Chapter 215, INSURANCE

(215 ILCS 5/351A-2) (from Ch. 73, par. 963A-2) Sec. 351A-2. Group policy issued in another state. No group long-term care insurance coverage may be offered to a resident of this State under a group policy issued in another state to a group described in paragraph (4) of subsection…

(215 ILCS 5/351A-3) (from Ch. 73, par. 963A-3) Sec. 351A-3. Disclosures. The Director may adopt rules that include standards for full and fair disclosure setting forth the manner, content, and required disclosures for the sale of long-term care insurance policies, terms of renewa…

(215 ILCS 5/351A-4) (from Ch. 73, par. 963A-4) Sec. 351A-4. Limitation. No long-term care insurance policy may: (1) Be cancelled, nonrenewed or otherwise terminated on grounds of the age or the deterioration of the mental or physical health of the insured individual or certificat…

(215 ILCS 5/351A-4.5) Sec. 351A-4.5. Long-term care; coverages. Nothing in this Code prohibits an insurance company from offering a long-term care insurance policy that provides for (1) reimbursement of paid premiums in the event of cancellation or (2) reduced benefits in the eve…

(215 ILCS 5/351A-5) (from Ch. 73, par. 963A-5) Sec. 351A-5. Preexisting condition. (a) No long-term care insurance policy or certificate other than a policy or certificate thereunder issued to a group as defined in paragraph (1) of subsection (e) of Section 351A-1 shall use a def…

(215 ILCS 5/351A-6) (from Ch. 73, par. 963A-6) Sec. 351A-6. Prior hospitalization; institutionalizations. (a) On and after the effective date of this amendatory Act of 1989, no long-term care insurance policy may be delivered or issued for delivery in this State if such policy: (…

(215 ILCS 5/351A-7) (from Ch. 73, par. 963A-7) Sec. 351A-7. Right to return. (a) An individual long-term care insurance policyholder shall have the right to return the policy within 30 days of its delivery and to have the premium refunded directly to him or her if, after examinat…

(215 ILCS 5/351A-8) (from Ch. 73, par. 963A-8) Sec. 351A-8. Outline of coverage. (a) An outline of coverage shall be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation through means which prominently direct the attention of the r…

(215 ILCS 5/351A-9) (from Ch. 73, par. 963A-9) Sec. 351A-9. Disclosure in certificate. A certificate issued pursuant to a group long-term care insurance policy, which policy is delivered or issued for delivery in this State, shall include each of the following: (1) A description …

(215 ILCS 5/351A-9.1) (from Ch. 73, par. 963A-9.1) Sec. 351A-9.1. Policy summary and benefit reports. (a) At the time of policy delivery, a policy summary shall be delivered for an individual life insurance policy which provides long-term care benefits within the policy or by rid…

(215 ILCS 5/351A-9.2) Sec. 351A-9.2. Delivery of policy. If an applicant for a long-term care insurance contract or certificate is approved, the issuer shall deliver the contract or certificate of insurance to the applicant no later than 30 days after the date of approval. (Sourc…

(215 ILCS 5/351A-9.3) Sec. 351A-9.3. Claim denial; explanation. If a claim under a long-term care insurance contract is denied, the issuer, within 60 days after receipt of a written request by a policyholder or certificate holder or a policyholder's or certificate holder's repres…

(215 ILCS 5/352) (from Ch. 73, par. 964) Sec. 352. Scope of Article. (a) Except as provided in subsections (b), (c), (d), (e), and (g), this Article shall apply to all companies transacting in this State the kinds of business enumerated in clause (b) of Class 1 and clause (a) of …

(215 ILCS 5/352a) (from Ch. 73, par. 964a) Sec. 352a. Mandated Coverages. No legislation enacted after the effective date of this Amendatory Act of 1990 which mandates or requires the offering of health care coverages or services shall apply to any insurer unless the legislation …

(215 ILCS 5/352b) Sec. 352b. Excepted benefits exempted. (a) Unless specified otherwise and when used in context of accident and health insurance policy benefits, coverage, terms, or conditions required to be provided under this Article, references to any policy of individual or …

(215 ILCS 5/352c) Sec. 352c. Short-term, limited-duration insurance prohibited. (a) In this Section: "Excepted benefits" has the meaning given to that term in 42 U.S.C. 300gg-91 and implementing regulations. "Excepted benefits" includes individual, group, or blanket coverage. "Sh…

(215 ILCS 5/353) (from Ch. 73, par. 965) Sec. 353. Non-cancellable accident and health insurance reserves. (1) The legal minimum standard for computing the active life reserve, including the unearned premium reserve, of non-cancellable accident and health policies issued on and a…

(215 ILCS 5/353a) (from Ch. 73, par. 965a) Sec. 353a. Accident and health reserves. The reserves for all accident and health policies issued after the operative date of this section shall be computed and maintained on a basis which shall place an actuarially sound value on the li…

(215 ILCS 5/354) (from Ch. 73, par. 966) Sec. 354. Accident and health loss reserves. The loss reserves of all accident and health policies other than non-cancellable accident and health policies shall be computed and maintained in accordance with the applicable provisions of Art…

(215 ILCS 5/355) Sec. 355. Accident and health policies; provisions. (a) As used in this Section: "Inadequate rate" means a rate: (1) that is insufficient to sustain projected losses and expenses to which the rate applies; and (2) the continued use of which endangers the solvency…

(215 ILCS 5/355.1) (from Ch. 73, par. 967.1) Sec. 355.1. No claim for benefits for loss of time from the insured person's occupation, under a group or individual accident and health insurance policy delivered in this State more than 120 days after the effective date of this Secti…

(215 ILCS 5/355.2) (from Ch. 73, par. 967.2) Sec. 355.2. Dental coverage reimbursement rates. (a) Every company that issues, delivers, amends, or renews any individual or group policy of accident and health insurance on or after the effective date of this amendatory Act of 1991 t…

(215 ILCS 5/355.3) Sec. 355.3. Noncovered dental services. (a) In this Section: "Covered services" means dental care services for which a reimbursement is available under an enrollee's plan contract, or for which a reimbursement would be available but for the application of contr…

(215 ILCS 5/355.4) Sec. 355.4. Provider notification of network plan changes. (a) As used in this Section: "Contracting entity" means any person or company that enters into direct contracts with providers for the delivery of dental services in the ordinary course of business, inc…

(215 ILCS 5/355.5) (Text of Section before amendment by P.A. 104-491) Sec. 355.5. Dental coverage reimbursement; prohibitions. No insurer, dental service plan corporation, professional service corporation, insurance network leasing company, or any company that amends, delivers, i…

(215 ILCS 5/355.6) Sec. 355.6. Health care provider reimbursement. (a) In this Section, "health care provider" has the meaning given to the term "provider" in Section 370g. (b) Any group or individual policy of accident and health insurance or managed care plan amended, delivered…

(215 ILCS 5/355.7) Sec. 355.7. Medical loss ratio report and premium rebate. (a) A health insurance issuer offering group or individual health insurance coverage, including a grandfathered health plan, shall, with respect to each plan year, submit to the Director a report concern…

(215 ILCS 5/355a) (from Ch. 73, par. 967a) Sec. 355a. Standardization of terms and coverage. (1) The purposes of this Section shall be (a) to provide reasonable standardization and simplification of terms and coverages of individual accident and health insurance policies to facil…

(215 ILCS 5/355b) Sec. 355b. Claim-related information; alternative means of communication. (a) For the purposes of this Section, "claim-related information" means all claim or billing information relating specifically to an insured, subscriber, or person covered by an individual…

(215 ILCS 5/355c) Sec. 355c. Availability of information on qualified health plans. (a) Without limiting the generality of paragraph (b) of subsection (5) of Section 355a, no qualified health plans shall be offered for sale directly to consumers through the health insurance marke…

(215 ILCS 5/355d) Sec. 355d. Denials of claims submitted after prior authorization. (a) In this Section: "Dental carrier" means an insurer, dental service corporation, insurance network leasing company, or any company that offers individual or group policies of accident and healt…

(215 ILCS 5/356K) (from Ch. 73, par. 968K) Sec. 356K. Coverage for Organ Transplantation Procedures. No insurer providing individual accident and health insurance coverage under this Act for hospital or medical expenses shall deny reimbursement for an otherwise covered expense in…

(215 ILCS 5/356L) (from Ch. 73, par. 968L) Sec. 356L. No individual policy of accident or health insurance shall include any provision which shall have the effect of denying coverage to or on behalf of an insured under such policy on the basis of a failure by the insured to file …

(215 ILCS 5/356a) (from Ch. 73, par. 968a) Sec. 356a. Form of policy. (1) No individual policy of accident and health insurance shall be delivered or issued for delivery to any person in this State unless: (a) the entire money and other considerations therefor are expressed there…

(215 ILCS 5/356b) (from Ch. 73, par. 968b) Sec. 356b. (a) This Section applies to the hospital and medical expense provisions of an individual accident or health insurance policy. (b) If a policy provides that coverage of a dependent person terminates upon attainment of the limit…

(215 ILCS 5/356c) (from Ch. 73, par. 968c) Sec. 356c. (1) No policy of accident and health insurance providing coverage of hospital expenses or medical expenses or both on an expense incurred basis which in addition to covering the insured, also covers members of the insured's im…

(215 ILCS 5/356d) (from Ch. 73, par. 968d) Sec. 356d. Conversion privileges for insured former spouses. (1) No individual policy of accident and health insurance providing coverage of hospital and/or medical expense on either an expense incurred basis or other than an expense inc…

(215 ILCS 5/356e) (from Ch. 73, par. 968e) Sec. 356e. Victims of certain offenses. (1) No individual policy of accident and health insurance, which provides benefits for hospital or medical expenses based upon the actual expenses incurred, delivered or issued for delivery to any …

(215 ILCS 5/356f) (from Ch. 73, par. 968f) Sec. 356f. No individual policy of accident or health insurance or any renewal thereof shall be denied or cancelled by the insurer, nor shall any such policy contain any exception or exclusion of benefits, solely because the mother of th…

(215 ILCS 5/356g) (from Ch. 73, par. 968g) (Text of Section before amendment by P.A. 104-783) Sec. 356g. Mammograms; mastectomies. (a) Every insurer shall provide in each group or individual policy, contract, or certificate of insurance issued or renewed for persons who are resid…

(215 ILCS 5/356g.5) Sec. 356g.5. Clinical breast exam. (a) The General Assembly finds that clinical breast examinations are a critical tool in the early detection of breast cancer, while the disease is in its earlier and potentially more treatable stages. Insurer reimbursement of…

(215 ILCS 5/356g.5-1) Sec. 356g.5-1. Breast cancer pain medication and therapy. A group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 95th General As…

(215 ILCS 5/356h) (from Ch. 73, par. 968h) Sec. 356h. No individual or group policy of accident and health insurance which covers the insured's immediate family or children, as well as covering the insured, shall exclude a child from coverage or limit coverage for a child solely …

(215 ILCS 5/356i) (from Ch. 73, par. 968i) Sec. 356i. Medical assistance; coverage of child. (a) In this Section, "Medicaid" means medical assistance authorized under Section 1902 of the Social Security Act. (b) An individual or group policy of accident and health insurance that …

(215 ILCS 5/356m) (from Ch. 73, par. 968m) Sec. 356m. Infertility coverage. (a) No group policy of accident and health insurance providing coverage for more than 25 employees that provides pregnancy-related benefits may be issued, amended, delivered, or renewed in this State afte…

(215 ILCS 5/356n) (from Ch. 73, par. 968n) Sec. 356n. Fibrocystic condition; denial of coverage. No group or individual policy of accident or health insurance or any renewal thereof shall be denied by the insurer, nor shall any policy contain any exception or exclusion of benefit…

(215 ILCS 5/356p) (from Ch. 73, par. 968p) Sec. 356p. Breast implant removal. No individual or group policy of accident and health insurance shall deny coverage for the removal of breast implants when the removal of the implants is medically necessary treatment for a sickness or …

(215 ILCS 5/356q) Sec. 356q. On or after the effective date of this Section, every insurer which delivers or issues for delivery in this State a group accident and health policy providing coverage for hospital, medical, or surgical treatment on an expense-incurred basis shall off…

(215 ILCS 5/356r) Sec. 356r. Access to obstetrical and gynecological care. (a) An individual or group policy of accident and health insurance or a managed care plan amended, delivered, issued, or renewed in this State must not require authorization or referral by the plan, issuer…

(215 ILCS 5/356s) Sec. 356s. Post-parturition care. An individual or group policy of accident and health insurance that provides maternity coverage and is amended, delivered, issued, or renewed after the effective date of this amendatory Act of 1996 shall provide coverage for the…