Illinois Administrative Code

Section 2008.70 Minimum Benefit Standards for Pre-Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery Prior to February 11, 1992 The following standards are applicable to all Medicare supplement policies or certificates delivered or issued f…

Section 2008.71 Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery after February 11, 1992 and Prior to June 1, 2010 The following standards are applicable to all Medicare supplement policies or certificates deliv…

Section 2008.72 Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or after February 11, 1992 and Prior to June 1, 2010 a) An issuer shall make available to each prospective policyholde…

Section 2008.73 Medicare Select Policies and Certificates a) This Section shall apply to Medicare Select policies and certificates, as defined in this Section. No policy or certificate may be advertised as a Medicare Select policy or certificate unless it meets the requirements o…

Section 2008.74 Open Enrollment a) Notwithstanding any Medicare Part B late enrollment penalty, no issuer shall deny or condition the issuance or effectiveness of any Medicare supplement policy or certificate available for sale in this State, nor discriminate in the pricing of su…

Section 2008.75 Guaranteed Issue for Eligible Persons All Medicare supplement insurance policies shall be guaranteed issue to eligible persons who meet the requirements of this Section (see 42 U.S.C. 1395ss(s)). a) Guaranteed Issue 1) Eligible persons are those individuals descri…

Section 2008.76 Standards for Claims Payment a) An issuer shall comply with Section 1882(c)(3) of the Social Security Act (as enacted by Section 4081(b)(2)(C) of the Omnibus Budget Reconciliation Act of 1987 (OBRA) (P.L. 100-203)) by: 1) Accepting a notice from a Medicare carrier…

Section 2008.80 Loss Ratio Standards and Refund or Credit of Premium a) Loss Ratio Standards. 1) A Medicare supplement policy form or certificate form shall not be delivered or issued for delivery unless the policy form or certificate form: A) Can be expected, as estimated for th…

Section 2008.81 Filing and Approval of Policies and Certificates and Premium Rates a) An issuer shall not deliver or issue for delivery a policy or certificate to a resident of this State unless the policy form or certificate form has been filed with and approved by the Director …

Section 2008.82 Permitted Compensation Arrangements a) An issuer or other entity may provide commission or other compensation to an insurance producer for the sale of a Medicare supplement policy or certificate only if the first year commission or other first year compensation is…

Section 2008.90 Required Disclosure Provisions a) General Rules 1) Medicare supplement policies and certificates shall include a renewal or continuation provision. The language or specifications of such provision must be consistent with the type of contract issued. Such provision…

Section 2008.91 Instructions for Use of the Disclosure Statements for Health Insurance Policies Sold to Medicare Beneficiaries that Duplicate Medicare a) Section 1882(d) of the federal Social Security Act prohibits the sale of health insurance policies (the term policy or policie…

Section 2008.APPENDIX V Disclosure Statements Companies shall provide one of the following disclosures as prescribed by the directions contained in paragraph (o). a) Original disclosure statement for policies that provide benefits for expenses incurred for an accidental injury on…

Section 2009.10 Purpose and Applicability a) The purpose of this regulation is to: 1) Permit, but not require, plans to include a coordination of benefits (COB) provision; 2) Establish an order in which plans pay their claims; 3) Provide the authority for the orderly transfer of …

Section 2009.20 Definitions The following words and terms, when used in this Part, shall have the following meanings unless the context clearly indicates otherwise: "Allowable Expense" means the necessary, reasonable, and customary item of expense for health care when the item of…

Section 2009.30 Model COB Contract Provision a) Exhibit A contains a model COB provision for use in contracts. That use is subject to subsections (b) and (c) and Section 2009.40. b) A contract's COB provision does not have to use the words and format shown at Exhibit A. Changes m…

Section 2009.40 Standards for Coordination of Benefits a) General The general order of benefits is as follows: 1) The primary plan must pay or provide its benefits as if the secondary plan or plans do not exist. A plan that does not include a coordination of benefits provision ma…

Section 2009.50 Procedure to be followed by Secondary Plan a) When it is determined, pursuant to Section 2009.40, that this Plan is a Secondary Plan, it may reduce its benefits so that the total benefits paid or provided by all plans during a Claim Determination Period are not mo…

Section 2009.60 Miscellaneous Provisions a) Reasonable Cash Values of Services A secondary plan that provides benefits in the form of services may recover the reasonable cash value of providing the services from the primary plan, to the extent that benefits for the services are c…

Section 2009.EXHIBIT A Model COB Provisions COORDINATION OF THE CONTRACT'S BENEFITS WITH OTHER BENEFITS I. APPLICABILITY A. This Coordination of Benefits ("COB") provision applies to This Plan when an enrollee or the enrollee's covered dependent has health care coverage under mor…

Section 2010.10 Purpose The purpose of this Part is to provide prospective purchasers with clear and unambiguous statements in the advertisement of Medicare supplement insurance; to assure the clear and truthful disclosure of the benefits, limitations and exclusions of policies s…

Section 2010.100 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 2010.110 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. b) An advertisement shall not create the…

Section 2010.120 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 2010.130 Group or Quasi-Group Implications a) 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 suc…

Section 2010.140 Introductory, Initial or Special Offers a) 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 substantia…

Section 2010.150 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 2010.160 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 2010.170 Filing Requirements for Advertising Every insurer shall provide a copy of any Medicare supplement advertisement intended for use in this State whether through written, radio or television medium to the Director of Insurance of this State. Such advertisement shall…

Section 2010.20 Applicability a) This Part shall apply to any "advertisement" of Medicare supplement insurance as that term is defined herein, unless otherwise specified in this Part, which the insurer knows or reasonably should know is intended for presentation, distribution or …

Section 2010.30 Definitions a) Advertisement 1) "Advertisement" shall include: A) printed and published material, audio visual material and descriptive literature used by or on behalf of an insurer in direct mail, newspapers, magazines, radio scripts, television scripts, billboar…

Section 2010.40 Methods 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 …

Section 2010.50 Form and Content of Advertisements a) The format and content of a Medicare supplement insurance advertisement shall avoid deception or the capacity or tendency to mislead or deceive. Whether an advertisement has a capacity or tendency to mislead or deceive shall b…

Section 2010.60 Advertisements of Benefits, 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 information or …

Section 2010.70 Necessity for Disclosing Policy Provisions Relating to Renewability, Cancellability and Termination An advertisement which is an invitation to contract shall disclose the provisions relating to renewability, cancellability and termination and any modification of b…

Section 2010.80 Testimonials or Endorsements by Third Parties a) Testimonials and endorsements 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 testimo…

Section 2010.90 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 such statistical information unless it pertains to the insurer's …

Section 2010.APPENDIX A Interpretive Guidelines

Section 2010.ILLUSTRATION G Guideline to Section 2010.60(a)(1) This Section prohibits the use of incomplete statements and words or phrases which create deception by omission or commission. The following examples are illustrations of the prohibitions created by this Section: a) A…

Section 2012.10 Purpose The purpose of this Part is to implement Article XIXA of the Illinois Insurance Code, to promote the public interest, to promote the availability of long-term care insurance coverage, to protect applicants for long-term care insurance from unfair or decept…

Section 2012.100 Filing Requirement Prior to an insurer offering group long-term care insurance to a resident of this State pursuant to Section 351A-2 of the Code, it shall file with the Director evidence that the group policy or certificate thereunder has been approved by a stat…

Section 2012.110 Loss Ratio a) This Section shall apply to all long-term care insurance policies or certificates, except those covered under Sections 2012.64, 2012.112 and 2012.113. b) Notice of Rate Schedule Increase 1) An insurer shall provide notice of a pending premium rate s…

Section 2012.112 Premium Rate Schedule Increases a) This Section shall apply as follows: 1) Except as provided in subsection (a)(2), this Section applies to any long-term care policy or certificate issued in this State on or after January 1, 2003 and prior to July 1, 2018. 2) For…

Section 2012.113 Premium Rate Schedule Increases for Policies Subject to Loss Ratio Limits Related to Original Filings a) This Section shall apply as follows: 1) Except as provided in subsection (a)(2), this Section applies to any long-term care policy or certificate issued in th…

Section 2012.115 Filing Requirements for Advertising Every insurer, as defined herein, providing long-term care insurance or benefits in this State shall comply with 50 Ill. Adm. Code 2002.180. (Source: Amended at 32 Ill. Reg. 7600, effective May 5, 2008)

Section 2012.120 Reserve Standards a) When long-term care benefits are provided through the acceleration of benefits under group or individual life policies or riders to such policies, policy reserves for such benefits shall be determined in accordance with Section 223 of the Cod…

Section 2012.121 Producer Training Requirements a) Long-Term Care Training Required 1) An individual may not sell, solicit or negotiate long-term care insurance unless the individual is licensed as an insurance producer for accident and health and has completed a one-time trainin…