Chapter 215 — INSURANCE

(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 125/4.5-1) Sec. 4.5-1. Point-of-service health service contracts. (a) A health maintenance organization that offers a point-of-service contract: (1) must include as in-plan covered services all services required by law to be provided by a health maintenance organization…

(215 ILCS 125/5-1) (from Ch. 111 1/2, par. 1409A) Sec. 5-1. Section 155 of the Illinois Insurance Code shall apply to Health Maintenance Organizations; except that no action shall be brought for an unreasonable delay in the settling of a claim if the delay is caused by the failur…

(215 ILCS 125/5-10) Sec. 5-10. Health maintenance organizations; revenue data. (a) No health maintenance organization shall pass the cost of the assessment imposed pursuant to Article V-H of the Illinois Public Aid Code on to consumers as a discrete addition to their premiums. (b…

(215 ILCS 125/5-2) (from Ch. 111 1/2, par. 1410) Sec. 5-2. Rules and regulations or licensing of producers. The Director may promulgate such reasonable rules and regulations as are necessary to provide for the licensing of producers. (Source: P.A. 85-20.)

(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) (Text of Section from P.A. 104-1) Sec. 5-3. Insurance Code provisions. (a) Health Maintenance Organizations shall be subject to the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3, 143, 143.31, 143c, 147,…

(215 ILCS 125/5-3.1) Sec. 5-3.1. Access to obstetrical and gynecological care. Health maintenance 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 125/5-3.5) Sec. 5-3.5. 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 125/5-3.6) Sec. 5-3.6. Managed Care Reform and Patient Rights Act. Health maintenance organizations are subject to the provisions of the Managed Care Reform and Patient Rights Act. (Source: P.A. 91-617, eff. 1-1-00.)

(215 ILCS 125/5-4) (from Ch. 111 1/2, par. 1412) Sec. 5-4. Examination of affairs and quality of services by the Director; books and records. The Director shall have with respect to health maintenance organizations the powers of examination conferred upon him relative to Sections…

(215 ILCS 125/5-5) (from Ch. 111 1/2, par. 1413) Sec. 5-5. Suspension, revocation, or denial of certification of authority. The Director may suspend or revoke any certificate of authority issued to a health maintenance organization under this Act or deny an application for a cert…

(215 ILCS 125/5-6) (from Ch. 111 1/2, par. 1414) Sec. 5-6. Supervision of rehabilitation, liquidation or conservation by the Director. (a) For purposes of the rehabilitation, liquidation or conservation of a health maintenance organization, the operation of a health maintenance o…

(215 ILCS 125/5-7) (from Ch. 111 1/2, par. 1415) Sec. 5-7. Rules and regulations to carry out provisions of Act. The Director may, after notice and hearing, promulgate reasonable rules and regulations as are necessary and proper to: (1) Establish minimum coverage standards for ba…

(215 ILCS 125/5-7.1) (from Ch. 111 1/2, par. 1415.1) Sec. 5-7.1. No health care plan shall include any provision which shall have the effect of denying coverage to or on behalf of an enrollee under such plan on the basis of a failure by the enrollee to file a notice of claim with…

(215 ILCS 125/5-8) (from Ch. 111 1/2, par. 1416) Sec. 5-8. Grounds for denial, suspension or revocation of certificate of authority-Hearing-Review under Administrative Review Law. (a) When the Director has cause to believe that grounds for the denial of an application for a certi…

(215 ILCS 125/5-9) (from Ch. 111 1/2, par. 1417) Sec. 5-9. Violations-Class B misdemeanor-Cease and desist order. (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 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) 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 published material, audiovisual material and descr…

(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 130/2007) Sec. 2007. (Repealed). (Source: P.A. 91-549, eff. 8-14-99. Repealed by P.A. 97-486, eff. 1-1-12.)

(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) 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 provided by an LHSO; (2) shall provide incentives,…

(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.…