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Illinois House Bill HB5493

Illinois 2023-2024 Regular Session

Illinois House Bill HB5493 Compare Versions

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1-Public Act 103-0718
21 HB5493 EnrolledLRB103 39189 RPS 69335 b HB5493 Enrolled LRB103 39189 RPS 69335 b
32 HB5493 Enrolled LRB103 39189 RPS 69335 b
4-AN ACT concerning regulation.
5-Be it enacted by the People of the State of Illinois,
6-represented in the General Assembly:
7-Section 5. The State Employees Group Insurance Act of 1971
8-is amended by changing Sections 6.7 and 6.11 as follows:
9-(5 ILCS 375/6.7)
10-Sec. 6.7. Access to obstetrical and gynecological care
11-Woman's health care provider. The program of health benefits
12-is subject to the provisions of Section 356r of the Illinois
13-Insurance Code.
14-(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
15-(5 ILCS 375/6.11)
16-Sec. 6.11. Required health benefits; Illinois Insurance
17-Code requirements. The program of health benefits shall
18-provide the post-mastectomy care benefits required to be
19-covered by a policy of accident and health insurance under
20-Section 356t of the Illinois Insurance Code. The program of
21-health benefits shall provide the coverage required under
22-Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
23-356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
24-356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
25-356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
3+1 AN ACT concerning regulation.
4+2 Be it enacted by the People of the State of Illinois,
5+3 represented in the General Assembly:
6+4 Section 5. The State Employees Group Insurance Act of 1971
7+5 is amended by changing Sections 6.7 and 6.11 as follows:
8+6 (5 ILCS 375/6.7)
9+7 Sec. 6.7. Access to obstetrical and gynecological care
10+8 Woman's health care provider. The program of health benefits
11+9 is subject to the provisions of Section 356r of the Illinois
12+10 Insurance Code.
13+11 (Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
14+12 (5 ILCS 375/6.11)
15+13 Sec. 6.11. Required health benefits; Illinois Insurance
16+14 Code requirements. The program of health benefits shall
17+15 provide the post-mastectomy care benefits required to be
18+16 covered by a policy of accident and health insurance under
19+17 Section 356t of the Illinois Insurance Code. The program of
20+18 health benefits shall provide the coverage required under
21+19 Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
22+20 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
23+21 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
24+22 356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
2625
2726
2827
2928 HB5493 Enrolled LRB103 39189 RPS 69335 b
3029
3130
32-356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
33-356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
34-356z.60, and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68,
35-and 356z.70 of the Illinois Insurance Code. The program of
36-health benefits must comply with Sections 155.22a, 155.37,
37-355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the
38-Illinois Insurance Code. The program of health benefits shall
39-provide the coverage required under Section 356m of the
40-Illinois Insurance Code and, for the employees of the State
41-Employee Group Insurance Program only, the coverage as also
42-provided in Section 6.11B of this Act. The Department of
43-Insurance shall enforce the requirements of this Section with
44-respect to Sections 370c and 370c.1 of the Illinois Insurance
45-Code; all other requirements of this Section shall be enforced
46-by the Department of Central Management Services.
47-Rulemaking authority to implement Public Act 95-1045, if
48-any, is conditioned on the rules being adopted in accordance
49-with all provisions of the Illinois Administrative Procedure
50-Act and all rules and procedures of the Joint Committee on
51-Administrative Rules; any purported rule not so adopted, for
52-whatever reason, is unauthorized.
53-(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
54-102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
55-1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
56-eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
57-102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
58-
59-
60-1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
61-eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
62-103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
63-8-11-23; revised 8-29-23.)
64-Section 10. The Counties Code is amended by changing
65-Sections 5-1069.3 and 5-1069.5 as follows:
66-(55 ILCS 5/5-1069.3)
67-Sec. 5-1069.3. Required health benefits. If a county,
68-including a home rule county, is a self-insurer for purposes
69-of providing health insurance coverage for its employees, the
70-coverage shall include coverage for the post-mastectomy care
71-benefits required to be covered by a policy of accident and
72-health insurance under Section 356t and the coverage required
73-under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
74-356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
75-356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
76-356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 356z.36,
77-356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
78-356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
79-356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
80-of the Illinois Insurance Code. The coverage shall comply with
81-Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
82-Insurance Code. The Department of Insurance shall enforce the
83-requirements of this Section. The requirement that health
84-
85-
86-benefits be covered as provided in this Section is an
87-exclusive power and function of the State and is a denial and
88-limitation under Article VII, Section 6, subsection (h) of the
89-Illinois Constitution. A home rule county to which this
90-Section applies must comply with every provision of this
91-Section.
92-Rulemaking authority to implement Public Act 95-1045, if
93-any, is conditioned on the rules being adopted in accordance
94-with all provisions of the Illinois Administrative Procedure
95-Act and all rules and procedures of the Joint Committee on
96-Administrative Rules; any purported rule not so adopted, for
97-whatever reason, is unauthorized.
98-(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
99-102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
100-1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
101-eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
102-102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
103-1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
104-eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
105-103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
106-8-29-23.)
107-(55 ILCS 5/5-1069.5)
108-Sec. 5-1069.5. Access to obstetrical and gynecological
109-care Woman's health care provider. All counties, including
110-home rule counties, are subject to the provisions of Section
111-
112-
113-356r of the Illinois Insurance Code. The requirement under
114-this Section that health care benefits provided by counties
115-comply with Section 356r of the Illinois Insurance Code is an
116-exclusive power and function of the State and is a denial and
117-limitation of home rule county powers under Article VII,
118-Section 6, subsection (h) of the Illinois Constitution.
119-(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
120-Section 15. The Illinois Municipal Code is amended by
121-changing Sections 10-4-2.3 and 10-4-2.5 as follows:
122-(65 ILCS 5/10-4-2.3)
123-Sec. 10-4-2.3. Required health benefits. If a
124-municipality, including a home rule municipality, is a
125-self-insurer for purposes of providing health insurance
126-coverage for its employees, the coverage shall include
127-coverage for the post-mastectomy care benefits required to be
128-covered by a policy of accident and health insurance under
129-Section 356t and the coverage required under Sections 356g,
130-356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
131-356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
132-356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
133-356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
134-356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
135-356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
136-356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois
137-
138-
139-Insurance Code. The coverage shall comply with Sections
140-155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
141-Code. The Department of Insurance shall enforce the
142-requirements of this Section. The requirement that health
143-benefits be covered as provided in this is an exclusive power
144-and function of the State and is a denial and limitation under
145-Article VII, Section 6, subsection (h) of the Illinois
146-Constitution. A home rule municipality to which this Section
147-applies must comply with every provision of this Section.
148-Rulemaking authority to implement Public Act 95-1045, if
149-any, is conditioned on the rules being adopted in accordance
150-with all provisions of the Illinois Administrative Procedure
151-Act and all rules and procedures of the Joint Committee on
152-Administrative Rules; any purported rule not so adopted, for
153-whatever reason, is unauthorized.
154-(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
155-102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
156-1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
157-eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
158-102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
159-1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
160-eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
161-103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
162-8-29-23.)
163-(65 ILCS 5/10-4-2.5)
164-
165-
166-Sec. 10-4-2.5. Access to obstetrical and gynecological
167-care Woman's health care provider. The corporate authorities
168-of all municipalities are subject to the provisions of Section
169-356r of the Illinois Insurance Code. The requirement under
170-this Section that health care benefits provided by
171-municipalities comply with Section 356r of the Illinois
172-Insurance Code is an exclusive power and function of the State
173-and is a denial and limitation of home rule municipality
174-powers under Article VII, Section 6, subsection (h) of the
175-Illinois Constitution.
176-(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
177-Section 20. The School Code is amended by changing
178-Sections 10-22.3d and 10-22.3f as follows:
179-(105 ILCS 5/10-22.3d)
180-Sec. 10-22.3d. Access to obstetrical and gynecological
181-care Woman's health care provider. Insurance protection and
182-benefits for employees are subject to the provisions of
183-Section 356r of the Illinois Insurance Code.
184-(Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
185-(105 ILCS 5/10-22.3f)
186-Sec. 10-22.3f. Required health benefits. Insurance
187-protection and benefits for employees shall provide the
188-post-mastectomy care benefits required to be covered by a
189-
190-
191-policy of accident and health insurance under Section 356t and
192-the coverage required under Sections 356g, 356g.5, 356g.5-1,
193-356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
194-356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
195-356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
196-356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
197-356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
198-and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and
199-356z.70 of the Illinois Insurance Code. Insurance policies
200-shall comply with Section 356z.19 of the Illinois Insurance
201-Code. The coverage shall comply with Sections 155.22a, 355b,
202-and 370c of the Illinois Insurance Code. The Department of
203-Insurance shall enforce the requirements of this Section.
204-Rulemaking authority to implement Public Act 95-1045, if
205-any, is conditioned on the rules being adopted in accordance
206-with all provisions of the Illinois Administrative Procedure
207-Act and all rules and procedures of the Joint Committee on
208-Administrative Rules; any purported rule not so adopted, for
209-whatever reason, is unauthorized.
210-(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
211-102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
212-1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
213-eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
214-102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
215-1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
216-eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
217-
218-
219-103-551, eff. 8-11-23; revised 8-29-23.)
220-Section 25. The Illinois Insurance Code is amended by
221-changing Sections 4, 352, 352b, 356a, 356b, 356d, 356e, 356f,
222-356K, 356L, 356r, 356s, 356z.3, 356z.33, 367a, 370e, 370i,
223-408, 412, and 531.03 as follows:
224-(215 ILCS 5/4) (from Ch. 73, par. 616)
225-Sec. 4. Classes of insurance. Insurance and insurance
226-business shall be classified as follows:
227-Class 1. Life, Accident and Health.
228-(a) Life. Insurance on the lives of persons and every
229-insurance appertaining thereto or connected therewith and
230-granting, purchasing or disposing of annuities. Policies of
231-life or endowment insurance or annuity contracts or contracts
232-supplemental thereto which contain provisions for additional
233-benefits in case of death by accidental means and provisions
234-operating to safeguard such policies or contracts against
235-lapse, to give a special surrender value, or special benefit,
236-or an annuity, in the event, that the insured or annuitant
237-shall become a person with a total and permanent disability as
238-defined by the policy or contract, or which contain benefits
239-providing acceleration of life or endowment or annuity
240-benefits in advance of the time they would otherwise be
241-payable, as an indemnity for long term care which is certified
242-or ordered by a physician, including but not limited to,
243-
244-
245-professional nursing care, medical care expenses, custodial
246-nursing care, non-nursing custodial care provided in a nursing
247-home or at a residence of the insured, or which contain
248-benefits providing acceleration of life or endowment or
249-annuity benefits in advance of the time they would otherwise
250-be payable, at any time during the insured's lifetime, as an
251-indemnity for a terminal illness shall be deemed to be
252-policies of life or endowment insurance or annuity contracts
253-within the intent of this clause.
254-Also to be deemed as policies of life or endowment
255-insurance or annuity contracts within the intent of this
256-clause shall be those policies or riders that provide for the
257-payment of up to 75% of the face amount of benefits in advance
258-of the time they would otherwise be payable upon a diagnosis by
259-a physician licensed to practice medicine in all of its
260-branches that the insured has incurred a covered condition
261-listed in the policy or rider.
262-"Covered condition", as used in this clause, means: heart
263-attack, stroke, coronary artery surgery, life-threatening life
264-threatening cancer, renal failure, Alzheimer's disease,
265-paraplegia, major organ transplantation, total and permanent
266-disability, and any other medical condition that the
267-Department may approve for any particular filing.
268-The Director may issue rules that specify prohibited
269-policy provisions, not otherwise specifically prohibited by
270-law, which in the opinion of the Director are unjust, unfair,
271-
272-
273-or unfairly discriminatory to the policyholder, any person
274-insured under the policy, or beneficiary.
275-(b) Accident and health. Insurance against bodily injury,
276-disablement or death by accident and against disablement
277-resulting from sickness or old age and every insurance
278-appertaining thereto, including stop-loss insurance. In this
279-clause, "stop-loss Stop-loss insurance" means is insurance
280-against the risk of economic loss issued to or for the benefit
281-of a single employer self-funded employee disability benefit
282-plan or an employee welfare benefit plan as described in 29
283-U.S.C. 1001 100 et seq., where (i) the policy is issued to and
284-insures an employer, trustee, or other sponsor of the plan, or
285-the plan itself, but not employees, members, or participants;
286-and (ii) payments by the insurer are made to the employer,
287-trustee, or other sponsors of the plan, or the plan itself, but
288-not to the employees, members, participants, or health care
289-providers. The insurance laws of this State, including this
290-Code, do not apply to arrangements between a religious
291-organization and the organization's members or participants
292-when the arrangement and organization meet all of the
293-following criteria:
294-(i) the organization is described in Section 501(c)(3)
295-of the Internal Revenue Code and is exempt from taxation
296-under Section 501(a) of the Internal Revenue Code;
297-(ii) members of the organization share a common set of
298-ethical or religious beliefs and share medical expenses
299-
300-
301-among members in accordance with those beliefs and without
302-regard to the state in which a member resides or is
303-employed;
304-(iii) no funds that have been given for the purpose of
305-the sharing of medical expenses among members described in
306-paragraph (ii) of this subsection (b) are held by the
307-organization in an off-shore trust or bank account;
308-(iv) the organization provides at least monthly to all
309-of its members a written statement listing the dollar
310-amount of qualified medical expenses that members have
311-submitted for sharing, as well as the amount of expenses
312-actually shared among the members;
313-(v) members of the organization retain membership even
314-after they develop a medical condition;
315-(vi) the organization or a predecessor organization
316-has been in existence at all times since December 31,
317-1999, and medical expenses of its members have been shared
318-continuously and without interruption since at least
319-December 31, 1999;
320-(vii) the organization conducts an annual audit that
321-is performed by an independent certified public accounting
322-firm in accordance with generally accepted accounting
323-principles and is made available to the public upon
324-request;
325-(viii) the organization includes the following
326-statement, in writing, on or accompanying all applications
327-
328-
329-and guideline materials:
330-"Notice: The organization facilitating the sharing of
331-medical expenses is not an insurance company, and
332-neither its guidelines nor plan of operation
333-constitute or create an insurance policy. Any
334-assistance you receive with your medical bills will be
335-totally voluntary. As such, participation in the
336-organization or a subscription to any of its documents
337-should never be considered to be insurance. Whether or
338-not you receive any payments for medical expenses and
339-whether or not this organization continues to operate,
340-you are always personally responsible for the payment
341-of your own medical bills.";
342-(ix) any membership card or similar document issued by
343-the organization and any written communication sent by the
344-organization to a hospital, physician, or other health
345-care provider shall include a statement that the
346-organization does not issue health insurance and that the
347-member or participant is personally liable for payment of
348-his or her medical bills;
349-(x) the organization provides to a participant, within
350-30 days after the participant joins, a complete set of its
351-rules for the sharing of medical expenses, appeals of
352-decisions made by the organization, and the filing of
353-complaints;
354-(xi) the organization does not offer any other
355-
356-
357-services that are regulated under any provision of the
358-Illinois Insurance Code or other insurance laws of this
359-State; and
360-(xii) the organization does not amass funds as
361-reserves intended for payment of medical services, rather
362-the organization facilitates the payments provided for in
363-this subsection (b) through payments made directly from
364-one participant to another.
365-(c) Legal Expense Insurance. Insurance which involves the
366-assumption of a contractual obligation to reimburse the
367-beneficiary against or pay on behalf of the beneficiary, all
368-or a portion of his fees, costs, or expenses related to or
369-arising out of services performed by or under the supervision
370-of an attorney licensed to practice in the jurisdiction
371-wherein the services are performed, regardless of whether the
372-payment is made by the beneficiaries individually or by a
373-third person for them, but does not include the provision of or
374-reimbursement for legal services incidental to other insurance
375-coverages. The insurance laws of this State, including this
376-Act do not apply to:
377-(i) retainer contracts made by attorneys at law with
378-individual clients with fees based on estimates of the
379-nature and amount of services to be provided to the
380-specific client, and similar contracts made with a group
381-of clients involved in the same or closely related legal
382-matters;
383-
384-
385-(ii) plans owned or operated by attorneys who are the
386-providers of legal services to the plan;
387-(iii) plans providing legal service benefits to groups
388-where such plans are owned or operated by authority of a
389-state, county, local or other bar association;
390-(iv) any lawyer referral service authorized or
391-operated by a state, county, local or other bar
392-association;
393-(v) the furnishing of legal assistance by labor unions
394-and other employee organizations to their members in
395-matters relating to employment or occupation;
396-(vi) the furnishing of legal assistance to members or
397-dependents, by churches, consumer organizations,
398-cooperatives, educational institutions, credit unions, or
399-organizations of employees, where such organizations
400-contract directly with lawyers or law firms for the
401-provision of legal services, and the administration and
402-marketing of such legal services is wholly conducted by
403-the organization or its subsidiary;
404-(vii) legal services provided by an employee welfare
405-benefit plan defined by the Employee Retirement Income
406-Security Act of 1974;
407-(viii) any collectively bargained plan for legal
408-services between a labor union and an employer negotiated
409-pursuant to Section 302 of the Labor Management Relations
410-Act as now or hereafter amended, under which plan legal
411-
412-
413-services will be provided for employees of the employer
414-whether or not payments for such services are funded to or
415-through an insurance company.
416-Class 2. Casualty, Fidelity and Surety.
417-(a) Accident and health. Insurance against bodily injury,
418-disablement or death by accident and against disablement
419-resulting from sickness or old age and every insurance
420-appertaining thereto, including stop-loss insurance. In this
421-clause, "stop-loss Stop-loss insurance" has meaning given to
422-that term in clause (b) of Class 1 is insurance against the
423-risk of economic loss issued to a single employer self-funded
424-employee disability benefit plan or an employee welfare
425-benefit plan as described in 29 U.S.C. 1001 et seq.
426-(b) Vehicle. Insurance against any loss or liability
427-resulting from or incident to the ownership, maintenance or
428-use of any vehicle (motor or otherwise), draft animal or
429-aircraft. Any policy insuring against any loss or liability on
430-account of the bodily injury or death of any person may contain
431-a provision for payment of disability benefits to injured
432-persons and death benefits to dependents, beneficiaries or
433-personal representatives of persons who are killed, including
434-the named insured, irrespective of legal liability of the
435-insured, if the injury or death for which benefits are
436-provided is caused by accident and sustained while in or upon
437-or while entering into or alighting from or through being
438-struck by a vehicle (motor or otherwise), draft animal or
439-
440-
441-aircraft, and such provision shall not be deemed to be
442-accident insurance.
443-(c) Liability. Insurance against the liability of the
444-insured for the death, injury or disability of an employee or
445-other person, and insurance against the liability of the
446-insured for damage to or destruction of another person's
447-property.
448-(d) Workers' compensation. Insurance of the obligations
449-accepted by or imposed upon employers under laws for workers'
450-compensation.
451-(e) Burglary and forgery. Insurance against loss or damage
452-by burglary, theft, larceny, robbery, forgery, fraud or
453-otherwise; including all householders' personal property
454-floater risks.
455-(f) Glass. Insurance against loss or damage to glass
456-including lettering, ornamentation and fittings from any
457-cause.
458-(g) Fidelity and surety. Become surety or guarantor for
459-any person, copartnership or corporation in any position or
460-place of trust or as custodian of money or property, public or
461-private; or, becoming a surety or guarantor for the
462-performance of any person, copartnership or corporation of any
463-lawful obligation, undertaking, agreement or contract of any
464-kind, except contracts or policies of insurance; and
465-underwriting blanket bonds. Such obligations shall be known
466-and treated as suretyship obligations and such business shall
467-
468-
469-be known as surety business.
470-(h) Miscellaneous. Insurance against loss or damage to
471-property and any liability of the insured caused by accidents
472-to boilers, pipes, pressure containers, machinery and
473-apparatus of any kind and any apparatus connected thereto, or
474-used for creating, transmitting or applying power, light,
475-heat, steam or refrigeration, making inspection of and issuing
476-certificates of inspection upon elevators, boilers, machinery
477-and apparatus of any kind and all mechanical apparatus and
478-appliances appertaining thereto; insurance against loss or
479-damage by water entering through leaks or openings in
480-buildings, or from the breakage or leakage of a sprinkler,
481-pumps, water pipes, plumbing and all tanks, apparatus,
482-conduits and containers designed to bring water into buildings
483-or for its storage or utilization therein, or caused by the
484-falling of a tank, tank platform or supports, or against loss
485-or damage from any cause (other than causes specifically
486-enumerated under Class 3 of this Section) to such sprinkler,
487-pumps, water pipes, plumbing, tanks, apparatus, conduits or
488-containers; insurance against loss or damage which may result
489-from the failure of debtors to pay their obligations to the
490-insured; and insurance of the payment of money for personal
491-services under contracts of hiring.
492-(i) Other casualty risks. Insurance against any other
493-casualty risk not otherwise specified under Classes 1 or 3,
494-which may lawfully be the subject of insurance and may
495-
496-
497-properly be classified under Class 2.
498-(j) Contingent losses. Contingent, consequential and
499-indirect coverages wherein the proximate cause of the loss is
500-attributable to any one of the causes enumerated under Class
501-2. Such coverages shall, for the purpose of classification, be
502-included in the specific grouping of the kinds of insurance
503-wherein such cause is specified.
504-(k) Livestock and domestic animals. Insurance against
505-mortality, accident and health of livestock and domestic
506-animals.
507-(l) Legal expense insurance. Insurance against risk
508-resulting from the cost of legal services as defined under
509-Class 1(c).
510-Class 3. Fire and Marine, etc.
511-(a) Fire. Insurance against loss or damage by fire, smoke
512-and smudge, lightning or other electrical disturbances.
513-(b) Elements. Insurance against loss or damage by
514-earthquake, windstorms, cyclone, tornado, tempests, hail,
515-frost, snow, ice, sleet, flood, rain, drought or other weather
516-or climatic conditions including excess or deficiency of
517-moisture, rising of the waters of the ocean or its
518-tributaries.
519-(c) War, riot and explosion. Insurance against loss or
520-damage by bombardment, invasion, insurrection, riot, strikes,
521-civil war or commotion, military or usurped power, or
522-explosion (other than explosion of steam boilers and the
523-
524-
525-breaking of fly wheels on premises owned, controlled, managed,
526-or maintained by the insured).
527-(d) Marine and transportation. Insurance against loss or
528-damage to vessels, craft, aircraft, vehicles of every kind,
529-(excluding vehicles operating under their own power or while
530-in storage not incidental to transportation) as well as all
531-goods, freights, cargoes, merchandise, effects, disbursements,
532-profits, moneys, bullion, precious stones, securities, choses
533-in action, evidences of debt, valuable papers, bottomry and
534-respondentia interests and all other kinds of property and
535-interests therein, in respect to, appertaining to or in
536-connection with any or all risks or perils of navigation,
537-transit, or transportation, including war risks, on or under
538-any seas or other waters, on land or in the air, or while being
539-assembled, packed, crated, baled, compressed or similarly
540-prepared for shipment or while awaiting the same or during any
541-delays, storage, transshipment, or reshipment incident
542-thereto, including marine builder's risks and all personal
543-property floater risks; and for loss or damage to persons or
544-property in connection with or appertaining to marine, inland
545-marine, transit or transportation insurance, including
546-liability for loss of or damage to either arising out of or in
547-connection with the construction, repair, operation,
548-maintenance, or use of the subject matter of such insurance,
549-(but not including life insurance or surety bonds); but,
550-except as herein specified, shall not mean insurances against
551-
552-
553-loss by reason of bodily injury to the person; and insurance
554-against loss or damage to precious stones, jewels, jewelry,
555-gold, silver and other precious metals whether used in
556-business or trade or otherwise and whether the same be in
557-course of transportation or otherwise, which shall include
558-jewelers' block insurance; and insurance against loss or
559-damage to bridges, tunnels and other instrumentalities of
560-transportation and communication (excluding buildings, their
561-furniture and furnishings, fixed contents and supplies held in
562-storage) unless fire, tornado, sprinkler leakage, hail,
563-explosion, earthquake, riot and civil commotion are the only
564-hazards to be covered; and to piers, wharves, docks and slips,
565-excluding the risks of fire, tornado, sprinkler leakage, hail,
566-explosion, earthquake, riot and civil commotion; and to other
567-aids to navigation and transportation, including dry docks and
568-marine railways, against all risk.
569-(e) Vehicle. Insurance against loss or liability resulting
570-from or incident to the ownership, maintenance or use of any
571-vehicle (motor or otherwise), draft animal or aircraft,
572-excluding the liability of the insured for the death, injury
573-or disability of another person.
574-(f) Property damage, sprinkler leakage and crop. Insurance
575-against the liability of the insured for loss or damage to
576-another person's property or property interests from any cause
577-enumerated in this class; insurance against loss or damage by
578-water entering through leaks or openings in buildings, or from
579-
580-
581-the breakage or leakage of a sprinkler, pumps, water pipes,
582-plumbing and all tanks, apparatus, conduits and containers
583-designed to bring water into buildings or for its storage or
584-utilization therein, or caused by the falling of a tank, tank
585-platform or supports or against loss or damage from any cause
586-to such sprinklers, pumps, water pipes, plumbing, tanks,
587-apparatus, conduits or containers; insurance against loss or
588-damage from insects, diseases or other causes to trees, crops
589-or other products of the soil.
590-(g) Other fire and marine risks. Insurance against any
591-other property risk not otherwise specified under Classes 1 or
592-2, which may lawfully be the subject of insurance and may
593-properly be classified under Class 3.
594-(h) Contingent losses. Contingent, consequential and
595-indirect coverages wherein the proximate cause of the loss is
596-attributable to any of the causes enumerated under Class 3.
597-Such coverages shall, for the purpose of classification, be
598-included in the specific grouping of the kinds of insurance
599-wherein such cause is specified.
600-(i) Legal expense insurance. Insurance against risk
601-resulting from the cost of legal services as defined under
602-Class 1(c).
603-(Source: P.A. 101-81, eff. 7-12-19.)
604-(215 ILCS 5/352) (from Ch. 73, par. 964)
605-Sec. 352. Scope of Article.
606-
607-
608-(a) Except as provided in subsections (b), (c), (d), and
609-(e), and (g), this Article shall apply to all companies
610-transacting in this State the kinds of business enumerated in
611-clause (b) of Class 1 and clause (a) of Class 2 of Section 4
612-and to all policies, contracts, and certificates of insurance
613-issued in connection therewith that are not otherwise excluded
614-under Article VII of this Code. Nothing in this Article shall
615-apply to, or in any way affect policies or contracts described
616-in clause (a) of Class 1 of Section 4; however, this Article
617-shall apply to policies and contracts which contain benefits
618-providing reimbursement for the expenses of long term health
619-care which are certified or ordered by a physician including
620-but not limited to professional nursing care, custodial
621-nursing care, and non-nursing custodial care provided in a
622-nursing home or at a residence of the insured.
623-(b) (Blank).
624-(c) A policy issued and delivered in this State that
625-provides coverage under that policy for certificate holders
626-who are neither residents of nor employed in this State does
627-not need to provide to those nonresident certificate holders
628-who are not employed in this State the coverages or services
629-mandated by this Article.
630-(d) Stop-loss insurance, as defined in clause (b) of Class
631-1 or clause (a) of Class 2 of Section 4, is exempt from all
632-Sections of this Article, except this Section and Sections
633-353a, 354, 357.30, and 370. For purposes of this exemption,
634-
635-
636-stop-loss insurance is further defined as follows:
637-(1) The policy must be issued to and insure an
638-employer, trustee, or other sponsor of the plan, or the
639-plan itself, but not employees, members, or participants.
640-(2) Payments by the insurer must be made to the
641-employer, trustee, or other sponsors of the plan, or the
642-plan itself, but not to the employees, members,
643-participants, or health care providers.
644-(e) A policy issued or delivered in this State to the
645-Department of Healthcare and Family Services (formerly
646-Illinois Department of Public Aid) and providing coverage,
647-under clause (b) of Class 1 or clause (a) of Class 2 as
648-described in Section 4, to persons who are enrolled under
649-Article V of the Illinois Public Aid Code or under the
650-Children's Health Insurance Program Act is exempt from all
651-restrictions, limitations, standards, rules, or regulations
652-respecting benefits imposed by or under authority of this
653-Code, except those specified by subsection (1) of Section 143,
654-Section 370c, and Section 370c.1. Nothing in this subsection,
655-however, affects the total medical services available to
656-persons eligible for medical assistance under the Illinois
657-Public Aid Code.
658-(f) An in-office membership care agreement provided under
659-the In-Office Membership Care Act is not insurance for the
660-purposes of this Code.
661-(g) The provisions of Sections 356a through 359a, both
662-
663-
664-inclusive, shall not apply to or affect:
665-(1) any policy or contract of reinsurance; or
666-(2) life insurance, endowment or annuity contracts, or
667-contracts supplemental thereto that contain only such
668-provisions relating to accident and sickness insurance
669-that (A) provide additional benefits in case of death or
670-dismemberment or loss of sight by accident, or (B) operate
671-to safeguard such contracts against lapse, or to give a
672-special surrender value or special benefit or an annuity
673-if the insured or annuitant becomes a person with a total
674-and permanent disability, as defined by the contract or
675-supplemental contract.
676-(Source: P.A. 101-190, eff. 8-2-19.)
677-(215 ILCS 5/352b)
678-Sec. 352b. Excepted benefits exempted Policy of individual
679-or group accident and health insurance.
680-(a) Unless specified otherwise and when used in context of
681-accident and health insurance policy benefits, coverage,
682-terms, or conditions required to be provided under this
683-Article, references to any "policy of individual or group
684-accident and health insurance", or both, as used in this
685-Article, do does not include any coverage or policy that
686-provides an excepted benefit, as that term is defined in
687-Section 2791(c) of the federal Public Health Service Act (42
688-U.S.C. 300gg-91). Nothing in this subsection amendatory Act of
689-
690-
691-the 101st General Assembly applies to a policy of liability,
692-workers' compensation, automobile medical payment, or limited
693-scope dental or vision benefits insurance issued under this
694-Code. Nothing in this subsection shall be construed to subject
695-excepted benefits outside the scope of Section 352 to any
696-requirements of this Article.
697-(b) Nothing in this Article shall require a policy of
698-excepted benefits to provide benefits, coverage, terms, or
699-conditions in such a manner as to disqualify it from being
700-classified under federal law as the type of excepted benefit
701-for which its policy forms are filed under Sections 143 and 355
702-of this Code.
703-(Source: P.A. 101-456, eff. 8-23-19.)
704-(215 ILCS 5/356a) (from Ch. 73, par. 968a)
705-Sec. 356a. Form of policy.
706-(1) No individual policy of accident and health insurance
707-shall be delivered or issued for delivery to any person in this
708-State state unless:
709-(a) the entire money and other considerations therefor
710-are expressed therein; and
711-(b) the time at which the insurance takes effect and
712-terminates is expressed therein; and
713-(c) it purports to insure only one person, except that
714-a policy may insure, originally or by subsequent
715-amendment, upon the application of an adult member of a
716-
717-
718-family who shall be deemed the policyholder, any 2 two or
719-more eligible members of that family, including husband,
720-wife, dependent children or any children under a specified
721-age which shall not exceed 19 years and any other person
722-dependent upon the policyholder; and
723-(d) the style, arrangement and over-all appearance of
724-the policy give no undue prominence to any portion of the
725-text, and unless every printed portion of the text of the
726-policy and of any endorsements or attached papers is
727-plainly printed in light-faced type of a style in general
728-use, the size of which shall be uniform and not less than
729-ten-point with a lower-case unspaced alphabet length not
730-less than one hundred and twenty-point (the "text" shall
731-include all printed matter except the name and address of
732-the insurer, name or title of the policy, the brief
733-description if any, and captions and subcaptions); and
734-(e) the exceptions and reductions of indemnity are set
735-forth in the policy and, except those which are set forth
736-in Sections 357.1 through 357.30 of this act, are printed,
737-at the insurer's option, either included with the benefit
738-provision to which they apply, or under an appropriate
739-caption such as "EXCEPTIONS", or "EXCEPTIONS AND
740-REDUCTIONS", provided that if an exception or reduction
741-specifically applies only to a particular benefit of the
742-policy, a statement of such exception or reduction shall
743-be included with the benefit provision to which it
744-
745-
746-applies; and
747-(f) each such form, including riders and endorsements,
748-shall be identified by a form number in the lower
749-left-hand corner of the first page thereof; and
750-(g) it contains no provision purporting to make any
751-portion of the charter, rules, constitution, or by-laws of
752-the insurer a part of the policy unless such portion is set
753-forth in full in the policy, except in the case of the
754-incorporation of, or reference to, a statement of rates or
755-classification of risks, or short-rate table filed with
756-the Director.
757-(2) If any policy is issued by an insurer domiciled in this
758-state for delivery to a person residing in another state, and
759-if the official having responsibility for the administration
760-of the insurance laws of such other state shall have advised
761-the Director that any such policy is not subject to approval or
762-disapproval by such official, the Director may by ruling
763-require that such policy meet the standards set forth in
764-subsection (1) of this section and in Sections 357.1 through
765-357.30.
766-(Source: P.A. 76-860.)
767-(215 ILCS 5/356b) (from Ch. 73, par. 968b)
768-Sec. 356b. (a) This Section applies to the hospital and
769-medical expense provisions of an individual accident or health
770-insurance policy.
771-
772-
773-(b) If a policy provides that coverage of a dependent
774-person terminates upon attainment of the limiting age for
775-dependent persons specified in the policy, the attainment of
776-such limiting age does not operate to terminate the hospital
777-and medical coverage of a person who, because of a disabling
778-condition that occurred before attainment of the limiting age,
779-is incapable of self-sustaining employment and is dependent on
780-his or her parents or other care providers for lifetime care
781-and supervision.
782-(c) For purposes of subsection (b), "dependent on other
783-care providers" is defined as requiring a Community Integrated
784-Living Arrangement, group home, supervised apartment, or other
785-residential services licensed or certified by the Department
786-of Human Services (as successor to the Department of Mental
787-Health and Developmental Disabilities), the Department of
788-Public Health, or the Department of Healthcare and Family
789-Services (formerly Department of Public Aid).
790-(d) The insurer may inquire of the policyholder 2 months
791-prior to attainment by a dependent of the limiting age set
792-forth in the policy, or at any reasonable time thereafter,
793-whether such dependent is in fact a person who has a disability
794-and is dependent and, in the absence of proof submitted within
795-60 days of such inquiry that such dependent is a person who has
796-a disability and is dependent may terminate coverage of such
797-person at or after attainment of the limiting age. In the
798-absence of such inquiry, coverage of any person who has a
799-
800-
801-disability and is dependent shall continue through the term of
802-such policy or any extension or renewal thereof.
803-(e) This amendatory Act of 1969 is applicable to policies
804-issued or renewed more than 60 days after the effective date of
805-this amendatory Act of 1969.
806-(Source: P.A. 99-143, eff. 7-27-15.)
807-(215 ILCS 5/356d) (from Ch. 73, par. 968d)
808-Sec. 356d. Conversion privileges for insured former
809-spouses. (1) No individual policy of accident and health
810-insurance providing coverage of hospital and/or medical
811-expense on either an expense incurred basis or other than an
812-expense incurred basis, which in addition to covering the
813-insured also provides coverage to the spouse of the insured
814-shall contain a provision for termination of coverage for a
815-spouse covered under the policy solely as a result of a break
816-in the marital relationship except by reason of an entry of a
817-valid judgment of dissolution of marriage between the parties.
818-(2) Every policy which contains a provision for
819-termination of coverage of the spouse upon dissolution of
820-marriage shall contain a provision to the effect that upon the
821-entry of a valid judgment of dissolution of marriage between
822-the insured parties the spouse whose marriage was dissolved
823-shall be entitled to have issued to him or her, without
824-evidence of insurability, upon application made to the company
825-within 60 days following the entry of such judgment, and upon
826-
827-
828-the payment of the appropriate premium, an individual policy
829-of accident and health insurance. Such policy shall provide
830-the coverage then being issued by the insurer which is most
831-nearly similar to, but not greater than, such terminated
832-coverages. Any and all probationary and/or waiting periods set
833-forth in such policy shall be considered as being met to the
834-extent coverage was in force under the prior policy.
835-(3) The requirements of this Section shall apply to all
836-policies delivered or issued for delivery on or after the 60th
837-day following the effective date of this Section.
838-(Source: P.A. 84-545.)
839-(215 ILCS 5/356e) (from Ch. 73, par. 968e)
840-Sec. 356e. Victims of certain offenses.
841-(1) No individual policy of accident and health insurance,
842-which provides benefits for hospital or medical expenses based
843-upon the actual expenses incurred, delivered or issued for
844-delivery to any person in this State shall contain any
845-specific exception to coverage which would preclude the
846-payment under that policy of actual expenses incurred in the
847-examination and testing of a victim of an offense defined in
848-Sections 11-1.20 through 11-1.60 or 12-13 through 12-16 of the
849-Criminal Code of 1961 or the Criminal Code of 2012, or an
850-attempt to commit such offense to establish that sexual
851-contact did occur or did not occur, and to establish the
852-presence or absence of sexually transmitted disease or
853-
854-
855-infection, and examination and treatment of injuries and
856-trauma sustained by a victim of such offense arising out of the
857-offense. Every policy of accident and health insurance which
858-specifically provides benefits for routine physical
859-examinations shall provide full coverage for expenses incurred
860-in the examination and testing of a victim of an offense
861-defined in Sections 11-1.20 through 11-1.60 or 12-13 through
862-12-16 of the Criminal Code of 1961 or the Criminal Code of
863-2012, or an attempt to commit such offense as set forth in this
864-Section. This Section shall not apply to a policy which covers
865-hospital and medical expenses for specified illnesses or
866-injuries only.
867-(2) For purposes of enabling the recovery of State funds,
868-any insurance carrier subject to this Section shall upon
869-reasonable demand by the Department of Public Health disclose
870-the names and identities of its insureds entitled to benefits
871-under this provision to the Department of Public Health
872-whenever the Department of Public Health has determined that
873-it has paid, or is about to pay, hospital or medical expenses
874-for which an insurance carrier is liable under this Section.
875-All information received by the Department of Public Health
876-under this provision shall be held on a confidential basis and
877-shall not be subject to subpoena and shall not be made public
878-by the Department of Public Health or used for any purpose
879-other than that authorized by this Section.
880-(3) Whenever the Department of Public Health finds that it
881-
882-
883-has paid all or part of any hospital or medical expenses which
884-an insurance carrier is obligated to pay under this Section,
885-the Department of Public Health shall be entitled to receive
886-reimbursement for its payments from such insurance carrier
887-provided that the Department of Public Health has notified the
888-insurance carrier of its claims before the carrier has paid
889-such benefits to its insureds or in behalf of its insureds.
890-(Source: P.A. 96-1551, eff. 7-1-11; 97-1150, eff. 1-25-13.)
891-(215 ILCS 5/356f) (from Ch. 73, par. 968f)
892-Sec. 356f. No individual policy of accident or health
893-insurance or any renewal thereof shall be denied or cancelled
894-by the insurer, nor shall any such policy contain any
895-exception or exclusion of benefits, solely because the mother
896-of the insured has taken diethylstilbestrol, commonly referred
897-to as DES.
898-(Source: P.A. 81-656.)
899-(215 ILCS 5/356K) (from Ch. 73, par. 968K)
900-Sec. 356K. Coverage for Organ Transplantation Procedures.
901-No accident and health insurer providing individual accident
902-and health insurance coverage under this Act for hospital or
903-medical expenses shall deny reimbursement for an otherwise
904-covered expense incurred for any organ transplantation
905-procedure solely on the basis that such procedure is deemed
906-experimental or investigational unless supported by the
907-
908-
909-determination of the Office of Health Care Technology
910-Assessment within the Agency for Health Care Policy and
911-Research within the federal Department of Health and Human
912-Services that such procedure is either experimental or
913-investigational or that there is insufficient data or
914-experience to determine whether an organ transplantation
915-procedure is clinically acceptable. If an accident and health
916-insurer has made written request, or had one made on its behalf
917-by a national organization, for determination by the Office of
918-Health Care Technology Assessment within the Agency for Health
919-Care Policy and Research within the federal Department of
920-Health and Human Services as to whether a specific organ
921-transplantation procedure is clinically acceptable and said
922-organization fails to respond to such a request within a
923-period of 90 days, the failure to act may be deemed a
924-determination that the procedure is deemed to be experimental
925-or investigational.
926-(Source: P.A. 87-218.)
927-(215 ILCS 5/356L) (from Ch. 73, par. 968L)
928-Sec. 356L. No individual policy of accident or health
929-insurance shall include any provision which shall have the
930-effect of denying coverage to or on behalf of an insured under
931-such policy on the basis of a failure by the insured to file a
932-notice of claim within the time period required by the policy,
933-provided such failure is caused solely by the physical
934-
935-
936-inability or mental incapacity of the insured to file such
937-notice of claim because of a period of emergency
938-hospitalization.
939-(Source: P.A. 86-784.)
940-(215 ILCS 5/356r)
941-Sec. 356r. Access to obstetrical and gynecological care
942-Woman's principal health care provider.
943-(a) An individual or group policy of accident and health
944-insurance or a managed care plan amended, delivered, issued,
945-or renewed in this State must not require authorization or
946-referral by the plan, issuer, or any person, including a
947-primary care provider, for any covered individual who seeks
948-coverage for obstetrical or gynecological care provided by any
949-licensed or certified participating health care professional
950-who specializes in obstetrics or gynecology. after November
951-14, 1996 that requires an insured or enrollee to designate an
952-individual to coordinate care or to control access to health
953-care services shall also permit a female insured or enrollee
954-to designate a participating woman's principal health care
955-provider, and the insurer or managed care plan shall provide
956-the following written notice to all female insureds or
957-enrollees no later than 120 days after the effective date of
958-this amendatory Act of 1998; to all new enrollees at the time
959-of enrollment; and thereafter to all existing enrollees at
960-least annually, as a part of a regular publication or
961-
962-
963-informational mailing:
964-"NOTICE TO ALL FEMALE PLAN MEMBERS:
965-YOUR RIGHT TO SELECT A WOMAN'S PRINCIPAL
966-HEALTH CARE PROVIDER.
967-Illinois law allows you to select "a woman's principal
968-health care provider" in addition to your selection of a
969-primary care physician. A woman's principal health care
970-provider is a physician licensed to practice medicine in
971-all its branches specializing in obstetrics or gynecology
972-or specializing in family practice. A woman's principal
973-health care provider may be seen for care without
974-referrals from your primary care physician. If you have
975-not already selected a woman's principal health care
976-provider, you may do so now or at any other time. You are
977-not required to have or to select a woman's principal
978-health care provider.
979-Your woman's principal health care provider must be a
980-part of your plan. You may get the list of participating
981-obstetricians, gynecologists, and family practice
982-specialists from your employer's employee benefits
983-coordinator, or for your own copy of the current list, you
984-may call [insert plan's toll free number]. The list will
985-be sent to you within 10 days after your call. To designate
986-a woman's principal health care provider from the list,
987-call [insert plan's toll free number] and tell our staff
988-the name of the physician you have selected.".
989-
990-
991-If the insurer or managed care plan exercises the option set
992-forth in subsection (a-5), the notice shall also state:
993-"Your plan requires that your primary care physician
994-and your woman's principal health care provider have a
995-referral arrangement with one another. If the woman's
996-principal health care provider that you select does not
997-have a referral arrangement with your primary care
998-physician, you will have to select a new primary care
999-physician who has a referral arrangement with your woman's
1000-principal health care provider or you may select a woman's
1001-principal health care provider who has a referral
1002-arrangement with your primary care physician. The list of
1003-woman's principal health care providers will also have the
1004-names of the primary care physicians and their referral
1005-arrangements.".
1006-No later than 120 days after the effective date of this
1007-amendatory Act of 1998, the insurer or managed care plan shall
1008-provide each employer who has a policy of insurance or a
1009-managed care plan with the insurer or managed care plan with a
1010-list of physicians licensed to practice medicine in all its
1011-branches specializing in obstetrics or gynecology or
1012-specializing in family practice who have contracted with the
1013-plan. At the time of enrollment and thereafter within 10 days
1014-after a request by an insured or enrollee, the insurer or
1015-managed care plan also shall provide this list directly to the
1016-insured or enrollee. The list shall include each physician's
1017-
1018-
1019-address, telephone number, and specialty. No insurer or plan
1020-formal or informal policy may restrict a female insured's or
1021-enrollee's right to designate a woman's principal health care
1022-provider, except as set forth in subsection (a-5). If the
1023-female enrollee is an enrollee of a managed care plan under
1024-contract with the Department of Healthcare and Family
1025-Services, the physician chosen by the enrollee as her woman's
1026-principal health care provider must be a Medicaid-enrolled
1027-provider. This requirement does not require a female insured
1028-or enrollee to make a selection of a woman's principal health
1029-care provider. The female insured or enrollee may designate a
1030-physician licensed to practice medicine in all its branches
1031-specializing in family practice as her woman's principal
1032-health care provider.
1033-(a-5) If a policy, contract, or certificate requires or
1034-allows a covered individual to designate a primary care
1035-provider and provides coverage for any obstetrical or
1036-gynecological care, the insurer shall provide the notice
1037-required under 45 CFR 147.138(a)(4) and 149.310(a)(4) in all
1038-circumstances required under that provision. The insured or
1039-enrollee may be required by the insurer or managed care plan to
1040-select a woman's principal health care provider who has a
1041-referral arrangement with the insured's or enrollee's
1042-individual who coordinates care or controls access to health
1043-care services if such referral arrangement exists or to select
1044-a new individual to coordinate care or to control access to
1045-
1046-
1047-health care services who has a referral arrangement with the
1048-woman's principal health care provider chosen by the insured
1049-or enrollee, if such referral arrangement exists. If an
1050-insurer or a managed care plan requires an insured or enrollee
1051-to select a new physician under this subsection (a-5), the
1052-insurer or managed care plan must provide the insured or
1053-enrollee with both options to select a new physician provided
1054-in this subsection (a-5).
1055-Notwithstanding a plan's restrictions of the frequency or
1056-timing of making designations of primary care providers, a
1057-female enrollee or insured who is subject to the selection
1058-requirements of this subsection, may, at any time, effect a
1059-change in primary care physicians in order to make a selection
1060-of a woman's principal health care provider.
1061-(a-6) The requirements of this Section shall be construed
1062-in a manner consistent with the requirements for access to and
1063-notice of obstetrical and gynecological care in 45 CFR 147.138
1064-and 45 CFR 149.310. If an insurer or managed care plan
1065-exercises the option in subsection (a-5), the list to be
1066-provided under subsection (a) shall identify the referral
1067-arrangements that exist between the individual who coordinates
1068-care or controls access to health care services and the
1069-woman's principal health care provider in order to assist the
1070-female insured or enrollee to make a selection within the
1071-insurer's or managed care plan's requirement.
1072-(b) Nothing in this Section prevents a health insurance
1073-
1074-
1075-issuer from requiring a participating obstetrical or
1076-gynecological health care professional to agree, with respect
1077-to individuals covered under a policy of accident and health
1078-insurance, to otherwise adhere to the health insurance
1079-issuer's policies and procedures, including procedures
1080-regarding referrals and obtaining prior authorization and
1081-providing services pursuant to a treatment plan, if any,
1082-approved by the issuer. If a female insured or enrollee has
1083-designated a woman's principal health care provider, then the
1084-insured or enrollee must be given direct access to the woman's
1085-principal health care provider for services covered by the
1086-policy or plan without the need for a referral or prior
1087-approval. Nothing shall prohibit the insurer or managed care
1088-plan from requiring prior authorization or approval from
1089-either a primary care provider or the woman's principal health
1090-care provider for referrals for additional care or services.
1091-(c) (Blank). For the purposes of this Section the
1092-following terms are defined:
1093-(1) "Woman's principal health care provider" means a
1094-physician licensed to practice medicine in all of its
1095-branches specializing in obstetrics or gynecology or
1096-specializing in family practice.
1097-(2) "Managed care entity" means any entity including a
1098-licensed insurance company, hospital or medical service
1099-plan, health maintenance organization, limited health
1100-service organization, preferred provider organization,
1101-
1102-
1103-third party administrator, an employer or employee
1104-organization, or any person or entity that establishes,
1105-operates, or maintains a network of participating
1106-providers.
1107-(3) "Managed care plan" means a plan operated by a
1108-managed care entity that provides for the financing of
1109-health care services to persons enrolled in the plan
1110-through:
1111-(A) organizational arrangements for ongoing
1112-quality assurance, utilization review programs, or
1113-dispute resolution; or
1114-(B) financial incentives for persons enrolled in
1115-the plan to use the participating providers and
1116-procedures covered by the plan.
1117-(4) "Participating provider" means a physician who has
1118-contracted with an insurer or managed care plan to provide
1119-services to insureds or enrollees as defined by the
1120-contract.
1121-(d) Nothing in this Section shall be construed to preclude
1122-a health insurance issuer from requiring that a participating
1123-obstetrical or gynecological health care professional notify
1124-the covered individual's primary care physician or the issuer
1125-of treatment decisions or update centralized medical records.
1126-The original provisions of this Section became law on July 17,
1127-1996 and took effect November 14, 1996, which is 120 days after
1128-becoming law.
1129-
1130-
1131-(Source: P.A. 95-331, eff. 8-21-07.)
1132-(215 ILCS 5/356s)
1133-Sec. 356s. Post-parturition care. An individual or group
1134-policy of accident and health insurance that provides
1135-maternity coverage and is amended, delivered, issued, or
1136-renewed after the effective date of this amendatory Act of
1137-1996 shall provide coverage for the following:
1138-(1) a minimum of 48 hours of inpatient care following
1139-a vaginal delivery for the mother and the newborn, except
1140-as otherwise provided in this Section; or
1141-(2) a minimum of 96 hours of inpatient care following
1142-a delivery by caesarian section for the mother and
1143-newborn, except as otherwise provided in this Section.
1144-Coverage may be limited to a A shorter length of hospital
1145-inpatient care stay for services related to maternity and
1146-newborn care may be provided if the attending physician
1147-licensed to practice medicine in all of its branches
1148-determines, in accordance with the protocols and guidelines
1149-developed by the American College of Obstetricians and
1150-Gynecologists or the American Academy of Pediatrics, that the
1151-mother and the newborn meet the appropriate guidelines for
1152-that length of stay based upon evaluation of the mother and
1153-newborn and the coverage and availability of a post-discharge
1154-physician office visit or in-home nurse visit to verify the
1155-condition of the infant in the first 48 hours after discharge.
1156-
1157-
1158-(Source: P.A. 89-513, eff. 9-15-96; 90-14, eff. 7-1-97.)
1159-(215 ILCS 5/356z.3)
1160-Sec. 356z.3. Disclosure of limited benefit. An insurer
1161-that issues, delivers, amends, or renews an individual or
1162-group policy of accident and health insurance in this State
1163-after the effective date of this amendatory Act of the 92nd
1164-General Assembly and arranges, contracts with, or administers
1165-contracts with a provider whereby beneficiaries are provided
1166-an incentive to use the services of such provider must include
1167-the following disclosure on its contracts and evidences of
1168-coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN
1169-NON-PARTICIPATING PROVIDERS ARE USED. YOU CAN EXPECT TO PAY
1170-MORE THAN THE COST-SHARING AMOUNT DEFINED IN THE POLICY IN
1171-NON-EMERGENCY SITUATIONS. Except in limited situations
1172-governed by the federal No Surprises Act or Section 356z.3a of
1173-the Illinois Insurance Code (215 ILCS 5/356z.3a),
1174-non-participating providers furnishing non-emergency services
1175-may bill members for any amount up to the billed charge after
1176-the plan has paid its portion of the bill. If you elect to use
1177-a non-participating provider, plan benefit payments will be
1178-determined according to your policy's fee schedule, usual and
1179-customary charge (which is determined by comparing charges for
1180-similar services adjusted to the geographical area where the
1181-services are performed), or other method as defined by the
1182-policy. Participating providers have agreed to ONLY bill
1183-
1184-
1185-members the cost-sharing amounts. You should be aware that
1186-when you elect to utilize the services of a non-participating
1187-provider for a covered service in non-emergency situations,
1188-benefit payments to such non-participating provider are not
1189-based upon the amount billed. The basis of your benefit
1190-payment will be determined according to your policy's fee
1191-schedule, usual and customary charge (which is determined by
1192-comparing charges for similar services adjusted to the
1193-geographical area where the services are performed), or other
1194-method as defined by the policy. YOU CAN EXPECT TO PAY MORE
1195-THAN THE COINSURANCE AMOUNT DEFINED IN THE POLICY AFTER THE
1196-PLAN HAS PAID ITS REQUIRED PORTION. Non-participating
1197-providers may bill members for any amount up to the billed
1198-charge after the plan has paid its portion of the bill, except
1199-as provided in Section 356z.3a of the Illinois Insurance Code
1200-for covered services received at a participating health care
1201-facility from a nonparticipating provider that are: (a)
1202-ancillary services, (b) items or services furnished as a
1203-result of unforeseen, urgent medical needs that arise at the
1204-time the item or service is furnished, or (c) items or services
1205-received when the facility or the non-participating provider
1206-fails to satisfy the notice and consent criteria specified
1207-under Section 356z.3a. Participating providers have agreed to
1208-accept discounted payments for services with no additional
1209-billing to the member other than co-insurance and deductible
1210-amounts. You may obtain further information about the
1211-
1212-
1213-participating status of professional providers and information
1214-on out-of-pocket expenses by calling the toll-free toll free
1215-telephone number on your identification card.".
1216-(Source: P.A. 102-901, eff. 1-1-23.)
1217-(215 ILCS 5/356z.33)
1218-(Text of Section before amendment by P.A. 103-454)
1219-Sec. 356z.33. Coverage for epinephrine injectors. A group
1220-or individual policy of accident and health insurance or a
1221-managed care plan that is amended, delivered, issued, or
1222-renewed on or after January 1, 2020 (the effective date of
1223-Public Act 101-281) shall provide coverage for medically
1224-necessary epinephrine injectors for persons 18 years of age or
1225-under. As used in this Section, "epinephrine injector" has the
1226-meaning given to that term in Section 5 of the Epinephrine
1227-Injector Act.
1228-(Source: P.A. 101-281, eff. 1-1-20; 102-558, eff. 8-20-21.)
1229-(Text of Section after amendment by P.A. 103-454)
1230-Sec. 356z.33. Coverage for epinephrine injectors.
1231-(a) A group or individual policy of accident and health
1232-insurance or a managed care plan that is amended, delivered,
1233-issued, or renewed on or after January 1, 2020 (the effective
1234-date of Public Act 101-281) shall provide coverage for
1235-medically necessary epinephrine injectors for persons 18 years
1236-of age or under. As used in this Section, "epinephrine
1237-
1238-
1239-injector" has the meaning given to that term in Section 5 of
1240-the Epinephrine Injector Act.
1241-(b) An insurer that provides coverage for medically
1242-necessary epinephrine injectors shall limit the total amount
1243-that an insured is required to pay for a twin-pack of medically
1244-necessary epinephrine injectors at an amount not to exceed
1245-$60, regardless of the type of epinephrine injector; except
1246-that this provision does not apply to the extent such coverage
1247-would disqualify a high-deductible health plan from
1248-eligibility for a health savings account pursuant to Section
1249-223 of the Internal Revenue Code (26 U.S.C. 223).
1250-(c) Nothing in this Section prevents an insurer from
1251-reducing an insured's cost sharing by an amount greater than
1252-the amount specified in subsection (b).
1253-(d) The Department may adopt rules as necessary to
1254-implement and administer this Section.
1255-(Source: P.A. 102-558, eff. 8-20-21; 103-454, eff. 1-1-25.)
1256-(215 ILCS 5/367a) (from Ch. 73, par. 979a)
1257-Sec. 367a. Blanket accident and health insurance.
1258-(1) Blanket accident and health insurance is that form of
1259-accident and health insurance covering special groups of
1260-persons as enumerated in one of the following paragraphs (a)
1261-to (g), inclusive:
1262-(a) Under a policy or contract issued to any carrier
1263-for hire, which shall be deemed the policyholder, covering
1264-
1265-
1266-a group defined as all persons who may become passengers
1267-on such carrier.
1268-(b) Under a policy or contract issued to an employer,
1269-who shall be deemed the policyholder, covering all
1270-employees or any group of employees defined by reference
1271-to exceptional hazards incident to such employment.
1272-(c) Under a policy or contract issued to a college,
1273-school, or other institution of learning or to the head or
1274-principal thereof, who or which shall be deemed the
1275-policyholder, covering students or teachers. However,
1276-student health insurance coverage, as defined in 45 CFR
1277-147.145, shall remain subject to the standards and
1278-requirements for individual health insurance coverage
1279-except where inconsistent with that regulation. Student
1280-health insurance coverage shall not be subject to the
1281-Short-Term, Limited-Duration Health Insurance Coverage
1282-Act. An insurer providing student health insurance
1283-coverage or a policy or contract covering students for
1284-limited-scope dental or vision under 45 CFR 148.220 shall
1285-require an individual application or enrollment form and
1286-shall furnish each insured individual a certificate, which
1287-shall have been approved by the Director under Section
1288-355.
1289-(d) Under a policy or contract issued in the name of
1290-any volunteer fire department, first aid, or other such
1291-volunteer group, which shall be deemed the policyholder,
1292-
1293-
1294-covering all of the members of such department or group.
1295-(e) Under a policy or contract issued to a creditor,
1296-who shall be deemed the policyholder, to insure debtors of
1297-the creditors; Provided, however, that in the case of a
1298-loan which is subject to the Small Loans Act, no insurance
1299-premium or other cost shall be directly or indirectly
1300-charged or assessed against, or collected or received from
1301-the borrower.
1302-(f) Under a policy or contract issued to a sports team
1303-or to a camp, which team or camp sponsor shall be deemed
1304-the policyholder, covering members or campers.
1305-(g) Under a policy or contract issued to any other
1306-substantially similar group which, in the discretion of
1307-the Director, may be subject to the issuance of a blanket
1308-accident and health policy or contract.
1309-(2) Any insurance company authorized to write accident and
1310-health insurance in this state shall have the power to issue
1311-blanket accident and health insurance. No such blanket policy
1312-may be issued or delivered in this State unless a copy of the
1313-form thereof shall have been filed in accordance with Section
1314-355, and it contains in substance such of those provisions
1315-contained in Sections 357.1 through 357.30 as may be
1316-applicable to blanket accident and health insurance and the
1317-following provisions:
1318-(a) A provision that the policy and the application
1319-shall constitute the entire contract between the parties,
1320-
1321-
1322-and that all statements made by the policyholder shall, in
1323-absence of fraud, be deemed representations and not
1324-warranties, and that no such statements shall be used in
1325-defense to a claim under the policy, unless it is
1326-contained in a written application.
1327-(b) A provision that to the group or class thereof
1328-originally insured shall be added from time to time all
1329-new persons or individuals eligible for coverage.
1330-(3) An individual application shall not be required from a
1331-person covered under a blanket accident or health policy or
1332-contract, nor shall it be necessary for the insurer to furnish
1333-each person a certificate.
1334-(3.5) Subsection (3) does not apply to major medical
1335-insurance, or to any excepted benefits or short-term,
1336-limited-duration health insurance coverage for which an
1337-insured individual pays premiums or contributions. In those
1338-cases, the insurer shall require an individual application or
1339-enrollment form and shall furnish each insured individual a
1340-certificate, which shall have been approved by the Director
1341-under Section 355 of this Code.
1342-(4) All benefits under any blanket accident and health
1343-policy shall be payable to the person insured, or to his
1344-designated beneficiary or beneficiaries, or to his or her
1345-estate, except that if the person insured be a minor or person
1346-under legal disability, such benefits may be made payable to
1347-his or her parent, guardian, or other person actually
1348-
1349-
1350-supporting him or her. Provided further, however, that the
1351-policy may provide that all or any portion of any indemnities
1352-provided by any such policy on account of hospital, nursing,
1353-medical or surgical services may, at the insurer's option, be
1354-paid directly to the hospital or person rendering such
1355-services; but the policy may not require that the service be
1356-rendered by a particular hospital or person. Payment so made
1357-shall discharge the insurer's obligation with respect to the
1358-amount of insurance so paid.
1359-(5) Nothing contained in this section shall be deemed to
1360-affect the legal liability of policyholders for the death of
1361-or injury to, any such member of such group.
1362-(Source: P.A. 83-1362.)
1363-(215 ILCS 5/370e) (from Ch. 73, par. 982e)
1364-Sec. 370e. Companies which issue group accident and health
1365-policies or blanket accident and health plans to employer
1366-groups in this State shall provide the employer with notice of
1367-termination of a group or blanket accident and health plan
1368-because of the employer's failure to pay the premium when due.
1369-The insurance company shall file send a copy of such notice
1370-with to the Department in an electronic format either through
1371-the System for Electronic Rate and Form Filing (SERFF) or as
1372-otherwise prescribed by the Director.
1373-(Source: P.A. 83-1006.)
1374-
1375-
1376-(215 ILCS 5/370i) (from Ch. 73, par. 982i)
1377-Sec. 370i. Policies, agreements or arrangements with
1378-incentives or limits on reimbursement authorized.
1379-(a) Policies, agreements or arrangements issued under this
1380-Article may not contain terms or conditions that would operate
1381-unreasonably to restrict the access and availability of health
1382-care services for the insured.
1383-(b) An insurer or administrator may:
1384-(1) enter into agreements with certain providers of
1385-its choice relating to health care services which may be
1386-rendered to insureds or beneficiaries of the insurer or
1387-administrator, including agreements relating to the
1388-amounts to be charged the insureds or beneficiaries for
1389-services rendered;
1390-(2) issue or administer programs, policies or
1391-subscriber contracts in this State that include incentives
1392-for the insured or beneficiary to utilize the services of
1393-a provider which has entered into an agreement with the
1394-insurer or administrator pursuant to paragraph (1) above.
1395-(c) (Blank). After the effective date of this amendatory
1396-Act of the 92nd General Assembly, any insurer that arranges,
1397-contracts with, or administers contracts with a provider
1398-whereby beneficiaries are provided an incentive to use the
1399-services of such provider must include the following
1400-disclosure on its contracts and evidences of coverage:
1401-"WARNING, LIMITED BENEFITS WILL BE PAID WHEN NON-PARTICIPATING
1402-
1403-
1404-PROVIDERS ARE USED. You should be aware that when you elect to
1405-utilize the services of a non-participating provider for a
1406-covered service in non-emergency situations, benefit payments
1407-to such non-participating provider are not based upon the
1408-amount billed. The basis of your benefit payment will be
1409-determined according to your policy's fee schedule, usual and
1410-customary charge (which is determined by comparing charges for
1411-similar services adjusted to the geographical area where the
1412-services are performed), or other method as defined by the
1413-policy. YOU CAN EXPECT TO PAY MORE THAN THE COINSURANCE AMOUNT
1414-DEFINED IN THE POLICY AFTER THE PLAN HAS PAID ITS REQUIRED
1415-PORTION. Non-participating providers may bill members for any
1416-amount up to the billed charge after the plan has paid its
1417-portion of the bill. Participating providers have agreed to
1418-accept discounted payments for services with no additional
1419-billing to the member other than co-insurance and deductible
1420-amounts. You may obtain further information about the
1421-participating status of professional providers and information
1422-on out-of-pocket expenses by calling the toll free telephone
1423-number on your identification card.".
1424-(Source: P.A. 92-579, eff. 1-1-03.)
1425-(215 ILCS 5/408) (from Ch. 73, par. 1020)
1426-(Text of Section before amendment by P.A. 103-75)
1427-Sec. 408. Fees and charges.
1428-(1) The Director shall charge, collect and give proper
1429-
1430-
1431-acquittances for the payment of the following fees and
1432-charges:
1433-(a) For filing all documents submitted for the
1434-incorporation or organization or certification of a
1435-domestic company, except for a fraternal benefit society,
1436-$2,000.
1437-(b) For filing all documents submitted for the
1438-incorporation or organization of a fraternal benefit
1439-society, $500.
1440-(c) For filing amendments to articles of incorporation
1441-and amendments to declaration of organization, except for
1442-a fraternal benefit society, a mutual benefit association,
1443-a burial society or a farm mutual, $200.
1444-(d) For filing amendments to articles of incorporation
1445-of a fraternal benefit society, a mutual benefit
1446-association or a burial society, $100.
1447-(e) For filing amendments to articles of incorporation
1448-of a farm mutual, $50.
1449-(f) For filing bylaws or amendments thereto, $50.
1450-(g) For filing agreement of merger or consolidation:
1451-(i) for a domestic company, except for a fraternal
1452-benefit society, a mutual benefit association, a
1453-burial society, or a farm mutual, $2,000.
1454-(ii) for a foreign or alien company, except for a
1455-fraternal benefit society, $600.
1456-(iii) for a fraternal benefit society, a mutual
1457-
1458-
1459-benefit association, a burial society, or a farm
1460-mutual, $200.
1461-(h) For filing agreements of reinsurance by a domestic
1462-company, $200.
1463-(i) For filing all documents submitted by a foreign or
1464-alien company to be admitted to transact business or
1465-accredited as a reinsurer in this State, except for a
1466-fraternal benefit society, $5,000.
1467-(j) For filing all documents submitted by a foreign or
1468-alien fraternal benefit society to be admitted to transact
1469-business in this State, $500.
1470-(k) For filing declaration of withdrawal of a foreign
1471-or alien company, $50.
1472-(l) For filing annual statement by a domestic company,
1473-except a fraternal benefit society, a mutual benefit
1474-association, a burial society, or a farm mutual, $200.
1475-(m) For filing annual statement by a domestic
1476-fraternal benefit society, $100.
1477-(n) For filing annual statement by a farm mutual, a
1478-mutual benefit association, or a burial society, $50.
1479-(o) For issuing a certificate of authority or renewal
1480-thereof except to a foreign fraternal benefit society,
1481-$400.
1482-(p) For issuing a certificate of authority or renewal
1483-thereof to a foreign fraternal benefit society, $200.
1484-(q) For issuing an amended certificate of authority,
1485-
1486-
1487-$50.
1488-(r) For each certified copy of certificate of
1489-authority, $20.
1490-(s) For each certificate of deposit, or valuation, or
1491-compliance or surety certificate, $20.
1492-(t) For copies of papers or records per page, $1.
1493-(u) For each certification to copies of papers or
1494-records, $10.
1495-(v) For multiple copies of documents or certificates
1496-listed in subparagraphs (r), (s), and (u) of paragraph (1)
1497-of this Section, $10 for the first copy of a certificate of
1498-any type and $5 for each additional copy of the same
1499-certificate requested at the same time, unless, pursuant
1500-to paragraph (2) of this Section, the Director finds these
1501-additional fees excessive.
1502-(w) For issuing a permit to sell shares or increase
1503-paid-up capital:
1504-(i) in connection with a public stock offering,
1505-$300;
1506-(ii) in any other case, $100.
1507-(x) For issuing any other certificate required or
1508-permissible under the law, $50.
1509-(y) For filing a plan of exchange of the stock of a
1510-domestic stock insurance company, a plan of
1511-demutualization of a domestic mutual company, or a plan of
1512-reorganization under Article XII, $2,000.
1513-
1514-
1515-(z) For filing a statement of acquisition of a
1516-domestic company as defined in Section 131.4 of this Code,
1517-$2,000.
1518-(aa) For filing an agreement to purchase the business
1519-of an organization authorized under the Dental Service
1520-Plan Act or the Voluntary Health Services Plans Act or of a
1521-health maintenance organization or a limited health
1522-service organization, $2,000.
1523-(bb) For filing a statement of acquisition of a
1524-foreign or alien insurance company as defined in Section
1525-131.12a of this Code, $1,000.
1526-(cc) For filing a registration statement as required
1527-in Sections 131.13 and 131.14, the notification as
1528-required by Sections 131.16, 131.20a, or 141.4, or an
1529-agreement or transaction required by Sections 124.2(2),
1530-141, 141a, or 141.1, $200.
1531-(dd) For filing an application for licensing of:
1532-(i) a religious or charitable risk pooling trust
1533-or a workers' compensation pool, $1,000;
1534-(ii) a workers' compensation service company,
1535-$500;
1536-(iii) a self-insured automobile fleet, $200; or
1537-(iv) a renewal of or amendment of any license
1538-issued pursuant to (i), (ii), or (iii) above, $100.
1539-(ee) For filing articles of incorporation for a
1540-syndicate to engage in the business of insurance through
1541-
1542-
1543-the Illinois Insurance Exchange, $2,000.
1544-(ff) For filing amended articles of incorporation for
1545-a syndicate engaged in the business of insurance through
1546-the Illinois Insurance Exchange, $100.
1547-(gg) For filing articles of incorporation for a
1548-limited syndicate to join with other subscribers or
1549-limited syndicates to do business through the Illinois
1550-Insurance Exchange, $1,000.
1551-(hh) For filing amended articles of incorporation for
1552-a limited syndicate to do business through the Illinois
1553-Insurance Exchange, $100.
1554-(ii) For a permit to solicit subscriptions to a
1555-syndicate or limited syndicate, $100.
1556-(jj) For the filing of each form as required in
1557-Section 143 of this Code, $50 per form. Informational and
1558-advertising filings shall be $25 per filing. The fee for
1559-advisory and rating organizations shall be $200 per form.
1560-(i) For the purposes of the form filing fee,
1561-filings made on insert page basis will be considered
1562-one form at the time of its original submission.
1563-Changes made to a form subsequent to its approval
1564-shall be considered a new filing.
1565-(ii) Only one fee shall be charged for a form,
1566-regardless of the number of other forms or policies
1567-with which it will be used.
1568-(iii) Fees charged for a policy filed as it will be
1569-
1570-
1571-issued regardless of the number of forms comprising
1572-that policy shall not exceed $1,500. For advisory or
1573-rating organizations, fees charged for a policy filed
1574-as it will be issued regardless of the number of forms
1575-comprising that policy shall not exceed $2,500.
1576-(iv) The Director may by rule exempt forms from
1577-such fees.
1578-(kk) For filing an application for licensing of a
1579-reinsurance intermediary, $500.
1580-(ll) For filing an application for renewal of a
1581-license of a reinsurance intermediary, $200.
1582-(mm) For filing a plan of division of a domestic stock
1583-company under Article IIB, $100,000 $10,000.
1584-(nn) For filing all documents submitted by a foreign
1585-or alien company to be a certified reinsurer in this
1586-State, except for a fraternal benefit society, $1,000.
1587-(oo) For filing a renewal by a foreign or alien
1588-company to be a certified reinsurer in this State, except
1589-for a fraternal benefit society, $400.
1590-(pp) For filing all documents submitted by a reinsurer
1591-domiciled in a reciprocal jurisdiction, $1,000.
1592-(qq) For filing a renewal by a reinsurer domiciled in
1593-a reciprocal jurisdiction, $400.
1594-(rr) For registering a captive management company or
1595-renewal thereof, $50.
1596-(2) When printed copies or numerous copies of the same
1597-
1598-
1599-paper or records are furnished or certified, the Director may
1600-reduce such fees for copies if he finds them excessive. He may,
1601-when he considers it in the public interest, furnish without
1602-charge to state insurance departments and persons other than
1603-companies, copies or certified copies of reports of
1604-examinations and of other papers and records.
1605-(3) The expenses incurred in any performance examination
1606-authorized by law shall be paid by the company or person being
1607-examined. The charge shall be reasonably related to the cost
1608-of the examination including but not limited to compensation
1609-of examiners, electronic data processing costs, supervision
1610-and preparation of an examination report and lodging and
1611-travel expenses. All lodging and travel expenses shall be in
1612-accord with the applicable travel regulations as published by
1613-the Department of Central Management Services and approved by
1614-the Governor's Travel Control Board, except that out-of-state
1615-lodging and travel expenses related to examinations authorized
1616-under Section 132 shall be in accordance with travel rates
1617-prescribed under paragraph 301-7.2 of the Federal Travel
1618-Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement of
1619-subsistence expenses incurred during official travel. All
1620-lodging and travel expenses may be reimbursed directly upon
1621-authorization of the Director. With the exception of the
1622-direct reimbursements authorized by the Director, all
1623-performance examination charges collected by the Department
1624-shall be paid to the Insurance Producer Administration Fund,
1625-
1626-
1627-however, the electronic data processing costs incurred by the
1628-Department in the performance of any examination shall be
1629-billed directly to the company being examined for payment to
1630-the Technology Management Revolving Fund.
1631-(4) At the time of any service of process on the Director
1632-as attorney for such service, the Director shall charge and
1633-collect the sum of $40, which may be recovered as taxable costs
1634-by the party to the suit or action causing such service to be
1635-made if he prevails in such suit or action.
1636-(5) (a) The costs incurred by the Department of Insurance
1637-in conducting any hearing authorized by law shall be assessed
1638-against the parties to the hearing in such proportion as the
1639-Director of Insurance may determine upon consideration of all
1640-relevant circumstances including: (1) the nature of the
1641-hearing; (2) whether the hearing was instigated by, or for the
1642-benefit of a particular party or parties; (3) whether there is
1643-a successful party on the merits of the proceeding; and (4) the
1644-relative levels of participation by the parties.
1645-(b) For purposes of this subsection (5) costs incurred
1646-shall mean the hearing officer fees, court reporter fees, and
1647-travel expenses of Department of Insurance officers and
1648-employees; provided however, that costs incurred shall not
1649-include hearing officer fees or court reporter fees unless the
1650-Department has retained the services of independent
1651-contractors or outside experts to perform such functions.
1652-(c) The Director shall make the assessment of costs
1653-
1654-
1655-incurred as part of the final order or decision arising out of
1656-the proceeding; provided, however, that such order or decision
1657-shall include findings and conclusions in support of the
1658-assessment of costs. This subsection (5) shall not be
1659-construed as permitting the payment of travel expenses unless
1660-calculated in accordance with the applicable travel
1661-regulations of the Department of Central Management Services,
1662-as approved by the Governor's Travel Control Board. The
1663-Director as part of such order or decision shall require all
1664-assessments for hearing officer fees and court reporter fees,
1665-if any, to be paid directly to the hearing officer or court
1666-reporter by the party(s) assessed for such costs. The
1667-assessments for travel expenses of Department officers and
1668-employees shall be reimbursable to the Director of Insurance
1669-for deposit to the fund out of which those expenses had been
1670-paid.
1671-(d) The provisions of this subsection (5) shall apply in
1672-the case of any hearing conducted by the Director of Insurance
1673-not otherwise specifically provided for by law.
1674-(6) The Director shall charge and collect an annual
1675-financial regulation fee from every domestic company for
1676-examination and analysis of its financial condition and to
1677-fund the internal costs and expenses of the Interstate
1678-Insurance Receivership Commission as may be allocated to the
1679-State of Illinois and companies doing an insurance business in
1680-this State pursuant to Article X of the Interstate Insurance
1681-
1682-
1683-Receivership Compact. The fee shall be the greater fixed
1684-amount based upon the combination of nationwide direct premium
1685-income and nationwide reinsurance assumed premium income or
1686-upon admitted assets calculated under this subsection as
1687-follows:
1688-(a) Combination of nationwide direct premium income
1689-and nationwide reinsurance assumed premium.
1690-(i) $150, if the premium is less than $500,000 and
1691-there is no reinsurance assumed premium;
1692-(ii) $750, if the premium is $500,000 or more, but
1693-less than $5,000,000 and there is no reinsurance
1694-assumed premium; or if the premium is less than
1695-$5,000,000 and the reinsurance assumed premium is less
1696-than $10,000,000;
1697-(iii) $3,750, if the premium is less than
1698-$5,000,000 and the reinsurance assumed premium is
1699-$10,000,000 or more;
1700-(iv) $7,500, if the premium is $5,000,000 or more,
1701-but less than $10,000,000;
1702-(v) $18,000, if the premium is $10,000,000 or
1703-more, but less than $25,000,000;
1704-(vi) $22,500, if the premium is $25,000,000 or
1705-more, but less than $50,000,000;
1706-(vii) $30,000, if the premium is $50,000,000 or
1707-more, but less than $100,000,000;
1708-(viii) $37,500, if the premium is $100,000,000 or
1709-
1710-
1711-more.
1712-(b) Admitted assets.
1713-(i) $150, if admitted assets are less than
1714-$1,000,000;
1715-(ii) $750, if admitted assets are $1,000,000 or
1716-more, but less than $5,000,000;
1717-(iii) $3,750, if admitted assets are $5,000,000 or
1718-more, but less than $25,000,000;
1719-(iv) $7,500, if admitted assets are $25,000,000 or
1720-more, but less than $50,000,000;
1721-(v) $18,000, if admitted assets are $50,000,000 or
1722-more, but less than $100,000,000;
1723-(vi) $22,500, if admitted assets are $100,000,000
1724-or more, but less than $500,000,000;
1725-(vii) $30,000, if admitted assets are $500,000,000
1726-or more, but less than $1,000,000,000;
1727-(viii) $37,500, if admitted assets are
1728-$1,000,000,000 or more.
1729-(c) The sum of financial regulation fees charged to
1730-the domestic companies of the same affiliated group shall
1731-not exceed $250,000 in the aggregate in any single year
1732-and shall be billed by the Director to the member company
1733-designated by the group.
1734-(7) The Director shall charge and collect an annual
1735-financial regulation fee from every foreign or alien company,
1736-except fraternal benefit societies, for the examination and
1737-
1738-
1739-analysis of its financial condition and to fund the internal
1740-costs and expenses of the Interstate Insurance Receivership
1741-Commission as may be allocated to the State of Illinois and
1742-companies doing an insurance business in this State pursuant
1743-to Article X of the Interstate Insurance Receivership Compact.
1744-The fee shall be a fixed amount based upon Illinois direct
1745-premium income and nationwide reinsurance assumed premium
1746-income in accordance with the following schedule:
1747-(a) $150, if the premium is less than $500,000 and
1748-there is no reinsurance assumed premium;
1749-(b) $750, if the premium is $500,000 or more, but less
1750-than $5,000,000 and there is no reinsurance assumed
1751-premium; or if the premium is less than $5,000,000 and the
1752-reinsurance assumed premium is less than $10,000,000;
1753-(c) $3,750, if the premium is less than $5,000,000 and
1754-the reinsurance assumed premium is $10,000,000 or more;
1755-(d) $7,500, if the premium is $5,000,000 or more, but
1756-less than $10,000,000;
1757-(e) $18,000, if the premium is $10,000,000 or more,
1758-but less than $25,000,000;
1759-(f) $22,500, if the premium is $25,000,000 or more,
1760-but less than $50,000,000;
1761-(g) $30,000, if the premium is $50,000,000 or more,
1762-but less than $100,000,000;
1763-(h) $37,500, if the premium is $100,000,000 or more.
1764-The sum of financial regulation fees under this subsection
1765-
1766-
1767-(7) charged to the foreign or alien companies within the same
1768-affiliated group shall not exceed $250,000 in the aggregate in
1769-any single year and shall be billed by the Director to the
1770-member company designated by the group.
1771-(8) Beginning January 1, 1992, the financial regulation
1772-fees imposed under subsections (6) and (7) of this Section
1773-shall be paid by each company or domestic affiliated group
1774-annually. After January 1, 1994, the fee shall be billed by
1775-Department invoice based upon the company's premium income or
1776-admitted assets as shown in its annual statement for the
1777-preceding calendar year. The invoice is due upon receipt and
1778-must be paid no later than June 30 of each calendar year. All
1779-financial regulation fees collected by the Department shall be
1780-paid to the Insurance Financial Regulation Fund. The
1781-Department may not collect financial examiner per diem charges
1782-from companies subject to subsections (6) and (7) of this
1783-Section undergoing financial examination after June 30, 1992.
1784-(9) In addition to the financial regulation fee required
1785-by this Section, a company undergoing any financial
1786-examination authorized by law shall pay the following costs
1787-and expenses incurred by the Department: electronic data
1788-processing costs, the expenses authorized under Section 131.21
1789-and subsection (d) of Section 132.4 of this Code, and lodging
1790-and travel expenses.
1791-Electronic data processing costs incurred by the
1792-Department in the performance of any examination shall be
1793-
1794-
1795-billed directly to the company undergoing examination for
1796-payment to the Technology Management Revolving Fund. Except
1797-for direct reimbursements authorized by the Director or direct
1798-payments made under Section 131.21 or subsection (d) of
1799-Section 132.4 of this Code, all financial regulation fees and
1800-all financial examination charges collected by the Department
1801-shall be paid to the Insurance Financial Regulation Fund.
1802-All lodging and travel expenses shall be in accordance
1803-with applicable travel regulations published by the Department
1804-of Central Management Services and approved by the Governor's
1805-Travel Control Board, except that out-of-state lodging and
1806-travel expenses related to examinations authorized under
1807-Sections 132.1 through 132.7 shall be in accordance with
1808-travel rates prescribed under paragraph 301-7.2 of the Federal
1809-Travel Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement
1810-of subsistence expenses incurred during official travel. All
1811-lodging and travel expenses may be reimbursed directly upon
1812-the authorization of the Director.
1813-In the case of an organization or person not subject to the
1814-financial regulation fee, the expenses incurred in any
1815-financial examination authorized by law shall be paid by the
1816-organization or person being examined. The charge shall be
1817-reasonably related to the cost of the examination including,
1818-but not limited to, compensation of examiners and other costs
1819-described in this subsection.
1820-(10) Any company, person, or entity failing to make any
1821-
1822-
1823-payment of $150 or more as required under this Section shall be
1824-subject to the penalty and interest provisions provided for in
1825-subsections (4) and (7) of Section 412.
1826-(11) Unless otherwise specified, all of the fees collected
1827-under this Section shall be paid into the Insurance Financial
1828-Regulation Fund.
1829-(12) For purposes of this Section:
1830-(a) "Domestic company" means a company as defined in
1831-Section 2 of this Code which is incorporated or organized
1832-under the laws of this State, and in addition includes a
1833-not-for-profit corporation authorized under the Dental
1834-Service Plan Act or the Voluntary Health Services Plans
1835-Act, a health maintenance organization, and a limited
1836-health service organization.
1837-(b) "Foreign company" means a company as defined in
1838-Section 2 of this Code which is incorporated or organized
1839-under the laws of any state of the United States other than
1840-this State and in addition includes a health maintenance
1841-organization and a limited health service organization
1842-which is incorporated or organized under the laws of any
1843-state of the United States other than this State.
1844-(c) "Alien company" means a company as defined in
1845-Section 2 of this Code which is incorporated or organized
1846-under the laws of any country other than the United
1847-States.
1848-(d) "Fraternal benefit society" means a corporation,
1849-
1850-
1851-society, order, lodge or voluntary association as defined
1852-in Section 282.1 of this Code.
1853-(e) "Mutual benefit association" means a company,
1854-association or corporation authorized by the Director to
1855-do business in this State under the provisions of Article
1856-XVIII of this Code.
1857-(f) "Burial society" means a person, firm,
1858-corporation, society or association of individuals
1859-authorized by the Director to do business in this State
1860-under the provisions of Article XIX of this Code.
1861-(g) "Farm mutual" means a district, county and
1862-township mutual insurance company authorized by the
1863-Director to do business in this State under the provisions
1864-of the Farm Mutual Insurance Company Act of 1986.
1865-(Source: P.A. 102-775, eff. 5-13-22.)
1866-(Text of Section after amendment by P.A. 103-75)
1867-Sec. 408. Fees and charges.
1868-(1) The Director shall charge, collect and give proper
1869-acquittances for the payment of the following fees and
1870-charges:
1871-(a) For filing all documents submitted for the
1872-incorporation or organization or certification of a
1873-domestic company, except for a fraternal benefit society,
1874-$2,000.
1875-(b) For filing all documents submitted for the
1876-
1877-
1878-incorporation or organization of a fraternal benefit
1879-society, $500.
1880-(c) For filing amendments to articles of incorporation
1881-and amendments to declaration of organization, except for
1882-a fraternal benefit society, a mutual benefit association,
1883-a burial society or a farm mutual, $200.
1884-(d) For filing amendments to articles of incorporation
1885-of a fraternal benefit society, a mutual benefit
1886-association or a burial society, $100.
1887-(e) For filing amendments to articles of incorporation
1888-of a farm mutual, $50.
1889-(f) For filing bylaws or amendments thereto, $50.
1890-(g) For filing agreement of merger or consolidation:
1891-(i) for a domestic company, except for a fraternal
1892-benefit society, a mutual benefit association, a
1893-burial society, or a farm mutual, $2,000.
1894-(ii) for a foreign or alien company, except for a
1895-fraternal benefit society, $600.
1896-(iii) for a fraternal benefit society, a mutual
1897-benefit association, a burial society, or a farm
1898-mutual, $200.
1899-(h) For filing agreements of reinsurance by a domestic
1900-company, $200.
1901-(i) For filing all documents submitted by a foreign or
1902-alien company to be admitted to transact business or
1903-accredited as a reinsurer in this State, except for a
1904-
1905-
1906-fraternal benefit society, $5,000.
1907-(j) For filing all documents submitted by a foreign or
1908-alien fraternal benefit society to be admitted to transact
1909-business in this State, $500.
1910-(k) For filing declaration of withdrawal of a foreign
1911-or alien company, $50.
1912-(l) For filing annual statement by a domestic company,
1913-except a fraternal benefit society, a mutual benefit
1914-association, a burial society, or a farm mutual, $200.
1915-(m) For filing annual statement by a domestic
1916-fraternal benefit society, $100.
1917-(n) For filing annual statement by a farm mutual, a
1918-mutual benefit association, or a burial society, $50.
1919-(o) For issuing a certificate of authority or renewal
1920-thereof except to a foreign fraternal benefit society,
1921-$400.
1922-(p) For issuing a certificate of authority or renewal
1923-thereof to a foreign fraternal benefit society, $200.
1924-(q) For issuing an amended certificate of authority,
1925-$50.
1926-(r) For each certified copy of certificate of
1927-authority, $20.
1928-(s) For each certificate of deposit, or valuation, or
1929-compliance or surety certificate, $20.
1930-(t) For copies of papers or records per page, $1.
1931-(u) For each certification to copies of papers or
1932-
1933-
1934-records, $10.
1935-(v) For multiple copies of documents or certificates
1936-listed in subparagraphs (r), (s), and (u) of paragraph (1)
1937-of this Section, $10 for the first copy of a certificate of
1938-any type and $5 for each additional copy of the same
1939-certificate requested at the same time, unless, pursuant
1940-to paragraph (2) of this Section, the Director finds these
1941-additional fees excessive.
1942-(w) For issuing a permit to sell shares or increase
1943-paid-up capital:
1944-(i) in connection with a public stock offering,
1945-$300;
1946-(ii) in any other case, $100.
1947-(x) For issuing any other certificate required or
1948-permissible under the law, $50.
1949-(y) For filing a plan of exchange of the stock of a
1950-domestic stock insurance company, a plan of
1951-demutualization of a domestic mutual company, or a plan of
1952-reorganization under Article XII, $2,000.
1953-(z) For filing a statement of acquisition of a
1954-domestic company as defined in Section 131.4 of this Code,
1955-$2,000.
1956-(aa) For filing an agreement to purchase the business
1957-of an organization authorized under the Dental Service
1958-Plan Act or the Voluntary Health Services Plans Act or of a
1959-health maintenance organization or a limited health
1960-
1961-
1962-service organization, $2,000.
1963-(bb) For filing a statement of acquisition of a
1964-foreign or alien insurance company as defined in Section
1965-131.12a of this Code, $1,000.
1966-(cc) For filing a registration statement as required
1967-in Sections 131.13 and 131.14, the notification as
1968-required by Sections 131.16, 131.20a, or 141.4, or an
1969-agreement or transaction required by Sections 124.2(2),
1970-141, 141a, or 141.1, $200.
1971-(dd) For filing an application for licensing of:
1972-(i) a religious or charitable risk pooling trust
1973-or a workers' compensation pool, $1,000;
1974-(ii) a workers' compensation service company,
1975-$500;
1976-(iii) a self-insured automobile fleet, $200; or
1977-(iv) a renewal of or amendment of any license
1978-issued pursuant to (i), (ii), or (iii) above, $100.
1979-(ee) For filing articles of incorporation for a
1980-syndicate to engage in the business of insurance through
1981-the Illinois Insurance Exchange, $2,000.
1982-(ff) For filing amended articles of incorporation for
1983-a syndicate engaged in the business of insurance through
1984-the Illinois Insurance Exchange, $100.
1985-(gg) For filing articles of incorporation for a
1986-limited syndicate to join with other subscribers or
1987-limited syndicates to do business through the Illinois
1988-
1989-
1990-Insurance Exchange, $1,000.
1991-(hh) For filing amended articles of incorporation for
1992-a limited syndicate to do business through the Illinois
1993-Insurance Exchange, $100.
1994-(ii) For a permit to solicit subscriptions to a
1995-syndicate or limited syndicate, $100.
1996-(jj) For the filing of each form as required in
1997-Section 143 of this Code, $50 per form. Informational and
1998-advertising filings shall be $25 per filing. The fee for
1999-advisory and rating organizations shall be $200 per form.
2000-(i) For the purposes of the form filing fee,
2001-filings made on insert page basis will be considered
2002-one form at the time of its original submission.
2003-Changes made to a form subsequent to its approval
2004-shall be considered a new filing.
2005-(ii) Only one fee shall be charged for a form,
2006-regardless of the number of other forms or policies
2007-with which it will be used.
2008-(iii) Fees charged for a policy filed as it will be
2009-issued regardless of the number of forms comprising
2010-that policy shall not exceed $1,500. For advisory or
2011-rating organizations, fees charged for a policy filed
2012-as it will be issued regardless of the number of forms
2013-comprising that policy shall not exceed $2,500.
2014-(iv) The Director may by rule exempt forms from
2015-such fees.
2016-
2017-
2018-(kk) For filing an application for licensing of a
2019-reinsurance intermediary, $500.
2020-(ll) For filing an application for renewal of a
2021-license of a reinsurance intermediary, $200.
2022-(mm) For filing a plan of division of a domestic stock
2023-company under Article IIB, $100,000 $10,000.
2024-(nn) For filing all documents submitted by a foreign
2025-or alien company to be a certified reinsurer in this
2026-State, except for a fraternal benefit society, $1,000.
2027-(oo) For filing a renewal by a foreign or alien
2028-company to be a certified reinsurer in this State, except
2029-for a fraternal benefit society, $400.
2030-(pp) For filing all documents submitted by a reinsurer
2031-domiciled in a reciprocal jurisdiction, $1,000.
2032-(qq) For filing a renewal by a reinsurer domiciled in
2033-a reciprocal jurisdiction, $400.
2034-(rr) For registering a captive management company or
2035-renewal thereof, $50.
2036-(ss) For filing an insurance business transfer plan
2037-under Article XLVII, $100,000 $25,000.
2038-(2) When printed copies or numerous copies of the same
2039-paper or records are furnished or certified, the Director may
2040-reduce such fees for copies if he finds them excessive. He may,
2041-when he considers it in the public interest, furnish without
2042-charge to state insurance departments and persons other than
2043-companies, copies or certified copies of reports of
2044-
2045-
2046-examinations and of other papers and records.
2047-(3) The expenses incurred in any performance examination
2048-authorized by law shall be paid by the company or person being
2049-examined. The charge shall be reasonably related to the cost
2050-of the examination including but not limited to compensation
2051-of examiners, electronic data processing costs, supervision
2052-and preparation of an examination report and lodging and
2053-travel expenses. All lodging and travel expenses shall be in
2054-accord with the applicable travel regulations as published by
2055-the Department of Central Management Services and approved by
2056-the Governor's Travel Control Board, except that out-of-state
2057-lodging and travel expenses related to examinations authorized
2058-under Section 132 shall be in accordance with travel rates
2059-prescribed under paragraph 301-7.2 of the Federal Travel
2060-Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement of
2061-subsistence expenses incurred during official travel. All
2062-lodging and travel expenses may be reimbursed directly upon
2063-authorization of the Director. With the exception of the
2064-direct reimbursements authorized by the Director, all
2065-performance examination charges collected by the Department
2066-shall be paid to the Insurance Producer Administration Fund,
2067-however, the electronic data processing costs incurred by the
2068-Department in the performance of any examination shall be
2069-billed directly to the company being examined for payment to
2070-the Technology Management Revolving Fund.
2071-(4) At the time of any service of process on the Director
2072-
2073-
2074-as attorney for such service, the Director shall charge and
2075-collect the sum of $40, which may be recovered as taxable costs
2076-by the party to the suit or action causing such service to be
2077-made if he prevails in such suit or action.
2078-(5) (a) The costs incurred by the Department of Insurance
2079-in conducting any hearing authorized by law shall be assessed
2080-against the parties to the hearing in such proportion as the
2081-Director of Insurance may determine upon consideration of all
2082-relevant circumstances including: (1) the nature of the
2083-hearing; (2) whether the hearing was instigated by, or for the
2084-benefit of a particular party or parties; (3) whether there is
2085-a successful party on the merits of the proceeding; and (4) the
2086-relative levels of participation by the parties.
2087-(b) For purposes of this subsection (5) costs incurred
2088-shall mean the hearing officer fees, court reporter fees, and
2089-travel expenses of Department of Insurance officers and
2090-employees; provided however, that costs incurred shall not
2091-include hearing officer fees or court reporter fees unless the
2092-Department has retained the services of independent
2093-contractors or outside experts to perform such functions.
2094-(c) The Director shall make the assessment of costs
2095-incurred as part of the final order or decision arising out of
2096-the proceeding; provided, however, that such order or decision
2097-shall include findings and conclusions in support of the
2098-assessment of costs. This subsection (5) shall not be
2099-construed as permitting the payment of travel expenses unless
2100-
2101-
2102-calculated in accordance with the applicable travel
2103-regulations of the Department of Central Management Services,
2104-as approved by the Governor's Travel Control Board. The
2105-Director as part of such order or decision shall require all
2106-assessments for hearing officer fees and court reporter fees,
2107-if any, to be paid directly to the hearing officer or court
2108-reporter by the party(s) assessed for such costs. The
2109-assessments for travel expenses of Department officers and
2110-employees shall be reimbursable to the Director of Insurance
2111-for deposit to the fund out of which those expenses had been
2112-paid.
2113-(d) The provisions of this subsection (5) shall apply in
2114-the case of any hearing conducted by the Director of Insurance
2115-not otherwise specifically provided for by law.
2116-(6) The Director shall charge and collect an annual
2117-financial regulation fee from every domestic company for
2118-examination and analysis of its financial condition and to
2119-fund the internal costs and expenses of the Interstate
2120-Insurance Receivership Commission as may be allocated to the
2121-State of Illinois and companies doing an insurance business in
2122-this State pursuant to Article X of the Interstate Insurance
2123-Receivership Compact. The fee shall be the greater fixed
2124-amount based upon the combination of nationwide direct premium
2125-income and nationwide reinsurance assumed premium income or
2126-upon admitted assets calculated under this subsection as
2127-follows:
2128-
2129-
2130-(a) Combination of nationwide direct premium income
2131-and nationwide reinsurance assumed premium.
2132-(i) $150, if the premium is less than $500,000 and
2133-there is no reinsurance assumed premium;
2134-(ii) $750, if the premium is $500,000 or more, but
2135-less than $5,000,000 and there is no reinsurance
2136-assumed premium; or if the premium is less than
2137-$5,000,000 and the reinsurance assumed premium is less
2138-than $10,000,000;
2139-(iii) $3,750, if the premium is less than
2140-$5,000,000 and the reinsurance assumed premium is
2141-$10,000,000 or more;
2142-(iv) $7,500, if the premium is $5,000,000 or more,
2143-but less than $10,000,000;
2144-(v) $18,000, if the premium is $10,000,000 or
2145-more, but less than $25,000,000;
2146-(vi) $22,500, if the premium is $25,000,000 or
2147-more, but less than $50,000,000;
2148-(vii) $30,000, if the premium is $50,000,000 or
2149-more, but less than $100,000,000;
2150-(viii) $37,500, if the premium is $100,000,000 or
2151-more.
2152-(b) Admitted assets.
2153-(i) $150, if admitted assets are less than
2154-$1,000,000;
2155-(ii) $750, if admitted assets are $1,000,000 or
2156-
2157-
2158-more, but less than $5,000,000;
2159-(iii) $3,750, if admitted assets are $5,000,000 or
2160-more, but less than $25,000,000;
2161-(iv) $7,500, if admitted assets are $25,000,000 or
2162-more, but less than $50,000,000;
2163-(v) $18,000, if admitted assets are $50,000,000 or
2164-more, but less than $100,000,000;
2165-(vi) $22,500, if admitted assets are $100,000,000
2166-or more, but less than $500,000,000;
2167-(vii) $30,000, if admitted assets are $500,000,000
2168-or more, but less than $1,000,000,000;
2169-(viii) $37,500, if admitted assets are
2170-$1,000,000,000 or more.
2171-(c) The sum of financial regulation fees charged to
2172-the domestic companies of the same affiliated group shall
2173-not exceed $250,000 in the aggregate in any single year
2174-and shall be billed by the Director to the member company
2175-designated by the group.
2176-(7) The Director shall charge and collect an annual
2177-financial regulation fee from every foreign or alien company,
2178-except fraternal benefit societies, for the examination and
2179-analysis of its financial condition and to fund the internal
2180-costs and expenses of the Interstate Insurance Receivership
2181-Commission as may be allocated to the State of Illinois and
2182-companies doing an insurance business in this State pursuant
2183-to Article X of the Interstate Insurance Receivership Compact.
2184-
2185-
2186-The fee shall be a fixed amount based upon Illinois direct
2187-premium income and nationwide reinsurance assumed premium
2188-income in accordance with the following schedule:
2189-(a) $150, if the premium is less than $500,000 and
2190-there is no reinsurance assumed premium;
2191-(b) $750, if the premium is $500,000 or more, but less
2192-than $5,000,000 and there is no reinsurance assumed
2193-premium; or if the premium is less than $5,000,000 and the
2194-reinsurance assumed premium is less than $10,000,000;
2195-(c) $3,750, if the premium is less than $5,000,000 and
2196-the reinsurance assumed premium is $10,000,000 or more;
2197-(d) $7,500, if the premium is $5,000,000 or more, but
2198-less than $10,000,000;
2199-(e) $18,000, if the premium is $10,000,000 or more,
2200-but less than $25,000,000;
2201-(f) $22,500, if the premium is $25,000,000 or more,
2202-but less than $50,000,000;
2203-(g) $30,000, if the premium is $50,000,000 or more,
2204-but less than $100,000,000;
2205-(h) $37,500, if the premium is $100,000,000 or more.
2206-The sum of financial regulation fees under this subsection
2207-(7) charged to the foreign or alien companies within the same
2208-affiliated group shall not exceed $250,000 in the aggregate in
2209-any single year and shall be billed by the Director to the
2210-member company designated by the group.
2211-(8) Beginning January 1, 1992, the financial regulation
2212-
2213-
2214-fees imposed under subsections (6) and (7) of this Section
2215-shall be paid by each company or domestic affiliated group
2216-annually. After January 1, 1994, the fee shall be billed by
2217-Department invoice based upon the company's premium income or
2218-admitted assets as shown in its annual statement for the
2219-preceding calendar year. The invoice is due upon receipt and
2220-must be paid no later than June 30 of each calendar year. All
2221-financial regulation fees collected by the Department shall be
2222-paid to the Insurance Financial Regulation Fund. The
2223-Department may not collect financial examiner per diem charges
2224-from companies subject to subsections (6) and (7) of this
2225-Section undergoing financial examination after June 30, 1992.
2226-(9) In addition to the financial regulation fee required
2227-by this Section, a company undergoing any financial
2228-examination authorized by law shall pay the following costs
2229-and expenses incurred by the Department: electronic data
2230-processing costs, the expenses authorized under Section 131.21
2231-and subsection (d) of Section 132.4 of this Code, and lodging
2232-and travel expenses.
2233-Electronic data processing costs incurred by the
2234-Department in the performance of any examination shall be
2235-billed directly to the company undergoing examination for
2236-payment to the Technology Management Revolving Fund. Except
2237-for direct reimbursements authorized by the Director or direct
2238-payments made under Section 131.21 or subsection (d) of
2239-Section 132.4 of this Code, all financial regulation fees and
2240-
2241-
2242-all financial examination charges collected by the Department
2243-shall be paid to the Insurance Financial Regulation Fund.
2244-All lodging and travel expenses shall be in accordance
2245-with applicable travel regulations published by the Department
2246-of Central Management Services and approved by the Governor's
2247-Travel Control Board, except that out-of-state lodging and
2248-travel expenses related to examinations authorized under
2249-Sections 132.1 through 132.7 shall be in accordance with
2250-travel rates prescribed under paragraph 301-7.2 of the Federal
2251-Travel Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement
2252-of subsistence expenses incurred during official travel. All
2253-lodging and travel expenses may be reimbursed directly upon
2254-the authorization of the Director.
2255-In the case of an organization or person not subject to the
2256-financial regulation fee, the expenses incurred in any
2257-financial examination authorized by law shall be paid by the
2258-organization or person being examined. The charge shall be
2259-reasonably related to the cost of the examination including,
2260-but not limited to, compensation of examiners and other costs
2261-described in this subsection.
2262-(10) Any company, person, or entity failing to make any
2263-payment of $150 or more as required under this Section shall be
2264-subject to the penalty and interest provisions provided for in
2265-subsections (4) and (7) of Section 412.
2266-(11) Unless otherwise specified, all of the fees collected
2267-under this Section shall be paid into the Insurance Financial
2268-
2269-
2270-Regulation Fund.
2271-(12) For purposes of this Section:
2272-(a) "Domestic company" means a company as defined in
2273-Section 2 of this Code which is incorporated or organized
2274-under the laws of this State, and in addition includes a
2275-not-for-profit corporation authorized under the Dental
2276-Service Plan Act or the Voluntary Health Services Plans
2277-Act, a health maintenance organization, and a limited
2278-health service organization.
2279-(b) "Foreign company" means a company as defined in
2280-Section 2 of this Code which is incorporated or organized
2281-under the laws of any state of the United States other than
2282-this State and in addition includes a health maintenance
2283-organization and a limited health service organization
2284-which is incorporated or organized under the laws of any
2285-state of the United States other than this State.
2286-(c) "Alien company" means a company as defined in
2287-Section 2 of this Code which is incorporated or organized
2288-under the laws of any country other than the United
2289-States.
2290-(d) "Fraternal benefit society" means a corporation,
2291-society, order, lodge or voluntary association as defined
2292-in Section 282.1 of this Code.
2293-(e) "Mutual benefit association" means a company,
2294-association or corporation authorized by the Director to
2295-do business in this State under the provisions of Article
2296-
2297-
2298-XVIII of this Code.
2299-(f) "Burial society" means a person, firm,
2300-corporation, society or association of individuals
2301-authorized by the Director to do business in this State
2302-under the provisions of Article XIX of this Code.
2303-(g) "Farm mutual" means a district, county and
2304-township mutual insurance company authorized by the
2305-Director to do business in this State under the provisions
2306-of the Farm Mutual Insurance Company Act of 1986.
2307-(Source: P.A. 102-775, eff. 5-13-22; 103-75, eff. 1-1-25.)
2308-(215 ILCS 5/412) (from Ch. 73, par. 1024)
2309-Sec. 412. Refunds; penalties; collection.
2310-(1)(a) Whenever it appears to the satisfaction of the
2311-Director that because of some mistake of fact, error in
2312-calculation, or erroneous interpretation of a statute of this
2313-or any other state, any authorized company, surplus line
2314-producer, or industrial insured has paid to him, pursuant to
2315-any provision of law, taxes, fees, or other charges in excess
2316-of the amount legally chargeable against it, during the 6-year
2317-6 year period immediately preceding the discovery of such
2318-overpayment, he shall have power to refund to such company,
2319-surplus line producer, or industrial insured the amount of the
2320-excess or excesses by applying the amount or amounts thereof
2321-toward the payment of taxes, fees, or other charges already
2322-due, or which may thereafter become due from that company
2323-
2324-
2325-until such excess or excesses have been fully refunded, or
2326-upon a written request from the authorized company, surplus
2327-line producer, or industrial insured, the Director shall
2328-provide a cash refund within 120 days after receipt of the
2329-written request if all necessary information has been filed
2330-with the Department in order for it to perform an audit of the
2331-tax report for the transaction or period or annual return for
2332-the year in which the overpayment occurred or within 120 days
2333-after the date the Department receives all the necessary
2334-information to perform such audit. The Director shall not
2335-provide a cash refund if there are insufficient funds in the
2336-Insurance Premium Tax Refund Fund to provide a cash refund, if
2337-the amount of the overpayment is less than $100, or if the
2338-amount of the overpayment can be fully offset against the
2339-taxpayer's estimated liability for the year following the year
2340-of the cash refund request. Any cash refund shall be paid from
2341-the Insurance Premium Tax Refund Fund, a special fund hereby
2342-created in the State treasury.
2343-(b) As determined by the Director pursuant to paragraph
2344-(a) of this subsection, the Department shall deposit an amount
2345-of cash refunds approved by the Director for payment as a
2346-result of overpayment of tax liability collected under
2347-Sections 121-2.08, 409, 444, 444.1, and 445 of this Code into
2348-the Insurance Premium Tax Refund Fund.
2349-(c) Beginning July 1, 1999, moneys in the Insurance
2350-Premium Tax Refund Fund shall be expended exclusively for the
2351-
2352-
2353-purpose of paying cash refunds resulting from overpayment of
2354-tax liability under Sections 121-2.08, 409, 444, 444.1, and
2355-445 of this Code as determined by the Director pursuant to
2356-subsection 1(a) of this Section. Cash refunds made in
2357-accordance with this Section may be made from the Insurance
2358-Premium Tax Refund Fund only to the extent that amounts have
2359-been deposited and retained in the Insurance Premium Tax
2360-Refund Fund.
2361-(d) This Section shall constitute an irrevocable and
2362-continuing appropriation from the Insurance Premium Tax Refund
2363-Fund for the purpose of paying cash refunds pursuant to the
2364-provisions of this Section.
2365-(2)(a) When any insurance company fails to file any tax
2366-return required under Sections 408.1, 409, 444, and 444.1 of
2367-this Code or Section 12 of the Fire Investigation Act on the
2368-date prescribed, including any extensions, there shall be
2369-added as a penalty $400 or 10% of the amount of such tax,
2370-whichever is greater, for each month or part of a month of
2371-failure to file, the entire penalty not to exceed $2,000 or 50%
2372-of the tax due, whichever is greater. In this paragraph, "tax
2373-due" means the full amount due for the applicable tax period
2374-under Section 408.1, 409, 444, or 444.1 of this Code or Section
2375-12 of the Fire Investigation Act.
2376-(b) When any industrial insured or surplus line producer
2377-fails to file any tax return or report required under Sections
2378-121-2.08 and 445 of this Code or Section 12 of the Fire
2379-
2380-
2381-Investigation Act on the date prescribed, including any
2382-extensions, there shall be added:
2383-(i) as a late fee, if the return or report is received
2384-at least one day but not more than 15 days after the
2385-prescribed due date, $50 or 5% of the tax due, whichever is
2386-greater, the entire fee not to exceed $1,000;
2387-(ii) as a late fee, if the return or report is received
2388-at least 16 days but not more than 30 days after the
2389-prescribed due date, $100 or 5% of the tax due, whichever
2390-is greater, the entire fee not to exceed $2,000; or
2391-(iii) as a penalty, if the return or report is
2392-received more than 30 days after the prescribed due date,
2393-$100 or 5% of the tax due, whichever is greater, for each
2394-month or part of a month of failure to file, the entire
2395-penalty not to exceed $500 or 30% of the tax due, whichever
2396-is greater.
2397-In this paragraph, "tax due" means the full amount due for
2398-the applicable tax period under Section 121-2.08 or 445 of
2399-this Code or Section 12 of the Fire Investigation Act. A tax
2400-return or report shall be deemed received as of the date mailed
2401-as evidenced by a postmark, proof of mailing on a recognized
2402-United States Postal Service form or a form acceptable to the
2403-United States Postal Service or other commercial mail delivery
2404-service, or other evidence acceptable to the Director.
2405-(3)(a) When any insurance company fails to pay the full
2406-amount due under the provisions of this Section, Sections
2407-
2408-
2409-408.1, 409, 444, or 444.1 of this Code, or Section 12 of the
2410-Fire Investigation Act, there shall be added to the amount due
2411-as a penalty an amount equal to 10% of the deficiency.
2412-(a-5) When any industrial insured or surplus line producer
2413-fails to pay the full amount due under the provisions of this
2414-Section, Sections 121-2.08 or 445 of this Code, or Section 12
2415-of the Fire Investigation Act on the date prescribed, there
2416-shall be added:
2417-(i) as a late fee, if the payment is received at least
2418-one day but not more than 7 days after the prescribed due
2419-date, 10% of the tax due, the entire fee not to exceed
2420-$1,000;
2421-(ii) as a late fee, if the payment is received at least
2422-8 days but not more than 14 days after the prescribed due
2423-date, 10% of the tax due, the entire fee not to exceed
2424-$1,500;
2425-(iii) as a late fee, if the payment is received at
2426-least 15 days but not more than 21 days after the
2427-prescribed due date, 10% of the tax due, the entire fee not
2428-to exceed $2,000; or
2429-(iv) as a penalty, if the return or report is received
2430-more than 21 days after the prescribed due date, 10% of the
2431-tax due.
2432-In this paragraph, "tax due" means the full amount due for
2433-the applicable tax period under this Section, Section 121-2.08
2434-or 445 of this Code, or Section 12 of the Fire Investigation
2435-
2436-
2437-Act. A tax payment shall be deemed received as of the date
2438-mailed as evidenced by a postmark, proof of mailing on a
2439-recognized United States Postal Service form or a form
2440-acceptable to the United States Postal Service or other
2441-commercial mail delivery service, or other evidence acceptable
2442-to the Director.
2443-(b) If such failure to pay is determined by the Director to
2444-be willful wilful, after a hearing under Sections 402 and 403,
2445-there shall be added to the tax as a penalty an amount equal to
2446-the greater of 50% of the deficiency or 10% of the amount due
2447-and unpaid for each month or part of a month that the
2448-deficiency remains unpaid commencing with the date that the
2449-amount becomes due. Such amount shall be in lieu of any
2450-determined under paragraph (a) or (a-5).
2451-(4) Any insurance company, industrial insured, or surplus
2452-line producer that fails to pay the full amount due under this
2453-Section or Sections 121-2.08, 408.1, 409, 444, 444.1, or 445
2454-of this Code, or Section 12 of the Fire Investigation Act is
2455-liable, in addition to the tax and any late fees and penalties,
2456-for interest on such deficiency at the rate of 12% per annum,
2457-or at such higher adjusted rates as are or may be established
2458-under subsection (b) of Section 6621 of the Internal Revenue
2459-Code, from the date that payment of any such tax was due,
2460-determined without regard to any extensions, to the date of
2461-payment of such amount.
2462-(5) The Director, through the Attorney General, may
2463-
2464-
2465-institute an action in the name of the People of the State of
2466-Illinois, in any court of competent jurisdiction, for the
2467-recovery of the amount of such taxes, fees, and penalties due,
2468-and prosecute the same to final judgment, and take such steps
2469-as are necessary to collect the same.
2470-(6) In the event that the certificate of authority of a
2471-foreign or alien company is revoked for any cause or the
2472-company withdraws from this State prior to the renewal date of
2473-the certificate of authority as provided in Section 114, the
2474-company may recover the amount of any such tax paid in advance.
2475-Except as provided in this subsection, no revocation or
2476-withdrawal excuses payment of or constitutes grounds for the
2477-recovery of any taxes or penalties imposed by this Code.
2478-(7) When an insurance company or domestic affiliated group
2479-fails to pay the full amount of any fee of $200 or more due
2480-under Section 408 of this Code, there shall be added to the
2481-amount due as a penalty the greater of $100 or an amount equal
2482-to 10% of the deficiency for each month or part of a month that
2483-the deficiency remains unpaid.
2484-(8) The Department shall have a lien for the taxes, fees,
2485-charges, fines, penalties, interest, other charges, or any
2486-portion thereof, imposed or assessed pursuant to this Code,
2487-upon all the real and personal property of any company or
2488-person to whom the assessment or final order has been issued or
2489-whenever a tax return is filed without payment of the tax or
2490-penalty shown therein to be due, including all such property
2491-
2492-
2493-of the company or person acquired after receipt of the
2494-assessment, issuance of the order, or filing of the return.
2495-The company or person is liable for the filing fee incurred by
2496-the Department for filing the lien and the filing fee incurred
2497-by the Department to file the release of that lien. The filing
2498-fees shall be paid to the Department in addition to payment of
2499-the tax, fee, charge, fine, penalty, interest, other charges,
2500-or any portion thereof, included in the amount of the lien.
2501-However, where the lien arises because of the issuance of a
2502-final order of the Director or tax assessment by the
2503-Department, the lien shall not attach and the notice referred
2504-to in this Section shall not be filed until all administrative
2505-proceedings or proceedings in court for review of the final
2506-order or assessment have terminated or the time for the taking
2507-thereof has expired without such proceedings being instituted.
2508-Upon the granting of Department review after a lien has
2509-attached, the lien shall remain in full force except to the
2510-extent to which the final assessment may be reduced by a
2511-revised final assessment following the rehearing or review.
2512-The lien created by the issuance of a final assessment shall
2513-terminate, unless a notice of lien is filed, within 3 years
2514-after the date all proceedings in court for the review of the
2515-final assessment have terminated or the time for the taking
2516-thereof has expired without such proceedings being instituted,
2517-or (in the case of a revised final assessment issued pursuant
2518-to a rehearing or review by the Department) within 3 years
2519-
2520-
2521-after the date all proceedings in court for the review of such
2522-revised final assessment have terminated or the time for the
2523-taking thereof has expired without such proceedings being
2524-instituted. Where the lien results from the filing of a tax
2525-return without payment of the tax or penalty shown therein to
2526-be due, the lien shall terminate, unless a notice of lien is
2527-filed, within 3 years after the date when the return is filed
2528-with the Department.
2529-The time limitation period on the Department's right to
2530-file a notice of lien shall not run during any period of time
2531-in which the order of any court has the effect of enjoining or
2532-restraining the Department from filing such notice of lien. If
2533-the Department finds that a company or person is about to
2534-depart from the State, to conceal himself or his property, or
2535-to do any other act tending to prejudice or to render wholly or
2536-partly ineffectual proceedings to collect the amount due and
2537-owing to the Department unless such proceedings are brought
2538-without delay, or if the Department finds that the collection
2539-of the amount due from any company or person will be
2540-jeopardized by delay, the Department shall give the company or
2541-person notice of such findings and shall make demand for
2542-immediate return and payment of the amount, whereupon the
2543-amount shall become immediately due and payable. If the
2544-company or person, within 5 days after the notice (or within
2545-such extension of time as the Department may grant), does not
2546-comply with the notice or show to the Department that the
2547-
2548-
2549-findings in the notice are erroneous, the Department may file
2550-a notice of jeopardy assessment lien in the office of the
2551-recorder of the county in which any property of the company or
2552-person may be located and shall notify the company or person of
2553-the filing. The jeopardy assessment lien shall have the same
2554-scope and effect as the statutory lien provided for in this
2555-Section. If the company or person believes that the company or
2556-person does not owe some or all of the tax for which the
2557-jeopardy assessment lien against the company or person has
2558-been filed, or that no jeopardy to the revenue in fact exists,
2559-the company or person may protest within 20 days after being
2560-notified by the Department of the filing of the jeopardy
2561-assessment lien and request a hearing, whereupon the
2562-Department shall hold a hearing in conformity with the
2563-provisions of this Code and, pursuant thereto, shall notify
2564-the company or person of its findings as to whether or not the
2565-jeopardy assessment lien will be released. If not, and if the
2566-company or person is aggrieved by this decision, the company
2567-or person may file an action for judicial review of the final
2568-determination of the Department in accordance with the
2569-Administrative Review Law. If, pursuant to such hearing (or
2570-after an independent determination of the facts by the
2571-Department without a hearing), the Department determines that
2572-some or all of the amount due covered by the jeopardy
2573-assessment lien is not owed by the company or person, or that
2574-no jeopardy to the revenue exists, or if on judicial review the
2575-
2576-
2577-final judgment of the court is that the company or person does
2578-not owe some or all of the amount due covered by the jeopardy
2579-assessment lien against them, or that no jeopardy to the
2580-revenue exists, the Department shall release its jeopardy
2581-assessment lien to the extent of such finding of nonliability
2582-for the amount, or to the extent of such finding of no jeopardy
2583-to the revenue. The Department shall also release its jeopardy
2584-assessment lien against the company or person whenever the
2585-amount due and owing covered by the lien, plus any interest
2586-which may be due, are paid and the company or person has paid
2587-the Department in cash or by guaranteed remittance an amount
2588-representing the filing fee for the lien and the filing fee for
2589-the release of that lien. The Department shall file that
2590-release of lien with the recorder of the county where that lien
2591-was filed.
2592-Nothing in this Section shall be construed to give the
2593-Department a preference over the rights of any bona fide
2594-purchaser, holder of a security interest, mechanics
2595-lienholder, mortgagee, or judgment lien creditor arising prior
2596-to the filing of a regular notice of lien or a notice of
2597-jeopardy assessment lien in the office of the recorder in the
2598-county in which the property subject to the lien is located.
2599-For purposes of this Section, "bona fide" shall not include
2600-any mortgage of real or personal property or any other credit
2601-transaction that results in the mortgagee or the holder of the
2602-security acting as trustee for unsecured creditors of the
2603-
2604-
2605-company or person mentioned in the notice of lien who executed
2606-such chattel or real property mortgage or the document
2607-evidencing such credit transaction. The lien shall be inferior
2608-to the lien of general taxes, special assessments, and special
2609-taxes levied by any political subdivision of this State. In
2610-case title to land to be affected by the notice of lien or
2611-notice of jeopardy assessment lien is registered under the
2612-provisions of the Registered Titles (Torrens) Act, such notice
2613-shall be filed in the office of the Registrar of Titles of the
2614-county within which the property subject to the lien is
2615-situated and shall be entered upon the register of titles as a
2616-memorial or charge upon each folium of the register of titles
2617-affected by such notice, and the Department shall not have a
2618-preference over the rights of any bona fide purchaser,
2619-mortgagee, judgment creditor, or other lienholder arising
2620-prior to the registration of such notice. The regular lien or
2621-jeopardy assessment lien shall not be effective against any
2622-purchaser with respect to any item in a retailer's stock in
2623-trade purchased from the retailer in the usual course of the
2624-retailer's business.
2625-(Source: P.A. 102-775, eff. 5-13-22; 103-426, eff. 8-4-23.)
2626-(215 ILCS 5/531.03) (from Ch. 73, par. 1065.80-3)
2627-Sec. 531.03. Coverage and limitations.
2628-(1) This Article shall provide coverage for the policies
2629-and contracts specified in subsection (2) of this Section:
2630-
2631-
2632-(a) to persons who, regardless of where they reside
2633-(except for non-resident certificate holders under group
2634-policies or contracts), are the beneficiaries, assignees
2635-or payees, including health care providers rendering
2636-services covered under a health insurance policy or
2637-certificate, of the persons covered under paragraph (b) of
2638-this subsection, and
2639-(b) to persons who are owners of or certificate
2640-holders or enrollees under the policies or contracts
2641-(other than unallocated annuity contracts and structured
2642-settlement annuities) and in each case who:
2643-(i) are residents; or
2644-(ii) are not residents, but only under all of the
2645-following conditions:
2646-(A) the member insurer that issued the
2647-policies or contracts is domiciled in this State;
2648-(B) the states in which the persons reside
2649-have associations similar to the Association
2650-created by this Article;
2651-(C) the persons are not eligible for coverage
2652-by an association in any other state due to the
2653-fact that the insurer or health maintenance
2654-organization was not licensed in that state at the
2655-time specified in that state's guaranty
2656-association law.
2657-(c) For unallocated annuity contracts specified in
2658-
2659-
2660-subsection (2), paragraphs (a) and (b) of this subsection
2661-(1) shall not apply and this Article shall (except as
2662-provided in paragraphs (e) and (f) of this subsection)
2663-provide coverage to:
2664-(i) persons who are the owners of the unallocated
2665-annuity contracts if the contracts are issued to or in
2666-connection with a specific benefit plan whose plan
2667-sponsor has its principal place of business in this
2668-State; and
2669-(ii) persons who are owners of unallocated annuity
2670-contracts issued to or in connection with government
2671-lotteries if the owners are residents.
2672-(d) For structured settlement annuities specified in
2673-subsection (2), paragraphs (a) and (b) of this subsection
2674-(1) shall not apply and this Article shall (except as
2675-provided in paragraphs (e) and (f) of this subsection)
2676-provide coverage to a person who is a payee under a
2677-structured settlement annuity (or beneficiary of a payee
2678-if the payee is deceased), if the payee:
2679-(i) is a resident, regardless of where the
2680-contract owner resides; or
2681-(ii) is not a resident, but only under both of the
2682-following conditions:
2683-(A) with regard to residency:
2684-(I) the contract owner of the structured
2685-settlement annuity is a resident; or
2686-
2687-
2688-(II) the contract owner of the structured
2689-settlement annuity is not a resident but the
2690-insurer that issued the structured settlement
2691-annuity is domiciled in this State and the
2692-state in which the contract owner resides has
2693-an association similar to the Association
2694-created by this Article; and
2695-(B) neither the payee or beneficiary nor the
2696-contract owner is eligible for coverage by the
2697-association of the state in which the payee or
2698-contract owner resides.
2699-(e) This Article shall not provide coverage to:
2700-(i) a person who is a payee or beneficiary of a
2701-contract owner resident of this State if the payee or
2702-beneficiary is afforded any coverage by the
2703-association of another state; or
2704-(ii) a person covered under paragraph (c) of this
2705-subsection (1), if any coverage is provided by the
2706-association of another state to that person.
2707-(f) This Article is intended to provide coverage to a
2708-person who is a resident of this State and, in special
2709-circumstances, to a nonresident. In order to avoid
2710-duplicate coverage, if a person who would otherwise
2711-receive coverage under this Article is provided coverage
2712-under the laws of any other state, then the person shall
2713-not be provided coverage under this Article. In
2714-
2715-
2716-determining the application of the provisions of this
2717-paragraph in situations where a person could be covered by
2718-the association of more than one state, whether as an
2719-owner, payee, enrollee, beneficiary, or assignee, this
2720-Article shall be construed in conjunction with other state
2721-laws to result in coverage by only one association.
2722-(2)(a) This Article shall provide coverage to the persons
2723-specified in subsection (1) of this Section for policies or
2724-contracts of direct, (i) nongroup life insurance, health
2725-insurance (that, for the purposes of this Article, includes
2726-health maintenance organization subscriber contracts and
2727-certificates), annuities and supplemental contracts to any of
2728-these, (ii) for certificates under direct group policies or
2729-contracts, (iii) for unallocated annuity contracts and (iv)
2730-for contracts to furnish health care services and subscription
2731-certificates for medical or health care services issued by
2732-persons licensed to transact insurance business in this State
2733-under this Code. Annuity contracts and certificates under
2734-group annuity contracts include but are not limited to
2735-guaranteed investment contracts, deposit administration
2736-contracts, unallocated funding agreements, allocated funding
2737-agreements, structured settlement agreements, lottery
2738-contracts and any immediate or deferred annuity contracts.
2739-(b) Except as otherwise provided in paragraph (c) of this
2740-subsection, this Article shall not provide coverage for:
2741-(i) that portion of a policy or contract not
2742-
2743-
2744-guaranteed by the member insurer, or under which the risk
2745-is borne by the policy or contract owner;
2746-(ii) any such policy or contract or part thereof
2747-assumed by the impaired or insolvent insurer under a
2748-contract of reinsurance, other than reinsurance for which
2749-assumption certificates have been issued;
2750-(iii) any portion of a policy or contract to the
2751-extent that the rate of interest on which it is based or
2752-the interest rate, crediting rate, or similar factor is
2753-determined by use of an index or other external reference
2754-stated in the policy or contract employed in calculating
2755-returns or changes in value:
2756-(A) averaged over the period of 4 years prior to
2757-the date on which the member insurer becomes an
2758-impaired or insolvent insurer under this Article,
2759-whichever is earlier, exceeds the rate of interest
2760-determined by subtracting 2 percentage points from
2761-Moody's Corporate Bond Yield Average averaged for that
2762-same 4-year period or for such lesser period if the
2763-policy or contract was issued less than 4 years before
2764-the member insurer becomes an impaired or insolvent
2765-insurer under this Article, whichever is earlier; and
2766-(B) on and after the date on which the member
2767-insurer becomes an impaired or insolvent insurer under
2768-this Article, whichever is earlier, exceeds the rate
2769-of interest determined by subtracting 3 percentage
2770-
2771-
2772-points from Moody's Corporate Bond Yield Average as
2773-most recently available;
2774-(iv) any unallocated annuity contract issued to or in
2775-connection with a benefit plan protected under the federal
2776-Pension Benefit Guaranty Corporation, regardless of
2777-whether the federal Pension Benefit Guaranty Corporation
2778-has yet become liable to make any payments with respect to
2779-the benefit plan;
2780-(v) any portion of any unallocated annuity contract
2781-which is not issued to or in connection with a specific
2782-employee, union or association of natural persons benefit
2783-plan or a government lottery;
2784-(vi) an obligation that does not arise under the
2785-express written terms of the policy or contract issued by
2786-the member insurer to the enrollee, certificate holder,
2787-contract owner, or policy owner, including without
2788-limitation:
2789-(A) a claim based on marketing materials;
2790-(B) a claim based on side letters, riders, or
2791-other documents that were issued by the member insurer
2792-without meeting applicable policy or contract form
2793-filing or approval requirements;
2794-(C) a misrepresentation of or regarding policy or
2795-contract benefits;
2796-(D) an extra-contractual claim; or
2797-(E) a claim for penalties or consequential or
2798-
2799-
2800-incidental damages;
2801-(vii) any stop-loss insurance, as defined in clause
2802-(b) of Class 1 or clause (a) of Class 2 of Section 4, and
2803-further defined in subsection (d) of Section 352;
2804-(viii) any policy or contract providing any hospital,
2805-medical, prescription drug, or other health care benefits
2806-pursuant to Part C or Part D of Subchapter XVIII, Chapter 7
2807-of Title 42 of the United States Code (commonly known as
2808-Medicare Part C & D), Subchapter XIX, Chapter 7 of Title 42
2809-of the United States Code (commonly known as Medicaid), or
2810-any regulations issued pursuant thereto;
2811-(ix) any portion of a policy or contract to the extent
2812-that the assessments required by Section 531.09 of this
2813-Code with respect to the policy or contract are preempted
2814-or otherwise not permitted by federal or State law;
2815-(x) any portion of a policy or contract issued to a
2816-plan or program of an employer, association, or other
2817-person to provide life, health, or annuity benefits to its
2818-employees, members, or others to the extent that the plan
2819-or program is self-funded or uninsured, including, but not
2820-limited to, benefits payable by an employer, association,
2821-or other person under:
2822-(A) a multiple employer welfare arrangement as
2823-defined in 29 U.S.C. Section 1002;
2824-(B) a minimum premium group insurance plan;
2825-(C) a stop-loss group insurance plan; or
2826-
2827-
2828-(D) an administrative services only contract;
2829-(xi) any portion of a policy or contract to the extent
2830-that it provides for:
2831-(A) dividends or experience rating credits;
2832-(B) voting rights; or
2833-(C) payment of any fees or allowances to any
2834-person, including the policy or contract owner, in
2835-connection with the service to or administration of
2836-the policy or contract;
2837-(xii) any policy or contract issued in this State by a
2838-member insurer at a time when it was not licensed or did
2839-not have a certificate of authority to issue the policy or
2840-contract in this State;
2841-(xiii) any contractual agreement that establishes the
2842-member insurer's obligations to provide a book value
2843-accounting guaranty for defined contribution benefit plan
2844-participants by reference to a portfolio of assets that is
2845-owned by the benefit plan or its trustee, which in each
2846-case is not an affiliate of the member insurer;
2847-(xiv) any portion of a policy or contract to the
2848-extent that it provides for interest or other changes in
2849-value to be determined by the use of an index or other
2850-external reference stated in the policy or contract, but
2851-which have not been credited to the policy or contract, or
2852-as to which the policy or contract owner's rights are
2853-subject to forfeiture, as of the date the member insurer
2854-
2855-
2856-becomes an impaired or insolvent insurer under this Code,
2857-whichever is earlier. If a policy's or contract's interest
2858-or changes in value are credited less frequently than
2859-annually, then for purposes of determining the values that
2860-have been credited and are not subject to forfeiture under
2861-this Section, the interest or change in value determined
2862-by using the procedures defined in the policy or contract
2863-will be credited as if the contractual date of crediting
2864-interest or changing values was the date of impairment or
2865-insolvency, whichever is earlier, and will not be subject
2866-to forfeiture; or
2867-(xv) that portion or part of a variable life insurance
2868-or variable annuity contract not guaranteed by a member
2869-insurer.
2870-(c) The exclusion from coverage referenced in subdivision
2871-(iii) of paragraph (b) of this subsection shall not apply to
2872-any portion of a policy or contract, including a rider, that
2873-provides long-term care or other health insurance benefits.
2874-(3) The benefits for which the Association may become
2875-liable shall in no event exceed the lesser of:
2876-(a) the contractual obligations for which the member
2877-insurer is liable or would have been liable if it were not
2878-an impaired or insolvent insurer, or
2879-(b)(i) with respect to any one life, regardless of the
2880-number of policies or contracts:
2881-(A) $300,000 in life insurance death benefits, but
2882-
2883-
2884-not more than $100,000 in net cash surrender and net
2885-cash withdrawal values for life insurance;
2886-(B) for health insurance benefits:
2887-(I) $100,000 for coverages not defined as
2888-disability income insurance or health benefit
2889-plans or long-term care insurance, including any
2890-net cash surrender and net cash withdrawal values;
2891-(II) $300,000 for disability income insurance
2892-and $300,000 for long-term care insurance; and
2893-(III) $500,000 for health benefit plans;
2894-(C) $250,000 in the present value of annuity
2895-benefits, including net cash surrender and net cash
2896-withdrawal values;
2897-(ii) with respect to each individual participating in
2898-a governmental retirement benefit plan established under
2899-Section 401, 403(b), or 457 of the U.S. Internal Revenue
2900-Code covered by an unallocated annuity contract or the
2901-beneficiaries of each such individual if deceased, in the
2902-aggregate, $250,000 in present value annuity benefits,
2903-including net cash surrender and net cash withdrawal
2904-values;
2905-(iii) with respect to each payee of a structured
2906-settlement annuity or beneficiary or beneficiaries of the
2907-payee if deceased, $250,000 in present value annuity
2908-benefits, in the aggregate, including net cash surrender
2909-and net cash withdrawal values, if any; or
2910-
2911-
2912-(iv) with respect to either (1) one contract owner
2913-provided coverage under subparagraph (ii) of paragraph (c)
2914-of subsection (1) of this Section or (2) one plan sponsor
2915-whose plans own directly or in trust one or more
2916-unallocated annuity contracts not included in subparagraph
2917-(ii) of paragraph (b) of this subsection, $5,000,000 in
2918-benefits, irrespective of the number of contracts with
2919-respect to the contract owner or plan sponsor. However, in
2920-the case where one or more unallocated annuity contracts
2921-are covered contracts under this Article and are owned by
2922-a trust or other entity for the benefit of 2 or more plan
2923-sponsors, coverage shall be afforded by the Association if
2924-the largest interest in the trust or entity owning the
2925-contract or contracts is held by a plan sponsor whose
2926-principal place of business is in this State. In no event
2927-shall the Association be obligated to cover more than
2928-$5,000,000 in benefits with respect to all these
2929-unallocated contracts.
2930-In no event shall the Association be obligated to cover
2931-more than (1) an aggregate of $300,000 in benefits with
2932-respect to any one life under subparagraphs (i), (ii), and
2933-(iii) of this paragraph (b) except with respect to benefits
2934-for health benefit plans under item (B) of subparagraph (i) of
2935-this paragraph (b), in which case the aggregate liability of
2936-the Association shall not exceed $500,000 with respect to any
2937-one individual or (2) with respect to one owner of multiple
2938-
2939-
2940-nongroup policies of life insurance, whether the policy or
2941-contract owner is an individual, firm, corporation, or other
2942-person and whether the persons insured are officers, managers,
2943-employees, or other persons, $5,000,000 in benefits,
2944-regardless of the number of policies and contracts held by the
2945-owner.
2946-The limitations set forth in this subsection are
2947-limitations on the benefits for which the Association is
2948-obligated before taking into account either its subrogation
2949-and assignment rights or the extent to which those benefits
2950-could be provided out of the assets of the impaired or
2951-insolvent insurer attributable to covered policies. The costs
2952-of the Association's obligations under this Article may be met
2953-by the use of assets attributable to covered policies or
2954-reimbursed to the Association pursuant to its subrogation and
2955-assignment rights.
2956-For purposes of this Article, benefits provided by a
2957-long-term care rider to a life insurance policy or annuity
2958-contract shall be considered the same type of benefits as the
2959-base life insurance policy or annuity contract to which it
2960-relates.
2961-(4) In performing its obligations to provide coverage
2962-under Section 531.08 of this Code, the Association shall not
2963-be required to guarantee, assume, reinsure, reissue, or
2964-perform or cause to be guaranteed, assumed, reinsured,
2965-reissued, or performed the contractual obligations of the
2966-
2967-
2968-insolvent or impaired insurer under a covered policy or
2969-contract that do not materially affect the economic values or
2970-economic benefits of the covered policy or contract.
2971-(Source: P.A. 100-687, eff. 8-3-18; 100-863, eff. 8-14-18.)
2972-(215 ILCS 5/356z.30a rep.)
2973-(215 ILCS 5/362a rep.)
2974-Section 26. The Illinois Insurance Code is amended by
2975-repealing Sections 356z.30a and 362a.
2976-Section 30. The Network Adequacy and Transparency Act is
2977-amended by changing Sections 5 and 10 as follows:
2978-(215 ILCS 124/5)
2979-Sec. 5. Definitions. In this Act:
2980-"Authorized representative" means a person to whom a
2981-beneficiary has given express written consent to represent the
2982-beneficiary; a person authorized by law to provide substituted
2983-consent for a beneficiary; or the beneficiary's treating
2984-provider only when the beneficiary or his or her family member
2985-is unable to provide consent.
2986-"Beneficiary" means an individual, an enrollee, an
2987-insured, a participant, or any other person entitled to
2988-reimbursement for covered expenses of or the discounting of
2989-provider fees for health care services under a program in
2990-which the beneficiary has an incentive to utilize the services
2991-
2992-
2993-of a provider that has entered into an agreement or
2994-arrangement with an insurer.
2995-"Department" means the Department of Insurance.
2996-"Director" means the Director of Insurance.
2997-"Family caregiver" means a relative, partner, friend, or
2998-neighbor who has a significant relationship with the patient
2999-and administers or assists the patient with activities of
3000-daily living, instrumental activities of daily living, or
3001-other medical or nursing tasks for the quality and welfare of
3002-that patient.
3003-"Insurer" means any entity that offers individual or group
3004-accident and health insurance, including, but not limited to,
3005-health maintenance organizations, preferred provider
3006-organizations, exclusive provider organizations, and other
3007-plan structures requiring network participation, excluding the
3008-medical assistance program under the Illinois Public Aid Code,
3009-the State employees group health insurance program, workers
3010-compensation insurance, and pharmacy benefit managers.
3011-"Material change" means a significant reduction in the
3012-number of providers available in a network plan, including,
3013-but not limited to, a reduction of 10% or more in a specific
3014-type of providers, the removal of a major health system that
3015-causes a network to be significantly different from the
3016-network when the beneficiary purchased the network plan, or
3017-any change that would cause the network to no longer satisfy
3018-the requirements of this Act or the Department's rules for
3019-
3020-
3021-network adequacy and transparency.
3022-"Network" means the group or groups of preferred providers
3023-providing services to a network plan.
3024-"Network plan" means an individual or group policy of
3025-accident and health insurance that either requires a covered
3026-person to use or creates incentives, including financial
3027-incentives, for a covered person to use providers managed,
3028-owned, under contract with, or employed by the insurer.
3029-"Ongoing course of treatment" means (1) treatment for a
3030-life-threatening condition, which is a disease or condition
3031-for which likelihood of death is probable unless the course of
3032-the disease or condition is interrupted; (2) treatment for a
3033-serious acute condition, defined as a disease or condition
3034-requiring complex ongoing care that the covered person is
3035-currently receiving, such as chemotherapy, radiation therapy,
3036-or post-operative visits; (3) a course of treatment for a
3037-health condition that a treating provider attests that
3038-discontinuing care by that provider would worsen the condition
3039-or interfere with anticipated outcomes; or (4) the third
3040-trimester of pregnancy through the post-partum period.
3041-"Preferred provider" means any provider who has entered,
3042-either directly or indirectly, into an agreement with an
3043-employer or risk-bearing entity relating to health care
3044-services that may be rendered to beneficiaries under a network
3045-plan.
3046-"Providers" means physicians licensed to practice medicine
3047-
3048-
3049-in all its branches, other health care professionals,
3050-hospitals, or other health care institutions that provide
3051-health care services.
3052-"Telehealth" has the meaning given to that term in Section
3053-356z.22 of the Illinois Insurance Code.
3054-"Telemedicine" has the meaning given to that term in
3055-Section 49.5 of the Medical Practice Act of 1987.
3056-"Tiered network" means a network that identifies and
3057-groups some or all types of provider and facilities into
3058-specific groups to which different provider reimbursement,
3059-covered person cost-sharing or provider access requirements,
3060-or any combination thereof, apply for the same services.
3061-"Woman's principal health care provider" means a physician
3062-licensed to practice medicine in all of its branches
3063-specializing in obstetrics, gynecology, or family practice.
3064-(Source: P.A. 102-92, eff. 7-9-21; 102-813, eff. 5-13-22.)
3065-(215 ILCS 124/10)
3066-Sec. 10. Network adequacy.
3067-(a) An insurer providing a network plan shall file a
3068-description of all of the following with the Director:
3069-(1) The written policies and procedures for adding
3070-providers to meet patient needs based on increases in the
3071-number of beneficiaries, changes in the
3072-patient-to-provider ratio, changes in medical and health
3073-care capabilities, and increased demand for services.
3074-
3075-
3076-(2) The written policies and procedures for making
3077-referrals within and outside the network.
3078-(3) The written policies and procedures on how the
3079-network plan will provide 24-hour, 7-day per week access
3080-to network-affiliated primary care, emergency services,
3081-and obstetrical and gynecological health care
3082-professionals women's principal health care providers.
3083-An insurer shall not prohibit a preferred provider from
3084-discussing any specific or all treatment options with
3085-beneficiaries irrespective of the insurer's position on those
3086-treatment options or from advocating on behalf of
3087-beneficiaries within the utilization review, grievance, or
3088-appeals processes established by the insurer in accordance
3089-with any rights or remedies available under applicable State
3090-or federal law.
3091-(b) Insurers must file for review a description of the
3092-services to be offered through a network plan. The description
3093-shall include all of the following:
3094-(1) A geographic map of the area proposed to be served
3095-by the plan by county service area and zip code, including
3096-marked locations for preferred providers.
3097-(2) As deemed necessary by the Department, the names,
3098-addresses, phone numbers, and specialties of the providers
3099-who have entered into preferred provider agreements under
3100-the network plan.
3101-(3) The number of beneficiaries anticipated to be
3102-
3103-
3104-covered by the network plan.
3105-(4) An Internet website and toll-free telephone number
3106-for beneficiaries and prospective beneficiaries to access
3107-current and accurate lists of preferred providers,
3108-additional information about the plan, as well as any
3109-other information required by Department rule.
3110-(5) A description of how health care services to be
3111-rendered under the network plan are reasonably accessible
3112-and available to beneficiaries. The description shall
3113-address all of the following:
3114-(A) the type of health care services to be
3115-provided by the network plan;
3116-(B) the ratio of physicians and other providers to
3117-beneficiaries, by specialty and including primary care
3118-physicians and facility-based physicians when
3119-applicable under the contract, necessary to meet the
3120-health care needs and service demands of the currently
3121-enrolled population;
3122-(C) the travel and distance standards for plan
3123-beneficiaries in county service areas; and
3124-(D) a description of how the use of telemedicine,
3125-telehealth, or mobile care services may be used to
3126-partially meet the network adequacy standards, if
3127-applicable.
3128-(6) A provision ensuring that whenever a beneficiary
3129-has made a good faith effort, as evidenced by accessing
3130-
3131-
3132-the provider directory, calling the network plan, and
3133-calling the provider, to utilize preferred providers for a
3134-covered service and it is determined the insurer does not
3135-have the appropriate preferred providers due to
3136-insufficient number, type, unreasonable travel distance or
3137-delay, or preferred providers refusing to provide a
3138-covered service because it is contrary to the conscience
3139-of the preferred providers, as protected by the Health
3140-Care Right of Conscience Act, the insurer shall ensure,
3141-directly or indirectly, by terms contained in the payer
3142-contract, that the beneficiary will be provided the
3143-covered service at no greater cost to the beneficiary than
3144-if the service had been provided by a preferred provider.
3145-This paragraph (6) does not apply to: (A) a beneficiary
3146-who willfully chooses to access a non-preferred provider
3147-for health care services available through the panel of
3148-preferred providers, or (B) a beneficiary enrolled in a
3149-health maintenance organization. In these circumstances,
3150-the contractual requirements for non-preferred provider
3151-reimbursements shall apply unless Section 356z.3a of the
3152-Illinois Insurance Code requires otherwise. In no event
3153-shall a beneficiary who receives care at a participating
3154-health care facility be required to search for
3155-participating providers under the circumstances described
3156-in subsection (b) or (b-5) of Section 356z.3a of the
3157-Illinois Insurance Code except under the circumstances
3158-
3159-
3160-described in paragraph (2) of subsection (b-5).
3161-(7) A provision that the beneficiary shall receive
3162-emergency care coverage such that payment for this
3163-coverage is not dependent upon whether the emergency
3164-services are performed by a preferred or non-preferred
3165-provider and the coverage shall be at the same benefit
3166-level as if the service or treatment had been rendered by a
3167-preferred provider. For purposes of this paragraph (7),
3168-"the same benefit level" means that the beneficiary is
3169-provided the covered service at no greater cost to the
3170-beneficiary than if the service had been provided by a
3171-preferred provider. This provision shall be consistent
3172-with Section 356z.3a of the Illinois Insurance Code.
3173-(8) A limitation that, if the plan provides that the
3174-beneficiary will incur a penalty for failing to
3175-pre-certify inpatient hospital treatment, the penalty may
3176-not exceed $1,000 per occurrence in addition to the plan
3177-cost-sharing cost sharing provisions.
3178-(c) The network plan shall demonstrate to the Director a
3179-minimum ratio of providers to plan beneficiaries as required
3180-by the Department.
3181-(1) The ratio of physicians or other providers to plan
3182-beneficiaries shall be established annually by the
3183-Department in consultation with the Department of Public
3184-Health based upon the guidance from the federal Centers
3185-for Medicare and Medicaid Services. The Department shall
3186-
3187-
3188-not establish ratios for vision or dental providers who
3189-provide services under dental-specific or vision-specific
3190-benefits. The Department shall consider establishing
3191-ratios for the following physicians or other providers:
3192-(A) Primary Care;
3193-(B) Pediatrics;
3194-(C) Cardiology;
3195-(D) Gastroenterology;
3196-(E) General Surgery;
3197-(F) Neurology;
3198-(G) OB/GYN;
3199-(H) Oncology/Radiation;
3200-(I) Ophthalmology;
3201-(J) Urology;
3202-(K) Behavioral Health;
3203-(L) Allergy/Immunology;
3204-(M) Chiropractic;
3205-(N) Dermatology;
3206-(O) Endocrinology;
3207-(P) Ears, Nose, and Throat (ENT)/Otolaryngology;
3208-(Q) Infectious Disease;
3209-(R) Nephrology;
3210-(S) Neurosurgery;
3211-(T) Orthopedic Surgery;
3212-(U) Physiatry/Rehabilitative;
3213-(V) Plastic Surgery;
3214-
3215-
3216-(W) Pulmonary;
3217-(X) Rheumatology;
3218-(Y) Anesthesiology;
3219-(Z) Pain Medicine;
3220-(AA) Pediatric Specialty Services;
3221-(BB) Outpatient Dialysis; and
3222-(CC) HIV.
3223-(2) The Director shall establish a process for the
3224-review of the adequacy of these standards, along with an
3225-assessment of additional specialties to be included in the
3226-list under this subsection (c).
3227-(d) The network plan shall demonstrate to the Director
3228-maximum travel and distance standards for plan beneficiaries,
3229-which shall be established annually by the Department in
3230-consultation with the Department of Public Health based upon
3231-the guidance from the federal Centers for Medicare and
3232-Medicaid Services. These standards shall consist of the
3233-maximum minutes or miles to be traveled by a plan beneficiary
3234-for each county type, such as large counties, metro counties,
3235-or rural counties as defined by Department rule.
3236-The maximum travel time and distance standards must
3237-include standards for each physician and other provider
3238-category listed for which ratios have been established.
3239-The Director shall establish a process for the review of
3240-the adequacy of these standards along with an assessment of
3241-additional specialties to be included in the list under this
3242-
3243-
3244-subsection (d).
3245-(d-5)(1) Every insurer shall ensure that beneficiaries
3246-have timely and proximate access to treatment for mental,
3247-emotional, nervous, or substance use disorders or conditions
3248-in accordance with the provisions of paragraph (4) of
3249-subsection (a) of Section 370c of the Illinois Insurance Code.
3250-Insurers shall use a comparable process, strategy, evidentiary
3251-standard, and other factors in the development and application
3252-of the network adequacy standards for timely and proximate
3253-access to treatment for mental, emotional, nervous, or
3254-substance use disorders or conditions and those for the access
3255-to treatment for medical and surgical conditions. As such, the
3256-network adequacy standards for timely and proximate access
3257-shall equally be applied to treatment facilities and providers
3258-for mental, emotional, nervous, or substance use disorders or
3259-conditions and specialists providing medical or surgical
3260-benefits pursuant to the parity requirements of Section 370c.1
3261-of the Illinois Insurance Code and the federal Paul Wellstone
3262-and Pete Domenici Mental Health Parity and Addiction Equity
3263-Act of 2008. Notwithstanding the foregoing, the network
3264-adequacy standards for timely and proximate access to
3265-treatment for mental, emotional, nervous, or substance use
3266-disorders or conditions shall, at a minimum, satisfy the
3267-following requirements:
3268-(A) For beneficiaries residing in the metropolitan
3269-counties of Cook, DuPage, Kane, Lake, McHenry, and Will,
3270-
3271-
3272-network adequacy standards for timely and proximate access
3273-to treatment for mental, emotional, nervous, or substance
3274-use disorders or conditions means a beneficiary shall not
3275-have to travel longer than 30 minutes or 30 miles from the
3276-beneficiary's residence to receive outpatient treatment
3277-for mental, emotional, nervous, or substance use disorders
3278-or conditions. Beneficiaries shall not be required to wait
3279-longer than 10 business days between requesting an initial
3280-appointment and being seen by the facility or provider of
3281-mental, emotional, nervous, or substance use disorders or
3282-conditions for outpatient treatment or to wait longer than
3283-20 business days between requesting a repeat or follow-up
3284-appointment and being seen by the facility or provider of
3285-mental, emotional, nervous, or substance use disorders or
3286-conditions for outpatient treatment; however, subject to
3287-the protections of paragraph (3) of this subsection, a
3288-network plan shall not be held responsible if the
3289-beneficiary or provider voluntarily chooses to schedule an
3290-appointment outside of these required time frames.
3291-(B) For beneficiaries residing in Illinois counties
3292-other than those counties listed in subparagraph (A) of
3293-this paragraph, network adequacy standards for timely and
3294-proximate access to treatment for mental, emotional,
3295-nervous, or substance use disorders or conditions means a
3296-beneficiary shall not have to travel longer than 60
3297-minutes or 60 miles from the beneficiary's residence to
3298-
3299-
3300-receive outpatient treatment for mental, emotional,
3301-nervous, or substance use disorders or conditions.
3302-Beneficiaries shall not be required to wait longer than 10
3303-business days between requesting an initial appointment
3304-and being seen by the facility or provider of mental,
3305-emotional, nervous, or substance use disorders or
3306-conditions for outpatient treatment or to wait longer than
3307-20 business days between requesting a repeat or follow-up
3308-appointment and being seen by the facility or provider of
3309-mental, emotional, nervous, or substance use disorders or
3310-conditions for outpatient treatment; however, subject to
3311-the protections of paragraph (3) of this subsection, a
3312-network plan shall not be held responsible if the
3313-beneficiary or provider voluntarily chooses to schedule an
3314-appointment outside of these required time frames.
3315-(2) For beneficiaries residing in all Illinois counties,
3316-network adequacy standards for timely and proximate access to
3317-treatment for mental, emotional, nervous, or substance use
3318-disorders or conditions means a beneficiary shall not have to
3319-travel longer than 60 minutes or 60 miles from the
3320-beneficiary's residence to receive inpatient or residential
3321-treatment for mental, emotional, nervous, or substance use
3322-disorders or conditions.
3323-(3) If there is no in-network facility or provider
3324-available for a beneficiary to receive timely and proximate
3325-access to treatment for mental, emotional, nervous, or
3326-
3327-
3328-substance use disorders or conditions in accordance with the
3329-network adequacy standards outlined in this subsection, the
3330-insurer shall provide necessary exceptions to its network to
3331-ensure admission and treatment with a provider or at a
3332-treatment facility in accordance with the network adequacy
3333-standards in this subsection.
3334-(e) Except for network plans solely offered as a group
3335-health plan, these ratio and time and distance standards apply
3336-to the lowest cost-sharing tier of any tiered network.
3337-(f) The network plan may consider use of other health care
3338-service delivery options, such as telemedicine or telehealth,
3339-mobile clinics, and centers of excellence, or other ways of
3340-delivering care to partially meet the requirements set under
3341-this Section.
3342-(g) Except for the requirements set forth in subsection
3343-(d-5), insurers who are not able to comply with the provider
3344-ratios and time and distance standards established by the
3345-Department may request an exception to these requirements from
3346-the Department. The Department may grant an exception in the
3347-following circumstances:
3348-(1) if no providers or facilities meet the specific
3349-time and distance standard in a specific service area and
3350-the insurer (i) discloses information on the distance and
3351-travel time points that beneficiaries would have to travel
3352-beyond the required criterion to reach the next closest
3353-contracted provider outside of the service area and (ii)
3354-
3355-
3356-provides contact information, including names, addresses,
3357-and phone numbers for the next closest contracted provider
3358-or facility;
3359-(2) if patterns of care in the service area do not
3360-support the need for the requested number of provider or
3361-facility type and the insurer provides data on local
3362-patterns of care, such as claims data, referral patterns,
3363-or local provider interviews, indicating where the
3364-beneficiaries currently seek this type of care or where
3365-the physicians currently refer beneficiaries, or both; or
3366-(3) other circumstances deemed appropriate by the
3367-Department consistent with the requirements of this Act.
3368-(h) Insurers are required to report to the Director any
3369-material change to an approved network plan within 15 days
3370-after the change occurs and any change that would result in
3371-failure to meet the requirements of this Act. Upon notice from
3372-the insurer, the Director shall reevaluate the network plan's
3373-compliance with the network adequacy and transparency
3374-standards of this Act.
3375-(Source: P.A. 102-144, eff. 1-1-22; 102-901, eff. 7-1-22;
3376-102-1117, eff. 1-13-23.)
3377-Section 35. The Health Maintenance Organization Act is
3378-amended by changing Sections 4.5-1, 5-3, and 5-3.1 as follows:
3379-(215 ILCS 125/4.5-1)
3380-
3381-
3382-Sec. 4.5-1. Point-of-service health service contracts.
3383-(a) A health maintenance organization that offers a
3384-point-of-service contract:
3385-(1) must include as in-plan covered services all
3386-services required by law to be provided by a health
3387-maintenance organization;
3388-(2) must provide incentives, which shall include
3389-financial incentives, for enrollees to use in-plan covered
3390-services;
3391-(3) may not offer services out-of-plan without
3392-providing those services on an in-plan basis;
3393-(4) may include annual out-of-pocket limits and
3394-lifetime maximum benefits allowances for out-of-plan
3395-services that are separate from any limits or allowances
3396-applied to in-plan services;
3397-(5) may not consider emergency services, authorized
3398-referral services, or non-routine services obtained out of
3399-the service area to be point-of-service services;
3400-(6) may treat as out-of-plan services those services
3401-that an enrollee obtains from a participating provider,
3402-but for which the proper authorization was not given by
3403-the health maintenance organization; and
3404-(7) after January 1, 2003 (the effective date of
3405-Public Act 92-579), must include the following disclosure
3406-on its point-of-service contracts and evidences of
3407-coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN
3408-
3409-
3410-NON-PARTICIPATING PROVIDERS ARE USED. YOU CAN EXPECT TO
3411-PAY MORE THAN THE COST-SHARING AMOUNT DEFINED IN THE
3412-POLICY IN NON-EMERGENCY SITUATIONS. Except in limited
3413-situations governed by the federal No Surprises Act or
3414-Section 356z.3a of the Illinois Insurance Code (215 ILCS
3415-5/356z.3a), non-participating providers furnishing
3416-non-emergency services may bill members for any amount up
3417-to the billed charge after the plan has paid its portion of
3418-the bill. If you elect to use a non-participating
3419-provider, plan benefit payments will be determined
3420-according to your policy's fee schedule, usual and
3421-customary charge (which is determined by comparing charges
3422-for similar services adjusted to the geographical area
3423-where the services are performed), or other method as
3424-defined by the policy. Participating providers have agreed
3425-to ONLY bill members the cost-sharing amounts. You should
3426-be aware that when you elect to utilize the services of a
3427-non-participating provider for a covered service in
3428-non-emergency situations, benefit payments to such
3429-non-participating provider are not based upon the amount
3430-billed. The basis of your benefit payment will be
3431-determined according to your policy's fee schedule, usual
3432-and customary charge (which is determined by comparing
3433-charges for similar services adjusted to the geographical
3434-area where the services are performed), or other method as
3435-defined by the policy. YOU CAN EXPECT TO PAY MORE THAN THE
3436-
3437-
3438-COINSURANCE AMOUNT DEFINED IN THE POLICY AFTER THE PLAN
3439-HAS PAID ITS REQUIRED PORTION. Non-participating providers
3440-may bill members for any amount up to the billed charge
3441-after the plan has paid its portion of the bill, except as
3442-provided in Section 356z.3a of the Illinois Insurance Code
3443-for covered services received at a participating health
3444-care facility from a non-participating provider that are:
3445-(a) ancillary services, (b) items or services furnished as
3446-a result of unforeseen, urgent medical needs that arise at
3447-the time the item or service is furnished, or (c) items or
3448-services received when the facility or the
3449-non-participating provider fails to satisfy the notice and
3450-consent criteria specified under Section 356z.3a.
3451-Participating providers have agreed to accept discounted
3452-payments for services with no additional billing to the
3453-member other than co-insurance and deductible amounts. You
3454-may obtain further information about the participating
3455-status of professional providers and information on
3456-out-of-pocket expenses by calling the toll-free toll free
3457-telephone number on your identification card.".
3458-(b) A health maintenance organization offering a
3459-point-of-service contract is subject to all of the following
3460-limitations:
3461-(1) The health maintenance organization may not expend
3462-in any calendar quarter more than 20% of its total
3463-expenditures for all its members for out-of-plan covered
3464-
3465-
3466-services.
3467-(2) If the amount specified in item (1) of this
3468-subsection is exceeded by 2% in a quarter, the health
3469-maintenance organization must effect compliance with item
3470-(1) of this subsection by the end of the following
3471-quarter.
3472-(3) If compliance with the amount specified in item
3473-(1) of this subsection is not demonstrated in the health
3474-maintenance organization's next quarterly report, the
3475-health maintenance organization may not offer the
3476-point-of-service contract to new groups or include the
3477-point-of-service option in the renewal of an existing
3478-group until compliance with the amount specified in item
3479-(1) of this subsection is demonstrated or until otherwise
3480-allowed by the Director.
3481-(4) A health maintenance organization failing, without
3482-just cause, to comply with the provisions of this
3483-subsection shall be required, after notice and hearing, to
3484-pay a penalty of $250 for each day out of compliance, to be
3485-recovered by the Director. Any penalty recovered shall be
3486-paid into the General Revenue Fund. The Director may
3487-reduce the penalty if the health maintenance organization
3488-demonstrates to the Director that the imposition of the
3489-penalty would constitute a financial hardship to the
3490-health maintenance organization.
3491-(c) A health maintenance organization that offers a
3492-
3493-
3494-point-of-service product must do all of the following:
3495-(1) File a quarterly financial statement detailing
3496-compliance with the requirements of subsection (b).
3497-(2) Track out-of-plan, point-of-service utilization
3498-separately from in-plan or non-point-of-service,
3499-out-of-plan emergency care, referral care, and urgent care
3500-out of the service area utilization.
3501-(3) Record out-of-plan utilization in a manner that
3502-will permit such utilization and cost reporting as the
3503-Director may, by rule, require.
3504-(4) Demonstrate to the Director's satisfaction that
3505-the health maintenance organization has the fiscal,
3506-administrative, and marketing capacity to control its
3507-point-of-service enrollment, utilization, and costs so as
3508-not to jeopardize the financial security of the health
3509-maintenance organization.
3510-(5) Maintain, in addition to any other deposit
3511-required under this Act, the deposit required by Section
3512-2-6.
3513-(6) Maintain cash and cash equivalents of sufficient
3514-amount to fully liquidate 10 days' average claim payments,
3515-subject to review by the Director.
3516-(7) Maintain and file with the Director, reinsurance
3517-coverage protecting against catastrophic losses on
3518-out-of-network point-of-service services. Deductibles may
3519-not exceed $100,000 per covered life per year, and the
3520-
3521-
3522-portion of risk retained by the health maintenance
3523-organization once deductibles have been satisfied may not
3524-exceed 20%. Reinsurance must be placed with licensed
3525-authorized reinsurers qualified to do business in this
3526-State.
3527-(d) A health maintenance organization may not issue a
3528-point-of-service contract until it has filed and had approved
3529-by the Director a plan to comply with the provisions of this
3530-Section. The compliance plan must, at a minimum, include
3531-provisions demonstrating that the health maintenance
3532-organization will do all of the following:
3533-(1) Design the benefit levels and conditions of
3534-coverage for in-plan covered services and out-of-plan
3535-covered services as required by this Article.
3536-(2) Provide or arrange for the provision of adequate
3537-systems to:
3538-(A) process and pay claims for all out-of-plan
3539-covered services;
3540-(B) meet the requirements for point-of-service
3541-contracts set forth in this Section and any additional
3542-requirements that may be set forth by the Director;
3543-and
3544-(C) generate accurate data and financial and
3545-regulatory reports on a timely basis so that the
3546-Department of Insurance can evaluate the health
3547-maintenance organization's experience with the
3548-
3549-
3550-point-of-service contract and monitor compliance with
3551-point-of-service contract provisions.
3552-(3) Comply with the requirements of subsections (b)
3553-and (c).
3554-(Source: P.A. 102-901, eff. 1-1-23; 103-154, eff. 6-30-23.)
3555-(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
3556-Sec. 5-3. Insurance Code provisions.
3557-(a) Health Maintenance Organizations shall be subject to
3558-the provisions of Sections 133, 134, 136, 137, 139, 140,
3559-141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
3560-154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
3561-355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v,
3562-356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
3563-356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
3564-356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22,
3565-356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30,
3566-356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35,
3567-356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44,
3568-356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51,
3569-356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59,
3570-356z.60, 356z.61, 356z.62, 356z.63, 356z.64, 356z.65, 356z.66,
3571-356z.67, 356z.68, 356z.69, 356z.70, 364, 364.01, 364.3, 367.2,
3572-367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1,
3573-401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and
3574-444.1, paragraph (c) of subsection (2) of Section 367, and
3575-
3576-
3577-Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
3578-XXVI, and XXXIIB of the Illinois Insurance Code.
3579-(b) For purposes of the Illinois Insurance Code, except
3580-for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
3581-Health Maintenance Organizations in the following categories
3582-are deemed to be "domestic companies":
3583-(1) a corporation authorized under the Dental Service
3584-Plan Act or the Voluntary Health Services Plans Act;
3585-(2) a corporation organized under the laws of this
3586-State; or
3587-(3) a corporation organized under the laws of another
3588-state, 30% or more of the enrollees of which are residents
3589-of this State, except a corporation subject to
3590-substantially the same requirements in its state of
3591-organization as is a "domestic company" under Article VIII
3592-1/2 of the Illinois Insurance Code.
3593-(c) In considering the merger, consolidation, or other
3594-acquisition of control of a Health Maintenance Organization
3595-pursuant to Article VIII 1/2 of the Illinois Insurance Code,
3596-(1) the Director shall give primary consideration to
3597-the continuation of benefits to enrollees and the
3598-financial conditions of the acquired Health Maintenance
3599-Organization after the merger, consolidation, or other
3600-acquisition of control takes effect;
3601-(2)(i) the criteria specified in subsection (1)(b) of
3602-Section 131.8 of the Illinois Insurance Code shall not
3603-
3604-
3605-apply and (ii) the Director, in making his determination
3606-with respect to the merger, consolidation, or other
3607-acquisition of control, need not take into account the
3608-effect on competition of the merger, consolidation, or
3609-other acquisition of control;
3610-(3) the Director shall have the power to require the
3611-following information:
3612-(A) certification by an independent actuary of the
3613-adequacy of the reserves of the Health Maintenance
3614-Organization sought to be acquired;
3615-(B) pro forma financial statements reflecting the
3616-combined balance sheets of the acquiring company and
3617-the Health Maintenance Organization sought to be
3618-acquired as of the end of the preceding year and as of
3619-a date 90 days prior to the acquisition, as well as pro
3620-forma financial statements reflecting projected
3621-combined operation for a period of 2 years;
3622-(C) a pro forma business plan detailing an
3623-acquiring party's plans with respect to the operation
3624-of the Health Maintenance Organization sought to be
3625-acquired for a period of not less than 3 years; and
3626-(D) such other information as the Director shall
3627-require.
3628-(d) The provisions of Article VIII 1/2 of the Illinois
3629-Insurance Code and this Section 5-3 shall apply to the sale by
3630-any health maintenance organization of greater than 10% of its
3631-
3632-
3633-enrollee population (including, without limitation, the health
3634-maintenance organization's right, title, and interest in and
3635-to its health care certificates).
3636-(e) In considering any management contract or service
3637-agreement subject to Section 141.1 of the Illinois Insurance
3638-Code, the Director (i) shall, in addition to the criteria
3639-specified in Section 141.2 of the Illinois Insurance Code,
3640-take into account the effect of the management contract or
3641-service agreement on the continuation of benefits to enrollees
3642-and the financial condition of the health maintenance
3643-organization to be managed or serviced, and (ii) need not take
3644-into account the effect of the management contract or service
3645-agreement on competition.
3646-(f) Except for small employer groups as defined in the
3647-Small Employer Rating, Renewability and Portability Health
3648-Insurance Act and except for medicare supplement policies as
3649-defined in Section 363 of the Illinois Insurance Code, a
3650-Health Maintenance Organization may by contract agree with a
3651-group or other enrollment unit to effect refunds or charge
3652-additional premiums under the following terms and conditions:
3653-(i) the amount of, and other terms and conditions with
3654-respect to, the refund or additional premium are set forth
3655-in the group or enrollment unit contract agreed in advance
3656-of the period for which a refund is to be paid or
3657-additional premium is to be charged (which period shall
3658-not be less than one year); and
3659-
3660-
3661-(ii) the amount of the refund or additional premium
3662-shall not exceed 20% of the Health Maintenance
3663-Organization's profitable or unprofitable experience with
3664-respect to the group or other enrollment unit for the
3665-period (and, for purposes of a refund or additional
3666-premium, the profitable or unprofitable experience shall
3667-be calculated taking into account a pro rata share of the
3668-Health Maintenance Organization's administrative and
3669-marketing expenses, but shall not include any refund to be
3670-made or additional premium to be paid pursuant to this
3671-subsection (f)). The Health Maintenance Organization and
3672-the group or enrollment unit may agree that the profitable
3673-or unprofitable experience may be calculated taking into
3674-account the refund period and the immediately preceding 2
3675-plan years.
3676-The Health Maintenance Organization shall include a
3677-statement in the evidence of coverage issued to each enrollee
3678-describing the possibility of a refund or additional premium,
3679-and upon request of any group or enrollment unit, provide to
3680-the group or enrollment unit a description of the method used
3681-to calculate (1) the Health Maintenance Organization's
3682-profitable experience with respect to the group or enrollment
3683-unit and the resulting refund to the group or enrollment unit
3684-or (2) the Health Maintenance Organization's unprofitable
3685-experience with respect to the group or enrollment unit and
3686-the resulting additional premium to be paid by the group or
3687-
3688-
3689-enrollment unit.
3690-In no event shall the Illinois Health Maintenance
3691-Organization Guaranty Association be liable to pay any
3692-contractual obligation of an insolvent organization to pay any
3693-refund authorized under this Section.
3694-(g) Rulemaking authority to implement Public Act 95-1045,
3695-if any, is conditioned on the rules being adopted in
3696-accordance with all provisions of the Illinois Administrative
3697-Procedure Act and all rules and procedures of the Joint
3698-Committee on Administrative Rules; any purported rule not so
3699-adopted, for whatever reason, is unauthorized.
3700-(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
3701-102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
3702-1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
3703-eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
3704-102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
3705-1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
3706-eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
3707-103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
3708-6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
3709-eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
3710-(215 ILCS 125/5-3.1)
3711-Sec. 5-3.1. Access to obstetrical and gynecological care
3712-Woman's health care provider. Health maintenance organizations
3713-are subject to the provisions of Section 356r of the Illinois
3714-
3715-
3716-Insurance Code.
3717-(Source: P.A. 89-514, eff. 7-17-96.)
3718-Section 40. The Limited Health Service Organization Act is
3719-amended by changing Sections 4002.1 and 4003 as follows:
3720-(215 ILCS 130/4002.1)
3721-Sec. 4002.1. Access to obstetrical and gynecological care
3722-Woman's health care provider. Limited health service
3723-organizations are subject to the provisions of Section 356r of
3724-the Illinois Insurance Code.
3725-(Source: P.A. 89-514, eff. 7-17-96.)
3726-(215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
3727-Sec. 4003. Illinois Insurance Code provisions. Limited
3728-health service organizations shall be subject to the
3729-provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
3730-141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
3731-154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2,
3732-355.3, 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21,
3733-356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
3734-356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
3735-356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 364.3,
3736-368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444,
3737-and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII
3738-1/2, XXV, and XXVI of the Illinois Insurance Code. Nothing in
3739-
3740-
3741-this Section shall require a limited health care plan to cover
3742-any service that is not a limited health service. For purposes
3743-of the Illinois Insurance Code, except for Sections 444 and
3744-444.1 and Articles XIII and XIII 1/2, limited health service
3745-organizations in the following categories are deemed to be
3746-domestic companies:
3747-(1) a corporation under the laws of this State; or
3748-(2) a corporation organized under the laws of another
3749-state, 30% or more of the enrollees of which are residents
3750-of this State, except a corporation subject to
3751-substantially the same requirements in its state of
3752-organization as is a domestic company under Article VIII
3753-1/2 of the Illinois Insurance Code.
3754-(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
3755-102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
3756-1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
3757-eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
3758-102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
3759-1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
3760-eff. 1-1-24; revised 8-29-23.)
3761-Section 43. The Voluntary Health Services Plans Act is
3762-amended by changing Section 10 as follows:
3763-(215 ILCS 165/10) (from Ch. 32, par. 604)
3764-Sec. 10. Application of Insurance Code provisions. Health
3765-
3766-
3767-services plan corporations and all persons interested therein
3768-or dealing therewith shall be subject to the provisions of
3769-Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
3770-143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
3771-356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
3772-356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
3773-356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
3774-356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
3775-356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
3776-356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
3777-356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
3778-356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401, 401.1, 402,
3779-403, 403A, 408, 408.2, and 412, and paragraphs (7) and (15) of
3780-Section 367 of the Illinois Insurance Code.
3781-Rulemaking authority to implement Public Act 95-1045, if
3782-any, is conditioned on the rules being adopted in accordance
3783-with all provisions of the Illinois Administrative Procedure
3784-Act and all rules and procedures of the Joint Committee on
3785-Administrative Rules; any purported rule not so adopted, for
3786-whatever reason, is unauthorized.
3787-(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
3788-102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
3789-10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
3790-eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
3791-102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
3792-1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
3793-
3794-
3795-eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
3796-103-551, eff. 8-11-23; revised 8-29-23.)
3797-Section 45. The Illinois Public Aid Code is amended by
3798-changing Section 5-16.9 as follows:
3799-(305 ILCS 5/5-16.9)
3800-Sec. 5-16.9. Access to obstetrical and gynecological care
3801-Woman's health care provider. The medical assistance program
3802-is subject to the provisions of Section 356r of the Illinois
3803-Insurance Code. The Illinois Department shall adopt rules to
3804-implement the requirements of Section 356r of the Illinois
3805-Insurance Code in the medical assistance program including
3806-managed care components.
3807-On and after July 1, 2012, the Department shall reduce any
3808-rate of reimbursement for services or other payments or alter
3809-any methodologies authorized by this Code to reduce any rate
3810-of reimbursement for services or other payments in accordance
3811-with Section 5-5e.
3812-(Source: P.A. 97-689, eff. 6-14-12.)
3813-Section 95. No acceleration or delay. Where this Act makes
3814-changes in a statute that is represented in this Act by text
3815-that is not yet or no longer in effect (for example, a Section
3816-represented by multiple versions), the use of that text does
3817-not accelerate or delay the taking effect of (i) the changes
3818-
3819-
3820-made by this Act or (ii) provisions derived from any other
3821-Public Act.
31+HB5493 Enrolled- 2 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 2 - LRB103 39189 RPS 69335 b
32+ HB5493 Enrolled - 2 - LRB103 39189 RPS 69335 b
33+1 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
34+2 356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
35+3 356z.60, and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68,
36+4 and 356z.70 of the Illinois Insurance Code. The program of
37+5 health benefits must comply with Sections 155.22a, 155.37,
38+6 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the
39+7 Illinois Insurance Code. The program of health benefits shall
40+8 provide the coverage required under Section 356m of the
41+9 Illinois Insurance Code and, for the employees of the State
42+10 Employee Group Insurance Program only, the coverage as also
43+11 provided in Section 6.11B of this Act. The Department of
44+12 Insurance shall enforce the requirements of this Section with
45+13 respect to Sections 370c and 370c.1 of the Illinois Insurance
46+14 Code; all other requirements of this Section shall be enforced
47+15 by the Department of Central Management Services.
48+16 Rulemaking authority to implement Public Act 95-1045, if
49+17 any, is conditioned on the rules being adopted in accordance
50+18 with all provisions of the Illinois Administrative Procedure
51+19 Act and all rules and procedures of the Joint Committee on
52+20 Administrative Rules; any purported rule not so adopted, for
53+21 whatever reason, is unauthorized.
54+22 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
55+23 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
56+24 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
57+25 eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
58+26 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
59+
60+
61+
62+
63+
64+ HB5493 Enrolled - 2 - LRB103 39189 RPS 69335 b
65+
66+
67+HB5493 Enrolled- 3 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 3 - LRB103 39189 RPS 69335 b
68+ HB5493 Enrolled - 3 - LRB103 39189 RPS 69335 b
69+1 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
70+2 eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
71+3 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
72+4 8-11-23; revised 8-29-23.)
73+5 Section 10. The Counties Code is amended by changing
74+6 Sections 5-1069.3 and 5-1069.5 as follows:
75+7 (55 ILCS 5/5-1069.3)
76+8 Sec. 5-1069.3. Required health benefits. If a county,
77+9 including a home rule county, is a self-insurer for purposes
78+10 of providing health insurance coverage for its employees, the
79+11 coverage shall include coverage for the post-mastectomy care
80+12 benefits required to be covered by a policy of accident and
81+13 health insurance under Section 356t and the coverage required
82+14 under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
83+15 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
84+16 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
85+17 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 356z.36,
86+18 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
87+19 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
88+20 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
89+21 of the Illinois Insurance Code. The coverage shall comply with
90+22 Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
91+23 Insurance Code. The Department of Insurance shall enforce the
92+24 requirements of this Section. The requirement that health
93+
94+
95+
96+
97+
98+ HB5493 Enrolled - 3 - LRB103 39189 RPS 69335 b
99+
100+
101+HB5493 Enrolled- 4 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 4 - LRB103 39189 RPS 69335 b
102+ HB5493 Enrolled - 4 - LRB103 39189 RPS 69335 b
103+1 benefits be covered as provided in this Section is an
104+2 exclusive power and function of the State and is a denial and
105+3 limitation under Article VII, Section 6, subsection (h) of the
106+4 Illinois Constitution. A home rule county to which this
107+5 Section applies must comply with every provision of this
108+6 Section.
109+7 Rulemaking authority to implement Public Act 95-1045, if
110+8 any, is conditioned on the rules being adopted in accordance
111+9 with all provisions of the Illinois Administrative Procedure
112+10 Act and all rules and procedures of the Joint Committee on
113+11 Administrative Rules; any purported rule not so adopted, for
114+12 whatever reason, is unauthorized.
115+13 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
116+14 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
117+15 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
118+16 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
119+17 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
120+18 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
121+19 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
122+20 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
123+21 8-29-23.)
124+22 (55 ILCS 5/5-1069.5)
125+23 Sec. 5-1069.5. Access to obstetrical and gynecological
126+24 care Woman's health care provider. All counties, including
127+25 home rule counties, are subject to the provisions of Section
128+
129+
130+
131+
132+
133+ HB5493 Enrolled - 4 - LRB103 39189 RPS 69335 b
134+
135+
136+HB5493 Enrolled- 5 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 5 - LRB103 39189 RPS 69335 b
137+ HB5493 Enrolled - 5 - LRB103 39189 RPS 69335 b
138+1 356r of the Illinois Insurance Code. The requirement under
139+2 this Section that health care benefits provided by counties
140+3 comply with Section 356r of the Illinois Insurance Code is an
141+4 exclusive power and function of the State and is a denial and
142+5 limitation of home rule county powers under Article VII,
143+6 Section 6, subsection (h) of the Illinois Constitution.
144+7 (Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
145+8 Section 15. The Illinois Municipal Code is amended by
146+9 changing Sections 10-4-2.3 and 10-4-2.5 as follows:
147+10 (65 ILCS 5/10-4-2.3)
148+11 Sec. 10-4-2.3. Required health benefits. If a
149+12 municipality, including a home rule municipality, is a
150+13 self-insurer for purposes of providing health insurance
151+14 coverage for its employees, the coverage shall include
152+15 coverage for the post-mastectomy care benefits required to be
153+16 covered by a policy of accident and health insurance under
154+17 Section 356t and the coverage required under Sections 356g,
155+18 356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
156+19 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
157+20 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
158+21 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
159+22 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
160+23 356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
161+24 356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois
162+
163+
164+
165+
166+
167+ HB5493 Enrolled - 5 - LRB103 39189 RPS 69335 b
168+
169+
170+HB5493 Enrolled- 6 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 6 - LRB103 39189 RPS 69335 b
171+ HB5493 Enrolled - 6 - LRB103 39189 RPS 69335 b
172+1 Insurance Code. The coverage shall comply with Sections
173+2 155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
174+3 Code. The Department of Insurance shall enforce the
175+4 requirements of this Section. The requirement that health
176+5 benefits be covered as provided in this is an exclusive power
177+6 and function of the State and is a denial and limitation under
178+7 Article VII, Section 6, subsection (h) of the Illinois
179+8 Constitution. A home rule municipality to which this Section
180+9 applies must comply with every provision of this Section.
181+10 Rulemaking authority to implement Public Act 95-1045, if
182+11 any, is conditioned on the rules being adopted in accordance
183+12 with all provisions of the Illinois Administrative Procedure
184+13 Act and all rules and procedures of the Joint Committee on
185+14 Administrative Rules; any purported rule not so adopted, for
186+15 whatever reason, is unauthorized.
187+16 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
188+17 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
189+18 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
190+19 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
191+20 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
192+21 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
193+22 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
194+23 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
195+24 8-29-23.)
196+25 (65 ILCS 5/10-4-2.5)
197+
198+
199+
200+
201+
202+ HB5493 Enrolled - 6 - LRB103 39189 RPS 69335 b
203+
204+
205+HB5493 Enrolled- 7 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 7 - LRB103 39189 RPS 69335 b
206+ HB5493 Enrolled - 7 - LRB103 39189 RPS 69335 b
207+1 Sec. 10-4-2.5. Access to obstetrical and gynecological
208+2 care Woman's health care provider. The corporate authorities
209+3 of all municipalities are subject to the provisions of Section
210+4 356r of the Illinois Insurance Code. The requirement under
211+5 this Section that health care benefits provided by
212+6 municipalities comply with Section 356r of the Illinois
213+7 Insurance Code is an exclusive power and function of the State
214+8 and is a denial and limitation of home rule municipality
215+9 powers under Article VII, Section 6, subsection (h) of the
216+10 Illinois Constitution.
217+11 (Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
218+12 Section 20. The School Code is amended by changing
219+13 Sections 10-22.3d and 10-22.3f as follows:
220+14 (105 ILCS 5/10-22.3d)
221+15 Sec. 10-22.3d. Access to obstetrical and gynecological
222+16 care Woman's health care provider. Insurance protection and
223+17 benefits for employees are subject to the provisions of
224+18 Section 356r of the Illinois Insurance Code.
225+19 (Source: P.A. 89-514, eff. 7-17-96; 90-14, eff. 7-1-97.)
226+20 (105 ILCS 5/10-22.3f)
227+21 Sec. 10-22.3f. Required health benefits. Insurance
228+22 protection and benefits for employees shall provide the
229+23 post-mastectomy care benefits required to be covered by a
230+
231+
232+
233+
234+
235+ HB5493 Enrolled - 7 - LRB103 39189 RPS 69335 b
236+
237+
238+HB5493 Enrolled- 8 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 8 - LRB103 39189 RPS 69335 b
239+ HB5493 Enrolled - 8 - LRB103 39189 RPS 69335 b
240+1 policy of accident and health insurance under Section 356t and
241+2 the coverage required under Sections 356g, 356g.5, 356g.5-1,
242+3 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
243+4 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
244+5 356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
245+6 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
246+7 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
247+8 and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and
248+9 356z.70 of the Illinois Insurance Code. Insurance policies
249+10 shall comply with Section 356z.19 of the Illinois Insurance
250+11 Code. The coverage shall comply with Sections 155.22a, 355b,
251+12 and 370c of the Illinois Insurance Code. The Department of
252+13 Insurance shall enforce the requirements of this Section.
253+14 Rulemaking authority to implement Public Act 95-1045, if
254+15 any, is conditioned on the rules being adopted in accordance
255+16 with all provisions of the Illinois Administrative Procedure
256+17 Act and all rules and procedures of the Joint Committee on
257+18 Administrative Rules; any purported rule not so adopted, for
258+19 whatever reason, is unauthorized.
259+20 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
260+21 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
261+22 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
262+23 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
263+24 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
264+25 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
265+26 eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
266+
267+
268+
269+
270+
271+ HB5493 Enrolled - 8 - LRB103 39189 RPS 69335 b
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273+
274+HB5493 Enrolled- 9 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 9 - LRB103 39189 RPS 69335 b
275+ HB5493 Enrolled - 9 - LRB103 39189 RPS 69335 b
276+1 103-551, eff. 8-11-23; revised 8-29-23.)
277+2 Section 25. The Illinois Insurance Code is amended by
278+3 changing Sections 4, 352, 352b, 356a, 356b, 356d, 356e, 356f,
279+4 356K, 356L, 356r, 356s, 356z.3, 356z.33, 367a, 370e, 370i,
280+5 408, 412, and 531.03 as follows:
281+6 (215 ILCS 5/4) (from Ch. 73, par. 616)
282+7 Sec. 4. Classes of insurance. Insurance and insurance
283+8 business shall be classified as follows:
284+9 Class 1. Life, Accident and Health.
285+10 (a) Life. Insurance on the lives of persons and every
286+11 insurance appertaining thereto or connected therewith and
287+12 granting, purchasing or disposing of annuities. Policies of
288+13 life or endowment insurance or annuity contracts or contracts
289+14 supplemental thereto which contain provisions for additional
290+15 benefits in case of death by accidental means and provisions
291+16 operating to safeguard such policies or contracts against
292+17 lapse, to give a special surrender value, or special benefit,
293+18 or an annuity, in the event, that the insured or annuitant
294+19 shall become a person with a total and permanent disability as
295+20 defined by the policy or contract, or which contain benefits
296+21 providing acceleration of life or endowment or annuity
297+22 benefits in advance of the time they would otherwise be
298+23 payable, as an indemnity for long term care which is certified
299+24 or ordered by a physician, including but not limited to,
300+
301+
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303+
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308+HB5493 Enrolled- 10 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 10 - LRB103 39189 RPS 69335 b
309+ HB5493 Enrolled - 10 - LRB103 39189 RPS 69335 b
310+1 professional nursing care, medical care expenses, custodial
311+2 nursing care, non-nursing custodial care provided in a nursing
312+3 home or at a residence of the insured, or which contain
313+4 benefits providing acceleration of life or endowment or
314+5 annuity benefits in advance of the time they would otherwise
315+6 be payable, at any time during the insured's lifetime, as an
316+7 indemnity for a terminal illness shall be deemed to be
317+8 policies of life or endowment insurance or annuity contracts
318+9 within the intent of this clause.
319+10 Also to be deemed as policies of life or endowment
320+11 insurance or annuity contracts within the intent of this
321+12 clause shall be those policies or riders that provide for the
322+13 payment of up to 75% of the face amount of benefits in advance
323+14 of the time they would otherwise be payable upon a diagnosis by
324+15 a physician licensed to practice medicine in all of its
325+16 branches that the insured has incurred a covered condition
326+17 listed in the policy or rider.
327+18 "Covered condition", as used in this clause, means: heart
328+19 attack, stroke, coronary artery surgery, life-threatening life
329+20 threatening cancer, renal failure, Alzheimer's disease,
330+21 paraplegia, major organ transplantation, total and permanent
331+22 disability, and any other medical condition that the
332+23 Department may approve for any particular filing.
333+24 The Director may issue rules that specify prohibited
334+25 policy provisions, not otherwise specifically prohibited by
335+26 law, which in the opinion of the Director are unjust, unfair,
336+
337+
338+
339+
340+
341+ HB5493 Enrolled - 10 - LRB103 39189 RPS 69335 b
342+
343+
344+HB5493 Enrolled- 11 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 11 - LRB103 39189 RPS 69335 b
345+ HB5493 Enrolled - 11 - LRB103 39189 RPS 69335 b
346+1 or unfairly discriminatory to the policyholder, any person
347+2 insured under the policy, or beneficiary.
348+3 (b) Accident and health. Insurance against bodily injury,
349+4 disablement or death by accident and against disablement
350+5 resulting from sickness or old age and every insurance
351+6 appertaining thereto, including stop-loss insurance. In this
352+7 clause, "stop-loss Stop-loss insurance" means is insurance
353+8 against the risk of economic loss issued to or for the benefit
354+9 of a single employer self-funded employee disability benefit
355+10 plan or an employee welfare benefit plan as described in 29
356+11 U.S.C. 1001 100 et seq., where (i) the policy is issued to and
357+12 insures an employer, trustee, or other sponsor of the plan, or
358+13 the plan itself, but not employees, members, or participants;
359+14 and (ii) payments by the insurer are made to the employer,
360+15 trustee, or other sponsors of the plan, or the plan itself, but
361+16 not to the employees, members, participants, or health care
362+17 providers. The insurance laws of this State, including this
363+18 Code, do not apply to arrangements between a religious
364+19 organization and the organization's members or participants
365+20 when the arrangement and organization meet all of the
366+21 following criteria:
367+22 (i) the organization is described in Section 501(c)(3)
368+23 of the Internal Revenue Code and is exempt from taxation
369+24 under Section 501(a) of the Internal Revenue Code;
370+25 (ii) members of the organization share a common set of
371+26 ethical or religious beliefs and share medical expenses
372+
373+
374+
375+
376+
377+ HB5493 Enrolled - 11 - LRB103 39189 RPS 69335 b
378+
379+
380+HB5493 Enrolled- 12 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 12 - LRB103 39189 RPS 69335 b
381+ HB5493 Enrolled - 12 - LRB103 39189 RPS 69335 b
382+1 among members in accordance with those beliefs and without
383+2 regard to the state in which a member resides or is
384+3 employed;
385+4 (iii) no funds that have been given for the purpose of
386+5 the sharing of medical expenses among members described in
387+6 paragraph (ii) of this subsection (b) are held by the
388+7 organization in an off-shore trust or bank account;
389+8 (iv) the organization provides at least monthly to all
390+9 of its members a written statement listing the dollar
391+10 amount of qualified medical expenses that members have
392+11 submitted for sharing, as well as the amount of expenses
393+12 actually shared among the members;
394+13 (v) members of the organization retain membership even
395+14 after they develop a medical condition;
396+15 (vi) the organization or a predecessor organization
397+16 has been in existence at all times since December 31,
398+17 1999, and medical expenses of its members have been shared
399+18 continuously and without interruption since at least
400+19 December 31, 1999;
401+20 (vii) the organization conducts an annual audit that
402+21 is performed by an independent certified public accounting
403+22 firm in accordance with generally accepted accounting
404+23 principles and is made available to the public upon
405+24 request;
406+25 (viii) the organization includes the following
407+26 statement, in writing, on or accompanying all applications
408+
409+
410+
411+
412+
413+ HB5493 Enrolled - 12 - LRB103 39189 RPS 69335 b
414+
415+
416+HB5493 Enrolled- 13 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 13 - LRB103 39189 RPS 69335 b
417+ HB5493 Enrolled - 13 - LRB103 39189 RPS 69335 b
418+1 and guideline materials:
419+2 "Notice: The organization facilitating the sharing of
420+3 medical expenses is not an insurance company, and
421+4 neither its guidelines nor plan of operation
422+5 constitute or create an insurance policy. Any
423+6 assistance you receive with your medical bills will be
424+7 totally voluntary. As such, participation in the
425+8 organization or a subscription to any of its documents
426+9 should never be considered to be insurance. Whether or
427+10 not you receive any payments for medical expenses and
428+11 whether or not this organization continues to operate,
429+12 you are always personally responsible for the payment
430+13 of your own medical bills.";
431+14 (ix) any membership card or similar document issued by
432+15 the organization and any written communication sent by the
433+16 organization to a hospital, physician, or other health
434+17 care provider shall include a statement that the
435+18 organization does not issue health insurance and that the
436+19 member or participant is personally liable for payment of
437+20 his or her medical bills;
438+21 (x) the organization provides to a participant, within
439+22 30 days after the participant joins, a complete set of its
440+23 rules for the sharing of medical expenses, appeals of
441+24 decisions made by the organization, and the filing of
442+25 complaints;
443+26 (xi) the organization does not offer any other
444+
445+
446+
447+
448+
449+ HB5493 Enrolled - 13 - LRB103 39189 RPS 69335 b
450+
451+
452+HB5493 Enrolled- 14 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 14 - LRB103 39189 RPS 69335 b
453+ HB5493 Enrolled - 14 - LRB103 39189 RPS 69335 b
454+1 services that are regulated under any provision of the
455+2 Illinois Insurance Code or other insurance laws of this
456+3 State; and
457+4 (xii) the organization does not amass funds as
458+5 reserves intended for payment of medical services, rather
459+6 the organization facilitates the payments provided for in
460+7 this subsection (b) through payments made directly from
461+8 one participant to another.
462+9 (c) Legal Expense Insurance. Insurance which involves the
463+10 assumption of a contractual obligation to reimburse the
464+11 beneficiary against or pay on behalf of the beneficiary, all
465+12 or a portion of his fees, costs, or expenses related to or
466+13 arising out of services performed by or under the supervision
467+14 of an attorney licensed to practice in the jurisdiction
468+15 wherein the services are performed, regardless of whether the
469+16 payment is made by the beneficiaries individually or by a
470+17 third person for them, but does not include the provision of or
471+18 reimbursement for legal services incidental to other insurance
472+19 coverages. The insurance laws of this State, including this
473+20 Act do not apply to:
474+21 (i) retainer contracts made by attorneys at law with
475+22 individual clients with fees based on estimates of the
476+23 nature and amount of services to be provided to the
477+24 specific client, and similar contracts made with a group
478+25 of clients involved in the same or closely related legal
479+26 matters;
480+
481+
482+
483+
484+
485+ HB5493 Enrolled - 14 - LRB103 39189 RPS 69335 b
486+
487+
488+HB5493 Enrolled- 15 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 15 - LRB103 39189 RPS 69335 b
489+ HB5493 Enrolled - 15 - LRB103 39189 RPS 69335 b
490+1 (ii) plans owned or operated by attorneys who are the
491+2 providers of legal services to the plan;
492+3 (iii) plans providing legal service benefits to groups
493+4 where such plans are owned or operated by authority of a
494+5 state, county, local or other bar association;
495+6 (iv) any lawyer referral service authorized or
496+7 operated by a state, county, local or other bar
497+8 association;
498+9 (v) the furnishing of legal assistance by labor unions
499+10 and other employee organizations to their members in
500+11 matters relating to employment or occupation;
501+12 (vi) the furnishing of legal assistance to members or
502+13 dependents, by churches, consumer organizations,
503+14 cooperatives, educational institutions, credit unions, or
504+15 organizations of employees, where such organizations
505+16 contract directly with lawyers or law firms for the
506+17 provision of legal services, and the administration and
507+18 marketing of such legal services is wholly conducted by
508+19 the organization or its subsidiary;
509+20 (vii) legal services provided by an employee welfare
510+21 benefit plan defined by the Employee Retirement Income
511+22 Security Act of 1974;
512+23 (viii) any collectively bargained plan for legal
513+24 services between a labor union and an employer negotiated
514+25 pursuant to Section 302 of the Labor Management Relations
515+26 Act as now or hereafter amended, under which plan legal
516+
517+
518+
519+
520+
521+ HB5493 Enrolled - 15 - LRB103 39189 RPS 69335 b
522+
523+
524+HB5493 Enrolled- 16 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 16 - LRB103 39189 RPS 69335 b
525+ HB5493 Enrolled - 16 - LRB103 39189 RPS 69335 b
526+1 services will be provided for employees of the employer
527+2 whether or not payments for such services are funded to or
528+3 through an insurance company.
529+4 Class 2. Casualty, Fidelity and Surety.
530+5 (a) Accident and health. Insurance against bodily injury,
531+6 disablement or death by accident and against disablement
532+7 resulting from sickness or old age and every insurance
533+8 appertaining thereto, including stop-loss insurance. In this
534+9 clause, "stop-loss Stop-loss insurance" has meaning given to
535+10 that term in clause (b) of Class 1 is insurance against the
536+11 risk of economic loss issued to a single employer self-funded
537+12 employee disability benefit plan or an employee welfare
538+13 benefit plan as described in 29 U.S.C. 1001 et seq.
539+14 (b) Vehicle. Insurance against any loss or liability
540+15 resulting from or incident to the ownership, maintenance or
541+16 use of any vehicle (motor or otherwise), draft animal or
542+17 aircraft. Any policy insuring against any loss or liability on
543+18 account of the bodily injury or death of any person may contain
544+19 a provision for payment of disability benefits to injured
545+20 persons and death benefits to dependents, beneficiaries or
546+21 personal representatives of persons who are killed, including
547+22 the named insured, irrespective of legal liability of the
548+23 insured, if the injury or death for which benefits are
549+24 provided is caused by accident and sustained while in or upon
550+25 or while entering into or alighting from or through being
551+26 struck by a vehicle (motor or otherwise), draft animal or
552+
553+
554+
555+
556+
557+ HB5493 Enrolled - 16 - LRB103 39189 RPS 69335 b
558+
559+
560+HB5493 Enrolled- 17 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 17 - LRB103 39189 RPS 69335 b
561+ HB5493 Enrolled - 17 - LRB103 39189 RPS 69335 b
562+1 aircraft, and such provision shall not be deemed to be
563+2 accident insurance.
564+3 (c) Liability. Insurance against the liability of the
565+4 insured for the death, injury or disability of an employee or
566+5 other person, and insurance against the liability of the
567+6 insured for damage to or destruction of another person's
568+7 property.
569+8 (d) Workers' compensation. Insurance of the obligations
570+9 accepted by or imposed upon employers under laws for workers'
571+10 compensation.
572+11 (e) Burglary and forgery. Insurance against loss or damage
573+12 by burglary, theft, larceny, robbery, forgery, fraud or
574+13 otherwise; including all householders' personal property
575+14 floater risks.
576+15 (f) Glass. Insurance against loss or damage to glass
577+16 including lettering, ornamentation and fittings from any
578+17 cause.
579+18 (g) Fidelity and surety. Become surety or guarantor for
580+19 any person, copartnership or corporation in any position or
581+20 place of trust or as custodian of money or property, public or
582+21 private; or, becoming a surety or guarantor for the
583+22 performance of any person, copartnership or corporation of any
584+23 lawful obligation, undertaking, agreement or contract of any
585+24 kind, except contracts or policies of insurance; and
586+25 underwriting blanket bonds. Such obligations shall be known
587+26 and treated as suretyship obligations and such business shall
588+
589+
590+
591+
592+
593+ HB5493 Enrolled - 17 - LRB103 39189 RPS 69335 b
594+
595+
596+HB5493 Enrolled- 18 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 18 - LRB103 39189 RPS 69335 b
597+ HB5493 Enrolled - 18 - LRB103 39189 RPS 69335 b
598+1 be known as surety business.
599+2 (h) Miscellaneous. Insurance against loss or damage to
600+3 property and any liability of the insured caused by accidents
601+4 to boilers, pipes, pressure containers, machinery and
602+5 apparatus of any kind and any apparatus connected thereto, or
603+6 used for creating, transmitting or applying power, light,
604+7 heat, steam or refrigeration, making inspection of and issuing
605+8 certificates of inspection upon elevators, boilers, machinery
606+9 and apparatus of any kind and all mechanical apparatus and
607+10 appliances appertaining thereto; insurance against loss or
608+11 damage by water entering through leaks or openings in
609+12 buildings, or from the breakage or leakage of a sprinkler,
610+13 pumps, water pipes, plumbing and all tanks, apparatus,
611+14 conduits and containers designed to bring water into buildings
612+15 or for its storage or utilization therein, or caused by the
613+16 falling of a tank, tank platform or supports, or against loss
614+17 or damage from any cause (other than causes specifically
615+18 enumerated under Class 3 of this Section) to such sprinkler,
616+19 pumps, water pipes, plumbing, tanks, apparatus, conduits or
617+20 containers; insurance against loss or damage which may result
618+21 from the failure of debtors to pay their obligations to the
619+22 insured; and insurance of the payment of money for personal
620+23 services under contracts of hiring.
621+24 (i) Other casualty risks. Insurance against any other
622+25 casualty risk not otherwise specified under Classes 1 or 3,
623+26 which may lawfully be the subject of insurance and may
624+
625+
626+
627+
628+
629+ HB5493 Enrolled - 18 - LRB103 39189 RPS 69335 b
630+
631+
632+HB5493 Enrolled- 19 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 19 - LRB103 39189 RPS 69335 b
633+ HB5493 Enrolled - 19 - LRB103 39189 RPS 69335 b
634+1 properly be classified under Class 2.
635+2 (j) Contingent losses. Contingent, consequential and
636+3 indirect coverages wherein the proximate cause of the loss is
637+4 attributable to any one of the causes enumerated under Class
638+5 2. Such coverages shall, for the purpose of classification, be
639+6 included in the specific grouping of the kinds of insurance
640+7 wherein such cause is specified.
641+8 (k) Livestock and domestic animals. Insurance against
642+9 mortality, accident and health of livestock and domestic
643+10 animals.
644+11 (l) Legal expense insurance. Insurance against risk
645+12 resulting from the cost of legal services as defined under
646+13 Class 1(c).
647+14 Class 3. Fire and Marine, etc.
648+15 (a) Fire. Insurance against loss or damage by fire, smoke
649+16 and smudge, lightning or other electrical disturbances.
650+17 (b) Elements. Insurance against loss or damage by
651+18 earthquake, windstorms, cyclone, tornado, tempests, hail,
652+19 frost, snow, ice, sleet, flood, rain, drought or other weather
653+20 or climatic conditions including excess or deficiency of
654+21 moisture, rising of the waters of the ocean or its
655+22 tributaries.
656+23 (c) War, riot and explosion. Insurance against loss or
657+24 damage by bombardment, invasion, insurrection, riot, strikes,
658+25 civil war or commotion, military or usurped power, or
659+26 explosion (other than explosion of steam boilers and the
660+
661+
662+
663+
664+
665+ HB5493 Enrolled - 19 - LRB103 39189 RPS 69335 b
666+
667+
668+HB5493 Enrolled- 20 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 20 - LRB103 39189 RPS 69335 b
669+ HB5493 Enrolled - 20 - LRB103 39189 RPS 69335 b
670+1 breaking of fly wheels on premises owned, controlled, managed,
671+2 or maintained by the insured).
672+3 (d) Marine and transportation. Insurance against loss or
673+4 damage to vessels, craft, aircraft, vehicles of every kind,
674+5 (excluding vehicles operating under their own power or while
675+6 in storage not incidental to transportation) as well as all
676+7 goods, freights, cargoes, merchandise, effects, disbursements,
677+8 profits, moneys, bullion, precious stones, securities, choses
678+9 in action, evidences of debt, valuable papers, bottomry and
679+10 respondentia interests and all other kinds of property and
680+11 interests therein, in respect to, appertaining to or in
681+12 connection with any or all risks or perils of navigation,
682+13 transit, or transportation, including war risks, on or under
683+14 any seas or other waters, on land or in the air, or while being
684+15 assembled, packed, crated, baled, compressed or similarly
685+16 prepared for shipment or while awaiting the same or during any
686+17 delays, storage, transshipment, or reshipment incident
687+18 thereto, including marine builder's risks and all personal
688+19 property floater risks; and for loss or damage to persons or
689+20 property in connection with or appertaining to marine, inland
690+21 marine, transit or transportation insurance, including
691+22 liability for loss of or damage to either arising out of or in
692+23 connection with the construction, repair, operation,
693+24 maintenance, or use of the subject matter of such insurance,
694+25 (but not including life insurance or surety bonds); but,
695+26 except as herein specified, shall not mean insurances against
696+
697+
698+
699+
700+
701+ HB5493 Enrolled - 20 - LRB103 39189 RPS 69335 b
702+
703+
704+HB5493 Enrolled- 21 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 21 - LRB103 39189 RPS 69335 b
705+ HB5493 Enrolled - 21 - LRB103 39189 RPS 69335 b
706+1 loss by reason of bodily injury to the person; and insurance
707+2 against loss or damage to precious stones, jewels, jewelry,
708+3 gold, silver and other precious metals whether used in
709+4 business or trade or otherwise and whether the same be in
710+5 course of transportation or otherwise, which shall include
711+6 jewelers' block insurance; and insurance against loss or
712+7 damage to bridges, tunnels and other instrumentalities of
713+8 transportation and communication (excluding buildings, their
714+9 furniture and furnishings, fixed contents and supplies held in
715+10 storage) unless fire, tornado, sprinkler leakage, hail,
716+11 explosion, earthquake, riot and civil commotion are the only
717+12 hazards to be covered; and to piers, wharves, docks and slips,
718+13 excluding the risks of fire, tornado, sprinkler leakage, hail,
719+14 explosion, earthquake, riot and civil commotion; and to other
720+15 aids to navigation and transportation, including dry docks and
721+16 marine railways, against all risk.
722+17 (e) Vehicle. Insurance against loss or liability resulting
723+18 from or incident to the ownership, maintenance or use of any
724+19 vehicle (motor or otherwise), draft animal or aircraft,
725+20 excluding the liability of the insured for the death, injury
726+21 or disability of another person.
727+22 (f) Property damage, sprinkler leakage and crop. Insurance
728+23 against the liability of the insured for loss or damage to
729+24 another person's property or property interests from any cause
730+25 enumerated in this class; insurance against loss or damage by
731+26 water entering through leaks or openings in buildings, or from
732+
733+
734+
735+
736+
737+ HB5493 Enrolled - 21 - LRB103 39189 RPS 69335 b
738+
739+
740+HB5493 Enrolled- 22 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 22 - LRB103 39189 RPS 69335 b
741+ HB5493 Enrolled - 22 - LRB103 39189 RPS 69335 b
742+1 the breakage or leakage of a sprinkler, pumps, water pipes,
743+2 plumbing and all tanks, apparatus, conduits and containers
744+3 designed to bring water into buildings or for its storage or
745+4 utilization therein, or caused by the falling of a tank, tank
746+5 platform or supports or against loss or damage from any cause
747+6 to such sprinklers, pumps, water pipes, plumbing, tanks,
748+7 apparatus, conduits or containers; insurance against loss or
749+8 damage from insects, diseases or other causes to trees, crops
750+9 or other products of the soil.
751+10 (g) Other fire and marine risks. Insurance against any
752+11 other property risk not otherwise specified under Classes 1 or
753+12 2, which may lawfully be the subject of insurance and may
754+13 properly be classified under Class 3.
755+14 (h) Contingent losses. Contingent, consequential and
756+15 indirect coverages wherein the proximate cause of the loss is
757+16 attributable to any of the causes enumerated under Class 3.
758+17 Such coverages shall, for the purpose of classification, be
759+18 included in the specific grouping of the kinds of insurance
760+19 wherein such cause is specified.
761+20 (i) Legal expense insurance. Insurance against risk
762+21 resulting from the cost of legal services as defined under
763+22 Class 1(c).
764+23 (Source: P.A. 101-81, eff. 7-12-19.)
765+24 (215 ILCS 5/352) (from Ch. 73, par. 964)
766+25 Sec. 352. Scope of Article.
767+
768+
769+
770+
771+
772+ HB5493 Enrolled - 22 - LRB103 39189 RPS 69335 b
773+
774+
775+HB5493 Enrolled- 23 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 23 - LRB103 39189 RPS 69335 b
776+ HB5493 Enrolled - 23 - LRB103 39189 RPS 69335 b
777+1 (a) Except as provided in subsections (b), (c), (d), and
778+2 (e), and (g), this Article shall apply to all companies
779+3 transacting in this State the kinds of business enumerated in
780+4 clause (b) of Class 1 and clause (a) of Class 2 of Section 4
781+5 and to all policies, contracts, and certificates of insurance
782+6 issued in connection therewith that are not otherwise excluded
783+7 under Article VII of this Code. Nothing in this Article shall
784+8 apply to, or in any way affect policies or contracts described
785+9 in clause (a) of Class 1 of Section 4; however, this Article
786+10 shall apply to policies and contracts which contain benefits
787+11 providing reimbursement for the expenses of long term health
788+12 care which are certified or ordered by a physician including
789+13 but not limited to professional nursing care, custodial
790+14 nursing care, and non-nursing custodial care provided in a
791+15 nursing home or at a residence of the insured.
792+16 (b) (Blank).
793+17 (c) A policy issued and delivered in this State that
794+18 provides coverage under that policy for certificate holders
795+19 who are neither residents of nor employed in this State does
796+20 not need to provide to those nonresident certificate holders
797+21 who are not employed in this State the coverages or services
798+22 mandated by this Article.
799+23 (d) Stop-loss insurance, as defined in clause (b) of Class
800+24 1 or clause (a) of Class 2 of Section 4, is exempt from all
801+25 Sections of this Article, except this Section and Sections
802+26 353a, 354, 357.30, and 370. For purposes of this exemption,
803+
804+
805+
806+
807+
808+ HB5493 Enrolled - 23 - LRB103 39189 RPS 69335 b
809+
810+
811+HB5493 Enrolled- 24 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 24 - LRB103 39189 RPS 69335 b
812+ HB5493 Enrolled - 24 - LRB103 39189 RPS 69335 b
813+1 stop-loss insurance is further defined as follows:
814+2 (1) The policy must be issued to and insure an
815+3 employer, trustee, or other sponsor of the plan, or the
816+4 plan itself, but not employees, members, or participants.
817+5 (2) Payments by the insurer must be made to the
818+6 employer, trustee, or other sponsors of the plan, or the
819+7 plan itself, but not to the employees, members,
820+8 participants, or health care providers.
821+9 (e) A policy issued or delivered in this State to the
822+10 Department of Healthcare and Family Services (formerly
823+11 Illinois Department of Public Aid) and providing coverage,
824+12 under clause (b) of Class 1 or clause (a) of Class 2 as
825+13 described in Section 4, to persons who are enrolled under
826+14 Article V of the Illinois Public Aid Code or under the
827+15 Children's Health Insurance Program Act is exempt from all
828+16 restrictions, limitations, standards, rules, or regulations
829+17 respecting benefits imposed by or under authority of this
830+18 Code, except those specified by subsection (1) of Section 143,
831+19 Section 370c, and Section 370c.1. Nothing in this subsection,
832+20 however, affects the total medical services available to
833+21 persons eligible for medical assistance under the Illinois
834+22 Public Aid Code.
835+23 (f) An in-office membership care agreement provided under
836+24 the In-Office Membership Care Act is not insurance for the
837+25 purposes of this Code.
838+26 (g) The provisions of Sections 356a through 359a, both
839+
840+
841+
842+
843+
844+ HB5493 Enrolled - 24 - LRB103 39189 RPS 69335 b
845+
846+
847+HB5493 Enrolled- 25 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 25 - LRB103 39189 RPS 69335 b
848+ HB5493 Enrolled - 25 - LRB103 39189 RPS 69335 b
849+1 inclusive, shall not apply to or affect:
850+2 (1) any policy or contract of reinsurance; or
851+3 (2) life insurance, endowment or annuity contracts, or
852+4 contracts supplemental thereto that contain only such
853+5 provisions relating to accident and sickness insurance
854+6 that (A) provide additional benefits in case of death or
855+7 dismemberment or loss of sight by accident, or (B) operate
856+8 to safeguard such contracts against lapse, or to give a
857+9 special surrender value or special benefit or an annuity
858+10 if the insured or annuitant becomes a person with a total
859+11 and permanent disability, as defined by the contract or
860+12 supplemental contract.
861+13 (Source: P.A. 101-190, eff. 8-2-19.)
862+14 (215 ILCS 5/352b)
863+15 Sec. 352b. Excepted benefits exempted Policy of individual
864+16 or group accident and health insurance.
865+17 (a) Unless specified otherwise and when used in context of
866+18 accident and health insurance policy benefits, coverage,
867+19 terms, or conditions required to be provided under this
868+20 Article, references to any "policy of individual or group
869+21 accident and health insurance", or both, as used in this
870+22 Article, do does not include any coverage or policy that
871+23 provides an excepted benefit, as that term is defined in
872+24 Section 2791(c) of the federal Public Health Service Act (42
873+25 U.S.C. 300gg-91). Nothing in this subsection amendatory Act of
874+
875+
876+
877+
878+
879+ HB5493 Enrolled - 25 - LRB103 39189 RPS 69335 b
880+
881+
882+HB5493 Enrolled- 26 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 26 - LRB103 39189 RPS 69335 b
883+ HB5493 Enrolled - 26 - LRB103 39189 RPS 69335 b
884+1 the 101st General Assembly applies to a policy of liability,
885+2 workers' compensation, automobile medical payment, or limited
886+3 scope dental or vision benefits insurance issued under this
887+4 Code. Nothing in this subsection shall be construed to subject
888+5 excepted benefits outside the scope of Section 352 to any
889+6 requirements of this Article.
890+7 (b) Nothing in this Article shall require a policy of
891+8 excepted benefits to provide benefits, coverage, terms, or
892+9 conditions in such a manner as to disqualify it from being
893+10 classified under federal law as the type of excepted benefit
894+11 for which its policy forms are filed under Sections 143 and 355
895+12 of this Code.
896+13 (Source: P.A. 101-456, eff. 8-23-19.)
897+14 (215 ILCS 5/356a) (from Ch. 73, par. 968a)
898+15 Sec. 356a. Form of policy.
899+16 (1) No individual policy of accident and health insurance
900+17 shall be delivered or issued for delivery to any person in this
901+18 State state unless:
902+19 (a) the entire money and other considerations therefor
903+20 are expressed therein; and
904+21 (b) the time at which the insurance takes effect and
905+22 terminates is expressed therein; and
906+23 (c) it purports to insure only one person, except that
907+24 a policy may insure, originally or by subsequent
908+25 amendment, upon the application of an adult member of a
909+
910+
911+
912+
913+
914+ HB5493 Enrolled - 26 - LRB103 39189 RPS 69335 b
915+
916+
917+HB5493 Enrolled- 27 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 27 - LRB103 39189 RPS 69335 b
918+ HB5493 Enrolled - 27 - LRB103 39189 RPS 69335 b
919+1 family who shall be deemed the policyholder, any 2 two or
920+2 more eligible members of that family, including husband,
921+3 wife, dependent children or any children under a specified
922+4 age which shall not exceed 19 years and any other person
923+5 dependent upon the policyholder; and
924+6 (d) the style, arrangement and over-all appearance of
925+7 the policy give no undue prominence to any portion of the
926+8 text, and unless every printed portion of the text of the
927+9 policy and of any endorsements or attached papers is
928+10 plainly printed in light-faced type of a style in general
929+11 use, the size of which shall be uniform and not less than
930+12 ten-point with a lower-case unspaced alphabet length not
931+13 less than one hundred and twenty-point (the "text" shall
932+14 include all printed matter except the name and address of
933+15 the insurer, name or title of the policy, the brief
934+16 description if any, and captions and subcaptions); and
935+17 (e) the exceptions and reductions of indemnity are set
936+18 forth in the policy and, except those which are set forth
937+19 in Sections 357.1 through 357.30 of this act, are printed,
938+20 at the insurer's option, either included with the benefit
939+21 provision to which they apply, or under an appropriate
940+22 caption such as "EXCEPTIONS", or "EXCEPTIONS AND
941+23 REDUCTIONS", provided that if an exception or reduction
942+24 specifically applies only to a particular benefit of the
943+25 policy, a statement of such exception or reduction shall
944+26 be included with the benefit provision to which it
945+
946+
947+
948+
949+
950+ HB5493 Enrolled - 27 - LRB103 39189 RPS 69335 b
951+
952+
953+HB5493 Enrolled- 28 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 28 - LRB103 39189 RPS 69335 b
954+ HB5493 Enrolled - 28 - LRB103 39189 RPS 69335 b
955+1 applies; and
956+2 (f) each such form, including riders and endorsements,
957+3 shall be identified by a form number in the lower
958+4 left-hand corner of the first page thereof; and
959+5 (g) it contains no provision purporting to make any
960+6 portion of the charter, rules, constitution, or by-laws of
961+7 the insurer a part of the policy unless such portion is set
962+8 forth in full in the policy, except in the case of the
963+9 incorporation of, or reference to, a statement of rates or
964+10 classification of risks, or short-rate table filed with
965+11 the Director.
966+12 (2) If any policy is issued by an insurer domiciled in this
967+13 state for delivery to a person residing in another state, and
968+14 if the official having responsibility for the administration
969+15 of the insurance laws of such other state shall have advised
970+16 the Director that any such policy is not subject to approval or
971+17 disapproval by such official, the Director may by ruling
972+18 require that such policy meet the standards set forth in
973+19 subsection (1) of this section and in Sections 357.1 through
974+20 357.30.
975+21 (Source: P.A. 76-860.)
976+22 (215 ILCS 5/356b) (from Ch. 73, par. 968b)
977+23 Sec. 356b. (a) This Section applies to the hospital and
978+24 medical expense provisions of an individual accident or health
979+25 insurance policy.
980+
981+
982+
983+
984+
985+ HB5493 Enrolled - 28 - LRB103 39189 RPS 69335 b
986+
987+
988+HB5493 Enrolled- 29 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 29 - LRB103 39189 RPS 69335 b
989+ HB5493 Enrolled - 29 - LRB103 39189 RPS 69335 b
990+1 (b) If a policy provides that coverage of a dependent
991+2 person terminates upon attainment of the limiting age for
992+3 dependent persons specified in the policy, the attainment of
993+4 such limiting age does not operate to terminate the hospital
994+5 and medical coverage of a person who, because of a disabling
995+6 condition that occurred before attainment of the limiting age,
996+7 is incapable of self-sustaining employment and is dependent on
997+8 his or her parents or other care providers for lifetime care
998+9 and supervision.
999+10 (c) For purposes of subsection (b), "dependent on other
1000+11 care providers" is defined as requiring a Community Integrated
1001+12 Living Arrangement, group home, supervised apartment, or other
1002+13 residential services licensed or certified by the Department
1003+14 of Human Services (as successor to the Department of Mental
1004+15 Health and Developmental Disabilities), the Department of
1005+16 Public Health, or the Department of Healthcare and Family
1006+17 Services (formerly Department of Public Aid).
1007+18 (d) The insurer may inquire of the policyholder 2 months
1008+19 prior to attainment by a dependent of the limiting age set
1009+20 forth in the policy, or at any reasonable time thereafter,
1010+21 whether such dependent is in fact a person who has a disability
1011+22 and is dependent and, in the absence of proof submitted within
1012+23 60 days of such inquiry that such dependent is a person who has
1013+24 a disability and is dependent may terminate coverage of such
1014+25 person at or after attainment of the limiting age. In the
1015+26 absence of such inquiry, coverage of any person who has a
1016+
1017+
1018+
1019+
1020+
1021+ HB5493 Enrolled - 29 - LRB103 39189 RPS 69335 b
1022+
1023+
1024+HB5493 Enrolled- 30 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 30 - LRB103 39189 RPS 69335 b
1025+ HB5493 Enrolled - 30 - LRB103 39189 RPS 69335 b
1026+1 disability and is dependent shall continue through the term of
1027+2 such policy or any extension or renewal thereof.
1028+3 (e) This amendatory Act of 1969 is applicable to policies
1029+4 issued or renewed more than 60 days after the effective date of
1030+5 this amendatory Act of 1969.
1031+6 (Source: P.A. 99-143, eff. 7-27-15.)
1032+7 (215 ILCS 5/356d) (from Ch. 73, par. 968d)
1033+8 Sec. 356d. Conversion privileges for insured former
1034+9 spouses. (1) No individual policy of accident and health
1035+10 insurance providing coverage of hospital and/or medical
1036+11 expense on either an expense incurred basis or other than an
1037+12 expense incurred basis, which in addition to covering the
1038+13 insured also provides coverage to the spouse of the insured
1039+14 shall contain a provision for termination of coverage for a
1040+15 spouse covered under the policy solely as a result of a break
1041+16 in the marital relationship except by reason of an entry of a
1042+17 valid judgment of dissolution of marriage between the parties.
1043+18 (2) Every policy which contains a provision for
1044+19 termination of coverage of the spouse upon dissolution of
1045+20 marriage shall contain a provision to the effect that upon the
1046+21 entry of a valid judgment of dissolution of marriage between
1047+22 the insured parties the spouse whose marriage was dissolved
1048+23 shall be entitled to have issued to him or her, without
1049+24 evidence of insurability, upon application made to the company
1050+25 within 60 days following the entry of such judgment, and upon
1051+
1052+
1053+
1054+
1055+
1056+ HB5493 Enrolled - 30 - LRB103 39189 RPS 69335 b
1057+
1058+
1059+HB5493 Enrolled- 31 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 31 - LRB103 39189 RPS 69335 b
1060+ HB5493 Enrolled - 31 - LRB103 39189 RPS 69335 b
1061+1 the payment of the appropriate premium, an individual policy
1062+2 of accident and health insurance. Such policy shall provide
1063+3 the coverage then being issued by the insurer which is most
1064+4 nearly similar to, but not greater than, such terminated
1065+5 coverages. Any and all probationary and/or waiting periods set
1066+6 forth in such policy shall be considered as being met to the
1067+7 extent coverage was in force under the prior policy.
1068+8 (3) The requirements of this Section shall apply to all
1069+9 policies delivered or issued for delivery on or after the 60th
1070+10 day following the effective date of this Section.
1071+11 (Source: P.A. 84-545.)
1072+12 (215 ILCS 5/356e) (from Ch. 73, par. 968e)
1073+13 Sec. 356e. Victims of certain offenses.
1074+14 (1) No individual policy of accident and health insurance,
1075+15 which provides benefits for hospital or medical expenses based
1076+16 upon the actual expenses incurred, delivered or issued for
1077+17 delivery to any person in this State shall contain any
1078+18 specific exception to coverage which would preclude the
1079+19 payment under that policy of actual expenses incurred in the
1080+20 examination and testing of a victim of an offense defined in
1081+21 Sections 11-1.20 through 11-1.60 or 12-13 through 12-16 of the
1082+22 Criminal Code of 1961 or the Criminal Code of 2012, or an
1083+23 attempt to commit such offense to establish that sexual
1084+24 contact did occur or did not occur, and to establish the
1085+25 presence or absence of sexually transmitted disease or
1086+
1087+
1088+
1089+
1090+
1091+ HB5493 Enrolled - 31 - LRB103 39189 RPS 69335 b
1092+
1093+
1094+HB5493 Enrolled- 32 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 32 - LRB103 39189 RPS 69335 b
1095+ HB5493 Enrolled - 32 - LRB103 39189 RPS 69335 b
1096+1 infection, and examination and treatment of injuries and
1097+2 trauma sustained by a victim of such offense arising out of the
1098+3 offense. Every policy of accident and health insurance which
1099+4 specifically provides benefits for routine physical
1100+5 examinations shall provide full coverage for expenses incurred
1101+6 in the examination and testing of a victim of an offense
1102+7 defined in Sections 11-1.20 through 11-1.60 or 12-13 through
1103+8 12-16 of the Criminal Code of 1961 or the Criminal Code of
1104+9 2012, or an attempt to commit such offense as set forth in this
1105+10 Section. This Section shall not apply to a policy which covers
1106+11 hospital and medical expenses for specified illnesses or
1107+12 injuries only.
1108+13 (2) For purposes of enabling the recovery of State funds,
1109+14 any insurance carrier subject to this Section shall upon
1110+15 reasonable demand by the Department of Public Health disclose
1111+16 the names and identities of its insureds entitled to benefits
1112+17 under this provision to the Department of Public Health
1113+18 whenever the Department of Public Health has determined that
1114+19 it has paid, or is about to pay, hospital or medical expenses
1115+20 for which an insurance carrier is liable under this Section.
1116+21 All information received by the Department of Public Health
1117+22 under this provision shall be held on a confidential basis and
1118+23 shall not be subject to subpoena and shall not be made public
1119+24 by the Department of Public Health or used for any purpose
1120+25 other than that authorized by this Section.
1121+26 (3) Whenever the Department of Public Health finds that it
1122+
1123+
1124+
1125+
1126+
1127+ HB5493 Enrolled - 32 - LRB103 39189 RPS 69335 b
1128+
1129+
1130+HB5493 Enrolled- 33 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 33 - LRB103 39189 RPS 69335 b
1131+ HB5493 Enrolled - 33 - LRB103 39189 RPS 69335 b
1132+1 has paid all or part of any hospital or medical expenses which
1133+2 an insurance carrier is obligated to pay under this Section,
1134+3 the Department of Public Health shall be entitled to receive
1135+4 reimbursement for its payments from such insurance carrier
1136+5 provided that the Department of Public Health has notified the
1137+6 insurance carrier of its claims before the carrier has paid
1138+7 such benefits to its insureds or in behalf of its insureds.
1139+8 (Source: P.A. 96-1551, eff. 7-1-11; 97-1150, eff. 1-25-13.)
1140+9 (215 ILCS 5/356f) (from Ch. 73, par. 968f)
1141+10 Sec. 356f. No individual policy of accident or health
1142+11 insurance or any renewal thereof shall be denied or cancelled
1143+12 by the insurer, nor shall any such policy contain any
1144+13 exception or exclusion of benefits, solely because the mother
1145+14 of the insured has taken diethylstilbestrol, commonly referred
1146+15 to as DES.
1147+16 (Source: P.A. 81-656.)
1148+17 (215 ILCS 5/356K) (from Ch. 73, par. 968K)
1149+18 Sec. 356K. Coverage for Organ Transplantation Procedures.
1150+19 No accident and health insurer providing individual accident
1151+20 and health insurance coverage under this Act for hospital or
1152+21 medical expenses shall deny reimbursement for an otherwise
1153+22 covered expense incurred for any organ transplantation
1154+23 procedure solely on the basis that such procedure is deemed
1155+24 experimental or investigational unless supported by the
1156+
1157+
1158+
1159+
1160+
1161+ HB5493 Enrolled - 33 - LRB103 39189 RPS 69335 b
1162+
1163+
1164+HB5493 Enrolled- 34 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 34 - LRB103 39189 RPS 69335 b
1165+ HB5493 Enrolled - 34 - LRB103 39189 RPS 69335 b
1166+1 determination of the Office of Health Care Technology
1167+2 Assessment within the Agency for Health Care Policy and
1168+3 Research within the federal Department of Health and Human
1169+4 Services that such procedure is either experimental or
1170+5 investigational or that there is insufficient data or
1171+6 experience to determine whether an organ transplantation
1172+7 procedure is clinically acceptable. If an accident and health
1173+8 insurer has made written request, or had one made on its behalf
1174+9 by a national organization, for determination by the Office of
1175+10 Health Care Technology Assessment within the Agency for Health
1176+11 Care Policy and Research within the federal Department of
1177+12 Health and Human Services as to whether a specific organ
1178+13 transplantation procedure is clinically acceptable and said
1179+14 organization fails to respond to such a request within a
1180+15 period of 90 days, the failure to act may be deemed a
1181+16 determination that the procedure is deemed to be experimental
1182+17 or investigational.
1183+18 (Source: P.A. 87-218.)
1184+19 (215 ILCS 5/356L) (from Ch. 73, par. 968L)
1185+20 Sec. 356L. No individual policy of accident or health
1186+21 insurance shall include any provision which shall have the
1187+22 effect of denying coverage to or on behalf of an insured under
1188+23 such policy on the basis of a failure by the insured to file a
1189+24 notice of claim within the time period required by the policy,
1190+25 provided such failure is caused solely by the physical
1191+
1192+
1193+
1194+
1195+
1196+ HB5493 Enrolled - 34 - LRB103 39189 RPS 69335 b
1197+
1198+
1199+HB5493 Enrolled- 35 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 35 - LRB103 39189 RPS 69335 b
1200+ HB5493 Enrolled - 35 - LRB103 39189 RPS 69335 b
1201+1 inability or mental incapacity of the insured to file such
1202+2 notice of claim because of a period of emergency
1203+3 hospitalization.
1204+4 (Source: P.A. 86-784.)
1205+5 (215 ILCS 5/356r)
1206+6 Sec. 356r. Access to obstetrical and gynecological care
1207+7 Woman's principal health care provider.
1208+8 (a) An individual or group policy of accident and health
1209+9 insurance or a managed care plan amended, delivered, issued,
1210+10 or renewed in this State must not require authorization or
1211+11 referral by the plan, issuer, or any person, including a
1212+12 primary care provider, for any covered individual who seeks
1213+13 coverage for obstetrical or gynecological care provided by any
1214+14 licensed or certified participating health care professional
1215+15 who specializes in obstetrics or gynecology. after November
1216+16 14, 1996 that requires an insured or enrollee to designate an
1217+17 individual to coordinate care or to control access to health
1218+18 care services shall also permit a female insured or enrollee
1219+19 to designate a participating woman's principal health care
1220+20 provider, and the insurer or managed care plan shall provide
1221+21 the following written notice to all female insureds or
1222+22 enrollees no later than 120 days after the effective date of
1223+23 this amendatory Act of 1998; to all new enrollees at the time
1224+24 of enrollment; and thereafter to all existing enrollees at
1225+25 least annually, as a part of a regular publication or
1226+
1227+
1228+
1229+
1230+
1231+ HB5493 Enrolled - 35 - LRB103 39189 RPS 69335 b
1232+
1233+
1234+HB5493 Enrolled- 36 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 36 - LRB103 39189 RPS 69335 b
1235+ HB5493 Enrolled - 36 - LRB103 39189 RPS 69335 b
1236+1 informational mailing:
1237+2 "NOTICE TO ALL FEMALE PLAN MEMBERS:
1238+3 YOUR RIGHT TO SELECT A WOMAN'S PRINCIPAL
1239+4 HEALTH CARE PROVIDER.
1240+5 Illinois law allows you to select "a woman's principal
1241+6 health care provider" in addition to your selection of a
1242+7 primary care physician. A woman's principal health care
1243+8 provider is a physician licensed to practice medicine in
1244+9 all its branches specializing in obstetrics or gynecology
1245+10 or specializing in family practice. A woman's principal
1246+11 health care provider may be seen for care without
1247+12 referrals from your primary care physician. If you have
1248+13 not already selected a woman's principal health care
1249+14 provider, you may do so now or at any other time. You are
1250+15 not required to have or to select a woman's principal
1251+16 health care provider.
1252+17 Your woman's principal health care provider must be a
1253+18 part of your plan. You may get the list of participating
1254+19 obstetricians, gynecologists, and family practice
1255+20 specialists from your employer's employee benefits
1256+21 coordinator, or for your own copy of the current list, you
1257+22 may call [insert plan's toll free number]. The list will
1258+23 be sent to you within 10 days after your call. To designate
1259+24 a woman's principal health care provider from the list,
1260+25 call [insert plan's toll free number] and tell our staff
1261+26 the name of the physician you have selected.".
1262+
1263+
1264+
1265+
1266+
1267+ HB5493 Enrolled - 36 - LRB103 39189 RPS 69335 b
1268+
1269+
1270+HB5493 Enrolled- 37 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 37 - LRB103 39189 RPS 69335 b
1271+ HB5493 Enrolled - 37 - LRB103 39189 RPS 69335 b
1272+1 If the insurer or managed care plan exercises the option set
1273+2 forth in subsection (a-5), the notice shall also state:
1274+3 "Your plan requires that your primary care physician
1275+4 and your woman's principal health care provider have a
1276+5 referral arrangement with one another. If the woman's
1277+6 principal health care provider that you select does not
1278+7 have a referral arrangement with your primary care
1279+8 physician, you will have to select a new primary care
1280+9 physician who has a referral arrangement with your woman's
1281+10 principal health care provider or you may select a woman's
1282+11 principal health care provider who has a referral
1283+12 arrangement with your primary care physician. The list of
1284+13 woman's principal health care providers will also have the
1285+14 names of the primary care physicians and their referral
1286+15 arrangements.".
1287+16 No later than 120 days after the effective date of this
1288+17 amendatory Act of 1998, the insurer or managed care plan shall
1289+18 provide each employer who has a policy of insurance or a
1290+19 managed care plan with the insurer or managed care plan with a
1291+20 list of physicians licensed to practice medicine in all its
1292+21 branches specializing in obstetrics or gynecology or
1293+22 specializing in family practice who have contracted with the
1294+23 plan. At the time of enrollment and thereafter within 10 days
1295+24 after a request by an insured or enrollee, the insurer or
1296+25 managed care plan also shall provide this list directly to the
1297+26 insured or enrollee. The list shall include each physician's
1298+
1299+
1300+
1301+
1302+
1303+ HB5493 Enrolled - 37 - LRB103 39189 RPS 69335 b
1304+
1305+
1306+HB5493 Enrolled- 38 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 38 - LRB103 39189 RPS 69335 b
1307+ HB5493 Enrolled - 38 - LRB103 39189 RPS 69335 b
1308+1 address, telephone number, and specialty. No insurer or plan
1309+2 formal or informal policy may restrict a female insured's or
1310+3 enrollee's right to designate a woman's principal health care
1311+4 provider, except as set forth in subsection (a-5). If the
1312+5 female enrollee is an enrollee of a managed care plan under
1313+6 contract with the Department of Healthcare and Family
1314+7 Services, the physician chosen by the enrollee as her woman's
1315+8 principal health care provider must be a Medicaid-enrolled
1316+9 provider. This requirement does not require a female insured
1317+10 or enrollee to make a selection of a woman's principal health
1318+11 care provider. The female insured or enrollee may designate a
1319+12 physician licensed to practice medicine in all its branches
1320+13 specializing in family practice as her woman's principal
1321+14 health care provider.
1322+15 (a-5) If a policy, contract, or certificate requires or
1323+16 allows a covered individual to designate a primary care
1324+17 provider and provides coverage for any obstetrical or
1325+18 gynecological care, the insurer shall provide the notice
1326+19 required under 45 CFR 147.138(a)(4) and 149.310(a)(4) in all
1327+20 circumstances required under that provision. The insured or
1328+21 enrollee may be required by the insurer or managed care plan to
1329+22 select a woman's principal health care provider who has a
1330+23 referral arrangement with the insured's or enrollee's
1331+24 individual who coordinates care or controls access to health
1332+25 care services if such referral arrangement exists or to select
1333+26 a new individual to coordinate care or to control access to
1334+
1335+
1336+
1337+
1338+
1339+ HB5493 Enrolled - 38 - LRB103 39189 RPS 69335 b
1340+
1341+
1342+HB5493 Enrolled- 39 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 39 - LRB103 39189 RPS 69335 b
1343+ HB5493 Enrolled - 39 - LRB103 39189 RPS 69335 b
1344+1 health care services who has a referral arrangement with the
1345+2 woman's principal health care provider chosen by the insured
1346+3 or enrollee, if such referral arrangement exists. If an
1347+4 insurer or a managed care plan requires an insured or enrollee
1348+5 to select a new physician under this subsection (a-5), the
1349+6 insurer or managed care plan must provide the insured or
1350+7 enrollee with both options to select a new physician provided
1351+8 in this subsection (a-5).
1352+9 Notwithstanding a plan's restrictions of the frequency or
1353+10 timing of making designations of primary care providers, a
1354+11 female enrollee or insured who is subject to the selection
1355+12 requirements of this subsection, may, at any time, effect a
1356+13 change in primary care physicians in order to make a selection
1357+14 of a woman's principal health care provider.
1358+15 (a-6) The requirements of this Section shall be construed
1359+16 in a manner consistent with the requirements for access to and
1360+17 notice of obstetrical and gynecological care in 45 CFR 147.138
1361+18 and 45 CFR 149.310. If an insurer or managed care plan
1362+19 exercises the option in subsection (a-5), the list to be
1363+20 provided under subsection (a) shall identify the referral
1364+21 arrangements that exist between the individual who coordinates
1365+22 care or controls access to health care services and the
1366+23 woman's principal health care provider in order to assist the
1367+24 female insured or enrollee to make a selection within the
1368+25 insurer's or managed care plan's requirement.
1369+26 (b) Nothing in this Section prevents a health insurance
1370+
1371+
1372+
1373+
1374+
1375+ HB5493 Enrolled - 39 - LRB103 39189 RPS 69335 b
1376+
1377+
1378+HB5493 Enrolled- 40 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 40 - LRB103 39189 RPS 69335 b
1379+ HB5493 Enrolled - 40 - LRB103 39189 RPS 69335 b
1380+1 issuer from requiring a participating obstetrical or
1381+2 gynecological health care professional to agree, with respect
1382+3 to individuals covered under a policy of accident and health
1383+4 insurance, to otherwise adhere to the health insurance
1384+5 issuer's policies and procedures, including procedures
1385+6 regarding referrals and obtaining prior authorization and
1386+7 providing services pursuant to a treatment plan, if any,
1387+8 approved by the issuer. If a female insured or enrollee has
1388+9 designated a woman's principal health care provider, then the
1389+10 insured or enrollee must be given direct access to the woman's
1390+11 principal health care provider for services covered by the
1391+12 policy or plan without the need for a referral or prior
1392+13 approval. Nothing shall prohibit the insurer or managed care
1393+14 plan from requiring prior authorization or approval from
1394+15 either a primary care provider or the woman's principal health
1395+16 care provider for referrals for additional care or services.
1396+17 (c) (Blank). For the purposes of this Section the
1397+18 following terms are defined:
1398+19 (1) "Woman's principal health care provider" means a
1399+20 physician licensed to practice medicine in all of its
1400+21 branches specializing in obstetrics or gynecology or
1401+22 specializing in family practice.
1402+23 (2) "Managed care entity" means any entity including a
1403+24 licensed insurance company, hospital or medical service
1404+25 plan, health maintenance organization, limited health
1405+26 service organization, preferred provider organization,
1406+
1407+
1408+
1409+
1410+
1411+ HB5493 Enrolled - 40 - LRB103 39189 RPS 69335 b
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1415+ HB5493 Enrolled - 41 - LRB103 39189 RPS 69335 b
1416+1 third party administrator, an employer or employee
1417+2 organization, or any person or entity that establishes,
1418+3 operates, or maintains a network of participating
1419+4 providers.
1420+5 (3) "Managed care plan" means a plan operated by a
1421+6 managed care entity that provides for the financing of
1422+7 health care services to persons enrolled in the plan
1423+8 through:
1424+9 (A) organizational arrangements for ongoing
1425+10 quality assurance, utilization review programs, or
1426+11 dispute resolution; or
1427+12 (B) financial incentives for persons enrolled in
1428+13 the plan to use the participating providers and
1429+14 procedures covered by the plan.
1430+15 (4) "Participating provider" means a physician who has
1431+16 contracted with an insurer or managed care plan to provide
1432+17 services to insureds or enrollees as defined by the
1433+18 contract.
1434+19 (d) Nothing in this Section shall be construed to preclude
1435+20 a health insurance issuer from requiring that a participating
1436+21 obstetrical or gynecological health care professional notify
1437+22 the covered individual's primary care physician or the issuer
1438+23 of treatment decisions or update centralized medical records.
1439+24 The original provisions of this Section became law on July 17,
1440+25 1996 and took effect November 14, 1996, which is 120 days after
1441+26 becoming law.
1442+
1443+
1444+
1445+
1446+
1447+ HB5493 Enrolled - 41 - LRB103 39189 RPS 69335 b
1448+
1449+
1450+HB5493 Enrolled- 42 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 42 - LRB103 39189 RPS 69335 b
1451+ HB5493 Enrolled - 42 - LRB103 39189 RPS 69335 b
1452+1 (Source: P.A. 95-331, eff. 8-21-07.)
1453+2 (215 ILCS 5/356s)
1454+3 Sec. 356s. Post-parturition care. An individual or group
1455+4 policy of accident and health insurance that provides
1456+5 maternity coverage and is amended, delivered, issued, or
1457+6 renewed after the effective date of this amendatory Act of
1458+7 1996 shall provide coverage for the following:
1459+8 (1) a minimum of 48 hours of inpatient care following
1460+9 a vaginal delivery for the mother and the newborn, except
1461+10 as otherwise provided in this Section; or
1462+11 (2) a minimum of 96 hours of inpatient care following
1463+12 a delivery by caesarian section for the mother and
1464+13 newborn, except as otherwise provided in this Section.
1465+14 Coverage may be limited to a A shorter length of hospital
1466+15 inpatient care stay for services related to maternity and
1467+16 newborn care may be provided if the attending physician
1468+17 licensed to practice medicine in all of its branches
1469+18 determines, in accordance with the protocols and guidelines
1470+19 developed by the American College of Obstetricians and
1471+20 Gynecologists or the American Academy of Pediatrics, that the
1472+21 mother and the newborn meet the appropriate guidelines for
1473+22 that length of stay based upon evaluation of the mother and
1474+23 newborn and the coverage and availability of a post-discharge
1475+24 physician office visit or in-home nurse visit to verify the
1476+25 condition of the infant in the first 48 hours after discharge.
1477+
1478+
1479+
1480+
1481+
1482+ HB5493 Enrolled - 42 - LRB103 39189 RPS 69335 b
1483+
1484+
1485+HB5493 Enrolled- 43 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 43 - LRB103 39189 RPS 69335 b
1486+ HB5493 Enrolled - 43 - LRB103 39189 RPS 69335 b
1487+1 (Source: P.A. 89-513, eff. 9-15-96; 90-14, eff. 7-1-97.)
1488+2 (215 ILCS 5/356z.3)
1489+3 Sec. 356z.3. Disclosure of limited benefit. An insurer
1490+4 that issues, delivers, amends, or renews an individual or
1491+5 group policy of accident and health insurance in this State
1492+6 after the effective date of this amendatory Act of the 92nd
1493+7 General Assembly and arranges, contracts with, or administers
1494+8 contracts with a provider whereby beneficiaries are provided
1495+9 an incentive to use the services of such provider must include
1496+10 the following disclosure on its contracts and evidences of
1497+11 coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN
1498+12 NON-PARTICIPATING PROVIDERS ARE USED. YOU CAN EXPECT TO PAY
1499+13 MORE THAN THE COST-SHARING AMOUNT DEFINED IN THE POLICY IN
1500+14 NON-EMERGENCY SITUATIONS. Except in limited situations
1501+15 governed by the federal No Surprises Act or Section 356z.3a of
1502+16 the Illinois Insurance Code (215 ILCS 5/356z.3a),
1503+17 non-participating providers furnishing non-emergency services
1504+18 may bill members for any amount up to the billed charge after
1505+19 the plan has paid its portion of the bill. If you elect to use
1506+20 a non-participating provider, plan benefit payments will be
1507+21 determined according to your policy's fee schedule, usual and
1508+22 customary charge (which is determined by comparing charges for
1509+23 similar services adjusted to the geographical area where the
1510+24 services are performed), or other method as defined by the
1511+25 policy. Participating providers have agreed to ONLY bill
1512+
1513+
1514+
1515+
1516+
1517+ HB5493 Enrolled - 43 - LRB103 39189 RPS 69335 b
1518+
1519+
1520+HB5493 Enrolled- 44 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 44 - LRB103 39189 RPS 69335 b
1521+ HB5493 Enrolled - 44 - LRB103 39189 RPS 69335 b
1522+1 members the cost-sharing amounts. You should be aware that
1523+2 when you elect to utilize the services of a non-participating
1524+3 provider for a covered service in non-emergency situations,
1525+4 benefit payments to such non-participating provider are not
1526+5 based upon the amount billed. The basis of your benefit
1527+6 payment will be determined according to your policy's fee
1528+7 schedule, usual and customary charge (which is determined by
1529+8 comparing charges for similar services adjusted to the
1530+9 geographical area where the services are performed), or other
1531+10 method as defined by the policy. YOU CAN EXPECT TO PAY MORE
1532+11 THAN THE COINSURANCE AMOUNT DEFINED IN THE POLICY AFTER THE
1533+12 PLAN HAS PAID ITS REQUIRED PORTION. Non-participating
1534+13 providers may bill members for any amount up to the billed
1535+14 charge after the plan has paid its portion of the bill, except
1536+15 as provided in Section 356z.3a of the Illinois Insurance Code
1537+16 for covered services received at a participating health care
1538+17 facility from a nonparticipating provider that are: (a)
1539+18 ancillary services, (b) items or services furnished as a
1540+19 result of unforeseen, urgent medical needs that arise at the
1541+20 time the item or service is furnished, or (c) items or services
1542+21 received when the facility or the non-participating provider
1543+22 fails to satisfy the notice and consent criteria specified
1544+23 under Section 356z.3a. Participating providers have agreed to
1545+24 accept discounted payments for services with no additional
1546+25 billing to the member other than co-insurance and deductible
1547+26 amounts. You may obtain further information about the
1548+
1549+
1550+
1551+
1552+
1553+ HB5493 Enrolled - 44 - LRB103 39189 RPS 69335 b
1554+
1555+
1556+HB5493 Enrolled- 45 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 45 - LRB103 39189 RPS 69335 b
1557+ HB5493 Enrolled - 45 - LRB103 39189 RPS 69335 b
1558+1 participating status of professional providers and information
1559+2 on out-of-pocket expenses by calling the toll-free toll free
1560+3 telephone number on your identification card.".
1561+4 (Source: P.A. 102-901, eff. 1-1-23.)
1562+5 (215 ILCS 5/356z.33)
1563+6 (Text of Section before amendment by P.A. 103-454)
1564+7 Sec. 356z.33. Coverage for epinephrine injectors. A group
1565+8 or individual policy of accident and health insurance or a
1566+9 managed care plan that is amended, delivered, issued, or
1567+10 renewed on or after January 1, 2020 (the effective date of
1568+11 Public Act 101-281) shall provide coverage for medically
1569+12 necessary epinephrine injectors for persons 18 years of age or
1570+13 under. As used in this Section, "epinephrine injector" has the
1571+14 meaning given to that term in Section 5 of the Epinephrine
1572+15 Injector Act.
1573+16 (Source: P.A. 101-281, eff. 1-1-20; 102-558, eff. 8-20-21.)
1574+17 (Text of Section after amendment by P.A. 103-454)
1575+18 Sec. 356z.33. Coverage for epinephrine injectors.
1576+19 (a) A group or individual policy of accident and health
1577+20 insurance or a managed care plan that is amended, delivered,
1578+21 issued, or renewed on or after January 1, 2020 (the effective
1579+22 date of Public Act 101-281) shall provide coverage for
1580+23 medically necessary epinephrine injectors for persons 18 years
1581+24 of age or under. As used in this Section, "epinephrine
1582+
1583+
1584+
1585+
1586+
1587+ HB5493 Enrolled - 45 - LRB103 39189 RPS 69335 b
1588+
1589+
1590+HB5493 Enrolled- 46 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 46 - LRB103 39189 RPS 69335 b
1591+ HB5493 Enrolled - 46 - LRB103 39189 RPS 69335 b
1592+1 injector" has the meaning given to that term in Section 5 of
1593+2 the Epinephrine Injector Act.
1594+3 (b) An insurer that provides coverage for medically
1595+4 necessary epinephrine injectors shall limit the total amount
1596+5 that an insured is required to pay for a twin-pack of medically
1597+6 necessary epinephrine injectors at an amount not to exceed
1598+7 $60, regardless of the type of epinephrine injector; except
1599+8 that this provision does not apply to the extent such coverage
1600+9 would disqualify a high-deductible health plan from
1601+10 eligibility for a health savings account pursuant to Section
1602+11 223 of the Internal Revenue Code (26 U.S.C. 223).
1603+12 (c) Nothing in this Section prevents an insurer from
1604+13 reducing an insured's cost sharing by an amount greater than
1605+14 the amount specified in subsection (b).
1606+15 (d) The Department may adopt rules as necessary to
1607+16 implement and administer this Section.
1608+17 (Source: P.A. 102-558, eff. 8-20-21; 103-454, eff. 1-1-25.)
1609+18 (215 ILCS 5/367a) (from Ch. 73, par. 979a)
1610+19 Sec. 367a. Blanket accident and health insurance.
1611+20 (1) Blanket accident and health insurance is that form of
1612+21 accident and health insurance covering special groups of
1613+22 persons as enumerated in one of the following paragraphs (a)
1614+23 to (g), inclusive:
1615+24 (a) Under a policy or contract issued to any carrier
1616+25 for hire, which shall be deemed the policyholder, covering
1617+
1618+
1619+
1620+
1621+
1622+ HB5493 Enrolled - 46 - LRB103 39189 RPS 69335 b
1623+
1624+
1625+HB5493 Enrolled- 47 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 47 - LRB103 39189 RPS 69335 b
1626+ HB5493 Enrolled - 47 - LRB103 39189 RPS 69335 b
1627+1 a group defined as all persons who may become passengers
1628+2 on such carrier.
1629+3 (b) Under a policy or contract issued to an employer,
1630+4 who shall be deemed the policyholder, covering all
1631+5 employees or any group of employees defined by reference
1632+6 to exceptional hazards incident to such employment.
1633+7 (c) Under a policy or contract issued to a college,
1634+8 school, or other institution of learning or to the head or
1635+9 principal thereof, who or which shall be deemed the
1636+10 policyholder, covering students or teachers. However,
1637+11 student health insurance coverage, as defined in 45 CFR
1638+12 147.145, shall remain subject to the standards and
1639+13 requirements for individual health insurance coverage
1640+14 except where inconsistent with that regulation. Student
1641+15 health insurance coverage shall not be subject to the
1642+16 Short-Term, Limited-Duration Health Insurance Coverage
1643+17 Act. An insurer providing student health insurance
1644+18 coverage or a policy or contract covering students for
1645+19 limited-scope dental or vision under 45 CFR 148.220 shall
1646+20 require an individual application or enrollment form and
1647+21 shall furnish each insured individual a certificate, which
1648+22 shall have been approved by the Director under Section
1649+23 355.
1650+24 (d) Under a policy or contract issued in the name of
1651+25 any volunteer fire department, first aid, or other such
1652+26 volunteer group, which shall be deemed the policyholder,
1653+
1654+
1655+
1656+
1657+
1658+ HB5493 Enrolled - 47 - LRB103 39189 RPS 69335 b
1659+
1660+
1661+HB5493 Enrolled- 48 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 48 - LRB103 39189 RPS 69335 b
1662+ HB5493 Enrolled - 48 - LRB103 39189 RPS 69335 b
1663+1 covering all of the members of such department or group.
1664+2 (e) Under a policy or contract issued to a creditor,
1665+3 who shall be deemed the policyholder, to insure debtors of
1666+4 the creditors; Provided, however, that in the case of a
1667+5 loan which is subject to the Small Loans Act, no insurance
1668+6 premium or other cost shall be directly or indirectly
1669+7 charged or assessed against, or collected or received from
1670+8 the borrower.
1671+9 (f) Under a policy or contract issued to a sports team
1672+10 or to a camp, which team or camp sponsor shall be deemed
1673+11 the policyholder, covering members or campers.
1674+12 (g) Under a policy or contract issued to any other
1675+13 substantially similar group which, in the discretion of
1676+14 the Director, may be subject to the issuance of a blanket
1677+15 accident and health policy or contract.
1678+16 (2) Any insurance company authorized to write accident and
1679+17 health insurance in this state shall have the power to issue
1680+18 blanket accident and health insurance. No such blanket policy
1681+19 may be issued or delivered in this State unless a copy of the
1682+20 form thereof shall have been filed in accordance with Section
1683+21 355, and it contains in substance such of those provisions
1684+22 contained in Sections 357.1 through 357.30 as may be
1685+23 applicable to blanket accident and health insurance and the
1686+24 following provisions:
1687+25 (a) A provision that the policy and the application
1688+26 shall constitute the entire contract between the parties,
1689+
1690+
1691+
1692+
1693+
1694+ HB5493 Enrolled - 48 - LRB103 39189 RPS 69335 b
1695+
1696+
1697+HB5493 Enrolled- 49 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 49 - LRB103 39189 RPS 69335 b
1698+ HB5493 Enrolled - 49 - LRB103 39189 RPS 69335 b
1699+1 and that all statements made by the policyholder shall, in
1700+2 absence of fraud, be deemed representations and not
1701+3 warranties, and that no such statements shall be used in
1702+4 defense to a claim under the policy, unless it is
1703+5 contained in a written application.
1704+6 (b) A provision that to the group or class thereof
1705+7 originally insured shall be added from time to time all
1706+8 new persons or individuals eligible for coverage.
1707+9 (3) An individual application shall not be required from a
1708+10 person covered under a blanket accident or health policy or
1709+11 contract, nor shall it be necessary for the insurer to furnish
1710+12 each person a certificate.
1711+13 (3.5) Subsection (3) does not apply to major medical
1712+14 insurance, or to any excepted benefits or short-term,
1713+15 limited-duration health insurance coverage for which an
1714+16 insured individual pays premiums or contributions. In those
1715+17 cases, the insurer shall require an individual application or
1716+18 enrollment form and shall furnish each insured individual a
1717+19 certificate, which shall have been approved by the Director
1718+20 under Section 355 of this Code.
1719+21 (4) All benefits under any blanket accident and health
1720+22 policy shall be payable to the person insured, or to his
1721+23 designated beneficiary or beneficiaries, or to his or her
1722+24 estate, except that if the person insured be a minor or person
1723+25 under legal disability, such benefits may be made payable to
1724+26 his or her parent, guardian, or other person actually
1725+
1726+
1727+
1728+
1729+
1730+ HB5493 Enrolled - 49 - LRB103 39189 RPS 69335 b
1731+
1732+
1733+HB5493 Enrolled- 50 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 50 - LRB103 39189 RPS 69335 b
1734+ HB5493 Enrolled - 50 - LRB103 39189 RPS 69335 b
1735+1 supporting him or her. Provided further, however, that the
1736+2 policy may provide that all or any portion of any indemnities
1737+3 provided by any such policy on account of hospital, nursing,
1738+4 medical or surgical services may, at the insurer's option, be
1739+5 paid directly to the hospital or person rendering such
1740+6 services; but the policy may not require that the service be
1741+7 rendered by a particular hospital or person. Payment so made
1742+8 shall discharge the insurer's obligation with respect to the
1743+9 amount of insurance so paid.
1744+10 (5) Nothing contained in this section shall be deemed to
1745+11 affect the legal liability of policyholders for the death of
1746+12 or injury to, any such member of such group.
1747+13 (Source: P.A. 83-1362.)
1748+14 (215 ILCS 5/370e) (from Ch. 73, par. 982e)
1749+15 Sec. 370e. Companies which issue group accident and health
1750+16 policies or blanket accident and health plans to employer
1751+17 groups in this State shall provide the employer with notice of
1752+18 termination of a group or blanket accident and health plan
1753+19 because of the employer's failure to pay the premium when due.
1754+20 The insurance company shall file send a copy of such notice
1755+21 with to the Department in an electronic format either through
1756+22 the System for Electronic Rate and Form Filing (SERFF) or as
1757+23 otherwise prescribed by the Director.
1758+24 (Source: P.A. 83-1006.)
1759+
1760+
1761+
1762+
1763+
1764+ HB5493 Enrolled - 50 - LRB103 39189 RPS 69335 b
1765+
1766+
1767+HB5493 Enrolled- 51 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 51 - LRB103 39189 RPS 69335 b
1768+ HB5493 Enrolled - 51 - LRB103 39189 RPS 69335 b
1769+1 (215 ILCS 5/370i) (from Ch. 73, par. 982i)
1770+2 Sec. 370i. Policies, agreements or arrangements with
1771+3 incentives or limits on reimbursement authorized.
1772+4 (a) Policies, agreements or arrangements issued under this
1773+5 Article may not contain terms or conditions that would operate
1774+6 unreasonably to restrict the access and availability of health
1775+7 care services for the insured.
1776+8 (b) An insurer or administrator may:
1777+9 (1) enter into agreements with certain providers of
1778+10 its choice relating to health care services which may be
1779+11 rendered to insureds or beneficiaries of the insurer or
1780+12 administrator, including agreements relating to the
1781+13 amounts to be charged the insureds or beneficiaries for
1782+14 services rendered;
1783+15 (2) issue or administer programs, policies or
1784+16 subscriber contracts in this State that include incentives
1785+17 for the insured or beneficiary to utilize the services of
1786+18 a provider which has entered into an agreement with the
1787+19 insurer or administrator pursuant to paragraph (1) above.
1788+20 (c) (Blank). After the effective date of this amendatory
1789+21 Act of the 92nd General Assembly, any insurer that arranges,
1790+22 contracts with, or administers contracts with a provider
1791+23 whereby beneficiaries are provided an incentive to use the
1792+24 services of such provider must include the following
1793+25 disclosure on its contracts and evidences of coverage:
1794+26 "WARNING, LIMITED BENEFITS WILL BE PAID WHEN NON-PARTICIPATING
1795+
1796+
1797+
1798+
1799+
1800+ HB5493 Enrolled - 51 - LRB103 39189 RPS 69335 b
1801+
1802+
1803+HB5493 Enrolled- 52 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 52 - LRB103 39189 RPS 69335 b
1804+ HB5493 Enrolled - 52 - LRB103 39189 RPS 69335 b
1805+1 PROVIDERS ARE USED. You should be aware that when you elect to
1806+2 utilize the services of a non-participating provider for a
1807+3 covered service in non-emergency situations, benefit payments
1808+4 to such non-participating provider are not based upon the
1809+5 amount billed. The basis of your benefit payment will be
1810+6 determined according to your policy's fee schedule, usual and
1811+7 customary charge (which is determined by comparing charges for
1812+8 similar services adjusted to the geographical area where the
1813+9 services are performed), or other method as defined by the
1814+10 policy. YOU CAN EXPECT TO PAY MORE THAN THE COINSURANCE AMOUNT
1815+11 DEFINED IN THE POLICY AFTER THE PLAN HAS PAID ITS REQUIRED
1816+12 PORTION. Non-participating providers may bill members for any
1817+13 amount up to the billed charge after the plan has paid its
1818+14 portion of the bill. Participating providers have agreed to
1819+15 accept discounted payments for services with no additional
1820+16 billing to the member other than co-insurance and deductible
1821+17 amounts. You may obtain further information about the
1822+18 participating status of professional providers and information
1823+19 on out-of-pocket expenses by calling the toll free telephone
1824+20 number on your identification card.".
1825+21 (Source: P.A. 92-579, eff. 1-1-03.)
1826+22 (215 ILCS 5/408) (from Ch. 73, par. 1020)
1827+23 (Text of Section before amendment by P.A. 103-75)
1828+24 Sec. 408. Fees and charges.
1829+25 (1) The Director shall charge, collect and give proper
1830+
1831+
1832+
1833+
1834+
1835+ HB5493 Enrolled - 52 - LRB103 39189 RPS 69335 b
1836+
1837+
1838+HB5493 Enrolled- 53 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 53 - LRB103 39189 RPS 69335 b
1839+ HB5493 Enrolled - 53 - LRB103 39189 RPS 69335 b
1840+1 acquittances for the payment of the following fees and
1841+2 charges:
1842+3 (a) For filing all documents submitted for the
1843+4 incorporation or organization or certification of a
1844+5 domestic company, except for a fraternal benefit society,
1845+6 $2,000.
1846+7 (b) For filing all documents submitted for the
1847+8 incorporation or organization of a fraternal benefit
1848+9 society, $500.
1849+10 (c) For filing amendments to articles of incorporation
1850+11 and amendments to declaration of organization, except for
1851+12 a fraternal benefit society, a mutual benefit association,
1852+13 a burial society or a farm mutual, $200.
1853+14 (d) For filing amendments to articles of incorporation
1854+15 of a fraternal benefit society, a mutual benefit
1855+16 association or a burial society, $100.
1856+17 (e) For filing amendments to articles of incorporation
1857+18 of a farm mutual, $50.
1858+19 (f) For filing bylaws or amendments thereto, $50.
1859+20 (g) For filing agreement of merger or consolidation:
1860+21 (i) for a domestic company, except for a fraternal
1861+22 benefit society, a mutual benefit association, a
1862+23 burial society, or a farm mutual, $2,000.
1863+24 (ii) for a foreign or alien company, except for a
1864+25 fraternal benefit society, $600.
1865+26 (iii) for a fraternal benefit society, a mutual
1866+
1867+
1868+
1869+
1870+
1871+ HB5493 Enrolled - 53 - LRB103 39189 RPS 69335 b
1872+
1873+
1874+HB5493 Enrolled- 54 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 54 - LRB103 39189 RPS 69335 b
1875+ HB5493 Enrolled - 54 - LRB103 39189 RPS 69335 b
1876+1 benefit association, a burial society, or a farm
1877+2 mutual, $200.
1878+3 (h) For filing agreements of reinsurance by a domestic
1879+4 company, $200.
1880+5 (i) For filing all documents submitted by a foreign or
1881+6 alien company to be admitted to transact business or
1882+7 accredited as a reinsurer in this State, except for a
1883+8 fraternal benefit society, $5,000.
1884+9 (j) For filing all documents submitted by a foreign or
1885+10 alien fraternal benefit society to be admitted to transact
1886+11 business in this State, $500.
1887+12 (k) For filing declaration of withdrawal of a foreign
1888+13 or alien company, $50.
1889+14 (l) For filing annual statement by a domestic company,
1890+15 except a fraternal benefit society, a mutual benefit
1891+16 association, a burial society, or a farm mutual, $200.
1892+17 (m) For filing annual statement by a domestic
1893+18 fraternal benefit society, $100.
1894+19 (n) For filing annual statement by a farm mutual, a
1895+20 mutual benefit association, or a burial society, $50.
1896+21 (o) For issuing a certificate of authority or renewal
1897+22 thereof except to a foreign fraternal benefit society,
1898+23 $400.
1899+24 (p) For issuing a certificate of authority or renewal
1900+25 thereof to a foreign fraternal benefit society, $200.
1901+26 (q) For issuing an amended certificate of authority,
1902+
1903+
1904+
1905+
1906+
1907+ HB5493 Enrolled - 54 - LRB103 39189 RPS 69335 b
1908+
1909+
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1911+ HB5493 Enrolled - 55 - LRB103 39189 RPS 69335 b
1912+1 $50.
1913+2 (r) For each certified copy of certificate of
1914+3 authority, $20.
1915+4 (s) For each certificate of deposit, or valuation, or
1916+5 compliance or surety certificate, $20.
1917+6 (t) For copies of papers or records per page, $1.
1918+7 (u) For each certification to copies of papers or
1919+8 records, $10.
1920+9 (v) For multiple copies of documents or certificates
1921+10 listed in subparagraphs (r), (s), and (u) of paragraph (1)
1922+11 of this Section, $10 for the first copy of a certificate of
1923+12 any type and $5 for each additional copy of the same
1924+13 certificate requested at the same time, unless, pursuant
1925+14 to paragraph (2) of this Section, the Director finds these
1926+15 additional fees excessive.
1927+16 (w) For issuing a permit to sell shares or increase
1928+17 paid-up capital:
1929+18 (i) in connection with a public stock offering,
1930+19 $300;
1931+20 (ii) in any other case, $100.
1932+21 (x) For issuing any other certificate required or
1933+22 permissible under the law, $50.
1934+23 (y) For filing a plan of exchange of the stock of a
1935+24 domestic stock insurance company, a plan of
1936+25 demutualization of a domestic mutual company, or a plan of
1937+26 reorganization under Article XII, $2,000.
1938+
1939+
1940+
1941+
1942+
1943+ HB5493 Enrolled - 55 - LRB103 39189 RPS 69335 b
1944+
1945+
1946+HB5493 Enrolled- 56 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 56 - LRB103 39189 RPS 69335 b
1947+ HB5493 Enrolled - 56 - LRB103 39189 RPS 69335 b
1948+1 (z) For filing a statement of acquisition of a
1949+2 domestic company as defined in Section 131.4 of this Code,
1950+3 $2,000.
1951+4 (aa) For filing an agreement to purchase the business
1952+5 of an organization authorized under the Dental Service
1953+6 Plan Act or the Voluntary Health Services Plans Act or of a
1954+7 health maintenance organization or a limited health
1955+8 service organization, $2,000.
1956+9 (bb) For filing a statement of acquisition of a
1957+10 foreign or alien insurance company as defined in Section
1958+11 131.12a of this Code, $1,000.
1959+12 (cc) For filing a registration statement as required
1960+13 in Sections 131.13 and 131.14, the notification as
1961+14 required by Sections 131.16, 131.20a, or 141.4, or an
1962+15 agreement or transaction required by Sections 124.2(2),
1963+16 141, 141a, or 141.1, $200.
1964+17 (dd) For filing an application for licensing of:
1965+18 (i) a religious or charitable risk pooling trust
1966+19 or a workers' compensation pool, $1,000;
1967+20 (ii) a workers' compensation service company,
1968+21 $500;
1969+22 (iii) a self-insured automobile fleet, $200; or
1970+23 (iv) a renewal of or amendment of any license
1971+24 issued pursuant to (i), (ii), or (iii) above, $100.
1972+25 (ee) For filing articles of incorporation for a
1973+26 syndicate to engage in the business of insurance through
1974+
1975+
1976+
1977+
1978+
1979+ HB5493 Enrolled - 56 - LRB103 39189 RPS 69335 b
1980+
1981+
1982+HB5493 Enrolled- 57 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 57 - LRB103 39189 RPS 69335 b
1983+ HB5493 Enrolled - 57 - LRB103 39189 RPS 69335 b
1984+1 the Illinois Insurance Exchange, $2,000.
1985+2 (ff) For filing amended articles of incorporation for
1986+3 a syndicate engaged in the business of insurance through
1987+4 the Illinois Insurance Exchange, $100.
1988+5 (gg) For filing articles of incorporation for a
1989+6 limited syndicate to join with other subscribers or
1990+7 limited syndicates to do business through the Illinois
1991+8 Insurance Exchange, $1,000.
1992+9 (hh) For filing amended articles of incorporation for
1993+10 a limited syndicate to do business through the Illinois
1994+11 Insurance Exchange, $100.
1995+12 (ii) For a permit to solicit subscriptions to a
1996+13 syndicate or limited syndicate, $100.
1997+14 (jj) For the filing of each form as required in
1998+15 Section 143 of this Code, $50 per form. Informational and
1999+16 advertising filings shall be $25 per filing. The fee for
2000+17 advisory and rating organizations shall be $200 per form.
2001+18 (i) For the purposes of the form filing fee,
2002+19 filings made on insert page basis will be considered
2003+20 one form at the time of its original submission.
2004+21 Changes made to a form subsequent to its approval
2005+22 shall be considered a new filing.
2006+23 (ii) Only one fee shall be charged for a form,
2007+24 regardless of the number of other forms or policies
2008+25 with which it will be used.
2009+26 (iii) Fees charged for a policy filed as it will be
2010+
2011+
2012+
2013+
2014+
2015+ HB5493 Enrolled - 57 - LRB103 39189 RPS 69335 b
2016+
2017+
2018+HB5493 Enrolled- 58 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 58 - LRB103 39189 RPS 69335 b
2019+ HB5493 Enrolled - 58 - LRB103 39189 RPS 69335 b
2020+1 issued regardless of the number of forms comprising
2021+2 that policy shall not exceed $1,500. For advisory or
2022+3 rating organizations, fees charged for a policy filed
2023+4 as it will be issued regardless of the number of forms
2024+5 comprising that policy shall not exceed $2,500.
2025+6 (iv) The Director may by rule exempt forms from
2026+7 such fees.
2027+8 (kk) For filing an application for licensing of a
2028+9 reinsurance intermediary, $500.
2029+10 (ll) For filing an application for renewal of a
2030+11 license of a reinsurance intermediary, $200.
2031+12 (mm) For filing a plan of division of a domestic stock
2032+13 company under Article IIB, $100,000 $10,000.
2033+14 (nn) For filing all documents submitted by a foreign
2034+15 or alien company to be a certified reinsurer in this
2035+16 State, except for a fraternal benefit society, $1,000.
2036+17 (oo) For filing a renewal by a foreign or alien
2037+18 company to be a certified reinsurer in this State, except
2038+19 for a fraternal benefit society, $400.
2039+20 (pp) For filing all documents submitted by a reinsurer
2040+21 domiciled in a reciprocal jurisdiction, $1,000.
2041+22 (qq) For filing a renewal by a reinsurer domiciled in
2042+23 a reciprocal jurisdiction, $400.
2043+24 (rr) For registering a captive management company or
2044+25 renewal thereof, $50.
2045+26 (2) When printed copies or numerous copies of the same
2046+
2047+
2048+
2049+
2050+
2051+ HB5493 Enrolled - 58 - LRB103 39189 RPS 69335 b
2052+
2053+
2054+HB5493 Enrolled- 59 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 59 - LRB103 39189 RPS 69335 b
2055+ HB5493 Enrolled - 59 - LRB103 39189 RPS 69335 b
2056+1 paper or records are furnished or certified, the Director may
2057+2 reduce such fees for copies if he finds them excessive. He may,
2058+3 when he considers it in the public interest, furnish without
2059+4 charge to state insurance departments and persons other than
2060+5 companies, copies or certified copies of reports of
2061+6 examinations and of other papers and records.
2062+7 (3) The expenses incurred in any performance examination
2063+8 authorized by law shall be paid by the company or person being
2064+9 examined. The charge shall be reasonably related to the cost
2065+10 of the examination including but not limited to compensation
2066+11 of examiners, electronic data processing costs, supervision
2067+12 and preparation of an examination report and lodging and
2068+13 travel expenses. All lodging and travel expenses shall be in
2069+14 accord with the applicable travel regulations as published by
2070+15 the Department of Central Management Services and approved by
2071+16 the Governor's Travel Control Board, except that out-of-state
2072+17 lodging and travel expenses related to examinations authorized
2073+18 under Section 132 shall be in accordance with travel rates
2074+19 prescribed under paragraph 301-7.2 of the Federal Travel
2075+20 Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement of
2076+21 subsistence expenses incurred during official travel. All
2077+22 lodging and travel expenses may be reimbursed directly upon
2078+23 authorization of the Director. With the exception of the
2079+24 direct reimbursements authorized by the Director, all
2080+25 performance examination charges collected by the Department
2081+26 shall be paid to the Insurance Producer Administration Fund,
2082+
2083+
2084+
2085+
2086+
2087+ HB5493 Enrolled - 59 - LRB103 39189 RPS 69335 b
2088+
2089+
2090+HB5493 Enrolled- 60 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 60 - LRB103 39189 RPS 69335 b
2091+ HB5493 Enrolled - 60 - LRB103 39189 RPS 69335 b
2092+1 however, the electronic data processing costs incurred by the
2093+2 Department in the performance of any examination shall be
2094+3 billed directly to the company being examined for payment to
2095+4 the Technology Management Revolving Fund.
2096+5 (4) At the time of any service of process on the Director
2097+6 as attorney for such service, the Director shall charge and
2098+7 collect the sum of $40, which may be recovered as taxable costs
2099+8 by the party to the suit or action causing such service to be
2100+9 made if he prevails in such suit or action.
2101+10 (5) (a) The costs incurred by the Department of Insurance
2102+11 in conducting any hearing authorized by law shall be assessed
2103+12 against the parties to the hearing in such proportion as the
2104+13 Director of Insurance may determine upon consideration of all
2105+14 relevant circumstances including: (1) the nature of the
2106+15 hearing; (2) whether the hearing was instigated by, or for the
2107+16 benefit of a particular party or parties; (3) whether there is
2108+17 a successful party on the merits of the proceeding; and (4) the
2109+18 relative levels of participation by the parties.
2110+19 (b) For purposes of this subsection (5) costs incurred
2111+20 shall mean the hearing officer fees, court reporter fees, and
2112+21 travel expenses of Department of Insurance officers and
2113+22 employees; provided however, that costs incurred shall not
2114+23 include hearing officer fees or court reporter fees unless the
2115+24 Department has retained the services of independent
2116+25 contractors or outside experts to perform such functions.
2117+26 (c) The Director shall make the assessment of costs
2118+
2119+
2120+
2121+
2122+
2123+ HB5493 Enrolled - 60 - LRB103 39189 RPS 69335 b
2124+
2125+
2126+HB5493 Enrolled- 61 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 61 - LRB103 39189 RPS 69335 b
2127+ HB5493 Enrolled - 61 - LRB103 39189 RPS 69335 b
2128+1 incurred as part of the final order or decision arising out of
2129+2 the proceeding; provided, however, that such order or decision
2130+3 shall include findings and conclusions in support of the
2131+4 assessment of costs. This subsection (5) shall not be
2132+5 construed as permitting the payment of travel expenses unless
2133+6 calculated in accordance with the applicable travel
2134+7 regulations of the Department of Central Management Services,
2135+8 as approved by the Governor's Travel Control Board. The
2136+9 Director as part of such order or decision shall require all
2137+10 assessments for hearing officer fees and court reporter fees,
2138+11 if any, to be paid directly to the hearing officer or court
2139+12 reporter by the party(s) assessed for such costs. The
2140+13 assessments for travel expenses of Department officers and
2141+14 employees shall be reimbursable to the Director of Insurance
2142+15 for deposit to the fund out of which those expenses had been
2143+16 paid.
2144+17 (d) The provisions of this subsection (5) shall apply in
2145+18 the case of any hearing conducted by the Director of Insurance
2146+19 not otherwise specifically provided for by law.
2147+20 (6) The Director shall charge and collect an annual
2148+21 financial regulation fee from every domestic company for
2149+22 examination and analysis of its financial condition and to
2150+23 fund the internal costs and expenses of the Interstate
2151+24 Insurance Receivership Commission as may be allocated to the
2152+25 State of Illinois and companies doing an insurance business in
2153+26 this State pursuant to Article X of the Interstate Insurance
2154+
2155+
2156+
2157+
2158+
2159+ HB5493 Enrolled - 61 - LRB103 39189 RPS 69335 b
2160+
2161+
2162+HB5493 Enrolled- 62 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 62 - LRB103 39189 RPS 69335 b
2163+ HB5493 Enrolled - 62 - LRB103 39189 RPS 69335 b
2164+1 Receivership Compact. The fee shall be the greater fixed
2165+2 amount based upon the combination of nationwide direct premium
2166+3 income and nationwide reinsurance assumed premium income or
2167+4 upon admitted assets calculated under this subsection as
2168+5 follows:
2169+6 (a) Combination of nationwide direct premium income
2170+7 and nationwide reinsurance assumed premium.
2171+8 (i) $150, if the premium is less than $500,000 and
2172+9 there is no reinsurance assumed premium;
2173+10 (ii) $750, if the premium is $500,000 or more, but
2174+11 less than $5,000,000 and there is no reinsurance
2175+12 assumed premium; or if the premium is less than
2176+13 $5,000,000 and the reinsurance assumed premium is less
2177+14 than $10,000,000;
2178+15 (iii) $3,750, if the premium is less than
2179+16 $5,000,000 and the reinsurance assumed premium is
2180+17 $10,000,000 or more;
2181+18 (iv) $7,500, if the premium is $5,000,000 or more,
2182+19 but less than $10,000,000;
2183+20 (v) $18,000, if the premium is $10,000,000 or
2184+21 more, but less than $25,000,000;
2185+22 (vi) $22,500, if the premium is $25,000,000 or
2186+23 more, but less than $50,000,000;
2187+24 (vii) $30,000, if the premium is $50,000,000 or
2188+25 more, but less than $100,000,000;
2189+26 (viii) $37,500, if the premium is $100,000,000 or
2190+
2191+
2192+
2193+
2194+
2195+ HB5493 Enrolled - 62 - LRB103 39189 RPS 69335 b
2196+
2197+
2198+HB5493 Enrolled- 63 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 63 - LRB103 39189 RPS 69335 b
2199+ HB5493 Enrolled - 63 - LRB103 39189 RPS 69335 b
2200+1 more.
2201+2 (b) Admitted assets.
2202+3 (i) $150, if admitted assets are less than
2203+4 $1,000,000;
2204+5 (ii) $750, if admitted assets are $1,000,000 or
2205+6 more, but less than $5,000,000;
2206+7 (iii) $3,750, if admitted assets are $5,000,000 or
2207+8 more, but less than $25,000,000;
2208+9 (iv) $7,500, if admitted assets are $25,000,000 or
2209+10 more, but less than $50,000,000;
2210+11 (v) $18,000, if admitted assets are $50,000,000 or
2211+12 more, but less than $100,000,000;
2212+13 (vi) $22,500, if admitted assets are $100,000,000
2213+14 or more, but less than $500,000,000;
2214+15 (vii) $30,000, if admitted assets are $500,000,000
2215+16 or more, but less than $1,000,000,000;
2216+17 (viii) $37,500, if admitted assets are
2217+18 $1,000,000,000 or more.
2218+19 (c) The sum of financial regulation fees charged to
2219+20 the domestic companies of the same affiliated group shall
2220+21 not exceed $250,000 in the aggregate in any single year
2221+22 and shall be billed by the Director to the member company
2222+23 designated by the group.
2223+24 (7) The Director shall charge and collect an annual
2224+25 financial regulation fee from every foreign or alien company,
2225+26 except fraternal benefit societies, for the examination and
2226+
2227+
2228+
2229+
2230+
2231+ HB5493 Enrolled - 63 - LRB103 39189 RPS 69335 b
2232+
2233+
2234+HB5493 Enrolled- 64 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 64 - LRB103 39189 RPS 69335 b
2235+ HB5493 Enrolled - 64 - LRB103 39189 RPS 69335 b
2236+1 analysis of its financial condition and to fund the internal
2237+2 costs and expenses of the Interstate Insurance Receivership
2238+3 Commission as may be allocated to the State of Illinois and
2239+4 companies doing an insurance business in this State pursuant
2240+5 to Article X of the Interstate Insurance Receivership Compact.
2241+6 The fee shall be a fixed amount based upon Illinois direct
2242+7 premium income and nationwide reinsurance assumed premium
2243+8 income in accordance with the following schedule:
2244+9 (a) $150, if the premium is less than $500,000 and
2245+10 there is no reinsurance assumed premium;
2246+11 (b) $750, if the premium is $500,000 or more, but less
2247+12 than $5,000,000 and there is no reinsurance assumed
2248+13 premium; or if the premium is less than $5,000,000 and the
2249+14 reinsurance assumed premium is less than $10,000,000;
2250+15 (c) $3,750, if the premium is less than $5,000,000 and
2251+16 the reinsurance assumed premium is $10,000,000 or more;
2252+17 (d) $7,500, if the premium is $5,000,000 or more, but
2253+18 less than $10,000,000;
2254+19 (e) $18,000, if the premium is $10,000,000 or more,
2255+20 but less than $25,000,000;
2256+21 (f) $22,500, if the premium is $25,000,000 or more,
2257+22 but less than $50,000,000;
2258+23 (g) $30,000, if the premium is $50,000,000 or more,
2259+24 but less than $100,000,000;
2260+25 (h) $37,500, if the premium is $100,000,000 or more.
2261+26 The sum of financial regulation fees under this subsection
2262+
2263+
2264+
2265+
2266+
2267+ HB5493 Enrolled - 64 - LRB103 39189 RPS 69335 b
2268+
2269+
2270+HB5493 Enrolled- 65 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 65 - LRB103 39189 RPS 69335 b
2271+ HB5493 Enrolled - 65 - LRB103 39189 RPS 69335 b
2272+1 (7) charged to the foreign or alien companies within the same
2273+2 affiliated group shall not exceed $250,000 in the aggregate in
2274+3 any single year and shall be billed by the Director to the
2275+4 member company designated by the group.
2276+5 (8) Beginning January 1, 1992, the financial regulation
2277+6 fees imposed under subsections (6) and (7) of this Section
2278+7 shall be paid by each company or domestic affiliated group
2279+8 annually. After January 1, 1994, the fee shall be billed by
2280+9 Department invoice based upon the company's premium income or
2281+10 admitted assets as shown in its annual statement for the
2282+11 preceding calendar year. The invoice is due upon receipt and
2283+12 must be paid no later than June 30 of each calendar year. All
2284+13 financial regulation fees collected by the Department shall be
2285+14 paid to the Insurance Financial Regulation Fund. The
2286+15 Department may not collect financial examiner per diem charges
2287+16 from companies subject to subsections (6) and (7) of this
2288+17 Section undergoing financial examination after June 30, 1992.
2289+18 (9) In addition to the financial regulation fee required
2290+19 by this Section, a company undergoing any financial
2291+20 examination authorized by law shall pay the following costs
2292+21 and expenses incurred by the Department: electronic data
2293+22 processing costs, the expenses authorized under Section 131.21
2294+23 and subsection (d) of Section 132.4 of this Code, and lodging
2295+24 and travel expenses.
2296+25 Electronic data processing costs incurred by the
2297+26 Department in the performance of any examination shall be
2298+
2299+
2300+
2301+
2302+
2303+ HB5493 Enrolled - 65 - LRB103 39189 RPS 69335 b
2304+
2305+
2306+HB5493 Enrolled- 66 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 66 - LRB103 39189 RPS 69335 b
2307+ HB5493 Enrolled - 66 - LRB103 39189 RPS 69335 b
2308+1 billed directly to the company undergoing examination for
2309+2 payment to the Technology Management Revolving Fund. Except
2310+3 for direct reimbursements authorized by the Director or direct
2311+4 payments made under Section 131.21 or subsection (d) of
2312+5 Section 132.4 of this Code, all financial regulation fees and
2313+6 all financial examination charges collected by the Department
2314+7 shall be paid to the Insurance Financial Regulation Fund.
2315+8 All lodging and travel expenses shall be in accordance
2316+9 with applicable travel regulations published by the Department
2317+10 of Central Management Services and approved by the Governor's
2318+11 Travel Control Board, except that out-of-state lodging and
2319+12 travel expenses related to examinations authorized under
2320+13 Sections 132.1 through 132.7 shall be in accordance with
2321+14 travel rates prescribed under paragraph 301-7.2 of the Federal
2322+15 Travel Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement
2323+16 of subsistence expenses incurred during official travel. All
2324+17 lodging and travel expenses may be reimbursed directly upon
2325+18 the authorization of the Director.
2326+19 In the case of an organization or person not subject to the
2327+20 financial regulation fee, the expenses incurred in any
2328+21 financial examination authorized by law shall be paid by the
2329+22 organization or person being examined. The charge shall be
2330+23 reasonably related to the cost of the examination including,
2331+24 but not limited to, compensation of examiners and other costs
2332+25 described in this subsection.
2333+26 (10) Any company, person, or entity failing to make any
2334+
2335+
2336+
2337+
2338+
2339+ HB5493 Enrolled - 66 - LRB103 39189 RPS 69335 b
2340+
2341+
2342+HB5493 Enrolled- 67 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 67 - LRB103 39189 RPS 69335 b
2343+ HB5493 Enrolled - 67 - LRB103 39189 RPS 69335 b
2344+1 payment of $150 or more as required under this Section shall be
2345+2 subject to the penalty and interest provisions provided for in
2346+3 subsections (4) and (7) of Section 412.
2347+4 (11) Unless otherwise specified, all of the fees collected
2348+5 under this Section shall be paid into the Insurance Financial
2349+6 Regulation Fund.
2350+7 (12) For purposes of this Section:
2351+8 (a) "Domestic company" means a company as defined in
2352+9 Section 2 of this Code which is incorporated or organized
2353+10 under the laws of this State, and in addition includes a
2354+11 not-for-profit corporation authorized under the Dental
2355+12 Service Plan Act or the Voluntary Health Services Plans
2356+13 Act, a health maintenance organization, and a limited
2357+14 health service organization.
2358+15 (b) "Foreign company" means a company as defined in
2359+16 Section 2 of this Code which is incorporated or organized
2360+17 under the laws of any state of the United States other than
2361+18 this State and in addition includes a health maintenance
2362+19 organization and a limited health service organization
2363+20 which is incorporated or organized under the laws of any
2364+21 state of the United States other than this State.
2365+22 (c) "Alien company" means a company as defined in
2366+23 Section 2 of this Code which is incorporated or organized
2367+24 under the laws of any country other than the United
2368+25 States.
2369+26 (d) "Fraternal benefit society" means a corporation,
2370+
2371+
2372+
2373+
2374+
2375+ HB5493 Enrolled - 67 - LRB103 39189 RPS 69335 b
2376+
2377+
2378+HB5493 Enrolled- 68 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 68 - LRB103 39189 RPS 69335 b
2379+ HB5493 Enrolled - 68 - LRB103 39189 RPS 69335 b
2380+1 society, order, lodge or voluntary association as defined
2381+2 in Section 282.1 of this Code.
2382+3 (e) "Mutual benefit association" means a company,
2383+4 association or corporation authorized by the Director to
2384+5 do business in this State under the provisions of Article
2385+6 XVIII of this Code.
2386+7 (f) "Burial society" means a person, firm,
2387+8 corporation, society or association of individuals
2388+9 authorized by the Director to do business in this State
2389+10 under the provisions of Article XIX of this Code.
2390+11 (g) "Farm mutual" means a district, county and
2391+12 township mutual insurance company authorized by the
2392+13 Director to do business in this State under the provisions
2393+14 of the Farm Mutual Insurance Company Act of 1986.
2394+15 (Source: P.A. 102-775, eff. 5-13-22.)
2395+16 (Text of Section after amendment by P.A. 103-75)
2396+17 Sec. 408. Fees and charges.
2397+18 (1) The Director shall charge, collect and give proper
2398+19 acquittances for the payment of the following fees and
2399+20 charges:
2400+21 (a) For filing all documents submitted for the
2401+22 incorporation or organization or certification of a
2402+23 domestic company, except for a fraternal benefit society,
2403+24 $2,000.
2404+25 (b) For filing all documents submitted for the
2405+
2406+
2407+
2408+
2409+
2410+ HB5493 Enrolled - 68 - LRB103 39189 RPS 69335 b
2411+
2412+
2413+HB5493 Enrolled- 69 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 69 - LRB103 39189 RPS 69335 b
2414+ HB5493 Enrolled - 69 - LRB103 39189 RPS 69335 b
2415+1 incorporation or organization of a fraternal benefit
2416+2 society, $500.
2417+3 (c) For filing amendments to articles of incorporation
2418+4 and amendments to declaration of organization, except for
2419+5 a fraternal benefit society, a mutual benefit association,
2420+6 a burial society or a farm mutual, $200.
2421+7 (d) For filing amendments to articles of incorporation
2422+8 of a fraternal benefit society, a mutual benefit
2423+9 association or a burial society, $100.
2424+10 (e) For filing amendments to articles of incorporation
2425+11 of a farm mutual, $50.
2426+12 (f) For filing bylaws or amendments thereto, $50.
2427+13 (g) For filing agreement of merger or consolidation:
2428+14 (i) for a domestic company, except for a fraternal
2429+15 benefit society, a mutual benefit association, a
2430+16 burial society, or a farm mutual, $2,000.
2431+17 (ii) for a foreign or alien company, except for a
2432+18 fraternal benefit society, $600.
2433+19 (iii) for a fraternal benefit society, a mutual
2434+20 benefit association, a burial society, or a farm
2435+21 mutual, $200.
2436+22 (h) For filing agreements of reinsurance by a domestic
2437+23 company, $200.
2438+24 (i) For filing all documents submitted by a foreign or
2439+25 alien company to be admitted to transact business or
2440+26 accredited as a reinsurer in this State, except for a
2441+
2442+
2443+
2444+
2445+
2446+ HB5493 Enrolled - 69 - LRB103 39189 RPS 69335 b
2447+
2448+
2449+HB5493 Enrolled- 70 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 70 - LRB103 39189 RPS 69335 b
2450+ HB5493 Enrolled - 70 - LRB103 39189 RPS 69335 b
2451+1 fraternal benefit society, $5,000.
2452+2 (j) For filing all documents submitted by a foreign or
2453+3 alien fraternal benefit society to be admitted to transact
2454+4 business in this State, $500.
2455+5 (k) For filing declaration of withdrawal of a foreign
2456+6 or alien company, $50.
2457+7 (l) For filing annual statement by a domestic company,
2458+8 except a fraternal benefit society, a mutual benefit
2459+9 association, a burial society, or a farm mutual, $200.
2460+10 (m) For filing annual statement by a domestic
2461+11 fraternal benefit society, $100.
2462+12 (n) For filing annual statement by a farm mutual, a
2463+13 mutual benefit association, or a burial society, $50.
2464+14 (o) For issuing a certificate of authority or renewal
2465+15 thereof except to a foreign fraternal benefit society,
2466+16 $400.
2467+17 (p) For issuing a certificate of authority or renewal
2468+18 thereof to a foreign fraternal benefit society, $200.
2469+19 (q) For issuing an amended certificate of authority,
2470+20 $50.
2471+21 (r) For each certified copy of certificate of
2472+22 authority, $20.
2473+23 (s) For each certificate of deposit, or valuation, or
2474+24 compliance or surety certificate, $20.
2475+25 (t) For copies of papers or records per page, $1.
2476+26 (u) For each certification to copies of papers or
2477+
2478+
2479+
2480+
2481+
2482+ HB5493 Enrolled - 70 - LRB103 39189 RPS 69335 b
2483+
2484+
2485+HB5493 Enrolled- 71 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 71 - LRB103 39189 RPS 69335 b
2486+ HB5493 Enrolled - 71 - LRB103 39189 RPS 69335 b
2487+1 records, $10.
2488+2 (v) For multiple copies of documents or certificates
2489+3 listed in subparagraphs (r), (s), and (u) of paragraph (1)
2490+4 of this Section, $10 for the first copy of a certificate of
2491+5 any type and $5 for each additional copy of the same
2492+6 certificate requested at the same time, unless, pursuant
2493+7 to paragraph (2) of this Section, the Director finds these
2494+8 additional fees excessive.
2495+9 (w) For issuing a permit to sell shares or increase
2496+10 paid-up capital:
2497+11 (i) in connection with a public stock offering,
2498+12 $300;
2499+13 (ii) in any other case, $100.
2500+14 (x) For issuing any other certificate required or
2501+15 permissible under the law, $50.
2502+16 (y) For filing a plan of exchange of the stock of a
2503+17 domestic stock insurance company, a plan of
2504+18 demutualization of a domestic mutual company, or a plan of
2505+19 reorganization under Article XII, $2,000.
2506+20 (z) For filing a statement of acquisition of a
2507+21 domestic company as defined in Section 131.4 of this Code,
2508+22 $2,000.
2509+23 (aa) For filing an agreement to purchase the business
2510+24 of an organization authorized under the Dental Service
2511+25 Plan Act or the Voluntary Health Services Plans Act or of a
2512+26 health maintenance organization or a limited health
2513+
2514+
2515+
2516+
2517+
2518+ HB5493 Enrolled - 71 - LRB103 39189 RPS 69335 b
2519+
2520+
2521+HB5493 Enrolled- 72 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 72 - LRB103 39189 RPS 69335 b
2522+ HB5493 Enrolled - 72 - LRB103 39189 RPS 69335 b
2523+1 service organization, $2,000.
2524+2 (bb) For filing a statement of acquisition of a
2525+3 foreign or alien insurance company as defined in Section
2526+4 131.12a of this Code, $1,000.
2527+5 (cc) For filing a registration statement as required
2528+6 in Sections 131.13 and 131.14, the notification as
2529+7 required by Sections 131.16, 131.20a, or 141.4, or an
2530+8 agreement or transaction required by Sections 124.2(2),
2531+9 141, 141a, or 141.1, $200.
2532+10 (dd) For filing an application for licensing of:
2533+11 (i) a religious or charitable risk pooling trust
2534+12 or a workers' compensation pool, $1,000;
2535+13 (ii) a workers' compensation service company,
2536+14 $500;
2537+15 (iii) a self-insured automobile fleet, $200; or
2538+16 (iv) a renewal of or amendment of any license
2539+17 issued pursuant to (i), (ii), or (iii) above, $100.
2540+18 (ee) For filing articles of incorporation for a
2541+19 syndicate to engage in the business of insurance through
2542+20 the Illinois Insurance Exchange, $2,000.
2543+21 (ff) For filing amended articles of incorporation for
2544+22 a syndicate engaged in the business of insurance through
2545+23 the Illinois Insurance Exchange, $100.
2546+24 (gg) For filing articles of incorporation for a
2547+25 limited syndicate to join with other subscribers or
2548+26 limited syndicates to do business through the Illinois
2549+
2550+
2551+
2552+
2553+
2554+ HB5493 Enrolled - 72 - LRB103 39189 RPS 69335 b
2555+
2556+
2557+HB5493 Enrolled- 73 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 73 - LRB103 39189 RPS 69335 b
2558+ HB5493 Enrolled - 73 - LRB103 39189 RPS 69335 b
2559+1 Insurance Exchange, $1,000.
2560+2 (hh) For filing amended articles of incorporation for
2561+3 a limited syndicate to do business through the Illinois
2562+4 Insurance Exchange, $100.
2563+5 (ii) For a permit to solicit subscriptions to a
2564+6 syndicate or limited syndicate, $100.
2565+7 (jj) For the filing of each form as required in
2566+8 Section 143 of this Code, $50 per form. Informational and
2567+9 advertising filings shall be $25 per filing. The fee for
2568+10 advisory and rating organizations shall be $200 per form.
2569+11 (i) For the purposes of the form filing fee,
2570+12 filings made on insert page basis will be considered
2571+13 one form at the time of its original submission.
2572+14 Changes made to a form subsequent to its approval
2573+15 shall be considered a new filing.
2574+16 (ii) Only one fee shall be charged for a form,
2575+17 regardless of the number of other forms or policies
2576+18 with which it will be used.
2577+19 (iii) Fees charged for a policy filed as it will be
2578+20 issued regardless of the number of forms comprising
2579+21 that policy shall not exceed $1,500. For advisory or
2580+22 rating organizations, fees charged for a policy filed
2581+23 as it will be issued regardless of the number of forms
2582+24 comprising that policy shall not exceed $2,500.
2583+25 (iv) The Director may by rule exempt forms from
2584+26 such fees.
2585+
2586+
2587+
2588+
2589+
2590+ HB5493 Enrolled - 73 - LRB103 39189 RPS 69335 b
2591+
2592+
2593+HB5493 Enrolled- 74 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 74 - LRB103 39189 RPS 69335 b
2594+ HB5493 Enrolled - 74 - LRB103 39189 RPS 69335 b
2595+1 (kk) For filing an application for licensing of a
2596+2 reinsurance intermediary, $500.
2597+3 (ll) For filing an application for renewal of a
2598+4 license of a reinsurance intermediary, $200.
2599+5 (mm) For filing a plan of division of a domestic stock
2600+6 company under Article IIB, $100,000 $10,000.
2601+7 (nn) For filing all documents submitted by a foreign
2602+8 or alien company to be a certified reinsurer in this
2603+9 State, except for a fraternal benefit society, $1,000.
2604+10 (oo) For filing a renewal by a foreign or alien
2605+11 company to be a certified reinsurer in this State, except
2606+12 for a fraternal benefit society, $400.
2607+13 (pp) For filing all documents submitted by a reinsurer
2608+14 domiciled in a reciprocal jurisdiction, $1,000.
2609+15 (qq) For filing a renewal by a reinsurer domiciled in
2610+16 a reciprocal jurisdiction, $400.
2611+17 (rr) For registering a captive management company or
2612+18 renewal thereof, $50.
2613+19 (ss) For filing an insurance business transfer plan
2614+20 under Article XLVII, $100,000 $25,000.
2615+21 (2) When printed copies or numerous copies of the same
2616+22 paper or records are furnished or certified, the Director may
2617+23 reduce such fees for copies if he finds them excessive. He may,
2618+24 when he considers it in the public interest, furnish without
2619+25 charge to state insurance departments and persons other than
2620+26 companies, copies or certified copies of reports of
2621+
2622+
2623+
2624+
2625+
2626+ HB5493 Enrolled - 74 - LRB103 39189 RPS 69335 b
2627+
2628+
2629+HB5493 Enrolled- 75 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 75 - LRB103 39189 RPS 69335 b
2630+ HB5493 Enrolled - 75 - LRB103 39189 RPS 69335 b
2631+1 examinations and of other papers and records.
2632+2 (3) The expenses incurred in any performance examination
2633+3 authorized by law shall be paid by the company or person being
2634+4 examined. The charge shall be reasonably related to the cost
2635+5 of the examination including but not limited to compensation
2636+6 of examiners, electronic data processing costs, supervision
2637+7 and preparation of an examination report and lodging and
2638+8 travel expenses. All lodging and travel expenses shall be in
2639+9 accord with the applicable travel regulations as published by
2640+10 the Department of Central Management Services and approved by
2641+11 the Governor's Travel Control Board, except that out-of-state
2642+12 lodging and travel expenses related to examinations authorized
2643+13 under Section 132 shall be in accordance with travel rates
2644+14 prescribed under paragraph 301-7.2 of the Federal Travel
2645+15 Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement of
2646+16 subsistence expenses incurred during official travel. All
2647+17 lodging and travel expenses may be reimbursed directly upon
2648+18 authorization of the Director. With the exception of the
2649+19 direct reimbursements authorized by the Director, all
2650+20 performance examination charges collected by the Department
2651+21 shall be paid to the Insurance Producer Administration Fund,
2652+22 however, the electronic data processing costs incurred by the
2653+23 Department in the performance of any examination shall be
2654+24 billed directly to the company being examined for payment to
2655+25 the Technology Management Revolving Fund.
2656+26 (4) At the time of any service of process on the Director
2657+
2658+
2659+
2660+
2661+
2662+ HB5493 Enrolled - 75 - LRB103 39189 RPS 69335 b
2663+
2664+
2665+HB5493 Enrolled- 76 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 76 - LRB103 39189 RPS 69335 b
2666+ HB5493 Enrolled - 76 - LRB103 39189 RPS 69335 b
2667+1 as attorney for such service, the Director shall charge and
2668+2 collect the sum of $40, which may be recovered as taxable costs
2669+3 by the party to the suit or action causing such service to be
2670+4 made if he prevails in such suit or action.
2671+5 (5) (a) The costs incurred by the Department of Insurance
2672+6 in conducting any hearing authorized by law shall be assessed
2673+7 against the parties to the hearing in such proportion as the
2674+8 Director of Insurance may determine upon consideration of all
2675+9 relevant circumstances including: (1) the nature of the
2676+10 hearing; (2) whether the hearing was instigated by, or for the
2677+11 benefit of a particular party or parties; (3) whether there is
2678+12 a successful party on the merits of the proceeding; and (4) the
2679+13 relative levels of participation by the parties.
2680+14 (b) For purposes of this subsection (5) costs incurred
2681+15 shall mean the hearing officer fees, court reporter fees, and
2682+16 travel expenses of Department of Insurance officers and
2683+17 employees; provided however, that costs incurred shall not
2684+18 include hearing officer fees or court reporter fees unless the
2685+19 Department has retained the services of independent
2686+20 contractors or outside experts to perform such functions.
2687+21 (c) The Director shall make the assessment of costs
2688+22 incurred as part of the final order or decision arising out of
2689+23 the proceeding; provided, however, that such order or decision
2690+24 shall include findings and conclusions in support of the
2691+25 assessment of costs. This subsection (5) shall not be
2692+26 construed as permitting the payment of travel expenses unless
2693+
2694+
2695+
2696+
2697+
2698+ HB5493 Enrolled - 76 - LRB103 39189 RPS 69335 b
2699+
2700+
2701+HB5493 Enrolled- 77 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 77 - LRB103 39189 RPS 69335 b
2702+ HB5493 Enrolled - 77 - LRB103 39189 RPS 69335 b
2703+1 calculated in accordance with the applicable travel
2704+2 regulations of the Department of Central Management Services,
2705+3 as approved by the Governor's Travel Control Board. The
2706+4 Director as part of such order or decision shall require all
2707+5 assessments for hearing officer fees and court reporter fees,
2708+6 if any, to be paid directly to the hearing officer or court
2709+7 reporter by the party(s) assessed for such costs. The
2710+8 assessments for travel expenses of Department officers and
2711+9 employees shall be reimbursable to the Director of Insurance
2712+10 for deposit to the fund out of which those expenses had been
2713+11 paid.
2714+12 (d) The provisions of this subsection (5) shall apply in
2715+13 the case of any hearing conducted by the Director of Insurance
2716+14 not otherwise specifically provided for by law.
2717+15 (6) The Director shall charge and collect an annual
2718+16 financial regulation fee from every domestic company for
2719+17 examination and analysis of its financial condition and to
2720+18 fund the internal costs and expenses of the Interstate
2721+19 Insurance Receivership Commission as may be allocated to the
2722+20 State of Illinois and companies doing an insurance business in
2723+21 this State pursuant to Article X of the Interstate Insurance
2724+22 Receivership Compact. The fee shall be the greater fixed
2725+23 amount based upon the combination of nationwide direct premium
2726+24 income and nationwide reinsurance assumed premium income or
2727+25 upon admitted assets calculated under this subsection as
2728+26 follows:
2729+
2730+
2731+
2732+
2733+
2734+ HB5493 Enrolled - 77 - LRB103 39189 RPS 69335 b
2735+
2736+
2737+HB5493 Enrolled- 78 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 78 - LRB103 39189 RPS 69335 b
2738+ HB5493 Enrolled - 78 - LRB103 39189 RPS 69335 b
2739+1 (a) Combination of nationwide direct premium income
2740+2 and nationwide reinsurance assumed premium.
2741+3 (i) $150, if the premium is less than $500,000 and
2742+4 there is no reinsurance assumed premium;
2743+5 (ii) $750, if the premium is $500,000 or more, but
2744+6 less than $5,000,000 and there is no reinsurance
2745+7 assumed premium; or if the premium is less than
2746+8 $5,000,000 and the reinsurance assumed premium is less
2747+9 than $10,000,000;
2748+10 (iii) $3,750, if the premium is less than
2749+11 $5,000,000 and the reinsurance assumed premium is
2750+12 $10,000,000 or more;
2751+13 (iv) $7,500, if the premium is $5,000,000 or more,
2752+14 but less than $10,000,000;
2753+15 (v) $18,000, if the premium is $10,000,000 or
2754+16 more, but less than $25,000,000;
2755+17 (vi) $22,500, if the premium is $25,000,000 or
2756+18 more, but less than $50,000,000;
2757+19 (vii) $30,000, if the premium is $50,000,000 or
2758+20 more, but less than $100,000,000;
2759+21 (viii) $37,500, if the premium is $100,000,000 or
2760+22 more.
2761+23 (b) Admitted assets.
2762+24 (i) $150, if admitted assets are less than
2763+25 $1,000,000;
2764+26 (ii) $750, if admitted assets are $1,000,000 or
2765+
2766+
2767+
2768+
2769+
2770+ HB5493 Enrolled - 78 - LRB103 39189 RPS 69335 b
2771+
2772+
2773+HB5493 Enrolled- 79 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 79 - LRB103 39189 RPS 69335 b
2774+ HB5493 Enrolled - 79 - LRB103 39189 RPS 69335 b
2775+1 more, but less than $5,000,000;
2776+2 (iii) $3,750, if admitted assets are $5,000,000 or
2777+3 more, but less than $25,000,000;
2778+4 (iv) $7,500, if admitted assets are $25,000,000 or
2779+5 more, but less than $50,000,000;
2780+6 (v) $18,000, if admitted assets are $50,000,000 or
2781+7 more, but less than $100,000,000;
2782+8 (vi) $22,500, if admitted assets are $100,000,000
2783+9 or more, but less than $500,000,000;
2784+10 (vii) $30,000, if admitted assets are $500,000,000
2785+11 or more, but less than $1,000,000,000;
2786+12 (viii) $37,500, if admitted assets are
2787+13 $1,000,000,000 or more.
2788+14 (c) The sum of financial regulation fees charged to
2789+15 the domestic companies of the same affiliated group shall
2790+16 not exceed $250,000 in the aggregate in any single year
2791+17 and shall be billed by the Director to the member company
2792+18 designated by the group.
2793+19 (7) The Director shall charge and collect an annual
2794+20 financial regulation fee from every foreign or alien company,
2795+21 except fraternal benefit societies, for the examination and
2796+22 analysis of its financial condition and to fund the internal
2797+23 costs and expenses of the Interstate Insurance Receivership
2798+24 Commission as may be allocated to the State of Illinois and
2799+25 companies doing an insurance business in this State pursuant
2800+26 to Article X of the Interstate Insurance Receivership Compact.
2801+
2802+
2803+
2804+
2805+
2806+ HB5493 Enrolled - 79 - LRB103 39189 RPS 69335 b
2807+
2808+
2809+HB5493 Enrolled- 80 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 80 - LRB103 39189 RPS 69335 b
2810+ HB5493 Enrolled - 80 - LRB103 39189 RPS 69335 b
2811+1 The fee shall be a fixed amount based upon Illinois direct
2812+2 premium income and nationwide reinsurance assumed premium
2813+3 income in accordance with the following schedule:
2814+4 (a) $150, if the premium is less than $500,000 and
2815+5 there is no reinsurance assumed premium;
2816+6 (b) $750, if the premium is $500,000 or more, but less
2817+7 than $5,000,000 and there is no reinsurance assumed
2818+8 premium; or if the premium is less than $5,000,000 and the
2819+9 reinsurance assumed premium is less than $10,000,000;
2820+10 (c) $3,750, if the premium is less than $5,000,000 and
2821+11 the reinsurance assumed premium is $10,000,000 or more;
2822+12 (d) $7,500, if the premium is $5,000,000 or more, but
2823+13 less than $10,000,000;
2824+14 (e) $18,000, if the premium is $10,000,000 or more,
2825+15 but less than $25,000,000;
2826+16 (f) $22,500, if the premium is $25,000,000 or more,
2827+17 but less than $50,000,000;
2828+18 (g) $30,000, if the premium is $50,000,000 or more,
2829+19 but less than $100,000,000;
2830+20 (h) $37,500, if the premium is $100,000,000 or more.
2831+21 The sum of financial regulation fees under this subsection
2832+22 (7) charged to the foreign or alien companies within the same
2833+23 affiliated group shall not exceed $250,000 in the aggregate in
2834+24 any single year and shall be billed by the Director to the
2835+25 member company designated by the group.
2836+26 (8) Beginning January 1, 1992, the financial regulation
2837+
2838+
2839+
2840+
2841+
2842+ HB5493 Enrolled - 80 - LRB103 39189 RPS 69335 b
2843+
2844+
2845+HB5493 Enrolled- 81 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 81 - LRB103 39189 RPS 69335 b
2846+ HB5493 Enrolled - 81 - LRB103 39189 RPS 69335 b
2847+1 fees imposed under subsections (6) and (7) of this Section
2848+2 shall be paid by each company or domestic affiliated group
2849+3 annually. After January 1, 1994, the fee shall be billed by
2850+4 Department invoice based upon the company's premium income or
2851+5 admitted assets as shown in its annual statement for the
2852+6 preceding calendar year. The invoice is due upon receipt and
2853+7 must be paid no later than June 30 of each calendar year. All
2854+8 financial regulation fees collected by the Department shall be
2855+9 paid to the Insurance Financial Regulation Fund. The
2856+10 Department may not collect financial examiner per diem charges
2857+11 from companies subject to subsections (6) and (7) of this
2858+12 Section undergoing financial examination after June 30, 1992.
2859+13 (9) In addition to the financial regulation fee required
2860+14 by this Section, a company undergoing any financial
2861+15 examination authorized by law shall pay the following costs
2862+16 and expenses incurred by the Department: electronic data
2863+17 processing costs, the expenses authorized under Section 131.21
2864+18 and subsection (d) of Section 132.4 of this Code, and lodging
2865+19 and travel expenses.
2866+20 Electronic data processing costs incurred by the
2867+21 Department in the performance of any examination shall be
2868+22 billed directly to the company undergoing examination for
2869+23 payment to the Technology Management Revolving Fund. Except
2870+24 for direct reimbursements authorized by the Director or direct
2871+25 payments made under Section 131.21 or subsection (d) of
2872+26 Section 132.4 of this Code, all financial regulation fees and
2873+
2874+
2875+
2876+
2877+
2878+ HB5493 Enrolled - 81 - LRB103 39189 RPS 69335 b
2879+
2880+
2881+HB5493 Enrolled- 82 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 82 - LRB103 39189 RPS 69335 b
2882+ HB5493 Enrolled - 82 - LRB103 39189 RPS 69335 b
2883+1 all financial examination charges collected by the Department
2884+2 shall be paid to the Insurance Financial Regulation Fund.
2885+3 All lodging and travel expenses shall be in accordance
2886+4 with applicable travel regulations published by the Department
2887+5 of Central Management Services and approved by the Governor's
2888+6 Travel Control Board, except that out-of-state lodging and
2889+7 travel expenses related to examinations authorized under
2890+8 Sections 132.1 through 132.7 shall be in accordance with
2891+9 travel rates prescribed under paragraph 301-7.2 of the Federal
2892+10 Travel Regulations, 41 CFR C.F.R. 301-7.2, for reimbursement
2893+11 of subsistence expenses incurred during official travel. All
2894+12 lodging and travel expenses may be reimbursed directly upon
2895+13 the authorization of the Director.
2896+14 In the case of an organization or person not subject to the
2897+15 financial regulation fee, the expenses incurred in any
2898+16 financial examination authorized by law shall be paid by the
2899+17 organization or person being examined. The charge shall be
2900+18 reasonably related to the cost of the examination including,
2901+19 but not limited to, compensation of examiners and other costs
2902+20 described in this subsection.
2903+21 (10) Any company, person, or entity failing to make any
2904+22 payment of $150 or more as required under this Section shall be
2905+23 subject to the penalty and interest provisions provided for in
2906+24 subsections (4) and (7) of Section 412.
2907+25 (11) Unless otherwise specified, all of the fees collected
2908+26 under this Section shall be paid into the Insurance Financial
2909+
2910+
2911+
2912+
2913+
2914+ HB5493 Enrolled - 82 - LRB103 39189 RPS 69335 b
2915+
2916+
2917+HB5493 Enrolled- 83 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 83 - LRB103 39189 RPS 69335 b
2918+ HB5493 Enrolled - 83 - LRB103 39189 RPS 69335 b
2919+1 Regulation Fund.
2920+2 (12) For purposes of this Section:
2921+3 (a) "Domestic company" means a company as defined in
2922+4 Section 2 of this Code which is incorporated or organized
2923+5 under the laws of this State, and in addition includes a
2924+6 not-for-profit corporation authorized under the Dental
2925+7 Service Plan Act or the Voluntary Health Services Plans
2926+8 Act, a health maintenance organization, and a limited
2927+9 health service organization.
2928+10 (b) "Foreign company" means a company as defined in
2929+11 Section 2 of this Code which is incorporated or organized
2930+12 under the laws of any state of the United States other than
2931+13 this State and in addition includes a health maintenance
2932+14 organization and a limited health service organization
2933+15 which is incorporated or organized under the laws of any
2934+16 state of the United States other than this State.
2935+17 (c) "Alien company" means a company as defined in
2936+18 Section 2 of this Code which is incorporated or organized
2937+19 under the laws of any country other than the United
2938+20 States.
2939+21 (d) "Fraternal benefit society" means a corporation,
2940+22 society, order, lodge or voluntary association as defined
2941+23 in Section 282.1 of this Code.
2942+24 (e) "Mutual benefit association" means a company,
2943+25 association or corporation authorized by the Director to
2944+26 do business in this State under the provisions of Article
2945+
2946+
2947+
2948+
2949+
2950+ HB5493 Enrolled - 83 - LRB103 39189 RPS 69335 b
2951+
2952+
2953+HB5493 Enrolled- 84 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 84 - LRB103 39189 RPS 69335 b
2954+ HB5493 Enrolled - 84 - LRB103 39189 RPS 69335 b
2955+1 XVIII of this Code.
2956+2 (f) "Burial society" means a person, firm,
2957+3 corporation, society or association of individuals
2958+4 authorized by the Director to do business in this State
2959+5 under the provisions of Article XIX of this Code.
2960+6 (g) "Farm mutual" means a district, county and
2961+7 township mutual insurance company authorized by the
2962+8 Director to do business in this State under the provisions
2963+9 of the Farm Mutual Insurance Company Act of 1986.
2964+10 (Source: P.A. 102-775, eff. 5-13-22; 103-75, eff. 1-1-25.)
2965+11 (215 ILCS 5/412) (from Ch. 73, par. 1024)
2966+12 Sec. 412. Refunds; penalties; collection.
2967+13 (1)(a) Whenever it appears to the satisfaction of the
2968+14 Director that because of some mistake of fact, error in
2969+15 calculation, or erroneous interpretation of a statute of this
2970+16 or any other state, any authorized company, surplus line
2971+17 producer, or industrial insured has paid to him, pursuant to
2972+18 any provision of law, taxes, fees, or other charges in excess
2973+19 of the amount legally chargeable against it, during the 6-year
2974+20 6 year period immediately preceding the discovery of such
2975+21 overpayment, he shall have power to refund to such company,
2976+22 surplus line producer, or industrial insured the amount of the
2977+23 excess or excesses by applying the amount or amounts thereof
2978+24 toward the payment of taxes, fees, or other charges already
2979+25 due, or which may thereafter become due from that company
2980+
2981+
2982+
2983+
2984+
2985+ HB5493 Enrolled - 84 - LRB103 39189 RPS 69335 b
2986+
2987+
2988+HB5493 Enrolled- 85 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 85 - LRB103 39189 RPS 69335 b
2989+ HB5493 Enrolled - 85 - LRB103 39189 RPS 69335 b
2990+1 until such excess or excesses have been fully refunded, or
2991+2 upon a written request from the authorized company, surplus
2992+3 line producer, or industrial insured, the Director shall
2993+4 provide a cash refund within 120 days after receipt of the
2994+5 written request if all necessary information has been filed
2995+6 with the Department in order for it to perform an audit of the
2996+7 tax report for the transaction or period or annual return for
2997+8 the year in which the overpayment occurred or within 120 days
2998+9 after the date the Department receives all the necessary
2999+10 information to perform such audit. The Director shall not
3000+11 provide a cash refund if there are insufficient funds in the
3001+12 Insurance Premium Tax Refund Fund to provide a cash refund, if
3002+13 the amount of the overpayment is less than $100, or if the
3003+14 amount of the overpayment can be fully offset against the
3004+15 taxpayer's estimated liability for the year following the year
3005+16 of the cash refund request. Any cash refund shall be paid from
3006+17 the Insurance Premium Tax Refund Fund, a special fund hereby
3007+18 created in the State treasury.
3008+19 (b) As determined by the Director pursuant to paragraph
3009+20 (a) of this subsection, the Department shall deposit an amount
3010+21 of cash refunds approved by the Director for payment as a
3011+22 result of overpayment of tax liability collected under
3012+23 Sections 121-2.08, 409, 444, 444.1, and 445 of this Code into
3013+24 the Insurance Premium Tax Refund Fund.
3014+25 (c) Beginning July 1, 1999, moneys in the Insurance
3015+26 Premium Tax Refund Fund shall be expended exclusively for the
3016+
3017+
3018+
3019+
3020+
3021+ HB5493 Enrolled - 85 - LRB103 39189 RPS 69335 b
3022+
3023+
3024+HB5493 Enrolled- 86 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 86 - LRB103 39189 RPS 69335 b
3025+ HB5493 Enrolled - 86 - LRB103 39189 RPS 69335 b
3026+1 purpose of paying cash refunds resulting from overpayment of
3027+2 tax liability under Sections 121-2.08, 409, 444, 444.1, and
3028+3 445 of this Code as determined by the Director pursuant to
3029+4 subsection 1(a) of this Section. Cash refunds made in
3030+5 accordance with this Section may be made from the Insurance
3031+6 Premium Tax Refund Fund only to the extent that amounts have
3032+7 been deposited and retained in the Insurance Premium Tax
3033+8 Refund Fund.
3034+9 (d) This Section shall constitute an irrevocable and
3035+10 continuing appropriation from the Insurance Premium Tax Refund
3036+11 Fund for the purpose of paying cash refunds pursuant to the
3037+12 provisions of this Section.
3038+13 (2)(a) When any insurance company fails to file any tax
3039+14 return required under Sections 408.1, 409, 444, and 444.1 of
3040+15 this Code or Section 12 of the Fire Investigation Act on the
3041+16 date prescribed, including any extensions, there shall be
3042+17 added as a penalty $400 or 10% of the amount of such tax,
3043+18 whichever is greater, for each month or part of a month of
3044+19 failure to file, the entire penalty not to exceed $2,000 or 50%
3045+20 of the tax due, whichever is greater. In this paragraph, "tax
3046+21 due" means the full amount due for the applicable tax period
3047+22 under Section 408.1, 409, 444, or 444.1 of this Code or Section
3048+23 12 of the Fire Investigation Act.
3049+24 (b) When any industrial insured or surplus line producer
3050+25 fails to file any tax return or report required under Sections
3051+26 121-2.08 and 445 of this Code or Section 12 of the Fire
3052+
3053+
3054+
3055+
3056+
3057+ HB5493 Enrolled - 86 - LRB103 39189 RPS 69335 b
3058+
3059+
3060+HB5493 Enrolled- 87 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 87 - LRB103 39189 RPS 69335 b
3061+ HB5493 Enrolled - 87 - LRB103 39189 RPS 69335 b
3062+1 Investigation Act on the date prescribed, including any
3063+2 extensions, there shall be added:
3064+3 (i) as a late fee, if the return or report is received
3065+4 at least one day but not more than 15 days after the
3066+5 prescribed due date, $50 or 5% of the tax due, whichever is
3067+6 greater, the entire fee not to exceed $1,000;
3068+7 (ii) as a late fee, if the return or report is received
3069+8 at least 16 days but not more than 30 days after the
3070+9 prescribed due date, $100 or 5% of the tax due, whichever
3071+10 is greater, the entire fee not to exceed $2,000; or
3072+11 (iii) as a penalty, if the return or report is
3073+12 received more than 30 days after the prescribed due date,
3074+13 $100 or 5% of the tax due, whichever is greater, for each
3075+14 month or part of a month of failure to file, the entire
3076+15 penalty not to exceed $500 or 30% of the tax due, whichever
3077+16 is greater.
3078+17 In this paragraph, "tax due" means the full amount due for
3079+18 the applicable tax period under Section 121-2.08 or 445 of
3080+19 this Code or Section 12 of the Fire Investigation Act. A tax
3081+20 return or report shall be deemed received as of the date mailed
3082+21 as evidenced by a postmark, proof of mailing on a recognized
3083+22 United States Postal Service form or a form acceptable to the
3084+23 United States Postal Service or other commercial mail delivery
3085+24 service, or other evidence acceptable to the Director.
3086+25 (3)(a) When any insurance company fails to pay the full
3087+26 amount due under the provisions of this Section, Sections
3088+
3089+
3090+
3091+
3092+
3093+ HB5493 Enrolled - 87 - LRB103 39189 RPS 69335 b
3094+
3095+
3096+HB5493 Enrolled- 88 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 88 - LRB103 39189 RPS 69335 b
3097+ HB5493 Enrolled - 88 - LRB103 39189 RPS 69335 b
3098+1 408.1, 409, 444, or 444.1 of this Code, or Section 12 of the
3099+2 Fire Investigation Act, there shall be added to the amount due
3100+3 as a penalty an amount equal to 10% of the deficiency.
3101+4 (a-5) When any industrial insured or surplus line producer
3102+5 fails to pay the full amount due under the provisions of this
3103+6 Section, Sections 121-2.08 or 445 of this Code, or Section 12
3104+7 of the Fire Investigation Act on the date prescribed, there
3105+8 shall be added:
3106+9 (i) as a late fee, if the payment is received at least
3107+10 one day but not more than 7 days after the prescribed due
3108+11 date, 10% of the tax due, the entire fee not to exceed
3109+12 $1,000;
3110+13 (ii) as a late fee, if the payment is received at least
3111+14 8 days but not more than 14 days after the prescribed due
3112+15 date, 10% of the tax due, the entire fee not to exceed
3113+16 $1,500;
3114+17 (iii) as a late fee, if the payment is received at
3115+18 least 15 days but not more than 21 days after the
3116+19 prescribed due date, 10% of the tax due, the entire fee not
3117+20 to exceed $2,000; or
3118+21 (iv) as a penalty, if the return or report is received
3119+22 more than 21 days after the prescribed due date, 10% of the
3120+23 tax due.
3121+24 In this paragraph, "tax due" means the full amount due for
3122+25 the applicable tax period under this Section, Section 121-2.08
3123+26 or 445 of this Code, or Section 12 of the Fire Investigation
3124+
3125+
3126+
3127+
3128+
3129+ HB5493 Enrolled - 88 - LRB103 39189 RPS 69335 b
3130+
3131+
3132+HB5493 Enrolled- 89 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 89 - LRB103 39189 RPS 69335 b
3133+ HB5493 Enrolled - 89 - LRB103 39189 RPS 69335 b
3134+1 Act. A tax payment shall be deemed received as of the date
3135+2 mailed as evidenced by a postmark, proof of mailing on a
3136+3 recognized United States Postal Service form or a form
3137+4 acceptable to the United States Postal Service or other
3138+5 commercial mail delivery service, or other evidence acceptable
3139+6 to the Director.
3140+7 (b) If such failure to pay is determined by the Director to
3141+8 be willful wilful, after a hearing under Sections 402 and 403,
3142+9 there shall be added to the tax as a penalty an amount equal to
3143+10 the greater of 50% of the deficiency or 10% of the amount due
3144+11 and unpaid for each month or part of a month that the
3145+12 deficiency remains unpaid commencing with the date that the
3146+13 amount becomes due. Such amount shall be in lieu of any
3147+14 determined under paragraph (a) or (a-5).
3148+15 (4) Any insurance company, industrial insured, or surplus
3149+16 line producer that fails to pay the full amount due under this
3150+17 Section or Sections 121-2.08, 408.1, 409, 444, 444.1, or 445
3151+18 of this Code, or Section 12 of the Fire Investigation Act is
3152+19 liable, in addition to the tax and any late fees and penalties,
3153+20 for interest on such deficiency at the rate of 12% per annum,
3154+21 or at such higher adjusted rates as are or may be established
3155+22 under subsection (b) of Section 6621 of the Internal Revenue
3156+23 Code, from the date that payment of any such tax was due,
3157+24 determined without regard to any extensions, to the date of
3158+25 payment of such amount.
3159+26 (5) The Director, through the Attorney General, may
3160+
3161+
3162+
3163+
3164+
3165+ HB5493 Enrolled - 89 - LRB103 39189 RPS 69335 b
3166+
3167+
3168+HB5493 Enrolled- 90 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 90 - LRB103 39189 RPS 69335 b
3169+ HB5493 Enrolled - 90 - LRB103 39189 RPS 69335 b
3170+1 institute an action in the name of the People of the State of
3171+2 Illinois, in any court of competent jurisdiction, for the
3172+3 recovery of the amount of such taxes, fees, and penalties due,
3173+4 and prosecute the same to final judgment, and take such steps
3174+5 as are necessary to collect the same.
3175+6 (6) In the event that the certificate of authority of a
3176+7 foreign or alien company is revoked for any cause or the
3177+8 company withdraws from this State prior to the renewal date of
3178+9 the certificate of authority as provided in Section 114, the
3179+10 company may recover the amount of any such tax paid in advance.
3180+11 Except as provided in this subsection, no revocation or
3181+12 withdrawal excuses payment of or constitutes grounds for the
3182+13 recovery of any taxes or penalties imposed by this Code.
3183+14 (7) When an insurance company or domestic affiliated group
3184+15 fails to pay the full amount of any fee of $200 or more due
3185+16 under Section 408 of this Code, there shall be added to the
3186+17 amount due as a penalty the greater of $100 or an amount equal
3187+18 to 10% of the deficiency for each month or part of a month that
3188+19 the deficiency remains unpaid.
3189+20 (8) The Department shall have a lien for the taxes, fees,
3190+21 charges, fines, penalties, interest, other charges, or any
3191+22 portion thereof, imposed or assessed pursuant to this Code,
3192+23 upon all the real and personal property of any company or
3193+24 person to whom the assessment or final order has been issued or
3194+25 whenever a tax return is filed without payment of the tax or
3195+26 penalty shown therein to be due, including all such property
3196+
3197+
3198+
3199+
3200+
3201+ HB5493 Enrolled - 90 - LRB103 39189 RPS 69335 b
3202+
3203+
3204+HB5493 Enrolled- 91 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 91 - LRB103 39189 RPS 69335 b
3205+ HB5493 Enrolled - 91 - LRB103 39189 RPS 69335 b
3206+1 of the company or person acquired after receipt of the
3207+2 assessment, issuance of the order, or filing of the return.
3208+3 The company or person is liable for the filing fee incurred by
3209+4 the Department for filing the lien and the filing fee incurred
3210+5 by the Department to file the release of that lien. The filing
3211+6 fees shall be paid to the Department in addition to payment of
3212+7 the tax, fee, charge, fine, penalty, interest, other charges,
3213+8 or any portion thereof, included in the amount of the lien.
3214+9 However, where the lien arises because of the issuance of a
3215+10 final order of the Director or tax assessment by the
3216+11 Department, the lien shall not attach and the notice referred
3217+12 to in this Section shall not be filed until all administrative
3218+13 proceedings or proceedings in court for review of the final
3219+14 order or assessment have terminated or the time for the taking
3220+15 thereof has expired without such proceedings being instituted.
3221+16 Upon the granting of Department review after a lien has
3222+17 attached, the lien shall remain in full force except to the
3223+18 extent to which the final assessment may be reduced by a
3224+19 revised final assessment following the rehearing or review.
3225+20 The lien created by the issuance of a final assessment shall
3226+21 terminate, unless a notice of lien is filed, within 3 years
3227+22 after the date all proceedings in court for the review of the
3228+23 final assessment have terminated or the time for the taking
3229+24 thereof has expired without such proceedings being instituted,
3230+25 or (in the case of a revised final assessment issued pursuant
3231+26 to a rehearing or review by the Department) within 3 years
3232+
3233+
3234+
3235+
3236+
3237+ HB5493 Enrolled - 91 - LRB103 39189 RPS 69335 b
3238+
3239+
3240+HB5493 Enrolled- 92 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 92 - LRB103 39189 RPS 69335 b
3241+ HB5493 Enrolled - 92 - LRB103 39189 RPS 69335 b
3242+1 after the date all proceedings in court for the review of such
3243+2 revised final assessment have terminated or the time for the
3244+3 taking thereof has expired without such proceedings being
3245+4 instituted. Where the lien results from the filing of a tax
3246+5 return without payment of the tax or penalty shown therein to
3247+6 be due, the lien shall terminate, unless a notice of lien is
3248+7 filed, within 3 years after the date when the return is filed
3249+8 with the Department.
3250+9 The time limitation period on the Department's right to
3251+10 file a notice of lien shall not run during any period of time
3252+11 in which the order of any court has the effect of enjoining or
3253+12 restraining the Department from filing such notice of lien. If
3254+13 the Department finds that a company or person is about to
3255+14 depart from the State, to conceal himself or his property, or
3256+15 to do any other act tending to prejudice or to render wholly or
3257+16 partly ineffectual proceedings to collect the amount due and
3258+17 owing to the Department unless such proceedings are brought
3259+18 without delay, or if the Department finds that the collection
3260+19 of the amount due from any company or person will be
3261+20 jeopardized by delay, the Department shall give the company or
3262+21 person notice of such findings and shall make demand for
3263+22 immediate return and payment of the amount, whereupon the
3264+23 amount shall become immediately due and payable. If the
3265+24 company or person, within 5 days after the notice (or within
3266+25 such extension of time as the Department may grant), does not
3267+26 comply with the notice or show to the Department that the
3268+
3269+
3270+
3271+
3272+
3273+ HB5493 Enrolled - 92 - LRB103 39189 RPS 69335 b
3274+
3275+
3276+HB5493 Enrolled- 93 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 93 - LRB103 39189 RPS 69335 b
3277+ HB5493 Enrolled - 93 - LRB103 39189 RPS 69335 b
3278+1 findings in the notice are erroneous, the Department may file
3279+2 a notice of jeopardy assessment lien in the office of the
3280+3 recorder of the county in which any property of the company or
3281+4 person may be located and shall notify the company or person of
3282+5 the filing. The jeopardy assessment lien shall have the same
3283+6 scope and effect as the statutory lien provided for in this
3284+7 Section. If the company or person believes that the company or
3285+8 person does not owe some or all of the tax for which the
3286+9 jeopardy assessment lien against the company or person has
3287+10 been filed, or that no jeopardy to the revenue in fact exists,
3288+11 the company or person may protest within 20 days after being
3289+12 notified by the Department of the filing of the jeopardy
3290+13 assessment lien and request a hearing, whereupon the
3291+14 Department shall hold a hearing in conformity with the
3292+15 provisions of this Code and, pursuant thereto, shall notify
3293+16 the company or person of its findings as to whether or not the
3294+17 jeopardy assessment lien will be released. If not, and if the
3295+18 company or person is aggrieved by this decision, the company
3296+19 or person may file an action for judicial review of the final
3297+20 determination of the Department in accordance with the
3298+21 Administrative Review Law. If, pursuant to such hearing (or
3299+22 after an independent determination of the facts by the
3300+23 Department without a hearing), the Department determines that
3301+24 some or all of the amount due covered by the jeopardy
3302+25 assessment lien is not owed by the company or person, or that
3303+26 no jeopardy to the revenue exists, or if on judicial review the
3304+
3305+
3306+
3307+
3308+
3309+ HB5493 Enrolled - 93 - LRB103 39189 RPS 69335 b
3310+
3311+
3312+HB5493 Enrolled- 94 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 94 - LRB103 39189 RPS 69335 b
3313+ HB5493 Enrolled - 94 - LRB103 39189 RPS 69335 b
3314+1 final judgment of the court is that the company or person does
3315+2 not owe some or all of the amount due covered by the jeopardy
3316+3 assessment lien against them, or that no jeopardy to the
3317+4 revenue exists, the Department shall release its jeopardy
3318+5 assessment lien to the extent of such finding of nonliability
3319+6 for the amount, or to the extent of such finding of no jeopardy
3320+7 to the revenue. The Department shall also release its jeopardy
3321+8 assessment lien against the company or person whenever the
3322+9 amount due and owing covered by the lien, plus any interest
3323+10 which may be due, are paid and the company or person has paid
3324+11 the Department in cash or by guaranteed remittance an amount
3325+12 representing the filing fee for the lien and the filing fee for
3326+13 the release of that lien. The Department shall file that
3327+14 release of lien with the recorder of the county where that lien
3328+15 was filed.
3329+16 Nothing in this Section shall be construed to give the
3330+17 Department a preference over the rights of any bona fide
3331+18 purchaser, holder of a security interest, mechanics
3332+19 lienholder, mortgagee, or judgment lien creditor arising prior
3333+20 to the filing of a regular notice of lien or a notice of
3334+21 jeopardy assessment lien in the office of the recorder in the
3335+22 county in which the property subject to the lien is located.
3336+23 For purposes of this Section, "bona fide" shall not include
3337+24 any mortgage of real or personal property or any other credit
3338+25 transaction that results in the mortgagee or the holder of the
3339+26 security acting as trustee for unsecured creditors of the
3340+
3341+
3342+
3343+
3344+
3345+ HB5493 Enrolled - 94 - LRB103 39189 RPS 69335 b
3346+
3347+
3348+HB5493 Enrolled- 95 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 95 - LRB103 39189 RPS 69335 b
3349+ HB5493 Enrolled - 95 - LRB103 39189 RPS 69335 b
3350+1 company or person mentioned in the notice of lien who executed
3351+2 such chattel or real property mortgage or the document
3352+3 evidencing such credit transaction. The lien shall be inferior
3353+4 to the lien of general taxes, special assessments, and special
3354+5 taxes levied by any political subdivision of this State. In
3355+6 case title to land to be affected by the notice of lien or
3356+7 notice of jeopardy assessment lien is registered under the
3357+8 provisions of the Registered Titles (Torrens) Act, such notice
3358+9 shall be filed in the office of the Registrar of Titles of the
3359+10 county within which the property subject to the lien is
3360+11 situated and shall be entered upon the register of titles as a
3361+12 memorial or charge upon each folium of the register of titles
3362+13 affected by such notice, and the Department shall not have a
3363+14 preference over the rights of any bona fide purchaser,
3364+15 mortgagee, judgment creditor, or other lienholder arising
3365+16 prior to the registration of such notice. The regular lien or
3366+17 jeopardy assessment lien shall not be effective against any
3367+18 purchaser with respect to any item in a retailer's stock in
3368+19 trade purchased from the retailer in the usual course of the
3369+20 retailer's business.
3370+21 (Source: P.A. 102-775, eff. 5-13-22; 103-426, eff. 8-4-23.)
3371+22 (215 ILCS 5/531.03) (from Ch. 73, par. 1065.80-3)
3372+23 Sec. 531.03. Coverage and limitations.
3373+24 (1) This Article shall provide coverage for the policies
3374+25 and contracts specified in subsection (2) of this Section:
3375+
3376+
3377+
3378+
3379+
3380+ HB5493 Enrolled - 95 - LRB103 39189 RPS 69335 b
3381+
3382+
3383+HB5493 Enrolled- 96 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 96 - LRB103 39189 RPS 69335 b
3384+ HB5493 Enrolled - 96 - LRB103 39189 RPS 69335 b
3385+1 (a) to persons who, regardless of where they reside
3386+2 (except for non-resident certificate holders under group
3387+3 policies or contracts), are the beneficiaries, assignees
3388+4 or payees, including health care providers rendering
3389+5 services covered under a health insurance policy or
3390+6 certificate, of the persons covered under paragraph (b) of
3391+7 this subsection, and
3392+8 (b) to persons who are owners of or certificate
3393+9 holders or enrollees under the policies or contracts
3394+10 (other than unallocated annuity contracts and structured
3395+11 settlement annuities) and in each case who:
3396+12 (i) are residents; or
3397+13 (ii) are not residents, but only under all of the
3398+14 following conditions:
3399+15 (A) the member insurer that issued the
3400+16 policies or contracts is domiciled in this State;
3401+17 (B) the states in which the persons reside
3402+18 have associations similar to the Association
3403+19 created by this Article;
3404+20 (C) the persons are not eligible for coverage
3405+21 by an association in any other state due to the
3406+22 fact that the insurer or health maintenance
3407+23 organization was not licensed in that state at the
3408+24 time specified in that state's guaranty
3409+25 association law.
3410+26 (c) For unallocated annuity contracts specified in
3411+
3412+
3413+
3414+
3415+
3416+ HB5493 Enrolled - 96 - LRB103 39189 RPS 69335 b
3417+
3418+
3419+HB5493 Enrolled- 97 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 97 - LRB103 39189 RPS 69335 b
3420+ HB5493 Enrolled - 97 - LRB103 39189 RPS 69335 b
3421+1 subsection (2), paragraphs (a) and (b) of this subsection
3422+2 (1) shall not apply and this Article shall (except as
3423+3 provided in paragraphs (e) and (f) of this subsection)
3424+4 provide coverage to:
3425+5 (i) persons who are the owners of the unallocated
3426+6 annuity contracts if the contracts are issued to or in
3427+7 connection with a specific benefit plan whose plan
3428+8 sponsor has its principal place of business in this
3429+9 State; and
3430+10 (ii) persons who are owners of unallocated annuity
3431+11 contracts issued to or in connection with government
3432+12 lotteries if the owners are residents.
3433+13 (d) For structured settlement annuities specified in
3434+14 subsection (2), paragraphs (a) and (b) of this subsection
3435+15 (1) shall not apply and this Article shall (except as
3436+16 provided in paragraphs (e) and (f) of this subsection)
3437+17 provide coverage to a person who is a payee under a
3438+18 structured settlement annuity (or beneficiary of a payee
3439+19 if the payee is deceased), if the payee:
3440+20 (i) is a resident, regardless of where the
3441+21 contract owner resides; or
3442+22 (ii) is not a resident, but only under both of the
3443+23 following conditions:
3444+24 (A) with regard to residency:
3445+25 (I) the contract owner of the structured
3446+26 settlement annuity is a resident; or
3447+
3448+
3449+
3450+
3451+
3452+ HB5493 Enrolled - 97 - LRB103 39189 RPS 69335 b
3453+
3454+
3455+HB5493 Enrolled- 98 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 98 - LRB103 39189 RPS 69335 b
3456+ HB5493 Enrolled - 98 - LRB103 39189 RPS 69335 b
3457+1 (II) the contract owner of the structured
3458+2 settlement annuity is not a resident but the
3459+3 insurer that issued the structured settlement
3460+4 annuity is domiciled in this State and the
3461+5 state in which the contract owner resides has
3462+6 an association similar to the Association
3463+7 created by this Article; and
3464+8 (B) neither the payee or beneficiary nor the
3465+9 contract owner is eligible for coverage by the
3466+10 association of the state in which the payee or
3467+11 contract owner resides.
3468+12 (e) This Article shall not provide coverage to:
3469+13 (i) a person who is a payee or beneficiary of a
3470+14 contract owner resident of this State if the payee or
3471+15 beneficiary is afforded any coverage by the
3472+16 association of another state; or
3473+17 (ii) a person covered under paragraph (c) of this
3474+18 subsection (1), if any coverage is provided by the
3475+19 association of another state to that person.
3476+20 (f) This Article is intended to provide coverage to a
3477+21 person who is a resident of this State and, in special
3478+22 circumstances, to a nonresident. In order to avoid
3479+23 duplicate coverage, if a person who would otherwise
3480+24 receive coverage under this Article is provided coverage
3481+25 under the laws of any other state, then the person shall
3482+26 not be provided coverage under this Article. In
3483+
3484+
3485+
3486+
3487+
3488+ HB5493 Enrolled - 98 - LRB103 39189 RPS 69335 b
3489+
3490+
3491+HB5493 Enrolled- 99 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 99 - LRB103 39189 RPS 69335 b
3492+ HB5493 Enrolled - 99 - LRB103 39189 RPS 69335 b
3493+1 determining the application of the provisions of this
3494+2 paragraph in situations where a person could be covered by
3495+3 the association of more than one state, whether as an
3496+4 owner, payee, enrollee, beneficiary, or assignee, this
3497+5 Article shall be construed in conjunction with other state
3498+6 laws to result in coverage by only one association.
3499+7 (2)(a) This Article shall provide coverage to the persons
3500+8 specified in subsection (1) of this Section for policies or
3501+9 contracts of direct, (i) nongroup life insurance, health
3502+10 insurance (that, for the purposes of this Article, includes
3503+11 health maintenance organization subscriber contracts and
3504+12 certificates), annuities and supplemental contracts to any of
3505+13 these, (ii) for certificates under direct group policies or
3506+14 contracts, (iii) for unallocated annuity contracts and (iv)
3507+15 for contracts to furnish health care services and subscription
3508+16 certificates for medical or health care services issued by
3509+17 persons licensed to transact insurance business in this State
3510+18 under this Code. Annuity contracts and certificates under
3511+19 group annuity contracts include but are not limited to
3512+20 guaranteed investment contracts, deposit administration
3513+21 contracts, unallocated funding agreements, allocated funding
3514+22 agreements, structured settlement agreements, lottery
3515+23 contracts and any immediate or deferred annuity contracts.
3516+24 (b) Except as otherwise provided in paragraph (c) of this
3517+25 subsection, this Article shall not provide coverage for:
3518+26 (i) that portion of a policy or contract not
3519+
3520+
3521+
3522+
3523+
3524+ HB5493 Enrolled - 99 - LRB103 39189 RPS 69335 b
3525+
3526+
3527+HB5493 Enrolled- 100 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 100 - LRB103 39189 RPS 69335 b
3528+ HB5493 Enrolled - 100 - LRB103 39189 RPS 69335 b
3529+1 guaranteed by the member insurer, or under which the risk
3530+2 is borne by the policy or contract owner;
3531+3 (ii) any such policy or contract or part thereof
3532+4 assumed by the impaired or insolvent insurer under a
3533+5 contract of reinsurance, other than reinsurance for which
3534+6 assumption certificates have been issued;
3535+7 (iii) any portion of a policy or contract to the
3536+8 extent that the rate of interest on which it is based or
3537+9 the interest rate, crediting rate, or similar factor is
3538+10 determined by use of an index or other external reference
3539+11 stated in the policy or contract employed in calculating
3540+12 returns or changes in value:
3541+13 (A) averaged over the period of 4 years prior to
3542+14 the date on which the member insurer becomes an
3543+15 impaired or insolvent insurer under this Article,
3544+16 whichever is earlier, exceeds the rate of interest
3545+17 determined by subtracting 2 percentage points from
3546+18 Moody's Corporate Bond Yield Average averaged for that
3547+19 same 4-year period or for such lesser period if the
3548+20 policy or contract was issued less than 4 years before
3549+21 the member insurer becomes an impaired or insolvent
3550+22 insurer under this Article, whichever is earlier; and
3551+23 (B) on and after the date on which the member
3552+24 insurer becomes an impaired or insolvent insurer under
3553+25 this Article, whichever is earlier, exceeds the rate
3554+26 of interest determined by subtracting 3 percentage
3555+
3556+
3557+
3558+
3559+
3560+ HB5493 Enrolled - 100 - LRB103 39189 RPS 69335 b
3561+
3562+
3563+HB5493 Enrolled- 101 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 101 - LRB103 39189 RPS 69335 b
3564+ HB5493 Enrolled - 101 - LRB103 39189 RPS 69335 b
3565+1 points from Moody's Corporate Bond Yield Average as
3566+2 most recently available;
3567+3 (iv) any unallocated annuity contract issued to or in
3568+4 connection with a benefit plan protected under the federal
3569+5 Pension Benefit Guaranty Corporation, regardless of
3570+6 whether the federal Pension Benefit Guaranty Corporation
3571+7 has yet become liable to make any payments with respect to
3572+8 the benefit plan;
3573+9 (v) any portion of any unallocated annuity contract
3574+10 which is not issued to or in connection with a specific
3575+11 employee, union or association of natural persons benefit
3576+12 plan or a government lottery;
3577+13 (vi) an obligation that does not arise under the
3578+14 express written terms of the policy or contract issued by
3579+15 the member insurer to the enrollee, certificate holder,
3580+16 contract owner, or policy owner, including without
3581+17 limitation:
3582+18 (A) a claim based on marketing materials;
3583+19 (B) a claim based on side letters, riders, or
3584+20 other documents that were issued by the member insurer
3585+21 without meeting applicable policy or contract form
3586+22 filing or approval requirements;
3587+23 (C) a misrepresentation of or regarding policy or
3588+24 contract benefits;
3589+25 (D) an extra-contractual claim; or
3590+26 (E) a claim for penalties or consequential or
3591+
3592+
3593+
3594+
3595+
3596+ HB5493 Enrolled - 101 - LRB103 39189 RPS 69335 b
3597+
3598+
3599+HB5493 Enrolled- 102 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 102 - LRB103 39189 RPS 69335 b
3600+ HB5493 Enrolled - 102 - LRB103 39189 RPS 69335 b
3601+1 incidental damages;
3602+2 (vii) any stop-loss insurance, as defined in clause
3603+3 (b) of Class 1 or clause (a) of Class 2 of Section 4, and
3604+4 further defined in subsection (d) of Section 352;
3605+5 (viii) any policy or contract providing any hospital,
3606+6 medical, prescription drug, or other health care benefits
3607+7 pursuant to Part C or Part D of Subchapter XVIII, Chapter 7
3608+8 of Title 42 of the United States Code (commonly known as
3609+9 Medicare Part C & D), Subchapter XIX, Chapter 7 of Title 42
3610+10 of the United States Code (commonly known as Medicaid), or
3611+11 any regulations issued pursuant thereto;
3612+12 (ix) any portion of a policy or contract to the extent
3613+13 that the assessments required by Section 531.09 of this
3614+14 Code with respect to the policy or contract are preempted
3615+15 or otherwise not permitted by federal or State law;
3616+16 (x) any portion of a policy or contract issued to a
3617+17 plan or program of an employer, association, or other
3618+18 person to provide life, health, or annuity benefits to its
3619+19 employees, members, or others to the extent that the plan
3620+20 or program is self-funded or uninsured, including, but not
3621+21 limited to, benefits payable by an employer, association,
3622+22 or other person under:
3623+23 (A) a multiple employer welfare arrangement as
3624+24 defined in 29 U.S.C. Section 1002;
3625+25 (B) a minimum premium group insurance plan;
3626+26 (C) a stop-loss group insurance plan; or
3627+
3628+
3629+
3630+
3631+
3632+ HB5493 Enrolled - 102 - LRB103 39189 RPS 69335 b
3633+
3634+
3635+HB5493 Enrolled- 103 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 103 - LRB103 39189 RPS 69335 b
3636+ HB5493 Enrolled - 103 - LRB103 39189 RPS 69335 b
3637+1 (D) an administrative services only contract;
3638+2 (xi) any portion of a policy or contract to the extent
3639+3 that it provides for:
3640+4 (A) dividends or experience rating credits;
3641+5 (B) voting rights; or
3642+6 (C) payment of any fees or allowances to any
3643+7 person, including the policy or contract owner, in
3644+8 connection with the service to or administration of
3645+9 the policy or contract;
3646+10 (xii) any policy or contract issued in this State by a
3647+11 member insurer at a time when it was not licensed or did
3648+12 not have a certificate of authority to issue the policy or
3649+13 contract in this State;
3650+14 (xiii) any contractual agreement that establishes the
3651+15 member insurer's obligations to provide a book value
3652+16 accounting guaranty for defined contribution benefit plan
3653+17 participants by reference to a portfolio of assets that is
3654+18 owned by the benefit plan or its trustee, which in each
3655+19 case is not an affiliate of the member insurer;
3656+20 (xiv) any portion of a policy or contract to the
3657+21 extent that it provides for interest or other changes in
3658+22 value to be determined by the use of an index or other
3659+23 external reference stated in the policy or contract, but
3660+24 which have not been credited to the policy or contract, or
3661+25 as to which the policy or contract owner's rights are
3662+26 subject to forfeiture, as of the date the member insurer
3663+
3664+
3665+
3666+
3667+
3668+ HB5493 Enrolled - 103 - LRB103 39189 RPS 69335 b
3669+
3670+
3671+HB5493 Enrolled- 104 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 104 - LRB103 39189 RPS 69335 b
3672+ HB5493 Enrolled - 104 - LRB103 39189 RPS 69335 b
3673+1 becomes an impaired or insolvent insurer under this Code,
3674+2 whichever is earlier. If a policy's or contract's interest
3675+3 or changes in value are credited less frequently than
3676+4 annually, then for purposes of determining the values that
3677+5 have been credited and are not subject to forfeiture under
3678+6 this Section, the interest or change in value determined
3679+7 by using the procedures defined in the policy or contract
3680+8 will be credited as if the contractual date of crediting
3681+9 interest or changing values was the date of impairment or
3682+10 insolvency, whichever is earlier, and will not be subject
3683+11 to forfeiture; or
3684+12 (xv) that portion or part of a variable life insurance
3685+13 or variable annuity contract not guaranteed by a member
3686+14 insurer.
3687+15 (c) The exclusion from coverage referenced in subdivision
3688+16 (iii) of paragraph (b) of this subsection shall not apply to
3689+17 any portion of a policy or contract, including a rider, that
3690+18 provides long-term care or other health insurance benefits.
3691+19 (3) The benefits for which the Association may become
3692+20 liable shall in no event exceed the lesser of:
3693+21 (a) the contractual obligations for which the member
3694+22 insurer is liable or would have been liable if it were not
3695+23 an impaired or insolvent insurer, or
3696+24 (b)(i) with respect to any one life, regardless of the
3697+25 number of policies or contracts:
3698+26 (A) $300,000 in life insurance death benefits, but
3699+
3700+
3701+
3702+
3703+
3704+ HB5493 Enrolled - 104 - LRB103 39189 RPS 69335 b
3705+
3706+
3707+HB5493 Enrolled- 105 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 105 - LRB103 39189 RPS 69335 b
3708+ HB5493 Enrolled - 105 - LRB103 39189 RPS 69335 b
3709+1 not more than $100,000 in net cash surrender and net
3710+2 cash withdrawal values for life insurance;
3711+3 (B) for health insurance benefits:
3712+4 (I) $100,000 for coverages not defined as
3713+5 disability income insurance or health benefit
3714+6 plans or long-term care insurance, including any
3715+7 net cash surrender and net cash withdrawal values;
3716+8 (II) $300,000 for disability income insurance
3717+9 and $300,000 for long-term care insurance; and
3718+10 (III) $500,000 for health benefit plans;
3719+11 (C) $250,000 in the present value of annuity
3720+12 benefits, including net cash surrender and net cash
3721+13 withdrawal values;
3722+14 (ii) with respect to each individual participating in
3723+15 a governmental retirement benefit plan established under
3724+16 Section 401, 403(b), or 457 of the U.S. Internal Revenue
3725+17 Code covered by an unallocated annuity contract or the
3726+18 beneficiaries of each such individual if deceased, in the
3727+19 aggregate, $250,000 in present value annuity benefits,
3728+20 including net cash surrender and net cash withdrawal
3729+21 values;
3730+22 (iii) with respect to each payee of a structured
3731+23 settlement annuity or beneficiary or beneficiaries of the
3732+24 payee if deceased, $250,000 in present value annuity
3733+25 benefits, in the aggregate, including net cash surrender
3734+26 and net cash withdrawal values, if any; or
3735+
3736+
3737+
3738+
3739+
3740+ HB5493 Enrolled - 105 - LRB103 39189 RPS 69335 b
3741+
3742+
3743+HB5493 Enrolled- 106 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 106 - LRB103 39189 RPS 69335 b
3744+ HB5493 Enrolled - 106 - LRB103 39189 RPS 69335 b
3745+1 (iv) with respect to either (1) one contract owner
3746+2 provided coverage under subparagraph (ii) of paragraph (c)
3747+3 of subsection (1) of this Section or (2) one plan sponsor
3748+4 whose plans own directly or in trust one or more
3749+5 unallocated annuity contracts not included in subparagraph
3750+6 (ii) of paragraph (b) of this subsection, $5,000,000 in
3751+7 benefits, irrespective of the number of contracts with
3752+8 respect to the contract owner or plan sponsor. However, in
3753+9 the case where one or more unallocated annuity contracts
3754+10 are covered contracts under this Article and are owned by
3755+11 a trust or other entity for the benefit of 2 or more plan
3756+12 sponsors, coverage shall be afforded by the Association if
3757+13 the largest interest in the trust or entity owning the
3758+14 contract or contracts is held by a plan sponsor whose
3759+15 principal place of business is in this State. In no event
3760+16 shall the Association be obligated to cover more than
3761+17 $5,000,000 in benefits with respect to all these
3762+18 unallocated contracts.
3763+19 In no event shall the Association be obligated to cover
3764+20 more than (1) an aggregate of $300,000 in benefits with
3765+21 respect to any one life under subparagraphs (i), (ii), and
3766+22 (iii) of this paragraph (b) except with respect to benefits
3767+23 for health benefit plans under item (B) of subparagraph (i) of
3768+24 this paragraph (b), in which case the aggregate liability of
3769+25 the Association shall not exceed $500,000 with respect to any
3770+26 one individual or (2) with respect to one owner of multiple
3771+
3772+
3773+
3774+
3775+
3776+ HB5493 Enrolled - 106 - LRB103 39189 RPS 69335 b
3777+
3778+
3779+HB5493 Enrolled- 107 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 107 - LRB103 39189 RPS 69335 b
3780+ HB5493 Enrolled - 107 - LRB103 39189 RPS 69335 b
3781+1 nongroup policies of life insurance, whether the policy or
3782+2 contract owner is an individual, firm, corporation, or other
3783+3 person and whether the persons insured are officers, managers,
3784+4 employees, or other persons, $5,000,000 in benefits,
3785+5 regardless of the number of policies and contracts held by the
3786+6 owner.
3787+7 The limitations set forth in this subsection are
3788+8 limitations on the benefits for which the Association is
3789+9 obligated before taking into account either its subrogation
3790+10 and assignment rights or the extent to which those benefits
3791+11 could be provided out of the assets of the impaired or
3792+12 insolvent insurer attributable to covered policies. The costs
3793+13 of the Association's obligations under this Article may be met
3794+14 by the use of assets attributable to covered policies or
3795+15 reimbursed to the Association pursuant to its subrogation and
3796+16 assignment rights.
3797+17 For purposes of this Article, benefits provided by a
3798+18 long-term care rider to a life insurance policy or annuity
3799+19 contract shall be considered the same type of benefits as the
3800+20 base life insurance policy or annuity contract to which it
3801+21 relates.
3802+22 (4) In performing its obligations to provide coverage
3803+23 under Section 531.08 of this Code, the Association shall not
3804+24 be required to guarantee, assume, reinsure, reissue, or
3805+25 perform or cause to be guaranteed, assumed, reinsured,
3806+26 reissued, or performed the contractual obligations of the
3807+
3808+
3809+
3810+
3811+
3812+ HB5493 Enrolled - 107 - LRB103 39189 RPS 69335 b
3813+
3814+
3815+HB5493 Enrolled- 108 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 108 - LRB103 39189 RPS 69335 b
3816+ HB5493 Enrolled - 108 - LRB103 39189 RPS 69335 b
3817+1 insolvent or impaired insurer under a covered policy or
3818+2 contract that do not materially affect the economic values or
3819+3 economic benefits of the covered policy or contract.
3820+4 (Source: P.A. 100-687, eff. 8-3-18; 100-863, eff. 8-14-18.)
3821+5 (215 ILCS 5/356z.30a rep.)
3822+6 (215 ILCS 5/362a rep.)
3823+7 Section 26. The Illinois Insurance Code is amended by
3824+8 repealing Sections 356z.30a and 362a.
3825+9 Section 30. The Network Adequacy and Transparency Act is
3826+10 amended by changing Sections 5 and 10 as follows:
3827+11 (215 ILCS 124/5)
3828+12 Sec. 5. Definitions. In this Act:
3829+13 "Authorized representative" means a person to whom a
3830+14 beneficiary has given express written consent to represent the
3831+15 beneficiary; a person authorized by law to provide substituted
3832+16 consent for a beneficiary; or the beneficiary's treating
3833+17 provider only when the beneficiary or his or her family member
3834+18 is unable to provide consent.
3835+19 "Beneficiary" means an individual, an enrollee, an
3836+20 insured, a participant, or any other person entitled to
3837+21 reimbursement for covered expenses of or the discounting of
3838+22 provider fees for health care services under a program in
3839+23 which the beneficiary has an incentive to utilize the services
3840+
3841+
3842+
3843+
3844+
3845+ HB5493 Enrolled - 108 - LRB103 39189 RPS 69335 b
3846+
3847+
3848+HB5493 Enrolled- 109 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 109 - LRB103 39189 RPS 69335 b
3849+ HB5493 Enrolled - 109 - LRB103 39189 RPS 69335 b
3850+1 of a provider that has entered into an agreement or
3851+2 arrangement with an insurer.
3852+3 "Department" means the Department of Insurance.
3853+4 "Director" means the Director of Insurance.
3854+5 "Family caregiver" means a relative, partner, friend, or
3855+6 neighbor who has a significant relationship with the patient
3856+7 and administers or assists the patient with activities of
3857+8 daily living, instrumental activities of daily living, or
3858+9 other medical or nursing tasks for the quality and welfare of
3859+10 that patient.
3860+11 "Insurer" means any entity that offers individual or group
3861+12 accident and health insurance, including, but not limited to,
3862+13 health maintenance organizations, preferred provider
3863+14 organizations, exclusive provider organizations, and other
3864+15 plan structures requiring network participation, excluding the
3865+16 medical assistance program under the Illinois Public Aid Code,
3866+17 the State employees group health insurance program, workers
3867+18 compensation insurance, and pharmacy benefit managers.
3868+19 "Material change" means a significant reduction in the
3869+20 number of providers available in a network plan, including,
3870+21 but not limited to, a reduction of 10% or more in a specific
3871+22 type of providers, the removal of a major health system that
3872+23 causes a network to be significantly different from the
3873+24 network when the beneficiary purchased the network plan, or
3874+25 any change that would cause the network to no longer satisfy
3875+26 the requirements of this Act or the Department's rules for
3876+
3877+
3878+
3879+
3880+
3881+ HB5493 Enrolled - 109 - LRB103 39189 RPS 69335 b
3882+
3883+
3884+HB5493 Enrolled- 110 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 110 - LRB103 39189 RPS 69335 b
3885+ HB5493 Enrolled - 110 - LRB103 39189 RPS 69335 b
3886+1 network adequacy and transparency.
3887+2 "Network" means the group or groups of preferred providers
3888+3 providing services to a network plan.
3889+4 "Network plan" means an individual or group policy of
3890+5 accident and health insurance that either requires a covered
3891+6 person to use or creates incentives, including financial
3892+7 incentives, for a covered person to use providers managed,
3893+8 owned, under contract with, or employed by the insurer.
3894+9 "Ongoing course of treatment" means (1) treatment for a
3895+10 life-threatening condition, which is a disease or condition
3896+11 for which likelihood of death is probable unless the course of
3897+12 the disease or condition is interrupted; (2) treatment for a
3898+13 serious acute condition, defined as a disease or condition
3899+14 requiring complex ongoing care that the covered person is
3900+15 currently receiving, such as chemotherapy, radiation therapy,
3901+16 or post-operative visits; (3) a course of treatment for a
3902+17 health condition that a treating provider attests that
3903+18 discontinuing care by that provider would worsen the condition
3904+19 or interfere with anticipated outcomes; or (4) the third
3905+20 trimester of pregnancy through the post-partum period.
3906+21 "Preferred provider" means any provider who has entered,
3907+22 either directly or indirectly, into an agreement with an
3908+23 employer or risk-bearing entity relating to health care
3909+24 services that may be rendered to beneficiaries under a network
3910+25 plan.
3911+26 "Providers" means physicians licensed to practice medicine
3912+
3913+
3914+
3915+
3916+
3917+ HB5493 Enrolled - 110 - LRB103 39189 RPS 69335 b
3918+
3919+
3920+HB5493 Enrolled- 111 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 111 - LRB103 39189 RPS 69335 b
3921+ HB5493 Enrolled - 111 - LRB103 39189 RPS 69335 b
3922+1 in all its branches, other health care professionals,
3923+2 hospitals, or other health care institutions that provide
3924+3 health care services.
3925+4 "Telehealth" has the meaning given to that term in Section
3926+5 356z.22 of the Illinois Insurance Code.
3927+6 "Telemedicine" has the meaning given to that term in
3928+7 Section 49.5 of the Medical Practice Act of 1987.
3929+8 "Tiered network" means a network that identifies and
3930+9 groups some or all types of provider and facilities into
3931+10 specific groups to which different provider reimbursement,
3932+11 covered person cost-sharing or provider access requirements,
3933+12 or any combination thereof, apply for the same services.
3934+13 "Woman's principal health care provider" means a physician
3935+14 licensed to practice medicine in all of its branches
3936+15 specializing in obstetrics, gynecology, or family practice.
3937+16 (Source: P.A. 102-92, eff. 7-9-21; 102-813, eff. 5-13-22.)
3938+17 (215 ILCS 124/10)
3939+18 Sec. 10. Network adequacy.
3940+19 (a) An insurer providing a network plan shall file a
3941+20 description of all of the following with the Director:
3942+21 (1) The written policies and procedures for adding
3943+22 providers to meet patient needs based on increases in the
3944+23 number of beneficiaries, changes in the
3945+24 patient-to-provider ratio, changes in medical and health
3946+25 care capabilities, and increased demand for services.
3947+
3948+
3949+
3950+
3951+
3952+ HB5493 Enrolled - 111 - LRB103 39189 RPS 69335 b
3953+
3954+
3955+HB5493 Enrolled- 112 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 112 - LRB103 39189 RPS 69335 b
3956+ HB5493 Enrolled - 112 - LRB103 39189 RPS 69335 b
3957+1 (2) The written policies and procedures for making
3958+2 referrals within and outside the network.
3959+3 (3) The written policies and procedures on how the
3960+4 network plan will provide 24-hour, 7-day per week access
3961+5 to network-affiliated primary care, emergency services,
3962+6 and obstetrical and gynecological health care
3963+7 professionals women's principal health care providers.
3964+8 An insurer shall not prohibit a preferred provider from
3965+9 discussing any specific or all treatment options with
3966+10 beneficiaries irrespective of the insurer's position on those
3967+11 treatment options or from advocating on behalf of
3968+12 beneficiaries within the utilization review, grievance, or
3969+13 appeals processes established by the insurer in accordance
3970+14 with any rights or remedies available under applicable State
3971+15 or federal law.
3972+16 (b) Insurers must file for review a description of the
3973+17 services to be offered through a network plan. The description
3974+18 shall include all of the following:
3975+19 (1) A geographic map of the area proposed to be served
3976+20 by the plan by county service area and zip code, including
3977+21 marked locations for preferred providers.
3978+22 (2) As deemed necessary by the Department, the names,
3979+23 addresses, phone numbers, and specialties of the providers
3980+24 who have entered into preferred provider agreements under
3981+25 the network plan.
3982+26 (3) The number of beneficiaries anticipated to be
3983+
3984+
3985+
3986+
3987+
3988+ HB5493 Enrolled - 112 - LRB103 39189 RPS 69335 b
3989+
3990+
3991+HB5493 Enrolled- 113 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 113 - LRB103 39189 RPS 69335 b
3992+ HB5493 Enrolled - 113 - LRB103 39189 RPS 69335 b
3993+1 covered by the network plan.
3994+2 (4) An Internet website and toll-free telephone number
3995+3 for beneficiaries and prospective beneficiaries to access
3996+4 current and accurate lists of preferred providers,
3997+5 additional information about the plan, as well as any
3998+6 other information required by Department rule.
3999+7 (5) A description of how health care services to be
4000+8 rendered under the network plan are reasonably accessible
4001+9 and available to beneficiaries. The description shall
4002+10 address all of the following:
4003+11 (A) the type of health care services to be
4004+12 provided by the network plan;
4005+13 (B) the ratio of physicians and other providers to
4006+14 beneficiaries, by specialty and including primary care
4007+15 physicians and facility-based physicians when
4008+16 applicable under the contract, necessary to meet the
4009+17 health care needs and service demands of the currently
4010+18 enrolled population;
4011+19 (C) the travel and distance standards for plan
4012+20 beneficiaries in county service areas; and
4013+21 (D) a description of how the use of telemedicine,
4014+22 telehealth, or mobile care services may be used to
4015+23 partially meet the network adequacy standards, if
4016+24 applicable.
4017+25 (6) A provision ensuring that whenever a beneficiary
4018+26 has made a good faith effort, as evidenced by accessing
4019+
4020+
4021+
4022+
4023+
4024+ HB5493 Enrolled - 113 - LRB103 39189 RPS 69335 b
4025+
4026+
4027+HB5493 Enrolled- 114 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 114 - LRB103 39189 RPS 69335 b
4028+ HB5493 Enrolled - 114 - LRB103 39189 RPS 69335 b
4029+1 the provider directory, calling the network plan, and
4030+2 calling the provider, to utilize preferred providers for a
4031+3 covered service and it is determined the insurer does not
4032+4 have the appropriate preferred providers due to
4033+5 insufficient number, type, unreasonable travel distance or
4034+6 delay, or preferred providers refusing to provide a
4035+7 covered service because it is contrary to the conscience
4036+8 of the preferred providers, as protected by the Health
4037+9 Care Right of Conscience Act, the insurer shall ensure,
4038+10 directly or indirectly, by terms contained in the payer
4039+11 contract, that the beneficiary will be provided the
4040+12 covered service at no greater cost to the beneficiary than
4041+13 if the service had been provided by a preferred provider.
4042+14 This paragraph (6) does not apply to: (A) a beneficiary
4043+15 who willfully chooses to access a non-preferred provider
4044+16 for health care services available through the panel of
4045+17 preferred providers, or (B) a beneficiary enrolled in a
4046+18 health maintenance organization. In these circumstances,
4047+19 the contractual requirements for non-preferred provider
4048+20 reimbursements shall apply unless Section 356z.3a of the
4049+21 Illinois Insurance Code requires otherwise. In no event
4050+22 shall a beneficiary who receives care at a participating
4051+23 health care facility be required to search for
4052+24 participating providers under the circumstances described
4053+25 in subsection (b) or (b-5) of Section 356z.3a of the
4054+26 Illinois Insurance Code except under the circumstances
4055+
4056+
4057+
4058+
4059+
4060+ HB5493 Enrolled - 114 - LRB103 39189 RPS 69335 b
4061+
4062+
4063+HB5493 Enrolled- 115 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 115 - LRB103 39189 RPS 69335 b
4064+ HB5493 Enrolled - 115 - LRB103 39189 RPS 69335 b
4065+1 described in paragraph (2) of subsection (b-5).
4066+2 (7) A provision that the beneficiary shall receive
4067+3 emergency care coverage such that payment for this
4068+4 coverage is not dependent upon whether the emergency
4069+5 services are performed by a preferred or non-preferred
4070+6 provider and the coverage shall be at the same benefit
4071+7 level as if the service or treatment had been rendered by a
4072+8 preferred provider. For purposes of this paragraph (7),
4073+9 "the same benefit level" means that the beneficiary is
4074+10 provided the covered service at no greater cost to the
4075+11 beneficiary than if the service had been provided by a
4076+12 preferred provider. This provision shall be consistent
4077+13 with Section 356z.3a of the Illinois Insurance Code.
4078+14 (8) A limitation that, if the plan provides that the
4079+15 beneficiary will incur a penalty for failing to
4080+16 pre-certify inpatient hospital treatment, the penalty may
4081+17 not exceed $1,000 per occurrence in addition to the plan
4082+18 cost-sharing cost sharing provisions.
4083+19 (c) The network plan shall demonstrate to the Director a
4084+20 minimum ratio of providers to plan beneficiaries as required
4085+21 by the Department.
4086+22 (1) The ratio of physicians or other providers to plan
4087+23 beneficiaries shall be established annually by the
4088+24 Department in consultation with the Department of Public
4089+25 Health based upon the guidance from the federal Centers
4090+26 for Medicare and Medicaid Services. The Department shall
4091+
4092+
4093+
4094+
4095+
4096+ HB5493 Enrolled - 115 - LRB103 39189 RPS 69335 b
4097+
4098+
4099+HB5493 Enrolled- 116 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 116 - LRB103 39189 RPS 69335 b
4100+ HB5493 Enrolled - 116 - LRB103 39189 RPS 69335 b
4101+1 not establish ratios for vision or dental providers who
4102+2 provide services under dental-specific or vision-specific
4103+3 benefits. The Department shall consider establishing
4104+4 ratios for the following physicians or other providers:
4105+5 (A) Primary Care;
4106+6 (B) Pediatrics;
4107+7 (C) Cardiology;
4108+8 (D) Gastroenterology;
4109+9 (E) General Surgery;
4110+10 (F) Neurology;
4111+11 (G) OB/GYN;
4112+12 (H) Oncology/Radiation;
4113+13 (I) Ophthalmology;
4114+14 (J) Urology;
4115+15 (K) Behavioral Health;
4116+16 (L) Allergy/Immunology;
4117+17 (M) Chiropractic;
4118+18 (N) Dermatology;
4119+19 (O) Endocrinology;
4120+20 (P) Ears, Nose, and Throat (ENT)/Otolaryngology;
4121+21 (Q) Infectious Disease;
4122+22 (R) Nephrology;
4123+23 (S) Neurosurgery;
4124+24 (T) Orthopedic Surgery;
4125+25 (U) Physiatry/Rehabilitative;
4126+26 (V) Plastic Surgery;
4127+
4128+
4129+
4130+
4131+
4132+ HB5493 Enrolled - 116 - LRB103 39189 RPS 69335 b
4133+
4134+
4135+HB5493 Enrolled- 117 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 117 - LRB103 39189 RPS 69335 b
4136+ HB5493 Enrolled - 117 - LRB103 39189 RPS 69335 b
4137+1 (W) Pulmonary;
4138+2 (X) Rheumatology;
4139+3 (Y) Anesthesiology;
4140+4 (Z) Pain Medicine;
4141+5 (AA) Pediatric Specialty Services;
4142+6 (BB) Outpatient Dialysis; and
4143+7 (CC) HIV.
4144+8 (2) The Director shall establish a process for the
4145+9 review of the adequacy of these standards, along with an
4146+10 assessment of additional specialties to be included in the
4147+11 list under this subsection (c).
4148+12 (d) The network plan shall demonstrate to the Director
4149+13 maximum travel and distance standards for plan beneficiaries,
4150+14 which shall be established annually by the Department in
4151+15 consultation with the Department of Public Health based upon
4152+16 the guidance from the federal Centers for Medicare and
4153+17 Medicaid Services. These standards shall consist of the
4154+18 maximum minutes or miles to be traveled by a plan beneficiary
4155+19 for each county type, such as large counties, metro counties,
4156+20 or rural counties as defined by Department rule.
4157+21 The maximum travel time and distance standards must
4158+22 include standards for each physician and other provider
4159+23 category listed for which ratios have been established.
4160+24 The Director shall establish a process for the review of
4161+25 the adequacy of these standards along with an assessment of
4162+26 additional specialties to be included in the list under this
4163+
4164+
4165+
4166+
4167+
4168+ HB5493 Enrolled - 117 - LRB103 39189 RPS 69335 b
4169+
4170+
4171+HB5493 Enrolled- 118 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 118 - LRB103 39189 RPS 69335 b
4172+ HB5493 Enrolled - 118 - LRB103 39189 RPS 69335 b
4173+1 subsection (d).
4174+2 (d-5)(1) Every insurer shall ensure that beneficiaries
4175+3 have timely and proximate access to treatment for mental,
4176+4 emotional, nervous, or substance use disorders or conditions
4177+5 in accordance with the provisions of paragraph (4) of
4178+6 subsection (a) of Section 370c of the Illinois Insurance Code.
4179+7 Insurers shall use a comparable process, strategy, evidentiary
4180+8 standard, and other factors in the development and application
4181+9 of the network adequacy standards for timely and proximate
4182+10 access to treatment for mental, emotional, nervous, or
4183+11 substance use disorders or conditions and those for the access
4184+12 to treatment for medical and surgical conditions. As such, the
4185+13 network adequacy standards for timely and proximate access
4186+14 shall equally be applied to treatment facilities and providers
4187+15 for mental, emotional, nervous, or substance use disorders or
4188+16 conditions and specialists providing medical or surgical
4189+17 benefits pursuant to the parity requirements of Section 370c.1
4190+18 of the Illinois Insurance Code and the federal Paul Wellstone
4191+19 and Pete Domenici Mental Health Parity and Addiction Equity
4192+20 Act of 2008. Notwithstanding the foregoing, the network
4193+21 adequacy standards for timely and proximate access to
4194+22 treatment for mental, emotional, nervous, or substance use
4195+23 disorders or conditions shall, at a minimum, satisfy the
4196+24 following requirements:
4197+25 (A) For beneficiaries residing in the metropolitan
4198+26 counties of Cook, DuPage, Kane, Lake, McHenry, and Will,
4199+
4200+
4201+
4202+
4203+
4204+ HB5493 Enrolled - 118 - LRB103 39189 RPS 69335 b
4205+
4206+
4207+HB5493 Enrolled- 119 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 119 - LRB103 39189 RPS 69335 b
4208+ HB5493 Enrolled - 119 - LRB103 39189 RPS 69335 b
4209+1 network adequacy standards for timely and proximate access
4210+2 to treatment for mental, emotional, nervous, or substance
4211+3 use disorders or conditions means a beneficiary shall not
4212+4 have to travel longer than 30 minutes or 30 miles from the
4213+5 beneficiary's residence to receive outpatient treatment
4214+6 for mental, emotional, nervous, or substance use disorders
4215+7 or conditions. Beneficiaries shall not be required to wait
4216+8 longer than 10 business days between requesting an initial
4217+9 appointment and being seen by the facility or provider of
4218+10 mental, emotional, nervous, or substance use disorders or
4219+11 conditions for outpatient treatment or to wait longer than
4220+12 20 business days between requesting a repeat or follow-up
4221+13 appointment and being seen by the facility or provider of
4222+14 mental, emotional, nervous, or substance use disorders or
4223+15 conditions for outpatient treatment; however, subject to
4224+16 the protections of paragraph (3) of this subsection, a
4225+17 network plan shall not be held responsible if the
4226+18 beneficiary or provider voluntarily chooses to schedule an
4227+19 appointment outside of these required time frames.
4228+20 (B) For beneficiaries residing in Illinois counties
4229+21 other than those counties listed in subparagraph (A) of
4230+22 this paragraph, network adequacy standards for timely and
4231+23 proximate access to treatment for mental, emotional,
4232+24 nervous, or substance use disorders or conditions means a
4233+25 beneficiary shall not have to travel longer than 60
4234+26 minutes or 60 miles from the beneficiary's residence to
4235+
4236+
4237+
4238+
4239+
4240+ HB5493 Enrolled - 119 - LRB103 39189 RPS 69335 b
4241+
4242+
4243+HB5493 Enrolled- 120 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 120 - LRB103 39189 RPS 69335 b
4244+ HB5493 Enrolled - 120 - LRB103 39189 RPS 69335 b
4245+1 receive outpatient treatment for mental, emotional,
4246+2 nervous, or substance use disorders or conditions.
4247+3 Beneficiaries shall not be required to wait longer than 10
4248+4 business days between requesting an initial appointment
4249+5 and being seen by the facility or provider of mental,
4250+6 emotional, nervous, or substance use disorders or
4251+7 conditions for outpatient treatment or to wait longer than
4252+8 20 business days between requesting a repeat or follow-up
4253+9 appointment and being seen by the facility or provider of
4254+10 mental, emotional, nervous, or substance use disorders or
4255+11 conditions for outpatient treatment; however, subject to
4256+12 the protections of paragraph (3) of this subsection, a
4257+13 network plan shall not be held responsible if the
4258+14 beneficiary or provider voluntarily chooses to schedule an
4259+15 appointment outside of these required time frames.
4260+16 (2) For beneficiaries residing in all Illinois counties,
4261+17 network adequacy standards for timely and proximate access to
4262+18 treatment for mental, emotional, nervous, or substance use
4263+19 disorders or conditions means a beneficiary shall not have to
4264+20 travel longer than 60 minutes or 60 miles from the
4265+21 beneficiary's residence to receive inpatient or residential
4266+22 treatment for mental, emotional, nervous, or substance use
4267+23 disorders or conditions.
4268+24 (3) If there is no in-network facility or provider
4269+25 available for a beneficiary to receive timely and proximate
4270+26 access to treatment for mental, emotional, nervous, or
4271+
4272+
4273+
4274+
4275+
4276+ HB5493 Enrolled - 120 - LRB103 39189 RPS 69335 b
4277+
4278+
4279+HB5493 Enrolled- 121 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 121 - LRB103 39189 RPS 69335 b
4280+ HB5493 Enrolled - 121 - LRB103 39189 RPS 69335 b
4281+1 substance use disorders or conditions in accordance with the
4282+2 network adequacy standards outlined in this subsection, the
4283+3 insurer shall provide necessary exceptions to its network to
4284+4 ensure admission and treatment with a provider or at a
4285+5 treatment facility in accordance with the network adequacy
4286+6 standards in this subsection.
4287+7 (e) Except for network plans solely offered as a group
4288+8 health plan, these ratio and time and distance standards apply
4289+9 to the lowest cost-sharing tier of any tiered network.
4290+10 (f) The network plan may consider use of other health care
4291+11 service delivery options, such as telemedicine or telehealth,
4292+12 mobile clinics, and centers of excellence, or other ways of
4293+13 delivering care to partially meet the requirements set under
4294+14 this Section.
4295+15 (g) Except for the requirements set forth in subsection
4296+16 (d-5), insurers who are not able to comply with the provider
4297+17 ratios and time and distance standards established by the
4298+18 Department may request an exception to these requirements from
4299+19 the Department. The Department may grant an exception in the
4300+20 following circumstances:
4301+21 (1) if no providers or facilities meet the specific
4302+22 time and distance standard in a specific service area and
4303+23 the insurer (i) discloses information on the distance and
4304+24 travel time points that beneficiaries would have to travel
4305+25 beyond the required criterion to reach the next closest
4306+26 contracted provider outside of the service area and (ii)
4307+
4308+
4309+
4310+
4311+
4312+ HB5493 Enrolled - 121 - LRB103 39189 RPS 69335 b
4313+
4314+
4315+HB5493 Enrolled- 122 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 122 - LRB103 39189 RPS 69335 b
4316+ HB5493 Enrolled - 122 - LRB103 39189 RPS 69335 b
4317+1 provides contact information, including names, addresses,
4318+2 and phone numbers for the next closest contracted provider
4319+3 or facility;
4320+4 (2) if patterns of care in the service area do not
4321+5 support the need for the requested number of provider or
4322+6 facility type and the insurer provides data on local
4323+7 patterns of care, such as claims data, referral patterns,
4324+8 or local provider interviews, indicating where the
4325+9 beneficiaries currently seek this type of care or where
4326+10 the physicians currently refer beneficiaries, or both; or
4327+11 (3) other circumstances deemed appropriate by the
4328+12 Department consistent with the requirements of this Act.
4329+13 (h) Insurers are required to report to the Director any
4330+14 material change to an approved network plan within 15 days
4331+15 after the change occurs and any change that would result in
4332+16 failure to meet the requirements of this Act. Upon notice from
4333+17 the insurer, the Director shall reevaluate the network plan's
4334+18 compliance with the network adequacy and transparency
4335+19 standards of this Act.
4336+20 (Source: P.A. 102-144, eff. 1-1-22; 102-901, eff. 7-1-22;
4337+21 102-1117, eff. 1-13-23.)
4338+22 Section 35. The Health Maintenance Organization Act is
4339+23 amended by changing Sections 4.5-1, 5-3, and 5-3.1 as follows:
4340+24 (215 ILCS 125/4.5-1)
4341+
4342+
4343+
4344+
4345+
4346+ HB5493 Enrolled - 122 - LRB103 39189 RPS 69335 b
4347+
4348+
4349+HB5493 Enrolled- 123 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 123 - LRB103 39189 RPS 69335 b
4350+ HB5493 Enrolled - 123 - LRB103 39189 RPS 69335 b
4351+1 Sec. 4.5-1. Point-of-service health service contracts.
4352+2 (a) A health maintenance organization that offers a
4353+3 point-of-service contract:
4354+4 (1) must include as in-plan covered services all
4355+5 services required by law to be provided by a health
4356+6 maintenance organization;
4357+7 (2) must provide incentives, which shall include
4358+8 financial incentives, for enrollees to use in-plan covered
4359+9 services;
4360+10 (3) may not offer services out-of-plan without
4361+11 providing those services on an in-plan basis;
4362+12 (4) may include annual out-of-pocket limits and
4363+13 lifetime maximum benefits allowances for out-of-plan
4364+14 services that are separate from any limits or allowances
4365+15 applied to in-plan services;
4366+16 (5) may not consider emergency services, authorized
4367+17 referral services, or non-routine services obtained out of
4368+18 the service area to be point-of-service services;
4369+19 (6) may treat as out-of-plan services those services
4370+20 that an enrollee obtains from a participating provider,
4371+21 but for which the proper authorization was not given by
4372+22 the health maintenance organization; and
4373+23 (7) after January 1, 2003 (the effective date of
4374+24 Public Act 92-579), must include the following disclosure
4375+25 on its point-of-service contracts and evidences of
4376+26 coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN
4377+
4378+
4379+
4380+
4381+
4382+ HB5493 Enrolled - 123 - LRB103 39189 RPS 69335 b
4383+
4384+
4385+HB5493 Enrolled- 124 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 124 - LRB103 39189 RPS 69335 b
4386+ HB5493 Enrolled - 124 - LRB103 39189 RPS 69335 b
4387+1 NON-PARTICIPATING PROVIDERS ARE USED. YOU CAN EXPECT TO
4388+2 PAY MORE THAN THE COST-SHARING AMOUNT DEFINED IN THE
4389+3 POLICY IN NON-EMERGENCY SITUATIONS. Except in limited
4390+4 situations governed by the federal No Surprises Act or
4391+5 Section 356z.3a of the Illinois Insurance Code (215 ILCS
4392+6 5/356z.3a), non-participating providers furnishing
4393+7 non-emergency services may bill members for any amount up
4394+8 to the billed charge after the plan has paid its portion of
4395+9 the bill. If you elect to use a non-participating
4396+10 provider, plan benefit payments will be determined
4397+11 according to your policy's fee schedule, usual and
4398+12 customary charge (which is determined by comparing charges
4399+13 for similar services adjusted to the geographical area
4400+14 where the services are performed), or other method as
4401+15 defined by the policy. Participating providers have agreed
4402+16 to ONLY bill members the cost-sharing amounts. You should
4403+17 be aware that when you elect to utilize the services of a
4404+18 non-participating provider for a covered service in
4405+19 non-emergency situations, benefit payments to such
4406+20 non-participating provider are not based upon the amount
4407+21 billed. The basis of your benefit payment will be
4408+22 determined according to your policy's fee schedule, usual
4409+23 and customary charge (which is determined by comparing
4410+24 charges for similar services adjusted to the geographical
4411+25 area where the services are performed), or other method as
4412+26 defined by the policy. YOU CAN EXPECT TO PAY MORE THAN THE
4413+
4414+
4415+
4416+
4417+
4418+ HB5493 Enrolled - 124 - LRB103 39189 RPS 69335 b
4419+
4420+
4421+HB5493 Enrolled- 125 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 125 - LRB103 39189 RPS 69335 b
4422+ HB5493 Enrolled - 125 - LRB103 39189 RPS 69335 b
4423+1 COINSURANCE AMOUNT DEFINED IN THE POLICY AFTER THE PLAN
4424+2 HAS PAID ITS REQUIRED PORTION. Non-participating providers
4425+3 may bill members for any amount up to the billed charge
4426+4 after the plan has paid its portion of the bill, except as
4427+5 provided in Section 356z.3a of the Illinois Insurance Code
4428+6 for covered services received at a participating health
4429+7 care facility from a non-participating provider that are:
4430+8 (a) ancillary services, (b) items or services furnished as
4431+9 a result of unforeseen, urgent medical needs that arise at
4432+10 the time the item or service is furnished, or (c) items or
4433+11 services received when the facility or the
4434+12 non-participating provider fails to satisfy the notice and
4435+13 consent criteria specified under Section 356z.3a.
4436+14 Participating providers have agreed to accept discounted
4437+15 payments for services with no additional billing to the
4438+16 member other than co-insurance and deductible amounts. You
4439+17 may obtain further information about the participating
4440+18 status of professional providers and information on
4441+19 out-of-pocket expenses by calling the toll-free toll free
4442+20 telephone number on your identification card.".
4443+21 (b) A health maintenance organization offering a
4444+22 point-of-service contract is subject to all of the following
4445+23 limitations:
4446+24 (1) The health maintenance organization may not expend
4447+25 in any calendar quarter more than 20% of its total
4448+26 expenditures for all its members for out-of-plan covered
4449+
4450+
4451+
4452+
4453+
4454+ HB5493 Enrolled - 125 - LRB103 39189 RPS 69335 b
4455+
4456+
4457+HB5493 Enrolled- 126 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 126 - LRB103 39189 RPS 69335 b
4458+ HB5493 Enrolled - 126 - LRB103 39189 RPS 69335 b
4459+1 services.
4460+2 (2) If the amount specified in item (1) of this
4461+3 subsection is exceeded by 2% in a quarter, the health
4462+4 maintenance organization must effect compliance with item
4463+5 (1) of this subsection by the end of the following
4464+6 quarter.
4465+7 (3) If compliance with the amount specified in item
4466+8 (1) of this subsection is not demonstrated in the health
4467+9 maintenance organization's next quarterly report, the
4468+10 health maintenance organization may not offer the
4469+11 point-of-service contract to new groups or include the
4470+12 point-of-service option in the renewal of an existing
4471+13 group until compliance with the amount specified in item
4472+14 (1) of this subsection is demonstrated or until otherwise
4473+15 allowed by the Director.
4474+16 (4) A health maintenance organization failing, without
4475+17 just cause, to comply with the provisions of this
4476+18 subsection shall be required, after notice and hearing, to
4477+19 pay a penalty of $250 for each day out of compliance, to be
4478+20 recovered by the Director. Any penalty recovered shall be
4479+21 paid into the General Revenue Fund. The Director may
4480+22 reduce the penalty if the health maintenance organization
4481+23 demonstrates to the Director that the imposition of the
4482+24 penalty would constitute a financial hardship to the
4483+25 health maintenance organization.
4484+26 (c) A health maintenance organization that offers a
4485+
4486+
4487+
4488+
4489+
4490+ HB5493 Enrolled - 126 - LRB103 39189 RPS 69335 b
4491+
4492+
4493+HB5493 Enrolled- 127 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 127 - LRB103 39189 RPS 69335 b
4494+ HB5493 Enrolled - 127 - LRB103 39189 RPS 69335 b
4495+1 point-of-service product must do all of the following:
4496+2 (1) File a quarterly financial statement detailing
4497+3 compliance with the requirements of subsection (b).
4498+4 (2) Track out-of-plan, point-of-service utilization
4499+5 separately from in-plan or non-point-of-service,
4500+6 out-of-plan emergency care, referral care, and urgent care
4501+7 out of the service area utilization.
4502+8 (3) Record out-of-plan utilization in a manner that
4503+9 will permit such utilization and cost reporting as the
4504+10 Director may, by rule, require.
4505+11 (4) Demonstrate to the Director's satisfaction that
4506+12 the health maintenance organization has the fiscal,
4507+13 administrative, and marketing capacity to control its
4508+14 point-of-service enrollment, utilization, and costs so as
4509+15 not to jeopardize the financial security of the health
4510+16 maintenance organization.
4511+17 (5) Maintain, in addition to any other deposit
4512+18 required under this Act, the deposit required by Section
4513+19 2-6.
4514+20 (6) Maintain cash and cash equivalents of sufficient
4515+21 amount to fully liquidate 10 days' average claim payments,
4516+22 subject to review by the Director.
4517+23 (7) Maintain and file with the Director, reinsurance
4518+24 coverage protecting against catastrophic losses on
4519+25 out-of-network point-of-service services. Deductibles may
4520+26 not exceed $100,000 per covered life per year, and the
4521+
4522+
4523+
4524+
4525+
4526+ HB5493 Enrolled - 127 - LRB103 39189 RPS 69335 b
4527+
4528+
4529+HB5493 Enrolled- 128 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 128 - LRB103 39189 RPS 69335 b
4530+ HB5493 Enrolled - 128 - LRB103 39189 RPS 69335 b
4531+1 portion of risk retained by the health maintenance
4532+2 organization once deductibles have been satisfied may not
4533+3 exceed 20%. Reinsurance must be placed with licensed
4534+4 authorized reinsurers qualified to do business in this
4535+5 State.
4536+6 (d) A health maintenance organization may not issue a
4537+7 point-of-service contract until it has filed and had approved
4538+8 by the Director a plan to comply with the provisions of this
4539+9 Section. The compliance plan must, at a minimum, include
4540+10 provisions demonstrating that the health maintenance
4541+11 organization will do all of the following:
4542+12 (1) Design the benefit levels and conditions of
4543+13 coverage for in-plan covered services and out-of-plan
4544+14 covered services as required by this Article.
4545+15 (2) Provide or arrange for the provision of adequate
4546+16 systems to:
4547+17 (A) process and pay claims for all out-of-plan
4548+18 covered services;
4549+19 (B) meet the requirements for point-of-service
4550+20 contracts set forth in this Section and any additional
4551+21 requirements that may be set forth by the Director;
4552+22 and
4553+23 (C) generate accurate data and financial and
4554+24 regulatory reports on a timely basis so that the
4555+25 Department of Insurance can evaluate the health
4556+26 maintenance organization's experience with the
4557+
4558+
4559+
4560+
4561+
4562+ HB5493 Enrolled - 128 - LRB103 39189 RPS 69335 b
4563+
4564+
4565+HB5493 Enrolled- 129 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 129 - LRB103 39189 RPS 69335 b
4566+ HB5493 Enrolled - 129 - LRB103 39189 RPS 69335 b
4567+1 point-of-service contract and monitor compliance with
4568+2 point-of-service contract provisions.
4569+3 (3) Comply with the requirements of subsections (b)
4570+4 and (c).
4571+5 (Source: P.A. 102-901, eff. 1-1-23; 103-154, eff. 6-30-23.)
4572+6 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
4573+7 Sec. 5-3. Insurance Code provisions.
4574+8 (a) Health Maintenance Organizations shall be subject to
4575+9 the provisions of Sections 133, 134, 136, 137, 139, 140,
4576+10 141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
4577+11 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
4578+12 355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v,
4579+13 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
4580+14 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
4581+15 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22,
4582+16 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30,
4583+17 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35,
4584+18 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44,
4585+19 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51,
4586+20 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59,
4587+21 356z.60, 356z.61, 356z.62, 356z.63, 356z.64, 356z.65, 356z.66,
4588+22 356z.67, 356z.68, 356z.69, 356z.70, 364, 364.01, 364.3, 367.2,
4589+23 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1,
4590+24 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and
4591+25 444.1, paragraph (c) of subsection (2) of Section 367, and
4592+
4593+
4594+
4595+
4596+
4597+ HB5493 Enrolled - 129 - LRB103 39189 RPS 69335 b
4598+
4599+
4600+HB5493 Enrolled- 130 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 130 - LRB103 39189 RPS 69335 b
4601+ HB5493 Enrolled - 130 - LRB103 39189 RPS 69335 b
4602+1 Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
4603+2 XXVI, and XXXIIB of the Illinois Insurance Code.
4604+3 (b) For purposes of the Illinois Insurance Code, except
4605+4 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
4606+5 Health Maintenance Organizations in the following categories
4607+6 are deemed to be "domestic companies":
4608+7 (1) a corporation authorized under the Dental Service
4609+8 Plan Act or the Voluntary Health Services Plans Act;
4610+9 (2) a corporation organized under the laws of this
4611+10 State; or
4612+11 (3) a corporation organized under the laws of another
4613+12 state, 30% or more of the enrollees of which are residents
4614+13 of this State, except a corporation subject to
4615+14 substantially the same requirements in its state of
4616+15 organization as is a "domestic company" under Article VIII
4617+16 1/2 of the Illinois Insurance Code.
4618+17 (c) In considering the merger, consolidation, or other
4619+18 acquisition of control of a Health Maintenance Organization
4620+19 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
4621+20 (1) the Director shall give primary consideration to
4622+21 the continuation of benefits to enrollees and the
4623+22 financial conditions of the acquired Health Maintenance
4624+23 Organization after the merger, consolidation, or other
4625+24 acquisition of control takes effect;
4626+25 (2)(i) the criteria specified in subsection (1)(b) of
4627+26 Section 131.8 of the Illinois Insurance Code shall not
4628+
4629+
4630+
4631+
4632+
4633+ HB5493 Enrolled - 130 - LRB103 39189 RPS 69335 b
4634+
4635+
4636+HB5493 Enrolled- 131 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 131 - LRB103 39189 RPS 69335 b
4637+ HB5493 Enrolled - 131 - LRB103 39189 RPS 69335 b
4638+1 apply and (ii) the Director, in making his determination
4639+2 with respect to the merger, consolidation, or other
4640+3 acquisition of control, need not take into account the
4641+4 effect on competition of the merger, consolidation, or
4642+5 other acquisition of control;
4643+6 (3) the Director shall have the power to require the
4644+7 following information:
4645+8 (A) certification by an independent actuary of the
4646+9 adequacy of the reserves of the Health Maintenance
4647+10 Organization sought to be acquired;
4648+11 (B) pro forma financial statements reflecting the
4649+12 combined balance sheets of the acquiring company and
4650+13 the Health Maintenance Organization sought to be
4651+14 acquired as of the end of the preceding year and as of
4652+15 a date 90 days prior to the acquisition, as well as pro
4653+16 forma financial statements reflecting projected
4654+17 combined operation for a period of 2 years;
4655+18 (C) a pro forma business plan detailing an
4656+19 acquiring party's plans with respect to the operation
4657+20 of the Health Maintenance Organization sought to be
4658+21 acquired for a period of not less than 3 years; and
4659+22 (D) such other information as the Director shall
4660+23 require.
4661+24 (d) The provisions of Article VIII 1/2 of the Illinois
4662+25 Insurance Code and this Section 5-3 shall apply to the sale by
4663+26 any health maintenance organization of greater than 10% of its
4664+
4665+
4666+
4667+
4668+
4669+ HB5493 Enrolled - 131 - LRB103 39189 RPS 69335 b
4670+
4671+
4672+HB5493 Enrolled- 132 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 132 - LRB103 39189 RPS 69335 b
4673+ HB5493 Enrolled - 132 - LRB103 39189 RPS 69335 b
4674+1 enrollee population (including, without limitation, the health
4675+2 maintenance organization's right, title, and interest in and
4676+3 to its health care certificates).
4677+4 (e) In considering any management contract or service
4678+5 agreement subject to Section 141.1 of the Illinois Insurance
4679+6 Code, the Director (i) shall, in addition to the criteria
4680+7 specified in Section 141.2 of the Illinois Insurance Code,
4681+8 take into account the effect of the management contract or
4682+9 service agreement on the continuation of benefits to enrollees
4683+10 and the financial condition of the health maintenance
4684+11 organization to be managed or serviced, and (ii) need not take
4685+12 into account the effect of the management contract or service
4686+13 agreement on competition.
4687+14 (f) Except for small employer groups as defined in the
4688+15 Small Employer Rating, Renewability and Portability Health
4689+16 Insurance Act and except for medicare supplement policies as
4690+17 defined in Section 363 of the Illinois Insurance Code, a
4691+18 Health Maintenance Organization may by contract agree with a
4692+19 group or other enrollment unit to effect refunds or charge
4693+20 additional premiums under the following terms and conditions:
4694+21 (i) the amount of, and other terms and conditions with
4695+22 respect to, the refund or additional premium are set forth
4696+23 in the group or enrollment unit contract agreed in advance
4697+24 of the period for which a refund is to be paid or
4698+25 additional premium is to be charged (which period shall
4699+26 not be less than one year); and
4700+
4701+
4702+
4703+
4704+
4705+ HB5493 Enrolled - 132 - LRB103 39189 RPS 69335 b
4706+
4707+
4708+HB5493 Enrolled- 133 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 133 - LRB103 39189 RPS 69335 b
4709+ HB5493 Enrolled - 133 - LRB103 39189 RPS 69335 b
4710+1 (ii) the amount of the refund or additional premium
4711+2 shall not exceed 20% of the Health Maintenance
4712+3 Organization's profitable or unprofitable experience with
4713+4 respect to the group or other enrollment unit for the
4714+5 period (and, for purposes of a refund or additional
4715+6 premium, the profitable or unprofitable experience shall
4716+7 be calculated taking into account a pro rata share of the
4717+8 Health Maintenance Organization's administrative and
4718+9 marketing expenses, but shall not include any refund to be
4719+10 made or additional premium to be paid pursuant to this
4720+11 subsection (f)). The Health Maintenance Organization and
4721+12 the group or enrollment unit may agree that the profitable
4722+13 or unprofitable experience may be calculated taking into
4723+14 account the refund period and the immediately preceding 2
4724+15 plan years.
4725+16 The Health Maintenance Organization shall include a
4726+17 statement in the evidence of coverage issued to each enrollee
4727+18 describing the possibility of a refund or additional premium,
4728+19 and upon request of any group or enrollment unit, provide to
4729+20 the group or enrollment unit a description of the method used
4730+21 to calculate (1) the Health Maintenance Organization's
4731+22 profitable experience with respect to the group or enrollment
4732+23 unit and the resulting refund to the group or enrollment unit
4733+24 or (2) the Health Maintenance Organization's unprofitable
4734+25 experience with respect to the group or enrollment unit and
4735+26 the resulting additional premium to be paid by the group or
4736+
4737+
4738+
4739+
4740+
4741+ HB5493 Enrolled - 133 - LRB103 39189 RPS 69335 b
4742+
4743+
4744+HB5493 Enrolled- 134 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 134 - LRB103 39189 RPS 69335 b
4745+ HB5493 Enrolled - 134 - LRB103 39189 RPS 69335 b
4746+1 enrollment unit.
4747+2 In no event shall the Illinois Health Maintenance
4748+3 Organization Guaranty Association be liable to pay any
4749+4 contractual obligation of an insolvent organization to pay any
4750+5 refund authorized under this Section.
4751+6 (g) Rulemaking authority to implement Public Act 95-1045,
4752+7 if any, is conditioned on the rules being adopted in
4753+8 accordance with all provisions of the Illinois Administrative
4754+9 Procedure Act and all rules and procedures of the Joint
4755+10 Committee on Administrative Rules; any purported rule not so
4756+11 adopted, for whatever reason, is unauthorized.
4757+12 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
4758+13 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
4759+14 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
4760+15 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
4761+16 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
4762+17 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
4763+18 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
4764+19 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
4765+20 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
4766+21 eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
4767+22 (215 ILCS 125/5-3.1)
4768+23 Sec. 5-3.1. Access to obstetrical and gynecological care
4769+24 Woman's health care provider. Health maintenance organizations
4770+25 are subject to the provisions of Section 356r of the Illinois
4771+
4772+
4773+
4774+
4775+
4776+ HB5493 Enrolled - 134 - LRB103 39189 RPS 69335 b
4777+
4778+
4779+HB5493 Enrolled- 135 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 135 - LRB103 39189 RPS 69335 b
4780+ HB5493 Enrolled - 135 - LRB103 39189 RPS 69335 b
4781+1 Insurance Code.
4782+2 (Source: P.A. 89-514, eff. 7-17-96.)
4783+3 Section 40. The Limited Health Service Organization Act is
4784+4 amended by changing Sections 4002.1 and 4003 as follows:
4785+5 (215 ILCS 130/4002.1)
4786+6 Sec. 4002.1. Access to obstetrical and gynecological care
4787+7 Woman's health care provider. Limited health service
4788+8 organizations are subject to the provisions of Section 356r of
4789+9 the Illinois Insurance Code.
4790+10 (Source: P.A. 89-514, eff. 7-17-96.)
4791+11 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
4792+12 Sec. 4003. Illinois Insurance Code provisions. Limited
4793+13 health service organizations shall be subject to the
4794+14 provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
4795+15 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
4796+16 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2,
4797+17 355.3, 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21,
4798+18 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
4799+19 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
4800+20 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 364.3,
4801+21 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444,
4802+22 and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII
4803+23 1/2, XXV, and XXVI of the Illinois Insurance Code. Nothing in
4804+
4805+
4806+
4807+
4808+
4809+ HB5493 Enrolled - 135 - LRB103 39189 RPS 69335 b
4810+
4811+
4812+HB5493 Enrolled- 136 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 136 - LRB103 39189 RPS 69335 b
4813+ HB5493 Enrolled - 136 - LRB103 39189 RPS 69335 b
4814+1 this Section shall require a limited health care plan to cover
4815+2 any service that is not a limited health service. For purposes
4816+3 of the Illinois Insurance Code, except for Sections 444 and
4817+4 444.1 and Articles XIII and XIII 1/2, limited health service
4818+5 organizations in the following categories are deemed to be
4819+6 domestic companies:
4820+7 (1) a corporation under the laws of this State; or
4821+8 (2) a corporation organized under the laws of another
4822+9 state, 30% or more of the enrollees of which are residents
4823+10 of this State, except a corporation subject to
4824+11 substantially the same requirements in its state of
4825+12 organization as is a domestic company under Article VIII
4826+13 1/2 of the Illinois Insurance Code.
4827+14 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
4828+15 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
4829+16 1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
4830+17 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
4831+18 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
4832+19 1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
4833+20 eff. 1-1-24; revised 8-29-23.)
4834+21 Section 43. The Voluntary Health Services Plans Act is
4835+22 amended by changing Section 10 as follows:
4836+23 (215 ILCS 165/10) (from Ch. 32, par. 604)
4837+24 Sec. 10. Application of Insurance Code provisions. Health
4838+
4839+
4840+
4841+
4842+
4843+ HB5493 Enrolled - 136 - LRB103 39189 RPS 69335 b
4844+
4845+
4846+HB5493 Enrolled- 137 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 137 - LRB103 39189 RPS 69335 b
4847+ HB5493 Enrolled - 137 - LRB103 39189 RPS 69335 b
4848+1 services plan corporations and all persons interested therein
4849+2 or dealing therewith shall be subject to the provisions of
4850+3 Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
4851+4 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
4852+5 356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
4853+6 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
4854+7 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
4855+8 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
4856+9 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
4857+10 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
4858+11 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
4859+12 356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401, 401.1, 402,
4860+13 403, 403A, 408, 408.2, and 412, and paragraphs (7) and (15) of
4861+14 Section 367 of the Illinois Insurance Code.
4862+15 Rulemaking authority to implement Public Act 95-1045, if
4863+16 any, is conditioned on the rules being adopted in accordance
4864+17 with all provisions of the Illinois Administrative Procedure
4865+18 Act and all rules and procedures of the Joint Committee on
4866+19 Administrative Rules; any purported rule not so adopted, for
4867+20 whatever reason, is unauthorized.
4868+21 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
4869+22 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
4870+23 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
4871+24 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
4872+25 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
4873+26 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
4874+
4875+
4876+
4877+
4878+
4879+ HB5493 Enrolled - 137 - LRB103 39189 RPS 69335 b
4880+
4881+
4882+HB5493 Enrolled- 138 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 138 - LRB103 39189 RPS 69335 b
4883+ HB5493 Enrolled - 138 - LRB103 39189 RPS 69335 b
4884+1 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
4885+2 103-551, eff. 8-11-23; revised 8-29-23.)
4886+3 Section 45. The Illinois Public Aid Code is amended by
4887+4 changing Section 5-16.9 as follows:
4888+5 (305 ILCS 5/5-16.9)
4889+6 Sec. 5-16.9. Access to obstetrical and gynecological care
4890+7 Woman's health care provider. The medical assistance program
4891+8 is subject to the provisions of Section 356r of the Illinois
4892+9 Insurance Code. The Illinois Department shall adopt rules to
4893+10 implement the requirements of Section 356r of the Illinois
4894+11 Insurance Code in the medical assistance program including
4895+12 managed care components.
4896+13 On and after July 1, 2012, the Department shall reduce any
4897+14 rate of reimbursement for services or other payments or alter
4898+15 any methodologies authorized by this Code to reduce any rate
4899+16 of reimbursement for services or other payments in accordance
4900+17 with Section 5-5e.
4901+18 (Source: P.A. 97-689, eff. 6-14-12.)
4902+19 Section 95. No acceleration or delay. Where this Act makes
4903+20 changes in a statute that is represented in this Act by text
4904+21 that is not yet or no longer in effect (for example, a Section
4905+22 represented by multiple versions), the use of that text does
4906+23 not accelerate or delay the taking effect of (i) the changes
4907+
4908+
4909+
4910+
4911+
4912+ HB5493 Enrolled - 138 - LRB103 39189 RPS 69335 b
4913+
4914+
4915+HB5493 Enrolled- 139 -LRB103 39189 RPS 69335 b HB5493 Enrolled - 139 - LRB103 39189 RPS 69335 b
4916+ HB5493 Enrolled - 139 - LRB103 39189 RPS 69335 b
4917+1 made by this Act or (ii) provisions derived from any other
4918+2 Public Act.
4919+
4920+
4921+
4922+
4923+
4924+ HB5493 Enrolled - 139 - LRB103 39189 RPS 69335 b