Chapter 215, INSURANCE

(215 ILCS 125/4-10) (from Ch. 111 1/2, par. 1409.3) Sec. 4-10. Medical necessity; dispute resolution; independent second opinion. Each Health Maintenance Organization shall provide a mechanism for the timely review by a physician holding the same class of license as the primary c…

(215 ILCS 125/4-11) (from Ch. 111 1/2, par. 1409.4) Sec. 4-11. Any person who enrolls recipients of Public Aid or Medicare in a health maintenance organization, either personally or by mail, shall, on or after July 1, 1989, be licensed as a limited insurance representative under …

(215 ILCS 125/4-12) (from Ch. 111 1/2, par. 1409.5) Sec. 4-12. Changes in rate methodology and benefits, material modifications. A health maintenance organization shall file with the Director, prior to use, a notice of any change in rate methodology, or benefits and of any materi…

(215 ILCS 125/4-13) (from Ch. 111 1/2, par. 1409.6) Sec. 4-13. Prior approval of policy forms. No health maintenance organization shall issue or deliver in this State a group contract or evidence of coverage, attach an endorsement or rider thereto, incorporate by reference bylaws…

(215 ILCS 125/4-14) (from Ch. 111 1/2, par. 1409.7) Sec. 4-14. Evidence of Coverage. (a) Every subscriber shall be issued an evidence of coverage, which shall contain a clear and complete statement of: (1) The health services to which each enrollee is entitled; (2) Eligibility re…

(215 ILCS 125/4-15) (from Ch. 111 1/2, par. 1409.8) (Text of Section before amendment by P.A. 104-732) Sec. 4-15. (a) No contract or evidence of coverage for basic health care services delivered, issued for delivery, renewed or amended by a Health Maintenance Organization shall e…

(215 ILCS 125/4-16) (from Ch. 111 1/2, par. 1409.9) Sec. 4-16. Fibrocystic condition; denial of coverage. No contract or evidence of coverage issued by a Health Maintenance Organization shall be denied by the Organization, nor shall any contract or evidence of coverage contain an…

(215 ILCS 125/4-17) Sec. 4-17. Basic outpatient preventive and primary health care services for children. In order to attempt to address the needs of children in Illinois (i) without health care coverage, either through a parent's employment, through medical assistance under the …

(215 ILCS 125/4-18) Sec. 4-18. Retirement facility residents. With respect to an enrollee who is a resident of a retirement facility consisting of a long-term care facility, as defined in the Nursing Home Care Act, and residential apartments, a contract or evidence of coverage is…

(215 ILCS 125/4-19) Sec. 4-19. Purchase of ophthalmic goods or services. A health maintenance organization may not require a provider, as a condition of participation in the health maintenance organization's health care plan, to purchase ophthalmic goods or services, including bu…

(215 ILCS 125/4-2) (from Ch. 111 1/2, par. 1408.2) Sec. 4-2. Medical assistance; coverage of child. (a) In this Section, "Medicaid" means medical assistance authorized under Section 1902 of the Social Security Act. (b) A contract or evidence of coverage delivered, issued for deli…

(215 ILCS 125/4-20) Sec. 4-20. Deductibles and copayments. (a) A Health Maintenance Organization may require deductibles and copayments of enrollees as a condition for the receipt of specific health care services, including basic health care services. Deductibles and copayments s…

(215 ILCS 125/4-4) (from Ch. 111 1/2, par. 1408.4) Sec. 4-4. Sexual assault or abuse victims; coverage of expenses; recovery of State funds; reimbursement of Department of Public Health. (1) Contracts or evidences of coverage issued by a health maintenance organization, which pro…

(215 ILCS 125/4-5) (from Ch. 111 1/2, par. 1408.5) Sec. 4-5. Organ Transplants. No contract or evidence of coverage issued by a health maintenance organization which provides coverage for health care services shall deny reimbursement for an otherwise covered expense incurred for …

(215 ILCS 125/4-6) (from Ch. 111 1/2, par. 1408.6) Sec. 4-6. Complaint handling procedure. (a) Every health maintenance organization shall establish and maintain a complaint system providing reasonable procedures for resolving complaints initiated by enrollees. Nothing herein sha…

(215 ILCS 125/4-6.1) (from Ch. 111 1/2, par. 1408.7) Sec. 4-6.1. Mammograms; mastectomies. (a) Every contract or evidence of coverage issued by a Health Maintenance Organization for persons who are residents of this State shall contain coverage for screening by low-dose mammograp…

(215 ILCS 125/4-6.2) (from Ch. 111 1/2, par. 1408.8) Sec. 4-6.2. Breast implant removal. No contract offered by Health Maintenance Organizations shall deny coverage for the removal of breast implants when the removal of the implants is medically necessary treatment for a sickness…

(215 ILCS 125/4-6.3) Sec. 4-6.3. Prescription drugs; cancer treatment. No health maintenance organization that provides coverage for prescribed drugs approved by the federal Food and Drug Administration for the treatment of certain types of cancer shall exclude coverage of any dr…

(215 ILCS 125/4-6.4) Sec. 4-6.4. Post-parturition care. A health maintenance organization is subject to the provisions of Section 356s of the Illinois Insurance Code. (Source: P.A. 89-513, eff. 9-15-96; 90-14, eff. 7-1-97.)

(215 ILCS 125/4-6.5) Sec. 4-6.5. Required health benefits; Illinois Insurance Code requirements. A health maintenance organization is subject to the provisions of Sections 155.37, 356g.5, 356t, 356u, and 356z.1 of the Illinois Insurance Code. (Source: P.A. 95-189, eff. 8-16-07.)…

(215 ILCS 125/4-7) (from Ch. 111 1/2, par. 1409) Sec. 4-7. Solicitations of enrollees. Solicitations of enrollees by a Health Maintenance Organization authorized under this Act, or its representatives shall not be construed to be violative of any provisions of law relating to sol…

(215 ILCS 125/4-8) (from Ch. 111 1/2, par. 1409.1) Sec. 4-8. Newborn Infants. (1) No contract or evidence of coverage issued by a Health Maintenance Organization which provides for coverage of dependents of the principal enrollee shall contain any disclaimer, waiver or other limi…

(215 ILCS 125/4-9) (from Ch. 111 1/2, par. 1409.2) Sec. 4-9. Adopted children. No contract or evidence of coverage issued by a Health Maintenance Organization which provides for coverage of dependents of the principal enrollees shall exclude a child from coverage or eligibility f…

(215 ILCS 125/4-9.1) (from Ch. 111 1/2, par. 1409.2-1) Sec. 4-9.1. Dependent Coverage Termination. (a) The attainment of a limiting age under a group contract or evidence of coverage which provides that coverage of a dependent person of an enrollee shall terminate upon attainment…

(215 ILCS 125/4-9.2) (from Ch. 111 1/2, par. 1409.2-2) Sec. 4-9.2. Continuation of group HMO coverage after termination of employee or membership. A group contract delivered, issued for delivery, renewed, or amended in this State that covers employees or members for health care s…

(215 ILCS 155/4.1) Sec. 4.1. Minimum capital and surplus. Before doing business in the State of Illinois, a title insurance company must satisfy the Secretary that it has a minimum capital and surplus of $2,000,000. The Secretary may provide the forms and standards for this purpo…

(215 ILCS 159/40) Sec. 40. Disclosure to insurer. Prior to the initiation of a plan, transaction, or series of transactions a viatical settlement broker or viatical settlement provider shall fully disclose to an insurer a plan, transaction, or series of transactions to which the …

(215 ILCS 113/40) Sec. 40. Insurer or service carrier audit. Insurers shall audit policies issued through the residual market pursuant to Section 30 of this Act within 90 days of the policy effective date and may conduct quarterly audits thereafter. Insurers may audit policies is…

(215 ILCS 200/40) Sec. 40. Requirements for adverse determination. If a health insurance issuer or its contracted utilization review organization makes an adverse determination, the health insurance issuer or its contracted utilization review organization shall include the follow…

(215 ILCS 111/40) (This Section may contain text from a Public Act with a delayed effective date) Sec. 40. Payment. Nothing in this Act requires a dental care provider to only accept electronic payment from a dental plan carrier. (Source: P.A. 104-203, eff. 1-1-27.)

(215 ILCS 185/40) Sec. 40. (Amendatory provisions; text omitted). (Source: P.A. 99-893, eff. 1-1-17; text omitted.)

(215 ILCS 110/40) (from Ch. 32, par. 690.40) Sec. 40. Every dental service plan corporation shall, at the written request of a subscriber, furnish a list of the names and addresses of all of the dentists in the geographic area of the subscriber's residence who have agreements wit…

(215 ILCS 152/40) Sec. 40. Incidental benefits. A service contract may provide full or partial reimbursement for other expenses incurred by the service contract holder as a direct and proximate result of an operational or structural failure if covered by the service contract. A r…

(215 ILCS 5/40) (from Ch. 73, par. 652) (Section scheduled to be repealed on January 1, 2037) Sec. 40. Directors or trustees. (1) After the date of incorporation, as determined by Section 48, and until the first meeting of the members, the incorporators shall have the powers and …

(215 ILCS 134/40) Sec. 40. Access to specialists. (a) All health care plans that require each enrollee to select a health care provider for any purpose including coordination of care shall permit an enrollee to choose any available primary care physician licensed to practice medi…

(215 ILCS 109/40) Sec. 40. Coverage; prior authorization. A managed care dental plan shall: (1) cover palliative treatment for emergency dental services, as included in its certificate of coverage, without regard to whether the provider furnishing the services has a contractual o…

(215 ILCS 124/40) Sec. 40. Confidentiality. (a) All records in the custody or possession of the Department are presumed to be open to public inspection or copying unless exempt from disclosure by Section 7 or 7.5 of the Freedom of Information Act. Except as otherwise provided in …

(215 ILCS 157/40) Sec. 40. Filing. (a) Insurers that use insurance scores to underwrite and rate risks must file their scoring models (or other scoring processes) with the Department. A third party may file scoring models on behalf of insurers. A filing that includes insurance sc…

(215 ILCS 106/40) Sec. 40. Waivers. The Department shall request any necessary waivers of federal requirements in order to allow receipt of federal funding. (Source: P.A. 96-328, eff. 8-11-09; 97-689, eff. 6-14-12.)

(215 ILCS 97/40) Sec. 40. Guaranteed availability of coverage for employers in the group market. (A) Issuance of coverage in the small group market. (1) In general. Subject to subsections (C) through (F), each health insurance issuer that offers health insurance coverage in the s…

(215 ILCS 93/40) Sec. 40. Director's Regulatory Authority. The Director may adopt and promulgate rules and regulations to carry out the provisions of this Act. (Source: P.A. 91-510, eff. 1-1-00.)

(215 ILCS 161/40) (Text of Section before amendment by P.A. 104-851) Sec. 40. Prohibitions; medical plan preconditions. (a) No vision care organization that issues, delivers, amends, or renews a vision care plan on or after the effective date of this Act shall issue a vision care…

(215 ILCS 215/40) Sec. 40. Penalties. In the case of a violation of this Act, a licensee may be penalized in accordance with the provisions of the Illinois Insurance Code, including Section 403A of the Illinois Insurance Code. (Source: P.A. 103-142, eff. 1-1-24.)

(215 ILCS 220/40) (This Section may contain text from a Public Act with a delayed effective date) Sec. 40. Administration and enforcement. (a) The Department of Insurance shall enforce the provisions of this Act pursuant to the enforcement powers granted to it by law, including, …

(215 ILCS 100/40) (from Ch. 73, par. 1640) Sec. 40. Prohibited acts. An intermediary manager shall not: (1) Cede retrocessions on behalf of the reinsurer, except that it may cede facultative retrocessions pursuant to obligatory facultative agreements if the contract with the rein…

(215 ILCS 180/40) Sec. 40. Expedited external review. (a) A covered person or a covered person's authorized representative may file a request for an expedited external review with the Director either orally or in writing: (1) immediately after the date of receipt of a notice prio…

(215 ILCS 5/400) (from Ch. 73, par. 1012) Sec. 400. Supplemental or comprehensive contracts. Forms for supplemental contracts or comprehensive contracts whereby the property described may be insured against one or more risks specified in Class 2 or Class 3 of Section 4, in additi…

(215 ILCS 5/400.1) (from Ch. 73, par. 1012.1) Sec. 400.1. Group or master policy-certificate inland marine insurance authorized. (1) Any insurance company authorized to write inland marine insurance in this State may issue group or master policy-certificate inland marine policies…

(215 ILCS 5/401) (from Ch. 73, par. 1013) Sec. 401. General powers of the director. The Director is charged with the rights, powers and duties appertaining to the enforcement and execution of all the insurance laws of this State. He shall have the power (a) to make reasonable rul…

(215 ILCS 5/401.1) (from Ch. 73, par. 1013.1) Sec. 401.1. (1) This Section applies to all companies and persons subject to examination by the Director, or purporting to do insurance business in this State, or in the process of organization with intent to do such business therein,…