Chapter 215, INSURANCE

(215 ILCS 5/35B-5) Sec. 35B-5. Purpose. The purpose of this Article is to stimulate economic development in the State of Illinois by creating and sustaining employment opportunities and increasing and sustaining taxable revenue, through improving the competitive position of domes…

(215 ILCS 5/35B-50) Sec. 35B-50. Rules. The Director may adopt such rules as are necessary or appropriate to carry out this Article. (Source: P.A. 100-1118, eff. 11-27-18.)

(215 ILCS 124/36) Sec. 36. Complaint of incorrect charges. (a) A beneficiary who, taking into account the reimbursement, if any, by the issuer, incurs a cost in excess of the in-network cost-sharing for a covered service from a provider, facility, or hospital that was listed as i…

(215 ILCS 5/36) (from Ch. 73, par. 648) (Section scheduled to be repealed on January 1, 2037) Sec. 36. Scope of Article. This Article shall apply to all domestic mutual companies transacting or being organized to transact any of the kinds of business enumerated in Section 4. (Sou…

(215 ILCS 5/360a) (from Ch. 73, par. 972a) Sec. 360a. Notice, waiver. The acknowledgement by any insurer of the receipt of notice given under any policy covered by this article, or the furnishing of forms for filing proofs of loss, or the acceptance of such proofs, or the investi…

(215 ILCS 5/361a) (from Ch. 73, par. 973a) Sec. 361a. Age limit. If any such policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which prem…

(215 ILCS 5/363) Sec. 363. Medicare supplement policies; minimum standards. (1) Except as otherwise specifically provided therein, this Section and Section 363a of this Code shall apply to: (a) all Medicare supplement policies and subscriber contracts delivered or issued for deli…

(215 ILCS 5/363a) (from Ch. 73, par. 975a) Sec. 363a. Medicare supplement policies; disclosure, advertising, loss ratio standards. (1) Scope. This Section pertains to disclosure requirements of companies and agents and mandatory and prohibited practices of agents when selling a p…

(215 ILCS 5/364) (from Ch. 73, par. 976) Sec. 364. Discrimination prohibited. Discrimination between individuals of the same class of risk in the issuance of its policies or in the amount of premiums or rates charged for any insurance covered by this article, or in the benefits p…

(215 ILCS 5/364.01) Sec. 364.01. Qualified clinical cancer trials. (a) No individual or group policy of accident and health insurance issued or renewed in this State may be cancelled or non-renewed for any individual based on that individual's participation in a qualified clinica…

(215 ILCS 5/364.1) (from Ch. 73, par. 976.1) Sec. 364.1. Every policy of accident and health insurance delivered or issued for delivery to any person in this State after the effective date of this amendatory Act of 1979 which provides coverage for services coming within the pract…

(215 ILCS 5/364.2) Sec. 364.2. Purchase of ophthalmic goods or services. An insurer may not require a provider, as a condition of participation by the provider, to purchase ophthalmic goods or services, including but not limited to eyeglass frames, in a quantity or dollar amount …

(215 ILCS 5/364.3) Sec. 364.3. Insurer uniform electronic prior authorization form; prescription benefits. (a) As used in this Section, "prescribing provider" includes a provider authorized to write a prescription, as described in subsection (e) of Section 3 of the Pharmacy Pract…

(215 ILCS 5/367) (from Ch. 73, par. 979) Sec. 367. Group accident and health insurance. (1) Group accident and health insurance is hereby declared to be that form of accident and health insurance covering not less than 2 employees, members, or employees of members, written under …

(215 ILCS 5/367.2) (from Ch. 73, par. 979.2) Sec. 367.2. Spousal continuation privilege; group contracts. A. No policy of group accident or health insurance, nor any certificate thereunder shall be delivered or issued for delivery in this State after December 1, 1985, unless the …

(215 ILCS 5/367.2-5) Sec. 367.2-5. Dependent child continuation privilege; group contracts. (a) No policy of group accident or health insurance, nor any certificate thereunder shall be amended, renewed, delivered, or issued for delivery in this State after July 1, 2004, unless th…

(215 ILCS 5/367.3) (from Ch. 73, par. 979.3) Sec. 367.3. Group accident and health insurance; discretionary groups. (a) No group health insurance offered to a resident of this State under a policy issued to a group, other than one specifically described in Section 367(1), shall b…

(215 ILCS 5/367a) (from Ch. 73, par. 979a) Sec. 367a. Blanket accident and health insurance. (1) Blanket accident and health insurance is the form of accident and health insurance providing excepted benefits, as defined in Section 352c, that covers special groups of persons as en…

(215 ILCS 5/367b) (from Ch. 73, par. 979b) Sec. 367b. (a) This Section applies to the hospital and medical expense provisions of a group accident or health insurance policy. (b) If a policy provides that coverage of a dependent of an employee or other member of the covered group …

(215 ILCS 5/367c) (from Ch. 73, par. 979c) Sec. 367c. No claim shall be denied, under any group accident and health policy delivered or renewed in this State after the effective date of this Amendatory Act, for treatment or services for mental illness rendered in a hospital solel…

(215 ILCS 5/367d) (from Ch. 73, par. 979d) Sec. 367d. No claim shall be denied, under any group accident and health policy delivered or renewed in this State after the effective date of this amendatory Act, for treatment or services for rehabilitation following either a physical …

(215 ILCS 5/367d.1) (from Ch. 73, par. 979d.1) Sec. 367d.1. After the effective date of this amendatory Act of 1992, no group policy of accident and health insurance that provides coverage for the treatment of alcoholism or other drug abuse or dependency on both an inpatient and …

(215 ILCS 5/367e) (from Ch. 73, par. 979e) Sec. 367e. Continuation of Group Hospital, Surgical and Major Medical Coverage After Termination of Employment or Membership. A group policy delivered, issued for delivery, renewed or amended in this state which insures employees or memb…

(215 ILCS 5/367e.1) Sec. 367e.1. Group Accident and Health Insurance Conversion Privilege. (A) A group policy which provides hospital, medical, or major medical expense insurance, or any combination of these coverages, on an expense-incurred basis, but not including a policy whic…

(215 ILCS 5/367f) (from Ch. 73, par. 979f) Sec. 367f. Firefighters' continuance privilege. As used in this Section: 1. The terms "municipality", "deferred pensioner" and "creditable service" shall have the meaning ascribed to such terms by Sections 4-103, 4-105a, and 4-108, respe…

(215 ILCS 5/367g) (from Ch. 73, par. 979g) Sec. 367g. Police officer's continuance privilege. As used in this Section: 1. The terms "municipality" and "creditable service" shall have the meaning ascribed to such terms by Sections 3-103 and 3-110, respectively, of the Illinois Pen…

(215 ILCS 5/367h) (from Ch. 73, par. 979h) Sec. 367h. Deputy's continuance privilege. As used in this Section: 1. The terms "municipality" and "creditable service" shall have the meaning ascribed to such terms by Sections 7-105 and 7-113, respectively, of the Illinois Pension Cod…

(215 ILCS 5/367i) (from Ch. 73, par. 979i) Sec. 367i. Discontinuance and replacement of coverage. Group health insurance policies issued, amended, delivered or renewed on and after the effective date of this amendatory Act of 1989, shall provide a reasonable extension of benefits…

(215 ILCS 5/367j) (from Ch. 73, par. 979j) Sec. 367j. Municipal employee's continuance privilege. (a) As used in this Section: (1) The term "creditable service" shall have the meaning ascribed to it by Section 7-113 of the Illinois Pension Code. (2) The term "municipality" means …

(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, 2037) 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.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) 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 insurer in at least one of the insurer's provider networks. "Applying provider" means …

(215 ILCS 5/370c.5) (This Section may contain text from a Public Act with a delayed effective date) Sec. 370c.5. Disability income insurance mental health and substance use disorder coverage disclosure. (a) No group or individual policy or contract of long-term disability income …