Illinois Administrative Code

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

Section 2002.ILLUSTRATION I Guideline to Section 2002.70(a)(1) This Section prohibits words, phrases or illustrations which create deception to the reader by omission or commission. The following examples are illustrations of the prohibitions created by the Section: a) An adverti…

Section 2003.10 Authority This Part is issued by the Director of Insurance pursuant to Section 401 of the Illinois Insurance Code, and it implements Sections 143, 149 and 357.5 of the Illinois Insurance Code by establishing requirements for the use of the terms "noncancellable", …

Section 2003.20 Applicability This Part shall apply to all companies transacting in this State the kinds of business enumerated in Section 4, Class 1(b) and Class 2(a) of the Illinois Insurance Code [215 ILCS 5/4] and to all other "persons" as defined in Section 422 of the Illino…

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 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…