|
prohibited. |
(a) In this Section: |
"Excepted benefits" has the meaning given to that term in |
42 U.S.C. 300gg-91 and implementing regulations. "Excepted |
benefits" includes individual, group, or blanket coverage. |
"Short-term, limited-duration insurance" means any type of |
accident and health insurance offered or provided within this |
State pursuant to a group or individual policy or individual |
certificate by a company, regardless of the situs state of the |
delivery of the policy, that has an expiration date specified |
in the contract that is fewer than 365 days after the original |
effective date. Regardless of the duration of coverage, |
"short-term, limited-duration insurance" does not include |
excepted benefits or any student health insurance coverage. |
(b) On and after January 1, 2025, no company shall issue, |
deliver, amend, or renew short-term, limited-duration |
insurance to any natural or legal person that is a resident or |
domiciled in this State.
|
(215 ILCS 5/356z.18) |
(Text of Section before amendment by P.A. 103-512) |
Sec. 356z.18. Prosthetic and customized orthotic devices. |
(a) For the purposes of this Section: |
"Customized orthotic device" means a supportive device for |
the body or a part of the body, the head, neck, or extremities, |
and includes the replacement or repair of the device based on |
|
the patient's physical condition as medically necessary, |
excluding foot orthotics defined as an in-shoe device designed |
to support the structural components of the foot during |
weight-bearing activities. |
"Licensed provider" means a prosthetist, orthotist, or |
pedorthist licensed to practice in this State. |
"Prosthetic device" means an artificial device to replace, |
in whole or in part, an arm or leg and includes accessories |
essential to the effective use of the device and the |
replacement or repair of the device based on the patient's |
physical condition as medically necessary. |
(b) This amendatory Act of the 96th General Assembly shall |
provide benefits to any person covered thereunder for expenses |
incurred in obtaining a prosthetic or custom orthotic device |
from any Illinois licensed prosthetist, licensed orthotist, or |
licensed pedorthist as required under the Orthotics, |
Prosthetics, and Pedorthics Practice Act. |
(c) A group or individual major medical policy of accident |
or health insurance or managed care plan or medical, health, |
or hospital service corporation contract that provides |
coverage for prosthetic or custom orthotic care and is |
amended, delivered, issued, or renewed 6 months after the |
effective date of this amendatory Act of the 96th General |
Assembly must provide coverage for prosthetic and orthotic |
devices in accordance with this subsection (c). The coverage |
required under this Section shall be subject to the other |
|
general exclusions, limitations, and financial requirements of |
the policy, including coordination of benefits, participating |
provider requirements, utilization review of health care |
services, including review of medical necessity, case |
management, and experimental and investigational treatments, |
and other managed care provisions under terms and conditions |
that are no less favorable than the terms and conditions that |
apply to substantially all medical and surgical benefits |
provided under the plan or coverage. |
(d) The policy or plan or contract may require prior |
authorization for the prosthetic or orthotic devices in the |
same manner that prior authorization is required for any other |
covered benefit. |
(e) Repairs and replacements of prosthetic and orthotic |
devices are also covered, subject to the co-payments and |
deductibles, unless necessitated by misuse or loss. |
(f) A policy or plan or contract may require that, if |
coverage is provided through a managed care plan, the benefits |
mandated pursuant to this Section shall be covered benefits |
only if the prosthetic or orthotic devices are provided by a |
licensed provider employed by a provider service who contracts |
with or is designated by the carrier, to the extent that the |
carrier provides in-network and out-of-network service, the |
coverage for the prosthetic or orthotic device shall be |
offered no less extensively. |
(g) The policy or plan or contract shall also meet |
|
adequacy requirements as established by the Health Care |
Reimbursement Reform Act of 1985 of the Illinois Insurance |
Code. |
(h) This Section shall not apply to accident only, |
specified disease, short-term travel hospital or medical, |
hospital confinement indemnity or other fixed indemnity, |
credit, dental, vision, Medicare supplement, long-term care, |
basic hospital and medical-surgical expense coverage, |
disability income insurance coverage, coverage issued as a |
supplement to liability insurance, workers' compensation |
insurance, or automobile medical payment insurance. |
(Source: P.A. 96-833, eff. 6-1-10.)
|
(Text of Section after amendment by P.A. 103-512) |
Sec. 356z.18. Prosthetic and customized orthotic devices. |
(a) For the purposes of this Section: |
"Customized orthotic device" means a supportive device for |
the body or a part of the body, the head, neck, or extremities, |
and includes the replacement or repair of the device based on |
the patient's physical condition as medically necessary, |
excluding foot orthotics defined as an in-shoe device designed |
to support the structural components of the foot during |
weight-bearing activities. |
"Licensed provider" means a prosthetist, orthotist, or |
pedorthist licensed to practice in this State. |
"Prosthetic device" means an artificial device to replace, |
|
in whole or in part, an arm or leg and includes accessories |
essential to the effective use of the device and the |
replacement or repair of the device based on the patient's |
physical condition as medically necessary. |
(b) This amendatory Act of the 96th General Assembly shall |
provide benefits to any person covered thereunder for expenses |
incurred in obtaining a prosthetic or custom orthotic device |
from any Illinois licensed prosthetist, licensed orthotist, or |
licensed pedorthist as required under the Orthotics, |
Prosthetics, and Pedorthics Practice Act. |
(c) A group or individual major medical policy of accident |
or health insurance or managed care plan or medical, health, |
or hospital service corporation contract that provides |
coverage for prosthetic or custom orthotic care and is |
amended, delivered, issued, or renewed 6 months after the |
effective date of this amendatory Act of the 96th General |
Assembly must provide coverage for prosthetic and orthotic |
devices in accordance with this subsection (c). The coverage |
required under this Section shall be subject to the other |
general exclusions, limitations, and financial requirements of |
the policy, including coordination of benefits, participating |
provider requirements, utilization review of health care |
services, including review of medical necessity, case |
management, and experimental and investigational treatments, |
and other managed care provisions under terms and conditions |
that are no less favorable than the terms and conditions that |
|
apply to substantially all medical and surgical benefits |
provided under the plan or coverage. |
(d) With respect to an enrollee at any age, in addition to |
coverage of a prosthetic or custom orthotic device required by |
this Section, benefits shall be provided for a prosthetic or |
custom orthotic device determined by the enrollee's provider |
to be the most appropriate model that is medically necessary |
for the enrollee to perform physical activities, as |
applicable, such as running, biking, swimming, and lifting |
weights, and to maximize the enrollee's whole body health and |
strengthen the lower and upper limb function. |
(e) The requirements of this Section do not constitute an |
addition to this State's essential health benefits that |
requires defrayal of costs by this State pursuant to 42 U.S.C. |
18031(d)(3)(B). |
(f) The policy or plan or contract may require prior |
authorization for the prosthetic or orthotic devices in the |
same manner that prior authorization is required for any other |
covered benefit. |
(g) Repairs and replacements of prosthetic and orthotic |
devices are also covered, subject to the co-payments and |
deductibles, unless necessitated by misuse or loss. |
(h) A policy or plan or contract may require that, if |
coverage is provided through a managed care plan, the benefits |
mandated pursuant to this Section shall be covered benefits |
only if the prosthetic or orthotic devices are provided by a |
|
licensed provider employed by a provider service who contracts |
with or is designated by the carrier, to the extent that the |
carrier provides in-network and out-of-network service, the |
coverage for the prosthetic or orthotic device shall be |
offered no less extensively. |
(i) The policy or plan or contract shall also meet |
adequacy requirements as established by the Health Care |
Reimbursement Reform Act of 1985 of the Illinois Insurance |
Code. |
(j) This Section shall not apply to accident only, |
specified disease, short-term travel hospital or medical, |
hospital confinement indemnity or other fixed indemnity, |
credit, dental, vision, Medicare supplement, long-term care, |
basic hospital and medical-surgical expense coverage, |
disability income insurance coverage, coverage issued as a |
supplement to liability insurance, workers' compensation |
insurance, or automobile medical payment insurance. |
(Source: P.A. 103-512, eff. 1-1-25.)
|
(215 ILCS 5/367.3) (from Ch. 73, par. 979.3) |
Sec. 367.3. Group accident and health insurance; |
discretionary groups. |
(a) No group health insurance offered to a resident of |
this State under a policy issued to a group, other than one |
specifically described in Section 367(1), shall be delivered |
or issued for delivery in this State unless the Director |
|
determines that: |
(1) the issuance of the policy is not contrary to the |
public interest; |
(2) the issuance of the policy will result in |
economies of acquisition and administration; and |
(3) the benefits under the policy are reasonable in |
relation to the premium charged. |
(b) No such group health insurance may be offered in this |
State under a policy issued in another state unless this State |
or the state in which the group policy is issued has made a |
determination that the requirements of subsection (a) have |
been met. |
Where insurance is to be offered in this State under a |
policy described in this subsection, the insurer shall file |
for informational review purposes: |
(1) a copy of the group master contract; |
(2) a copy of the statute authorizing the issuance of |
the group policy in the state of situs, which statute has |
the same or similar requirements as this State, or in the |
absence of such statute, a certification by an officer of |
the company that the policy meets the Illinois minimum |
standards required for individual accident and health |
policies under authority of Section 401 of this Code, as |
now or hereafter amended, as promulgated by rule at 50 |
Illinois Administrative Code, Ch. I, Sec. 2007, et seq., |
as now or hereafter amended, or by a successor rule; |
|
(3) evidence of approval by the state of situs of the |
group master policy; and |
(4) copies of all supportive material furnished to the |
state of situs to satisfy the criteria for approval. |
(c) The Director may, at any time after receipt of the |
information required under subsection (b) and after finding |
that the standards of subsection (a) have not been met, order |
the insurer to cease the issuance or marketing of that |
coverage in this State. |
(d) Notwithstanding subsections (a) and (b), group Group |
accident and health insurance subject to the provisions of |
this Section is also subject to the provisions of Sections |
352c and Section 367i of this Code and rules thereunder. |
(Source: P.A. 90-655, eff. 7-30-98.)
|
(215 ILCS 5/367a) (from Ch. 73, par. 979a) |
Sec. 367a. Blanket accident and health insurance. |
(1) Blanket accident and health insurance is the that form |
of accident and health insurance providing excepted benefits, |
as defined in Section 352c, that covers covering special |
groups of persons as enumerated in one of the following |
paragraphs (a) to (g), inclusive: |
(a) Under a policy or contract issued to any carrier for |
hire, which shall be deemed the policyholder, covering a group |
defined as all persons who may become passengers on such |
carrier. |
|
(b) Under a policy or contract issued to an employer, who |
shall be deemed the policyholder, covering all employees or |
any group of employees defined by reference to exceptional |
hazards incident to such employment. |
(c) Under a policy or contract issued to a college, |
school, or other institution of learning or to the head or |
principal thereof, who or which shall be deemed the |
policyholder, covering students or teachers. However, student |
health insurance coverage, as defined in 45 CFR 147.145, shall |
remain subject to the standards and requirements for |
individual health insurance coverage except where inconsistent |
with that regulation. An issuer providing student health |
insurance coverage or a policy or contract covering students |
for limited-scope dental or vision under 45 CFR 148.220 shall |
require an individual application or enrollment form and shall |
furnish each insured individual a certificate, which shall |
have been approved by the Director under Section 355. |
(d) Under a policy or contract issued in the name of any |
volunteer fire department, first aid, or other such volunteer |
group, which shall be deemed the policyholder, covering all of |
the members of such department or group. |
(e) Under a policy or contract issued to a creditor, who |
shall be deemed the policyholder, to insure debtors of the |
creditors; Provided, however, that in the case of a loan which |
is subject to the Small Loans Act, no insurance premium or |
other cost shall be directly or indirectly charged or assessed |
|
against, or collected or received from the borrower. |
(f) Under a policy or contract issued to a sports team or |
to a camp, which team or camp sponsor shall be deemed the |
policyholder, covering members or campers. |
(g) Under a policy or contract issued to any other |
substantially similar group which, in the discretion of the |
Director, may be subject to the issuance of a blanket accident |
and health policy or contract. |
(2) Any insurance company authorized to write accident and |
health insurance in this state shall have the power to issue |
blanket accident and health insurance. No such blanket policy |
may be issued or delivered in this State unless a copy of the |
form thereof shall have been filed in accordance with Section |
355, and it contains in substance such of those provisions |
contained in Sections 357.1 through 357.30 as may be |
applicable to blanket accident and health insurance and the |
following provisions: |
(a) A provision that the policy and the application shall |
constitute the entire contract between the parties, and that |
all statements made by the policyholder shall, in absence of |
fraud, be deemed representations and not warranties, and that |
no such statements shall be used in defense to a claim under |
the policy, unless it is contained in a written application. |
(b) A provision that to the group or class thereof |
originally insured shall be added from time to time all new |
persons or individuals eligible for coverage. |
|
(3) An individual application shall not be required from a |
person covered under a blanket accident or health policy or |
contract, nor shall it be necessary for the insurer to furnish |
each person a certificate. |
(4) All benefits under any blanket accident and health |
policy shall be payable to the person insured, or to his |
designated beneficiary or beneficiaries, or to his or her |
estate, except that if the person insured be a minor or person |
under legal disability, such benefits may be made payable to |
his or her parent, guardian, or other person actually |
supporting him or her. Provided further, however, that the |
policy may provide that all or any portion of any indemnities |
provided by any such policy on account of hospital, nursing, |
medical or surgical services may, at the insurer's option, be |
paid directly to the hospital or person rendering such |
services; but the policy may not require that the service be |
rendered by a particular hospital or person. Payment so made |
shall discharge the insurer's obligation with respect to the |
amount of insurance so paid. |
(5) Nothing contained in this section shall be deemed to |
affect the legal liability of policyholders for the death of |
or injury to, any such member of such group. |
(Source: P.A. 83-1362.)
|
(215 ILCS 5/368f) |
Sec. 368f. Military service member insurance |
|
reinstatement. |
(a) No Illinois resident activated for military service |
and no spouse or dependent of the resident who becomes |
eligible for a federal government-sponsored health insurance |
program, including the TriCare program providing coverage for |
civilian dependents of military personnel, as a result of the |
activation shall be denied reinstatement into the same |
individual health insurance coverage with the health insurer |
that the resident lapsed as a result of activation or becoming |
covered by the federal government-sponsored health insurance |
program. The resident shall have the right to reinstatement in |
the same individual health insurance coverage without medical |
underwriting, subject to payment of the current premium |
charged to other persons of the same age and gender that are |
covered under the same individual health coverage. Except in |
the case of birth or adoption that occurs during the period of |
activation, reinstatement must be into the same coverage type |
as the resident held prior to lapsing the individual health |
insurance coverage and at the same or, at the option of the |
resident, higher deductible level. The reinstatement rights |
provided under this subsection (a) are not available to a |
resident or dependents if the activated person is discharged |
from the military under other than honorable conditions. |
(b) The health insurer with which the reinstatement is |
being requested must receive a request for reinstatement no |
later than 63 days following the later of (i) deactivation or |
|
(ii) loss of coverage under the federal government-sponsored |
health insurance program. The health insurer may request proof |
of loss of coverage and the timing of the loss of coverage of |
the government-sponsored coverage in order to determine |
eligibility for reinstatement into the individual coverage. |
The effective date of the reinstatement of individual health |
coverage shall be the first of the month following receipt of |
the notice requesting reinstatement. |
(c) All insurers must provide written notice to the |
policyholder of individual health coverage of the rights |
described in subsection (a) of this Section. In lieu of the |
inclusion of the notice in the individual health insurance |
policy, an insurance company may satisfy the notification |
requirement by providing a single written notice: |
(1) in conjunction with the enrollment process for a |
policyholder initially enrolling in the individual |
coverage on or after the effective date of this amendatory |
Act of the 94th General Assembly; or |
(2) by mailing written notice to policyholders whose |
coverage was effective prior to the effective date of this |
amendatory Act of the 94th General Assembly no later than |
90 days following the effective date of this amendatory |
Act of the 94th General Assembly. |
(d) The provisions of subsection (a) of this Section do |
not apply to any policy or certificate providing coverage for |
any specified disease, specified accident or accident-only |
|
coverage, credit, dental, disability income, hospital |
indemnity or other fixed indemnity, long-term care, Medicare |
supplement, vision care, or short-term travel nonrenewable |
health policy or other limited-benefit supplemental insurance, |
or any coverage issued as a supplement to any liability |
insurance, workers' compensation or similar insurance, or any |
insurance under which benefits are payable with or without |
regard to fault, whether written on a group, blanket, or |
individual basis. |
(e) Nothing in this Section shall require an insurer to |
reinstate the resident if the insurer requires residency in an |
enrollment area and those residency requirements are not met |
after deactivation or loss of coverage under the |
government-sponsored health insurance program. |
(f) All terms, conditions, and limitations of the |
individual coverage into which reinstatement is made apply |
equally to all insureds enrolled in the coverage. |
(g) The Secretary may adopt rules as may be necessary to |
carry out the provisions of this Section. |
(Source: P.A. 94-1037, eff. 7-20-06.)
|
Section 10. The Health Maintenance Organization Act is |
amended by changing Section 5-3 as follows:
|
(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) |
Sec. 5-3. Insurance Code provisions. |
|
(a) Health Maintenance Organizations shall be subject to |
the provisions of Sections 133, 134, 136, 137, 139, 140, |
141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, |
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49, |
352c, 355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, |
356v, 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, |
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, |
356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, |
356z.22, 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, |
356z.30, 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, |
356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, |
356z.44, 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, |
356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, |
356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, |
356z.68, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, |
368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, |
408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of |
subsection (2) of Section 367, and Articles IIA, VIII 1/2, |
XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the |
Illinois Insurance Code. |
(b) For purposes of the Illinois Insurance Code, except |
for Sections 444 and 444.1 and Articles XIII and XIII 1/2, |
Health Maintenance Organizations in the following categories |
are deemed to be "domestic companies": |
(1) a corporation authorized under the Dental Service |
Plan Act or the Voluntary Health Services Plans Act; |
|
(2) a corporation organized under the laws of this |
State; or |
(3) a corporation organized under the laws of another |
state, 30% or more of the enrollees of which are residents |
of this State, except a corporation subject to |
substantially the same requirements in its state of |
organization as is a "domestic company" under Article VIII |
1/2 of the Illinois Insurance Code. |
(c) In considering the merger, consolidation, or other |
acquisition of control of a Health Maintenance Organization |
pursuant to Article VIII 1/2 of the Illinois Insurance Code, |
(1) the Director shall give primary consideration to |
the continuation of benefits to enrollees and the |
financial conditions of the acquired Health Maintenance |
Organization after the merger, consolidation, or other |
acquisition of control takes effect; |
(2)(i) the criteria specified in subsection (1)(b) of |
Section 131.8 of the Illinois Insurance Code shall not |
apply and (ii) the Director, in making his determination |
with respect to the merger, consolidation, or other |
acquisition of control, need not take into account the |
effect on competition of the merger, consolidation, or |
other acquisition of control; |
(3) the Director shall have the power to require the |
following information: |
(A) certification by an independent actuary of the |
|
adequacy of the reserves of the Health Maintenance |
Organization sought to be acquired; |
(B) pro forma financial statements reflecting the |
combined balance sheets of the acquiring company and |
the Health Maintenance Organization sought to be |
acquired as of the end of the preceding year and as of |
a date 90 days prior to the acquisition, as well as pro |
forma financial statements reflecting projected |
combined operation for a period of 2 years; |
(C) a pro forma business plan detailing an |
acquiring party's plans with respect to the operation |
of the Health Maintenance Organization sought to be |
acquired for a period of not less than 3 years; and |
(D) such other information as the Director shall |
require. |
(d) The provisions of Article VIII 1/2 of the Illinois |
Insurance Code and this Section 5-3 shall apply to the sale by |
any health maintenance organization of greater than 10% of its |
enrollee population (including, without limitation, the health |
maintenance organization's right, title, and interest in and |
to its health care certificates). |
(e) In considering any management contract or service |
agreement subject to Section 141.1 of the Illinois Insurance |
Code, the Director (i) shall, in addition to the criteria |
specified in Section 141.2 of the Illinois Insurance Code, |
take into account the effect of the management contract or |
|
service agreement on the continuation of benefits to enrollees |
and the financial condition of the health maintenance |
organization to be managed or serviced, and (ii) need not take |
into account the effect of the management contract or service |
agreement on competition. |
(f) Except for small employer groups as defined in the |
Small Employer Rating, Renewability and Portability Health |
Insurance Act and except for medicare supplement policies as |
defined in Section 363 of the Illinois Insurance Code, a |
Health Maintenance Organization may by contract agree with a |
group or other enrollment unit to effect refunds or charge |
additional premiums under the following terms and conditions: |
(i) the amount of, and other terms and conditions with |
respect to, the refund or additional premium are set forth |
in the group or enrollment unit contract agreed in advance |
of the period for which a refund is to be paid or |
additional premium is to be charged (which period shall |
not be less than one year); and |
(ii) the amount of the refund or additional premium |
shall not exceed 20% of the Health Maintenance |
Organization's profitable or unprofitable experience with |
respect to the group or other enrollment unit for the |
period (and, for purposes of a refund or additional |
premium, the profitable or unprofitable experience shall |
be calculated taking into account a pro rata share of the |
Health Maintenance Organization's administrative and |
|
marketing expenses, but shall not include any refund to be |
made or additional premium to be paid pursuant to this |
subsection (f)). The Health Maintenance Organization and |
the group or enrollment unit may agree that the profitable |
or unprofitable experience may be calculated taking into |
account the refund period and the immediately preceding 2 |
plan years. |
The Health Maintenance Organization shall include a |
statement in the evidence of coverage issued to each enrollee |
describing the possibility of a refund or additional premium, |
and upon request of any group or enrollment unit, provide to |
the group or enrollment unit a description of the method used |
to calculate (1) the Health Maintenance Organization's |
profitable experience with respect to the group or enrollment |
unit and the resulting refund to the group or enrollment unit |
or (2) the Health Maintenance Organization's unprofitable |
experience with respect to the group or enrollment unit and |
the resulting additional premium to be paid by the group or |
enrollment unit. |
In no event shall the Illinois Health Maintenance |
Organization Guaranty Association be liable to pay any |
contractual obligation of an insolvent organization to pay any |
refund authorized under this Section. |
(g) Rulemaking authority to implement Public Act 95-1045, |
if any, is conditioned on the rules being adopted in |
accordance with all provisions of the Illinois Administrative |
|
Procedure Act and all rules and procedures of the Joint |
Committee on Administrative Rules; any purported rule not so |
adopted, for whatever reason, is unauthorized. |
(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; |
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. |
1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, |
eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; |
102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. |
1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, |
eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; |
103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff. |
6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, |
eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
|
Section 15. The Limited Health Service Organization Act is |
amended by changing Section 4003 as follows:
|
(215 ILCS 130/4003) (from Ch. 73, par. 1504-3) |
Sec. 4003. Illinois Insurance Code provisions. Limited |
health service organizations shall be subject to the |
provisions of Sections 133, 134, 136, 137, 139, 140, 141.1, |
141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, |
154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c, |
355.2, 355.3, 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, |
356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, |
356z.32, 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, |
|
356z.54, 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, |
364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, |
444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, |
XIII 1/2, XXV, and XXVI of the Illinois Insurance Code. |
Nothing in this Section shall require a limited health care |
plan to cover any service that is not a limited health service. |
For purposes of the Illinois Insurance Code, except for |
Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited |
health service organizations in the following categories are |
deemed to be domestic companies: |
(1) a corporation under the laws of this State; or |
(2) a corporation organized under the laws of another |
state, 30% or more of the enrollees of which are residents |
of this State, except a corporation subject to |
substantially the same requirements in its state of |
organization as is a domestic company under Article VIII |
1/2 of the Illinois Insurance Code. |
(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; |
102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff. |
1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816, |
eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; |
102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. |
1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, |
eff. 1-1-24; revised 8-29-23.)
|
(215 ILCS 190/Act rep.) |
