Chapter 215 — INSURANCE

(215 ILCS 5/367k) Sec. 367k. Intoxication and narcotics; exclusion of coverage prohibited. (a) A group or individual major medical policy of accident or health insurance or managed care plan amended, delivered, issued, or renewed after January 1, 2008 shall not, solely on the bas…

(215 ILCS 5/367m) Sec. 367m. Early intervention services. A policy of accident and health insurance that provides coverage for early intervention services must conform to the following criteria: (1) The use of private health insurance to pay for early intervention services under …

(215 ILCS 5/368) (from Ch. 73, par. 980) Sec. 368. Industrial accident and health insurance. (1) Industrial accident and health insurance is hereby declared to be that form of accident and health insurance in which the premium is payable weekly. (2) Any insurance company authoriz…

(215 ILCS 5/368a) Sec. 368a. Timely payment for health care services. (a) This Section applies to insurers, health maintenance organizations, managed care plans, health care plans, preferred provider organizations, third party administrators, independent practice associations, an…

(215 ILCS 5/368b) Sec. 368b. Contracting procedures. (a) A health care professional or health care provider offered a contract by an insurer, health maintenance organization, independent practice association, or physician hospital organization for signature after the effective da…

(215 ILCS 5/368c) Sec. 368c. Remittance advice and procedures. (a) A remittance advice shall be furnished to a health care professional or health care provider that identifies the disposition of each claim. The remittance advice shall identify the services billed; the patient res…

(215 ILCS 5/368d) Sec. 368d. Recoupments. (a) A health care professional or health care provider shall be provided a remittance advice, which must include an explanation of a recoupment or offset taken by an insurer, health maintenance organization, independent practice associati…

(215 ILCS 5/368e) Sec. 368e. Administration and enforcement. (a) Other than the duties specifically created in Sections 368b, 368c, and 368d, nothing in those Sections is intended to preclude, prevent, or require the adoption, modification, or termination of any utilization manag…

(215 ILCS 5/368f) Sec. 368f. Military service member insurance reinstatement. (a) No Illinois resident activated for military service and no spouse or dependent of the resident who becomes eligible for a federal government-sponsored health insurance program, including the TriCare…

(215 ILCS 5/368g) Sec. 368g. Time-based billing. (a) As used in this Section, "CPT code" means the medical billing code set contained in the most recent version of the Current Procedural Terminology code book published by the American Medical Association. (b) A health care plan r…

(215 ILCS 5/369) (from Ch. 73, par. 981) Sec. 369. Rights of minors. Any minor of the age of fifteen years or more may, notwithstanding such minority, contract for health and accident insurance on his own life for his own benefit or for the benefit of his father, mother, husband,…

(215 ILCS 5/37) (from Ch. 73, par. 649) (Section scheduled to be repealed on January 1, 2027) Sec. 37. Name. The corporate name of any company organized under this Article shall contain the word "Mutual" and shall not be the same as, or deceptively similar to, the name of any dom…

(215 ILCS 5/370) (from Ch. 73, par. 982) Sec. 370. Policies issued in violation of article-Penalty. (1) Any company, or any officer or agent thereof, issuing or delivering to any person in this State any policy in wilful violation of the provision of this article shall be guilty …

(215 ILCS 5/370a) (from Ch. 73, par. 982a) Sec. 370a. Assignability of accident and health insurance, including dental insurance. No provision of the Illinois Insurance Code, or any other law, prohibits an insured under any policy of dental insurance or accident and health insura…

(215 ILCS 5/370b) (from Ch. 73, par. 982b) Sec. 370b. Reimbursement on equal basis. Notwithstanding any provision of any individual or group policy of accident and health insurance, or any provision of a policy, contract, plan or agreement for hospital or medical service or indem…

(215 ILCS 5/370b.1) Sec. 370b.1. Surgical assistant payments. Payment for services rendered by a registered surgical assistant, as defined in the Registered Surgical Assistant and Registered Surgical Technologist Title Protection Act, who is neither an employee of an ambulatory s…

(215 ILCS 5/370c) (from Ch. 73, par. 982c) Sec. 370c. Mental and emotional disorders. (a)(1) On and after January 1, 2022 (the effective date of Public Act 102-579), every insurer that amends, delivers, issues, or renews group accident and health policies providing coverage for h…

(215 ILCS 5/370c.1) Sec. 370c.1. Mental, emotional, nervous, or substance use disorder or condition parity. (a) On and after July 23, 2021 (the effective date of Public Act 102-135), every insurer that amends, delivers, issues, or renews a group or individual policy of accident a…

(215 ILCS 5/370c.2) Sec. 370c.2. (Repealed). (Source: P.A. 102-304, eff. 8-6-21. Repealed internally, eff. 1-1-23.)

(215 ILCS 5/370c.3) Sec. 370c.3. Parity for coverage for nonopioid medications to treat acute pain. (a) Beginning January 1, 2027, a health insurance issuer shall develop a plan to provide adequate coverage and access to a broad spectrum of pain management services, including, bu…

(215 ILCS 5/370c.4) (This Section may contain text from a Public Act with a delayed effective date) Sec. 370c.4. Mental health and substance use parity. (a) In this Section: "Application" means a person's or facility's application to become a participating provider with an insure…

(215 ILCS 5/370d) (from Ch. 73, par. 982d) Sec. 370d. Companies which issue insurance policies under this Article containing business overhead expense coverage shall make available to persons whose occupation is that of homemaker and who are not otherwise gainfully employed, cove…

(215 ILCS 5/370d.1) Sec. 370d.1. Group policies; chambers of commerce. Companies that issue group policies of accident and health insurance under this Article must offer such policies to local chambers of commerce. (Source: P.A. 102-611, eff. 1-1-22.)

(215 ILCS 5/370e) (from Ch. 73, par. 982e) Sec. 370e. Companies which issue group accident and health policies or blanket accident and health plans to employer groups in this State shall provide the employer with notice of termination of a group or blanket accident and health pla…

(215 ILCS 5/370f) (from Ch. 73, par. 982f) Sec. 370f. Short Title. This Article may be cited as the "Health Care Reimbursement Reform Act of 1985". (Source: P.A. 84-618.)

(215 ILCS 5/370g) (from Ch. 73, par. 982g) Sec. 370g. Definitions. As used in this Article, the following definitions apply: (a) "Health care services" means health care services or products rendered or sold by a provider within the scope of the provider's license or legal author…

(215 ILCS 5/370h) (from Ch. 73, par. 982h) Sec. 370h. Noninstitutional providers. Before entering into any agreement under this Article an insurer or administrator shall establish terms and conditions that must be met by noninstitutional providers wishing to enter into an agreeme…

(215 ILCS 5/370i) (from Ch. 73, par. 982i) Sec. 370i. Policies, agreements or arrangements with incentives or limits on reimbursement authorized. (a) Policies, agreements or arrangements issued under this Article may not contain terms or conditions that would operate unreasonably…

(215 ILCS 5/370j) (from Ch. 73, par. 982j) Sec. 370j. Requirements not applicable to insurers. Except as otherwise provided, no insurer authorized to do business in this State shall be subject to any of the requirements of this Article that are applicable to administrators. Requi…

(215 ILCS 5/370k) (from Ch. 73, par. 982k) Sec. 370k. Registration. (a) All administrators of a preferred provider program subject to this Article shall register with the Department of Insurance, which shall by rule establish criteria for such registration including minimum solve…

(215 ILCS 5/370l) (from Ch. 73, par. 982l) Sec. 370l. Fiduciary and bonding requirements. Each administrator who handles money for purposes of payment for providers services subject to this Article shall (1) establish and maintain a fiduciary account, separate and apart from any …

(215 ILCS 5/370m) (from Ch. 73, par. 982m) Sec. 370m. Program Requirements. Each administrator shall provide to each beneficiary of any program subject to this Article a document which (1) sets forth those providers with which agreements or arrangements have been made to provide …

(215 ILCS 5/370n) (from Ch. 73, par. 982n) Sec. 370n. Utilization Review Requirements: Any preferred provider organization providing hospital, medical or dental services must include a program of utilization review. This Section applies to insurers and administrators. (Source: P.…

(215 ILCS 5/370o) (from Ch. 73, par. 982o) Sec. 370o. Emergency Care. Any preferred provider contract, subject to this Article shall provide the beneficiary or insured emergency care coverage such that payment for this coverage is not dependent upon whether such services are perf…

(215 ILCS 5/370p) (from Ch. 73, par. 982p) Sec. 370p. Failure to register. Any administrator subject to this Article who fails to register or pay the fee required by this Article shall be construed to be an unauthorized insurer as defined in Article VII of the "Illinois Insurance…

(215 ILCS 5/370q) (from Ch. 73, par. 982q) Sec. 370q. To the extent of any conflict between this Article and any other statutory provision, this Article prevails over the conflicting provision. Agreements may be entered into under this Article notwithstanding any policy provision…

(215 ILCS 5/370r) (from Ch. 73, par. 982r) Sec. 370r. (Renumbered). (Source: Renumbered by P.A. 95-331, eff. 8-21-07.)

(215 ILCS 5/370s) Sec. 370s. Managed Care Reform and Patient Rights Act. All administrators shall comply with Sections 55 and 85 of the Managed Care Reform and Patient Rights Act. Except as provided by Section 85 of the Managed Care Reform and Patient Rights Act, no law or rule s…

(215 ILCS 5/370t) Sec. 370t. Drug formulary; notice. All administrators must comply with Section 155.37 of this Code. (Source: P.A. 92-440, eff. 8-17-01.)

(215 ILCS 5/378) (from Ch. 73, par. 990) Sec. 378. Scope of article. This article shall apply to all companies authorized in this State to transact the kind or kinds of business enumerated in Class 2 of section 4. Every such company shall, at all times, maintain reserves in an am…

(215 ILCS 5/379.1) (from Ch. 73, par. 991.1) Sec. 379.1. Unearned premium reserve. Every insurance company authorized to transact in this State any of the kind or kinds of business enumerated in Class 2 of Section 4 except accident and health insurance shall maintain an unearned …

(215 ILCS 5/38) (from Ch. 73, par. 650) (Section scheduled to be repealed on January 1, 2027) Sec. 38. Principal office and place of business. The principal office of any company organized under this Article shall be located in this State. Unless the Director has approved otherwi…

(215 ILCS 5/388) (from Ch. 73, par. 1000) Sec. 388. Standard provision for liability policies - Provisions forbidden. No policy of insurance against liability or indemnity for loss or damage to any person other than the insured, or to the property of any person other than the ins…

(215 ILCS 5/388-1) (from Ch. 73, par. 1000-1) Sec. 388-1. No company selling insurance defined in clause (b) of class 2 of Section 4 may require a policyholder to take a physical examination as a condition for renewal of such policy if the policyholder has been insured by the com…

(215 ILCS 5/388a) (from Ch. 73, par. 1000a) Sec. 388a. Group vehicle insurance defined. (a) Group vehicle insurance is declared to be that form of vehicle insurance covering not less than 10 employees, members, or employees of members, written under a master policy issued to any …

(215 ILCS 5/388b) (from Ch. 73, par. 1000b) Sec. 388b. Group vehicle insurance authorized. Any insurance company authorized to write vehicle insurance in this State, as authorized by clause (b) of Class 2 and clause (e) of Class 3 of Section 4, shall have power to issue group veh…

(215 ILCS 5/388c) (from Ch. 73, par. 1000c) Sec. 388c. "Entire contract" specified. Each group vehicle insurance policy shall provide that the policy, the application of the employer, or executive officer or trustee of any association, and the individual applications, if any, of …

(215 ILCS 5/388d) (from Ch. 73, par. 1000d) Sec. 388d. Certificates required. Each group vehicle insurance policy shall provide that the insurer will issue to the employer, or to the executive officer or trustee of the association, for delivery to the employee, member or employee…

(215 ILCS 5/388e) (from Ch. 73, par. 1000e) Sec. 388e. New members of group. Each group vehicle insurance policy shall provide that to the group or class thereof originally insured shall be added from time to time all new employees of the employer, members of the association or e…

(215 ILCS 5/388f) (from Ch. 73, par. 1000f) Sec. 388f. Conversion rights. Each group vehicle insurance policy shall provide that any member of the group shall have the right to convert his group policy to an individual standard policy of insurance in the same company as offered b…