Chapter 215, INSURANCE

(215 ILCS 130/1001) (from Ch. 73, par. 1501-1) Sec. 1001. Short Title. This Act may be cited as the Limited Health Service Organization Act. (Source: P.A. 86-600.)

(215 ILCS 130/1002) (from Ch. 73, par. 1501-2) (Text of Section before amendment by P.A. 104-562) Sec. 1002. Definitions. As used in this Act, unless the context otherwise requires, the following terms shall have the meanings ascribed to them: "Advertisement" means any printed or…

(215 ILCS 130/1003) (from Ch. 73, par. 1501-3) Sec. 1003. Definition of admitted assets. "Admitted assets" of a limited health service organization shall only include the admitted assets and investments authorized or permitted for health maintenance organizations by Sections 1-3 …

(215 ILCS 130/2001) (from Ch. 73, par. 1502-1) Sec. 2001. Certificate of authority; exception for corporate employee programs; applications; material modification of operation. (a) No organization shall establish or operate a limited health service organization in this State with…

(215 ILCS 130/2002) (from Ch. 73, par. 1502-2) Sec. 2002. Issuance of certificate of authority. (a) Issuance of a certificate of authority shall be granted if the following conditions are met: (1) The requirements of subsection (c) of Section 2001 have been fulfilled. (2) The per…

(215 ILCS 130/2003) (from Ch. 73, par. 1502-3) Sec. 2003. Powers of limited health service organizations. The powers of a limited health service organization include, but are not limited to the following: (1) The purchase, lease, construction, renovation, operation or maintenance…

(215 ILCS 130/2004) (from Ch. 73, par. 1502-4) Sec. 2004. Required minimum net worth; impairment. (a) A limited health service organization issued a certificate of authority shall have and at all times maintain net worth of not less than the greater of: (1) $50,000; or (2) 2% of …

(215 ILCS 130/2005) (from Ch. 73, par. 1502-5) Sec. 2005. Claims liabilities. (a) Every limited health service organization shall, at all times, maintain liabilities in an amount estimated in the aggregate to provide for the payment of all claims incurred and any due and unpaid p…

(215 ILCS 130/2006) (from Ch. 73, par. 1502-6) Sec. 2006. Statutory deposits. (a) An organization subject to the provisions of this Act shall make and maintain with the Director, for the protection of enrollees of the organization, a deposit of securities that are in the form aut…

(215 ILCS 130/2008) (from Ch. 73, par. 1502-8) Sec. 2008. Provider contracts. (a) All contracts with providers or with entities which subcontract for the provision of limited health services to enrollees on a prepayment or other basis and any contract with any subcontractor there…

(215 ILCS 130/2009) (from Ch. 73, par. 1502-9) Sec. 2009. Subordinated indebtedness. An organization having a certificate of authority under this Act may borrow or assume a liability for the repayment of a sum of money upon a written agreement that the loan or advance with intere…

(215 ILCS 130/3001) (from Ch. 73, par. 1503-1) Sec. 3001. Description and securing of services. The limited health service organization shall issue to each subscriber or enrollee a group contract or evidence of coverage. Any such group contract or evidence of coverage shall provi…

(215 ILCS 130/3002) (from Ch. 73, par. 1503-2) Sec. 3002. Complaint system. Every limited health service organization shall establish and maintain a complaint system providing reasonable procedures for resolving complaints initiated by enrollees. Nothing herein shall be construed…

(215 ILCS 130/3003) (from Ch. 73, par. 1503-3) Sec. 3003. Department complaint handling procedure. (a) When a complaint is received by the Department of Insurance (Department) against a limited health service organization (respondent) or producer (respondent), the respondent shal…

(215 ILCS 130/3004) (from Ch. 73, par. 1503-4) Sec. 3004. Solicitations of enrollees. (a) Solicitations of enrollees by a limited health service organization authorized under this Act, or its representatives shall not be construed to be violative of any provisions of law relating…

(215 ILCS 130/3005) (from Ch. 73, par. 1503-5) Sec. 3005. Producers. No person may apply, procure, solicit, negotiate, or place for others any evidence of coverage of a limited health service organization unless that person holds a valid limited insurance representative license o…

(215 ILCS 130/3006) (from Ch. 73, par. 1503-6) Sec. 3006. Changes in rate methodology and benefits; material modifications; addition of limited health services. (a) A limited health service organization shall file with the Director prior to use, a notice of any change in rate met…

(215 ILCS 130/3007) (from Ch. 73, par. 1503-7) Sec. 3007. Prior approval of policy forms. (a) No limited health service organization shall issue or deliver, in this State, a group contract or evidence of coverage, attach an endorsement or rider thereto, incorporate by reference, …

(215 ILCS 130/3008) (from Ch. 73, par. 1503-8) Sec. 3008. Evidence of coverage. (a) Every subscriber shall be issued an evidence of coverage, which shall contain a clear and complete statement of: (1) The limited health services to which each enrollee is entitled. (2) Eligibility…

(215 ILCS 130/3009) (from Ch. 73, par. 1503-9) (Text of Section before amendment by P.A. 104-562) Sec. 3009. Point-of-service limited health service contracts. (a) An LHSO that offers a POS contract: (1) shall include as in-plan covered services all services required by law to be…

(215 ILCS 130/3010) Sec. 3010. Purchase of ophthalmic goods or services. An organization may not require a provider, as a condition of participation in the organization's limited health care plan, to purchase ophthalmic goods or services, including but not limited to eyeglass fra…

(215 ILCS 130/4001) (from Ch. 73, par. 1504-1) Sec. 4001. Applicability of Section 155 of the Illinois Insurance Code to limited health service organizations. Section 155 of the Illinois Insurance Code, as now or hereafter amended, shall apply to limited health service organizati…

(215 ILCS 130/4002) (from Ch. 73, par. 1504-2) Sec. 4002. Health Maintenance Organization Act. Limited health service organizations shall be subject to the provisions of Sections 1-3 and 3-1 of the Health Maintenance Organization Act, as now or hereafter amended. (Source: P.A. 86…

(215 ILCS 130/4002.1) Sec. 4002.1. Access to obstetrical and gynecological care. Limited health service organizations are subject to the provisions of Section 356r of the Illinois Insurance Code. (Source: P.A. 103-718, eff. 7-19-24.)

(215 ILCS 130/4002.5) Sec. 4002.5. Illinois Health Insurance Portability and Accountability Act. The provisions of this Act are subject to the Illinois Health Insurance Portability and Accountability Act as provided in Section 15 of that Act. (Source: P.A. 90-30, eff. 7-1-97.)…

(215 ILCS 130/4002.6) Sec. 4002.6. Managed Care Reform and Patient Rights Act. Except for health care plans offering only dental services or only vision services, limited health service organizations are subject to the provisions of the Managed Care Reform and Patient Rights Act.…

(215 ILCS 130/4003) (from Ch. 73, par. 1504-3) (Text of Section from P.A. 104-528) Sec. 4003. Illinois Insurance Code provisions. Limited health service organizations shall be subject to the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3, 143, 143.31, 14…

(215 ILCS 130/4004) (from Ch. 73, par. 1504-4) Sec. 4004. Examination of affairs and quality of services by the Director; books and records. (a) The Director shall have, with respect to limited health service organizations, the powers of examination conferred upon him pursuant to…

(215 ILCS 130/4005) (from Ch. 73, par. 1504-5) Sec. 4005. Suspension or revocation or denial of certification of authority. (a) The Director may suspend or revoke any certificate of authority issued to a limited health service organization under this Act or deny an application fo…

(215 ILCS 130/4006) (from Ch. 73, par. 1504-6) Sec. 4006. Supervision of rehabilitation, liquidation or conservation by the Director. (a) For purposes of the rehabilitation, liquidation or conservation of a limited health service organization, the operation of a limited health se…

(215 ILCS 130/4007) (from Ch. 73, par. 1504-7) Sec. 4007. Rules and regulations. (a) The Director may promulgate reasonable rules and regulations as are necessary and proper to establish specific standards, including standards for the full and fair disclosure of limited health se…

(215 ILCS 130/4008) (from Ch. 73, par. 1504-8) Sec. 4008. Grounds for denial, suspension or revocation of certificate of authority under Administrative Review Law. (a) When the Director has cause to believe that grounds for the denial of an application for a certificate of author…

(215 ILCS 130/4009) (from Ch. 73, par. 1504-9) Sec. 4009. Violations; cease and desist order; corrective orders. (a) Any organization which violates this Act shall be guilty of a Class B misdemeanor. (b) The Director may issue to any organization subject to this Act, a cease and …

(215 ILCS 5/131.1) Sec. 131.1. Definitions. As used in this Article, the following terms have the respective meanings set forth in this Section unless the context requires otherwise: (a) An "affiliate" of, or person "affiliated" with, a specific person, is a person that directly,…

(215 ILCS 5/131.10) (from Ch. 73, par. 743.10) Sec. 131.10. Sections 131.4 through 131.12 do not apply to: (1) any transaction which is subject to Article X of this Code dealing with merger, consolidation or plans of exchange; (2) any offer, request, invitation, agreement or acqu…

(215 ILCS 5/131.11) (from Ch. 73, par. 743.11) Sec. 131.11. The following are violations of Sections 131.4 through 131.12: (1) the failure to file any statement, amendment, or other material required to be filed under Sections 131.4 or 131.5; or (2) the effectuation or any attemp…

(215 ILCS 5/131.12) (from Ch. 73, par. 743.12) Sec. 131.12. The courts of this State are hereby vested with jurisdiction over every person not resident, domiciled, or authorized to do business in this State who files a statement with the Director under Section 131.4, and over all…

(215 ILCS 5/131.12a) (from Ch. 73, par. 743.12a) Sec. 131.12a. Acquisitions involving companies not otherwise covered. (1) Definitions. The following definitions shall apply for the purposes of this Section only: (a) "Acquisition" means any agreement, arrangement or activity the …

(215 ILCS 5/131.13) (from Ch. 73, par. 743.13) Sec. 131.13. Registration of companies. Every company which is authorized to do business in this State and which is a member of an insurance holding company system must register with the Director, except a foreign or alien company su…

(215 ILCS 5/131.14) (from Ch. 73, par. 743.14) Sec. 131.14. Every company subject to registration must file a registration statement on a form and in a format prescribed by the Director, which shall contain the following current information: (1) the capital structure, general fin…

(215 ILCS 5/131.14a) Sec. 131.14a. Summary filing. Every company subject to registration must file a summary outlining all items in the current registration statement representing changes from the prior registration statement. (Source: P.A. 98-609, eff. 1-1-14.)

(215 ILCS 5/131.14b) Sec. 131.14b. Enterprise risk filings. (a) Annual enterprise risk report. The ultimate controlling person of every company subject to registration shall also file an annual enterprise risk report. The report shall, to the best of the ultimate controlling pers…

(215 ILCS 5/131.14c) Sec. 131.14c. Violations. The failure to file a registration statement or any summary of the registration statement or enterprise risk filing required by this Article within the time specified for filing shall be a violation of this Article. (Source: P.A. 98-…

(215 ILCS 5/131.15) (from Ch. 73, par. 743.15) Sec. 131.15. No information need be disclosed on the registration statement filed under Section 131.14 if the information is not material for the purposes of Sections 131.13 through 131.19. Unless the Director by rule, regulation or …

(215 ILCS 5/131.16) (from Ch. 73, par. 743.16) Sec. 131.16. Reporting material changes or additions; penalty for late registration statement. (1) Each registered company must keep current the information required to be included in its registration statement by reporting all mater…

(215 ILCS 5/131.17) (from Ch. 73, par. 743.17) Sec. 131.17. (1) The Director must terminate the registration of any company which demonstrates that it no longer is a member of an insurance holding company system. (2) The Director may require or allow 2 or more affiliated companie…

(215 ILCS 5/131.18) (from Ch. 73, par. 743.18) Sec. 131.18. Sections 131.13 through 131.19 do not apply to any company, information, or transaction if and to the extent that the Director by rule, regulation, or order may exempt the same from Sections 131.13 through 131.19. (Sourc…

(215 ILCS 5/131.19) (from Ch. 73, par. 743.19) Sec. 131.19. Disclaimer of affiliation. Any person may file with the Director a disclaimer of affiliation with any authorized company or a disclaimer may be filed by the company or any member of an insurance holding company system. T…

(215 ILCS 5/131.2) (from Ch. 73, par. 743.2) Sec. 131.2. Subsidiaries. A domestic company, either by itself or in cooperation with one or more persons, may organize or acquire one or more subsidiaries. The subsidiaries may conduct any kind of business or businesses and their auth…

(215 ILCS 5/131.20) (from Ch. 73, par. 743.20) Sec. 131.20. Standards for transactions with affiliates; adequacy of surplus. (1) Transactions with their affiliates by companies subject to registration are subject to the following standards: (a) the terms are fair and reasonable; …