(215 ILCS 125/5-5)
(from Ch. 111 1/2, par. 1413)
Suspension, revocation or denial of certification of authority.
The Director may suspend or revoke any certificate of authority issued
to a health maintenance organization under this Act or deny an
application for a certificate of authority if he finds any of the
(a) The health maintenance organization is operating significantly
in contravention of its basic organizational document, its health care
plan, or in a manner contrary to that described in any information
submitted under Section 2-1 or 4-12.
(b) The health maintenance organization issues contracts or
evidences of coverage or uses a schedule of charges for health care
services that do not comply with the requirement of Section 2-1
(c) The health care plan does not provide or arrange for basic health
care services, except as provided in Section 4-13 concerning mental health
services for clients of the Department of Children and Family Services.
(d) The Director of Public Health certifies to the Director that
(1) the health maintenance organization does not meet the requirements of
Section 2-2 or (2) the health maintenance organization is unable to fulfill
its obligations to furnish health care services as required under its
health care plan. The Department of Public Health shall promulgate by
rule, pursuant to the Illinois Administrative Procedure Act, the precise
standards used for determining what constitutes a material
misrepresentation, what constitutes a material violation of a contract or
evidence of coverage, or what constitutes good faith with regard to
certification under this paragraph.
(e) The health maintenance organization is no longer financially
responsible and may reasonably be expected to be unable to meet its
obligations to enrollees or prospective enrollees.
(f) The health maintenance organization, or any person on its behalf,
has advertised or merchandised its services in an untrue, misrepresentative,
misleading, deceptive, or unfair manner.
(g) The continued operation of the health maintenance organization would
be hazardous to its enrollees.
(h) The health maintenance organization has neglected to correct, within the
time prescribed by subsection (c) of Section 2-4, any deficiency occurring due
to the organization's prescribed minimum net worth or special contingent
reserve being impaired.
(i) The health maintenance organization has otherwise failed to
substantially comply with this Act.
(j) The health maintenance organization has failed to meet the
requirements for issuance of a certificate of authority set forth in
When the certificate of authority of a health maintenance organization
is revoked, the organization shall proceed, immediately following the
effective date of the order of revocation, to wind up its affairs and shall
conduct no further business except as may be essential to the orderly
conclusion of the affairs of the organization. The Director may permit further
operation of the organization that he finds to be in the best interest of
enrollees to the end that the enrollees will be afforded the greatest practical
opportunity to obtain health care services.
(Source: P.A. 88-487.)