Illinois Administrative Code

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…

Section 2012.122 Standards for Marketing a) Every insurer, as defined herein, marketing long-term care insurance coverage in this State, directly or through its producers, shall: 1) Establish marketing procedures and producer training requirements to assure that: A) Any marketing…

Section 2012.123 Suitability a) This Section shall not apply to life insurance policies that accelerate benefits for long-term care. b) Every insurer, health care service plan or other entity marketing long-term care insurance (the "issuer") shall: 1) Develop and use suitability …

Section 2012.124 Prohibition Against Preexisting Conditions and Probationary Periods in Replacement Policies or Certificates If a long-term care insurance policy or certificate replaces another long-term care policy or certificate, the replacing insurer shall waive any time perio…

Section 2012.125 Availability of New Services or Providers a) An insurer shall notify policyholders of the availability of a new long-term care policy series that provides coverage for new long-term care services or providers that are material in nature and not previously availab…

Section 2012.126 Right to Reduce Coverage and Lower Premiums a) Coverage Reduction Options 1) Every long-term care insurance policy and certificate shall include a provision that allows the policyholder or certificateholder to reduce coverage and lower the policy or certificate p…

Section 2012.127 Nonforfeiture Benefit Requirement a) This Section does not apply to life insurance policies or riders containing accelerated long-term care benefits. b) To comply with the requirement to offer a nonforfeiture benefit pursuant to Section 2012.86 of this Part: 1) A…

Section 2012.128 Standards for Benefit Triggers a) A long-term care insurance policy shall condition the payment of benefits on a determination of the insured's ability to perform activities of daily living and on cognitive impairment. Eligibility for the payment of benefits shal…

Section 2012.129 Additional Standards for Benefit Triggers for Qualified Long-Term Care a) A qualified long-term care insurance contract shall pay only for qualified long-term care services received by a chronically ill individual provided pursuant to a plan of care prescribed by…

Section 2012.130 Standard Format Outline of Coverage Requirements This Section implements, interprets and makes specific the provisions of Section 351A-8 of the Code in prescribing a standard format and the content of an outline of coverage. a) The outline of coverage shall be a …

Section 2012.140 Requirement to Deliver Shopper's Guide a) A long-term care insurance shopper's guide in the format developed by the National Association of Insurance Commissioners, or a guide developed or approved by the Director shall be provided to all prospective applicants o…

Section 2012.145 Long-Term Care Insurance Partnership Program a) In accordance with section 6021 of the Deficit Reduction Act of 2005 (42 USC 1305) and the Illinois Long-Term Care Partnership Program Act [215 ILCS 132], in addition to the applicable provisions of this Part, the p…

Section 2012.150 Penalties In addition to any other penalties provided by the laws of this State any insurer or any insurance producer found to have violated any requirement of this State relating to the regulation of long-term care insurance or the marketing of such insurance sh…

Section 2012.20 Applicability and Scope a) Except as otherwise specifically provided, this Part applies to all long-term care insurance policies including qualified long-term care insurance contracts and life insurance policies that accelerate benefits for long-term care insuranc…

Section 2012.30 Definitions "Accelerated Long-Term Care Benefit" means a life insurance policy, contract, rider endorsement or amendment that contains benefits providing payment from life or endowment or annuity benefits in advance of the time they would otherwise be payable at a…

Section 2012.40 Policy Definitions a) For policies issued after January 1, 2009, no long-term care insurance policy delivered or issued for delivery in this State shall use the terms set forth below, unless the terms are defined in the policy and the definitions satisfy the follo…

Section 2012.50 Policy Practices and Provisions a) Renewability. The terms "guaranteed renewable" and "noncancellable" shall not be used in any individual long-term care insurance policy or certificate without explanatory language in accordance with the disclosure requirements of…

Section 2012.55 Unintentional Lapse Each insurer offering long-term care insurance shall, as a protection against unintentional lapse, comply with the following: a) Notice before lapse or termination. 1) No individual long-term care policy or certificate shall be issued until the…

Section 2012.60 Required Disclosure Provisions a) Renewability. Individual long-term care insurance policies shall contain a renewability provision. The provision shall be appropriately captioned, shall appear on the first page of the policy, and shall clearly state that the cove…

Section 2012.62 Required Disclosure of Rating Practices to Consumers a) This Section shall apply as follows: 1) Except as provided in subsection (a)(2), this Section applies to any long-term care policy issued in this State on or after January 1, 2003. 2) For certificates issued …

Section 2012.64 Initial Filing Requirements a) This Section applies to any long-term care policy issued in this State on or after January 1, 2003, except that subsections (b)(2)(D) and (b)(3) apply to any long-term care policy issued in this State on or after July 1, 2018. b) An …

Section 2012.65 Prohibition Against Post Claims Underwriting a) All applications for long-term care insurance policies or certificates except those which are guaranteed issue shall contain unambiguous questions designed to ascertain the health condition of the applicant. 1) If an…

Section 2012.70 Minimum Standards for Home Health and Community Care Benefits in Long-Term Care Insurance Policies a) A long-term care insurance policy or certificate may not, if it provides benefits for home health care or community care services, limit or exclude benefits: 1) B…

Section 2012.80 Requirement to Offer Inflation Protection a) No insurer may offer a long-term care insurance policy unless the insurer also offers to the policyholder in addition to any other inflation protection the option to purchase a policy that provides for benefit levels to…