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Illinois Compiled Statutes
Information maintained by the Legislative Reference Bureau Updating the database of the Illinois Compiled Statutes (ILCS) is an ongoing process. Recent laws may not yet be included in the ILCS database, but they are found on this site as Public Acts soon after they become law. For information concerning the relationship between statutes and Public Acts, refer to the Guide. Because the statute database is maintained primarily for legislative drafting purposes, statutory changes are sometimes included in the statute database before they take effect. If the source note at the end of a Section of the statutes includes a Public Act that has not yet taken effect, the version of the law that is currently in effect may have already been removed from the database and you should refer to that Public Act to see the changes made to the current law.
INSURANCE (215 ILCS 5/) Illinois Insurance Code. 215 ILCS 5/367g
(215 ILCS 5/367g) (from Ch. 73, par. 979g)
Sec. 367g.
Police officer's continuance privilege.
As used in this Section:
1. The terms "municipality" and "creditable service"
shall have the meaning ascribed to such terms by Sections 3-103
and 3-110, respectively, of the Illinois Pension Code, as now or hereafter amended.
The term "deferred pensioner" means a police officer who has retired,
having accumulated enough creditable service to qualify for a pension, but
who has not attained the required age.
2. The term "police officer" shall have the meaning ascribed
to it by Section 3-106 of the Illinois Pension Code, and include those
persons under the coverage of Article 3 of that Code, as heretofore or hereafter
amended.
3. The "retirement or disability period" of a police officer means the period:
a. which begins on the day the police officer is removed from a municipality's
police department payroll because of the occurrence of any of the following
events, to wit: (i) the police officer retires as a deferred pensioner,
(ii) the police officer retires from active
service as a police officer with an attained age and accumulated creditable service
which together qualify the police officer for immediate receipt of retirement pension
benefits under Section 3-111 of the Illinois Pension Code, or (iii) the
police officer's disability is established under Section 3-115 of the Illinois
Pension Code; and
b. which ends on the first to occur of any of the following events,
to wit: (i) the police officer's reinstatement or reentry into active service
on the municipality's police department as provided for under Article 3 of
the Illinois Pension Code, (ii) the police officer's exercise of any refund option
available under Section 3-124 of the Illinois Pension Code, (iii) the police officer's
loss pursuant to Section 3-147 of the Illinois Pension Code of any benefits
provided for in Article 3 of that Code, or (iv) the police officer's death or --
if at the time of the police officer's death the police officer is survived by a spouse
who, in that capacity, is entitled to receive a surviving spouse's monthly
pension pursuant to Article 3 of the Illinois Pension Code -- the death
or remarriage of that spouse.
No policy of group accident and health insurance under which policemen
employed by a municipality are insured for their individual benefit shall
be issued or delivered in this State to any municipality unless such group
policy provides for the election of continued group insurance coverage for
the retirement or disability period of each police officer who is insured under the
provisions of the group policy on the day immediately preceding the day
on which the retirement or disability period of such police officer begins. So
long as any required premiums for continued group insurance coverage are
paid in accordance with the provisions of the group policy, an election
made pursuant to this Section shall provide continued group insurance coverage
for a police officer throughout the retirement or disability period of the
police officer and, unless
the police officer otherwise elects and subject to any other provisions of the
group policy which relate either to the provision or to the termination
of dependents' coverage and which are not inconsistent with this Section,
for any dependents of the police officer who are insured under the group policy on the
day immediately preceding the day on which the retirement or disability
period of the police officer begins; provided, however, that when such continued
group insurance coverage is in effect with respect to a police officer on the date
of the police officer's death but the retirement or disability period of
the police officer
does not end with such police officer's death, then the deceased police
officer's surviving
spouse upon whose death or remarriage such retirement or disability period
will end shall be entitled, without further election and upon payment of
any required premiums in accordance with the provisions of the group policy,
to maintain such continued group
insurance coverage in effect until the end of such retirement or disability
period. Continued group insurance coverage shall be provided in accordance
with this Section at the same premium rate from time to time charged for
equivalent coverage provided under the group policy with respect to covered
policemen whose retirement or disability period has not begun, and no distinction
or discrimination in the amount or rate of premiums or in any waiver of premium
or other benefit provision shall be made between continued group insurance
coverage elected pursuant to this Section and equivalent coverage provided
to policemen under the group policy other than pursuant to the provisions
of this Section; provided that no municipality shall be required by reason
of any provision of this Section to pay any group insurance premium other
than one that may be negotiated in a collective bargaining agreement.
If the group policy provides for a reduction in benefits and premium for
insureds who become eligible for medicare, such provision shall apply to
persons electing continued coverage under this Section.
Within 15 days of the beginning of the retirement or disability period
of any police officer entitled to elect continued group insurance coverage under any
group policy affected by this Section, the municipality last employing such
police officer shall give written notice of such beginning by certified mail, return
receipt requested to the insurance company issuing such policy. The notice
shall include the police officer's name and last known place of residence and the
beginning date of the police officer's retirement or disability period.
Within 15 days of the date of receipt of such notice from the municipality,
the insurance company by certified mail, return receipt requested, shall
give written notice to the police officer at the police officer's last known place of
residence that coverage under the group policy may be continued for the
retirement or disability period of the police officer as provided in this Section.
Such notice shall set forth: (i) a statement of election to be filed by
the police officer if the police officer wishes to continue such group insurance
coverage,
(ii) the amount of monthly premium, including a statement of the portion
of such monthly premium attributable to any dependents' coverage which the
police officer may elect, and (iii) instructions as to the return of the election
form to the insurance company issuing such policy. Election shall be made,
if at all, by returning the statement of election to the insurance company
by certified mail, return receipt requested within 15 days after having received it.
If the police officer elects to continue coverage, it shall be the obligation
of the police officer to pay the monthly premium directly to the municipality which
shall forward it to the insurance company
issuing the group insurance policy, or as otherwise directed by the insurance
company; provided, however, that the police officer shall be entitled to designate
on the statement of election required to be filed with the insurance company
that the total monthly premium, or such portion thereof as is not
contributed by a municipality, be deducted by a Police Pension Fund
from any monthly pension payment otherwise payable
to or on behalf of the police officer pursuant to Article 3 of the Illinois Pension
Code, and be remitted by such Pension Fund to the insurance company. The
portion, if any, of the monthly premium contributed by a
municipality for such continued group insurance coverage shall be paid by
the municipality directly to the insurance company issuing the group insurance
policy, or as otherwise directed by the insurance company. Such continued
group insurance coverage shall relate back to the beginning of the police officer's
retirement or disability period.
The amendment, renewal or extension of any group insurance policy affected
by this Section shall be deemed to be the issuance of a new policy of insurance
for purposes of this Section.
In the event that a municipality makes a program of accident, health,
hospital or medical benefits available to its police officers through
self-insurance, or by participation in a pool or reciprocal insurer, or by
contract in a form other than a policy of group insurance with one or more
medical service plans, health care service corporations, health maintenance
organizations, or any other professional corporations or plans under which
health care or reimbursement for the costs thereof is
provided, whether the cost of such benefits is borne by the municipality or
the police officers or both, such police officers and their surviving spouses shall have
the same right to elect continued coverage under such program of benefits
as they would have if such benefits were provided by a policy of group
accident and health insurance. In such cases, the notice of right to elect
continued coverage shall be sent by the municipality; the statement of
election shall be sent to the municipality; and references to the required
premium shall refer to that portion of the cost of such benefits which is not
borne by the municipality, either voluntarily or pursuant to the provisions
of a collective bargaining agreement. In the case of a municipality
providing such benefits through self-insurance or participation in a pool or
reciprocal insurer, the right to elect continued coverage which is provided
by this paragraph shall be implemented and made available to the police officers of
the municipality and qualifying surviving spouses not later than July 1, 1986.
The amendment, renewal or extension of any such contract in a form other
than a policy of group insurance policy shall be deemed the formation of a
new contract for the purposes of this Section.
This Section shall not limit the exercise of any conversion privileges
available under Section 367e.
(Source: P.A. 84-1010.)
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215 ILCS 5/367h
(215 ILCS 5/367h) (from Ch. 73, par. 979h)
Sec. 367h.
Deputy's continuance privilege.
As used in this Section:
1. The terms "municipality" and "creditable service"
shall have the meaning ascribed to such terms by Sections 7-105
and 7-113, respectively, of the Illinois Pension Code, as now or hereafter
amended.
The term "deferred pensioner" means a deputy who has retired,
having accumulated enough creditable service to qualify for a pension, but
who has not attained the required age.
2. The term "deputy" shall mean a "sheriff's
law enforcement employee" as defined in Section 7-109.3 of the Illinois
Pension Code, and include only
persons under the coverage of Article 7 of that Code, as heretofore or
hereafter
amended.
3. The "retirement or disability period" of a deputy means the period:
a. which begins on the day the deputy is removed from | | a sheriff's police department payroll because of the occurrence of any of the following events, to wit: (i) the deputy retires as a deferred pensioner, (ii) the deputy retires from active service as a deputy with an attained age and accumulated creditable service which together qualify the deputy for immediate receipt of retirement pension benefits under Section 7-142.1 of the Illinois Pension Code, or (iii) the deputy's disability is established under Article 7 of the Illinois Pension Code; and
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b. which ends on the first to occur of any of the
| | following events, to wit: (i) the deputy's reinstatement or reentry into active service in the sheriff's police department as provided for under Article 7 of the Illinois Pension Code, (ii) the deputy's exercise of any refund option or acceptance of any separation benefit available under Article 7 of the Illinois Pension Code, (iii) the deputy's loss pursuant to Section 7-219 of the Illinois Pension Code of any benefits provided for in Article 7 of that Code, or (iv) the deputy's death or -- if at the time of the deputy's death the deputy is survived by a spouse who, in that capacity, is entitled to receive a surviving spouse's monthly pension pursuant to Article 7 of the Illinois Pension Code -- the death or remarriage of that spouse.
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No policy of group accident and health insurance under which deputies
employed by a municipality are insured for their individual benefit shall
be issued or delivered in this State to any municipality unless such group
policy provides for the election of continued group insurance coverage for
the retirement or disability period of each deputy who is insured under the
provisions of the group policy on the day immediately preceding the day
on which the retirement or disability period of such deputy begins. So
long as any required premiums for continued group insurance coverage are
paid in accordance with the provisions of the group policy, an election
made pursuant to this Section shall provide continued group insurance coverage
for a deputy throughout the retirement or disability period of the
deputy and, unless
the deputy otherwise elects and subject to any other provisions of the
group policy which relate either to the provision or to the termination
of dependents' coverage and which are not inconsistent with this Section,
for any dependents of the deputy who are insured under the group policy on the
day immediately preceding the day on which the retirement or disability
period of the deputy begins; provided, however, that when such continued
group insurance coverage is in effect with respect to a deputy on the date
of the deputy's death but the retirement or disability period of
the deputy
does not end with such deputy's death, then the deceased deputy's surviving
spouse upon whose death or remarriage such retirement or disability period
will end shall be entitled, without further election and upon payment of
any required premiums in accordance with the provisions of the group policy,
to maintain such continued group insurance coverage in effect until the end of
such retirement or disability period. Continued group insurance coverage shall
be provided in accordance with this Section at the same premium rate from time
to time charged for equivalent coverage provided under the group policy with
respect to covered deputies whose retirement or disability period has not
begun, and no distinction or discrimination in the amount or rate of premiums
or in any waiver of premium
or other benefit provision shall be made between continued group insurance
coverage elected pursuant to this Section and equivalent coverage provided
to deputies under the group policy other than pursuant to the provisions
of this Section; provided that no municipality shall be required by reason
of any provision of this Section to pay any group insurance premium other
than one that may be negotiated in a collective bargaining agreement.
If the group policy provides for a reduction in benefits and premium for
insureds who become eligible for medicare, such provision shall apply to
persons electing continued coverage under this Section.
Within 15 days of the beginning of the retirement or disability period
of any deputy entitled to elect continued group insurance coverage under any
group policy affected by this Section, the municipality last employing such
deputy shall give written notice of such beginning by certified mail, return
receipt requested, to the insurance company issuing such policy. The notice
shall include the deputy's name and last known place of residence and the
beginning date of the deputy's retirement or disability period.
Within 15 days of the date of receipt of such notice from the municipality,
the insurance company by certified mail, return receipt requested, shall
give written notice to the deputy at the deputy's last known place of
residence that coverage under the group policy may be continued for the
retirement or disability period of the deputy as provided in this Section.
Such notice shall set forth: (i) a statement of election to be filed by
the deputy if the deputy wishes to continue such group insurance
coverage,
(ii) the amount of monthly premium, including a statement of the portion
of such monthly premium attributable to any dependents' coverage which the
deputy may elect, and (iii) instructions as to the return of the election
form to the insurance company issuing such policy. Election shall be made,
if at all, by returning the statement of election to the insurance company
by certified mail, return receipt requested, within 15 days after having
received it.
If the deputy elects to continue coverage, it shall be the obligation
of the deputy to pay the monthly premium directly to the municipality which
shall forward it to the insurance company issuing the group insurance
policy, or as otherwise
directed by the insurance company; provided, however, that the deputy
shall be entitled to designate on the statement of election
required to be filed with the insurance company that the total
monthly premium, or such portion thereof as is not contributed by
a municipality, be deducted by the Illinois Municipal Retirement Fund
from the monthly pension payment otherwise payable
to or on behalf of the deputy pursuant to Article 7 of the Illinois Pension Code, and be remitted by such Fund to
the insurance company. The portion, if any, of the monthly premium
contributed by a municipality for such continued group insurance
coverage shall be paid by
the directly to the insurance company issuing the group insurance
policy, or as directed by the insurance company. Such continued
group insurance coverage shall relate back to the beginning of the deputy's
retirement or disability period.
The amendment, renewal or extension of any group insurance policy affected
by this Section shall be deemed to be the issuance of a new policy of insurance
for purposes of this Section.
In the event that a municipality makes a program of accident, health,
hospital or medical benefits available to its deputies through
self-insurance, or by participation in a pool or reciprocal insurer, or by
contract in a form other than a policy of group insurance with one or more
medical service plans, health care service corporations, health maintenance
organizations, or any other professional corporations or plans under which
health care or reimbursement for the costs thereof is
provided, whether the cost of such benefits is borne by the municipality or
the deputies or both, such deputies and their surviving spouses shall have
the same right to elect continued coverage under such program of benefits
as they would have if such benefits were provided by a policy of group
accident and health insurance. In such cases, the notice of right to elect
continued coverage shall be sent by the municipality; the statement of
election shall be sent to the municipality; and references to the required
premium shall refer to that portion of the cost of such benefits which is not
borne by the municipality, either voluntarily or pursuant to the provisions
of a collective bargaining agreement. In the case of a municipality
providing such benefits through self-insurance or participation in a pool or
reciprocal insurer, the right to elect continued coverage which is provided
by this paragraph shall be implemented and made available to the deputies of
the municipality and qualifying surviving spouses not later than July 1, 1986.
The amendment, renewal or extension of any such contract in a form other
than a policy of group insurance policy shall be deemed the formation of a
new contract for the purposes of this Section.
This Section shall not limit the exercise of any conversion privileges
available under Section 367e.
(Source: P.A. 90-655, eff. 7-30-98.)
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215 ILCS 5/367i
(215 ILCS 5/367i) (from Ch. 73, par. 979i)
Sec. 367i. Discontinuance and replacement of coverage. Group health
insurance policies issued, amended, delivered or renewed on and after the
effective date of this amendatory Act of 1989, shall provide a reasonable
extension of benefits in the event of total disability on the date the
policy is discontinued for any reason.
Any applicable extension of benefits or accrued liability shall be
described in the policy and group certificate. Benefits payable during any
extension of benefits may be subject to the policy's regular benefit limits.
Any insurer discontinuing a group health insurance policy shall provide
to the policyholder for delivery to covered employees or members a notice
as to the date such discontinuation is to be effective and urging them to
refer to their group certificates to determine what contract rights, if
any, are available to them.
In the event a discontinued policy is replaced by another group policy,
the prior insurer or plan shall be liable only to the extent of its accrued
liabilities and extension of benefits. Persons eligible for coverage
under the succeeding insurer's plan shall include all
employees and dependents covered under the prior insurer's plan, including
individuals with disabilities covered under the prior plan but absent from work on the
effective date and thereafter. The prior insurer shall provide extension of
benefits for an insured's disabling condition when no coverage is available
under the succeeding insurer's plan whether due to the absence of coverage in
the contract or lack of required creditable coverage for a preexisting
condition.
The Director shall promulgate reasonable rules as necessary to carry
out this Section.
(Source: P.A. 99-143, eff. 7-27-15.)
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215 ILCS 5/367j
(215 ILCS 5/367j) (from Ch. 73, par. 979j)
Sec. 367j.
Municipal employee's continuance privilege.
(a) As used in this Section:
(1) The term "creditable service" shall have the | | meaning ascribed to it by Section 7-113 of the Illinois Pension Code.
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(2) The term "municipality" means any municipality,
| | instrumentality, or participating instrumentality (as those terms are defined in Sections 7-105, 7-107 and 7-108, respectively, of the Illinois Pension Code) that participates in the Illinois Municipal Retirement Fund pursuant to Section 7-132 of the Illinois Pension Code.
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(3) The term "employee" shall mean an employee as
| | defined in Section 7-109 of the Illinois Pension Code, but does not include any person who is a deputy as defined in Section 367h of this Code.
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(4) The "retirement or disability period" of an
| | employee means the period:
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(A) which begins on the day the employee is
| | removed from the municipality payroll because of the occurrence of either of the following events: (i) the employee retires from active service as an employee with an attained age and accumulated creditable service which together qualify the employee for immediate receipt of retirement pension benefits under Article 7 of the Illinois Pension Code, or (ii) the employee's disability is established under Article 7 of the Illinois Pension Code; and
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(B) which ends on the first to occur of any of
| | the following events: (i) the employee's reinstatement or reentry into active service as provided for under Article 7 of the Illinois Pension Code, (ii) the employee's exercise of any refund option or acceptance of any separation benefit available under Article 7 of the Illinois Pension Code, (iii) the employee's loss pursuant to Section 7-219 of the Illinois Pension Code of any benefits provided for in Article 7 of that Code, or (iv) the employee's death or, if at the time of the employee's death the employee is survived by a spouse who, in that capacity, is entitled to receive a surviving spouse's monthly pension pursuant to Article 7 of the Illinois Pension Code, the death or remarriage of that spouse.
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(b) No policy of group accident and health insurance under which
employees of a municipality are insured for their individual benefit shall
be issued or delivered in this State to a municipality unless such group
policy provides for the election of continued group insurance coverage for
the retirement or disability period of each employee who is insured under
the provisions of the group policy on the day immediately preceding the day
on which the retirement or disability period of such employee begins. So
long as any required premiums for continued group insurance coverage are
paid in accordance with the provisions of the group policy, an election
made pursuant to this Section shall provide continued group insurance
coverage for an employee throughout the retirement or disability period of
the employee and, unless the employee otherwise elects and subject to any
other provisions of the group policy which relate either to the provision
or to the termination of dependents' coverage and which are not
inconsistent with this Section, for any dependents of the employee who are
insured under the group policy on the day immediately preceding the day on
which the retirement or disability period of the employee begins; provided,
however, that when such continued group insurance coverage is in effect
with respect to an employee on the date of the employee's death but the
retirement or disability period of the employee does not end with the
employee's death, then the deceased employee's surviving spouse upon whose
death or remarriage such retirement or disability period will end shall be
entitled, without further election and upon payment of any required
premiums in accordance with the provisions of the group policy, to maintain
such continued group insurance coverage in effect until the end of the
retirement or disability period. Continued group insurance coverage shall
be provided in accordance with this Section at the same premium rate from
time to time charged for equivalent coverage provided under the group
policy with respect to covered employees whose retirement or disability
period has not begun, and no distinction or discrimination in the amount or
rate of premiums or in any waiver of premium or other benefit provision
shall be made between continued group insurance coverage elected pursuant
to this Section and equivalent coverage provided to employees under the
group policy other than pursuant to the provisions of this Section;
provided that no municipality shall be required by reason of any provision
of this Section to pay any group insurance premium other than one that may
be negotiated in a collective bargaining agreement. If the group policy
provides for a reduction in benefits and premium for insureds who become
eligible for medicare, such provision shall apply to persons electing
continued coverage under this Section.
Within 15 days of the beginning of the retirement or disability period of
any employee entitled to elect continued group insurance coverage under any
group policy affected by this Section, the municipality last employing such
employee shall give written notice of such beginning by certified mail,
return receipt requested, to the insurance company issuing such policy.
The notice shall include the employee's name and last known place of
residence and the beginning date of the employee's retirement or disability
period.
Within 15 days of the date of receipt of such notice from the municipality,
the insurance company by certified mail, return receipt requested, shall
give written notice to the employee at the employee's last known place of
residence that coverage under the group policy may be continued for the
retirement or disability period of the employee as provided in this
Section. Such notice shall set forth: (i) a statement of election to be
filed by the employee if the employee wishes to continue such group
insurance coverage, (ii) the amount of monthly premium, including a
statement of the portion of such monthly premium attributable to any
dependents' coverage which the employee may elect, and (iii) instructions
as to the return of the election form to the insurance company issuing such
policy. Election shall be made, if at all, by returning the statement of
election to the insurance company by certified mail, return receipt
requested, within 15 days after having received it.
If the employee elects to continue coverage, it shall be the obligation
of the employee to pay the monthly premium directly to the municipality
which shall forward it to the insurance company issuing the group insurance
policy, or as otherwise directed by the insurance company; provided,
however, that the employee shall be entitled to designate on the statement
of election required to be filed with the insurance company that the total
monthly premium, or such portion thereof as is not contributed by a
municipality, be deducted by the Illinois Municipal Retirement Fund from
the monthly pension payment otherwise payable to or on behalf of the
employee pursuant to Article 7 of the Illinois Pension Code, and be
remitted by such Fund to the insurance company. The portion, if any, of
the monthly premium contributed by a municipality for such continued group
insurance coverage shall be paid by the municipality directly to the
insurance company issuing the group insurance policy, or as directed by the
insurance company. Such continued group insurance coverage shall relate
back to the beginning of the employee's retirement or disability period.
The amendment, renewal or extension of any group insurance policy affected
by this Section shall be deemed to be the issuance of a new policy of insurance
for purposes of this Section.
(c) In the event that a municipality makes a program of accident,
health, hospital or medical benefits available to its employees through
self-insurance, or by participation in a pool or reciprocal insurer, or by
contract in a form other than a policy of group insurance with one or more
medical service plans, health care service corporations, health maintenance
organizations, or any other professional corporations or plans under which
health care or reimbursement for the costs thereof is provided, whether the
cost of such benefits is borne by the municipality or the employees or
both, such employees and their surviving spouses shall have the same
right to elect continued coverage under such program of benefits
as they would have if such benefits were provided by a policy of group
accident and health insurance. In such cases, the notice of right to elect
continued coverage shall be sent by the municipality; the statement of
election shall be sent to the municipality; and references to the required
premium shall refer to that portion of the cost of such benefits which is not
borne by the municipality, either voluntarily or pursuant to the provisions
of a collective bargaining agreement. In the case of a municipality
providing such benefits through self-insurance or participation in a pool or
reciprocal insurer, the right to elect continued coverage which is provided
by this paragraph shall be implemented and made available to the employees
of the municipality and qualifying surviving spouses not later than July 1,
1991.
The amendment, renewal or extension of any such contract in a form other
than a policy of group insurance policy shall be deemed the formation of a
new contract for the purposes of this Section.
(d) This Section shall not limit the exercise of any conversion
privileges available under Section 367e.
(Source: P.A. 86-1444; 87-435.)
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215 ILCS 5/367k (215 ILCS 5/367k) Sec. 367k. Intoxication and narcotics; exclusion of coverage prohibited.
(a) A group or individual major medical policy of accident or health insurance or managed care plan amended, delivered, issued, or renewed after January 1, 2008 shall not, solely on the basis of the insured being intoxicated or under the influence of a narcotic, exclude coverage for any emergency or other medical, hospital, or surgical expenses incurred by an insured as a result of and related to an injury acquired while the insured is intoxicated or under the influence of any narcotic, regardless of whether the intoxicant or narcotic is administered on the advice of a health care practitioner. (b) Coverage required under this Section may be subject to deductibles, copayments, coinsurance, or annual or maximum payment limits that are consistent with deductibles, copayments, coinsurance, or annual or maximum payment limits applicable to other similar coverage under the plan.
(Source: P.A. 95-230, eff. 1-1-08.) |
215 ILCS 5/367m (215 ILCS 5/367m) Sec. 367m. Early intervention services. A policy of accident and health insurance that provides coverage for early intervention services must conform to the following criteria: (1) The use of private health insurance to pay for | | early intervention services under Part C of the federal Individuals with Disabilities Education Act may not count towards or result in a loss of benefits due to annual or lifetime insurance caps for an infant or toddler with a disability, the infant's or toddler's parent, or the infant's or toddler's family members who are covered under that health insurance policy.
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| (2) The use of private health insurance to pay for
| | early intervention services under Part C of the federal Individuals with Disabilities Education Act may not negatively affect the availability of health insurance to an infant or toddler with a disability, the infant's or toddler's parent, or the infant's or toddler's family members who are covered under that health insurance policy, and health insurance coverage may not be discontinued for these individuals due to the use of the health insurance to pay for services under Part C of the federal Individuals with Disabilities Education Act.
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| (3) The use of private health insurance to pay for
| | early intervention services under Part C of the federal Individuals with Disabilities Education Act may not be the basis for increasing the health insurance premiums of an infant or toddler with a disability, the infant's or toddler's parent, or the infant's or toddler's family members covered under that health insurance policy.
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| For the purposes of this Section, "early intervention services" has the same meaning as in the Early Intervention Services System Act.
(Source: P.A. 98-41, eff. 6-28-13.)
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215 ILCS 5/368
(215 ILCS 5/368) (from Ch. 73, par. 980)
Sec. 368.
Industrial
accident and health insurance.
(1) Industrial accident and health insurance is hereby declared to be
that form of accident and health insurance in which the premium is payable
weekly.
(2) Any insurance company authorized to write accident and health
insurance in this State shall have power to issue industrial accident and
health policies. No policy of industrial accident and health insurance may
be issued or delivered in this State unless it has printed thereon the
words "Industrial Policy," a copy of the form thereof shall have been filed
with the department and approved by it in accordance with section 355.
(Source: Laws 1951, p. 611.)
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215 ILCS 5/368a
(215 ILCS 5/368a)
Sec. 368a. Timely payment for health care services.
(a) This Section applies to insurers, health maintenance organizations,
managed care plans, health care plans, preferred provider organizations, third
party
administrators, independent practice associations, and physician-hospital
organizations (hereinafter referred to as "payors") that
provide
periodic payments, which are payments not requiring a claim, bill, capitation
encounter
data, or capitation reconciliation reports, such as
prospective capitation payments, to
health care professionals and health care facilities
to provide medical or health care services for insureds or enrollees.
(1) A payor shall make periodic payments in | | accordance with item (3). Failure to make periodic payments within the period of time specified in item (3) shall entitle the health care professional or health care facility to interest at the rate of 9% per year from the date payment was required to be made to the date of the late payment, provided that interest amounting to less than $1 need not be paid. Any required interest payments shall be made within 30 days after the payment.
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(2) When a payor requires selection of a health care
| | professional or health care facility, the selection shall be completed by the insured or enrollee no later than 30 days after enrollment. The payor shall provide written notice of this requirement to all insureds and enrollees. Nothing in this Section shall be construed to require a payor to select a health care professional or health care facility for an insured or enrollee.
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(3) A payor shall provide the health care
| | professional or health care facility with notice of the selection as a health care professional or health care facility by an insured or enrollee and the effective date of the selection within 60 calendar days after the selection. No later than the 60th day following the date an insured or enrollee has selected a health care professional or health care facility or the date that selection becomes effective, whichever is later, or in cases of retrospective enrollment only, 30 days after notice by an employer to the payor of the selection, a payor shall begin periodic payment of the required amounts to the insured's or enrollee's health care professional or health care facility, or the designee of either, calculated from the date of selection or the date the selection becomes effective, whichever is later. All subsequent payments shall be made in accordance with a monthly periodic cycle.
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(b) Notwithstanding any other provision of this Section,
independent practice associations and physician-hospital organizations shall
make periodic payment of the required amounts in
accordance with a monthly periodic schedule after
an insured or enrollee has selected a health care professional or health care
facility or after that selection becomes effective, whichever
is later.
Notwithstanding any other provision of this Section, independent
practice associations and physician-hospital organizations shall make all
other payments for health services within 30 days after receipt of
due proof
of loss. Independent
practice associations and physician-hospital organizations shall notify the
insured, insured's assignee, health care professional, or health care facility
of any failure to provide sufficient documentation for a due proof of
loss within 30 days after receipt of the claim for health services.
Failure to pay within the required time period shall entitle the payee to
interest at the rate of 9% per year from the date the payment is due to the
date of the late payment, provided that interest amounting to less than $1
need not be paid. Any required interest payments shall be made within 30
days after the payment.
(c) All insurers, health maintenance
organizations, managed care plans, health care plans, preferred provider
organizations, and third party administrators
shall ensure that all claims and indemnities
concerning health care services
other than for
any periodic payment shall be paid within 30 days after receipt of due
written proof of such loss. An insured, insured's assignee, health care
professional, or health care facility shall be
notified of any known failure to provide sufficient documentation for a
due proof of
loss within 30 days after receipt of the claim for health care
services.
Failure to pay
within such period shall entitle the payee
to interest at the rate of 9% per year from the 30th day after
receipt of such proof of loss to
the date of late payment, provided that interest amounting to less than one
dollar need not be paid. Any
required interest payments shall be made within 30 days after the payment.
(d) The Department shall enforce the provisions of this Section pursuant to
the enforcement powers granted to it by law.
(e) The Department is hereby granted specific authority to issue a
cease and desist order, fine, or otherwise penalize independent practice
associations and physician-hospital organizations that violate this Section.
The Department shall adopt reasonable rules to enforce compliance with this
Section by
independent practice associations and physician-hospital organizations.
(Source: P.A. 97-813, eff. 7-13-12.)
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215 ILCS 5/368b
(215 ILCS 5/368b)
Sec. 368b. Contracting procedures.
(a) A health care professional or health care provider offered a contract by
an
insurer, health maintenance organization,
independent practice association, or physician
hospital organization for signature after the effective date of this amendatory
Act of the
93rd General Assembly shall be provided with a proposed health care
professional or
health care provider
services contract including, if any, exhibits and attachments that the contract
indicates are
to be attached. Within 35 days after a written request, the health care
professional or health
care provider offered a contract shall be given the opportunity to review and
obtain a
copy of the following: a specialty-specific fee schedule sample based on a
minimum of
the 50 highest volume fee schedule codes with the rates applicable to the
health care
professional or health care provider to whom the contract is offered, the
network
provider
administration manual, and a summary capitation schedule, if payment is made on
a
capitation basis. If 50 codes do not exist for a particular specialty, the
health care
professional or health care provider offered a contract shall be given the
opportunity to
review or obtain a copy of a fee schedule sample with the codes applicable to
that
particular specialty. This information may be provided electronically. An
insurer, health
maintenance organization, independent practice
association, or physician hospital
organization may substitute the fee schedule sample with a document providing
reference
to the information needed to calculate the fee schedule that is available to
the public at no
charge and the percentage or conversion factor at which the insurer, health
maintenance
organization, preferred provider organization, independent practice
association, or physician hospital organization sets its rates.
(b) The fee schedule, the capitation schedule, and
the network provider
administration manual constitute confidential, proprietary, and trade secret
information and are subject to the provisions of the Illinois Trade Secrets
Act.
The health
care professional or health care provider receiving such protected information
may disclose
the information on a need to know basis and only to individuals and entities
that provide
services directly related to the health care professional's or health care
provider's decision
to enter into the contract or keep the contract in force. Any person or entity
receiving or
reviewing such protected information pursuant to this Section shall not
disclose
the
information to any other person, organization, or entity, unless the disclosure
is requested
pursuant to a valid court order or required by a state or federal government
agency.
Individuals or entities receiving such information from a health care
professional
or health care provider as delineated in this subsection are subject to the
provisions of the
Illinois Trade Secrets Act.
(c) The health care professional or health care provider shall be allowed at
least
30 days to review the health care professional or health care provider services
contract, including
exhibits and
attachments, if any, before signing. The 30-day review period begins upon
receipt of the
health care
professional or health care provider services contract, unless the information
available
upon request
in subsection (a) is not included. If information is not included in the
professional
services contract and is requested pursuant to subsection (a), the 30-day
review period
begins on the date of receipt of the information. Nothing in this subsection
shall prohibit
a health care professional or health care provider from signing a contract
prior to the
expiration of the 30-day review period.
(d) As used in this subsection: "Change" means an increase or decrease in the fee schedule referred to in subsection (a). "Nonroutine change" means any proposed change to the fee schedule except a change that is otherwise required by law, regulation, or an applicable regulatory authority or that is required as a result of changes in fee schedules, reimbursement methodology, or payment policies established by a government agency or by the American Medical Association's current procedural terminology codes, reporting guidelines, and conventions, or a change that is expressly provided for under the terms of the contract by the inclusion of or reference to a specific fee or fee schedule, reimbursement methodology, or payment policy indexing mechanism. The insurer, health maintenance organization,
independent practice
association, or physician hospital organization shall provide all contracted
health care
professionals or health care providers with any changes to the fee schedule
provided
under subsection (a) not later than 35 days after the effective date of the
changes,
unless such
changes are specified in the contract and the health care professional or
health care
provider is able to calculate the changed rates based on information in the
contract and
information available to the public at no charge. Beginning January 1, 2023, with respect to nonroutine changes to the fee schedule, the insurer, health maintenance organization, independent practice association, or physician hospital organization shall provide all contracted health care professionals or health care providers impacted by the nonroutine change with notice of the change at least 60 days before the effective date of the change. The right to advance notice of nonroutine changes to the fee schedule may not be waived by the health care professional or health care provider. For the purposes of this subsection (d), health maintenance organizations that provide or arrange for and pay or reimburse for the cost of any health care services for persons who are enrolled in the medical assistance programs under the Illinois Public Aid Code shall comply with provider notification requirements established by the Department of Healthcare and Family Services.
This information may be made available by mail, e-mail, newsletter, website
listing, or
other reasonable method. For nonroutine changes, the information directing the health care professional or health care provider to the information provided by newsletter, website listing, or other reasonable method shall be provided by email or, if requested by the health care professional or health care provider, by mail. Upon request, a health care professional or health
care provider
may request an updated copy of the fee schedule referred to in subsection (a)
every
calendar quarter. (e) Upon termination of a contract with an insurer, health maintenance
organization, independent practice
association, or physician hospital
organization and at
the request of the patient, a health care professional or health care provider
shall transfer
copies of the patient's medical records. Any other provision of law
notwithstanding, the
costs for copying and transferring copies of medical records shall be assigned
per the
arrangements agreed upon, if any, in the health care professional or health
care provider services
contract.
(Source: P.A. 102-957, eff. 1-1-23 .)
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215 ILCS 5/368c
(215 ILCS 5/368c)
Sec. 368c.
Remittance advice and procedures.
(a) A remittance advice shall be furnished to a health care professional or
health
care provider that identifies the disposition of each claim. The remittance
advice shall identify the services billed; the patient responsibility, if any;
the actual payment, if any, for the services billed; and the reason for any
reduction to the amount for
which the claim was submitted. For any reductions to the amount for which the
claim was submitted, the remittance shall identify any withholds and the reason
for any denial or reduction.
A remittance advice for capitation or prospective payment arrangements shall
be
furnished to a health care professional or health care provider pursuant to a
contract with
an insurer, health maintenance organization,
independent practice association,
or
physician hospital organization in accordance with the terms of the contract.
(b) When health care services are provided by a non-participating
health care
professional or health care provider, an insurer, health maintenance
organization,
independent practice association, or physician hospital organization may pay
for covered
services either to a patient directly or to the non-participating health care
professional or
health care provider.
(c) When a person presents a
benefits information card,
a health care professional or health care provider shall make a good faith
effort
to inform the
person if the
health care professional or health care provider has a participation contract
with the
insurer,
health maintenance organization, or other
entity identified on the card.
(Source: P.A. 93-261, eff. 1-1-04.)
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215 ILCS 5/368d
(215 ILCS 5/368d)
Sec. 368d. Recoupments.
(a) A health care professional or health care provider shall be provided a
remittance advice, which must include an explanation of a
recoupment or
offset taken by an insurer, health maintenance organization,
independent practice association, or physician hospital
organization, if any. The recoupment explanation shall, at a minimum, include
the name
of the patient; the date of service; the service code or if no service code is
available a service description;
the recoupment amount; and the reason for the recoupment or offset. In
addition,
an insurer,
health maintenance organization, independent
practice association, or physician
hospital organization shall provide with the remittance advice, or with any demand for recoupment or offset, a telephone
number or mailing address to initiate an appeal of the recoupment or offset together with the deadline for initiating an appeal. Such information shall be prominently displayed on the remittance advice or written document containing the demand for recoupment or offset. Any appeal of a recoupment or offset by a health care professional or health care provider must be made within 60 days after receipt of the remittance advice.
(b) It is not a recoupment when a health care professional or health care
provider
is paid an amount prospectively or concurrently under a contract with an
insurer, health
maintenance organization, independent practice
association, or physician
hospital
organization that requires a retrospective reconciliation based upon specific
conditions
outlined in the contract.
(c) No recoupment or offset may be requested or withheld from future payments 12 months or more after the original payment is made, except in cases in which: (1) a court, government administrative agency, other | | tribunal, or independent third-party arbitrator makes or has made a formal finding of fraud or material misrepresentation;
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| | the Comprehensive Health Insurance Plan under the Comprehensive Health Insurance Plan Act;
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| (3) the provider has already been paid in full by any
| | other payer, third party, or workers' compensation insurer; or
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| (4) an insurer contracted with the Department of
| | Healthcare and Family Services is required by the Department of Healthcare and Family Services to recoup or offset payments due to a federal Medicaid requirement.
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| No contract between an insurer and a health care professional or health care provider may provide for recoupments in violation of this Section. Nothing in this Section shall be construed to preclude insurers, health maintenance organizations, independent practice associations, or physician hospital organizations from resolving coordination of benefits between or among each other, including, but not limited to, resolution of workers' compensation and third-party liability cases, without recouping payment from the provider beyond the 18-month time limit provided in this subsection (c).
(Source: P.A. 102-632, eff. 1-1-22 .)
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215 ILCS 5/368e
(215 ILCS 5/368e)
Sec. 368e.
Administration and enforcement.
(a) Other than the duties specifically created in Sections 368b, 368c, and
368d,
nothing in those Sections is intended to preclude, prevent, or require the
adoption,
modification, or termination of any utilization management, quality management,
or
claims processing methodologies or other provisions of a contract applicable to
services provided under a
contract
between an insurer, health maintenance organization,
independent practice
association, or
physician hospital organization and a health care professional or health care
provider.
(b) Nothing in Sections 368b, 368c, and 368d precludes, prevents, or
requires
the
adoption, modification, or termination of any health plan term, benefit,
coverage or
eligibility provision, or payment methodology.
(c) The provisions of Sections 368b, 368c, and 368d are deemed incorporated
into health care professional and health care provider service contracts
entered into on or before the
effective date of
this amendatory Act of the 93rd General Assembly and do not require an insurer,
health
maintenance organization, independent practice
association, or physician
hospital
organization to renew or renegotiate the contracts with a health care
professional or health
care provider.
(d) The Department shall enforce the provisions of this Section and
Sections 368b, 368c, and 368d pursuant to the enforcement powers granted to it
by law.
(e) The Department is hereby granted specific authority to issue a cease and
desist order against, fine, or otherwise penalize independent practice
associations and
physician-hospital organizations for violations.
(f) The Department shall adopt reasonable rules to enforce compliance with
this Section and Sections 368b, 368c, and 368d.
(Source: P.A. 93-261, eff. 1-1-04.)
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215 ILCS 5/368f (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
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| (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.
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| (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, long-term care, Medicare supplement, vision care, or short-term 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.)
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215 ILCS 5/368g (215 ILCS 5/368g) Sec. 368g. Time-based billing. (a) As used in this Section, "CPT code" means the medical billing code set contained in the most recent version of the Current Procedural Terminology code book published by the American Medical Association. (b) A health care plan requiring a health care provider to use a time-based CPT code to bill for health care services shall not apply a time measurement standard that results in fewer units billed than allowed by the CPT code book, except as required by federal law for federally funded patients.
(Source: P.A. 101-119, eff. 7-22-19; 102-558, eff. 8-20-21.) |
215 ILCS 5/369
(215 ILCS 5/369) (from Ch. 73, par. 981)
Sec. 369.
Rights of
minors.
Any minor of the age of fifteen years or more may, notwithstanding such
minority, contract for health and accident insurance on his own life for
his own benefit or for the benefit of his father, mother, husband, wife,
child, brother or sister, and may exercise all such contractual rights and
powers with respect to any such contract of insurance as might be exercised
by a person of full legal age, and may exercise with like effect all rights
and privileges under such contract, including the surrender of his interest
therein and the giving of a valid discharge for any benefit accruing or
money payable thereunder. Such minor shall not, by reason of his minority,
be entitled to rescind, avoid, or repudiate such contract, or any exercise
of a right or privilege thereunder.
(Source: Laws 1937, p. 696.)
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215 ILCS 5/370
(215 ILCS 5/370) (from Ch. 73, par. 982)
Sec. 370.
Policies
issued in violation of article-Penalty.
(1) Any company, or any officer or agent thereof, issuing or delivering
to any person in this State any policy in wilful violation of the provision
of this article shall be guilty of a petty offense.
(2) The Director may revoke the license of any foreign or alien company,
or of the agent thereof wilfully violating any provision of this article or
suspend such license for any period of time up to, but not to exceed, two
years; or may by order require such insurance company or agent to pay to
the people of the State of Illinois a penalty in a sum not exceeding $1,000,
and upon the failure of such insurance company or agent to
pay such penalty within twenty days after the mailing of such order,
postage prepaid, registered, and addressed to the last known place of
business of such insurance company or agent, unless such order is stayed by
an order of a court of competent jurisdiction, the Director of Insurance
may revoke or suspend the license of such insurance company or agent for
any period of time up to, but not exceeding a period of, two years.
(Source: P.A. 93-32, eff. 7-1-03.)
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215 ILCS 5/370a
(215 ILCS 5/370a) (from Ch. 73, par. 982a)
Sec. 370a.
Assignability of Accident and Health Insurance.
No provision of the Illinois Insurance Code, or any other law, prohibits
an insured under any policy of accident and health insurance or any other
person who may be the owner of any rights under such policy from making an
assignment of all or any part of his rights and privileges under the policy
including but not limited to the right to designate a beneficiary and to
have an individual policy issued in accordance with its terms. Subject to
the terms of the policy or any contract relating thereto, an assignment by
an insured or by any other owner of rights under the policy, made before or
after the effective date of this amendatory Act of 1969 is valid for the
purpose of vesting in the assignee, in accordance with any provisions
included therein as to the time at which it is effective, all rights and
privileges so assigned. However, such assignment is without prejudice to
the company on account of any payment it makes or individual policy it
issues before receipt of notice of the assignment. This amendatory Act of
1969 acknowledges, declares and codifies the existing right of assignment
of interests under accident and health insurance policies.
If an enrollee or insured of an insurer, health maintenance organization,
managed care plan, health care plan, preferred provider organization, or third
party administrator assigns a claim to a health care professional or health
care facility, then payment
shall be made directly to the health care professional or health care facility
including any interest
required under Section 368a, of this Code for failure to pay
claims
within 30
days after receipt by the insurer of due proof of loss. Nothing in this
Section shall be construed to prevent any parties from reconciling duplicate
payments.
(Source: P.A. 91-605, eff. 12-14-99; 91-788, eff. 6-9-00.)
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215 ILCS 5/370b
(215 ILCS 5/370b) (from Ch. 73, par. 982b)
Sec. 370b.
Reimbursement on equal basis.
Notwithstanding any provision
of any individual or group
policy of accident and health insurance, or any provision of a policy,
contract, plan or agreement for hospital or medical service or indemnity,
wherever such policy, contract, plan or agreement provides for
reimbursement for any service provided by persons licensed under the Medical Practice Act of 1987 or the Podiatric Medical
Practice
Act of 1987, the person entitled to benefits or person performing services
under such policy, contract, plan or agreement is entitled to reimbursement
on an equal basis for such service, when the service is performed by a
person licensed under the Medical Practice Act of 1987 or the
Podiatric Medical Practice Act of 1987. The provisions of this Section do
not apply to any policy, contract, plan or agreement in effect prior to
September 19, 1969 or to
preferred provider arrangements or benefit agreements.
(Source: P.A. 90-14, eff. 7-1-97.)
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