151, 155.22,
155.22a, 155.42,
236, 237, | 4 | | 364, and 469 of this Code.
| 5 | | (2) Entering into any agreement to commit, or by any | 6 | | concerted
action committing, any act of boycott, coercion | 7 | | or intimidation
resulting in or tending to result in | 8 | | unreasonable restraint of, or
monopoly in, the business of | 9 | | insurance.
| 10 | | (3) Making or permitting, in the case of insurance of | 11 | | the types
enumerated in Classes 1, 2, and 3 of Section 4, | 12 | | any unfair discrimination
between individuals or risks of | 13 | | the same class or of essentially the same
hazard and | 14 | | expense element because of the race, color, religion, or | 15 | | national
origin of such insurance risks or applicants. The | 16 | | application of this Article
to the types of insurance | 17 | | enumerated in Class 1 of Section 4 shall in no way
limit, | 18 | | reduce, or impair the protections and remedies already | 19 | | provided for by
Sections 236 and 364 of this Code or any | 20 | | other provision of this Code.
| 21 | | (4) Engaging in any of the acts or practices defined | 22 | | in or prohibited by
Sections 154.5 through 154.8 of this | 23 | | Code.
| 24 | | (5) Making or charging any rate for insurance against | 25 | | losses arising
from the use or ownership of a motor | 26 | | vehicle which requires a higher
premium of any person by |
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| 1 | | reason of his physical disability, race, color,
religion, | 2 | | or national origin.
| 3 | | (6) Failing to meet any requirement of the Unclaimed | 4 | | Life Insurance Benefits Act with such frequency as to | 5 | | constitute a general business practice. | 6 | | (7) Failing to make a disclosure or obtain a signed | 7 | | confirmation required under Section 15 of the Short-Term, | 8 | | Limited-Duration Health Insurance Coverage Act
or any | 9 | | unlawful practice described in Section 30 of the | 10 | | Short-Term, Limited-Duration Health Insurance Coverage | 11 | | Act. | 12 | | (Source: P.A. 99-143, eff. 7-27-15; 99-893, eff. 1-1-17 .)
| 13 | | (215 ILCS 5/425) (from Ch. 73, par. 1032)
| 14 | | Sec. 425.
Power of
Director.
| 15 | | The Director shall have power to examine and investigate | 16 | | into the
affairs of every person engaged in the business of | 17 | | insurance in this State , or otherwise subject to the | 18 | | provisions of Section 30 of the Short-Term, Limited-Duration | 19 | | Health Insurance Coverage Act,
and to examine and investigate | 20 | | into the affairs of any person domiciled in
or resident of this | 21 | | State engaged in the business of insurance in any other
State, | 22 | | Territory, Province, Possession, Country or District in which | 23 | | he is
not licensed or otherwise authorized to transact | 24 | | business in order to
determine whether such person has been or | 25 | | is engaged in any unfair method
of competition or in any unfair |
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| 1 | | or deceptive act or practice prohibited by
Section 424.
| 2 | | (Source: Laws 1967, p. 990.)
| 3 | | (215 ILCS 5/500-70)
| 4 | | (Section scheduled to be repealed on January 1, 2027)
| 5 | | Sec. 500-70. License denial, nonrenewal, or revocation.
| 6 | | (a) The Director may place on probation, suspend, revoke, | 7 | | or refuse to issue
or renew
an insurance producer's license or | 8 | | may levy a civil penalty in accordance with
this Section or
| 9 | | take any combination of actions, for any one or more of the | 10 | | following causes:
| 11 | | (1) providing incorrect, misleading, incomplete, or | 12 | | materially untrue
information in the license application;
| 13 | | (2) violating any insurance laws, or violating any | 14 | | rule, subpoena, or
order of
the Director or of another | 15 | | state's insurance commissioner;
| 16 | | (3) obtaining or attempting to obtain a license | 17 | | through misrepresentation
or
fraud;
| 18 | | (4) improperly withholding, misappropriating or | 19 | | converting any moneys or
properties received in the course | 20 | | of doing insurance business;
| 21 | | (5) intentionally misrepresenting the terms of an | 22 | | actual or proposed
insurance
contract or application for | 23 | | insurance;
| 24 | | (6) having been convicted of a felony, unless the | 25 | | individual demonstrates to the Director sufficient |
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| 1 | | rehabilitation to warrant the public trust; consideration | 2 | | of such conviction of an applicant shall be in accordance | 3 | | with Section 500-76;
| 4 | | (7) having admitted or been found to have committed | 5 | | any insurance unfair
trade practice or fraud;
| 6 | | (8) using fraudulent, coercive, or dishonest | 7 | | practices, or demonstrating
incompetence, | 8 | | untrustworthiness or financial irresponsibility in the | 9 | | conduct of
business in
this State or elsewhere;
| 10 | | (9) having an insurance producer license,
or its | 11 | | equivalent, denied, suspended,
or revoked in any other | 12 | | state, province, district or territory;
| 13 | | (10) forging a name to an application for insurance or | 14 | | to a document
related
to
an insurance transaction;
| 15 | | (11) improperly using notes or any other reference | 16 | | material to complete an
examination for an insurance | 17 | | license;
| 18 | | (12) knowingly accepting insurance business from an | 19 | | individual who is not
licensed;
| 20 | | (13) failing to comply with an administrative or court | 21 | | order imposing a
child
support obligation;
| 22 | | (14) failing to pay state income tax or penalty or | 23 | | interest or comply with
any
administrative or court order | 24 | | directing payment of state income tax or failed
to file a
| 25 | | return or to pay any final assessment of any tax due to the | 26 | | Department of
Revenue;
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| 1 | | (15) (blank); or
| 2 | | (16) failing to comply with any provision of the | 3 | | Viatical Settlements Act of 2009 ; or . | 4 | | (17) failing to make a disclosure or obtain a signed | 5 | | confirmation required under Section 15 of the Short-Term, | 6 | | Limited-Duration Health Insurance Coverage Act or any | 7 | | unlawful practice described in Section 30 of the | 8 | | Short-Term, Limited-Duration Health Insurance Coverage | 9 | | Act. | 10 | | (b) If the action by the Director is to nonrenew, suspend, | 11 | | or revoke a
license or to
deny an application for a license, | 12 | | the Director shall notify the applicant or
licensee and | 13 | | advise, in
writing, the applicant or licensee of the reason | 14 | | for the suspension,
revocation, denial or
nonrenewal of the | 15 | | applicant's or licensee's license. The applicant or licensee
| 16 | | may make written
demand upon the Director within 30 days after | 17 | | the date of mailing for a hearing
before the
Director to | 18 | | determine the reasonableness of the Director's action. The | 19 | | hearing
must be held
within not fewer than 20 days nor more | 20 | | than 30 days after the mailing of the
notice of hearing
and | 21 | | shall be held pursuant to 50 Ill. Adm. Code 2402.
| 22 | | (c) The license of a business entity may be suspended, | 23 | | revoked, or refused
if the
Director finds, after hearing, that | 24 | | an individual licensee's violation was
known or should have
| 25 | | been known by one or more of the partners, officers, or | 26 | | managers acting on
behalf of the
partnership, corporation, |
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| 1 | | limited liability company, or limited liability
partnership | 2 | | and the
violation was neither reported to the Director nor | 3 | | corrective action taken.
| 4 | | (d) In addition to or instead of any applicable denial, | 5 | | suspension, or
revocation of a
license, a person may, after | 6 | | hearing, be subject to a civil penalty of up to
$10,000 for | 7 | | each cause for
denial, suspension, or revocation, however, the | 8 | | civil penalty may total no more
than $100,000.
| 9 | | (e) The Director has the authority to enforce the | 10 | | provisions of and impose
any penalty
or remedy authorized by | 11 | | this Article against any person who is under
investigation for | 12 | | or charged
with a violation of this Code or rules even if the | 13 | | person's license or
registration has been
surrendered or has | 14 | | lapsed by operation of law.
| 15 | | (f) Upon the suspension, denial, or revocation of a | 16 | | license, the licensee or
other
person having possession or | 17 | | custody of the license shall promptly deliver it to
the | 18 | | Director in
person or by mail. The Director shall publish all | 19 | | suspensions, denials, or
revocations after the
suspensions, | 20 | | denials, or revocations become final in a manner designed to
| 21 | | notify interested
insurance companies and other persons.
| 22 | | (g) A person whose license is revoked or whose application | 23 | | is denied
pursuant to this
Section is ineligible to apply for | 24 | | any license for 3 years after the revocation
or denial. A | 25 | | person
whose license as an insurance producer has been | 26 | | revoked, suspended, or denied
may not be
employed, contracted, |
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| 1 | | or engaged in any insurance related capacity during the
time | 2 | | the
revocation, suspension, or denial is in effect.
| 3 | | (Source: P.A. 100-286, eff. 1-1-18; 100-872, eff. 8-14-18.)
| 4 | | Section 10. The Short-Term, Limited-Duration Health | 5 | | Insurance Coverage Act is amended by changing Sections 5, 10, | 6 | | 15, and 20 and by adding Sections 2, 25, 30, and 35 as follows: | 7 | | (215 ILCS 190/2 new) | 8 | | Sec. 2. Purpose and scope. This Act is intended to | 9 | | regulate the sale, solicitation, and marketing of short-term, | 10 | | limited-duration health insurance coverage to insurance | 11 | | consumers, and the referral of insurance consumers to | 12 | | short-term, limited-duration health insurance coverage, and to | 13 | | protect consumers from confusing or deceptive marketing | 14 | | practices. This Act applies to health insurance issuers and | 15 | | insurance producers. Additionally, except as provided therein, | 16 | | Section 30 applies to any other person whose business | 17 | | transactions include advertising, referring, or directing | 18 | | prospective insurance purchasers or enrollees to health | 19 | | insurance coverage even when such persons are not otherwise | 20 | | required to obtain a license, certificate, or registration | 21 | | from the Department. | 22 | | (215 ILCS 190/5)
| 23 | | Sec. 5. Definitions. In this Act: |
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| 1 | | "Department" means the Department of Insurance. | 2 | | "Excepted benefits" has the meaning given to that term in | 3 | | 42 U.S.C. 300gg-91(c) and regulations thereunder. | 4 | | "Health insurance coverage" has the meaning given to that | 5 | | term in Section 5 of the Illinois Health Insurance Portability | 6 | | and Accountability Act. | 7 | | "Health insurance issuer" has the meaning given to that | 8 | | term in Section 5 of the Illinois Health Insurance Portability | 9 | | and Accountability Act. | 10 | | "Health insurance issuer doing direct sales" means a | 11 | | health insurance issuer that provides a means to accept a | 12 | | completed application or enrollment form for a policy or | 13 | | certificate of health insurance coverage directly from an | 14 | | individual or group without any prior live interaction or | 15 | | written correspondence between that individual or group and an | 16 | | insurance producer. A "health insurance issuer doing direct | 17 | | sales" includes a health insurance issuer that accepts an | 18 | | application for health insurance coverage through its own | 19 | | website. A "health insurance issuer doing direct sales" does | 20 | | not include the enrollment of individuals under a group policy | 21 | | by a non-producer representative of the group or the group's | 22 | | own website. | 23 | | "Fraud" means an intentional misrepresentation of a | 24 | | material fact in connection with the coverage. | 25 | | "Person" means any natural or legal person, organization, | 26 | | body, association, corporation, company, partnership, society, |
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| 1 | | order, aggregation of individuals, or other entity described | 2 | | under any State or federal law. | 3 | | "Short-term, limited-duration health insurance coverage" | 4 | | means health insurance coverage , other than excepted benefits, | 5 | | provided pursuant to a policy or certificate with an issuer, | 6 | | regardless of the situs of the delivery of the policy, that has | 7 | | an expiration date of is less than 365 days after the effective | 8 | | date of the policy or certificate .
| 9 | | (Source: P.A. 100-1118, eff. 11-27-18.) | 10 | | (215 ILCS 190/10)
| 11 | | Sec. 10. Application; scope; duration of coverage. | 12 | | (a) This Act applies to health insurance issuers that | 13 | | offer short-term, limited-duration health insurance coverage | 14 | | to groups and individuals in this State and to short-term, | 15 | | limited-duration health insurance coverage that is delivered | 16 | | or issued for delivery in this State, including group coverage | 17 | | issued outside of this State that covers individuals in this | 18 | | State. | 19 | | (b) A short-term, limited-duration health insurance | 20 | | coverage policy or certificate may not be issued or delivered | 21 | | to any natural or legal person residing in this State unless | 22 | | the policy or certificate , when delivered or issued for | 23 | | delivery in this State, complies with the provisions of this | 24 | | Act. | 25 | | (b-5) In addition to the entities recognized under Section |
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| 1 | | 230.1 or 367 of the Illinois Insurance Code or under the Health | 2 | | Maintenance Organization Act as eligible for group coverage, a | 3 | | group policy of short-term, limited-duration health insurance | 4 | | coverage may be issued to an institution of higher education | 5 | | for the benefit of its enrolled students and their dependents | 6 | | for purposes of this Act. | 7 | | (c) Any short-term, limited-duration health insurance | 8 | | coverage policy or certificate that is delivered or issued for | 9 | | delivery in this State must have an expiration date in the | 10 | | policy that is less than the lesser of 181 days after the | 11 | | effective date or any applicable time limitation provided in | 12 | | federal law or regulation and shall not be renewable or | 13 | | extendable within a period of 365 days after the individual's | 14 | | coverage under the policy ends, either at the option of the | 15 | | issuer or the individual. Renewal of a short-term, | 16 | | limited-duration health insurance coverage policy or | 17 | | certificate includes the issuance of a new or different | 18 | | short-term, limited-duration health insurance policy or | 19 | | certificate by an issuer to a policyholder within 60 days | 20 | | after the expiration of a policy or certificate previously | 21 | | issued by the issuer to the policyholder. | 22 | | (d) An issuer may not rescind any Any short-term, | 23 | | limited-duration health insurance coverage policy or | 24 | | certificate that is delivered or issued for delivery in this | 25 | | State may not be rescinded before the expiration date in the | 26 | | policy, except as provided in Section 154 of the Illinois |
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| 1 | | Insurance Code. An issuer may not cancel any such policy or | 2 | | certificate except for nonpayment of premiums or for fraud in | 3 | | the making of a claim or an application for the policy or | 4 | | certificate. Notwithstanding Section 357.22 of the Illinois | 5 | | Insurance Code, cancellations for nonpayment of premiums shall | 6 | | not be valid except upon 10 days' notice but may be effectuated | 7 | | retroactively back to the last date of coverage for which | 8 | | premiums were paid in cases of nonpayment of premiums, fraud, | 9 | | or as provided in subsection (e) . | 10 | | (e) Any short-term, limited-duration health insurance | 11 | | coverage policy or certificate that is delivered or issued for | 12 | | delivery in this State shall contain an option for an | 13 | | individual to cancel coverage after any 30-day interval during | 14 | | the term of the plan , counting such intervals from the | 15 | | effective date of coverage .
| 16 | | (Source: P.A. 100-1118, eff. 11-27-18.) | 17 | | (215 ILCS 190/15)
| 18 | | Sec. 15. Disclosure requirements. | 19 | | (a) A health insurance issuer that offers short-term, | 20 | | limited-duration health insurance coverage to be delivered or | 21 | | issued for delivery in this State shall, in addition to all | 22 | | other documents required, including, but not limited to, the | 23 | | policy, the certificate, the membership booklet, the completed | 24 | | and signed application or enrollment form, all signed | 25 | | confirmations required by this Section, and a description of |
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| 1 | | appeal and external review rights, deliver an outline of | 2 | | coverage to an applicant for or an enrollee in short-term, | 3 | | limited-duration health insurance coverage delivered or issued | 4 | | for delivery in this State. | 5 | | (b) Any short-term, limited-duration health insurance | 6 | | coverage policy that is delivered or issued for delivery in | 7 | | the State shall display prominently in the policy, any | 8 | | application, sales, and marketing materials provided in | 9 | | connection with enrollment in such coverage, and the outline | 10 | | of coverage for such coverage, in at least 14-point, bold | 11 | | type, the following: "NOTICE: THE SHORT-TERM, LIMITED-DURATION | 12 | | INSURANCE BENEFITS UNDER THIS COVERAGE DO NOT MEET ALL FEDERAL | 13 | | REQUIREMENTS TO QUALIFY AS "MINIMUM ESSENTIAL COVERAGE" FOR | 14 | | HEALTH INSURANCE UNDER THE AFFORDABLE CARE ACT. THIS PLAN OF | 15 | | COVERAGE DOES NOT INCLUDE ALL ESSENTIAL HEALTH BENEFITS AS | 16 | | REQUIRED BY THE AFFORDABLE CARE ACT. PREEXISTING CONDITIONS | 17 | | ARE NOT COVERED UNDER THIS PLAN OF COVERAGE. BE SURE TO CHECK | 18 | | YOUR POLICY CAREFULLY TO MAKE SURE YOU UNDERSTAND WHAT THE | 19 | | POLICY DOES AND DOES NOT COVER. IF THIS COVERAGE EXPIRES OR YOU | 20 | | LOSE ELIGIBILITY FOR THIS COVERAGE, YOU MIGHT HAVE TO WAIT | 21 | | UNTIL THE NEXT OPEN ENROLLMENT PERIOD TO GET OTHER HEALTH | 22 | | INSURANCE COVERAGE. YOU MAY BE ABLE TO GET LONGER TERM | 23 | | INSURANCE THAT QUALIFIES AS "MINIMUM ESSENTIAL COVERAGE" FOR | 24 | | HEALTH INSURANCE UNDER THE AFFORDABLE CARE ACT NOW AND HELP TO | 25 | | PAY FOR IT AT WWW.HEALTHCARE.GOV.". | 26 | | (c)(1) Before enrolling any individual or accepting any |
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| 1 | | application for group or individual short-term, | 2 | | limited-duration health insurance coverage to be delivered or | 3 | | issued for delivery in this State, an insurance producer or a | 4 | | health insurance issuer doing direct sales shall review with | 5 | | the prospective purchaser or enrollee each essential health | 6 | | benefit in the State of Illinois, identify whether the policy | 7 | | or certificate covers that benefit, and obtain the prospective | 8 | | purchaser or enrollee's signed confirmation of receipt of this | 9 | | disclosure. The signed confirmation document must be in at | 10 | | least 12-point type and must include the complete list of | 11 | | essential health benefits and an indication for each benefit | 12 | | as to whether the policy or certificate covers it to the extent | 13 | | provided in the Illinois Essential Health Benefits Benchmark | 14 | | Plan. An insurance producer or other representative of an | 15 | | issuer or its administrator may not sign on the prospective | 16 | | purchaser or enrollee's behalf. | 17 | | (2) For coverage offered to an individual in this State | 18 | | under a group policy by a representative of the group | 19 | | policyholder or its administrator, if the issuer does not | 20 | | receive the signed confirmation with the individual's | 21 | | completed and signed application or enrollment form, the | 22 | | issuer must provide this disclosure to the individual and | 23 | | obtain the individual's signed confirmation before enrolling | 24 | | the individual under the coverage. | 25 | | (d)(1) Before enrolling any individual or accepting any | 26 | | individual application for short-term, limited-duration health |
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| 1 | | insurance coverage, an insurance producer or a health | 2 | | insurance issuer doing direct sales must review the complete | 3 | | list of qualifying events for special enrollment with the | 4 | | prospective purchaser or enrollee, verify whether the | 5 | | individual qualifies for special enrollment on the date the | 6 | | short-term, limited-duration health insurance coverage is | 7 | | offered, and obtain the prospective purchaser or enrollee's | 8 | | signed confirmation as to whether the individual has | 9 | | experienced a qualifying event within the time frames provided | 10 | | under the Patient Protection and Affordable Care Act. The | 11 | | signed confirmation must be in at least 12-point type and must | 12 | | include the complete list of qualifying events, the relevant | 13 | | time frames for each, and an indication for each qualifying | 14 | | event as to whether it applies to the individual. An insurance | 15 | | producer or other representative of the issuer or its | 16 | | administrator may not sign the confirmation on the | 17 | | individual's behalf. | 18 | | (2) If the individual qualifies for special enrollment, or | 19 | | during an open enrollment period described in 42 U.S.C. | 20 | | 300gg-1, the issuer or producer, before accepting the | 21 | | application or enrollment, must inform the individual in | 22 | | writing and via either face-to-face interaction or telephone | 23 | | call or voicemail about the availability of qualified health | 24 | | plans on the healthcare.gov website. If the issuer or producer | 25 | | also offers policies in the individual market, the issuer or | 26 | | producer may also inform the individual of the availability of |
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| 1 | | such plans. | 2 | | (3) For coverage offered to an individual in this State | 3 | | under a group policy by a representative of the group | 4 | | policyholder or its administrator, if the issuer does not | 5 | | receive the signed confirmation regarding qualifying events | 6 | | with the individual's completed and signed application or | 7 | | enrollment form, the issuer must provide this disclosure to | 8 | | the individual and obtain the individual's signed confirmation | 9 | | regarding qualifying events before enrolling the individual | 10 | | under the coverage. If the individual indicates that a | 11 | | qualifying event has occurred within the relevant time frame, | 12 | | the issuer must comply with paragraph (2). | 13 | | (e) A health insurance issuer shall provide a website | 14 | | where prospective purchasers or enrollees can review the | 15 | | complete policy or certificate and the outline of coverage | 16 | | before submitting their application or enrollment form. The | 17 | | availability of this website shall be disclosed on the | 18 | | application or enrollment form and in any sales or marketing | 19 | | materials for the coverage. | 20 | | (f) The policy or certificate and any application or | 21 | | enrollment form must contain a provision stating that, during | 22 | | a period of 10 days from the date the policy or certificate is | 23 | | delivered, the group or individual may submit a written | 24 | | request for retroactive cancellation of coverage and that in | 25 | | such event the issuer will refund any premium paid for the | 26 | | policy or certificate, including any contract fees or other |
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| 1 | | charges. | 2 | | (g) In addition to the written disclosures, any insurance | 3 | | producer (c) Any individual selling a short-term, | 4 | | limited-duration health insurance coverage policy in this | 5 | | State in face-to-face or telephonic sales interactions must | 6 | | read out loud the disclosures disclosure in subsections | 7 | | subsection (b) , (c), (d), (e), and (f) to a prospective | 8 | | purchaser or enrollee . An issuer entity selling a short-term, | 9 | | limited-duration health insurance coverage policy or | 10 | | certificate in Illinois must display the disclosures | 11 | | disclosure in subsections subsection (b) , (c), (d), (e), and | 12 | | (f) on the webpage where a prospective purchaser or enrollee | 13 | | would purchase or enroll in coverage. For sales conducted by | 14 | | an insurance producer in face-to-face or telephonic | 15 | | interactions, the application or enrollment form shall contain | 16 | | an attestation to be initialed by the applicant that the | 17 | | producer read each disclosure out loud, that the applicant | 18 | | understood each disclosure, and that the applicant was given | 19 | | opportunities to ask the producer questions about each | 20 | | disclosure and to review the policy or certificate and the | 21 | | outline of coverage. | 22 | | (h) (d) Nothing in this Section precludes an issuer | 23 | | insurer from providing disclosures in addition to those | 24 | | required in subsections (b) , and (c) , (d), (e), and (f) . | 25 | | Nothing in this Section precludes an insurer from providing | 26 | | disclosures intended to clarify those required in subsections |
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| 1 | | (b) , and (c) , (d), (e), and (f) if approved by the Department. | 2 | | Nothing in this Section precludes an issuer from including the | 3 | | written disclosures required in subsections (c) and (d) on the | 4 | | application or enrollment form. | 5 | | (i) No policy or certificate of short-term, | 6 | | limited-duration health insurance coverage shall be delivered | 7 | | or issued for delivery in this State unless the prospective | 8 | | purchaser or enrollee reviews and signs the completed written | 9 | | application or enrollment form. Any application or enrollment | 10 | | form submitted by an insurance producer to a health insurance | 11 | | issuer shall contain an attestation clause signed by the | 12 | | producer stating that the producer received the signed form | 13 | | from the applicant, that no alterations have been made to any | 14 | | of the applicant's personal information appearing on the | 15 | | signed form at the time the producer received it, and that the | 16 | | applicant received and signed all disclosures described in | 17 | | this Section. | 18 | | (j) Nothing in this Act shall preclude a prospective | 19 | | purchaser or enrollee from designating an authorized | 20 | | representative to act on his or her behalf in relation to the | 21 | | purchase or enrollment. However, no designation of an | 22 | | insurance producer, a health insurance issuer, or an agent or | 23 | | employee of either shall be valid with respect to the | 24 | | disclosures, applications, enrollment forms, and signed | 25 | | confirmations under this Section.
| 26 | | (Source: P.A. 100-1118, eff. 11-27-18.) |
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| 1 | | (215 ILCS 190/20)
| 2 | | Sec. 20. Filing and approval. | 3 | | (a) Coverage subject to this Act may not be delivered or | 4 | | issued for delivery in this State unless the health insurance | 5 | | issuer has complied with the policy form and rate filing | 6 | | requirements of Sections 143 and 355 of the Illinois Insurance | 7 | | Code or Sections 4-12 and 4-13 of the Health Maintenance | 8 | | Organization Act, as applicable, including rules thereunder | 9 | | policy evidencing such coverage has been filed with and been | 10 | | approved by the Department . | 11 | | (b) A health insurance issuer that who intends to deliver | 12 | | or issue for delivery a short-term, limited-duration health | 13 | | insurance coverage policy or certificate in this State shall | 14 | | file with the Department : (1) all paperwork required for | 15 | | individual health insurance coverage pursuant to 50 Ill. Adm. | 16 | | Code 916; and (2) all sales and marketing materials provided | 17 | | in connection with enrollment in such coverage for | 18 | | informational purposes. | 19 | | (c) (Blank). The Department shall adopt any rules | 20 | | necessary to carry out the provisions of this Act.
| 21 | | (Source: P.A. 100-1118, eff. 11-27-18.) | 22 | | (215 ILCS 190/25 new) | 23 | | Sec. 25. Coverage requirements; other laws. | 24 | | (a) Except where inconsistent with this Act, a health |
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| 1 | | insurance issuer that offers any policy or certificate of | 2 | | short-term, limited-duration health insurance coverage shall | 3 | | be subject to all Illinois insurance laws or rules not | 4 | | specifically referenced in this Act that apply to major | 5 | | medical accident and health insurance or health maintenance | 6 | | organization health care plans, as applicable to the | 7 | | certificate of authority under which the short-term, | 8 | | limited-duration health insurance coverage is offered or | 9 | | issued, and that do not: | 10 | | (1) require the policy or certificate to cover | 11 | | essential health benefits or other specified health care | 12 | | services or to maintain parity between certain types of | 13 | | benefits; | 14 | | (2) prescribe standards for continuation coverage or | 15 | | conversion privileges; | 16 | | (3) prohibit or prescribe standards for allowable | 17 | | cost-sharing amounts; or | 18 | | (4) require an issuer to satisfy standards for the | 19 | | adequacy and transparency of any provider network through | 20 | | which the insured or enrollee is required or incentivized | 21 | | to obtain covered health care services. | 22 | | (b) Notwithstanding subsection (a), no State law or rule | 23 | | shall apply to the extent that it would require a policy or | 24 | | certificate of short-term, limited-duration health insurance | 25 | | coverage to provide coverage for at least 3 calendar months or | 26 | | to renew, extend, or reinstate coverage within 365 days of the |
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| 1 | | date that coverage terminates. | 2 | | (c) Nothing in this Act shall exempt a health maintenance | 3 | | organization offering short-term, limited-duration health | 4 | | insurance coverage from the requirements for coverage of basic | 5 | | health care services or other requirements to maintain and | 6 | | restrictions on a certificate of authority under Sections 2-1 | 7 | | through 2-3 of the Health Maintenance Organization Act. | 8 | | (215 ILCS 190/30 new) | 9 | | Sec. 30. Unfair or deceptive practices relating to the | 10 | | sale of supplemental or short-term, limited-duration health | 11 | | insurance coverage. | 12 | | (a) It is an unlawful method, act, or practice within the | 13 | | meaning of this Act for any person who solicits, negotiates, | 14 | | sells, offers, offers to enroll, issues, or delivers | 15 | | short-term, limited-duration health insurance coverage or | 16 | | excepted benefits within this State, or advertisers for such | 17 | | persons, or persons whose business transactions include | 18 | | referring or directing prospective purchasers or enrollees of | 19 | | health insurance coverage that reside or are domiciled in this | 20 | | State to health insurance issuers or insurance producers | 21 | | transacting business in this State, to do any of the | 22 | | following: | 23 | | (1) represent or warrant to any prospective purchaser | 24 | | or enrollee, or use language or imagery in speech or | 25 | | published content that is suggestive, that a policy or |
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| 1 | | certificate of excepted benefits or short-term, | 2 | | limited-duration health insurance coverage, or any | 3 | | combination of such policies or certificates, constitutes | 4 | | minimum essential coverage; | 5 | | (2) represent or warrant to any prospective purchaser | 6 | | or enrollee, or use language or imagery in speech or | 7 | | published content that is suggestive, that a policy or | 8 | | certificate of excepted benefits or short-term, | 9 | | limited-duration health insurance coverage, or any | 10 | | combination of such policies or certificates, is similar | 11 | | to, is almost as beneficial as, can be used for similar | 12 | | purposes as, or may be better for the prospective | 13 | | purchaser or enrollee than minimum essential coverage, | 14 | | major medical coverage that complies with all Illinois | 15 | | requirements, a health maintenance organization health | 16 | | care plan that complies with all Illinois requirements, a | 17 | | voluntary health services plan, comprehensive health | 18 | | insurance coverage, a qualified health plan, or any other | 19 | | description of coverage indicating such policies or | 20 | | certificates. An application or enrollment form for | 21 | | specified disease or accident-only excepted benefits that | 22 | | allows an individual prospective purchaser or enrollee to | 23 | | choose coverage for a majority of the diseases, health | 24 | | conditions, or accidents typically covered under major | 25 | | medical accident health insurance or a health maintenance | 26 | | organization health care plan, or that covers a majority |
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| 1 | | of the health care services constituting preventive care | 2 | | under 42 U.S.C. 300gg-13, shall be deemed an unlawful | 3 | | practice within the meaning of this Act; or | 4 | | (3) use any logo, brand, trademark, service mark, | 5 | | mark, device, name, tagline, slogan, descriptor, or | 6 | | website domain that is deceptively similar to those used | 7 | | for Get Covered Illinois or the healthcare.gov website, | 8 | | including those that do not expressly mention Illinois or | 9 | | its political subdivisions. This paragraph expressly | 10 | | includes circumstances that would not violate the | 11 | | Counterfeit Trademark Act. | 12 | | (b) This Section does not apply to Internet search | 13 | | engines, Internet service providers, website domain | 14 | | registrars, Internet network hardware providers, or other | 15 | | natural or legal persons insofar as they do not propose, | 16 | | approve, or submit the content published by an insurance | 17 | | producer, health insurance issuer, or their advertisers, or | 18 | | propose, approve, or submit the content published by persons | 19 | | whose business transactions include referring prospective | 20 | | purchasers or enrollees resident or domiciled in this State to | 21 | | health insurance issuers or insurance producers transacting | 22 | | business in this State. | 23 | | (215 ILCS 190/35 new) | 24 | | Sec. 35. Department administration and enforcement. The | 25 | | Department may adopt any rules necessary to carry out the |
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| 1 | | provisions of this Act. The Department shall have all | 2 | | enforcement powers granted to it by law with respect to | 3 | | accident and health insurance and health maintenance | 4 | | organization health care plans and all persons otherwise under | 5 | | the Director's jurisdiction.
| 6 | | Section 99. Effective date. This Act takes effect January | 7 | | 1, 2023.
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