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Public Act 103-0718 |
HB5493 Enrolled | LRB103 39189 RPS 69335 b |
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AN ACT concerning regulation. |
Be it enacted by the People of the State of Illinois, |
represented in the General Assembly: |
Section 5. The State Employees Group Insurance Act of 1971 |
is amended by changing Sections 6.7 and 6.11 as follows: |
(5 ILCS 375/6.7) |
Sec. 6.7. Access to obstetrical and gynecological care |
Woman's health care provider . The program of health benefits |
is subject to the provisions of Section 356r of the Illinois |
Insurance Code. |
(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.) |
(5 ILCS 375/6.11) |
Sec. 6.11. Required health benefits; Illinois Insurance |
Code requirements. The program of health benefits shall |
provide the post-mastectomy care benefits required to be |
covered by a policy of accident and health insurance under |
Section 356t of the Illinois Insurance Code. The program of |
health benefits shall provide the coverage required under |
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, |
356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, |
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, |
356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, |
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356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, |
356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, |
356z.60, and 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, |
and 356z.70 of the Illinois Insurance Code. The program of |
health benefits must comply with Sections 155.22a, 155.37, |
355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the |
Illinois Insurance Code. The program of health benefits shall |
provide the coverage required under Section 356m of the |
Illinois Insurance Code and, for the employees of the State |
Employee Group Insurance Program only, the coverage as also |
provided in Section 6.11B of this Act. The Department of |
Insurance shall enforce the requirements of this Section with |
respect to Sections 370c and 370c.1 of the Illinois Insurance |
Code; all other requirements of this Section shall be enforced |
by the Department of Central Management Services. |
Rulemaking authority to implement Public Act 95-1045, if |
any, is conditioned on the rules being adopted in accordance |
with all provisions of the Illinois Administrative Procedure |
Act and all rules and procedures of the Joint Committee on |
Administrative Rules; any purported rule not so adopted, for |
whatever reason, is unauthorized. |
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; |
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. |
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768, |
eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; |
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. |
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1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84, |
eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24; |
103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff. |
8-11-23; revised 8-29-23.) |
Section 10. The Counties Code is amended by changing |
Sections 5-1069.3 and 5-1069.5 as follows: |
(55 ILCS 5/5-1069.3) |
Sec. 5-1069.3. Required health benefits. If a county, |
including a home rule county, is a self-insurer for purposes |
of providing health insurance coverage for its employees, the |
coverage shall include coverage for the post-mastectomy care |
benefits required to be covered by a policy of accident and |
health insurance under Section 356t and the coverage required |
under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x, |
356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, |
356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, |
356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 356z.36, |
356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, |
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and |
356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, and 356z.70 |
of the Illinois Insurance Code. The coverage shall comply with |
Sections 155.22a, 355b, 356z.19, and 370c of the Illinois |
Insurance Code. The Department of Insurance shall enforce the |
requirements of this Section. The requirement that health |
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benefits be covered as provided in this Section is an |
exclusive power and function of the State and is a denial and |
limitation under Article VII, Section 6, subsection (h) of the |
Illinois Constitution. A home rule county to which this |
Section applies must comply with every provision of this |
Section. |
Rulemaking authority to implement Public Act 95-1045, if |
any, is conditioned on the rules being adopted in accordance |
with all provisions of the Illinois Administrative Procedure |
Act and all rules and procedures of the Joint Committee on |
Administrative Rules; any purported rule not so adopted, for |
whatever reason, is unauthorized. |
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; |
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. |
1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, |
eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; |
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. |
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, |
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; |
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised |
8-29-23.) |
(55 ILCS 5/5-1069.5) |
Sec. 5-1069.5. Access to obstetrical and gynecological |
care Woman's health care provider . All counties, including |
home rule counties, are subject to the provisions of Section |
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356r of the Illinois Insurance Code. The requirement under |
this Section that health care benefits provided by counties |
comply with Section 356r of the Illinois Insurance Code is an |
exclusive power and function of the State and is a denial and |
limitation of home rule county powers under Article VII, |
Section 6, subsection (h) of the Illinois Constitution. |
(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.) |
Section 15. The Illinois Municipal Code is amended by |
changing Sections 10-4-2.3 and 10-4-2.5 as follows: |
(65 ILCS 5/10-4-2.3) |
Sec. 10-4-2.3. Required health benefits. If a |
municipality, including a home rule municipality, is a |
self-insurer for purposes of providing health insurance |
coverage for its employees, the coverage shall include |
coverage for the post-mastectomy care benefits required to be |
covered by a policy of accident and health insurance under |
Section 356t and the coverage required under Sections 356g, |
356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, |
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, |
356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, |
356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, |
356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, |
356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62 , |
356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois |
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Insurance Code. The coverage shall comply with Sections |
155.22a, 355b, 356z.19, and 370c of the Illinois Insurance |
Code. The Department of Insurance shall enforce the |
requirements of this Section. The requirement that health |
benefits be covered as provided in this is an exclusive power |
and function of the State and is a denial and limitation under |
Article VII, Section 6, subsection (h) of the Illinois |
Constitution. A home rule municipality to which this Section |
applies must comply with every provision of this Section. |
Rulemaking authority to implement Public Act 95-1045, if |
any, is conditioned on the rules being adopted in accordance |
with all provisions of the Illinois Administrative Procedure |
Act and all rules and procedures of the Joint Committee on |
Administrative Rules; any purported rule not so adopted, for |
whatever reason, is unauthorized. |
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; |
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. |
1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, |
eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; |
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. |
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, |
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; |
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised |
8-29-23.) |
(65 ILCS 5/10-4-2.5) |
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Sec. 10-4-2.5. Access to obstetrical and gynecological |
care Woman's health care provider . The corporate authorities |
of all municipalities are subject to the provisions of Section |
356r of the Illinois Insurance Code. The requirement under |
this Section that health care benefits provided by |
municipalities comply with Section 356r of the Illinois |
Insurance Code is an exclusive power and function of the State |
and is a denial and limitation of home rule municipality |
powers under Article VII, Section 6, subsection (h) of the |
Illinois Constitution. |
(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.) |
Section 20. The School Code is amended by changing |
Sections 10-22.3d and 10-22.3f as follows: |
(105 ILCS 5/10-22.3d) |
Sec. 10-22.3d. Access to obstetrical and gynecological |
care Woman's health care provider . Insurance protection and |
benefits for employees are subject to the provisions of |
Section 356r of the Illinois Insurance Code. |
(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.) |
(105 ILCS 5/10-22.3f) |
Sec. 10-22.3f. Required health benefits. Insurance |
protection and benefits for employees shall provide the |
post-mastectomy care benefits required to be covered by a |
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policy of accident and health insurance under Section 356t and |
the coverage required under Sections 356g, 356g.5, 356g.5-1, |
356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, |
356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, |
356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, |
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, |
356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, |
and 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, and |
356z.70 of the Illinois Insurance Code. Insurance policies |
shall comply with Section 356z.19 of the Illinois Insurance |
Code. The coverage shall comply with Sections 155.22a, 355b, |
and 370c of the Illinois Insurance Code. The Department of |
Insurance shall enforce the requirements of this Section. |
Rulemaking authority to implement Public Act 95-1045, if |
any, is conditioned on the rules being adopted in accordance |
with all provisions of the Illinois Administrative Procedure |
Act and all rules and procedures of the Joint Committee on |
Administrative Rules; any purported rule not so adopted, for |
whatever reason, is unauthorized. |
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; |
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. |
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, |
eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; |
102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. |
1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, |
eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; |
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103-551, eff. 8-11-23; revised 8-29-23.) |
Section 25. The Illinois Insurance Code is amended by |
changing Sections 4, 352, 352b, 356a, 356b, 356d, 356e, 356f, |
356K, 356L, 356r, 356s, 356z.3, 356z.33, 367a, 370e, 370i, |
408, 412, and 531.03 as follows: |
(215 ILCS 5/4) (from Ch. 73, par. 616) |
Sec. 4. Classes of insurance. Insurance and insurance |
business shall be classified as follows: |
Class 1. Life, Accident and Health. |
(a) Life. Insurance on the lives of persons and every |
insurance appertaining thereto or connected therewith and |
granting, purchasing or disposing of annuities. Policies of |
life or endowment insurance or annuity contracts or contracts |
supplemental thereto which contain provisions for additional |
benefits in case of death by accidental means and provisions |
operating to safeguard such policies or contracts against |
lapse, to give a special surrender value, or special benefit, |
or an annuity, in the event, that the insured or annuitant |
shall become a person with a total and permanent disability as |
defined by the policy or contract, or which contain benefits |
providing acceleration of life or endowment or annuity |
benefits in advance of the time they would otherwise be |
payable, as an indemnity for long term care which is certified |
or ordered by a physician, including but not limited to, |
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professional nursing care, medical care expenses, custodial |
nursing care, non-nursing custodial care provided in a nursing |
home or at a residence of the insured, or which contain |
benefits providing acceleration of life or endowment or |
annuity benefits in advance of the time they would otherwise |
be payable, at any time during the insured's lifetime, as an |
indemnity for a terminal illness shall be deemed to be |
policies of life or endowment insurance or annuity contracts |
within the intent of this clause. |
Also to be deemed as policies of life or endowment |
insurance or annuity contracts within the intent of this |
clause shall be those policies or riders that provide for the |
payment of up to 75% of the face amount of benefits in advance |
of the time they would otherwise be payable upon a diagnosis by |
a physician licensed to practice medicine in all of its |
branches that the insured has incurred a covered condition |
listed in the policy or rider. |
"Covered condition", as used in this clause, means: heart |
attack, stroke, coronary artery surgery, life-threatening life |
threatening cancer, renal failure, Alzheimer's disease, |
paraplegia, major organ transplantation, total and permanent |
disability, and any other medical condition that the |
Department may approve for any particular filing. |
The Director may issue rules that specify prohibited |
policy provisions, not otherwise specifically prohibited by |
law, which in the opinion of the Director are unjust, unfair, |
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or unfairly discriminatory to the policyholder, any person |
insured under the policy, or beneficiary. |
(b) Accident and health. Insurance against bodily injury, |
disablement or death by accident and against disablement |
resulting from sickness or old age and every insurance |
appertaining thereto, including stop-loss insurance. In this |
clause, "stop-loss Stop-loss insurance " means is insurance |
against the risk of economic loss issued to or for the benefit |
of a single employer self-funded employee disability benefit |
plan or an employee welfare benefit plan as described in 29 |
U.S.C. 1001 100 et seq. , where (i) the policy is issued to and |
insures an employer, trustee, or other sponsor of the plan, or |
the plan itself, but not employees, members, or participants; |
and (ii) payments by the insurer are made to the employer, |
trustee, or other sponsors of the plan, or the plan itself, but |
not to the employees, members, participants, or health care |
providers. The insurance laws of this State, including this |
Code, do not apply to arrangements between a religious |
organization and the organization's members or participants |
when the arrangement and organization meet all of the |
following criteria: |
(i) the organization is described in Section 501(c)(3) |
of the Internal Revenue Code and is exempt from taxation |
under Section 501(a) of the Internal Revenue Code; |
(ii) members of the organization share a common set of |
ethical or religious beliefs and share medical expenses |
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among members in accordance with those beliefs and without |
regard to the state in which a member resides or is |
employed; |
(iii) no funds that have been given for the purpose of |
the sharing of medical expenses among members described in |
paragraph (ii) of this subsection (b) are held by the |
organization in an off-shore trust or bank account; |
(iv) the organization provides at least monthly to all |
of its members a written statement listing the dollar |
amount of qualified medical expenses that members have |
submitted for sharing, as well as the amount of expenses |
actually shared among the members; |
(v) members of the organization retain membership even |
after they develop a medical condition; |
(vi) the organization or a predecessor organization |
has been in existence at all times since December 31, |
1999, and medical expenses of its members have been shared |
continuously and without interruption since at least |
December 31, 1999; |
(vii) the organization conducts an annual audit that |
is performed by an independent certified public accounting |
firm in accordance with generally accepted accounting |
principles and is made available to the public upon |
request; |
(viii) the organization includes the following |
statement, in writing, on or accompanying all applications |
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and guideline materials: |
"Notice: The organization facilitating the sharing of |
medical expenses is not an insurance company, and |
neither its guidelines nor plan of operation |
constitute or create an insurance policy. Any |
assistance you receive with your medical bills will be |
totally voluntary. As such, participation in the |
organization or a subscription to any of its documents |
should never be considered to be insurance. Whether or |
not you receive any payments for medical expenses and |
whether or not this organization continues to operate, |
you are always personally responsible for the payment |
of your own medical bills."; |
(ix) any membership card or similar document issued by |
the organization and any written communication sent by the |
organization to a hospital, physician, or other health |
care provider shall include a statement that the |
organization does not issue health insurance and that the |
member or participant is personally liable for payment of |
his or her medical bills; |
(x) the organization provides to a participant, within |
30 days after the participant joins, a complete set of its |
rules for the sharing of medical expenses, appeals of |
decisions made by the organization, and the filing of |
complaints; |
(xi) the organization does not offer any other |
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services that are regulated under any provision of the |
Illinois Insurance Code or other insurance laws of this |
State; and |
(xii) the organization does not amass funds as |
reserves intended for payment of medical services, rather |
the organization facilitates the payments provided for in |
this subsection (b) through payments made directly from |
one participant to another. |
(c) Legal Expense Insurance. Insurance which involves the |
assumption of a contractual obligation to reimburse the |
beneficiary against or pay on behalf of the beneficiary, all |
or a portion of his fees, costs, or expenses related to or |
arising out of services performed by or under the supervision |
of an attorney licensed to practice in the jurisdiction |
wherein the services are performed, regardless of whether the |
payment is made by the beneficiaries individually or by a |
third person for them, but does not include the provision of or |
reimbursement for legal services incidental to other insurance |
coverages. The insurance laws of this State, including this |
Act do not apply to: |
(i) retainer contracts made by attorneys at law with |
individual clients with fees based on estimates of the |
nature and amount of services to be provided to the |
specific client, and similar contracts made with a group |
of clients involved in the same or closely related legal |
matters; |
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(ii) plans owned or operated by attorneys who are the |
providers of legal services to the plan; |
(iii) plans providing legal service benefits to groups |
where such plans are owned or operated by authority of a |
state, county, local or other bar association; |
(iv) any lawyer referral service authorized or |
operated by a state, county, local or other bar |
association; |
(v) the furnishing of legal assistance by labor unions |
and other employee organizations to their members in |
matters relating to employment or occupation; |
(vi) the furnishing of legal assistance to members or |
dependents, by churches, consumer organizations, |
cooperatives, educational institutions, credit unions, or |
organizations of employees, where such organizations |
contract directly with lawyers or law firms for the |
provision of legal services, and the administration and |
marketing of such legal services is wholly conducted by |
the organization or its subsidiary; |
(vii) legal services provided by an employee welfare |
benefit plan defined by the Employee Retirement Income |
Security Act of 1974; |
(viii) any collectively bargained plan for legal |
services between a labor union and an employer negotiated |
pursuant to Section 302 of the Labor Management Relations |
Act as now or hereafter amended, under which plan legal |
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services will be provided for employees of the employer |
whether or not payments for such services are funded to or |
through an insurance company. |
Class 2. Casualty, Fidelity and Surety. |
(a) Accident and health. Insurance against bodily injury, |
disablement or death by accident and against disablement |
resulting from sickness or old age and every insurance |
appertaining thereto, including stop-loss insurance. In this |
clause, "stop-loss Stop-loss insurance " has meaning given to |
that term in clause (b) of Class 1 is insurance against the |
risk of economic loss issued to a single employer self-funded |
employee disability benefit plan or an employee welfare |
benefit plan as described in 29 U.S.C. 1001 et seq . |
(b) Vehicle. Insurance against any loss or liability |
resulting from or incident to the ownership, maintenance or |
use of any vehicle (motor or otherwise), draft animal or |
aircraft. Any policy insuring against any loss or liability on |
account of the bodily injury or death of any person may contain |
a provision for payment of disability benefits to injured |
persons and death benefits to dependents, beneficiaries or |
personal representatives of persons who are killed, including |
the named insured, irrespective of legal liability of the |
insured, if the injury or death for which benefits are |
provided is caused by accident and sustained while in or upon |
or while entering into or alighting from or through being |
struck by a vehicle (motor or otherwise), draft animal or |
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aircraft, and such provision shall not be deemed to be |
accident insurance. |
(c) Liability. Insurance against the liability of the |
insured for the death, injury or disability of an employee or |
other person, and insurance against the liability of the |
insured for damage to or destruction of another person's |
property. |
(d) Workers' compensation. Insurance of the obligations |
accepted by or imposed upon employers under laws for workers' |
compensation. |
(e) Burglary and forgery. Insurance against loss or damage |
by burglary, theft, larceny, robbery, forgery, fraud or |
otherwise; including all householders' personal property |
floater risks. |
(f) Glass. Insurance against loss or damage to glass |
including lettering, ornamentation and fittings from any |
cause. |
(g) Fidelity and surety. Become surety or guarantor for |
any person, copartnership or corporation in any position or |
place of trust or as custodian of money or property, public or |
private; or, becoming a surety or guarantor for the |
performance of any person, copartnership or corporation of any |
lawful obligation, undertaking, agreement or contract of any |
kind, except contracts or policies of insurance; and |
underwriting blanket bonds. Such obligations shall be known |
and treated as suretyship obligations and such business shall |
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be known as surety business. |
(h) Miscellaneous. Insurance against loss or damage to |
property and any liability of the insured caused by accidents |
to boilers, pipes, pressure containers, machinery and |
apparatus of any kind and any apparatus connected thereto, or |
used for creating, transmitting or applying power, light, |
heat, steam or refrigeration, making inspection of and issuing |
certificates of inspection upon elevators, boilers, machinery |
and apparatus of any kind and all mechanical apparatus and |
appliances appertaining thereto; insurance against loss or |
damage by water entering through leaks or openings in |
buildings, or from the breakage or leakage of a sprinkler, |
pumps, water pipes, plumbing and all tanks, apparatus, |
conduits and containers designed to bring water into buildings |
or for its storage or utilization therein, or caused by the |
falling of a tank, tank platform or supports, or against loss |
or damage from any cause (other than causes specifically |
enumerated under Class 3 of this Section) to such sprinkler, |
pumps, water pipes, plumbing, tanks, apparatus, conduits or |
containers; insurance against loss or damage which may result |
from the failure of debtors to pay their obligations to the |
insured; and insurance of the payment of money for personal |
services under contracts of hiring. |
(i) Other casualty risks. Insurance against any other |
casualty risk not otherwise specified under Classes 1 or 3, |
which may lawfully be the subject of insurance and may |
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properly be classified under Class 2. |
(j) Contingent losses. Contingent, consequential and |
indirect coverages wherein the proximate cause of the loss is |
attributable to any one of the causes enumerated under Class |
2. Such coverages shall, for the purpose of classification, be |
included in the specific grouping of the kinds of insurance |
wherein such cause is specified. |
(k) Livestock and domestic animals. Insurance against |
mortality, accident and health of livestock and domestic |
animals. |
(l) Legal expense insurance. Insurance against risk |
resulting from the cost of legal services as defined under |
Class 1(c). |
Class 3. Fire and Marine, etc. |
(a) Fire. Insurance against loss or damage by fire, smoke |
and smudge, lightning or other electrical disturbances. |
(b) Elements. Insurance against loss or damage by |
earthquake, windstorms, cyclone, tornado, tempests, hail, |
frost, snow, ice, sleet, flood, rain, drought or other weather |
or climatic conditions including excess or deficiency of |
moisture, rising of the waters of the ocean or its |
tributaries. |
(c) War, riot and explosion. Insurance against loss or |
damage by bombardment, invasion, insurrection, riot, strikes, |
civil war or commotion, military or usurped power, or |
explosion (other than explosion of steam boilers and the |
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breaking of fly wheels on premises owned, controlled, managed, |
or maintained by the insured). |
(d) Marine and transportation. Insurance against loss or |
damage to vessels, craft, aircraft, vehicles of every kind, |
(excluding vehicles operating under their own power or while |
in storage not incidental to transportation) as well as all |
goods, freights, cargoes, merchandise, effects, disbursements, |
profits, moneys, bullion, precious stones, securities, choses |
in action, evidences of debt, valuable papers, bottomry and |
respondentia interests and all other kinds of property and |
interests therein, in respect to, appertaining to or in |
connection with any or all risks or perils of navigation, |
transit, or transportation, including war risks, on or under |
any seas or other waters, on land or in the air, or while being |
assembled, packed, crated, baled, compressed or similarly |
prepared for shipment or while awaiting the same or during any |
delays, storage, transshipment, or reshipment incident |
thereto, including marine builder's risks and all personal |
property floater risks; and for loss or damage to persons or |
property in connection with or appertaining to marine, inland |
marine, transit or transportation insurance, including |
liability for loss of or damage to either arising out of or in |
connection with the construction, repair, operation, |
maintenance, or use of the subject matter of such insurance, |
(but not including life insurance or surety bonds); but, |
except as herein specified, shall not mean insurances against |
|
loss by reason of bodily injury to the person; and insurance |
against loss or damage to precious stones, jewels, jewelry, |
gold, silver and other precious metals whether used in |
business or trade or otherwise and whether the same be in |
course of transportation or otherwise, which shall include |
jewelers' block insurance; and insurance against loss or |
damage to bridges, tunnels and other instrumentalities of |
transportation and communication (excluding buildings, their |
furniture and furnishings, fixed contents and supplies held in |
storage) unless fire, tornado, sprinkler leakage, hail, |
explosion, earthquake, riot and civil commotion are the only |
hazards to be covered; and to piers, wharves, docks and slips, |
excluding the risks of fire, tornado, sprinkler leakage, hail, |
explosion, earthquake, riot and civil commotion; and to other |
aids to navigation and transportation, including dry docks and |
marine railways, against all risk. |
(e) Vehicle. Insurance against loss or liability resulting |
from or incident to the ownership, maintenance or use of any |
vehicle (motor or otherwise), draft animal or aircraft, |
excluding the liability of the insured for the death, injury |
or disability of another person. |
(f) Property damage, sprinkler leakage and crop. Insurance |
against the liability of the insured for loss or damage to |
another person's property or property interests from any cause |
enumerated in this class; insurance against loss or damage by |
water entering through leaks or openings in buildings, or from |
|
the breakage or leakage of a sprinkler, pumps, water pipes, |
plumbing and all tanks, apparatus, conduits and containers |
designed to bring water into buildings or for its storage or |
utilization therein, or caused by the falling of a tank, tank |
platform or supports or against loss or damage from any cause |
to such sprinklers, pumps, water pipes, plumbing, tanks, |
apparatus, conduits or containers; insurance against loss or |
damage from insects, diseases or other causes to trees, crops |
or other products of the soil. |
(g) Other fire and marine risks. Insurance against any |
other property risk not otherwise specified under Classes 1 or |
2, which may lawfully be the subject of insurance and may |
properly be classified under Class 3. |
(h) Contingent losses. Contingent, consequential and |
indirect coverages wherein the proximate cause of the loss is |
attributable to any of the causes enumerated under Class 3. |
Such coverages shall, for the purpose of classification, be |
included in the specific grouping of the kinds of insurance |
wherein such cause is specified. |
(i) Legal expense insurance. Insurance against risk |
resulting from the cost of legal services as defined under |
Class 1(c). |
(Source: P.A. 101-81, eff. 7-12-19.) |
(215 ILCS 5/352) (from Ch. 73, par. 964) |
Sec. 352. Scope of Article. |
|
(a) Except as provided in subsections (b), (c), (d), and |
(e) , and (g) , this Article shall apply to all companies |
transacting in this State the kinds of business enumerated in |
clause (b) of Class 1 and clause (a) of Class 2 of Section 4 |
and to all policies, contracts, and certificates of insurance |
issued in connection therewith that are not otherwise excluded |
under Article VII of this Code . Nothing in this Article shall |
apply to, or in any way affect policies or contracts described |
in clause (a) of Class 1 of Section 4; however, this Article |
shall apply to policies and contracts which contain benefits |
providing reimbursement for the expenses of long term health |
care which are certified or ordered by a physician including |
but not limited to professional nursing care, custodial |
nursing care, and non-nursing custodial care provided in a |
nursing home or at a residence of the insured. |
(b) (Blank). |
(c) A policy issued and delivered in this State that |
provides coverage under that policy for certificate holders |
who are neither residents of nor employed in this State does |
not need to provide to those nonresident certificate holders |
who are not employed in this State the coverages or services |
mandated by this Article. |
(d) Stop-loss insurance , as defined in clause (b) of Class |
1 or clause (a) of Class 2 of Section 4, is exempt from all |
Sections of this Article, except this Section and Sections |
353a, 354, 357.30, and 370. For purposes of this exemption, |
|
stop-loss insurance is further defined as follows: |
(1) The policy must be issued to and insure an |
employer, trustee, or other sponsor of the plan, or the |
plan itself, but not employees, members, or participants. |
(2) Payments by the insurer must be made to the |
employer, trustee, or other sponsors of the plan, or the |
plan itself, but not to the employees, members, |
participants, or health care providers. |
(e) A policy issued or delivered in this State to the |
Department of Healthcare and Family Services (formerly |
Illinois Department of Public Aid) and providing coverage, |
under clause (b) of Class 1 or clause (a) of Class 2 as |
described in Section 4, to persons who are enrolled under |
Article V of the Illinois Public Aid Code or under the |
Children's Health Insurance Program Act is exempt from all |
restrictions, limitations, standards, rules, or regulations |
respecting benefits imposed by or under authority of this |
Code, except those specified by subsection (1) of Section 143, |
Section 370c, and Section 370c.1. Nothing in this subsection, |
however, affects the total medical services available to |
persons eligible for medical assistance under the Illinois |
Public Aid Code. |
(f) An in-office membership care agreement provided under |
the In-Office Membership Care Act is not insurance for the |
purposes of this Code. |
(g) The provisions of Sections 356a through 359a, both |
|
inclusive, shall not apply to or affect: |
(1) any policy or contract of reinsurance; or |
(2) life insurance, endowment or annuity contracts, or |
contracts supplemental thereto that contain only such |
provisions relating to accident and sickness insurance |
that (A) provide additional benefits in case of death or |
dismemberment or loss of sight by accident, or (B) operate |
to safeguard such contracts against lapse, or to give a |
special surrender value or special benefit or an annuity |
if the insured or annuitant becomes a person with a total |
and permanent disability, as defined by the contract or |
supplemental contract. |
(Source: P.A. 101-190, eff. 8-2-19.) |
(215 ILCS 5/352b) |
Sec. 352b. Excepted benefits exempted Policy of individual |
or group accident and health insurance . |
(a) Unless specified otherwise and when used in context of |
accident and health insurance policy benefits, coverage, |
terms, or conditions required to be provided under this |
Article, references to any " policy of individual or group |
accident and health insurance " , or both, as used in this |
Article, do does not include any coverage or policy that |
provides an excepted benefit, as that term is defined in |
Section 2791(c) of the federal Public Health Service Act (42 |
U.S.C. 300gg-91). Nothing in this subsection amendatory Act of |
|
the 101st General Assembly applies to a policy of liability, |
workers' compensation, automobile medical payment, or limited |
scope dental or vision benefits insurance issued under this |
Code. Nothing in this subsection shall be construed to subject |
excepted benefits outside the scope of Section 352 to any |
requirements of this Article. |
(b) Nothing in this Article shall require a policy of |
excepted benefits to provide benefits, coverage, terms, or |
conditions in such a manner as to disqualify it from being |
classified under federal law as the type of excepted benefit |
for which its policy forms are filed under Sections 143 and 355 |
of this Code. |
(Source: P.A. 101-456, eff. 8-23-19.) |
(215 ILCS 5/356a) (from Ch. 73, par. 968a) |
Sec. 356a. Form of policy. |
(1) No individual policy of accident and health insurance |
shall be delivered or issued for delivery to any person in this |
State state unless: |
(a) the entire money and other considerations therefor |
are expressed therein; and |
(b) the time at which the insurance takes effect and |
terminates is expressed therein; and |
(c) it purports to insure only one person, except that |
a policy may insure, originally or by subsequent |
amendment, upon the application of an adult member of a |
|
family who shall be deemed the policyholder, any 2 two or |
more eligible members of that family, including husband, |
wife, dependent children or any children under a specified |
age which shall not exceed 19 years and any other person |
dependent upon the policyholder; and |
(d) the style, arrangement and over-all appearance of |
the policy give no undue prominence to any portion of the |
text, and unless every printed portion of the text of the |
policy and of any endorsements or attached papers is |
plainly printed in light-faced type of a style in general |
use, the size of which shall be uniform and not less than |
ten-point with a lower-case unspaced alphabet length not |
less than one hundred and twenty-point (the "text" shall |
include all printed matter except the name and address of |
the insurer, name or title of the policy, the brief |
description if any, and captions and subcaptions); and |
(e) the exceptions and reductions of indemnity are set |
forth in the policy and, except those which are set forth |
in Sections 357.1 through 357.30 of this act, are printed, |
at the insurer's option, either included with the benefit |
provision to which they apply, or under an appropriate |
caption such as "EXCEPTIONS", or "EXCEPTIONS AND |
REDUCTIONS", provided that if an exception or reduction |
specifically applies only to a particular benefit of the |
policy, a statement of such exception or reduction shall |
be included with the benefit provision to which it |
|
applies; and |
(f) each such form, including riders and endorsements, |
shall be identified by a form number in the lower |
left-hand corner of the first page thereof; and |
(g) it contains no provision purporting to make any |
portion of the charter, rules, constitution, or by-laws of |
the insurer a part of the policy unless such portion is set |
forth in full in the policy, except in the case of the |
incorporation of, or reference to, a statement of rates or |
classification of risks, or short-rate table filed with |
the Director. |
(2) If any policy is issued by an insurer domiciled in this |
state for delivery to a person residing in another state, and |
if the official having responsibility for the administration |
of the insurance laws of such other state shall have advised |
the Director that any such policy is not subject to approval or |
disapproval by such official, the Director may by ruling |
require that such policy meet the standards set forth in |
subsection (1) of this section and in Sections 357.1 through |
357.30. |
(Source: P.A. 76-860.) |
(215 ILCS 5/356b) (from Ch. 73, par. 968b) |
Sec. 356b. (a) This Section applies to the hospital and |
medical expense provisions of an individual accident or health |
insurance policy. |
|
(b) If a policy provides that coverage of a dependent |
person terminates upon attainment of the limiting age for |
dependent persons specified in the policy, the attainment of |
such limiting age does not operate to terminate the hospital |
and medical coverage of a person who, because of a disabling |
condition that occurred before attainment of the limiting age, |
is incapable of self-sustaining employment and is dependent on |
his or her parents or other care providers for lifetime care |
and supervision. |
(c) For purposes of subsection (b), "dependent on other |
care providers" is defined as requiring a Community Integrated |
Living Arrangement, group home, supervised apartment, or other |
residential services licensed or certified by the Department |
of Human Services (as successor to the Department of Mental |
Health and Developmental Disabilities), the Department of |
Public Health, or the Department of Healthcare and Family |
Services (formerly Department of Public Aid). |
(d) The insurer may inquire of the policyholder 2 months |
prior to attainment by a dependent of the limiting age set |
forth in the policy, or at any reasonable time thereafter, |
whether such dependent is in fact a person who has a disability |
and is dependent and, in the absence of proof submitted within |
60 days of such inquiry that such dependent is a person who has |
a disability and is dependent may terminate coverage of such |
person at or after attainment of the limiting age. In the |
absence of such inquiry, coverage of any person who has a |
|
disability and is dependent shall continue through the term of |
such policy or any extension or renewal thereof. |
(e) This amendatory Act of 1969 is applicable to policies |
issued or renewed more than 60 days after the effective date of |
this amendatory Act of 1969. |
(Source: P.A. 99-143, eff. 7-27-15.) |
(215 ILCS 5/356d) (from Ch. 73, par. 968d) |
Sec. 356d. Conversion privileges for insured former |
spouses. (1) No individual policy of accident and health |
insurance providing coverage of hospital and/or medical |
expense on either an expense incurred basis or other than an |
expense incurred basis, which in addition to covering the |
insured also provides coverage to the spouse of the insured |
shall contain a provision for termination of coverage for a |
spouse covered under the policy solely as a result of a break |
in the marital relationship except by reason of an entry of a |
valid judgment of dissolution of marriage between the parties. |
(2) Every policy which contains a provision for |
termination of coverage of the spouse upon dissolution of |
marriage shall contain a provision to the effect that upon the |
entry of a valid judgment of dissolution of marriage between |
the insured parties the spouse whose marriage was dissolved |
shall be entitled to have issued to him or her, without |
evidence of insurability, upon application made to the company |
within 60 days following the entry of such judgment, and upon |
|
the payment of the appropriate premium, an individual policy |
of accident and health insurance. Such policy shall provide |
the coverage then being issued by the insurer which is most |
nearly similar to, but not greater than, such terminated |
coverages. Any and all probationary and/or waiting periods set |
forth in such policy shall be considered as being met to the |
extent coverage was in force under the prior policy. |
(3) The requirements of this Section shall apply to all |
policies delivered or issued for delivery on or after the 60th |
day following the effective date of this Section. |
(Source: P.A. 84-545.) |
(215 ILCS 5/356e) (from Ch. 73, par. 968e) |
Sec. 356e. Victims of certain offenses. |
(1) No individual policy of accident and health insurance, |
which provides benefits for hospital or medical expenses based |
upon the actual expenses incurred, delivered or issued for |
delivery to any person in this State shall contain any |
specific exception to coverage which would preclude the |
payment under that policy of actual expenses incurred in the |
examination and testing of a victim of an offense defined in |
Sections 11-1.20 through 11-1.60 or 12-13 through 12-16 of the |
Criminal Code of 1961 or the Criminal Code of 2012, or an |
attempt to commit such offense to establish that sexual |
contact did occur or did not occur, and to establish the |
presence or absence of sexually transmitted disease or |
|
infection, and examination and treatment of injuries and |
trauma sustained by a victim of such offense arising out of the |
offense. Every policy of accident and health insurance which |
specifically provides benefits for routine physical |
examinations shall provide full coverage for expenses incurred |
in the examination and testing of a victim of an offense |
defined in Sections 11-1.20 through 11-1.60 or 12-13 through |
12-16 of the Criminal Code of 1961 or the Criminal Code of |
2012, or an attempt to commit such offense as set forth in this |
Section. This Section shall not apply to a policy which covers |
hospital and medical expenses for specified illnesses or |
injuries only. |
(2) For purposes of enabling the recovery of State funds, |
any insurance carrier subject to this Section shall upon |
reasonable demand by the Department of Public Health disclose |
the names and identities of its insureds entitled to benefits |
under this provision to the Department of Public Health |
whenever the Department of Public Health has determined that |
it has paid, or is about to pay, hospital or medical expenses |
for which an insurance carrier is liable under this Section. |
All information received by the Department of Public Health |
under this provision shall be held on a confidential basis and |
shall not be subject to subpoena and shall not be made public |
by the Department of Public Health or used for any purpose |
other than that authorized by this Section. |
(3) Whenever the Department of Public Health finds that it |
|
has paid all or part of any hospital or medical expenses which |
an insurance carrier is obligated to pay under this Section, |
the Department of Public Health shall be entitled to receive |
reimbursement for its payments from such insurance carrier |
provided that the Department of Public Health has notified the |
insurance carrier of its claims before the carrier has paid |
such benefits to its insureds or in behalf of its insureds. |
(Source: P.A. 96-1551, eff. 7-1-11; 97-1150, eff. 1-25-13.) |
(215 ILCS 5/356f) (from Ch. 73, par. 968f) |
Sec. 356f. No individual policy of accident or health |
insurance or any renewal thereof shall be denied or cancelled |
by the insurer, nor shall any such policy contain any |
exception or exclusion of benefits, solely because the mother |
of the insured has taken diethylstilbestrol, commonly referred |
to as DES. |
(Source: P.A. 81-656.) |
(215 ILCS 5/356K) (from Ch. 73, par. 968K) |
Sec. 356K. Coverage for Organ Transplantation Procedures. |
No accident and health insurer providing individual accident |
and health insurance coverage under this Act for hospital or |
medical expenses shall deny reimbursement for an otherwise |
covered expense incurred for any organ transplantation |
procedure solely on the basis that such procedure is deemed |
experimental or investigational unless supported by the |
|
determination of the Office of Health Care Technology |
Assessment within the Agency for Health Care Policy and |
Research within the federal Department of Health and Human |
Services that such procedure is either experimental or |
investigational or that there is insufficient data or |
experience to determine whether an organ transplantation |
procedure is clinically acceptable. If an accident and health |
insurer has made written request, or had one made on its behalf |
by a national organization, for determination by the Office of |
Health Care Technology Assessment within the Agency for Health |
Care Policy and Research within the federal Department of |
Health and Human Services as to whether a specific organ |
transplantation procedure is clinically acceptable and said |
organization fails to respond to such a request within a |
period of 90 days, the failure to act may be deemed a |
determination that the procedure is deemed to be experimental |
or investigational. |
(Source: P.A. 87-218.) |
(215 ILCS 5/356L) (from Ch. 73, par. 968L) |
Sec. 356L. No individual policy of accident or health |
insurance shall include any provision which shall have the |
effect of denying coverage to or on behalf of an insured under |
such policy on the basis of a failure by the insured to file a |
notice of claim within the time period required by the policy, |
provided such failure is caused solely by the physical |
|
inability or mental incapacity of the insured to file such |
notice of claim because of a period of emergency |
hospitalization. |
(Source: P.A. 86-784.) |
(215 ILCS 5/356r) |
Sec. 356r. Access to obstetrical and gynecological care |
Woman's principal health care provider . |
(a) An individual or group policy of accident and health |
insurance or a managed care plan amended, delivered, issued, |
or renewed in this State must not require authorization or |
referral by the plan, issuer, or any person, including a |
primary care provider, for any covered individual who seeks |
coverage for obstetrical or gynecological care provided by any |
licensed or certified participating health care professional |
who specializes in obstetrics or gynecology. after November |
14, 1996 that requires an insured or enrollee to designate an |
individual to coordinate care or to control access to health |
care services shall also permit a female insured or enrollee |
to designate a participating woman's principal health care |
provider, and the insurer or managed care plan shall provide |
the following written notice to all female insureds or |
enrollees no later than 120 days after the effective date of |
this amendatory Act of 1998; to all new enrollees at the time |
of enrollment; and thereafter to all existing enrollees at |
least annually, as a part of a regular publication or |
|
informational mailing: |
"NOTICE TO ALL FEMALE PLAN MEMBERS: |
YOUR RIGHT TO SELECT A WOMAN'S PRINCIPAL |
HEALTH CARE PROVIDER. |
Illinois law allows you to select "a woman's principal |
health care provider" in addition to your selection of a |
primary care physician. A woman's principal health care |
provider is a physician licensed to practice medicine in |
all its branches specializing in obstetrics or gynecology |
or specializing in family practice. A woman's principal |
health care provider may be seen for care without |
referrals from your primary care physician. If you have |
not already selected a woman's principal health care |
provider, you may do so now or at any other time. You are |
not required to have or to select a woman's principal |
health care provider. |
Your woman's principal health care provider must be a |
part of your plan. You may get the list of participating |
obstetricians, gynecologists, and family practice |
specialists from your employer's employee benefits |
coordinator, or for your own copy of the current list, you |
may call [insert plan's toll free number]. The list will |
be sent to you within 10 days after your call. To designate |
a woman's principal health care provider from the list, |
call [insert plan's toll free number] and tell our staff |
the name of the physician you have selected.". |
|
If the insurer or managed care plan exercises the option set |
forth in subsection (a-5), the notice shall also state: |
"Your plan requires that your primary care physician |
and your woman's principal health care provider have a |
referral arrangement with one another. If the woman's |
principal health care provider that you select does not |
have a referral arrangement with your primary care |
physician, you will have to select a new primary care |
physician who has a referral arrangement with your woman's |
principal health care provider or you may select a woman's |
principal health care provider who has a referral |
arrangement with your primary care physician. The list of |
woman's principal health care providers will also have the |
names of the primary care physicians and their referral |
arrangements.". |
No later than 120 days after the effective date of this |
amendatory Act of 1998, the insurer or managed care plan shall |
provide each employer who has a policy of insurance or a |
managed care plan with the insurer or managed care plan with a |
list of physicians licensed to practice medicine in all its |
branches specializing in obstetrics or gynecology or |
specializing in family practice who have contracted with the |
plan. At the time of enrollment and thereafter within 10 days |
after a request by an insured or enrollee, the insurer or |
managed care plan also shall provide this list directly to the |
insured or enrollee. The list shall include each physician's |
|
address, telephone number, and specialty. No insurer or plan |
formal or informal policy may restrict a female insured's or |
enrollee's right to designate a woman's principal health care |
provider, except as set forth in subsection (a-5). If the |
female enrollee is an enrollee of a managed care plan under |
contract with the Department of Healthcare and Family |
Services, the physician chosen by the enrollee as her woman's |
principal health care provider must be a Medicaid-enrolled |
provider. This requirement does not require a female insured |
or enrollee to make a selection of a woman's principal health |
care provider. The female insured or enrollee may designate a |
physician licensed to practice medicine in all its branches |
specializing in family practice as her woman's principal |
health care provider. |
(a-5) If a policy, contract, or certificate requires or |
allows a covered individual to designate a primary care |
provider and provides coverage for any obstetrical or |
gynecological care, the insurer shall provide the notice |
required under 45 CFR 147.138(a)(4) and 149.310(a)(4) in all |
circumstances required under that provision. The insured or |
enrollee may be required by the insurer or managed care plan to |
select a woman's principal health care provider who has a |
referral arrangement with the insured's or enrollee's |
individual who coordinates care or controls access to health |
care services if such referral arrangement exists or to select |
a new individual to coordinate care or to control access to |
|
health care services who has a referral arrangement with the |
woman's principal health care provider chosen by the insured |
or enrollee, if such referral arrangement exists. If an |
insurer or a managed care plan requires an insured or enrollee |
to select a new physician under this subsection (a-5), the |
insurer or managed care plan must provide the insured or |
enrollee with both options to select a new physician provided |
in this subsection (a-5). |
Notwithstanding a plan's restrictions of the frequency or |
timing of making designations of primary care providers, a |
female enrollee or insured who is subject to the selection |
requirements of this subsection, may, at any time, effect a |
change in primary care physicians in order to make a selection |
of a woman's principal health care provider. |
(a-6) The requirements of this Section shall be construed |
in a manner consistent with the requirements for access to and |
notice of obstetrical and gynecological care in 45 CFR 147.138 |
and 45 CFR 149.310. If an insurer or managed care plan |
exercises the option in subsection (a-5), the list to be |
provided under subsection (a) shall identify the referral |
arrangements that exist between the individual who coordinates |
care or controls access to health care services and the |
woman's principal health care provider in order to assist the |
female insured or enrollee to make a selection within the |
insurer's or managed care plan's requirement. |
(b) Nothing in this Section prevents a health insurance |
|
issuer from requiring a participating obstetrical or |
gynecological health care professional to agree, with respect |
to individuals covered under a policy of accident and health |
insurance, to otherwise adhere to the health insurance |
issuer's policies and procedures, including procedures |
regarding referrals and obtaining prior authorization and |
providing services pursuant to a treatment plan, if any, |
approved by the issuer. If a female insured or enrollee has |
designated a woman's principal health care provider, then the |
insured or enrollee must be given direct access to the woman's |
principal health care provider for services covered by the |
policy or plan without the need for a referral or prior |
approval. Nothing shall prohibit the insurer or managed care |
plan from requiring prior authorization or approval from |
either a primary care provider or the woman's principal health |
care provider for referrals for additional care or services. |
(c) (Blank). For the purposes of this Section the |
following terms are defined: |
(1) "Woman's principal health care provider" means a |
physician licensed to practice medicine in all of its |
branches specializing in obstetrics or gynecology or |
specializing in family practice. |
(2) "Managed care entity" means any entity including a |
licensed insurance company, hospital or medical service |
plan, health maintenance organization, limited health |
service organization, preferred provider organization, |
|
third party administrator, an employer or employee |
organization, or any person or entity that establishes, |
operates, or maintains a network of participating |
providers. |
(3) "Managed care plan" means a plan operated by a |
managed care entity that provides for the financing of |
health care services to persons enrolled in the plan |
through: |
(A) organizational arrangements for ongoing |
quality assurance, utilization review programs, or |
dispute resolution; or |
(B) financial incentives for persons enrolled in |
the plan to use the participating providers and |
procedures covered by the plan. |
(4) "Participating provider" means a physician who has |
contracted with an insurer or managed care plan to provide |
services to insureds or enrollees as defined by the |
contract. |
(d) Nothing in this Section shall be construed to preclude |
a health insurance issuer from requiring that a participating |
obstetrical or gynecological health care professional notify |
the covered individual's primary care physician or the issuer |
of treatment decisions or update centralized medical records. |
The original provisions of this Section became law on July 17, |
1996 and took effect November 14, 1996, which is 120 days after |
becoming law. |
|
(Source: P.A. 95-331, eff. 8-21-07.) |
(215 ILCS 5/356s) |
Sec. 356s. Post-parturition care. An individual or group |
policy of accident and health insurance that provides |
maternity coverage and is amended, delivered, issued, or |
renewed after the effective date of this amendatory Act of |
1996 shall provide coverage for the following: |
(1) a minimum of 48 hours of inpatient care following |
a vaginal delivery for the mother and the newborn, except |
as otherwise provided in this Section; or |
(2) a minimum of 96 hours of inpatient care following |
a delivery by caesarian section for the mother and |
newborn, except as otherwise provided in this Section. |
Coverage may be limited to a A shorter length of hospital |
inpatient care stay for services related to maternity and |
newborn care may be provided if the attending physician |
licensed to practice medicine in all of its branches |
determines, in accordance with the protocols and guidelines |
developed by the American College of Obstetricians and |
Gynecologists or the American Academy of Pediatrics, that the |
mother and the newborn meet the appropriate guidelines for |
that length of stay based upon evaluation of the mother and |
newborn and the coverage and availability of a post-discharge |
physician office visit or in-home nurse visit to verify the |
condition of the infant in the first 48 hours after discharge. |
|
(Source: P.A. 89-513, eff. 9-15-96; 90-14, eff. 7-1-97.) |
(215 ILCS 5/356z.3) |
Sec. 356z.3. Disclosure of limited benefit. An insurer |
that issues, delivers, amends, or renews an individual or |
group policy of accident and health insurance in this State |
after the effective date of this amendatory Act of the 92nd |
General Assembly and arranges, contracts with, or administers |
contracts with a provider whereby beneficiaries are provided |
an incentive to use the services of such provider must include |
the following disclosure on its contracts and evidences of |
coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN |
NON-PARTICIPATING PROVIDERS ARE USED. YOU CAN EXPECT TO PAY |
MORE THAN THE COST-SHARING AMOUNT DEFINED IN THE POLICY IN |
NON-EMERGENCY SITUATIONS. Except in limited situations |
governed by the federal No Surprises Act or Section 356z.3a of |
the Illinois Insurance Code (215 ILCS 5/356z.3a), |
non-participating providers furnishing non-emergency services |
may bill members for any amount up to the billed charge after |
the plan has paid its portion of the bill. If you elect to use |
a non-participating provider, plan benefit payments will be |
determined according to your policy's fee schedule, usual and |
customary charge (which is determined by comparing charges for |
similar services adjusted to the geographical area where the |
services are performed), or other method as defined by the |
policy. Participating providers have agreed to ONLY bill |
|
members the cost-sharing amounts. You should be aware that |
when you elect to utilize the services of a non-participating |
provider for a covered service in non-emergency situations, |
benefit payments to such non-participating provider are not |
based upon the amount billed. The basis of your benefit |
payment will be determined according to your policy's fee |
schedule, usual and customary charge (which is determined by |
comparing charges for similar services adjusted to the |
geographical area where the services are performed), or other |
method as defined by the policy. YOU CAN EXPECT TO PAY MORE |
THAN THE COINSURANCE AMOUNT DEFINED IN THE POLICY AFTER THE |
PLAN HAS PAID ITS REQUIRED PORTION. Non-participating |
providers may bill members for any amount up to the billed |
charge after the plan has paid its portion of the bill, except |
as provided in Section 356z.3a of the Illinois Insurance Code |
for covered services received at a participating health care |
facility from a nonparticipating provider that are: (a) |
ancillary services, (b) items or services furnished as a |
result of unforeseen, urgent medical needs that arise at the |
time the item or service is furnished, or (c) items or services |
received when the facility or the non-participating provider |
fails to satisfy the notice and consent criteria specified |
under Section 356z.3a. Participating providers have agreed to |
accept discounted payments for services with no additional |
billing to the member other than co-insurance and deductible |
amounts. You may obtain further information about the |
|
participating status of professional providers and information |
on out-of-pocket expenses by calling the toll-free toll free |
telephone number on your identification card.". |
(Source: P.A. 102-901, eff. 1-1-23 .) |
(215 ILCS 5/356z.33) |
(Text of Section before amendment by P.A. 103-454 ) |
Sec. 356z.33. Coverage for epinephrine injectors. A group |
or individual policy of accident and health insurance or a |
managed care plan that is amended, delivered, issued, or |
renewed on or after January 1, 2020 (the effective date of |
Public Act 101-281) shall provide coverage for medically |
necessary epinephrine injectors for persons 18 years of age or |
under. As used in this Section, "epinephrine injector" has the |
meaning given to that term in Section 5 of the Epinephrine |
Injector Act. |
(Source: P.A. 101-281, eff. 1-1-20; 102-558, eff. 8-20-21.) |
(Text of Section after amendment by P.A. 103-454 ) |
Sec. 356z.33. Coverage for epinephrine injectors. |
(a) A group or individual policy of accident and health |
insurance or a managed care plan that is amended, delivered, |
issued, or renewed on or after January 1, 2020 (the effective |
date of Public Act 101-281) shall provide coverage for |
medically necessary epinephrine injectors for persons 18 years |
of age or under. As used in this Section, "epinephrine |
|
injector" has the meaning given to that term in Section 5 of |
the Epinephrine Injector Act. |
(b) An insurer that provides coverage for medically |
necessary epinephrine injectors shall limit the total amount |
that an insured is required to pay for a twin-pack of medically |
necessary epinephrine injectors at an amount not to exceed |
$60, regardless of the type of epinephrine injector ; except |
that this provision does not apply to the extent such coverage |
would disqualify a high-deductible health plan from |
eligibility for a health savings account pursuant to Section |
223 of the Internal Revenue Code (26 U.S.C. 223) . |
(c) Nothing in this Section prevents an insurer from |
reducing an insured's cost sharing by an amount greater than |
the amount specified in subsection (b). |
(d) The Department may adopt rules as necessary to |
implement and administer this Section. |
(Source: P.A. 102-558, eff. 8-20-21; 103-454, eff. 1-1-25.) |
(215 ILCS 5/367a) (from Ch. 73, par. 979a) |
Sec. 367a. Blanket accident and health insurance. |
(1) Blanket accident and health insurance is that form of |
accident and health insurance covering special groups of |
persons as enumerated in one of the following paragraphs (a) |
to (g), inclusive: |
(a) Under a policy or contract issued to any carrier |
for hire, which shall be deemed the policyholder, covering |
|
a group defined as all persons who may become passengers |
on such carrier. |
(b) Under a policy or contract issued to an employer, |
who shall be deemed the policyholder, covering all |
employees or any group of employees defined by reference |
to exceptional hazards incident to such employment. |
(c) Under a policy or contract issued to a college, |
school, or other institution of learning or to the head or |
principal thereof, who or which shall be deemed the |
policyholder, covering students or teachers. However, |
student health insurance coverage, as defined in 45 CFR |
147.145, shall remain subject to the standards and |
requirements for individual health insurance coverage |
except where inconsistent with that regulation. Student |
health insurance coverage shall not be subject to the |
Short-Term, Limited-Duration Health Insurance Coverage |
Act. An insurer providing student health insurance |
coverage or a policy or contract covering students for |
limited-scope dental or vision under 45 CFR 148.220 shall |
require an individual application or enrollment form and |
shall furnish each insured individual a certificate, which |
shall have been approved by the Director under Section |
355. |
(d) Under a policy or contract issued in the name of |
any volunteer fire department, first aid, or other such |
volunteer group, which shall be deemed the policyholder, |
|
covering all of the members of such department or group. |
(e) Under a policy or contract issued to a creditor, |
who shall be deemed the policyholder, to insure debtors of |
the creditors; Provided, however, that in the case of a |
loan which is subject to the Small Loans Act, no insurance |
premium or other cost shall be directly or indirectly |
charged or assessed against, or collected or received from |
the borrower. |
(f) Under a policy or contract issued to a sports team |
or to a camp, which team or camp sponsor shall be deemed |
the policyholder, covering members or campers. |
(g) Under a policy or contract issued to any other |
substantially similar group which, in the discretion of |
the Director, may be subject to the issuance of a blanket |
accident and health policy or contract. |
(2) Any insurance company authorized to write accident and |
health insurance in this state shall have the power to issue |
blanket accident and health insurance. No such blanket policy |
may be issued or delivered in this State unless a copy of the |
form thereof shall have been filed in accordance with Section |
355, and it contains in substance such of those provisions |
contained in Sections 357.1 through 357.30 as may be |
applicable to blanket accident and health insurance and the |
following provisions: |
(a) A provision that the policy and the application |
shall constitute the entire contract between the parties, |
|
and that all statements made by the policyholder shall, in |
absence of fraud, be deemed representations and not |
warranties, and that no such statements shall be used in |
defense to a claim under the policy, unless it is |
contained in a written application. |
(b) A provision that to the group or class thereof |
originally insured shall be added from time to time all |
new persons or individuals eligible for coverage. |
(3) An individual application shall not be required from a |
person covered under a blanket accident or health policy or |
contract, nor shall it be necessary for the insurer to furnish |
each person a certificate. |
(3.5) Subsection (3) does not apply to major medical |
insurance, or to any excepted benefits or short-term, |
limited-duration health insurance coverage for which an |
insured individual pays premiums or contributions. In those |
cases, the insurer shall require an individual application or |
enrollment form and shall furnish each insured individual a |
certificate, which shall have been approved by the Director |
under Section 355 of this Code. |
(4) All benefits under any blanket accident and health |
policy shall be payable to the person insured, or to his |
designated beneficiary or beneficiaries, or to his or her |
estate, except that if the person insured be a minor or person |
under legal disability, such benefits may be made payable to |
his or her parent, guardian, or other person actually |
|
supporting him or her. Provided further, however, that the |
policy may provide that all or any portion of any indemnities |
provided by any such policy on account of hospital, nursing, |
medical or surgical services may, at the insurer's option, be |
paid directly to the hospital or person rendering such |
services; but the policy may not require that the service be |
rendered by a particular hospital or person. Payment so made |
shall discharge the insurer's obligation with respect to the |
amount of insurance so paid. |
(5) Nothing contained in this section shall be deemed to |
affect the legal liability of policyholders for the death of |
or injury to, any such member of such group. |
(Source: P.A. 83-1362.) |
(215 ILCS 5/370e) (from Ch. 73, par. 982e) |
Sec. 370e. Companies which issue group accident and health |
policies or blanket accident and health plans to employer |
groups in this State shall provide the employer with notice of |
termination of a group or blanket accident and health plan |
because of the employer's failure to pay the premium when due. |
The insurance company shall file send a copy of such notice |
with to the Department in an electronic format either through |
the System for Electronic Rate and Form Filing (SERFF) or as |
otherwise prescribed by the Director . |
(Source: P.A. 83-1006.) |
|
(215 ILCS 5/370i) (from Ch. 73, par. 982i) |
Sec. 370i. Policies, agreements or arrangements with |
incentives or limits on reimbursement authorized. |
(a) Policies, agreements or arrangements issued under this |
Article may not contain terms or conditions that would operate |
unreasonably to restrict the access and availability of health |
care services for the insured. |
(b) An insurer or administrator may: |
(1) enter into agreements with certain providers of |
its choice relating to health care services which may be |
rendered to insureds or beneficiaries of the insurer or |
administrator, including agreements relating to the |
amounts to be charged the insureds or beneficiaries for |
services rendered; |
(2) issue or administer programs, policies or |
subscriber contracts in this State that include incentives |
for the insured or beneficiary to utilize the services of |
a provider which has entered into an agreement with the |
insurer or administrator pursuant to paragraph (1) above. |
(c) (Blank). After the effective date of this amendatory |
Act of the 92nd General Assembly, any insurer that arranges, |
contracts with, or administers contracts with a provider |
whereby beneficiaries are provided an incentive to use the |
services of such provider must include the following |
disclosure on its contracts and evidences of coverage: |
"WARNING, LIMITED BENEFITS WILL BE PAID WHEN NON-PARTICIPATING |
|
PROVIDERS ARE USED. You should be aware that when you elect to |
utilize the services of a non-participating provider for a |
covered service in non-emergency situations, benefit payments |
to such non-participating provider are not based upon the |
amount billed. The basis of your benefit payment will be |
determined according to your policy's fee schedule, usual and |
customary charge (which is determined by comparing charges for |
similar services adjusted to the geographical area where the |
services are performed), or other method as defined by the |
policy. YOU CAN EXPECT TO PAY MORE THAN THE COINSURANCE AMOUNT |
DEFINED IN THE POLICY AFTER THE PLAN HAS PAID ITS REQUIRED |
PORTION. Non-participating providers may bill members for any |
amount up to the billed charge after the plan has paid its |
portion of the bill. Participating providers have agreed to |
accept discounted payments for services with no additional |
billing to the member other than co-insurance and deductible |
amounts. You may obtain further information about the |
participating status of professional providers and information |
on out-of-pocket expenses by calling the toll free telephone |
number on your identification card.". |
(Source: P.A. 92-579, eff. 1-1-03.) |
(215 ILCS 5/408) (from Ch. 73, par. 1020) |
(Text of Section before amendment by P.A. 103-75 ) |
Sec. 408. Fees and charges. |
(1) The Director shall charge, collect and give proper |
|
acquittances for the payment of the following fees and |
charges: |
(a) For filing all documents submitted for the |
incorporation or organization or certification of a |
domestic company, except for a fraternal benefit society, |
$2,000. |
(b) For filing all documents submitted for the |
incorporation or organization of a fraternal benefit |
society, $500. |
(c) For filing amendments to articles of incorporation |
and amendments to declaration of organization, except for |
a fraternal benefit society, a mutual benefit association, |
a burial society or a farm mutual, $200. |
(d) For filing amendments to articles of incorporation |
of a fraternal benefit society, a mutual benefit |
association or a burial society, $100. |
(e) For filing amendments to articles of incorporation |
of a farm mutual, $50. |
(f) For filing bylaws or amendments thereto, $50. |
(g) For filing agreement of merger or consolidation: |
(i) for a domestic company, except for a fraternal |
benefit society, a mutual benefit association, a |
burial society, or a farm mutual, $2,000. |
(ii) for a foreign or alien company, except for a |
fraternal benefit society, $600. |
(iii) for a fraternal benefit society, a mutual |
|
benefit association, a burial society, or a farm |
mutual, $200. |
(h) For filing agreements of reinsurance by a domestic |
company, $200. |
(i) For filing all documents submitted by a foreign or |
alien company to be admitted to transact business or |
accredited as a reinsurer in this State, except for a |
fraternal benefit society, $5,000. |
(j) For filing all documents submitted by a foreign or |
alien fraternal benefit society to be admitted to transact |
business in this State, $500. |
(k) For filing declaration of withdrawal of a foreign |
or alien company, $50. |
(l) For filing annual statement by a domestic company, |
except a fraternal benefit society, a mutual benefit |
association, a burial society, or a farm mutual, $200. |
(m) For filing annual statement by a domestic |
fraternal benefit society, $100. |
(n) For filing annual statement by a farm mutual, a |
mutual benefit association, or a burial society, $50. |
(o) For issuing a certificate of authority or renewal |
thereof except to a foreign fraternal benefit society, |
$400. |
(p) For issuing a certificate of authority or renewal |
thereof to a foreign fraternal benefit society, $200. |
(q) For issuing an amended certificate of authority, |
|
$50. |
(r) For each certified copy of certificate of |
authority, $20. |
(s) For each certificate of deposit, or valuation, or |
compliance or surety certificate, $20. |
(t) For copies of papers or records per page, $1. |
(u) For each certification to copies of papers or |
records, $10. |
(v) For multiple copies of documents or certificates |
listed in subparagraphs (r), (s), and (u) of paragraph (1) |
of this Section, $10 for the first copy of a certificate of |
any type and $5 for each additional copy of the same |
certificate requested at the same time, unless, pursuant |
to paragraph (2) of this Section, the Director finds these |
additional fees excessive. |
(w) For issuing a permit to sell shares or increase |
paid-up capital: |
(i) in connection with a public stock offering, |
$300; |
(ii) in any other case, $100. |
(x) For issuing any other certificate required or |
permissible under the law, $50. |
(y) For filing a plan of exchange of the stock of a |
domestic stock insurance company, a plan of |
demutualization of a domestic mutual company, or a plan of |
reorganization under Article XII, $2,000. |
|
(z) For filing a statement of acquisition of a |
domestic company as defined in Section 131.4 of this Code, |
$2,000. |
(aa) For filing an agreement to purchase the business |
of an organization authorized under the Dental Service |
Plan Act or the Voluntary Health Services Plans Act or of a |
health maintenance organization or a limited health |
service organization, $2,000. |
(bb) For filing a statement of acquisition of a |
foreign or alien insurance company as defined in Section |
131.12a of this Code, $1,000. |
(cc) For filing a registration statement as required |
in Sections 131.13 and 131.14, the notification as |
required by Sections 131.16, 131.20a, or 141.4, or an |
agreement or transaction required by Sections 124.2(2), |
141, 141a, or 141.1, $200. |
(dd) For filing an application for licensing of: |
(i) a religious or charitable risk pooling trust |
or a workers' compensation pool, $1,000; |
(ii) a workers' compensation service company, |
$500; |
(iii) a self-insured automobile fleet, $200; or |
(iv) a renewal of or amendment of any license |
issued pursuant to (i), (ii), or (iii) above, $100. |
(ee) For filing articles of incorporation for a |
syndicate to engage in the business of insurance through |
|
the Illinois Insurance Exchange, $2,000. |
(ff) For filing amended articles of incorporation for |
a syndicate engaged in the business of insurance through |
the Illinois Insurance Exchange, $100. |
(gg) For filing articles of incorporation for a |
limited syndicate to join with other subscribers or |
limited syndicates to do business through the Illinois |
Insurance Exchange, $1,000. |
(hh) For filing amended articles of incorporation for |
a limited syndicate to do business through the Illinois |
Insurance Exchange, $100. |
(ii) For a permit to solicit subscriptions to a |
syndicate or limited syndicate, $100. |
(jj) For the filing of each form as required in |
Section 143 of this Code, $50 per form. Informational and |
advertising filings shall be $25 per filing. The fee for |
advisory and rating organizations shall be $200 per form. |
(i) For the purposes of the form filing fee, |
filings made on insert page basis will be considered |
one form at the time of its original submission. |
Changes made to a form subsequent to its approval |
shall be considered a new filing. |
(ii) Only one fee shall be charged for a form, |
regardless of the number of other forms or policies |
with which it will be used. |
(iii) Fees charged for a policy filed as it will be |
|
issued regardless of the number of forms comprising |
that policy shall not exceed $1,500. For advisory or |
rating organizations, fees charged for a policy filed |
as it will be issued regardless of the number of forms |
comprising that policy shall not exceed $2,500. |
(iv) The Director may by rule exempt forms from |
such fees. |
(kk) For filing an application for licensing of a |
reinsurance intermediary, $500. |
(ll) For filing an application for renewal of a |
license of a reinsurance intermediary, $200. |
(mm) For filing a plan of division of a domestic stock |
company under Article IIB, $100,000 $10,000 . |
(nn) For filing all documents submitted by a foreign |
or alien company to be a certified reinsurer in this |
State, except for a fraternal benefit society, $1,000. |
(oo) For filing a renewal by a foreign or alien |
company to be a certified reinsurer in this State, except |
for a fraternal benefit society, $400. |
(pp) For filing all documents submitted by a reinsurer |
domiciled in a reciprocal jurisdiction, $1,000. |
(qq) For filing a renewal by a reinsurer domiciled in |
a reciprocal jurisdiction, $400. |
(rr) For registering a captive management company or |
renewal thereof, $50. |
(2) When printed copies or numerous copies of the same |
|
paper or records are furnished or certified, the Director may |
reduce such fees for copies if he finds them excessive. He may, |
when he considers it in the public interest, furnish without |
charge to state insurance departments and persons other than |
companies, copies or certified copies of reports of |
examinations and of other papers and records. |
(3) The expenses incurred in any performance examination |
authorized by law shall be paid by the company or person being |
examined. The charge shall be reasonably related to the cost |
of the examination including but not limited to compensation |
of examiners, electronic data processing costs, supervision |
and preparation of an examination report and lodging and |
travel expenses. All lodging and travel expenses shall be in |
accord with the applicable travel regulations as published by |
the Department of Central Management Services and approved by |
the Governor's Travel Control Board, except that out-of-state |
lodging and travel expenses related to examinations authorized |
under Section 132 shall be in accordance with travel rates |
prescribed under paragraph 301-7.2 of the Federal Travel |
Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement of |
subsistence expenses incurred during official travel. All |
lodging and travel expenses may be reimbursed directly upon |
authorization of the Director. With the exception of the |
direct reimbursements authorized by the Director, all |
performance examination charges collected by the Department |
shall be paid to the Insurance Producer Administration Fund, |
|
however, the electronic data processing costs incurred by the |
Department in the performance of any examination shall be |
billed directly to the company being examined for payment to |
the Technology Management Revolving Fund. |
(4) At the time of any service of process on the Director |
as attorney for such service, the Director shall charge and |
collect the sum of $40, which may be recovered as taxable costs |
by the party to the suit or action causing such service to be |
made if he prevails in such suit or action. |
(5) (a) The costs incurred by the Department of Insurance |
in conducting any hearing authorized by law shall be assessed |
against the parties to the hearing in such proportion as the |
Director of Insurance may determine upon consideration of all |
relevant circumstances including: (1) the nature of the |
hearing; (2) whether the hearing was instigated by, or for the |
benefit of a particular party or parties; (3) whether there is |
a successful party on the merits of the proceeding; and (4) the |
relative levels of participation by the parties. |
(b) For purposes of this subsection (5) costs incurred |
shall mean the hearing officer fees, court reporter fees, and |
travel expenses of Department of Insurance officers and |
employees; provided however, that costs incurred shall not |
include hearing officer fees or court reporter fees unless the |
Department has retained the services of independent |
contractors or outside experts to perform such functions. |
(c) The Director shall make the assessment of costs |
|
incurred as part of the final order or decision arising out of |
the proceeding; provided, however, that such order or decision |
shall include findings and conclusions in support of the |
assessment of costs. This subsection (5) shall not be |
construed as permitting the payment of travel expenses unless |
calculated in accordance with the applicable travel |
regulations of the Department of Central Management Services, |
as approved by the Governor's Travel Control Board. The |
Director as part of such order or decision shall require all |
assessments for hearing officer fees and court reporter fees, |
if any, to be paid directly to the hearing officer or court |
reporter by the party(s) assessed for such costs. The |
assessments for travel expenses of Department officers and |
employees shall be reimbursable to the Director of Insurance |
for deposit to the fund out of which those expenses had been |
paid. |
(d) The provisions of this subsection (5) shall apply in |
the case of any hearing conducted by the Director of Insurance |
not otherwise specifically provided for by law. |
(6) The Director shall charge and collect an annual |
financial regulation fee from every domestic company for |
examination and analysis of its financial condition and to |
fund the internal costs and expenses of the Interstate |
Insurance Receivership Commission as may be allocated to the |
State of Illinois and companies doing an insurance business in |
this State pursuant to Article X of the Interstate Insurance |
|
Receivership Compact. The fee shall be the greater fixed |
amount based upon the combination of nationwide direct premium |
income and nationwide reinsurance assumed premium income or |
upon admitted assets calculated under this subsection as |
follows: |
(a) Combination of nationwide direct premium income |
and nationwide reinsurance assumed premium. |
(i) $150, if the premium is less than $500,000 and |
there is no reinsurance assumed premium; |
(ii) $750, if the premium is $500,000 or more, but |
less than $5,000,000 and there is no reinsurance |
assumed premium; or if the premium is less than |
$5,000,000 and the reinsurance assumed premium is less |
than $10,000,000; |
(iii) $3,750, if the premium is less than |
$5,000,000 and the reinsurance assumed premium is |
$10,000,000 or more; |
(iv) $7,500, if the premium is $5,000,000 or more, |
but less than $10,000,000; |
(v) $18,000, if the premium is $10,000,000 or |
more, but less than $25,000,000; |
(vi) $22,500, if the premium is $25,000,000 or |
more, but less than $50,000,000; |
(vii) $30,000, if the premium is $50,000,000 or |
more, but less than $100,000,000; |
(viii) $37,500, if the premium is $100,000,000 or |
|
more. |
(b) Admitted assets. |
(i) $150, if admitted assets are less than |
$1,000,000; |
(ii) $750, if admitted assets are $1,000,000 or |
more, but less than $5,000,000; |
(iii) $3,750, if admitted assets are $5,000,000 or |
more, but less than $25,000,000; |
(iv) $7,500, if admitted assets are $25,000,000 or |
more, but less than $50,000,000; |
(v) $18,000, if admitted assets are $50,000,000 or |
more, but less than $100,000,000; |
(vi) $22,500, if admitted assets are $100,000,000 |
or more, but less than $500,000,000; |
(vii) $30,000, if admitted assets are $500,000,000 |
or more, but less than $1,000,000,000; |
(viii) $37,500, if admitted assets are |
$1,000,000,000 or more. |
(c) The sum of financial regulation fees charged to |
the domestic companies of the same affiliated group shall |
not exceed $250,000 in the aggregate in any single year |
and shall be billed by the Director to the member company |
designated by the group. |
(7) The Director shall charge and collect an annual |
financial regulation fee from every foreign or alien company, |
except fraternal benefit societies, for the examination and |
|
analysis of its financial condition and to fund the internal |
costs and expenses of the Interstate Insurance Receivership |
Commission as may be allocated to the State of Illinois and |
companies doing an insurance business in this State pursuant |
to Article X of the Interstate Insurance Receivership Compact. |
The fee shall be a fixed amount based upon Illinois direct |
premium income and nationwide reinsurance assumed premium |
income in accordance with the following schedule: |
(a) $150, if the premium is less than $500,000 and |
there is no reinsurance assumed premium; |
(b) $750, if the premium is $500,000 or more, but less |
than $5,000,000 and there is no reinsurance assumed |
premium; or if the premium is less than $5,000,000 and the |
reinsurance assumed premium is less than $10,000,000; |
(c) $3,750, if the premium is less than $5,000,000 and |
the reinsurance assumed premium is $10,000,000 or more; |
(d) $7,500, if the premium is $5,000,000 or more, but |
less than $10,000,000; |
(e) $18,000, if the premium is $10,000,000 or more, |
but less than $25,000,000; |
(f) $22,500, if the premium is $25,000,000 or more, |
but less than $50,000,000; |
(g) $30,000, if the premium is $50,000,000 or more, |
but less than $100,000,000; |
(h) $37,500, if the premium is $100,000,000 or more. |
The sum of financial regulation fees under this subsection |
|
(7) charged to the foreign or alien companies within the same |
affiliated group shall not exceed $250,000 in the aggregate in |
any single year and shall be billed by the Director to the |
member company designated by the group. |
(8) Beginning January 1, 1992, the financial regulation |
fees imposed under subsections (6) and (7) of this Section |
shall be paid by each company or domestic affiliated group |
annually. After January 1, 1994, the fee shall be billed by |
Department invoice based upon the company's premium income or |
admitted assets as shown in its annual statement for the |
preceding calendar year. The invoice is due upon receipt and |
must be paid no later than June 30 of each calendar year. All |
financial regulation fees collected by the Department shall be |
paid to the Insurance Financial Regulation Fund. The |
Department may not collect financial examiner per diem charges |
from companies subject to subsections (6) and (7) of this |
Section undergoing financial examination after June 30, 1992. |
(9) In addition to the financial regulation fee required |
by this Section, a company undergoing any financial |
examination authorized by law shall pay the following costs |
and expenses incurred by the Department: electronic data |
processing costs, the expenses authorized under Section 131.21 |
and subsection (d) of Section 132.4 of this Code, and lodging |
and travel expenses. |
Electronic data processing costs incurred by the |
Department in the performance of any examination shall be |
|
billed directly to the company undergoing examination for |
payment to the Technology Management Revolving Fund. Except |
for direct reimbursements authorized by the Director or direct |
payments made under Section 131.21 or subsection (d) of |
Section 132.4 of this Code, all financial regulation fees and |
all financial examination charges collected by the Department |
shall be paid to the Insurance Financial Regulation Fund. |
All lodging and travel expenses shall be in accordance |
with applicable travel regulations published by the Department |
of Central Management Services and approved by the Governor's |
Travel Control Board, except that out-of-state lodging and |
travel expenses related to examinations authorized under |
Sections 132.1 through 132.7 shall be in accordance with |
travel rates prescribed under paragraph 301-7.2 of the Federal |
Travel Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement |
of subsistence expenses incurred during official travel. All |
lodging and travel expenses may be reimbursed directly upon |
the authorization of the Director. |
In the case of an organization or person not subject to the |
financial regulation fee, the expenses incurred in any |
financial examination authorized by law shall be paid by the |
organization or person being examined. The charge shall be |
reasonably related to the cost of the examination including, |
but not limited to, compensation of examiners and other costs |
described in this subsection. |
(10) Any company, person, or entity failing to make any |
|
payment of $150 or more as required under this Section shall be |
subject to the penalty and interest provisions provided for in |
subsections (4) and (7) of Section 412. |
(11) Unless otherwise specified, all of the fees collected |
under this Section shall be paid into the Insurance Financial |
Regulation Fund. |
(12) For purposes of this Section: |
(a) "Domestic company" means a company as defined in |
Section 2 of this Code which is incorporated or organized |
under the laws of this State, and in addition includes a |
not-for-profit corporation authorized under the Dental |
Service Plan Act or the Voluntary Health Services Plans |
Act, a health maintenance organization, and a limited |
health service organization. |
(b) "Foreign company" means a company as defined in |
Section 2 of this Code which is incorporated or organized |
under the laws of any state of the United States other than |
this State and in addition includes a health maintenance |
organization and a limited health service organization |
which is incorporated or organized under the laws of any |
state of the United States other than this State. |
(c) "Alien company" means a company as defined in |
Section 2 of this Code which is incorporated or organized |
under the laws of any country other than the United |
States. |
(d) "Fraternal benefit society" means a corporation, |
|
society, order, lodge or voluntary association as defined |
in Section 282.1 of this Code. |
(e) "Mutual benefit association" means a company, |
association or corporation authorized by the Director to |
do business in this State under the provisions of Article |
XVIII of this Code. |
(f) "Burial society" means a person, firm, |
corporation, society or association of individuals |
authorized by the Director to do business in this State |
under the provisions of Article XIX of this Code. |
(g) "Farm mutual" means a district, county and |
township mutual insurance company authorized by the |
Director to do business in this State under the provisions |
of the Farm Mutual Insurance Company Act of 1986. |
(Source: P.A. 102-775, eff. 5-13-22.) |
(Text of Section after amendment by P.A. 103-75 ) |
Sec. 408. Fees and charges. |
(1) The Director shall charge, collect and give proper |
acquittances for the payment of the following fees and |
charges: |
(a) For filing all documents submitted for the |
incorporation or organization or certification of a |
domestic company, except for a fraternal benefit society, |
$2,000. |
(b) For filing all documents submitted for the |
|
incorporation or organization of a fraternal benefit |
society, $500. |
(c) For filing amendments to articles of incorporation |
and amendments to declaration of organization, except for |
a fraternal benefit society, a mutual benefit association, |
a burial society or a farm mutual, $200. |
(d) For filing amendments to articles of incorporation |
of a fraternal benefit society, a mutual benefit |
association or a burial society, $100. |
(e) For filing amendments to articles of incorporation |
of a farm mutual, $50. |
(f) For filing bylaws or amendments thereto, $50. |
(g) For filing agreement of merger or consolidation: |
(i) for a domestic company, except for a fraternal |
benefit society, a mutual benefit association, a |
burial society, or a farm mutual, $2,000. |
(ii) for a foreign or alien company, except for a |
fraternal benefit society, $600. |
(iii) for a fraternal benefit society, a mutual |
benefit association, a burial society, or a farm |
mutual, $200. |
(h) For filing agreements of reinsurance by a domestic |
company, $200. |
(i) For filing all documents submitted by a foreign or |
alien company to be admitted to transact business or |
accredited as a reinsurer in this State, except for a |
|
fraternal benefit society, $5,000. |
(j) For filing all documents submitted by a foreign or |
alien fraternal benefit society to be admitted to transact |
business in this State, $500. |
(k) For filing declaration of withdrawal of a foreign |
or alien company, $50. |
(l) For filing annual statement by a domestic company, |
except a fraternal benefit society, a mutual benefit |
association, a burial society, or a farm mutual, $200. |
(m) For filing annual statement by a domestic |
fraternal benefit society, $100. |
(n) For filing annual statement by a farm mutual, a |
mutual benefit association, or a burial society, $50. |
(o) For issuing a certificate of authority or renewal |
thereof except to a foreign fraternal benefit society, |
$400. |
(p) For issuing a certificate of authority or renewal |
thereof to a foreign fraternal benefit society, $200. |
(q) For issuing an amended certificate of authority, |
$50. |
(r) For each certified copy of certificate of |
authority, $20. |
(s) For each certificate of deposit, or valuation, or |
compliance or surety certificate, $20. |
(t) For copies of papers or records per page, $1. |
(u) For each certification to copies of papers or |
|
records, $10. |
(v) For multiple copies of documents or certificates |
listed in subparagraphs (r), (s), and (u) of paragraph (1) |
of this Section, $10 for the first copy of a certificate of |
any type and $5 for each additional copy of the same |
certificate requested at the same time, unless, pursuant |
to paragraph (2) of this Section, the Director finds these |
additional fees excessive. |
(w) For issuing a permit to sell shares or increase |
paid-up capital: |
(i) in connection with a public stock offering, |
$300; |
(ii) in any other case, $100. |
(x) For issuing any other certificate required or |
permissible under the law, $50. |
(y) For filing a plan of exchange of the stock of a |
domestic stock insurance company, a plan of |
demutualization of a domestic mutual company, or a plan of |
reorganization under Article XII, $2,000. |
(z) For filing a statement of acquisition of a |
domestic company as defined in Section 131.4 of this Code, |
$2,000. |
(aa) For filing an agreement to purchase the business |
of an organization authorized under the Dental Service |
Plan Act or the Voluntary Health Services Plans Act or of a |
health maintenance organization or a limited health |
|
service organization, $2,000. |
(bb) For filing a statement of acquisition of a |
foreign or alien insurance company as defined in Section |
131.12a of this Code, $1,000. |
(cc) For filing a registration statement as required |
in Sections 131.13 and 131.14, the notification as |
required by Sections 131.16, 131.20a, or 141.4, or an |
agreement or transaction required by Sections 124.2(2), |
141, 141a, or 141.1, $200. |
(dd) For filing an application for licensing of: |
(i) a religious or charitable risk pooling trust |
or a workers' compensation pool, $1,000; |
(ii) a workers' compensation service company, |
$500; |
(iii) a self-insured automobile fleet, $200; or |
(iv) a renewal of or amendment of any license |
issued pursuant to (i), (ii), or (iii) above, $100. |
(ee) For filing articles of incorporation for a |
syndicate to engage in the business of insurance through |
the Illinois Insurance Exchange, $2,000. |
(ff) For filing amended articles of incorporation for |
a syndicate engaged in the business of insurance through |
the Illinois Insurance Exchange, $100. |
(gg) For filing articles of incorporation for a |
limited syndicate to join with other subscribers or |
limited syndicates to do business through the Illinois |
|
Insurance Exchange, $1,000. |
(hh) For filing amended articles of incorporation for |
a limited syndicate to do business through the Illinois |
Insurance Exchange, $100. |
(ii) For a permit to solicit subscriptions to a |
syndicate or limited syndicate, $100. |
(jj) For the filing of each form as required in |
Section 143 of this Code, $50 per form. Informational and |
advertising filings shall be $25 per filing. The fee for |
advisory and rating organizations shall be $200 per form. |
(i) For the purposes of the form filing fee, |
filings made on insert page basis will be considered |
one form at the time of its original submission. |
Changes made to a form subsequent to its approval |
shall be considered a new filing. |
(ii) Only one fee shall be charged for a form, |
regardless of the number of other forms or policies |
with which it will be used. |
(iii) Fees charged for a policy filed as it will be |
issued regardless of the number of forms comprising |
that policy shall not exceed $1,500. For advisory or |
rating organizations, fees charged for a policy filed |
as it will be issued regardless of the number of forms |
comprising that policy shall not exceed $2,500. |
(iv) The Director may by rule exempt forms from |
such fees. |
|
(kk) For filing an application for licensing of a |
reinsurance intermediary, $500. |
(ll) For filing an application for renewal of a |
license of a reinsurance intermediary, $200. |
(mm) For filing a plan of division of a domestic stock |
company under Article IIB, $100,000 $10,000 . |
(nn) For filing all documents submitted by a foreign |
or alien company to be a certified reinsurer in this |
State, except for a fraternal benefit society, $1,000. |
(oo) For filing a renewal by a foreign or alien |
company to be a certified reinsurer in this State, except |
for a fraternal benefit society, $400. |
(pp) For filing all documents submitted by a reinsurer |
domiciled in a reciprocal jurisdiction, $1,000. |
(qq) For filing a renewal by a reinsurer domiciled in |
a reciprocal jurisdiction, $400. |
(rr) For registering a captive management company or |
renewal thereof, $50. |
(ss) For filing an insurance business transfer plan |
under Article XLVII, $100,000 $25,000 . |
(2) When printed copies or numerous copies of the same |
paper or records are furnished or certified, the Director may |
reduce such fees for copies if he finds them excessive. He may, |
when he considers it in the public interest, furnish without |
charge to state insurance departments and persons other than |
companies, copies or certified copies of reports of |
|
examinations and of other papers and records. |
(3) The expenses incurred in any performance examination |
authorized by law shall be paid by the company or person being |
examined. The charge shall be reasonably related to the cost |
of the examination including but not limited to compensation |
of examiners, electronic data processing costs, supervision |
and preparation of an examination report and lodging and |
travel expenses. All lodging and travel expenses shall be in |
accord with the applicable travel regulations as published by |
the Department of Central Management Services and approved by |
the Governor's Travel Control Board, except that out-of-state |
lodging and travel expenses related to examinations authorized |
under Section 132 shall be in accordance with travel rates |
prescribed under paragraph 301-7.2 of the Federal Travel |
Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement of |
subsistence expenses incurred during official travel. All |
lodging and travel expenses may be reimbursed directly upon |
authorization of the Director. With the exception of the |
direct reimbursements authorized by the Director, all |
performance examination charges collected by the Department |
shall be paid to the Insurance Producer Administration Fund, |
however, the electronic data processing costs incurred by the |
Department in the performance of any examination shall be |
billed directly to the company being examined for payment to |
the Technology Management Revolving Fund. |
(4) At the time of any service of process on the Director |
|
as attorney for such service, the Director shall charge and |
collect the sum of $40, which may be recovered as taxable costs |
by the party to the suit or action causing such service to be |
made if he prevails in such suit or action. |
(5) (a) The costs incurred by the Department of Insurance |
in conducting any hearing authorized by law shall be assessed |
against the parties to the hearing in such proportion as the |
Director of Insurance may determine upon consideration of all |
relevant circumstances including: (1) the nature of the |
hearing; (2) whether the hearing was instigated by, or for the |
benefit of a particular party or parties; (3) whether there is |
a successful party on the merits of the proceeding; and (4) the |
relative levels of participation by the parties. |
(b) For purposes of this subsection (5) costs incurred |
shall mean the hearing officer fees, court reporter fees, and |
travel expenses of Department of Insurance officers and |
employees; provided however, that costs incurred shall not |
include hearing officer fees or court reporter fees unless the |
Department has retained the services of independent |
contractors or outside experts to perform such functions. |
(c) The Director shall make the assessment of costs |
incurred as part of the final order or decision arising out of |
the proceeding; provided, however, that such order or decision |
shall include findings and conclusions in support of the |
assessment of costs. This subsection (5) shall not be |
construed as permitting the payment of travel expenses unless |
|
calculated in accordance with the applicable travel |
regulations of the Department of Central Management Services, |
as approved by the Governor's Travel Control Board. The |
Director as part of such order or decision shall require all |
assessments for hearing officer fees and court reporter fees, |
if any, to be paid directly to the hearing officer or court |
reporter by the party(s) assessed for such costs. The |
assessments for travel expenses of Department officers and |
employees shall be reimbursable to the Director of Insurance |
for deposit to the fund out of which those expenses had been |
paid. |
(d) The provisions of this subsection (5) shall apply in |
the case of any hearing conducted by the Director of Insurance |
not otherwise specifically provided for by law. |
(6) The Director shall charge and collect an annual |
financial regulation fee from every domestic company for |
examination and analysis of its financial condition and to |
fund the internal costs and expenses of the Interstate |
Insurance Receivership Commission as may be allocated to the |
State of Illinois and companies doing an insurance business in |
this State pursuant to Article X of the Interstate Insurance |
Receivership Compact. The fee shall be the greater fixed |
amount based upon the combination of nationwide direct premium |
income and nationwide reinsurance assumed premium income or |
upon admitted assets calculated under this subsection as |
follows: |
|
(a) Combination of nationwide direct premium income |
and nationwide reinsurance assumed premium. |
(i) $150, if the premium is less than $500,000 and |
there is no reinsurance assumed premium; |
(ii) $750, if the premium is $500,000 or more, but |
less than $5,000,000 and there is no reinsurance |
assumed premium; or if the premium is less than |
$5,000,000 and the reinsurance assumed premium is less |
than $10,000,000; |
(iii) $3,750, if the premium is less than |
$5,000,000 and the reinsurance assumed premium is |
$10,000,000 or more; |
(iv) $7,500, if the premium is $5,000,000 or more, |
but less than $10,000,000; |
(v) $18,000, if the premium is $10,000,000 or |
more, but less than $25,000,000; |
(vi) $22,500, if the premium is $25,000,000 or |
more, but less than $50,000,000; |
(vii) $30,000, if the premium is $50,000,000 or |
more, but less than $100,000,000; |
(viii) $37,500, if the premium is $100,000,000 or |
more. |
(b) Admitted assets. |
(i) $150, if admitted assets are less than |
$1,000,000; |
(ii) $750, if admitted assets are $1,000,000 or |
|
more, but less than $5,000,000; |
(iii) $3,750, if admitted assets are $5,000,000 or |
more, but less than $25,000,000; |
(iv) $7,500, if admitted assets are $25,000,000 or |
more, but less than $50,000,000; |
(v) $18,000, if admitted assets are $50,000,000 or |
more, but less than $100,000,000; |
(vi) $22,500, if admitted assets are $100,000,000 |
or more, but less than $500,000,000; |
(vii) $30,000, if admitted assets are $500,000,000 |
or more, but less than $1,000,000,000; |
(viii) $37,500, if admitted assets are |
$1,000,000,000 or more. |
(c) The sum of financial regulation fees charged to |
the domestic companies of the same affiliated group shall |
not exceed $250,000 in the aggregate in any single year |
and shall be billed by the Director to the member company |
designated by the group. |
(7) The Director shall charge and collect an annual |
financial regulation fee from every foreign or alien company, |
except fraternal benefit societies, for the examination and |
analysis of its financial condition and to fund the internal |
costs and expenses of the Interstate Insurance Receivership |
Commission as may be allocated to the State of Illinois and |
companies doing an insurance business in this State pursuant |
to Article X of the Interstate Insurance Receivership Compact. |
|
The fee shall be a fixed amount based upon Illinois direct |
premium income and nationwide reinsurance assumed premium |
income in accordance with the following schedule: |
(a) $150, if the premium is less than $500,000 and |
there is no reinsurance assumed premium; |
(b) $750, if the premium is $500,000 or more, but less |
than $5,000,000 and there is no reinsurance assumed |
premium; or if the premium is less than $5,000,000 and the |
reinsurance assumed premium is less than $10,000,000; |
(c) $3,750, if the premium is less than $5,000,000 and |
the reinsurance assumed premium is $10,000,000 or more; |
(d) $7,500, if the premium is $5,000,000 or more, but |
less than $10,000,000; |
(e) $18,000, if the premium is $10,000,000 or more, |
but less than $25,000,000; |
(f) $22,500, if the premium is $25,000,000 or more, |
but less than $50,000,000; |
(g) $30,000, if the premium is $50,000,000 or more, |
but less than $100,000,000; |
(h) $37,500, if the premium is $100,000,000 or more. |
The sum of financial regulation fees under this subsection |
(7) charged to the foreign or alien companies within the same |
affiliated group shall not exceed $250,000 in the aggregate in |
any single year and shall be billed by the Director to the |
member company designated by the group. |
(8) Beginning January 1, 1992, the financial regulation |
|
fees imposed under subsections (6) and (7) of this Section |
shall be paid by each company or domestic affiliated group |
annually. After January 1, 1994, the fee shall be billed by |
Department invoice based upon the company's premium income or |
admitted assets as shown in its annual statement for the |
preceding calendar year. The invoice is due upon receipt and |
must be paid no later than June 30 of each calendar year. All |
financial regulation fees collected by the Department shall be |
paid to the Insurance Financial Regulation Fund. The |
Department may not collect financial examiner per diem charges |
from companies subject to subsections (6) and (7) of this |
Section undergoing financial examination after June 30, 1992. |
(9) In addition to the financial regulation fee required |
by this Section, a company undergoing any financial |
examination authorized by law shall pay the following costs |
and expenses incurred by the Department: electronic data |
processing costs, the expenses authorized under Section 131.21 |
and subsection (d) of Section 132.4 of this Code, and lodging |
and travel expenses. |
Electronic data processing costs incurred by the |
Department in the performance of any examination shall be |
billed directly to the company undergoing examination for |
payment to the Technology Management Revolving Fund. Except |
for direct reimbursements authorized by the Director or direct |
payments made under Section 131.21 or subsection (d) of |
Section 132.4 of this Code, all financial regulation fees and |
|
all financial examination charges collected by the Department |
shall be paid to the Insurance Financial Regulation Fund. |
All lodging and travel expenses shall be in accordance |
with applicable travel regulations published by the Department |
of Central Management Services and approved by the Governor's |
Travel Control Board, except that out-of-state lodging and |
travel expenses related to examinations authorized under |
Sections 132.1 through 132.7 shall be in accordance with |
travel rates prescribed under paragraph 301-7.2 of the Federal |
Travel Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement |
of subsistence expenses incurred during official travel. All |
lodging and travel expenses may be reimbursed directly upon |
the authorization of the Director. |
In the case of an organization or person not subject to the |
financial regulation fee, the expenses incurred in any |
financial examination authorized by law shall be paid by the |
organization or person being examined. The charge shall be |
reasonably related to the cost of the examination including, |
but not limited to, compensation of examiners and other costs |
described in this subsection. |
(10) Any company, person, or entity failing to make any |
payment of $150 or more as required under this Section shall be |
subject to the penalty and interest provisions provided for in |
subsections (4) and (7) of Section 412. |
(11) Unless otherwise specified, all of the fees collected |
under this Section shall be paid into the Insurance Financial |
|
Regulation Fund. |
(12) For purposes of this Section: |
(a) "Domestic company" means a company as defined in |
Section 2 of this Code which is incorporated or organized |
under the laws of this State, and in addition includes a |
not-for-profit corporation authorized under the Dental |
Service Plan Act or the Voluntary Health Services Plans |
Act, a health maintenance organization, and a limited |
health service organization. |
(b) "Foreign company" means a company as defined in |
Section 2 of this Code which is incorporated or organized |
under the laws of any state of the United States other than |
this State and in addition includes a health maintenance |
organization and a limited health service organization |
which is incorporated or organized under the laws of any |
state of the United States other than this State. |
(c) "Alien company" means a company as defined in |
Section 2 of this Code which is incorporated or organized |
under the laws of any country other than the United |
States. |
(d) "Fraternal benefit society" means a corporation, |
society, order, lodge or voluntary association as defined |
in Section 282.1 of this Code. |
(e) "Mutual benefit association" means a company, |
association or corporation authorized by the Director to |
do business in this State under the provisions of Article |
|
XVIII of this Code. |
(f) "Burial society" means a person, firm, |
corporation, society or association of individuals |
authorized by the Director to do business in this State |
under the provisions of Article XIX of this Code. |
(g) "Farm mutual" means a district, county and |
township mutual insurance company authorized by the |
Director to do business in this State under the provisions |
of the Farm Mutual Insurance Company Act of 1986. |
(Source: P.A. 102-775, eff. 5-13-22; 103-75, eff. 1-1-25.) |
(215 ILCS 5/412) (from Ch. 73, par. 1024) |
Sec. 412. Refunds; penalties; collection. |
(1)(a) Whenever it appears to the satisfaction of the |
Director that because of some mistake of fact, error in |
calculation, or erroneous interpretation of a statute of this |
or any other state, any authorized company, surplus line |
producer, or industrial insured has paid to him, pursuant to |
any provision of law, taxes, fees, or other charges in excess |
of the amount legally chargeable against it, during the 6-year |
6 year period immediately preceding the discovery of such |
overpayment, he shall have power to refund to such company, |
surplus line producer, or industrial insured the amount of the |
excess or excesses by applying the amount or amounts thereof |
toward the payment of taxes, fees, or other charges already |
due, or which may thereafter become due from that company |
|
until such excess or excesses have been fully refunded, or |
upon a written request from the authorized company, surplus |
line producer, or industrial insured, the Director shall |
provide a cash refund within 120 days after receipt of the |
written request if all necessary information has been filed |
with the Department in order for it to perform an audit of the |
tax report for the transaction or period or annual return for |
the year in which the overpayment occurred or within 120 days |
after the date the Department receives all the necessary |
information to perform such audit. The Director shall not |
provide a cash refund if there are insufficient funds in the |
Insurance Premium Tax Refund Fund to provide a cash refund, if |
the amount of the overpayment is less than $100, or if the |
amount of the overpayment can be fully offset against the |
taxpayer's estimated liability for the year following the year |
of the cash refund request. Any cash refund shall be paid from |
the Insurance Premium Tax Refund Fund, a special fund hereby |
created in the State treasury. |
(b) As determined by the Director pursuant to paragraph |
(a) of this subsection, the Department shall deposit an amount |
of cash refunds approved by the Director for payment as a |
result of overpayment of tax liability collected under |
Sections 121-2.08, 409, 444, 444.1, and 445 of this Code into |
the Insurance Premium Tax Refund Fund. |
(c) Beginning July 1, 1999, moneys in the Insurance |
Premium Tax Refund Fund shall be expended exclusively for the |
|
purpose of paying cash refunds resulting from overpayment of |
tax liability under Sections 121-2.08, 409, 444, 444.1, and |
445 of this Code as determined by the Director pursuant to |
subsection 1(a) of this Section. Cash refunds made in |
accordance with this Section may be made from the Insurance |
Premium Tax Refund Fund only to the extent that amounts have |
been deposited and retained in the Insurance Premium Tax |
Refund Fund. |
(d) This Section shall constitute an irrevocable and |
continuing appropriation from the Insurance Premium Tax Refund |
Fund for the purpose of paying cash refunds pursuant to the |
provisions of this Section. |
(2)(a) When any insurance company fails to file any tax |
return required under Sections 408.1, 409, 444, and 444.1 of |
this Code or Section 12 of the Fire Investigation Act on the |
date prescribed, including any extensions, there shall be |
added as a penalty $400 or 10% of the amount of such tax, |
whichever is greater, for each month or part of a month of |
failure to file, the entire penalty not to exceed $2,000 or 50% |
of the tax due, whichever is greater. In this paragraph, "tax |
due" means the full amount due for the applicable tax period |
under Section 408.1, 409, 444, or 444.1 of this Code or Section |
12 of the Fire Investigation Act. |
(b) When any industrial insured or surplus line producer |
fails to file any tax return or report required under Sections |
121-2.08 and 445 of this Code or Section 12 of the Fire |
|
Investigation Act on the date prescribed, including any |
extensions, there shall be added: |
(i) as a late fee, if the return or report is received |
at least one day but not more than 15 days after the |
prescribed due date, $50 or 5% of the tax due, whichever is |
greater, the entire fee not to exceed $1,000; |
(ii) as a late fee, if the return or report is received |
at least 16 days but not more than 30 days after the |
prescribed due date, $100 or 5% of the tax due, whichever |
is greater, the entire fee not to exceed $2,000; or |
(iii) as a penalty, if the return or report is |
received more than 30 days after the prescribed due date, |
$100 or 5% of the tax due, whichever is greater, for each |
month or part of a month of failure to file, the entire |
penalty not to exceed $500 or 30% of the tax due, whichever |
is greater. |
In this paragraph, "tax due" means the full amount due for |
the applicable tax period under Section 121-2.08 or 445 of |
this Code or Section 12 of the Fire Investigation Act. A tax |
return or report shall be deemed received as of the date mailed |
as evidenced by a postmark, proof of mailing on a recognized |
United States Postal Service form or a form acceptable to the |
United States Postal Service or other commercial mail delivery |
service, or other evidence acceptable to the Director. |
(3)(a) When any insurance company fails to pay the full |
amount due under the provisions of this Section, Sections |
|
408.1, 409, 444, or 444.1 of this Code, or Section 12 of the |
Fire Investigation Act, there shall be added to the amount due |
as a penalty an amount equal to 10% of the deficiency. |
(a-5) When any industrial insured or surplus line producer |
fails to pay the full amount due under the provisions of this |
Section, Sections 121-2.08 or 445 of this Code, or Section 12 |
of the Fire Investigation Act on the date prescribed, there |
shall be added: |
(i) as a late fee, if the payment is received at least |
one day but not more than 7 days after the prescribed due |
date, 10% of the tax due, the entire fee not to exceed |
$1,000; |
(ii) as a late fee, if the payment is received at least |
8 days but not more than 14 days after the prescribed due |
date, 10% of the tax due, the entire fee not to exceed |
$1,500; |
(iii) as a late fee, if the payment is received at |
least 15 days but not more than 21 days after the |
prescribed due date, 10% of the tax due, the entire fee not |
to exceed $2,000; or |
(iv) as a penalty, if the return or report is received |
more than 21 days after the prescribed due date, 10% of the |
tax due. |
In this paragraph, "tax due" means the full amount due for |
the applicable tax period under this Section, Section 121-2.08 |
or 445 of this Code, or Section 12 of the Fire Investigation |
|
Act. A tax payment shall be deemed received as of the date |
mailed as evidenced by a postmark, proof of mailing on a |
recognized United States Postal Service form or a form |
acceptable to the United States Postal Service or other |
commercial mail delivery service, or other evidence acceptable |
to the Director. |
(b) If such failure to pay is determined by the Director to |
be willful wilful , after a hearing under Sections 402 and 403, |
there shall be added to the tax as a penalty an amount equal to |
the greater of 50% of the deficiency or 10% of the amount due |
and unpaid for each month or part of a month that the |
deficiency remains unpaid commencing with the date that the |
amount becomes due. Such amount shall be in lieu of any |
determined under paragraph (a) or (a-5). |
(4) Any insurance company, industrial insured, or surplus |
line producer that fails to pay the full amount due under this |
Section or Sections 121-2.08, 408.1, 409, 444, 444.1, or 445 |
of this Code, or Section 12 of the Fire Investigation Act is |
liable, in addition to the tax and any late fees and penalties, |
for interest on such deficiency at the rate of 12% per annum, |
or at such higher adjusted rates as are or may be established |
under subsection (b) of Section 6621 of the Internal Revenue |
Code, from the date that payment of any such tax was due, |
determined without regard to any extensions, to the date of |
payment of such amount. |
(5) The Director, through the Attorney General, may |
|
institute an action in the name of the People of the State of |
Illinois, in any court of competent jurisdiction, for the |
recovery of the amount of such taxes, fees, and penalties due, |
and prosecute the same to final judgment, and take such steps |
as are necessary to collect the same. |
(6) In the event that the certificate of authority of a |
foreign or alien company is revoked for any cause or the |
company withdraws from this State prior to the renewal date of |
the certificate of authority as provided in Section 114, the |
company may recover the amount of any such tax paid in advance. |
Except as provided in this subsection, no revocation or |
withdrawal excuses payment of or constitutes grounds for the |
recovery of any taxes or penalties imposed by this Code. |
(7) When an insurance company or domestic affiliated group |
fails to pay the full amount of any fee of $200 or more due |
under Section 408 of this Code, there shall be added to the |
amount due as a penalty the greater of $100 or an amount equal |
to 10% of the deficiency for each month or part of a month that |
the deficiency remains unpaid. |
(8) The Department shall have a lien for the taxes, fees, |
charges, fines, penalties, interest, other charges, or any |
portion thereof, imposed or assessed pursuant to this Code, |
upon all the real and personal property of any company or |
person to whom the assessment or final order has been issued or |
whenever a tax return is filed without payment of the tax or |
penalty shown therein to be due, including all such property |
|
of the company or person acquired after receipt of the |
assessment, issuance of the order, or filing of the return. |
The company or person is liable for the filing fee incurred by |
the Department for filing the lien and the filing fee incurred |
by the Department to file the release of that lien. The filing |
fees shall be paid to the Department in addition to payment of |
the tax, fee, charge, fine, penalty, interest, other charges, |
or any portion thereof, included in the amount of the lien. |
However, where the lien arises because of the issuance of a |
final order of the Director or tax assessment by the |
Department, the lien shall not attach and the notice referred |
to in this Section shall not be filed until all administrative |
proceedings or proceedings in court for review of the final |
order or assessment have terminated or the time for the taking |
thereof has expired without such proceedings being instituted. |
Upon the granting of Department review after a lien has |
attached, the lien shall remain in full force except to the |
extent to which the final assessment may be reduced by a |
revised final assessment following the rehearing or review. |
The lien created by the issuance of a final assessment shall |
terminate, unless a notice of lien is filed, within 3 years |
after the date all proceedings in court for the review of the |
final assessment have terminated or the time for the taking |
thereof has expired without such proceedings being instituted, |
or (in the case of a revised final assessment issued pursuant |
to a rehearing or review by the Department) within 3 years |
|
after the date all proceedings in court for the review of such |
revised final assessment have terminated or the time for the |
taking thereof has expired without such proceedings being |
instituted. Where the lien results from the filing of a tax |
return without payment of the tax or penalty shown therein to |
be due, the lien shall terminate, unless a notice of lien is |
filed, within 3 years after the date when the return is filed |
with the Department. |
The time limitation period on the Department's right to |
file a notice of lien shall not run during any period of time |
in which the order of any court has the effect of enjoining or |
restraining the Department from filing such notice of lien. If |
the Department finds that a company or person is about to |
depart from the State, to conceal himself or his property, or |
to do any other act tending to prejudice or to render wholly or |
partly ineffectual proceedings to collect the amount due and |
owing to the Department unless such proceedings are brought |
without delay, or if the Department finds that the collection |
of the amount due from any company or person will be |
jeopardized by delay, the Department shall give the company or |
person notice of such findings and shall make demand for |
immediate return and payment of the amount, whereupon the |
amount shall become immediately due and payable. If the |
company or person, within 5 days after the notice (or within |
such extension of time as the Department may grant), does not |
comply with the notice or show to the Department that the |
|
findings in the notice are erroneous, the Department may file |
a notice of jeopardy assessment lien in the office of the |
recorder of the county in which any property of the company or |
person may be located and shall notify the company or person of |
the filing. The jeopardy assessment lien shall have the same |
scope and effect as the statutory lien provided for in this |
Section. If the company or person believes that the company or |
person does not owe some or all of the tax for which the |
jeopardy assessment lien against the company or person has |
been filed, or that no jeopardy to the revenue in fact exists, |
the company or person may protest within 20 days after being |
notified by the Department of the filing of the jeopardy |
assessment lien and request a hearing, whereupon the |
Department shall hold a hearing in conformity with the |
provisions of this Code and, pursuant thereto, shall notify |
the company or person of its findings as to whether or not the |
jeopardy assessment lien will be released. If not, and if the |
company or person is aggrieved by this decision, the company |
or person may file an action for judicial review of the final |
determination of the Department in accordance with the |
Administrative Review Law. If, pursuant to such hearing (or |
after an independent determination of the facts by the |
Department without a hearing), the Department determines that |
some or all of the amount due covered by the jeopardy |
assessment lien is not owed by the company or person, or that |
no jeopardy to the revenue exists, or if on judicial review the |
|
final judgment of the court is that the company or person does |
not owe some or all of the amount due covered by the jeopardy |
assessment lien against them, or that no jeopardy to the |
revenue exists, the Department shall release its jeopardy |
assessment lien to the extent of such finding of nonliability |
for the amount, or to the extent of such finding of no jeopardy |
to the revenue. The Department shall also release its jeopardy |
assessment lien against the company or person whenever the |
amount due and owing covered by the lien, plus any interest |
which may be due, are paid and the company or person has paid |
the Department in cash or by guaranteed remittance an amount |
representing the filing fee for the lien and the filing fee for |
the release of that lien. The Department shall file that |
release of lien with the recorder of the county where that lien |
was filed. |
Nothing in this Section shall be construed to give the |
Department a preference over the rights of any bona fide |
purchaser, holder of a security interest, mechanics |
lienholder, mortgagee, or judgment lien creditor arising prior |
to the filing of a regular notice of lien or a notice of |
jeopardy assessment lien in the office of the recorder in the |
county in which the property subject to the lien is located. |
For purposes of this Section, "bona fide" shall not include |
any mortgage of real or personal property or any other credit |
transaction that results in the mortgagee or the holder of the |
security acting as trustee for unsecured creditors of the |
|
company or person mentioned in the notice of lien who executed |
such chattel or real property mortgage or the document |
evidencing such credit transaction. The lien shall be inferior |
to the lien of general taxes, special assessments, and special |
taxes levied by any political subdivision of this State. In |
case title to land to be affected by the notice of lien or |
notice of jeopardy assessment lien is registered under the |
provisions of the Registered Titles (Torrens) Act, such notice |
shall be filed in the office of the Registrar of Titles of the |
county within which the property subject to the lien is |
situated and shall be entered upon the register of titles as a |
memorial or charge upon each folium of the register of titles |
affected by such notice, and the Department shall not have a |
preference over the rights of any bona fide purchaser, |
mortgagee, judgment creditor, or other lienholder arising |
prior to the registration of such notice. The regular lien or |
jeopardy assessment lien shall not be effective against any |
purchaser with respect to any item in a retailer's stock in |
trade purchased from the retailer in the usual course of the |
retailer's business. |
(Source: P.A. 102-775, eff. 5-13-22; 103-426, eff. 8-4-23.) |
(215 ILCS 5/531.03) (from Ch. 73, par. 1065.80-3) |
Sec. 531.03. Coverage and limitations. |
(1) This Article shall provide coverage for the policies |
and contracts specified in subsection (2) of this Section: |
|
(a) to persons who, regardless of where they reside |
(except for non-resident certificate holders under group |
policies or contracts), are the beneficiaries, assignees |
or payees, including health care providers rendering |
services covered under a health insurance policy or |
certificate, of the persons covered under paragraph (b) of |
this subsection, and |
(b) to persons who are owners of or certificate |
holders or enrollees under the policies or contracts |
(other than unallocated annuity contracts and structured |
settlement annuities) and in each case who: |
(i) are residents; or |
(ii) are not residents, but only under all of the |
following conditions: |
(A) the member insurer that issued the |
policies or contracts is domiciled in this State; |
(B) the states in which the persons reside |
have associations similar to the Association |
created by this Article; |
(C) the persons are not eligible for coverage |
by an association in any other state due to the |
fact that the insurer or health maintenance |
organization was not licensed in that state at the |
time specified in that state's guaranty |
association law. |
(c) For unallocated annuity contracts specified in |
|
subsection (2), paragraphs (a) and (b) of this subsection |
(1) shall not apply and this Article shall (except as |
provided in paragraphs (e) and (f) of this subsection) |
provide coverage to: |
(i) persons who are the owners of the unallocated |
annuity contracts if the contracts are issued to or in |
connection with a specific benefit plan whose plan |
sponsor has its principal place of business in this |
State; and |
(ii) persons who are owners of unallocated annuity |
contracts issued to or in connection with government |
lotteries if the owners are residents. |
(d) For structured settlement annuities specified in |
subsection (2), paragraphs (a) and (b) of this subsection |
(1) shall not apply and this Article shall (except as |
provided in paragraphs (e) and (f) of this subsection) |
provide coverage to a person who is a payee under a |
structured settlement annuity (or beneficiary of a payee |
if the payee is deceased), if the payee: |
(i) is a resident, regardless of where the |
contract owner resides; or |
(ii) is not a resident, but only under both of the |
following conditions: |
(A) with regard to residency: |
(I) the contract owner of the structured |
settlement annuity is a resident; or |
|
(II) the contract owner of the structured |
settlement annuity is not a resident but the |
insurer that issued the structured settlement |
annuity is domiciled in this State and the |
state in which the contract owner resides has |
an association similar to the Association |
created by this Article; and |
(B) neither the payee or beneficiary nor the |
contract owner is eligible for coverage by the |
association of the state in which the payee or |
contract owner resides. |
(e) This Article shall not provide coverage to: |
(i) a person who is a payee or beneficiary of a |
contract owner resident of this State if the payee or |
beneficiary is afforded any coverage by the |
association of another state; or |
(ii) a person covered under paragraph (c) of this |
subsection (1), if any coverage is provided by the |
association of another state to that person. |
(f) This Article is intended to provide coverage to a |
person who is a resident of this State and, in special |
circumstances, to a nonresident. In order to avoid |
duplicate coverage, if a person who would otherwise |
receive coverage under this Article is provided coverage |
under the laws of any other state, then the person shall |
not be provided coverage under this Article. In |
|
determining the application of the provisions of this |
paragraph in situations where a person could be covered by |
the association of more than one state, whether as an |
owner, payee, enrollee, beneficiary, or assignee, this |
Article shall be construed in conjunction with other state |
laws to result in coverage by only one association. |
(2)(a) This Article shall provide coverage to the persons |
specified in subsection (1) of this Section for policies or |
contracts of direct, (i) nongroup life insurance, health |
insurance (that, for the purposes of this Article, includes |
health maintenance organization subscriber contracts and |
certificates), annuities and supplemental contracts to any of |
these, (ii) for certificates under direct group policies or |
contracts, (iii) for unallocated annuity contracts and (iv) |
for contracts to furnish health care services and subscription |
certificates for medical or health care services issued by |
persons licensed to transact insurance business in this State |
under this Code. Annuity contracts and certificates under |
group annuity contracts include but are not limited to |
guaranteed investment contracts, deposit administration |
contracts, unallocated funding agreements, allocated funding |
agreements, structured settlement agreements, lottery |
contracts and any immediate or deferred annuity contracts. |
(b) Except as otherwise provided in paragraph (c) of this |
subsection, this Article shall not provide coverage for: |
(i) that portion of a policy or contract not |
|
guaranteed by the member insurer, or under which the risk |
is borne by the policy or contract owner; |
(ii) any such policy or contract or part thereof |
assumed by the impaired or insolvent insurer under a |
contract of reinsurance, other than reinsurance for which |
assumption certificates have been issued; |
(iii) any portion of a policy or contract to the |
extent that the rate of interest on which it is based or |
the interest rate, crediting rate, or similar factor is |
determined by use of an index or other external reference |
stated in the policy or contract employed in calculating |
returns or changes in value: |
(A) averaged over the period of 4 years prior to |
the date on which the member insurer becomes an |
impaired or insolvent insurer under this Article, |
whichever is earlier, exceeds the rate of interest |
determined by subtracting 2 percentage points from |
Moody's Corporate Bond Yield Average averaged for that |
same 4-year period or for such lesser period if the |
policy or contract was issued less than 4 years before |
the member insurer becomes an impaired or insolvent |
insurer under this Article, whichever is earlier; and |
(B) on and after the date on which the member |
insurer becomes an impaired or insolvent insurer under |
this Article, whichever is earlier, exceeds the rate |
of interest determined by subtracting 3 percentage |
|
points from Moody's Corporate Bond Yield Average as |
most recently available; |
(iv) any unallocated annuity contract issued to or in |
connection with a benefit plan protected under the federal |
Pension Benefit Guaranty Corporation, regardless of |
whether the federal Pension Benefit Guaranty Corporation |
has yet become liable to make any payments with respect to |
the benefit plan; |
(v) any portion of any unallocated annuity contract |
which is not issued to or in connection with a specific |
employee, union or association of natural persons benefit |
plan or a government lottery; |
(vi) an obligation that does not arise under the |
express written terms of the policy or contract issued by |
the member insurer to the enrollee, certificate holder, |
contract owner, or policy owner, including without |
limitation: |
(A) a claim based on marketing materials; |
(B) a claim based on side letters, riders, or |
other documents that were issued by the member insurer |
without meeting applicable policy or contract form |
filing or approval requirements; |
(C) a misrepresentation of or regarding policy or |
contract benefits; |
(D) an extra-contractual claim; or |
(E) a claim for penalties or consequential or |
|
incidental damages; |
(vii) any stop-loss insurance, as defined in clause |
(b) of Class 1 or clause (a) of Class 2 of Section 4 , and |
further defined in subsection (d) of Section 352 ; |
(viii) any policy or contract providing any hospital, |
medical, prescription drug, or other health care benefits |
pursuant to Part C or Part D of Subchapter XVIII, Chapter 7 |
of Title 42 of the United States Code (commonly known as |
Medicare Part C & D), Subchapter XIX, Chapter 7 of Title 42 |
of the United States Code (commonly known as Medicaid), or |
any regulations issued pursuant thereto; |
(ix) any portion of a policy or contract to the extent |
that the assessments required by Section 531.09 of this |
Code with respect to the policy or contract are preempted |
or otherwise not permitted by federal or State law; |
(x) any portion of a policy or contract issued to a |
plan or program of an employer, association, or other |
person to provide life, health, or annuity benefits to its |
employees, members, or others to the extent that the plan |
or program is self-funded or uninsured, including, but not |
limited to, benefits payable by an employer, association, |
or other person under: |
(A) a multiple employer welfare arrangement as |
defined in 29 U.S.C. Section 1002; |
(B) a minimum premium group insurance plan; |
(C) a stop-loss group insurance plan; or |
|
(D) an administrative services only contract; |
(xi) any portion of a policy or contract to the extent |
that it provides for: |
(A) dividends or experience rating credits; |
(B) voting rights; or |
(C) payment of any fees or allowances to any |
person, including the policy or contract owner, in |
connection with the service to or administration of |
the policy or contract; |
(xii) any policy or contract issued in this State by a |
member insurer at a time when it was not licensed or did |
not have a certificate of authority to issue the policy or |
contract in this State; |
(xiii) any contractual agreement that establishes the |
member insurer's obligations to provide a book value |
accounting guaranty for defined contribution benefit plan |
participants by reference to a portfolio of assets that is |
owned by the benefit plan or its trustee, which in each |
case is not an affiliate of the member insurer; |
(xiv) any portion of a policy or contract to the |
extent that it provides for interest or other changes in |
value to be determined by the use of an index or other |
external reference stated in the policy or contract, but |
which have not been credited to the policy or contract, or |
as to which the policy or contract owner's rights are |
subject to forfeiture, as of the date the member insurer |
|
becomes an impaired or insolvent insurer under this Code, |
whichever is earlier. If a policy's or contract's interest |
or changes in value are credited less frequently than |
annually, then for purposes of determining the values that |
have been credited and are not subject to forfeiture under |
this Section, the interest or change in value determined |
by using the procedures defined in the policy or contract |
will be credited as if the contractual date of crediting |
interest or changing values was the date of impairment or |
insolvency, whichever is earlier, and will not be subject |
to forfeiture; or |
(xv) that portion or part of a variable life insurance |
or variable annuity contract not guaranteed by a member |
insurer. |
(c) The exclusion from coverage referenced in subdivision |
(iii) of paragraph (b) of this subsection shall not apply to |
any portion of a policy or contract, including a rider, that |
provides long-term care or other health insurance benefits. |
(3) The benefits for which the Association may become |
liable shall in no event exceed the lesser of: |
(a) the contractual obligations for which the member |
insurer is liable or would have been liable if it were not |
an impaired or insolvent insurer, or |
(b)(i) with respect to any one life, regardless of the |
number of policies or contracts: |
(A) $300,000 in life insurance death benefits, but |
|
not more than $100,000 in net cash surrender and net |
cash withdrawal values for life insurance; |
(B) for health insurance benefits: |
(I) $100,000 for coverages not defined as |
disability income insurance or health benefit |
plans or long-term care insurance, including any |
net cash surrender and net cash withdrawal values; |
(II) $300,000 for disability income insurance |
and $300,000 for long-term care insurance; and |
(III) $500,000 for health benefit plans; |
(C) $250,000 in the present value of annuity |
benefits, including net cash surrender and net cash |
withdrawal values; |
(ii) with respect to each individual participating in |
a governmental retirement benefit plan established under |
Section 401, 403(b), or 457 of the U.S. Internal Revenue |
Code covered by an unallocated annuity contract or the |
beneficiaries of each such individual if deceased, in the |
aggregate, $250,000 in present value annuity benefits, |
including net cash surrender and net cash withdrawal |
values; |
(iii) with respect to each payee of a structured |
settlement annuity or beneficiary or beneficiaries of the |
payee if deceased, $250,000 in present value annuity |
benefits, in the aggregate, including net cash surrender |
and net cash withdrawal values, if any; or |
|
(iv) with respect to either (1) one contract owner |
provided coverage under subparagraph (ii) of paragraph (c) |
of subsection (1) of this Section or (2) one plan sponsor |
whose plans own directly or in trust one or more |
unallocated annuity contracts not included in subparagraph |
(ii) of paragraph (b) of this subsection, $5,000,000 in |
benefits, irrespective of the number of contracts with |
respect to the contract owner or plan sponsor. However, in |
the case where one or more unallocated annuity contracts |
are covered contracts under this Article and are owned by |
a trust or other entity for the benefit of 2 or more plan |
sponsors, coverage shall be afforded by the Association if |
the largest interest in the trust or entity owning the |
contract or contracts is held by a plan sponsor whose |
principal place of business is in this State. In no event |
shall the Association be obligated to cover more than |
$5,000,000 in benefits with respect to all these |
unallocated contracts. |
In no event shall the Association be obligated to cover |
more than (1) an aggregate of $300,000 in benefits with |
respect to any one life under subparagraphs (i), (ii), and |
(iii) of this paragraph (b) except with respect to benefits |
for health benefit plans under item (B) of subparagraph (i) of |
this paragraph (b), in which case the aggregate liability of |
the Association shall not exceed $500,000 with respect to any |
one individual or (2) with respect to one owner of multiple |
|
nongroup policies of life insurance, whether the policy or |
contract owner is an individual, firm, corporation, or other |
person and whether the persons insured are officers, managers, |
employees, or other persons, $5,000,000 in benefits, |
regardless of the number of policies and contracts held by the |
owner. |
The limitations set forth in this subsection are |
limitations on the benefits for which the Association is |
obligated before taking into account either its subrogation |
and assignment rights or the extent to which those benefits |
could be provided out of the assets of the impaired or |
insolvent insurer attributable to covered policies. The costs |
of the Association's obligations under this Article may be met |
by the use of assets attributable to covered policies or |
reimbursed to the Association pursuant to its subrogation and |
assignment rights. |
For purposes of this Article, benefits provided by a |
long-term care rider to a life insurance policy or annuity |
contract shall be considered the same type of benefits as the |
base life insurance policy or annuity contract to which it |
relates. |
(4) In performing its obligations to provide coverage |
under Section 531.08 of this Code, the Association shall not |
be required to guarantee, assume, reinsure, reissue, or |
perform or cause to be guaranteed, assumed, reinsured, |
reissued, or performed the contractual obligations of the |
|
insolvent or impaired insurer under a covered policy or |
contract that do not materially affect the economic values or |
economic benefits of the covered policy or contract. |
(Source: P.A. 100-687, eff. 8-3-18; 100-863, eff. 8-14-18.) |
(215 ILCS 5/356z.30a rep.) |
(215 ILCS 5/362a rep.) |
Section 26. The Illinois Insurance Code is amended by |
repealing Sections 356z.30a and 362a. |
Section 30. The Network Adequacy and Transparency Act is |
amended by changing Sections 5 and 10 as follows: |
(215 ILCS 124/5) |
Sec. 5. Definitions. In this Act: |
"Authorized representative" means a person to whom a |
beneficiary has given express written consent to represent the |
beneficiary; a person authorized by law to provide substituted |
consent for a beneficiary; or the beneficiary's treating |
provider only when the beneficiary or his or her family member |
is unable to provide consent. |
"Beneficiary" means an individual, an enrollee, an |
insured, a participant, or any other person entitled to |
reimbursement for covered expenses of or the discounting of |
provider fees for health care services under a program in |
which the beneficiary has an incentive to utilize the services |
|
of a provider that has entered into an agreement or |
arrangement with an insurer. |
"Department" means the Department of Insurance. |
"Director" means the Director of Insurance. |
"Family caregiver" means a relative, partner, friend, or |
neighbor who has a significant relationship with the patient |
and administers or assists the patient with activities of |
daily living, instrumental activities of daily living, or |
other medical or nursing tasks for the quality and welfare of |
that patient. |
"Insurer" means any entity that offers individual or group |
accident and health insurance, including, but not limited to, |
health maintenance organizations, preferred provider |
organizations, exclusive provider organizations, and other |
plan structures requiring network participation, excluding the |
medical assistance program under the Illinois Public Aid Code, |
the State employees group health insurance program, workers |
compensation insurance, and pharmacy benefit managers. |
"Material change" means a significant reduction in the |
number of providers available in a network plan, including, |
but not limited to, a reduction of 10% or more in a specific |
type of providers, the removal of a major health system that |
causes a network to be significantly different from the |
network when the beneficiary purchased the network plan, or |
any change that would cause the network to no longer satisfy |
the requirements of this Act or the Department's rules for |
|
network adequacy and transparency. |
"Network" means the group or groups of preferred providers |
providing services to a network plan. |
"Network plan" means an individual or group policy of |
accident and health insurance that either requires a covered |
person to use or creates incentives, including financial |
incentives, for a covered person to use providers managed, |
owned, under contract with, or employed by the insurer. |
"Ongoing course of treatment" means (1) treatment for a |
life-threatening condition, which is a disease or condition |
for which likelihood of death is probable unless the course of |
the disease or condition is interrupted; (2) treatment for a |
serious acute condition, defined as a disease or condition |
requiring complex ongoing care that the covered person is |
currently receiving, such as chemotherapy, radiation therapy, |
or post-operative visits; (3) a course of treatment for a |
health condition that a treating provider attests that |
discontinuing care by that provider would worsen the condition |
or interfere with anticipated outcomes; or (4) the third |
trimester of pregnancy through the post-partum period. |
"Preferred provider" means any provider who has entered, |
either directly or indirectly, into an agreement with an |
employer or risk-bearing entity relating to health care |
services that may be rendered to beneficiaries under a network |
plan. |
"Providers" means physicians licensed to practice medicine |
|
in all its branches, other health care professionals, |
hospitals, or other health care institutions that provide |
health care services. |
"Telehealth" has the meaning given to that term in Section |
356z.22 of the Illinois Insurance Code. |
"Telemedicine" has the meaning given to that term in |
Section 49.5 of the Medical Practice Act of 1987. |
"Tiered network" means a network that identifies and |
groups some or all types of provider and facilities into |
specific groups to which different provider reimbursement, |
covered person cost-sharing or provider access requirements, |
or any combination thereof, apply for the same services. |
"Woman's principal health care provider" means a physician |
licensed to practice medicine in all of its branches |
specializing in obstetrics, gynecology, or family practice. |
(Source: P.A. 102-92, eff. 7-9-21; 102-813, eff. 5-13-22.) |
(215 ILCS 124/10) |
Sec. 10. Network adequacy. |
(a) An insurer providing a network plan shall file a |
description of all of the following with the Director: |
(1) The written policies and procedures for adding |
providers to meet patient needs based on increases in the |
number of beneficiaries, changes in the |
patient-to-provider ratio, changes in medical and health |
care capabilities, and increased demand for services. |
|
(2) The written policies and procedures for making |
referrals within and outside the network. |
(3) The written policies and procedures on how the |
network plan will provide 24-hour, 7-day per week access |
to network-affiliated primary care, emergency services, |
and obstetrical and gynecological health care |
professionals women's principal health care providers . |
An insurer shall not prohibit a preferred provider from |
discussing any specific or all treatment options with |
beneficiaries irrespective of the insurer's position on those |
treatment options or from advocating on behalf of |
beneficiaries within the utilization review, grievance, or |
appeals processes established by the insurer in accordance |
with any rights or remedies available under applicable State |
or federal law. |
(b) Insurers must file for review a description of the |
services to be offered through a network plan. The description |
shall include all of the following: |
(1) A geographic map of the area proposed to be served |
by the plan by county service area and zip code, including |
marked locations for preferred providers. |
(2) As deemed necessary by the Department, the names, |
addresses, phone numbers, and specialties of the providers |
who have entered into preferred provider agreements under |
the network plan. |
(3) The number of beneficiaries anticipated to be |
|
covered by the network plan. |
(4) An Internet website and toll-free telephone number |
for beneficiaries and prospective beneficiaries to access |
current and accurate lists of preferred providers, |
additional information about the plan, as well as any |
other information required by Department rule. |
(5) A description of how health care services to be |
rendered under the network plan are reasonably accessible |
and available to beneficiaries. The description shall |
address all of the following: |
(A) the type of health care services to be |
provided by the network plan; |
(B) the ratio of physicians and other providers to |
beneficiaries, by specialty and including primary care |
physicians and facility-based physicians when |
applicable under the contract, necessary to meet the |
health care needs and service demands of the currently |
enrolled population; |
(C) the travel and distance standards for plan |
beneficiaries in county service areas; and |
(D) a description of how the use of telemedicine, |
telehealth, or mobile care services may be used to |
partially meet the network adequacy standards, if |
applicable. |
(6) A provision ensuring that whenever a beneficiary |
has made a good faith effort, as evidenced by accessing |
|
the provider directory, calling the network plan, and |
calling the provider, to utilize preferred providers for a |
covered service and it is determined the insurer does not |
have the appropriate preferred providers due to |
insufficient number, type, unreasonable travel distance or |
delay, or preferred providers refusing to provide a |
covered service because it is contrary to the conscience |
of the preferred providers, as protected by the Health |
Care Right of Conscience Act, the insurer shall ensure, |
directly or indirectly, by terms contained in the payer |
contract, that the beneficiary will be provided the |
covered service at no greater cost to the beneficiary than |
if the service had been provided by a preferred provider. |
This paragraph (6) does not apply to: (A) a beneficiary |
who willfully chooses to access a non-preferred provider |
for health care services available through the panel of |
preferred providers, or (B) a beneficiary enrolled in a |
health maintenance organization. In these circumstances, |
the contractual requirements for non-preferred provider |
reimbursements shall apply unless Section 356z.3a of the |
Illinois Insurance Code requires otherwise. In no event |
shall a beneficiary who receives care at a participating |
health care facility be required to search for |
participating providers under the circumstances described |
in subsection (b) or (b-5) of Section 356z.3a of the |
Illinois Insurance Code except under the circumstances |
|
described in paragraph (2) of subsection (b-5). |
(7) A provision that the beneficiary shall receive |
emergency care coverage such that payment for this |
coverage is not dependent upon whether the emergency |
services are performed by a preferred or non-preferred |
provider and the coverage shall be at the same benefit |
level as if the service or treatment had been rendered by a |
preferred provider. For purposes of this paragraph (7), |
"the same benefit level" means that the beneficiary is |
provided the covered service at no greater cost to the |
beneficiary than if the service had been provided by a |
preferred provider. This provision shall be consistent |
with Section 356z.3a of the Illinois Insurance Code. |
(8) A limitation that, if the plan provides that the |
beneficiary will incur a penalty for failing to |
pre-certify inpatient hospital treatment, the penalty may |
not exceed $1,000 per occurrence in addition to the plan |
cost-sharing cost sharing provisions. |
(c) The network plan shall demonstrate to the Director a |
minimum ratio of providers to plan beneficiaries as required |
by the Department. |
(1) The ratio of physicians or other providers to plan |
beneficiaries shall be established annually by the |
Department in consultation with the Department of Public |
Health based upon the guidance from the federal Centers |
for Medicare and Medicaid Services. The Department shall |
|
(W) Pulmonary; |
(X) Rheumatology; |
(Y) Anesthesiology; |
(Z) Pain Medicine; |
(AA) Pediatric Specialty Services; |
(BB) Outpatient Dialysis; and |
(CC) HIV. |
(2) The Director shall establish a process for the |
review of the adequacy of these standards, along with an |
assessment of additional specialties to be included in the |
list under this subsection (c). |
(d) The network plan shall demonstrate to the Director |
maximum travel and distance standards for plan beneficiaries, |
which shall be established annually by the Department in |
consultation with the Department of Public Health based upon |
the guidance from the federal Centers for Medicare and |
Medicaid Services. These standards shall consist of the |
maximum minutes or miles to be traveled by a plan beneficiary |
for each county type, such as large counties, metro counties, |
or rural counties as defined by Department rule. |
The maximum travel time and distance standards must |
include standards for each physician and other provider |
category listed for which ratios have been established. |
The Director shall establish a process for the review of |
the adequacy of these standards along with an assessment of |
additional specialties to be included in the list under this |
|
subsection (d). |
(d-5)(1) Every insurer shall ensure that beneficiaries |
have timely and proximate access to treatment for mental, |
emotional, nervous, or substance use disorders or conditions |
in accordance with the provisions of paragraph (4) of |
subsection (a) of Section 370c of the Illinois Insurance Code. |
Insurers shall use a comparable process, strategy, evidentiary |
standard, and other factors in the development and application |
of the network adequacy standards for timely and proximate |
access to treatment for mental, emotional, nervous, or |
substance use disorders or conditions and those for the access |
to treatment for medical and surgical conditions. As such, the |
network adequacy standards for timely and proximate access |
shall equally be applied to treatment facilities and providers |
for mental, emotional, nervous, or substance use disorders or |
conditions and specialists providing medical or surgical |
benefits pursuant to the parity requirements of Section 370c.1 |
of the Illinois Insurance Code and the federal Paul Wellstone |
and Pete Domenici Mental Health Parity and Addiction Equity |
Act of 2008. Notwithstanding the foregoing, the network |
adequacy standards for timely and proximate access to |
treatment for mental, emotional, nervous, or substance use |
disorders or conditions shall, at a minimum, satisfy the |
following requirements: |
(A) For beneficiaries residing in the metropolitan |
counties of Cook, DuPage, Kane, Lake, McHenry, and Will, |
|
network adequacy standards for timely and proximate access |
to treatment for mental, emotional, nervous, or substance |
use disorders or conditions means a beneficiary shall not |
have to travel longer than 30 minutes or 30 miles from the |
beneficiary's residence to receive outpatient treatment |
for mental, emotional, nervous, or substance use disorders |
or conditions. Beneficiaries shall not be required to wait |
longer than 10 business days between requesting an initial |
appointment and being seen by the facility or provider of |
mental, emotional, nervous, or substance use disorders or |
conditions for outpatient treatment or to wait longer than |
20 business days between requesting a repeat or follow-up |
appointment and being seen by the facility or provider of |
mental, emotional, nervous, or substance use disorders or |
conditions for outpatient treatment; however, subject to |
the protections of paragraph (3) of this subsection, a |
network plan shall not be held responsible if the |
beneficiary or provider voluntarily chooses to schedule an |
appointment outside of these required time frames. |
(B) For beneficiaries residing in Illinois counties |
other than those counties listed in subparagraph (A) of |
this paragraph, network adequacy standards for timely and |
proximate access to treatment for mental, emotional, |
nervous, or substance use disorders or conditions means a |
beneficiary shall not have to travel longer than 60 |
minutes or 60 miles from the beneficiary's residence to |
|
receive outpatient treatment for mental, emotional, |
nervous, or substance use disorders or conditions. |
Beneficiaries shall not be required to wait longer than 10 |
business days between requesting an initial appointment |
and being seen by the facility or provider of mental, |
emotional, nervous, or substance use disorders or |
conditions for outpatient treatment or to wait longer than |
20 business days between requesting a repeat or follow-up |
appointment and being seen by the facility or provider of |
mental, emotional, nervous, or substance use disorders or |
conditions for outpatient treatment; however, subject to |
the protections of paragraph (3) of this subsection, a |
network plan shall not be held responsible if the |
beneficiary or provider voluntarily chooses to schedule an |
appointment outside of these required time frames. |
(2) For beneficiaries residing in all Illinois counties, |
network adequacy standards for timely and proximate access to |
treatment for mental, emotional, nervous, or substance use |
disorders or conditions means a beneficiary shall not have to |
travel longer than 60 minutes or 60 miles from the |
beneficiary's residence to receive inpatient or residential |
treatment for mental, emotional, nervous, or substance use |
disorders or conditions. |
(3) If there is no in-network facility or provider |
available for a beneficiary to receive timely and proximate |
access to treatment for mental, emotional, nervous, or |
|
substance use disorders or conditions in accordance with the |
network adequacy standards outlined in this subsection, the |
insurer shall provide necessary exceptions to its network to |
ensure admission and treatment with a provider or at a |
treatment facility in accordance with the network adequacy |
standards in this subsection. |
(e) Except for network plans solely offered as a group |
health plan, these ratio and time and distance standards apply |
to the lowest cost-sharing tier of any tiered network. |
(f) The network plan may consider use of other health care |
service delivery options, such as telemedicine or telehealth, |
mobile clinics, and centers of excellence, or other ways of |
delivering care to partially meet the requirements set under |
this Section. |
(g) Except for the requirements set forth in subsection |
(d-5), insurers who are not able to comply with the provider |
ratios and time and distance standards established by the |
Department may request an exception to these requirements from |
the Department. The Department may grant an exception in the |
following circumstances: |
(1) if no providers or facilities meet the specific |
time and distance standard in a specific service area and |
the insurer (i) discloses information on the distance and |
travel time points that beneficiaries would have to travel |
beyond the required criterion to reach the next closest |
contracted provider outside of the service area and (ii) |
|
provides contact information, including names, addresses, |
and phone numbers for the next closest contracted provider |
or facility; |
(2) if patterns of care in the service area do not |
support the need for the requested number of provider or |
facility type and the insurer provides data on local |
patterns of care, such as claims data, referral patterns, |
or local provider interviews, indicating where the |
beneficiaries currently seek this type of care or where |
the physicians currently refer beneficiaries, or both; or |
(3) other circumstances deemed appropriate by the |
Department consistent with the requirements of this Act. |
(h) Insurers are required to report to the Director any |
material change to an approved network plan within 15 days |
after the change occurs and any change that would result in |
failure to meet the requirements of this Act. Upon notice from |
the insurer, the Director shall reevaluate the network plan's |
compliance with the network adequacy and transparency |
standards of this Act. |
(Source: P.A. 102-144, eff. 1-1-22; 102-901, eff. 7-1-22; |
102-1117, eff. 1-13-23.) |
Section 35. The Health Maintenance Organization Act is |
amended by changing Sections 4.5-1, 5-3, and 5-3.1 as follows: |
(215 ILCS 125/4.5-1) |
|
Sec. 4.5-1. Point-of-service health service contracts. |
(a) A health maintenance organization that offers a |
point-of-service contract: |
(1) must include as in-plan covered services all |
services required by law to be provided by a health |
maintenance organization; |
(2) must provide incentives, which shall include |
financial incentives, for enrollees to use in-plan covered |
services; |
(3) may not offer services out-of-plan without |
providing those services on an in-plan basis; |
(4) may include annual out-of-pocket limits and |
lifetime maximum benefits allowances for out-of-plan |
services that are separate from any limits or allowances |
applied to in-plan services; |
(5) may not consider emergency services, authorized |
referral services, or non-routine services obtained out of |
the service area to be point-of-service services; |
(6) may treat as out-of-plan services those services |
that an enrollee obtains from a participating provider, |
but for which the proper authorization was not given by |
the health maintenance organization; and |
(7) after January 1, 2003 (the effective date of |
Public Act 92-579), must include the following disclosure |
on its point-of-service contracts and evidences of |
coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN |
|
NON-PARTICIPATING PROVIDERS ARE USED. YOU CAN EXPECT TO |
PAY MORE THAN THE COST-SHARING AMOUNT DEFINED IN THE |
POLICY IN NON-EMERGENCY SITUATIONS. Except in limited |
situations governed by the federal No Surprises Act or |
Section 356z.3a of the Illinois Insurance Code (215 ILCS |
5/356z.3a), non-participating providers furnishing |
non-emergency services may bill members for any amount up |
to the billed charge after the plan has paid its portion of |
the bill. If you elect to use a non-participating |
provider, plan benefit payments will be determined |
according to your policy's fee schedule, usual and |
customary charge (which is determined by comparing charges |
for similar services adjusted to the geographical area |
where the services are performed), or other method as |
defined by the policy. Participating providers have agreed |
to ONLY bill members the cost-sharing amounts. You should |
be aware that when you elect to utilize the services of a |
non-participating provider for a covered service in |
non-emergency situations, benefit payments to such |
non-participating provider are not based upon the amount |
billed. The basis of your benefit payment will be |
determined according to your policy's fee schedule, usual |
and customary charge (which is determined by comparing |
charges for similar services adjusted to the geographical |
area where the services are performed), or other method as |
defined by the policy. YOU CAN EXPECT TO PAY MORE THAN THE |
|
COINSURANCE AMOUNT DEFINED IN THE POLICY AFTER THE PLAN |
HAS PAID ITS REQUIRED PORTION. Non-participating providers |
may bill members for any amount up to the billed charge |
after the plan has paid its portion of the bill, except as |
provided in Section 356z.3a of the Illinois Insurance Code |
for covered services received at a participating health |
care facility from a non-participating provider that are: |
(a) ancillary services, (b) items or services furnished as |
a result of unforeseen, urgent medical needs that arise at |
the time the item or service is furnished, or (c) items or |
services received when the facility or the |
non-participating provider fails to satisfy the notice and |
consent criteria specified under Section 356z.3a. |
Participating providers have agreed to accept discounted |
payments for services with no additional billing to the |
member other than co-insurance and deductible amounts. You |
may obtain further information about the participating |
status of professional providers and information on |
out-of-pocket expenses by calling the toll-free toll free |
telephone number on your identification card.". |
(b) A health maintenance organization offering a |
point-of-service contract is subject to all of the following |
limitations: |
(1) The health maintenance organization may not expend |
in any calendar quarter more than 20% of its total |
expenditures for all its members for out-of-plan covered |
|
services. |
(2) If the amount specified in item (1) of this |
subsection is exceeded by 2% in a quarter, the health |
maintenance organization must effect compliance with item |
(1) of this subsection by the end of the following |
quarter. |
(3) If compliance with the amount specified in item |
(1) of this subsection is not demonstrated in the health |
maintenance organization's next quarterly report, the |
health maintenance organization may not offer the |
point-of-service contract to new groups or include the |
point-of-service option in the renewal of an existing |
group until compliance with the amount specified in item |
(1) of this subsection is demonstrated or until otherwise |
allowed by the Director. |
(4) A health maintenance organization failing, without |
just cause, to comply with the provisions of this |
subsection shall be required, after notice and hearing, to |
pay a penalty of $250 for each day out of compliance, to be |
recovered by the Director. Any penalty recovered shall be |
paid into the General Revenue Fund. The Director may |
reduce the penalty if the health maintenance organization |
demonstrates to the Director that the imposition of the |
penalty would constitute a financial hardship to the |
health maintenance organization. |
(c) A health maintenance organization that offers a |
|
point-of-service product must do all of the following: |
(1) File a quarterly financial statement detailing |
compliance with the requirements of subsection (b). |
(2) Track out-of-plan, point-of-service utilization |
separately from in-plan or non-point-of-service, |
out-of-plan emergency care, referral care, and urgent care |
out of the service area utilization. |
(3) Record out-of-plan utilization in a manner that |
will permit such utilization and cost reporting as the |
Director may, by rule, require. |
(4) Demonstrate to the Director's satisfaction that |
the health maintenance organization has the fiscal, |
administrative, and marketing capacity to control its |
point-of-service enrollment, utilization, and costs so as |
not to jeopardize the financial security of the health |
maintenance organization. |
(5) Maintain, in addition to any other deposit |
required under this Act, the deposit required by Section |
2-6. |
(6) Maintain cash and cash equivalents of sufficient |
amount to fully liquidate 10 days' average claim payments, |
subject to review by the Director. |
(7) Maintain and file with the Director, reinsurance |
coverage protecting against catastrophic losses on |
out-of-network point-of-service services. Deductibles may |
not exceed $100,000 per covered life per year, and the |
|
portion of risk retained by the health maintenance |
organization once deductibles have been satisfied may not |
exceed 20%. Reinsurance must be placed with licensed |
authorized reinsurers qualified to do business in this |
State. |
(d) A health maintenance organization may not issue a |
point-of-service contract until it has filed and had approved |
by the Director a plan to comply with the provisions of this |
Section. The compliance plan must, at a minimum, include |
provisions demonstrating that the health maintenance |
organization will do all of the following: |
(1) Design the benefit levels and conditions of |
coverage for in-plan covered services and out-of-plan |
covered services as required by this Article. |
(2) Provide or arrange for the provision of adequate |
systems to: |
(A) process and pay claims for all out-of-plan |
covered services; |
(B) meet the requirements for point-of-service |
contracts set forth in this Section and any additional |
requirements that may be set forth by the Director; |
and |
(C) generate accurate data and financial and |
regulatory reports on a timely basis so that the |
Department of Insurance can evaluate the health |
maintenance organization's experience with the |
|
point-of-service contract and monitor compliance with |
point-of-service contract provisions. |
(3) Comply with the requirements of subsections (b) |
and (c). |
(Source: P.A. 102-901, eff. 1-1-23; 103-154, eff. 6-30-23.) |
(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) |
Sec. 5-3. Insurance Code provisions. |
(a) Health Maintenance Organizations shall be subject to |
the provisions of Sections 133, 134, 136, 137, 139, 140, |
141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, |
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49, |
355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v, |
356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, |
356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, |
356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, |
356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, |
356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35, |
356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44, |
356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, |
356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, |
356z.60, 356z.61, 356z.62, 356z.63, 356z.64, 356z.65, 356z.66, |
356z.67, 356z.68, 356z.69, 356z.70, 364, 364.01, 364.3, 367.2, |
367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, |
401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and |
444.1, paragraph (c) of subsection (2) of Section 367, and |
|
Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, |
XXVI, and XXXIIB of the Illinois Insurance Code. |
(b) For purposes of the Illinois Insurance Code, except |
for Sections 444 and 444.1 and Articles XIII and XIII 1/2, |
Health Maintenance Organizations in the following categories |
are deemed to be "domestic companies": |
(1) a corporation authorized under the Dental Service |
Plan Act or the Voluntary Health Services Plans Act; |
(2) a corporation organized under the laws of this |
State; or |
(3) a corporation organized under the laws of another |
state, 30% or more of the enrollees of which are residents |
of this State, except a corporation subject to |
substantially the same requirements in its state of |
organization as is a "domestic company" under Article VIII |
1/2 of the Illinois Insurance Code. |
(c) In considering the merger, consolidation, or other |
acquisition of control of a Health Maintenance Organization |
pursuant to Article VIII 1/2 of the Illinois Insurance Code, |
(1) the Director shall give primary consideration to |
the continuation of benefits to enrollees and the |
financial conditions of the acquired Health Maintenance |
Organization after the merger, consolidation, or other |
acquisition of control takes effect; |
(2)(i) the criteria specified in subsection (1)(b) of |
Section 131.8 of the Illinois Insurance Code shall not |
|
apply and (ii) the Director, in making his determination |
with respect to the merger, consolidation, or other |
acquisition of control, need not take into account the |
effect on competition of the merger, consolidation, or |
other acquisition of control; |
(3) the Director shall have the power to require the |
following information: |
(A) certification by an independent actuary of the |
adequacy of the reserves of the Health Maintenance |
Organization sought to be acquired; |
(B) pro forma financial statements reflecting the |
combined balance sheets of the acquiring company and |
the Health Maintenance Organization sought to be |
acquired as of the end of the preceding year and as of |
a date 90 days prior to the acquisition, as well as pro |
forma financial statements reflecting projected |
combined operation for a period of 2 years; |
(C) a pro forma business plan detailing an |
acquiring party's plans with respect to the operation |
of the Health Maintenance Organization sought to be |
acquired for a period of not less than 3 years; and |
(D) such other information as the Director shall |
require. |
(d) The provisions of Article VIII 1/2 of the Illinois |
Insurance Code and this Section 5-3 shall apply to the sale by |
any health maintenance organization of greater than 10% of its |
|
enrollee population (including , without limitation , the health |
maintenance organization's right, title, and interest in and |
to its health care certificates). |
(e) In considering any management contract or service |
agreement subject to Section 141.1 of the Illinois Insurance |
Code, the Director (i) shall, in addition to the criteria |
specified in Section 141.2 of the Illinois Insurance Code, |
take into account the effect of the management contract or |
service agreement on the continuation of benefits to enrollees |
and the financial condition of the health maintenance |
organization to be managed or serviced, and (ii) need not take |
into account the effect of the management contract or service |
agreement on competition. |
(f) Except for small employer groups as defined in the |
Small Employer Rating, Renewability and Portability Health |
Insurance Act and except for medicare supplement policies as |
defined in Section 363 of the Illinois Insurance Code, a |
Health Maintenance Organization may by contract agree with a |
group or other enrollment unit to effect refunds or charge |
additional premiums under the following terms and conditions: |
(i) the amount of, and other terms and conditions with |
respect to, the refund or additional premium are set forth |
in the group or enrollment unit contract agreed in advance |
of the period for which a refund is to be paid or |
additional premium is to be charged (which period shall |
not be less than one year); and |
|
(ii) the amount of the refund or additional premium |
shall not exceed 20% of the Health Maintenance |
Organization's profitable or unprofitable experience with |
respect to the group or other enrollment unit for the |
period (and, for purposes of a refund or additional |
premium, the profitable or unprofitable experience shall |
be calculated taking into account a pro rata share of the |
Health Maintenance Organization's administrative and |
marketing expenses, but shall not include any refund to be |
made or additional premium to be paid pursuant to this |
subsection (f)). The Health Maintenance Organization and |
the group or enrollment unit may agree that the profitable |
or unprofitable experience may be calculated taking into |
account the refund period and the immediately preceding 2 |
plan years. |
The Health Maintenance Organization shall include a |
statement in the evidence of coverage issued to each enrollee |
describing the possibility of a refund or additional premium, |
and upon request of any group or enrollment unit, provide to |
the group or enrollment unit a description of the method used |
to calculate (1) the Health Maintenance Organization's |
profitable experience with respect to the group or enrollment |
unit and the resulting refund to the group or enrollment unit |
or (2) the Health Maintenance Organization's unprofitable |
experience with respect to the group or enrollment unit and |
the resulting additional premium to be paid by the group or |
|
enrollment unit. |
In no event shall the Illinois Health Maintenance |
Organization Guaranty Association be liable to pay any |
contractual obligation of an insolvent organization to pay any |
refund authorized under this Section. |
(g) Rulemaking authority to implement Public Act 95-1045, |
if any, is conditioned on the rules being adopted in |
accordance with all provisions of the Illinois Administrative |
Procedure Act and all rules and procedures of the Joint |
Committee on Administrative Rules; any purported rule not so |
adopted, for whatever reason, is unauthorized. |
(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; |
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. |
1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, |
eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; |
102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. |
1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, |
eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; |
103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff. |
6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, |
eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.) |
(215 ILCS 125/5-3.1) |
Sec. 5-3.1. Access to obstetrical and gynecological care |
Woman's health care provider . Health maintenance organizations |
are subject to the provisions of Section 356r of the Illinois |
|
Insurance Code. |
(Source: P.A. 89-514, eff. 7-17-96.) |
Section 40. The Limited Health Service Organization Act is |
amended by changing Sections 4002.1 and 4003 as follows: |
(215 ILCS 130/4002.1) |
Sec. 4002.1. Access to obstetrical and gynecological care |
Woman's health care provider . Limited health service |
organizations are subject to the provisions of Section 356r of |
the Illinois Insurance Code. |
(Source: P.A. 89-514, eff. 7-17-96.) |
(215 ILCS 130/4003) (from Ch. 73, par. 1504-3) |
Sec. 4003. Illinois Insurance Code provisions. Limited |
health service organizations shall be subject to the |
provisions of Sections 133, 134, 136, 137, 139, 140, 141.1, |
141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, |
154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2, |
355.3, 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, |
356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, |
356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, |
356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 364.3, |
368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, |
and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII |
1/2, XXV, and XXVI of the Illinois Insurance Code. Nothing in |
|
this Section shall require a limited health care plan to cover |
any service that is not a limited health service. For purposes |
of the Illinois Insurance Code, except for Sections 444 and |
444.1 and Articles XIII and XIII 1/2, limited health service |
organizations in the following categories are deemed to be |
domestic companies: |
(1) a corporation under the laws of this State; or |
(2) a corporation organized under the laws of another |
state, 30% or more of the enrollees of which are residents |
of this State, except a corporation subject to |
substantially the same requirements in its state of |
organization as is a domestic company under Article VIII |
1/2 of the Illinois Insurance Code. |
(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; |
102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff. |
1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816, |
eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; |
102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. |
1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, |
eff. 1-1-24; revised 8-29-23.) |
Section 43. The Voluntary Health Services Plans Act is |
amended by changing Section 10 as follows: |
(215 ILCS 165/10) (from Ch. 32, par. 604) |
Sec. 10. Application of Insurance Code provisions. Health |
|
services plan corporations and all persons interested therein |
or dealing therewith shall be subject to the provisions of |
Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140, |
143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, |
356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w, |
356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, |
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, |
356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, |
356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, |
356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, |
356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, |
356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401, 401.1, 402, |
403, 403A, 408, 408.2, and 412, and paragraphs (7) and (15) of |
Section 367 of the Illinois Insurance Code. |
Rulemaking authority to implement Public Act 95-1045, if |
any, is conditioned on the rules being adopted in accordance |
with all provisions of the Illinois Administrative Procedure |
Act and all rules and procedures of the Joint Committee on |
Administrative Rules; any purported rule not so adopted, for |
whatever reason, is unauthorized. |
(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; |
102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. |
10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, |
eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; |
102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. |
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, |
|
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; |
103-551, eff. 8-11-23; revised 8-29-23.) |
Section 45. The Illinois Public Aid Code is amended by |
changing Section 5-16.9 as follows: |
(305 ILCS 5/5-16.9) |
Sec. 5-16.9. Access to obstetrical and gynecological care |
Woman's health care provider . The medical assistance program |
is subject to the provisions of Section 356r of the Illinois |
Insurance Code. The Illinois Department shall adopt rules to |
implement the requirements of Section 356r of the Illinois |
Insurance Code in the medical assistance program including |
managed care components. |
On and after July 1, 2012, the Department shall reduce any |
rate of reimbursement for services or other payments or alter |
any methodologies authorized by this Code to reduce any rate |
of reimbursement for services or other payments in accordance |
with Section 5-5e. |
(Source: P.A. 97-689, eff. 6-14-12.) |
Section 95. No acceleration or delay. Where this Act makes |
changes in a statute that is represented in this Act by text |
that is not yet or no longer in effect (for example, a Section |
represented by multiple versions), the use of that text does |
not accelerate or delay the taking effect of (i) the changes |