(215 ILCS 5/352)
(from Ch. 73, par. 964)
Scope of Article.
(a) Except as provided in subsections (b), (c), (d), and (e),
this Article shall
apply to all companies transacting in this State the kinds of business
enumerated in clause (b) of Class 1 and clause (a) of Class 2 of section 4.
Nothing in this Article shall apply to, or in any way affect policies or
contracts described in clause (a) of Class 1 of Section 4; however, this
Article shall apply to policies and contracts which contain benefits
providing reimbursement for the expenses of long term health care which are
certified or ordered by a physician including but not limited to
professional nursing care, custodial nursing care, and non-nursing
custodial care provided in a nursing home or at a residence of the insured.
(c) A policy issued and delivered in this State
that provides coverage under that policy for
certificate holders who are neither residents of nor employed in this State
does not need to provide to those nonresident
certificate holders who are not employed in this State the coverages or
services mandated by this Article.
(d) Stop-loss insurance is exempt from all Sections
of this Article, except this Section and Sections 353a, 354, 357.30, and
370. For purposes of this exemption, stop-loss insurance is further defined as
(1) The policy must be issued to and insure an
employer, trustee, or other sponsor of the plan, or the plan itself, but not employees, members, or participants.
(2) Payments by the insurer must be made to the
employer, trustee, or other sponsors of the plan, or the plan itself, but not to the employees, members, participants, or health care providers.
(e) A policy issued or delivered in this State to the Department of Healthcare and Family Services (formerly
of Public Aid) and providing coverage, under clause (b) of Class 1 or clause (a)
of Class 2 as described in Section 4, to persons who are enrolled under Article V of the Illinois
Public Aid Code or under the Children's Health Insurance Program Act is
exempt from all restrictions, limitations,
standards, rules, or regulations respecting benefits imposed by or under
authority of this Code, except those specified by subsection (1) of Section
143, Section 370c, and Section 370c.1. Nothing in this subsection, however, affects the total medical services
available to persons eligible for medical assistance under the Illinois Public
(Source: P.A. 99-480, eff. 9-9-15.)