Illinois Administrative Code

Section 2003.25 Definitions Advertisement means any printed or published material, audiovisual material and descriptive literature of the health care plan used in direct mail, newspapers, magazines, radio scripts, television scripts, billboards, websites, electronic mail and simi…

Section 2003.30 Requirements if the Term "Noncancellable" Is Used in a Policy or Advertisement If the terms "noncancellable" or "noncancellable and guaranteed renewable" are used in a policy, or in the advertisement of a policy, the insured has the right to continue in force by t…

Section 2003.40 Requirements if the Term "Guaranteed Renewable" Is Used in a Policy or Advertisement Except as provided in Section 2003.30, the term "guaranteed renewable" may be used only in a policy, or in the advertisement of a policy, that the insured has the right to continu…

Section 2003.50 Synonyms The limitations on use of the term "noncancellable" described in Sections 2003.30 and 2003.40 above shall also apply to any synonymous term such as "not cancellable", and the limitation on use of the term "guaranteed renewable" shall apply to any synonymo…

Section 2003.60 Medicare Exception The requirements in Sections 2003.30 and 2003.40 of this Part are not intended to preclude the issuance of hospital, surgical and medical coverages which may be classified as "noncancellable", "noncancellable and guaranteed renewable" or "guaran…

Section 2003.70 Other Guarantees Nothing contained within this Part is intended to restrict the development of policies having other guarantees of renewability, or to prevent the accurate description of their terms of renewability or the classification of such policies as guarant…

Section 2003.80 Effective Date This Part shall be effective and apply to all individual and family accident and health insurance policies issued or issued for delivery in this State and the advertising of those policies on and after December 28, 1965. (Source: Amended at 25 Ill. …

Section 2004.10 Application, Effective Dates and Incorporations by Reference a) This Part applies 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 of the Code, and it applies to all acciden…

Section 2004.20 Active Life Reserves – Individual Policies a) General Provisions Active life reserves are required for all in force policies and are in addition to any reserves required in connection with claims. For policy types in subsections (b)(1)-(3) of this Section, the min…

Section 2004.30 Active Life Reserves – Group Policies a) This Section applies to accident and health insurance as defined in Section 367 (excluding subsection (4) thereof) and Section 367(a) of the Code [215 ILCS 5/367 and 367(a)]. b) The minimum reserve for active lives on all g…

Section 2004.40 Claim Reserves – Present Value of Amounts Not Yet Due on Claims a) General (Also called "Disabled Life Reserves" in the case of insurance providing loss-of-time benefits for disability due to accident or sickness) Reserves are required for claims on all health ins…

Section 2004.5 Authority This Part is promulgated and adopted pursuant to and in accordance with the provisions of Section 401 of the Illinois Insurance Code in order to implement Section 353(a) of the Code. (Source: Amended at 30 Ill. Reg. 19360, effective November 29, 2006)

Section 2004.50 Policies Issued Prior to Operative Date of Section 353a Any company may elect to establish and maintain reserves for policies issued prior to the operative date of Section 353a of the Code in accordance with the standards prescribed by Section 353a of the Code. In…

Section 2004.7 Definitions Code means the Illinois Insurance Code [215 ILCS 5]. Department means the Department of Insurance. Director means the Director of the Department of Insurance. Insurer means an insurance company that has delivered or issued for delivery in this State an …

Section 2005.10 Authority This Rule is issued by the Director of Insurance pursuant to Section 401 of the Illinois Insurance Code and it implements especially Sections 143, 359a and 154 of the Illinois Insurance Code by establishing minimum standards for the terms "pre-existing i…

Section 2005.20 Applicability a) This Part shall apply to individual and group accident and health insurance policies to the extent that they provide benefits and coverage that fall under an excepted benefits plan and to all other individual and group insurance policies that are …

Section 2005.30 The Minimum Definition of Pre-existing Illness or Pre-existing Condition a) A "pre-existing illness" or "pre-existing condition" as constructed by the definition of sickness and the provisions for Time Limit on Certain Defenses in an accident and health insurance …

Section 2005.40 Application of the Definition a) In applying Section 2005.30 to determine if an insured received consultation, advice or treatment from a physician for a disease, illness, sickness, malady or condition, the consultation, advice or treatment must be clearly indicat…

Section 2005.50 Policy Form Requirements All policies which exclude the payment of a claim due to a "Pre-existing Illness" or "Pre-existing Condition" as constructed by terms used in the definition of illness or insuring clause of a policy such as "manifests", "beings", "commence…

Section 2005.60 Effective Date a) This Part shall be effective October 30, 1974. b) For all policies which were approved by the Director of Insurance before the effective date of this Part shall, for all such policies issued or delivered in this State after the effective date of …

Section 2007.10 Authority This Part is issued by the Director of Insurance pursuant to Section 401 of the Illinois Insurance Code [215 ILCS 5/401] which empowers the Director ". . . to make reasonable rules and regulations as may be necessary for making effective . . ." the insur…

Section 2007.100 Severability If any provision of this Part or the application thereof to any person or circumstances is for any reason held to be invalid, the remainder of the Part and the application of such provision to other persons or circumstances shall not be affected ther…

Section 2007.20 Purpose The purpose of this Part is to define terms, establish minimum standards for benefits, prohibit certain policy provisions and require disclosure provisions and replacement procedures in relation to policies of individual accident and health insurance. (Sou…

Section 2007.30 Applicability a) This Part applies to all individual accident and health insurance policies except that it does not apply to individual policies issued pursuant to a conversion privilege under a policy of group or individual insurance when the individual policy in…

Section 2007.40 Revision of Noncomplying Policy Form and Subscriber Contracts Certificate of Compliance Required a) Any policy as defined in Section 355a of the Illinois Insurance Code [215 ILCS 5/355a] previously filed and approved by the Director need not be refiled if such pol…

Section 2007.50 Definitions Except as provided hereafter, no individual accident or health insurance policy delivered or issued for delivery to any person in this State shall contain definitions respecting the matters set forth in this Part unless the definitions comply with the …

Section 2007.60 Prohibited Policy Provisions a) Except as provided in the Section 2007.50 definition of "sickness", no policy shall contain provisions establishing a probationary or waiting period during which no coverage is provided under the policy. An excepted benefit policy m…

Section 2007.70 Accident and Health Minimum Standards for Benefits a) The following minimum standards for benefits are prescribed for the categories of coverage noted in subsection (b). No individual policy of accident and health insurance shall be delivered or issued for deliver…

Section 2007.80 Required Disclosure Provisions a) General Rules 1) Each individual policy of accident and health insurance shall include a renewal, continuation or nonrenewal provision. The language or specifications of the provision must be consistent with the requirements of 50…

Section 2007.90 Requirements for Replacement a) Application forms shall include a question designed to elicit information as to whether the insurance to be issued is intended to replace any other accident and health insurance presently in force. A supplementary application or oth…

Section 2008.10 Authority This Part is issued by the Director of the Department of Insurance (Director) pursuant to Section 401 of the Illinois Insurance Code [215 ILCS 5/401] which empowers the Director to make reasonable rules and regulations as may be necessary for making effe…

Section 2008.100 Requirements for Application Forms and Replacement Coverage a) Application forms shall include the following questions designed to elicit information as to whether, as of the date of the application, the applicant currently has Medicare supplement, Medicare Advan…

Section 2008.101 Standards for Marketing a) An issuer, directly or through its producers, shall: 1) Establish fair and accurate marketing procedures which comply with the standards set forth in Section 363a(5) and (6) of the Code. 2) Establish marketing procedures to assure dupli…

Section 2008.102 Appropriateness of Recommended Purchase and Excessive Insurance a) In recommending the purchase or replacement of any Medicare supplement policy or certificate, an insurance producer shall make reasonable efforts to determine the appropriateness of a recommended …

Section 2008.103 Reporting of Multiple Policies a) On or before March 1 of each year an issuer shall report the following information prescribed in Appendix P of this Part for every individual resident of this State for which the issuer has in force more than one Medicare supplem…

Section 2008.104 Prohibition Against Preexisting Conditions, Waiting Periods, Elimination Periods and Probationary Periods in Replacement Policies or Certificates a) If a Medicare supplement policy or certificate replaces another Medicare supplement policy or certificate, the rep…

Section 2008.107 Prohibition Against Use of Genetic Information and Requests for Genetic Testing This Section applies to all policies with policy years beginning on or after May 21, 2009. a) An issuer of a Medicare supplement policy or certificate; 1) shall not deny or condition …

Section 2008.110 Severability If any provision of this Part or the application thereof to any person or circumstances is for any reason held to be invalid, the remainder of this Part and the application of such provision to other persons or circumstances shall not be affected the…

Section 2008.120 Effective Date (Repealed) (Source: Repealed at 14 Ill. Reg. 19243, effective November 27, 1990)

Section 2008.20 Purpose The purpose of this Part is to provide for the reasonable standardization of coverage and simplification of terms and benefits of Medicare supplement policies; to facilitate public understanding and comparison of such policies; to eliminate provisions cont…

Section 2008.30 Applicability and Scope a) Except as otherwise specifically provided in Sections 2008.70, 2008.75, 2008.76, 2008.80, 2008.90 and 2008.103 of this Part, this Part shall apply to: 1) All Medicare supplement policies delivered or issued for delivery in this State on …

Section 2008.35 Effective Date (Repealed) (Source: Repealed at 33 Ill. Reg. 8904, effective June 10, 2009)

Section 2008.40 Definitions For the purposes of this Part: "1990 Standardized Medicare Supplement Benefit Plan", "1990 Standardized Benefit Plan" or "1990 Plan" means a group or individual policy of Medicare supplement insurance issued on or after February 11, 1992 and with an ef…

Section 2008.45 Creditable coverage Creditable coverage means: a) With respect to an individual, coverage of the individual provided under any of the following: 1) A group health plan; 2) Health insurance coverage; 3) Part A or Part B of Title XVIII of the Social Security Act (Me…

Section 2008.50 Policy Definitions and Terms No policy or certificate may be advertised, solicited or issued for delivery in this State as a Medicare supplement policy or certificate unless that policy or certificate contains definitions or terms that conform to the requirements …

Section 2008.60 Policy Provisions a) Except for permitted preexisting condition clauses as described in Section 2008.70(a)(1), Section 2008.71(a)(1), and Section 2008.64(a)(1) of this Part, no policy or certificate may be advertised, solicited or issued for delivery in this State…

Section 2008.61 Benefit Conversion Requirements During Transition (Repealed) (Source: Repealed at 16 Ill. Reg. 2766, effective February 11, 1992; corrected at 16 Ill. Reg. 3590)