Chapter 215 — INSURANCE

(215 ILCS 165/15.7) (from Ch. 32, par. 609.7) Sec. 15.7. No claim shall be denied, under a contract issued or renewed by a voluntary health services plan after the effective day of this amendatory Act, for treatment or services for rehabilitation following either a physical or me…

(215 ILCS 165/15.8) (from Ch. 32, par. 609.8) Sec. 15.8. Sexual assault or abuse victims. (1) Policies, contracts or subscription certificates issued by a health services plan corporation, which provide benefits for hospital or medical expenses based upon the actual expenses incu…

(215 ILCS 165/15.9) (from Ch. 32, par. 609.9) Sec. 15.9. Coverage of services for mental illness. To the extent not inconsistent with this Act every Health Service Corporation shall be subject to the provisions of Section 370c of the "Illinois Insurance Code", approved June 29, 1…

(215 ILCS 165/15.9-1) (from Ch. 32, par. 609.9-1) Sec. 15.9-1. No service plan contract or any renewal thereof shall be denied or cancelled by a health service plan corporation, nor shall any such contract contain any exception or exclusion of benefits, solely because the mother …

(215 ILCS 165/15a) (from Ch. 32, par. 609a) Sec. 15a. Dependent Coverage Termination. (a) The attainment of a limiting age under a voluntary health services plan which provides that coverage of a dependent of a subscriber terminates upon attainment of the limiting age for depende…

(215 ILCS 165/16) (from Ch. 32, par. 610) Sec. 16. In every subscription certificate, referred to in Section 15: (a) All printed portions shall be plainly printed in type of which the face is not smaller than ten point; (b) There shall be a brief description of the subscription c…

(215 ILCS 165/17) (from Ch. 32, par. 611) Sec. 17. A health services plan corporation may enter into agreements with qualified physicians, podiatric physicians, dentists, dental surgeons, pharmacists, hospitals, nurses, registered optometrists, dental hygienists and assistants or…

(215 ILCS 165/18) (from Ch. 32, par. 612) Sec. 18. No corporation subject to the provisions of this Act shall, except under the approval of the Director, disburse during any one calendar year more than 10% of the aggregate amount of payments received from subscribers during that …

(215 ILCS 165/19) (from Ch. 32, par. 613) Sec. 19. No such corporation shall disburse as administrative expenses during any one year, except upon approval of the Director, a sum greater than 20% of payments received from subscribers during that year. The term "administrative expe…

(215 ILCS 165/2) (from Ch. 32, par. 596) Sec. 2. For the purposes of this Act, the following terms have the respective meanings set forth in this section, unless different meanings are plainly indicated by the context: (a) "Health Services Plan Corporation" means a corporation or…

(215 ILCS 165/20) (from Ch. 32, par. 614) Sec. 20. The funds of any health services plan corporation shall be handled in accordance with the following rules: (a) All loans made to original capital of the corporation may be repayable only out of earned surplus. (b) The funds of th…

(215 ILCS 165/21) Sec. 21. (Repealed). (Source: Laws 1951, p. 569. Repealed by P.A. 97-486, eff. 1-1-12.)

(215 ILCS 165/22) Sec. 22. (Repealed). (Source: Laws 1951, p. 569. Repealed by P.A. 97-486, eff. 1-1-12.)

(215 ILCS 165/23) (from Ch. 32, par. 617) Sec. 23. To the extent that the same are applicable and not inconsistent with the provisions of this Act, all proceedings for the rehabilitation, liquidation, conservation or dissolution of health services plan corporations shall be subje…

(215 ILCS 165/24) (from Ch. 32, par. 618) Sec. 24. Every health services plan corporation shall pay to the Director the fees and charges set forth in Sections 408 and 408.2 of the Illinois Insurance Code. (Source: P.A. 84-989.)

(215 ILCS 165/25) (from Ch. 32, par. 619) Sec. 25. A health services plan corporation may receive and accept from governmental or private agencies or from other persons as defined in this Act, payments covering all or part of the cost of subscriptions to provide health services f…

(215 ILCS 165/26) (from Ch. 32, par. 620) Sec. 26. A health services plan corporation incorporated prior to January 1, 1965, operated on a not for profit basis, and neither owned or controlled by a hospital shall not be liable for injuries resulting from negligence, misfeasance, …

(215 ILCS 165/27) (from Ch. 32, par. 621) Sec. 27. Health services plan corporations organized under this Act shall be operated and conducted not-for-profit and shall be governed by the provisions of the "General Not for Profit Corporation Act", approved July 17, 1943, as amended…

(215 ILCS 165/28) (from Ch. 32, par. 622) Sec. 28. Any person or any agent or officer of the corporation who violates any provisions of this Act, or who makes any false statement with respect to any report or statement required by this Act or required by the Director under this A…

(215 ILCS 165/29) (from Ch. 32, par. 623) Sec. 29. The provisions of this Act shall be severable, and if any provision of this Act is declared unconstitutional or the applicability thereof to any person or circumstances is held invalid, the constitutionality of the remainder of t…

(215 ILCS 165/3) (from Ch. 32, par. 597) Sec. 3. It shall be unlawful for any person, except a health services plan corporation, incorporated under this Act, to establish, maintain or operate a voluntary health services plan. This prohibition, however, shall not be construed as p…

(215 ILCS 165/3.1) (from Ch. 32, par. 597.1) Sec. 3.1. No new plans may be chartered. No voluntary health services plan shall be issued a charter for the purpose of doing business under this Act after the effective date of this Amendatory Act of 1989. (Source: P.A. 86-600.)

(215 ILCS 165/30) (from Ch. 32, par. 624) Sec. 30. Every final administrative decision of the Director shall be subject to judicial review only under and in accordance with the Administrative Review Law. The Administrative Review Law and all amendments and modifications thereof, …

(215 ILCS 165/4) (from Ch. 32, par. 598) Sec. 4. Five or more persons of legal age all of whom are residents of Illinois and citizens of the United States may incorporate under the provisions of this Act a health services plan corporation for the purpose of establishing and opera…

(215 ILCS 165/5) (from Ch. 32, par. 599) Sec. 5. The business and affairs of a health services plan corporation shall be managed by a board of trustees, which shall have the power to adopt, and to amend from time to time, by-laws governing the conduct of the corporation's busines…

(215 ILCS 165/6) (from Ch. 32, par. 600) Sec. 6. A health services plan corporation may, in the discretion of its board of trustees, through its by-laws, limit or define the classes of persons who shall be eligible to become subscribers or beneficiaries, limit and define the bene…

(215 ILCS 165/7) (from Ch. 32, par. 601) Sec. 7. Every physician licensed in Illinois to practice medicine in all of its branches, every podiatric physician licensed to practice podiatric medicine in Illinois, and every dentist and dental surgeon licensed to practice in Illinois …

(215 ILCS 165/8) (from Ch. 32, par. 602) Sec. 8. Except as otherwise provided by Section 3 of this Act, no person shall offer to the public any voluntary health service plan or otherwise engage in the business of a health service plan corporation without having first received a c…

(215 ILCS 165/9) (from Ch. 32, par. 603) Sec. 9. After the issuance of a charter, the Director as he deems in the public interest may authorize or require a health services plan corporation to charge rates or to utilize soliciting methods different from those on which the charter…

(215 ILCS 175/1) Sec. 1. Short title. This Act may be cited as the Organ Transplant Medication Notification Act. (Source: P.A. 96-766, eff. 1-1-10.)

(215 ILCS 175/10) Sec. 10. Definitions. For the purpose of this Act: "Health insurance policy or health care service plan" means any policy of health or accident insurance subject to the provisions of the Illinois Insurance Code, Health Maintenance Organization Act, Voluntary Hea…

(215 ILCS 175/15) Sec. 15. Quality assurance in patient care. In accordance with the Pharmacy Practice Act, when a prescribing physician has indicated on a prescription "may not substitute", a health insurance policy or health care service plan that covers immunosuppressant drugs…

(215 ILCS 175/20) Sec. 20. Provision of notice; formulary changes. (a) At least 60 days prior to making any formulary change that alters the terms of coverage for a patient receiving immunosuppressant drugs or discontinues coverage for a prescribed immunosuppressant drug that a p…

(215 ILCS 175/5) Sec. 5. Applicability. This Act shall apply solely to cases of immunosuppressive therapy when (i) an immunosuppressant drug has been prescribed to a patient to prevent the rejection of transplanted organs and tissues and (ii) as set forth in Section 15 of this Ac…

(215 ILCS 180/1) Sec. 1. Short title. This Act may be cited as the Health Carrier External Review Act. (Source: P.A. 96-857, eff. 7-1-10.)

(215 ILCS 180/10) Sec. 10. Definitions. For the purposes of this Act: "Adverse determination" means: (1) a determination by a health carrier or its designee utilization review organization that, based upon the health information provided for a covered person, a request for a bene…

(215 ILCS 180/15) Sec. 15. Applicability and scope. (a) Except as provided in subsection (b) of this Section, this Act shall apply to all health carriers. (b) The provisions of this Act shall not apply to a policy or certificate that provides coverage only for a specified disease…

(215 ILCS 180/20) Sec. 20. Notice of right to external review. (a) At the same time the health carrier sends written notice of a covered person's right to appeal a coverage decision upon an adverse determination or a final adverse determination, a health carrier shall notify a co…

(215 ILCS 180/25) Sec. 25. Request for external review. A covered person or the covered person's authorized representative may make a request for a standard external or expedited external review of an adverse determination or final adverse determination. Except as set forth in Se…

(215 ILCS 180/30) Sec. 30. Exhaustion of internal appeal process. (a) Except as provided in subsection (b) of this Section, a request for an external review shall not be made until the covered person has exhausted the health carrier's internal appeal process. (b) A covered person…

(215 ILCS 180/35) Sec. 35. Standard external review. (a) Within 4 months after the date of receipt of a notice of an adverse determination or final adverse determination, a covered person or the covered person's authorized representative may file a request for an external review …

(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 180/42) Sec. 42. External review of experimental or investigational treatment adverse determinations. (a) Within 4 months after the date of receipt of a notice of an adverse determination or final adverse determination that involves a denial of coverage based on a deter…

(215 ILCS 180/45) Sec. 45. Binding nature of external review decision. An external review decision is binding on the health carrier. An external review decision is binding on the covered person except to the extent the covered person has other remedies available under applicable …

(215 ILCS 180/5) Sec. 5. Purpose and intent. The purpose of this Act is to provide uniform standards for the establishment and maintenance of external review procedures to assure that covered persons have the opportunity for an independent review of an adverse determination or fi…

(215 ILCS 180/50) Sec. 50. Approval of independent review organizations. (a) The Director shall approve independent review organizations eligible to be assigned to conduct external reviews under this Act. (b) In order to be eligible for approval by the Director under this Section…

(215 ILCS 180/55) Sec. 55. Minimum qualifications for independent review organizations. (a) To be approved to conduct external reviews, an independent review organization shall have and maintain written policies and procedures that govern all aspects of both the standard external…

(215 ILCS 180/60) Sec. 60. Hold harmless for independent review organizations. No independent review organization or clinical reviewer working on behalf of an independent review organization or an employee, agent or contractor of an independent review organization shall be liable…

(215 ILCS 180/65) Sec. 65. External review reporting requirements. (a) Each health carrier shall maintain written records in the aggregate, by state, and for each type of health benefit plan offered by the health carrier on all requests for external review that the health carrier…

(215 ILCS 180/70) Sec. 70. Funding of external review. The health carrier shall be solely responsible for paying the cost of external reviews conducted by independent review organizations. (Source: P.A. 96-857, eff. 7-1-10.)