Illinois Administrative Code

Section 2051.230 Administrators Not to Assume Underwriting Risk An administrator may negotiate and make arrangements with providers in compliance with the Act, and market and otherwise make available such arrangements to insurance companies, HMO's, limited health service organiza…

Section 2051.240 Registration, Renewals and Appeals a) No person, partnership or corporation shall act as an administrator until that person, partnership or corporation has registered with the Director as required by this Section. In addition, all administrators shall annually re…

Section 2051.250 Fees On or after January 1, 2010, each new administrator doing business in this State shall pay to the Director an initial registration fee of $1000. Each administrator doing business in this State shall annually pay to the Director a renewal fee of $500 in order…

Section 2051.260 Administrator Requirements Each applicant for registration shall file the following information and documents with the Director in the format provided in the Health Care Preferred Provider Program Administrator Checklist. DHCSP administrators who only administer …

Section 2051.270 Organizational Requirements Upon application for registration, administrators must file the following information: a) An organizational chart describing the relationship between the administrator, its parent organization and any affiliates, including the state of…

Section 2051.280 Health Care Preferred Provider Program Payor Agreements Administrators shall file with the Department a sample copy of all payor agreements. WC PPPs are exempt from the requirements of this Section, but must instead comply with the requirements of Section 2051.28…

Section 2051.285 Workers' Compensation Preferred Provider Program Payor Agreements Any payor agreements between WC PPP administrators and payors shall contain, at a minimum: a) Terms requiring and specifying all incentives to be provided to the insured to utilize services of a pr…

Section 2051.290 Health Care Preferred Provider Program Administrator Provider Agreements Administrators shall file a sample of copy of all provider agreements. WC PPPs are exempt from the requirements of this Section, but must instead comply with the requirements of Section 2051…

Section 2051.295 Workers' Compensation Preferred Provider Program Provider Agreements All provider agreements between providers and insurers, employers or WC PPP administrators with regard to a WC PPP shall contain, at a minimum: a) A provision stating, within the preamble, that …

Section 2051.300 Requirements for Agreements with Other Administrators a) Before entering into a contract with another administrator to administer programs, policies or subscriber contracts in this State as provided by Section 370i(b)(2) of the Act, an administrator shall perform…

Section 2051.310 Health Care Preferred Provider Program Administrator Network Availability and Adequacy Requirements a) Administrators and insurers must file a description of the services to be offered through the preferred provider program. WC PPPs are exempt from the requiremen…

Section 2051.315 Workers' Compensation Network Availability and Adequacy Requirements a) WC PPP administrators and insurers must file a description of the services to be offered through a WC PPP. The description shall include: 1) The method of marketing the program; 2) A geograph…

Section 2051.320 Discounted Health Care Services Plan Requirements a) A DHCSP administrator shall have a written agreement between the administrator and its beneficiaries that specifies the benefits a beneficiary is to receive under the DHCSP and that complies with this Section. …

Section 2051.330 Insurer Requirements a) As required by Section 143(1) of the Code and consistent with the requirements of 50 Ill. Adm. Code 916, insurers must file the following compliance documents in the format prescribed in the Insurer Filing Requirements Form, located under …

Section 2051.340 Fiduciary and Bond Requirements a) This Section outlines requirements for administrators who must establish either a bond or a fiduciary account pursuant to Section 370l of the Act. Administrators who administer only DHCSPs need not comply with these requirements…

Section 2051.350 Maintenance of Records a) All administrators shall maintain detailed books and records of all of their transactions as an administrator of preferred provider programs. The records required to be maintained by this Section shall include, but are not limited to: 1)…

Section 2051.360 Advertising and Solicitation a) No administrator or its representative shall cause, or knowingly permit the use of, advertising, solicitation, or any form of evidence of coverage that encourages misrepresentation, or is untrue, misleading or deceptive, unjust, un…

Section 2051.370 Examination a) The Director or his or her designee may examine any applicant for registration or any registrant when he or she obtains information that gives him or her reason to believe that the applicant or registrant may be in violation of this Part, or any ap…

Section 2051.APPENDIX D Workers' Compensation Preferred Provider Program Administrator Registration Form (Repealed) (Source: Repealed at 43 Ill. Reg. 11356, effective September 24, 2019)

Section 2201.10 Application and Scope This Rule applies to all insurance companies authorized to transact the kind or kinds of business enumerated in Class 2 of Section 4 of the Illinois Insurance Code. (Ill. Rev. Stat. 1981, ch. 73, par. 616).

Section 2201.20 Definitions "Compensation" shall relate to all insurance effected by virtue of statutes providing compensation to employees for personal injury or occupational disease irrespective of fault of the employer; "Earned premiums" shall include gross premiums charged on…

Section 2201.30 Loss and Loss Expense Reserves The company shall keep a complete and itemized record showing all losses and claims on which it has received notice, including all notices received by it of the occurrence of any event which may result in a loss. Such record shall be…

Section 2201.5 Purpose It is the purpose of this Rule to implement Section 378 of the Illinois Insurance Code by providing a method of computing loss and loss expense reserves.

Section 2301.10 Authority This Rule is promulgated by the Director of Insurance under 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 this State. T…

Section 2301.100 Policy Conformance All policies written in this State shall conform to the foregoing requirements of the Standard Policy of the State of Illinois.

Section 2301.110 Optional Information The information on the filing back of the Standard Five Policy is optional, however, there shall be a form number and edition identification on the policy (this form is available from the Department of Insurance, 320 West Washington, Springfi…

Section 2301.20 Scope This Part shall apply to any company licensed to do an insurance business in this State that is transacting the kind of business described as Class 3(a) of Section 4 of the Illinois Insurance Code (Ill. Rev Stat. 1981, ch. 73, par. 616). This Part shall appl…

Section 2301.30 Form The printed form of the policy together with optional first page thereof is available from the state of Illinois Department of Insurance, 320 West Washington, Springfield Illinois 62706, and is hereby designated as the Standard Policy for fire and lightning i…

Section 2301.40 Information To Be Printed on Policy There shall be printed at the head of the policy, the spacing of which, as to the first page, shall be optional, the name of the insurer or insurers issuing the policy; the location of the Home Office thereof; a statement of whe…

Section 2301.50 Contingent Liability of Members or Subscribers In a policy in which contingent liability of members or subscribers is provided for, the provision therefor shall be plainly stated in each policy with prominence equal to the indemnifying clause. Any insurer may also…

Section 2301.60 Contracts or Endorsements Against Other Perils Appropriate forms of contracts or endorsements, whereby the interest in the property described in such policy shall be insured against other perils which the insurer is empowered to assume, may be used in connection w…

Section 2301.70 Binder or Other Contract for Temporary Insurance Binder or other contract for temporary insurance may be made, and shall be deemed to include all the terms of the Standard Policy and all such applicable endorsements as may be designated in such binder or contract …

Section 2301.80 Filing of Form The form of Standard Policy and the form of other basic contracts, riders or endorsements to be attached to the Standard Policy to be used by each insurer shall be filed with the Director of Insurance by each insurer or by an organization, bureau or…

Section 2301.90 Applicability The provisions of this Part shall not be applicable to policies of fire insurance on any vehicle, motor or otherwise, to policies of marine and transportation insurance, or to policies of reinsurance between insurers.

Section 2302.10 Authority (Repealed) (Source: Repealed at 43 Ill. Reg. 7230, effective June 13, 2019)

Section 2302.20 Purpose and Scope a) The purpose of this Part is to establish a uniform procedure under which all companies must file with and secure approval of the Director of Insurance for group or master policy-certificate inland marine insurance forms, rules, and rates befor…

Section 2302.30 Definitions "Code" means the Illinois Insurance Code [215 ILCS 5]. "Company", as used in this Part, means any entity defined as a "company" in Section 2 of the Code and that issues or delivers in the State of Illinois any policy, contract or certificate of Group I…

Section 2302.40 Procedure a) Forms 1) All companies must file, using the System for Electronic Rate and Form Filing (SERFF): A) Copies of all policy forms and, for mutual companies, a separate proxy signature line for the insured to sign, if applicable; B) Copies of generally use…

Section 2302.50 Severability Provision If any Section or portion of a Section of this Part, or the applicability of that Section or portion of a Section to any person or circumstances, is held invalid by a court, the remainder of this Part or the applicability of the provision to…

Section 2302.60 Effective Date (Repealed) (Source: Repealed at 43 Ill. Reg. 7230, effective June 13, 2019)

Section 2302.EXHIBIT A Illinois Departmental Regulations (Repealed) (Source: Repealed at 43 Ill. Reg. 7230, effective June 13, 2019)

Section 2401.10 Authority This Part is promulgated by the Director of Insurance under 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 this State.…

Section 2401.20 Plan of Operation The plans of operation governing the rates, rules and rating plans applicable to casualty and property coverages assigned pursuant to Section 7-501 of the Illinois Safety Responsibility Law and Sections 478.1 and 523 of the Illinois Insurance Cod…

Section 2401.30 Unfair Method of Competition Insurers shall not be deemed guilty of an unfair method of competition if; a) such insurers agree to provide a method for the equitable apportionment among them of property and casualty insurance for applicants who are in good faith en…

Section 2401.40 Effective Date This revised Rule is effective on October 1, 1972.

Section 2402.10 Authority This Rule 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 this Stat…

Section 2402.100 Motion and Answer a) Any party receiving a Notice of Hearing may file an answer not later than five days prior to the date of hearing. All answers or motions preliminary to a hearing shall be presented to the Department and to the Hearing Officer at least five da…

Section 2402.110 Consolidation and Severance of Matters − Additional Parties In the interests of convenient, expeditious, and complete determination of matters, the Hearing Officer may consolidate or sever hearing proceedings involving any number of parties, and may order additio…

Section 2402.120 Intervention a) Upon timely written application, the Hearing Officer shall permit any party to intervene in a hearing proceeding, subject to the necessity for conducting an orderly and expeditious hearing, when either of the following conditions is met: 1) when t…

Section 2402.130 Postponement on Continuance of Hearing A hearing may be postponed or continued for due cause by the Director or the Hearing Officer upon their own motion or upon motion of a party to the hearing. Notice of any postponement or continuance shall be given in writing…