Illinois Administrative Code

Section 1704.60 Transferral of Accounts to Other Societies Any society may provide that all or any part of the surplus in the accident and health accounts may be transferred to and become a part of any other accounts of the society.

Section 1705.10 Application This Part shall apply to: a) Life Certificates, endorsement, rider and application forms filed with the Department by foreign, alien and domestic societies as required by Section 143 of the Illinois Insurance Code (Ill. Rev. Stat. 1981, ch. 73, par. 75…

Section 1705.20 Construction of Life Certificate Forms a) 1) Fraternal Benefit Societies "Societies" may issue certificates providing for the payment of death benefits as authorized by the Code. 2) Section 288(1) of the Illinois Insurance Code, insofar as it authorizes additional…

Section 1705.30 Construction of Accident and Health Forms a) A separate certificate which provides for the payment of benefits as a result of bodily injury, disablement or death by accident and against disablement resulting from sickness or old age, and every benefit appertaining…

Section 1705.40 Construction of All Forms Issued by Fraternal Benefit Societies a) Certificates issued under Section 288(2) of the Illinois Insurance Code may be issued in connection with or separate from life certificates issued under Section 288(1). Because such certificates mu…

Section 1705.EXHIBIT A Certificate of Compliance STATE OF ) ) SS COUNTY OF ) (Official's name) , being first duly sworn, deposes and says that: 1. He is the (Official title) of the (Name of fraternal benefit society) , a fraternal benefit society formed under the laws of the Stat…

Section 1710.10 Hiring and Discharge of Chief Executive Officer A domestic fraternal benefit society that provides any of the benefits specified in Section 297.1 of the Illinois Insurance Code (Code) [215 ILCS 5/297.1] must be governed by a board of directors and managed by a qua…

Section 2001.1 Applicability a) Unless otherwise provided, this Subpart applies to all individual and group policies and certificates of accident and health insurance, dental service plans, voluntary health services plans, health care plans, and limited health care plans, includi…

Section 2001.10 Summary of Benefits and Coverage and Uniform Glossary a) Summary of Benefits and Coverage in General A group health plan (and its administrator as defined in section 3(16)(A) of ERISA), and a health insurance issuer offering group or individual health insurance co…

Section 2001.11 Essential Health Benefits a) Coverage for Essential Health Benefits Package 1) A health insurance issuer that offers health insurance coverage in the individual or small group market shall ensure that the coverage includes an essential health benefits (EHB) packag…

Section 2001.110 Applicability This Subpart shall apply to: a) Individual accident and health policy, certificate, endorsement, rider and application forms filed with the Department by both foreign and domestic companies with respect to Section 143, Article IX and Article XX of t…

Section 2001.12 Cost-Sharing a) Cost-Sharing Under Group Health Plans A group health plan shall ensure that any annual cost-sharing imposed under the plan does not exceed the limitations provided for under subsections (a)(1) and (2). (See 42 USC 300gg-6(b).) Requirements relating…

Section 2001.120 Construction of Accident and Health Insurance Policy Forms a) Section 356a − Form of Policy Each policy form of a domestic company that is issued for delivery to a person residing in another state must be approved by the Director unless that policy form is subjec…

Section 2001.13 Corporate Name Requirements The name of the actual health insurance issuer shall be stated on all of its forms. Policy forms or other items incorporated by reference shall not use a trade name, any insurance group designation, name of the parent company of the iss…

Section 2001.130 Filing of Policy Forms a) Policy forms, riders and endorsements must be formally filed pursuant to 50 Ill. Adm. Code 916 as follows: 1) Two copies of all forms shall be submitted in blank. If the form does not clearly indicate the place for the name of the insure…

Section 2001.2 Definitions and Cross-References a) The following definitions apply to this Part: "ACA" means the Patient Protection and Affordable Care Act (42 U.S.C. 18001 et seq.). "Accident and Health Insurance" means insurance transacted under Class 1(b) or 2(a) of Section 4 …

Section 2001.20 Construction of Accident and Health Insurance Policy Forms (Renumbered) (Source: Section 2001.20 renumbered to Section 2001.120 at 38 Ill. Reg. 2037, effective January 2, 2014)

Section 2001.210 Applicability This Subpart is applicable to all group accident and health policies except to the extent that they provide excepted benefits. (Source: Added at 38 Ill. Reg. 2037, effective January 2, 2014)

Section 2001.220 Ban on Excessive Waiting Periods A group health plan, and a health insurance issuer offering group health insurance coverage, must not apply any waiting period that exceeds 90 days (42 USC 300gg-7). (Source: Added at 38 Ill. Reg. 2037, effective January 2, 2014)

Section 2001.3 Discretionary Clauses Prohibited No policy, contract, certificate, endorsement, rider application or agreement offered or issued in this State, by a health carrier, to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services or o…

Section 2001.30 Filing of Policy Forms (Renumbered) (Source: Section 2001.30 renumbered to Section 2001.l30 at 38 Ill. Reg. 2037, effective January 2, 2014)

Section 2001.4 Guaranteed Availability and Renewability of Coverage a) Guaranteed Availability of Coverage in the Individual and Group Market Subject to subsections (b) through (d), a health insurance issuer that offers health insurance coverage in the individual or group market …

Section 2001.5 Prohibition of Preexisting Condition Exclusions a) No Preexisting Condition Exclusions 1) In General A group health plan, or a health insurance issuer offering group or individual health insurance coverage, may not impose any preexisting condition exclusion (as def…

Section 2001.6 No Lifetime or Annual Limits a) Prohibition 1) Lifetime Limits Except as provided in subsection (b), a group health plan, or a health insurance issuer offering group or individual health insurance coverage, may not establish any lifetime limit on the dollar amount …

Section 2001.7 Prohibition on Rescissions a) Prohibition on Rescissions 1) A group health plan, or a health insurance issuer offering group or individual health insurance coverage, must not rescind coverage under the plan, or under the policy, certificate, or contract of insuranc…

Section 2001.8 Coverage of Preventive Health Services a) A group health plan, or a health insurance issuer offering group or individual health insurance coverage, must cover preventive services without cost-sharing as described in Sections 356z.62 and 356z.77 of the Code. 1) For …

Section 2001.9 Prohibiting Discrimination Against Participants and Beneficiaries Based on Health Status a) Health Factors 1) The term health factor means, in relation to an individual, any of the following health status-related factors: A) Health status; B) Medical condition (inc…

Section 2002.10 Authority This Part is issued by the Director of Insurance pursuant to Section 401 of the Illinois Insurance Code which empowers the Director " . . . to make reasonable rules and regulations as may be necessary for making effective . . ." the insurance laws of thi…

Section 2002.100 Use of Statistics a) An advertisement relating to the dollar amounts of claims paid, the number of persons insured, or similar statistical information relating to any insurer or policy shall not use irrelevant facts, and shall not be used unless it accurately ref…

Section 2002.110 Identification of Plan or Number of Policies a) When a choice of the amount of benefits is referred to, an advertisement which is an invitation to contract shall disclose that the amount of benefits provided depends upon the plan selected and that the premium wil…

Section 2002.120 Disparaging Comparisons and Statements An advertisement shall not directly or indirectly make unfair or incomplete comparisons of policies or benefits or comparisons of non-comparable policies of other insurers, and shall not disparage competitors, their policies…

Section 2002.130 Jurisdictional Licensing and Status of Insurer a) An advertisement which is intended to be seen or heard beyond the limits of the jurisdiction in which the insurer is licensed shall not imply licensing beyond those limits. The Guideline for this paragraph (a) is …

Section 2002.140 Identity of Insurer a) The name of the actual insurer shall be stated in all of its advertisements. The form number or numbers of the policy advertised shall be stated in an advertisement which is an invitation to contract. An advertisement shall not use a trade …

Section 2002.150 Group or Quasi-Group Implications An advertisement of a particular policy shall not state or imply that prospective insureds become group or quasi-group members covered under a group policy and as such enjoy special rates or underwriting privileges, unless such i…

Section 2002.160 Introductory, Initial or Special Offers a) 1) An advertisement of an individual policy shall not directly or by implication represent that a contract or combination of contracts is an introductory, initial or special offer, or that applicants will receive substan…

Section 2002.170 Statements About an Insurer An advertisement shall not contain statements which are untrue in fact, or by implication misleading, with respect to the assets, corporate structure, financial standing, age or relative position of the insurer in the insurance busines…

Section 2002.180 Enforcement Procedures a) Advertising File. Each insurer shall maintain at its home or principal office a complete file containing every printed, published or prepared advertisement of its individual policies and typical printed, published or prepared advertiseme…

Section 2002.190 Severability Provision If any Section or portion of a Section of this Part or the applicability thereof to any person or circumstance is held invalid by a court, the remainder of the Part, or the applicability of such provision to other persons or circumstances, …

Section 2002.20 Purpose The purpose of this Part is to assure truthful and adequate disclosure of all material and relevant information in the advertising of accident and sickness insurance. This purpose is intended to be accomplished by the establishment of, and adherence to, ce…

Section 2002.30 Applicability a) This Part shall apply to any accident and sickness insurance "advertisement" as that term is hereinafter defined in Section 2002.40, unless otherwise specified in this Part, intended for presentation, distribution or dissemination in this State wh…

Section 2002.40 Definitions An "advertisement," for the purpose of this Part, shall include: printed and published material, audio-visual material, and descriptive literature of an insurer used in direct mail, email, internet pages, blogs, social media, newspapers, magazines, rad…

Section 2002.50 Method of Disclosure of Required Information All information required to be disclosed by this Part shall be set out conspicuously and in close conjunction with the statements to which such information relates or under appropriate captions of such prominence that i…

Section 2002.60 Form and Content of Advertisements a) The format and content of an advertisement of an accident or sickness insurance policy shall be sufficiently complete and clear to avoid deception or the capacity or tendency to mislead or deceive. Whether an advertisement has…

Section 2002.70 Advertisements of Benefits Payable, Losses Covered or Premiums Payable a) Deceptive words, phrases or illustrations prohibited. 1) No advertisement shall omit information or use words, phrases, statements, references or illustrations if the omission of such inform…

Section 2002.80 Necessity for Disclosing Policy Provisions Relating to Renewability, Cancellability and Termination When an advertisement, which is an invitation to contract, refers to either a dollar amount or a period of time for which any benefit is payable, or the cost of the…

Section 2002.90 Testimonials or Endorsements by Third Parties a) Testimonials used in advertisements must be genuine, represent the current opinion of the author, be applicable to the policy advertised and be accurately reproduced. The insurer, in using a testimonial, makes as it…

Section 2002.APPENDIX A Guidelines