Illinois Administrative Code

Section 2908.50 Billing Code Sets All billing codes and modifier systems used for electronic billing shall be in accordance with 50 Ill. Adm. Code 9110.90 (Illinois Workers' Compensation Commission Medical Fee Schedule). Billing codes and modifier systems identified in this Secti…

Section 2908.60 Electronic Medical Billing, Reimbursement and Documentation a) Applicability 1) This Section outlines the exclusive process for the initial exchange of electronic medical bill and related payment processing data for professional, institutional/hospital, pharmacy a…

Section 2908.70 Employer, Insurance Carrier, Managed Care Organization or Agents' Receipt of Medical Bills from Health Care Providers a) Upon receipt of medical bills submitted in accordance with Sections 2908.30, 2908.40 and 2908.50, a payer shall evaluate each bill's conformanc…

Section 2908.80 Communication Between Health Care Providers and Payers a) Any communication between the health care provider and the payer related to medical bill processing shall be of sufficient specific detail to allow the responder to easily identify the information required …

Section 2908.90 Medical Documentation Necessary for Billing Adjudication a) Medical documentation includes all medical reports and records permitted or required in accordance with the Act. b) Requests for medical reports shall be accompanied by releases from the patient. c) Any r…

Section 2909.10 Applicability This Part applies to every insurer as defined in Section 155.44(b) of the Code that issues "large deductible agreements" as defined in Section 155.44(c) of the Code and that does not meet the definition of "exempt insurer" (see Section 2909.30).

Section 2909.20 Purpose and Scope Subject to Section 155.44 of the Code, the purpose of this Part is to set forth the requirements for maintaining collateral and underwriting large deductible workers' compensation insurance by nonexempt insurers.

Section 2909.30 Definitions "Audited Financial Statement" means a financial statement audited by a certified public accountant based on the most recent fiscal year, but in no event no more than 15 months old, measured by the end of the audited period, at the time of application o…

Section 2909.40 Collateral Requirements a) Exempt insurers are not required to comply with the requirements of this Part. b) As provided in this Part, every nonexempt insurer writing workers' compensation policies that are subject to a large deductible agreement covering employee…

Section 2909.50 Large Deductible Amount Each nonexempt insurer writing workers' compensation policies that are subject to a large deductible agreement that covers employees located in this State must require the policyholder to provide an audited financial statement during the un…

Section 2909.60 Annual Reporting Every nonexempt insurer licensed to do business in Illinois that has issued a large deductible agreement must file an annual disclosure statement, as a supplement pursuant to 215 ILCS 5/136, with the Department by March 1 of each year using the fo…

Section 2909.70 Fines and Penalties Any nonexempt insurer found to be in violation of any provision of this Part or of Section 155.44 of the Code shall be subject to fines and penalties as provided in Section 403A of the Code.

Section 2909.EXHIBIT A Collateral Report COLLATERAL REPORT Annual Disclosure Large Deductible Supplement 215 ILCS 5/155.44 and 136 and 50 Ill. Adm. Code 2909.60 Due Date: March 1 each calendar year (Company Name) By: (Signature) Title: Date: Please enter the required information:…

Section 2915.10 Notice of Non-Compliance a) The Insurance Compliance Division of the Illinois Department of Insurance (“Department”) shall issue a Notice of Non-Compliance (“Notice”) to any employer that the Department believes has failed to comply with the provisions of the Work…

Section 3109.10 Authority This Part is promulgated 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 insurance laws of this State. This Part imp…

Section 3109.20 Purpose and Scope This Part establishes uniform procedural guidelines for individuals conducting insurance business under an assumed name or firm name. (Source: Amended at 9 Ill. Reg. 5327, effective April 12, 1985)

Section 3109.30 Procedural Guidelines a) Prior to a licensee transacting insurance business in this State under an assumed name, the licensee shall comply with the Assumed Business Name Act [805 ILCS 405]. b) Applicants operating under an assumed name shall notify the Department …

Section 3109.40 Effective Date (Repealed) (Source: Repealed at 9 Ill. Reg. 5327, effective April 12, 1985)

Section 3110.10 Application The following rules apply to any person who shall notify the Director of Insurance that while licensed other than temporarily he has entered any of the military services of the United States: a) An Insurance Producer License in force on the date of ent…

Section 3113.10 Authority (Repealed) (Source: Repealed at 8 Ill. Reg. 25007, effective January 1, 1985)

Section 3113.20 Purpose and Scope a) The purpose of this Part is: 1) To implement Sections 500-70, 500-110 and 500-115 of Article XXXI of the Illinois Insurance Code [215 ILCS 5/500-70, 500-110 and 500-115] . Failure to adhere to the standards set forth in this Part shall subject…

Section 3113.30 Definitions Financial Institution means a Federal or State chartered bank(s) or savings and loan institution(s) which is a member of the Federal Deposit Insurance Corporation (FDIC) or the Federal Savings and Loan Insurance Corporation (FSLIC). Premium means any a…

Section 3113.40 Premium Fund Trust Account a) All licensees required to maintain a PFTA, pursuant to subsection (c), shall establish and maintain a PFTA in a financial institution. All resident and quasi-resident licensees required to maintain a PFTA pursuant to this Section shal…

Section 3113.50 Minimum Record Requirements a) Licensees shall maintain books and records which reflect all insurance transactions, specifically in regard to premiums and other monies received and deposited into the PFTA and lawfully withdrawn from the PFTA. The preparation, jour…

Section 3113.60 Return Premium a) Return premiums must be paid to the insured or credited to the insured's account within 15 days after receipt from the insurer or other licensee. If the return premium is reflected as a credit on the licensee's billing statement from the insurer …

Section 3113.70 Severability If any provision of this Part or the application thereof to any person or circumstance 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 thereb…

Section 3113.EXHIBIT A Consent and Authorization Form I hereby give written (or) principal licensee permission and authorization to place on deposit with any Federal or State chartered bank(s) money which represents premium to be held or held on my behalf pursuant to 50 Ill. Adm.…

Section 3118.10 Authority (Repealed) (Source: Repealed at 47 Ill. Reg. 2301, effective February 1, 2023)

Section 3118.100 Maintenance of Records (Repealed) (Source: Repealed at 14 Ill. Reg. 17978, effective October 18, 1990)

Section 3118.110 Performance Standards Applicable to All Public Adjusters (Repealed) (Source: Repealed at 14 Ill. Reg. 17978, effective October 18, 1990)

Section 3118.115 Performance Standards Applicable to All Public Adjusters a) A public adjuster shall not allow any unlicensed individual or entity in which the public adjuster has any interest, or that will compensate the adjuster, to solicit a loss in violation of Section 1590(b…

Section 3118.120 Hearings Any hearing granted under this Part shall be in accordance with 50 Ill. Adm. Code 2402 entitled Administrative Hearing Procedures. (Source: Amended at 30 Ill. Reg. 19367, effective November 29, 2006)

Section 3118.130 Severability If any provision of this Part shall be held invalid, the remainder of the Part shall not be affected. (Source: Amended at 30 Ill. Reg. 19367, effective November 29, 2006)

Section 3118.20 Purpose and Scope The purpose of this Part is to regulate the activities of public adjusters. This Part applies to all public adjusters licensed in accordance with Article XLV of the Code. (Source: Amended at 47 Ill. Reg. 2301, effective February 1, 2023)

Section 3118.25 Definitions "Code" means the Illinois Insurance Code [215 ILCS 5]. "Department" means the Illinois Department of Insurance. "Director" means the Director of the Illinois Department of Insurance. (Source: Amended at 47 Ill. Reg. 2301, effective February 1, 2023)

Section 3118.30 Engaged in the Business of Adjusting Insurance Claims (Repealed) (Source: Repealed at 14 Ill. Reg. 17978, effective October 18, 1990)

Section 3118.35 License Required All contracts entered into by anyone violating Section 1515 or Section 1575 of the Code are void and invalid. (Source: Amended at 48 Ill. Reg. 7257, effective April 30, 2024)

Section 3118.40 Valuable Consideration (Repealed) (Source: Repealed at 14 Ill. Reg. 17978, effective October 18, 1990)

Section 3118.45 Fingerprinting Prior to the Department's issuance of a public adjuster's license or a renewal of the existing license, the applicant or adjuster (resident and non-resident) must have his or her fingerprints on file with the Department in accordance with Section 15…

Section 3118.50 Records Material As used in Section 1585 of the Code, records material means all books, papers, and documentary materials regardless of physical form or characteristics made, produced, executed, or received by any public adjuster pursuant to a law or in connection…

Section 3118.60 Grandfather License Provisions (Repealed) (Source: Repealed at 39 Ill. Reg. 1528, effective January 9, 2015)

Section 3118.65 Resident License a) Each public adjuster shall complete continuing education in accordance with Section 1565 of the Code. The public adjuster must complete the continuing education no later than 30 days prior to the license renewal date to allow time for the conti…

Section 3118.70 Nonresident Public Adjusters (Repealed) (Source: Repealed at 14 Ill. Reg. 17978, effective October 18, 1990)

Section 3118.80 Contract Between Public Adjuster and Insured a) Each public adjuster shall file with and secure the approval of the Director of each contract before it is used in the State of Illinois. b) Each contract form filing submitted for approval must include provisions re…

Section 3118.85 Financial Disclosure and Consumer Rights Notice a) Public adjusters must provide full written financial disclosure consistent with Sections 1575(d) and 1590(d), (f), (g), and (h) of the Code. The financial disclosure must contain, at a minimum, the following wordi…

Section 3118.90 Charges for Services a) A public adjuster client shall not be required by the licensed public adjuster, or its agent, to pay higher fees to the public adjuster if the client does not elect to work with the contractor or vendor preferred or primarily recommended by…

Section 3118.95 Required Disclosure (Repealed) (Source: Repealed at 47 Ill. Reg. 2301, effective February 1, 2023)

Section 3119.10 Purpose The purpose of this Part is to establish pre-licensing education requirements for applicants for an insurance producer license, establish continuing education requirements for licensed insurance producers, and establish requirements for providers and instr…

Section 3119.20 Definitions For the purposes of this Part, the following definitions shall apply: "CER Agreement" means the NAIC Continuing Education Reciprocity (CER) Agreement – 2019 Version (no later amendments or editions) available on National Association of Insurance Commis…

Section 3119.25 NAIC Continuing Education Reciprocity Agreement a) The Department has agreed to review and approve continuing education courses in accordance with the CER Agreement. 1) The Department will accept the CER Course Filing Form and the required home state course approv…