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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 5/370j
(215 ILCS 5/370j) (from Ch. 73, par. 982j)
Sec. 370j.
Requirements not applicable to insurers.
Except as otherwise
provided, no insurer authorized to do business in this State shall be subject to any
of the requirements of this Article that are applicable to administrators.
Requirements not applicable to self-insured
employers, employee benefit trust funds, other ERISA exempt
organizations or the State of Illinois. Such organizations are not
subject to any provisions of
this Article even though they may contract with administrators for
administration of health insurance claims subject to contractual
arrangements of the administrator's preferred provider program.
(Source: P.A. 84-1431.)
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215 ILCS 5/370k
(215 ILCS 5/370k) (from Ch. 73, par. 982k)
Sec. 370k.
Registration.
(a) All administrators of a preferred provider
program subject to this Article shall register with the Department of
Insurance, which shall by rule establish criteria for such registration
including minimum solvency requirements and an annual registration fee for
each administrator.
(b) The Department of Insurance shall compile and maintain a listing
updated
at least annually of administrators and insurers offering agreements
authorized under this Article.
(c) Preferred provider administrators are subject
to the provisions of Sections 368b, 368c, 368d, and 368e of this
Code.
(Source: P.A. 93-261, eff. 1-1-04.)
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215 ILCS 5/370l
(215 ILCS 5/370l) (from Ch. 73, par. 982l)
Sec. 370l.
Fiduciary and bonding requirements.
Each
administrator who handles money for purposes of payment for providers
services subject to this Article shall (1) establish and maintain
a fiduciary account, separate and apart from any and all other accounts,
for the receipt and disbursement of funds for reimbursement for programs
covered under this Article, or (2) post or cause to be posted, a bond of
indemnity in an amount equal to not less than 10% of the total estimated
annual reimbursements under such programs.
If a bond of indemnity is posted, it shall be held by the Director of
Insurance for the benefit and indemnification of the beneficiaries and
payors of services under the programs subject to this Article.
An administrator who operates more than one such program may establish
and maintain a separate fiduciary account or bond of indemnity for each
such program, or may operate and maintain a consolidated fiduciary account
or bond of indemnity for all such programs.
(Source: P.A. 84-618.)
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215 ILCS 5/370m
(215 ILCS 5/370m) (from Ch. 73, par. 982m)
Sec. 370m.
Program Requirements.
Each
administrator shall provide to each beneficiary of any program subject to
this Article a document which (1) sets forth those providers with which
agreements or arrangements have been made to provide health care services
to such beneficiary, a source for the beneficiary to contact regarding
changes in such providers and a clear description of any incentives for the
beneficiary to utilize such providers, (2) discloses the extent of coverage
as well as any limitations or exclusions of health care services under the
program, (3) clearly sets out the circumstances under which reimbursement
will be made to a beneficiary unable to utilize the services of a provider
with which an arrangement or agreement has been made, (4) a description of
the process for addressing a beneficiary complaint under the program, and
(5) discloses deductible and coinsurance amounts charged to any person
receiving health care services from such a provider.
(Source: P.A. 84-618.)
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215 ILCS 5/370n
(215 ILCS 5/370n) (from Ch. 73, par. 982n)
Sec. 370n.
Utilization Review Requirements:
Any preferred provider
organization providing hospital, medical or dental services must include a
program of utilization review.
This Section applies to insurers and administrators.
(Source: P.A. 84-1431.)
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215 ILCS 5/370o
(215 ILCS 5/370o) (from Ch. 73, par. 982o)
Sec. 370o.
Emergency Care.
Any preferred provider contract, subject to
this Article shall provide the beneficiary or insured emergency care
coverage such that payment for this coverage is not dependent upon whether
such services are performed by a preferred or nonpreferred provider and
such coverage shall be at the same benefit level as if the service or
treatment had been rendered by a plan provider.
(Source: P.A. 85-476.)
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215 ILCS 5/370p
(215 ILCS 5/370p) (from Ch. 73, par. 982p)
Sec. 370p.
Failure to register.
Any
administrator subject to this Article who fails to register or pay the fee
required by this Article shall be construed to be an unauthorized insurer as
defined in Article VII of the "Illinois Insurance Code", as now or
hereafter amended, and shall be subject to the penalties contained therein.
(Source: P.A. 84-618.)
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215 ILCS 5/370q
(215 ILCS 5/370q) (from Ch. 73, par. 982q)
Sec. 370q.
To the extent of any conflict between this Article and any
other statutory provision, this Article prevails over the conflicting
provision. Agreements may be entered into under this Article
notwithstanding any policy provision to the contrary.
(Source: P.A. 84-618.)
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215 ILCS 5/370r
(215 ILCS 5/370r) (from Ch. 73, par. 982r)
Sec. 370r.
(Renumbered).
(Source: Renumbered by P.A. 95-331, eff. 8-21-07.)
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215 ILCS 5/370s
(215 ILCS 5/370s)
(Text of Section before amendment by P.A. 103-656 )
Sec. 370s.
Managed Care Reform and Patient Rights Act.
All
administrators shall comply with Sections 55 and
85 of the Managed Care Reform and Patient
Rights Act.
(Source: P.A. 91-617, eff. 1-1-00.)
(Text of Section after amendment by P.A. 103-656 ) Sec. 370s. Managed Care Reform and Patient Rights Act. All administrators shall comply with Sections 55 and 85 of the Managed Care Reform and Patient Rights Act. Except as provided by Section 85 of the Managed Care Reform and Patient Rights Act, no law or rule shall be construed to exempt any utilization review program from the requirements of Section 85 of the Managed Care Reform and Patient Rights Act with respect to any insured or beneficiary described in this Article. (Source: P.A. 103-656, eff. 1-1-25.)
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215 ILCS 5/370t
(215 ILCS 5/370t)
Sec. 370t.
Drug formulary; notice.
All administrators must comply with
Section 155.37 of this Code.
(Source: P.A. 92-440, eff. 8-17-01.)
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215 ILCS 5/Art. XXII
(215 ILCS 5/Art. XXII heading)
ARTICLE XXII.
CASUALTY INSURANCE, FIDELITY BONDS AND SURETY CONTRACTS
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215 ILCS 5/378
(215 ILCS 5/378) (from Ch. 73, par. 990)
Sec. 378.
Scope of
article.
This article shall apply to all companies authorized in this State to
transact the kind or kinds of business enumerated in Class 2 of section
4.
Every such company shall, at all times, maintain reserves in an amount
estimated in the aggregate to provide for the payment of all losses and
claims incurred, whether reported or unreported, which are unpaid and for
which such company may be liable, and to provide for the expenses of
adjustment or settlement of such losses and claims. Such reserves shall be
computed in accordance with regulations made from time to time by the
Director after notice and hearing, upon reasonable consideration of the
ascertained experience and the character of such kinds of business for the
purpose of adequately protecting the insured and securing the solvency of
such company.
Whenever the loss and loss expense experience of such company shows the
reserves, calculated in accordance with such regulations, to be inadequate,
the Director may require such company to maintain additional reserves.
Each company that writes liability or compensation policies shall
include in the annual statement required by law, a schedule of its
experience thereunder in such form as the Director may prescribe.
(Source: Laws 1967, p. 1812.)
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215 ILCS 5/379.1
(215 ILCS 5/379.1) (from Ch. 73, par. 991.1)
Sec. 379.1.
Unearned premium reserve.
Every insurance company authorized to transact in this State any of the
kind or kinds of business enumerated in Class 2 of Section 4 except
accident and health insurance shall maintain an unearned premium reserve on
all policies and bonds in force which shall be calculated in the manner
described in Section 393.1 of this Code.
(Source: Laws 1967, p. 1745.)
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215 ILCS 5/388
(215 ILCS 5/388) (from Ch. 73, par. 1000)
Sec. 388.
Standard provision for liability policies - Provisions forbidden.
No policy of insurance against liability or indemnity for loss or damage
to any person other than the insured, or to the property of any person
other than the insured, for which any insured is liable, shall be issued or
delivered in this State after July 1, 1937, by any
company subject to this Article unless it contains in substance a provision
that the insolvency or bankruptcy of the insured shall not release the
company from the payment of damages for injuries sustained or death
resulting therefrom, or loss occasioned during the term of such policy, and
stating that in case a certified copy of a judgment against the
insured is returned unsatisfied
in any action brought by the injured person or his or her personal
representative in case death results from the accident because of such
insolvency or bankruptcy, then an action may be maintained by the injured
person or his or her personal representative against such company under the
terms of the policy and subject to all of the conditions thereof for the
amount of the judgment in such action not exceeding the amount of the
policy.
No policy of insurance against liability or indemnity for loss or damage
arising as a result of the operation of Section 6-21 of "An Act
relating to alcoholic liquors", approved January 31, 1934, as amended,
shall contain a provision or provisions which exempt the company from
liability if the damage sustained was the result of the sale or giving away
of alcoholic liquor to a minor.
(Source: P.A. 84-546.)
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