Chapter 215 — INSURANCE

(215 ILCS 130/4003) (from Ch. 73, par. 1504-3) (Text of Section from P.A. 104-1, 104-42, 104-73, 104-289, 104-324, and 104-379) Sec. 4003. Illinois Insurance Code provisions. Limited health service organizations shall be subject to the provisions of Sections 133, 134, 136, 137, 1…

(215 ILCS 130/4004) (from Ch. 73, par. 1504-4) Sec. 4004. Examination of affairs and quality of services by the Director; books and records. (a) The Director shall have, with respect to limited health service organizations, the powers of examination conferred upon him pursuant to…

(215 ILCS 130/4005) (from Ch. 73, par. 1504-5) Sec. 4005. Suspension or revocation or denial of certification of authority. (a) The Director may suspend or revoke any certificate of authority issued to a limited health service organization under this Act or deny an application fo…

(215 ILCS 130/4006) (from Ch. 73, par. 1504-6) Sec. 4006. Supervision of rehabilitation, liquidation or conservation by the Director. (a) For purposes of the rehabilitation, liquidation or conservation of a limited health service organization, the operation of a limited health se…

(215 ILCS 130/4007) (from Ch. 73, par. 1504-7) Sec. 4007. Rules and regulations. (a) The Director may promulgate reasonable rules and regulations as are necessary and proper to establish specific standards, including standards for the full and fair disclosure of limited health se…

(215 ILCS 130/4008) (from Ch. 73, par. 1504-8) Sec. 4008. Grounds for denial, suspension or revocation of certificate of authority under Administrative Review Law. (a) When the Director has cause to believe that grounds for the denial of an application for a certificate of author…

(215 ILCS 130/4009) (from Ch. 73, par. 1504-9) Sec. 4009. Violations; cease and desist order; corrective orders. (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 132/1) Sec. 1. Short title. This Act may be cited as the Illinois Long-Term Care Partnership Program Act. (Source: P.A. 95-200, eff. 8-16-07.)

(215 ILCS 132/10) Sec. 10. Definitions. As used in this Act: "Agency" means the Department of Healthcare and Family Services. "Asset disregard" means, with respect to qualification for State Medicaid benefits, the disregard of any assets or resources in an amount equal to the ins…

(215 ILCS 132/15) Sec. 15. Illinois Long-term Care Partnership Program. (a) In accordance with Title VI, Section 6021 of the federal Deficit Reduction Act of 2005, there shall be established the Illinois Long-Term Care Partnership Program, to be administered by the Agency with th…

(215 ILCS 132/20) Sec. 20. Administration. (a) The Agency and the Department are authorized to adopt regulations to implement the provisions of this Act and rules for its administration. (b) The Agency and Department must comply with all federal rules developed in accordance with…

(215 ILCS 132/25) Sec. 25. The Partnership for Long-Term Care Act is repealed. (Source: P.A. 95-200, eff. 8-16-07.)

(215 ILCS 132/5) Sec. 5. Findings. The General Assembly finds that our nation's current financing structure relies too heavily on individuals and families to bear the financial burden of long-term supportive services. The financial burden can be so large that, for many individual…

(215 ILCS 132/99) Sec. 99. Effective date. This Act takes effect upon becoming law. (Source: P.A. 95-200, eff. 8-16-07.)

(215 ILCS 134/1) Sec. 1. Short title. This Act may be cited as the Managed Care Reform and Patient Rights Act. (Source: P.A. 91-617, eff. 1-1-00.)

(215 ILCS 134/10) Sec. 10. Definitions. In this Act: For a health care plan under Section 45 or for a utilization review program under Section 85, "adverse determination" has the meaning given to that term in Section 10 of the Health Carrier External Review Act. "Clinical peer" m…

(215 ILCS 134/100) Sec. 100. Prohibition of waiver of rights. No health care plan or contract shall contain any provision, policy, or procedure that limits, restricts, or waives any of the rights set forth in this Act. Any such policy or procedure shall be void and unenforceable.…

(215 ILCS 134/105) Sec. 105. Administration and enforcement. The Director of Insurance may adopt rules necessary to implement the Department's responsibilities under this Act. To enforce the provisions of this Act, the Director may issue a cease and desist order or require a heal…

(215 ILCS 134/110) Sec. 110. Applicability and scope. This Act applies to policies and contracts amended, delivered, issued, or renewed on or after the effective date of this Act. This Act does not diminish a health care plan's duties and responsibilities under other federal or S…

(215 ILCS 134/115) Sec. 115. Effect on benefits under Workers' Compensation Act and Workers' Occupational Diseases Act. Nothing in this Act shall be construed to expand, modify, or restrict the health care benefits provided to employees under the Workers' Compensation Act and Wor…

(215 ILCS 134/120) Sec. 120. Severability. The provisions of this Act are severable under Section 1.31 of the Statute on Statutes. (Source: P.A. 91-617, eff. 1-1-00.)

(215 ILCS 134/15) Sec. 15. Provision of information. (a) A health care plan shall provide annually to enrollees and prospective enrollees, upon request, a complete list of participating health care providers in the health care plan's service area and a description of the followin…

(215 ILCS 134/20) Sec. 20. Notice of nonrenewal or termination. A health care plan must give at least 60 days notice of nonrenewal or termination of a health care provider to the health care provider and to the enrollees served by the health care provider. The notice shall includ…

(215 ILCS 134/200) Sec. 200. (Amendatory provisions; text omitted). (Source: P.A. 91-617, eff. 8-19-99; text omitted.)

(215 ILCS 134/205) Sec. 205. (Amendatory provisions; text omitted). (Source: P.A. 91-617, eff. 1-1-00; text omitted.)

(215 ILCS 134/210) Sec. 210. (Amendatory provisions; text omitted). (Source: P.A. 91-617, eff. 1-1-00; text omitted.)

(215 ILCS 134/215) Sec. 215. (Amendatory provisions, text omitted). (Source: P.A. 91-617, eff. 1-1-00; text omitted.)

(215 ILCS 134/220) Sec. 220. (Amendatory provisions; text omitted.) (Source: P.A. 91-617, eff. 1-1-00; text omitted.)

(215 ILCS 134/225) Sec. 225. (Amendatory provisions; text omitted.) (Source: P.A. 91-617, eff. 1-1-00; text omitted.)

(215 ILCS 134/230) Sec. 230. (Amendatory provisions; text omitted). (Source: P.A. 91-617, eff. 1-1-00; text omitted.)

(215 ILCS 134/235) Sec. 235. (Amendatory provisions; text omitted). (Source: P.A. 91-617, eff. 1-1-00; text omitted.)

(215 ILCS 134/240) Sec. 240. (Amendatory provisions; text omitted). (Source: P.A. 91-617, eff. 1-1-00; text omitted.)

(215 ILCS 134/245) Sec. 245. (Amendatory provisions; text omitted). (Source: P.A. 91-617, eff. 1-1-00; text omitted.)

(215 ILCS 134/25) Sec. 25. Transition of services. (a) A health care plan shall provide for continuity of care for its enrollees as follows: (1) If an enrollee's health care provider leaves the health care plan's network of health care providers for reasons other than termination…

(215 ILCS 134/250) Sec. 250. (Amendatory provisions; text omitted.) (Source: P.A. 91-617, eff. 1-1-00; text omitted.)

(215 ILCS 134/299) Sec. 299. Effective date. This Section and Section 200 of this Act take effect upon becoming law; Sections 25 and 85 take effect July 1, 2000; and the remaining Sections of this Act take effect January 1, 2000. (Source: P.A. 91-617, eff. 8-19-99.)

(215 ILCS 134/30) Sec. 30. Prohibitions. (a) No health care plan or its subcontractors may prohibit or discourage health care providers by contract or policy from discussing any health care services and health care providers, utilization review and quality assurance policies, ter…

(215 ILCS 134/35) Sec. 35. Medically appropriate health care protection. (a) No health care plan or its subcontractors shall retaliate against a physician or other health care provider who advocates for appropriate health care services for patients. (b) It is the public policy of…

(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 134/43) Sec. 43. Utilization of health care facilities. (a) A health care plan must provide its enrollees with a description of their rights and responsibilities in obtaining referrals to and making appropriate use of health care facilities when access to their primary …

(215 ILCS 134/45) Sec. 45. Health care services appeals, complaints, and external independent reviews. (a) A health care plan shall establish and maintain an appeals procedure as outlined in this Act. Compliance with this Act's appeals procedures shall satisfy a health care plan'…

(215 ILCS 134/45.1) Sec. 45.1. Medical exceptions procedures required. (a) Notwithstanding any other provision of law, on or after January 1, 2018 (the effective date of Public Act 99-761), every insurer licensed in this State to sell a policy of group or individual accident and …

(215 ILCS 134/45.2) Sec. 45.2. Prior authorization form; prescription benefits. (a) Notwithstanding any other provision of law, on and after January 1, 2015, a health insurer that provides prescription drug benefits must, within 72 hours after receipt of a paper or electronic pri…

(215 ILCS 134/45.3) Sec. 45.3. Prescription drug benefits; plan choice. (a) Notwithstanding any other provision of law, beginning January 1, 2023, every health insurance carrier that offers an individual health plan that provides coverage for prescription drugs shall ensure that …

(215 ILCS 134/5) Sec. 5. Health care patient rights. (a) The General Assembly finds that: (1) A patient has the right to care consistent with professional standards of practice to assure quality nursing and medical practices, to choose the participating physician responsible for …

(215 ILCS 134/50) Sec. 50. Administrative complaints and Departmental review. (a) Administrative complaint process. (1) A health care plan shall accept and review appeals of its determinations and complaints related to administrative issues initiated by enrollees or their health …

(215 ILCS 134/55) Sec. 55. Record of complaints. (a) The Department shall maintain records concerning the complaints filed against health care plans. To that end, the Department shall require health care plans to annually report complaints made to and resolutions by health care p…

(215 ILCS 134/60) Sec. 60. Choosing a physician. (a) A health care plan may also offer other arrangements under which enrollees may access health care services from contracted providers without a referral or authorization from their primary care physician. (b) The enrollee may be…

(215 ILCS 134/65) Sec. 65. Emergency services prior to stabilization. (a) A health care plan that provides or that is required by law to provide coverage for emergency services shall provide coverage such that payment under this coverage is not dependent upon whether the services…

(215 ILCS 134/70) Sec. 70. Post-stabilization medical services. (a) If prior authorization for covered post-stabilization services is required by the health care plan, the plan shall provide access 24 hours a day, 7 days a week to persons designated by the plan to make such deter…