(215 ILCS 5/155.39)
Sec. 155.39. Vehicle protection products.
(a) As used in this Section:
"Administrator" means a third party other than the warrantor who is
designated by the warrantor to be responsible for the administration of
vehicle protection product warranties.
"Incidental costs" means expenses specified in the vehicle protection
product warranty incurred by the warranty holder related to the failure of the
vehicle protection product to perform as provided in the warranty.
Incidental costs may include, without limitation, insurance policy
deductibles, rental vehicle charges, the difference between the actual value
of the stolen vehicle at the time of theft and the cost of a replacement
vehicle, sales taxes, registration fees, transaction fees, and mechanical
inspection fees.
"Vehicle protection product" means a protective chemical, substance, device,
system, or service that is (i) installed on or applied to a vehicle and (ii)
designed to prevent loss or damage to a vehicle from a specific cause. The term "vehicle protection product"
shall include, without limitation, protective chemicals, alarm systems, body part marking products,
steering locks, window etch products, pedal and ignition locks, fuel and
ignition kill switches, and electronic, radio, and satellite tracking devices. "Vehicle protection product" does not include fuel additives, oil additives, or other chemical products applied to the engine, transmission, or fuel system of a motor vehicle.
"Vehicle protection product warrantor" or "warrantor"
means a person who is contractually obligated to the
warranty holder under the terms of a vehicle protection product warranty.
"Warrantor" does not include an authorized insurer.
"Vehicle protection product warranty" means a written warranty by a vehicle protection product warrantor that (i) is included, for no separate and identifiable consideration, with the purchase of a vehicle protection product sold or offered for sale in this State and (ii) provides if the vehicle protection product fails to prevent loss or damage to a vehicle from a specific cause, that the warranty holder shall be paid specified incidental costs by the warrantor as a result of the failure of the vehicle protection product to perform pursuant to the terms of the warranty. "Warranty reimbursement insurance policy" means a policy of
insurance
issued to the vehicle protection product warrantor
to pay on behalf of the warrantor
all covered contractual obligations incurred by the warrantor under the terms
and conditions of the insured vehicle protection product warranties sold by
the warrantor. The warranty reimbursement insurance policy shall be issued by
an insurer authorized to do business in this State that has filed its policy
form with the Department.
(a-5) A vehicle protection product warrantor's liabilities under a vehicle protection product warranty shall be covered by a warranty reimbursement insurance policy. (b) No vehicle protection product warranty sold or offered for sale in this State
shall be subject to the provisions of this Code. Vehicle protection product warranties are express warranties and not insurance. Vehicle protection product warrantors and related vehicle protection
product sellers and warranty administrators are
not required to comply with and are not subject to any other provision of this
Code.
(c) This Section applies to all vehicle protection products sold or
offered for sale prior to, on, or after the effective date of this amendatory
Act
of the 93rd General Assembly. The enactment of this Section does not
imply that vehicle protection products should have been subject to regulation
under this Code prior to the enactment of this Section. The changes made to this Section by this amendatory Act of the 100th General Assembly do not imply that vehicle protection products and vehicle protection product warranties should have been subject to regulation under this Code prior to this amendatory Act of the 100th General Assembly.
(Source: P.A. 100-272, eff. 1-1-18.)
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(215 ILCS 5/155.40)
Sec. 155.40. Auto insurance; application; false address.
(a) An applicant for a policy of insurance that insures against any loss or
liability resulting from or incident to the ownership, maintenance, or use of a
motor vehicle shall not provide to the insurer to which the application for
coverage is made any address for the applicant other than the address
at which the applicant resides.
(b) A person who knowingly violates this Section is guilty of a business
offense. The penalty is a fine of not less than $1,001 and not more than
$1,200.
(Source: P.A. 95-331, eff. 8-21-07.)
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(215 ILCS 5/155.41)
Sec. 155.41. Slave era policies.
(a) The General Assembly finds and declares all of the
following:
(1) Insurance policies from the slavery era have been | ||
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(2) Legislation has been introduced in Congress for | ||
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(3) The Director of Insurance and the Department of | ||
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(b) The Department shall request and obtain information from
insurers licensed and doing business in this State regarding any
records of slaveholder insurance policies issued by any predecessor
corporation during the slavery era.
(c) The Department shall obtain the names of any
slaveholders or slaves described in those insurance records, and
shall make the information available to the public and the
General Assembly.
(d) Any insurer licensed and doing business in this State
shall research and report to the Department with respect to any
records within the insurer's possession or knowledge relating to
insurance policies issued to slaveholders that provided coverage for
damage to or death of their slaves.
(e) Descendants of slaves, whose ancestors were defined as
private property, dehumanized, divided from their families, forced to
perform labor without appropriate compensation or benefits, and
whose ancestors' owners were compensated for damages by insurers, are
entitled to full disclosure.
(Source: P.A. 95-331, eff. 8-21-07.)
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(215 ILCS 5/155.42) Sec. 155.42. Identity theft insurance consumer fact sheet. The Department shall develop an appropriate consumer fact sheet to be provided to consumers, either via the Department's
website or by hard copy if requested, regarding identity theft insurance. The fact sheet shall include at a minimum, information on what is generally covered under identity theft insurance and on how to protect himself or herself from
identity theft.
(Source: P.A. 96-167, eff. 1-1-10.) |
(215 ILCS 5/155.43) Sec. 155.43. Misrepresentation of Senior-Specific Certification. (a) No insurance producer shall use a senior-specific certification or professional designation that indicates or implies in such a way as to mislead a purchaser or prospective purchaser that the insurance producer has a special certification or training in advising or servicing seniors in connection with the solicitation, sale, or purchase of a life insurance or annuity product or in the provision of advice as to the value of or the advisability of purchasing or selling a life insurance or annuity product, either directly or indirectly through publications, writings, or by issuing or promulgating analyses or reports related to a life insurance or annuity product. (b) "Use of senior-specific certifications or professional designations" includes, but is not limited to, all of the following: (1) Use of a certification or professional | ||
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(2) Use of a nonexistent or self-conferred | ||
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(3) Use of a certification or professional | ||
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(4) Use of a certification or professional | ||
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(i) is primarily engaged in the business of | ||
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(ii) does not have reasonable standards or | ||
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(iii) does not have reasonable standards or | ||
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(iv) does not have reasonable continuing | ||
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(c) There is a rebuttable presumption that a certifying or designating organization is not disqualified under this Section if the certification or designation issued from the organization does not primarily apply to sales or marketing and if the organization or the certification or designation in question has been accredited by any of the following entities: (i) the American National Standards Institute; (ii) the National Commission for Certifying Agencies; | ||
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(iii) any organization included on the list | ||
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(d) In determining whether a combination of words or an acronym standing for a combination of words constitutes a certification or professional designation indicating or implying that a person has a special certification or training in advising or servicing seniors, the Department of Insurance shall consider all of the following: (1) Use of one or more words, such as "senior", | ||
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(2) The manner in which the words listed in | ||
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(e) For purposes of this Section, a job title within an organization that is licensed or registered by a State or federal financial services regulatory agency is not a certification or professional designation, unless it is used in a manner that would confuse or mislead a reasonable consumer, if the job title indicates seniority or standing within the organization or specifies an individual's area of specialization within the organization. For purposes of this subsection (e), "financial services regulatory agency" includes, but is not limited to, an agency that regulates insurers, insurance producers, broker-dealers, investment advisers, or investment companies.
(Source: P.A. 97-527, eff. 8-23-11.) |
(215 ILCS 5/155.44) Sec. 155.44. Financial requirements; large deductible agreements for workers' compensation insurance. (a) An insurer shall: (1) require full collateralization of the outstanding | ||
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(A) a surety bond issued by a surety insurer | ||
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(B) an irrevocable letter of credit issued by a | ||
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(C) cash or securities held in trust by a third | ||
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(2) limit the size of the policyholder's obligations | ||
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(b) As used in this Section, "insurer" means any insurer authorized to issue a workers' compensation policy covering risks located in this State that has an A.M. Best Company rating below "A-" and does not have at least $200,000,000 in surplus. (c) As used in this Section, "large deductible agreement" means any combination of one or more policies, endorsements, contracts, or security agreements which provide for the policyholder to bear the risk of loss of $100,000 or greater per claim or occurrence covered under a policy of workers' compensation insurance and which may be subject to the aggregate limit of policyholder reimbursement obligations. (d) Except when approved by the Director of Insurance, any insurer determined to be in a financially hazardous condition pursuant to Article XII 1/2 or XIII of this Code by the Director of Insurance in this State or the equivalent in any other state is prohibited from issuing or renewing a policy that includes a large deductible agreement. (e) This Section applies to large deductible agreements issued or renewed by any insurer on or after January 1, 2016.
(Source: P.A. 99-369, eff. 8-14-15.) |
(215 ILCS 5/155.45) Sec. 155.45. Certificates of insurance. (a) In this Section: "Certificate of insurance" means a document prepared | ||
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"Department" means the Department of Insurance. "Director" means the Director of Insurance. "Insurance producer" means a person required to be | ||
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"Insurer" means a company, firm, partnership, | ||
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"Person" means any individual, aggregation of | ||
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"Property or casualty insurance" means the kinds of | ||
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(b) This Section applies to a certificate of insurance that is
issued in connection with a contract related to property,
operations, or risks located in this State, regardless of the location of
the policyholder, insurer, insurance producer, or person that
requests or requires the issuance of the certificate of insurance. (c) The use of a certificate of insurance form that is unfair, misleading, or deceptive or
violates any law
is an unfair and deceptive act or practice in the business of
insurance under Article XXVI of this Code. (d) A certificate of insurance may not amend, extend, or alter the coverage provided under, or
confer to a person any rights in addition to the rights
expressly provided in,
the policy of property or casualty insurance to which the certificate
of insurance refers. (e) A person may not prepare, issue, request, or
require the issuance of a certificate of insurance that: (1) contains false or misleading information | ||
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(2) alters, amends, or extends the coverage provided | ||
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(f) A certificate of insurance may not contain a
warranty that the policy of property or casualty insurance to which
the certificate of insurance refers complies with the insurance or
indemnification requirements of a contract. The inclusion of a contract number or contract description
in a certificate of insurance does not warrant that the policy of
property or casualty insurance to which the certificate of insurance
refers complies with the insurance or indemnification requirements
of the contract. (g) A person is not entitled to notice of, cancellation of, nonrenewal of, or
a material change in
a policy of property or casualty insurance unless the person has
notice rights under the terms of the policy of property or casualty
insurance or an endorsement to the policy.
The terms and conditions of notice described in this subsection
(g) are governed by the policy of property or casualty insurance or
an endorsement to the policy and are not altered by a certificate of
insurance. (h) A certificate of insurance or any other document that is
prepared, issued, requested, or required in violation of this Section
is void. (i) The Director may refer a matter to the Department of Financial and Professional Regulation for review pursuant to the rules of that department if the Director has reason to believe that a certificate of
insurance form as described in subsection (c) of this Section has been provided by a
financial institution. (j) The Director may examine and investigate the
activities of a person that the Director reasonably believes has
violated the provisions of this Section. The Director shall have the power to enforce the provisions of this Section and impose any authorized penalty or remedy as provided under Section 401 of this Code upon any person who violates the provisions of this Section. (k) The Department may adopt rules to
implement the provisions of this Section.
(Source: P.A. 98-819, eff. 1-1-15.) |
(215 ILCS 5/155.46) Sec. 155.46. Prohibition on denial of coverage or increase in premiums for living organ donors. (a) As used in this Section: "Human organ" means all or part of a human's liver, pancreas, kidney, intestine, lung, blood, plasma, skin, or bone marrow. "Living organ donor" means an individual who has donated all or part of a human organ and is not deceased. "Disability insurance policy" means a contract under which an entity promises to pay a person a sum of money if an illness or injury resulting in a disability prevents that person from working. "Life insurance policy" means a contract under which an entity promises to pay a designated beneficiary a sum of money upon the death of the insured. "Long-term care insurance policy" means a contract for which the only insurance protection provided under the contract is coverage of qualified long-term care services. (b) Notwithstanding any other provision of law, it is unlawful to refuse to insure, to refuse to continue to insure, to limit the amount, extent, or kind of coverage available for life insurance, disability insurance, or long-term care insurance to an individual, or to charge an individual a different rate for the same coverage, solely because of the individual's status as a living organ donor. (c) With respect to all other conditions, persons who are living organ donors shall be subject to the same standards of sound actuarial principles or actual or reasonably anticipated experience as are persons who are not organ donors.
(Source: P.A. 101-179, eff. 1-1-20.) |
(215 ILCS 5/155.47) Sec. 155.47. Prohibited practices relating to substance use disorder treatment. (a) As used in this Section, "recovery support", "substance use disorder", and "treatment" have the meanings set forth in the Substance Use Disorder Act. (b) A company authorized to transact life insurance in this State may not, based solely on whether an individual has participated in a substance use treatment or recovery support program no less than 5 years before application: (1) deny coverage to the individual; (2) limit the amount, extent, or kind of coverage | ||
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(3) charge the individual or a group to which the | ||
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(Source: P.A. 102-107, eff. 1-1-22.) |
(215 ILCS 5/155.48) Sec. 155.48. Prohibited practices relating to prescription for or obtainment of opioid antagonist. (a) As used in this Section, "opioid antagonist" means any drug that binds to opioid receptors and blocks or otherwise inhibits the effects of opioids acting on those receptors to reverse the effects of an opioid overdose. (b) A company authorized to transact life insurance in this State may not, based solely on whether an individual has been prescribed or has obtained through a standing order an opioid antagonist: (1) deny coverage to the individual; (2) limit the amount, extent, or kind of coverage | ||
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(3) charge the individual or a group to which the | ||
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(Source: P.A. 102-107, eff. 1-1-22.) |
(215 ILCS 5/155.49) Sec. 155.49. Insurance company supplier diversity report. (a) Every company authorized to do business in this State or accredited by this State with assets of at least $50,000,000 shall submit a 2-page report on its voluntary supplier diversity program, or the company's procurement program if there is no supplier diversity program, to the Department. The report shall set forth all of the following: (1) The name, address, phone number, and email | ||
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(2) Local and State certifications the company | ||
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(3) On the second page, a narrative explaining the | ||
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(4) The voluntary goals for the calendar year for | ||
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Each company is required to submit a searchable report, in Portable Document Format (PDF), to the Department on or before April 1, 2024 and on or before April 1 every year thereafter. (b) For each report submitted under subsection (a), the Department shall publish the results on its Internet website for 5 years after submission. The Department is not responsible for collecting the reports or for the content of the reports. (c) The Department shall hold an annual insurance company supplier diversity workshop in July of 2024 and every July thereafter to discuss the reports with representatives of the companies and vendors. (d) The Department shall prepare a one-page template, not including the narrative section, for the voluntary supplier diversity reports. (e) The Department may adopt such rules as it deems necessary to implement this Section.
(Source: P.A. 103-426, eff. 8-4-23.) |
(215 ILCS 5/Art. IX.5 heading) ARTICLE IX 1/2.
CREDIT LIFE AND CREDIT ACCIDENT AND HEALTH INSURANCE
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(215 ILCS 5/155.51) (from Ch. 73, par. 767.51)
Sec. 155.51.
Purpose and scope.)
(a) The purpose of this Article is to promote the public welfare by
regulating credit life insurance and credit accident and health insurance.
Nothing in this Article is intended to prohibit or discourage reasonable
competition. The provisions of this Article are to be liberally construed.
(b) All life insurance and all accident and health insurance sold, or
otherwise made effective, in connection with loans or other credit transactions
of less than 10 years
duration is subject to this Article. Such insurance sold in connection with
a loan or other credit transaction of 10 years duration or more is not
subject to this Article.
(Source: P.A. 79-930.)
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(215 ILCS 5/155.52) (from Ch. 73, par. 767.52)
Sec. 155.52. Definitions. For the purpose of this Article:
(a) "Credit life insurance" means insurance on the life of a debtor
pursuant to or in connection with a specific loan or other credit
transaction;
(b) "Credit Accident and health insurance" means insurance on a debtor
to provide indemnity for payments becoming due on a specific loan or other
credit transaction while the debtor is a person with a disability as defined in the policy;
(c) "Creditor" means the lender of money or vendor or lessor of goods,
services, property, rights or privileges, for which payment is arranged
through a credit transaction or any successor to the right, title or
interest of any such lender, vendor or lessor, and an affiliate, associate
or subsidiary of any of them or any director, officer or employee of any of
them or any other person in any way associated with any of them;
(d) "Debtor" means a borrower of money or a purchaser or lessee of
goods, services, property, rights or privileges for which payment is
arranged through a credit transaction;
(e) "Indebtedness" means the total amount payable by a debtor to a
creditor in connection with a loan or other credit transaction;
(f) "Director" means the Director of Insurance of the State of Illinois.
(Source: P.A. 99-143, eff. 7-27-15.)
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(215 ILCS 5/155.53) (from Ch. 73, par. 767.53)
Sec. 155.53.
Forms of credit life insurance and credit accident and health
insurance.)
Credit life insurance and credit accident and health insurance shall be
issued only in the following forms:
(a) Individual policies of life insurance issued to debtors on the term
plan;
(b) Individual policies of accident and health insurance issued to
debtors on a term plan or disability benefit provisions in individual
policies of credit life insurance;
(c) Group policies of life insurance issued to creditors providing
insurance upon the lives of debtors on the term plan;
(d) Group policies of accident and health insurance issued to creditors
on a term plan insuring debtors or disability benefit provisions in group
credit life insurance policies to provide such coverage.
(Source: Laws 1959, p. 1140.)
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(215 ILCS 5/155.54) (from Ch. 73, par. 767.54)
Sec. 155.54.
Amount of credit life insurance and credit accident and health
insurance.) (a) Credit Life Insurance
The amount of credit life insurance shall not exceed the initial indebtedness.
Where an indebtedness is repayable in substantially equal installments,
the amount of insurance shall at no time exceed the scheduled or actual
amount of unpaid indebtedness, whichever is greater.
(b) Credit Accident and Health Insurance
The total amount of indemnity payable by credit accident and health insurance
in the event of disability, as defined in the policy, shall not exceed the
aggregate of the periodic scheduled unpaid installments of the indebtedness
and the amount of each periodic indemnity payment shall not exceed the original
indebtedness divided by the number of periodic installments.
(Source: P.A. 79-930.)
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(215 ILCS 5/155.55) (from Ch. 73, par. 767.55)
Sec. 155.55.
Term of credit life insurance and credit accident and health insurance.
The term of any credit life insurance or credit accident and health
insurance shall, subject to acceptance by the insurer, commence on the date
when the debtor becomes obligated to the creditor, or the date from which
interest or finance charges accrue, if later, except that, where a group
policy provides coverage with respect to existing obligations, the
insurance on a debtor with respect to such indebtedness shall commence on
the effective date of the policy. Where evidence of insurability is
required and such evidence is furnished more than 30 days after the date
when the debtor becomes obligated to the creditor, the term of the
insurance may commence on the date on which the insurer determines the
evidence to be satisfactory, and in such event there shall be an
appropriate refund or adjustment of any charge to the debtor for insurance.
The term of such insurance shall not extend more than 15 days beyond the
scheduled maturity date of the indebtedness except when extended without
additional cost to the debtor. If the indebtedness is discharged due to
renewal or refinancing prior to the scheduled maturity date, the insurance
in force shall be terminated before any new insurance may be issued in
connection with the renewed or refinanced indebtedness. In all cases of
termination prior to scheduled maturity, a refund shall be paid or credited
as provided in Section 155.58.
(Source: Laws 1959, p. 1140.)
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(215 ILCS 5/155.56) (from Ch. 73, par. 767.56)
Sec. 155.56.
Provisions of policies and certificates of insurance; disclosure to debtors.
(a) All credit life insurance and credit accident and health insurance
sold shall be evidenced by an individual policy, or in the case of group
insurance by a certificate of insurance, which individual policy or group
certificate of insurance shall be delivered to the debtor.
(b) Each individual policy or group certificate of credit life
insurance, and/or credit accident and health insurance shall, in addition
to other requirements of law, set forth, the name and home office address
of the insurer, and the identity by name or otherwise of the person or
persons insured, the rate or amount of payment, if any, by the debtor
separately for credit life insurance and credit accident and health
insurance, a description of the amount, term and coverage including any
exceptions, limitations or restrictions, and shall state that the benefits
shall be paid to the creditor to reduce or extinguish the unpaid
indebtedness and, wherever the amount of insurance may exceed the unpaid
indebtedness, that any such excess shall be payable to a beneficiary, other
than the creditor, named by the debtor or to his estate.
(c) Said individual policy or group certificate of insurance shall be
delivered to the insured debtor at the time the indebtedness is incurred
except as hereinafter provided.
(d) If said individual policy or group certificate of insurance is not
delivered to the debtor at the time the indebtedness is incurred, a copy of
the application for such policy or a notice of proposed insurance, signed
by the debtor and setting forth the name and home office address of the
insurer, the identity by name or otherwise of the person or persons
insured, the rate or amount of payment by the debtor, if any, separately
for credit life insurance and credit accident and health insurance, a
description of the amount, term and coverage provided, shall be delivered
to the debtor at the time such indebtedness is incurred. The copy of the
application for, or notice of proposed insurance shall refer exclusively to
insurance coverage, and shall be separate and apart from the loan, sale or
other credit statement of account, instrument or agreement, unless the
information required by this subsection is prominently set forth therein.
Upon acceptance of the insurance by the insurer and within 30 days of the
date upon which the indebtedness is incurred, the insurer shall cause the
individual policy or group certificate of insurance to be delivered to the
debtor. Said application or notice of proposed insurance shall state that
upon acceptance by the insurer, the insurance shall become effective as
provided in Section 155.55.
(Source: Laws 1959, p. 1140.)
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(215 ILCS 5/155.57) (from Ch. 73, par. 767.57)
Sec. 155.57. Filing, approval, and withdrawal of forms. (a) All policies,
certificates of insurance, notices of proposed insurance, applications for
insurance, endorsements, and riders delivered or issued for delivery in this
State and the schedules of premium rates pertaining thereto shall be filed
with the Director.
(b) The Director shall within a reasonable time after the filing of any
such policies, certificates of insurance, notices of proposed insurance,
applications for insurance, endorsements, and riders, disapprove any such
form if the benefits provided therein are not reasonable in relation to
the premium charge, or if it contains provisions which are unjust, unfair,
inequitable, misleading, deceptive, or encourage misrepresentation of the
coverage, or are contrary to any provision of this Code or of any
rule or regulation promulgated thereunder.
(c) If the Director notifies the insurer that the form is disapproved,
it is unlawful thereafter for such insurer to issue or use such form. In
such notice, the Director shall specify the reason for his disapproval and
state that a hearing will be granted within 20 days after request in writing
by the insurer. No such policy, certificate of insurance, notice of proposed
insurance, nor any application, endorsement of rider, shall be issued or
used until after it has been so filed and the Director has given his prior
written approval thereto.
(d) The Director may at any time, after giving not less than 20 days prior
written notice to the insurer, withdraw his approval of any such form on
any ground set forth in subsection (b) above. The written notice of withdrawal
shall state the reason for the action. The insurer may request a hearing
within 10 days after receipt of the notice of withdrawal by giving the Director
written notice of such request, together with a statement of its objections.
The Director must then conduct a hearing in accordance
with Sections 402 and 403. The withdrawal shall be stayed pending the issuance
of the Director's orders following the hearing.
However, if it appears to the Director that the continued use of any such
policy, certificate of insurance, notice of proposed insurance, application
for insurance, endorsement, or rider by an insurer is hazardous to its policyholders
or the public, the Director may take such action as is prescribed by Section 401.1.
(e) It is not lawful for the insurer to issue such forms or use them after
the effective date of such withdrawal.
(f) If a group policy of credit life insurance or credit accident and
health insurance has been or is delivered in another state before or after October 1, 1975 (the effective date of Public Act 79-930), the insurer shall be
required to file only the group certificate and notice of proposed insurance
delivered or issued for delivery in this State as specified in subsections
(b) and (d) of Section 155.57 of this Article and such forms shall be approved
by the Director if they conform with the requirements so specified in said
subsections and if the schedules of premium rates applicable to the insurance
evidenced by such certificate or notice are not in excess of the insurer's
schedules of premium rates filed with the Director; provided, however, the
premium rate in effect on existing group policies may be continued until
the first policy anniversary date following October 1, 1975 (the effective date of Public Act 79-930).
(g) Any order or final determination of the Director under the provisions
of this Section shall be subject to judicial review.
(Source: P.A. 100-863, eff. 8-14-18.)
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(215 ILCS 5/155.58) (from Ch. 73, par. 767.58)
Sec. 155.58.
Premiums and refunds.
(a) Each insurer issuing credit life insurance or credit accident and
health insurance shall file with the Director its schedules of premium
rates for use in connection with such insurance. Any insurer may revise
such schedules from time to time, and shall file such revised schedules
with the Director. No insurer shall issue any credit life insurance policy
or credit accident and health insurance policy for which the premium rate
exceeds that determined by the schedules of such insurer as then on file
with the Director. The Director may require the filing of the schedule of
premium rates for use in connection with and as a part of the specific
policy filings as provided by Section 155.57.
(b) Each individual policy, group certificate or notice of proposed
insurance shall provide that in the event of termination of the insurance
prior to the scheduled maturity date of the indebtedness, any refund of an
amount paid by the debtor for insurance shall be paid or credited promptly
to the person entitled thereto; provided, however, that the Director shall
prescribe a minimum refund and no refund which would be less than such
minimum need be made. The formula to be used in computing such refund shall
be filed with and approved by the Director.
(c) If a creditor requires a debtor to make any payment for credit life
insurance or credit accident and health insurance and an individual policy
or group certificate of insurance is not issued, the creditor shall
immediately give written notice to such debtor and shall promptly make an
appropriate credit to the account.
(d) The amount charged to a debtor for credit life or credit health and
accident insurance shall not exceed the premium charged by the insurer, as
computed at the time the charge to the debtor is determined.
(e) Nothing in this Article shall be construed to authorize any payments
for insurance now prohibited under any statute, or rule thereunder,
governing credit transactions.
(Source: Laws 1959, p. 1140.)
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(215 ILCS 5/155.59) (from Ch. 73, par. 767.59)
Sec. 155.59.
Issuance of policies.
All policies of credit life insurance and credit accident and health
insurance shall be delivered or issued for delivery in this state only by
an insurer authorized to do an insurance business herein, and shall be
issued only through licensed agents or brokers.
(Source: Laws 1959, p. 1140.)
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(215 ILCS 5/155.60) (from Ch. 73, par. 767.60)
Sec. 155.60.
Claims.
(a) All claims shall be promptly reported to the insurer or its
designated claim representative, and the insurer shall maintain adequate
claim files. All claims shall be settled as soon as possible and in
accordance with the terms of the insurance contract.
(b) All claims shall be paid either by draft drawn upon the insurer or
by check of the insurer to the order of the claimant to whom payment of the
claim is due pursuant to the policy provisions, or upon direction of such
claimant to one specified.
(c) No plan or arrangement shall be used whereby any person, firm or
corporation other than the insurer or its designated claim representative
shall be authorized to settle or adjust claims. The creditor shall not be
designated as claim representative for the insurer in adjusting claims;
provided, that a group policyholder may, by arrangement with the group
insurer, draw drafts or checks in payment of claims due to the group
policyholder subjects to audit and review by the insurer.
(Source: Laws 1959, p. 1140.)
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(215 ILCS 5/155.61) (from Ch. 73, par. 767.61)
Sec. 155.61.
Existing insurance-Choice of insurer.
When credit life insurance or credit accident and health insurance is
required as additional security for any indebtedness, the debtor shall,
upon request to the creditor, have the option of furnishing the required
amount of insurance through existing policies of insurance owned or
controlled by him or of procuring and furnishing the required coverage
through any insurer authorized to transact an insurance business within
this state.
(Source: Laws 1959, p. 1140.)
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(215 ILCS 5/155.62) (from Ch. 73, par. 767.62)
Sec. 155.62.
Enforcement.
The Director may, issue such rules and regulations as he deems
appropriate for the administration of this Article. Whenever the Director
finds that there has been a violation of this Article or any rules or
regulations issued pursuant thereto, and after written notice thereof and
hearing given to the insurer or other person authorized or licensed by the
Director, he shall set forth the details of his findings together with an
order for compliance by a specified date. Such order shall be binding on
the insurer and other person authorized or licensed by the Director on the
date specified unless sooner withdrawn by the Director or a stay thereof
has been ordered by a court of competent jurisdiction.
(Source: Laws 1959, p. 1140.)
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(215 ILCS 5/155.63) (from Ch. 73, par. 767.63)
Sec. 155.63.
Judicial review.
Any party to the proceeding affected by an order of the Director shall
be entitled to judicial review by following the procedure set forth in
Section 407 of the Illinois Insurance Code.
(Source: Laws 1959, p. 1140.)
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(215 ILCS 5/155.64) (from Ch. 73, par. 767.64)
Sec. 155.64.
Penalties.
In addition to any other penalty provided by law, any person who
violates an order of the Director after it has become final, and while such
order is in effect, shall, upon proof thereof to the satisfaction of the
court, forfeit and pay to the State of Illinois a sum not to exceed $250.00
which may be recovered in a civil action, except that if such violation is
found to be willful, the amount of such penalty shall be a sum not to
exceed $1,000.00. The Director in his discretion, may revoke or suspend the
license or certificate of authority of a person guilty of such violation.
Such order for suspension or revocation shall be upon notice and hearing,
and shall be subject to judicial review as provided in Section 155.63 of
this Article.
(Source: Laws 1959, p. 1140.)
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(215 ILCS 5/155.65) (from Ch. 73, par. 767.65)
Sec. 155.65.
Separability provision.
If any provision of this Article, or the application of such provision
to any person or circumstances, shall be held invalid, the remainder of the
Article, and the application of such provision to any person or
circumstances other than those as to which it is held invalid, shall not be
affected thereby.
(Source: Laws 1959, p. 1140.)
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(215 ILCS 5/Art. X heading) ARTICLE X.
MERGER, CONSOLIDATION OR PLANS OF EXCHANGE
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(215 ILCS 5/156) (from Ch. 73, par. 768)
Sec. 156. Merger and
consolidation permitted. (a) Upon complying with the provisions of this article, any domestic
company, except a Lloyds, is hereby authorized and empowered to merge or
consolidate with any domestic company or with any foreign or alien company,
except a Lloyds if the surviving company meets the requirements for
authorization to engage in the insurance business in this state and, if
such merger or consolidation is authorized by the laws of the state or
country under which such foreign or alien company is incorporated or
organized. (b) The Director may permit the formation of a domestic stock company that is established for the sole purpose of merging or consolidating with an existing stock company simultaneously with the effectiveness of a division authorized by this Code. Upon request of the dividing company, the Director may waive the requirements of Section 131.8 of this Code. Each domestic stock company formed under this subsection shall be deemed to exist before a merger and division under this Section becomes effective, but solely for the purpose of being a party to such merger and division. The Director shall not require that such domestic stock company be licensed to transact insurance business in this state before such merger and division. All insurance policies, annuities, or reinsurance agreements allocated to such domestic stock company shall become the obligation of the domestic stock company that survives the merger simultaneously with the effectiveness of the merger and division. The plan of merger or consolidation shall be deemed to have been authorized and approved by such domestic stock company if the dividing company authorized and approved such plan. The certificate of merger shall state that it was approved by the domestic stock company formed under this subsection.
(Source: P.A. 100-1118, eff. 11-27-18.)
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(215 ILCS 5/156.1) (from Ch. 73, par. 768.1)
Sec. 156.1.
Acquisition by exchange of stock permitted.
Any domestic stock insurance company may adopt a plan of exchange of the
outstanding stock of its stockholders for the consideration herein
designated to be paid or provided by a corporation which acquires such
stock, in the manner provided in this Article.
The plan of exchange may provide that the acquiring corporation, as
consideration for the stock of the domestic corporation, (1) transfer
shares of its stock, or (2) transfer other securities issued by it, or (3)
pay cash therefor, or (4) pay or provide other consideration, or (5) pay or
provide any combination of the foregoing types of consideration.
"Acquiring corporation", as used in this Article, means any stock
insurance corporation incorporated under this Code or under prior laws of
this State relating to the incorporation of domestic insurance
corporations; any stock corporation incorporated under the "Business
Corporation Act of 1983" or under prior laws of this State authorizing the
establishment of business corporations; and any foreign or alien stock
corporation qualified to do business in Illinois and registered by the
corporation department; and any foreign or alien stock insurance company
authorized to do business in Illinois.
(Source: P.A. 83-1362.)
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(215 ILCS 5/157) (from Ch. 73, par. 769)
Sec. 157.
Powers of
company not enlarged.
Nothing in this article contained shall be construed to authorize any
company to engage in any kind of insurance business not authorized by its
articles of incorporation nor to authorize any foreign or alien company to
engage in any kind of insurance business in this State not covered by its
certificate of authority to do business in this State.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/158) (from Ch. 73, par. 770)
Sec. 158.
Resolutions for merger or consolidation or adoption of a plan of exchange.
The Board of Directors, Trustees or other governing body of each
domestic company desiring to merge or consolidate or to adopt a plan of
exchange shall, by resolution, approve an agreement of merger or
consolidation or plan of exchange, as the case may be, setting forth:
(a) the names of the companies proposing to merge or consolidate or to
adopt a plan of exchange, and the names of the states or countries under
which each of the companies is incorporated or organized;
(b) in the case of a merger, the name of the company into which they
propose to merge, hereafter designated as the surviving company; in the
case of a consolidation, the name of the company into which they propose to
consolidate, hereafter designated as the new company, and the name of the
state or country under the laws of which the new company is to be
incorporated or organized;
(c) the terms and conditions of the proposed merger or consolidation or
plan of exchange, and the mode of carrying the same into effect;
(d) the manner and basis of converting the shares of stock, if any, of
each merging or consolidating company into shares, securities and
obligations, if any are to be issued, of the surviving or new company as
the case may be;
(e) in the case of a merger, a statement of any changes in the articles
of incorporation of the surviving company; in the case of consolidation,
all the statements with respect to the new company required to be set forth
in original articles of incorporation for a similar company formed under
this Code; and
(f) such other provisions with respect to the merger or consolidation or
plan of exchange as are deemed necessary or advisable.
(Source: Laws 1967, p. 2406.)
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(215 ILCS 5/159) (from Ch. 73, par. 771)
Sec. 159.
Vote of
shareholders and policyholders.
(1) The agreement of merger or consolidation shall be submitted to a
vote at a meeting of the shareholders, if any, of each domestic company and
at a meeting of such policyholders of each domestic company, other than a
fraternal benefit society, as are entitled to vote. The plan of exchange
shall be submitted to a vote at a meeting of the shareholders of the
company to be acquired. The meetings may be either annual, periodic or
special. Written or printed notice shall be given not less than 20 days
before each such meeting, either personally or by mail, to each shareholder
of record and to each policyholder entitled to vote. If mailed, such notice
is deemed to be delivered when deposited in the United States mail, with
postage prepaid, addressed to the shareholder or policyholder, at his
address as it appears on the records of the company. However, a domestic
mutual company licensed in 2 or more States may give notice by publication
in a newspaper of general circulation in the county in which the company
has its principal office and in either of the two largest cities in each
State in which the company shall be licensed to do business except as
provided in paragraph (3). If the domestic mutual company is licensed in
Illinois only, then such notice may be given by publication in a newspaper
of general circulation in the 10 counties that have the largest
concentration of its policyholders. Notice by publication as approved by
the Director shall be published once weekly on 3 successive weeks, the last
publication to be at least 20 days before such meeting and not more than 40
days before such meeting. Such notice, whether the meeting is annual,
periodic or special, shall state the place, day, hour and purpose of the
meeting. A copy or a summary of the agreement of merger or consolidation,
or plan of exchange, as the case may be, shall be included in or enclosed
with such notice. The shareholders or policyholders may vote in person or
by proxy. Each shareholder entitled to vote at such meeting shall have one
vote for each share of stock held by him. In the case of domestic companies
other than fraternal benefit societies the affirmative vote of two-thirds
of all outstanding shares, if any, and if policyholders are entitled to
vote, two-thirds of the votes cast by such policyholders of each such
company, as are represented at the meeting in person or by proxy, is
necessary for the approval of any such agreement or plan.
(2) In the event that a domestic fraternal benefit society is a party to
the agreement of merger or consolidation, the board of managers, directors
or trustees of such society shall submit the agreement to the supreme
legislative and governing body of such society at any regular or special
meeting thereof, provided a copy or summary of such agreement shall have
been included in or enclosed with the notice of such meeting. Such notice
shall be given as provided in the laws of the society for the convening of
such supreme legislative and governing body in regular or special session,
as the case may be. The affirmative votes of two-thirds of all members of
such supreme legislative and governing body is necessary for the approval
of the agreement.
(3) The provisions of paragraph (1) relating to notice by publication
shall not apply to a merger or consolidation between a mutual company and a
stock company if the agreement provides that the stock company is the
surviving company. In such case, notice either mailed or personal as
provided by paragraph (1) shall be given to each shareholder of record and
to each policyholder entitled to vote.
(Source: Laws 1968, p. 276.)
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(215 ILCS 5/160) (from Ch. 73, par. 772)
Sec. 160.
Execution
of agreement or plan of exchange by domestic company.
Upon such approval of an agreement of merger or consolidation or plan of
exchange it shall be executed by any domestic company party thereto by its
president or a vice-president and secretary or an assistant secretary, or
the executive officers corresponding thereto.
(Source: Laws 1967, p. 2406.)
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(215 ILCS 5/161) (from Ch. 73, par. 773)
Sec. 161.
Approval
and execution of agreement or plan of exchange by foreign or alien
company.
In the event that a foreign or alien company is a party to the agreement
of merger or consolidation or plan of exchange, the agreement or plan shall
be executed by the proper officers of such foreign or alien company when
they are duly authorized thereto by such action on the part of the
directors, shareholders, members, or policyholders of such foreign or alien
company as may be required by the laws of the domiciliary state or country
of such foreign or alien company.
(Source: Laws 1967, p. 2406.)
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(215 ILCS 5/162) (from Ch. 73, par. 774)
Sec. 162.
Certificate of Merger or Consolidation or Plan of Exchange
and Certificate of Approval.
(1) Upon the execution of an agreement of
merger or consolidation or plan of exchange, there shall be delivered to
the Director:
(a) two duplicate originals of the agreement or plan;
(b) affidavits of officers of each of the companies | ||
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(c) certificates of the secretaries or assistant | ||
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(d) the certificates required by Section 171;
(e) if the surviving or new company is a domestic | ||
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(f) in case of consolidation where the new company is | ||
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In addition, the Director shall be provided, in substantially the same
form, the information required under Article VIII 1/2 of this Code.
(2) In case the surviving or new company is a domestic company, if
the Director finds that:
(a) the agreement of merger or consolidation is in | ||
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(b) the surviving or new company has complied with | ||
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(c) no reasonable objection exists to such merger or | ||
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(d) the standards established under Article VIII 1/2 | ||
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he or she shall approve the agreement. The provisions of any law with
reference to age limits and medical examination shall be inoperative in
so far as agreements of merger or consolidation are concerned. If the
agreement of merger or consolidation be approved by the Director, he or she
shall file the affidavits and certificates and one of the duplicate
originals of the agreement in his or her office, endorse upon the other
duplicate original his or her approval thereof, and deliver it, together
with a
certificate of merger or consolidation, as the case may be, to the
surviving or new company. In the case of a consolidation, the Director
shall also issue a certificate of authority to the new company.
(3) In case the surviving or new company is a foreign or alien
company, if the Director finds that:
(a) the agreement of merger or consolidation is in | ||
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(b) the agreement of merger or consolidation provides | ||
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(c) the surviving or new company has complied with | ||
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(d) no reasonable objection exists to such merger or | ||
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(e) the standards established under Article VIII 1/2 | ||
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he or she
shall approve the agreement. If the agreement be approved by the
Director, he or she shall file the affidavits and certificates and one of
the
duplicate originals of the agreement in his or her office, endorse upon the
other duplicate original his or her approval thereof, and deliver it,
together
with a certificate of approval of the merger or consolidation, as the
case may be, to the surviving or new company.
(4) In the case of a plan of exchange, if the Director finds that the
parties
to the exchange have established that:
(a) the plan, if effective, will not tend adversely | ||
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(b) the interests of the policyholders and | ||
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(c) the competence, experience and integrity of those | ||
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(d) the terms and conditions of the plan are fair and | ||
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(e) the standards established under Article VIII 1/2 | ||
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he or she
shall approve the plan of exchange. If the plan of exchange be approved
by the Director, he or she shall file the affidavits and certificates and
one of
the duplicate originals of the plan of exchange in his or her office,
endorse upon
the other duplicate original his or her approval thereof, and deliver it,
together
with a certificate of approval of the plan of exchange to the domestic company.
(5) If the Director refuses to approve the agreement of merger or
consolidation, or plan of exchange, notice of such refusal, assigning
the reasons therefor,
shall be given in writing by the Director to each of the companies party
thereto, within 60 days from the date of the delivery of such agreements
or plan to him or her, and he or she shall grant any of such companies
a hearing
upon
request. The hearing shall be held within 30 days of the Director's receipt
of request for hearing. All persons to whom it is proposed to issue securities
in such agreements or exchange shall have a right to appear.
Within 30 days after the close of the hearing the Director shall approve
or disapprove or place conditions precedent upon his or her approval of the
merger or consolidation or plan by issuing a written order stating his or
her
determination and the reasons therefor.
(Source: P.A. 90-381, eff. 8-14-97.)
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(215 ILCS 5/163) (from Ch. 73, par. 775)
Sec. 163.
Date
merger or consolidation or plan of exchange effected.
(1) If the surviving or new company is a domestic company, the merger or
consolidation is effected upon the issuance of the certificate of merger or
the certificate of consolidation, as the case may be.
(2) If the surviving or new company is a foreign or alien company and
the Director has issued a certificate of approval of the merger or
consolidation, the date upon which the merger or consolidation is effected
shall be determined by the laws of the state or country of incorporation or
organization of the surviving or new company. However, the merger or
consolidation shall in no event become effective in this State until a
certificate of merger or consolidation, as the case may be, or other
evidence that the merger or consolidation is effected is issued by the
proper official of the state or country of incorporation or organization of
the surviving or new company and is filed with and approved by the
Director.
(3) Notice of adoption of the plan and the approval thereof by the
Director shall be delivered or mailed to each shareholder of record of the
domestic insurance company to be acquired who was entitled to vote thereon
and an affidavit of the secretary or assistant secretary of such company or
of an officer of the company's transfer agent that such notice was given
shall be filed with the Director. The plan shall become effective 10 days
after receipt of the affidavit by the Director. A plan of exchange may be
abandoned pursuant to any provisions for abandonment contained therein at
any time, provided that notice of such abandonment shall be delivered or
mailed to each such stockholder and filed with the Director prior to the
termination of such 10 day period.
(Source: Laws 1967, p. 2406.)
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(215 ILCS 5/164) (from Ch. 73, par. 776)
Sec. 164.
Removal of
property of domestic, merged or consolidated company from this State.
(1) If the surviving or new company shall be a foreign or alien company,
no property of the domestic merged or consolidated company shall be removed
from this State by reason of such merger or consolidation, prior to, nor
shall title to such property vest in the surviving or new company until,
the merger or consolidation shall become effective in this State as
provided in section 163.
(2) Any director or officer of any domestic company removing or
permitting the removal of any property of company from this State in
violation of this section, shall be guilty of a Class A misdemeanor.
(Source: P.A. 77-2699.)
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(215 ILCS 5/165) (from Ch. 73, par. 777)
Sec. 165.
Recording of certificate of merger or consolidation.
Within 15 days after such merger or consolidation has become
effective, the surviving or new company shall file for record with the recorder
of the county in which the principal office of any of the
companies parties to the agreement is located in this State, the agreement
of merger or consolidation, or copy thereof, certified by the Director, any
certificate of approval issued by the Director, or copy thereof, certified
by him and a certificate of merger or consolidation, as the case may be, or
a copy thereof, certified by the Director, or by the official of the state
or country that issued such certificate. The certificate of merger or
consolidation, or a copy thereof so certified, shall also be recorded with
the recorder of each other county in this State in which any of the
companies parties to the agreement, shall have real property at the time of
such merger or consolidation, the title to which will be transferred by the
merger or consolidation.
(Source: P.A. 83-358.)
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(215 ILCS 5/166) (from Ch. 73, par. 778)
Sec. 166.
Effect of
merger or consolidation.
(1) If the surviving or new company is a domestic company, when such
merger or consolidation has been effected
(a) the several companies parties to the agreement of merger or
consolidation shall be a single company, which, in the case of a merger,
shall be that company designated in the agreement of merger as the
surviving company, and in the case of a consolidation, shall be the new
company provided for in the agreement of consolidation;
(b) the separate existence of all of the companies parties to the
agreement of merger or consolidation, except the surviving company in the
case of a merger, shall cease;
(c) such surviving or new company shall have all of the rights,
privileges, immunities and powers and shall be subject to all of the duties
and liabilities granted or imposed by this Code;
(d) such surviving or new company shall thereupon and thereafter possess
all the rights, privileges, immunities, powers and franchises of a public
as well as of a private nature, of each of the companies so merged or
consolidated; and all property, real, personal and mixed, and all debts due
on whatever account, including subscriptions to shares, assessments payable
from members or policyholders, and all other choses in action and all and
every other interest of, or belonging to or due to, each of the companies
so merged or consolidated shall be deemed to be transferred to and vested
in such surviving or new company without further act or deed; and the title
to any real estate, or any interest therein, under the laws of this State
vested in any of such companies shall not revert or be in any way impaired
by reason of such merger or consolidation;
(e) such surviving or new company shall thenceforth be responsible and
liable for all the liabilities and obligations of each of the companies so
merged or consolidated; any claim existing or action or proceeding pending
by or against any of such companies may be prosecuted to judgment as if
such merger or consolidation had not taken place, or such surviving or new
company may be substituted in its place; neither the rights of creditors
nor any liens upon the property of any of such companies shall be impaired
by such merger or consolidation, but such liens shall be limited to the
property upon which they were liens immediately prior to the time of such
merger or consolidation, unless otherwise provided in the agreement of
merger or consolidation; and
(f) in case of a merger, the articles of incorporation of the surviving
company shall be supplanted and superseded to the extent, if any, that any
provision or provisions of such articles shall be restated in the agreement
of merger as provided in section 158, and such articles of incorporation,
shall be deemed to be thereby and to that extent amended; in case of a
consolidation, the statements set forth in the agreement of consolidation
as provided in section 158 shall be deemed to be articles of incorporation
of the new company formed by such consolidation.
(2) If the surviving or new company is a foreign or alien company, when
such merger or consolidation has become effective in this State
(a) the effect of the merger or consolidation shall be determined by the
law of the state of incorporation or organization of such company;
(b) the separate existence of all domestic companies parties to the plan
of merger or consolidation shall cease;
(c) all property, real, personal, and mixed, and all debts due on
whatever account including subscriptions to shares, assessments payable
from members or policyholders and all other choses in action and all and
every other interest of or belonging to and due to each of the companies so
merged or consolidated shall be taken and deemed to be transferred to and
vested in such surviving or new company without further act or deed, and
the title to any real estate, or any interest therein, shall not revert or
be in any way impaired by reason of such merger or consolidation.
(3) In the event of a merger or consolidation under this article, the
surviving company or the consolidated company shall be considered as having
the age of the oldest company which is a party to such merger or
consolidation for the purpose of complying with requirements of the laws
relating to age of company.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/167) (from Ch. 73, par. 779)
Sec. 167.
Rights of
dissenting shareholders of domestic company.
(1) If a shareholder entitled to vote of (a) a domestic company which is
a party to a merger or consolidation or (b) a domestic insurance company to
be acquired under a plan of exchange files with such company, prior to or
at the meeting of shareholders at which the agreement of merger or
consolidation or plan of exchange is submitted to a vote, a written
objection to such agreement or plan, and does not vote in favor thereof,
and such shareholder, within 20 days after the merger or consolidation or
plan of exchange has become effective in this State makes written demand on
the surviving or new company or on the domestic insurance company to be
acquired under a plan of exchange for payment of the fair value of his
shares as of the day prior to the date on which the vote of shareholders
was taken approving the merger or consolidation or plan of exchange, such
surviving or new company or domestic insurance company shall pay to such
shareholder upon surrender of his certificate or certificates representing
such shares, the fair value thereof. Any shareholder who makes such
objection and demand shall cease to be a shareholder and shall have no
rights with respect to such shares except the right to receive payment
therefor. If within 30 days after the effective date, the value of such
shares is agreed upon between the shareholder and the surviving or new
company or the domestic insurance company to be acquired under a plan of
exchange, as the case may be, and such agreement is approved in writing by
the Director, payment therefor shall be made within 90 days after the
effective date. If within 30 days after the effective date the surviving or
new company or the domestic insurance company to be acquired under a plan
of exchange, as the case may be, and the shareholders do not so agree, or
any agreement as to value is not approved in writing by the Director,
either such company or the shareholder may, within 90 days after the
effective date, petition the circuit court of the county in which the
principal office of the surviving or new company or domestic insurance
company is located, to appraise the value of such shares. In the event the
surviving or new company has no office in this State, then such petition
may be filed in the circuit court of the county in which the principal
office of the company in which such shareholder holds shares was located,
immediately prior to such merger or consolidation. A copy of the petition
shall be delivered or mailed by registered mail to the Director within 5
days after the filing thereof and proof of such delivery or mailing shall
be filed with the court. The Director has the right to appear through the
Attorney General and be heard upon all questions and issues in the
proceeding. The practice, procedure and judgment in the circuit court upon
such petition shall be the same, so far as practicable, as that under the
eminent domain laws in this State.
(2) Payment of the appraised value of such shares shall be made within
60 days after the entry of the judgment or order finding such appraised
value and the judgment shall be payable only upon and simultaneously with
the surrender to the surviving or new company or the domestic insurance
company to be acquired under a plan of exchange of the certificate or
certificates representing such shares. The right of a dissenting
shareholder to be paid the fair value of his shares as herein provided
shall cease if and when the Director revokes the approval to the merger or
consolidation, as provided in Section 168, or if the merger or
consolidation or plan of exchange be abandoned.
(3) Every shareholder who did not vote in favor of such merger or
consolidation or plan of exchange and who does not object in writing and
demand payment of the value of his shares at the time and in the manner
aforesaid, or does not file a petition within the time herein limited, is
conclusively presumed to have assented to such merger or consolidation or
plan of exchange and shall be bound by the terms thereof.
(4) All shares of dissenting shareholders so acquired by a domestic
insurance company party to a plan of exchange shall be cancelled by the
board of directors of such company upon the plan of exchange becoming
effective or at any time thereafter, and the capital stock of the company
shall be decreased in accordance with Section 33.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/168) (from Ch. 73, par. 780)
Sec. 168.
Rights of
dissenting policyholder of domestic company.
(1) If not less than five per centum of all the policyholders in any
domestic company who were entitled to vote with respect to any merger or
consolidation and who did not vote in favor of such merger or consolidation
at the meeting at which the agreement of merger or consolidation was
adopted by the policyholders of such company, or if not less than five per
centum of the members of any domestic fraternal benefit society party to a
merger or consolidation shall file, at any time within thirty days after
the agreement of merger or consolidation is effected, a petition with the
Director for a hearing upon such agreement of merger or consolidation, the
Director shall order a hearing upon said petition, fix the time and place
of such hearing, and give written notice to the companies that are parties
to the merger or consolidation, at least fifteen days before the date of
such hearing. Any member or policyholder so petitioning may appear before
the Director at such hearing, either in person or by an attorney, and be
heard with reference to said agreement. If, upon such hearing being had,
the Director finds that the interests of the members or policyholders, as
the case may be, of such company are not properly protected, or if he finds
that any reasonable objection exists to such agreement, he shall enter an
order revoking the approval already given, and the agreement of merger or
consolidation shall, thereupon, become null and void.
(2) The Director shall have like power to revoke any approval of any
such agreement if any officer, director or employee of any company party to
such agreement shall, after reasonable notice, fail or refuse without
reasonable cause to attend and testify at such hearing, or to produce any
books or papers called for by said Director.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/169) (from Ch. 73, par. 781)
Sec. 169.
Rights of
dissenting shareholders and policyholders of foreign or alien company.
The rights of any dissenting shareholder, member or policyholder of any
foreign or alien company party to a merger or consolidation, shall be those
afforded to such shareholder, member, or policyholder by the laws of the
domiciliary state or country of such foreign or alien company.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/169.1) (from Ch. 73, par. 781.1)
Sec. 169.1.
Effect
of exchange under plan of exchange.
(1) Upon a plan of exchange becoming effective, the exchange provided
for therein is considered to have been consummated and each shareholder of
the domestic stock insurance company acquired ceases to be a shareholder of
such company. The ownership of all shares of the issued and outstanding
stock of such company, except shares payment of the value of which is
required to be made by such company under Section 167, vests in the
acquiring corporation automatically without any physical transfer or
deposit of certificates representing such shares. All shares payment of the
value of which is required to be made by such company under Section 167 are
considered no longer outstanding shares of such company. The acquiring
corporation thereupon becomes the sole shareholder of such domestic stock
insurance company and has all the rights, privileges, immunities and powers
and, except as otherwise provided herein, is subject to all of the duties
and liabilities to the extent provided by law of a shareholder of an
insurance company organized under the laws of this State.
(2) Certificates representing shares of the domestic insurance company
to be acquired prior to the plan of exchange becoming effective, except
certificates representing shares payment of the value of which is required
under Section 167, shall after the plan of exchange becomes effective,
represent (a) shares of the issued and outstanding capital stock or other
securities issued by the acquiring corporations and (b) the right, if any,
to receive cash or other consideration upon such terms as are specified in
the plan of exchange. However, the plan of exchange may specify that all
such certificates shall after the plan of exchange becomes effective
represent only the right to receive shares of stock or other securities
issued by the acquiring corporation, or cash or other consideration or any
combination thereof upon such terms as are specified in the plan of
exchange.
(Source: Laws 1967, p. 2406.)
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(215 ILCS 5/169.2) (from Ch. 73, par. 781.2)
Sec. 169.2.
Acquiring and acquired corporations under a plan of exchange to be
separate.
The domestic stock insurance company acquired under a plan of exchange
and the acquiring corporation are in all respects separate and distinct
corporations, with neither corporation having any liability to the
creditors or policyholders, if any, or shareholders of the other, for any
acts or omissions of the officers, directors or shareholders of either or
both of such corporations.
(Source: Laws 1967, p. 2406.)
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(215 ILCS 5/170) (from Ch. 73, par. 782)
Sec. 170.
Transfer
of deposits.
(1) If the surviving or new company shall be a foreign or alien company
and the laws of the state or country under which such surviving or new
company is incorporated or organized shall require the maintenance with any
official of such State or country of a deposit of the legal reserve on any
policies, then the Director is authorized to deliver to the proper
custodian of such deposits of such state or country any deposits
theretofore made with the Director pertaining to policies of any of the
merged or consolidated companies. If the surviving or new company shall be
a domestic company into which has been merged or consolidated a foreign or
alien company incorporated or organized in a state or country the laws of
which require the maintenance with an official of a deposit of the legal
reserve on any policies, then the Director is hereby authorized to receive
from such official any deposit theretofore made with such official
pertaining to the policies of any of the merged or consolidated companies.
(2) Any surviving or new company shall, within 60 days after the
transfer of such deposit, notify the holder of every policy secured by such
transferred deposit, that the transfer has been made. The president or
vice-president and secretary or assistant secretary of such company, or the
executive officers corresponding thereto, shall within 30 days thereafter,
file with the Director an affidavit of the fact that due notice to
policyholders, as provided for herein, has been given. If a surviving or
new company shall be a foreign or alien company, the Director shall require
from such company, before transferring any deposit to any official of the
state or country under the laws of which such foreign or alien company is
incorporated or organized, a written agreement that notice of such transfer
will be given to policyholders and that an affidavit with regard to such
notice will be furnished to the Director as in this section provided.
(3) In the event any deposit is to be maintained in this State by reason
of this section, the amount thereof from time to time for each such policy
shall be at least equal to the amount which would be required in the state
where such deposit was theretofore maintained under the provisions of the
law of such state in effect on the date the merger or consolidation was
effected. The deposits so maintained in this State shall consist of
securities of the kinds authorized for investment by Article VIII of this
Code.
(Source: Laws 1959, p. 1431.)
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(215 ILCS 5/171) (from Ch. 73, par. 783)
Sec. 171.
Certificates of fees and commissions paid.
Whenever agreements of merger or consolidation or plans of exchange are
filed with the Director, there shall also be filed a certificate executed
by the president or a vice-president and attested by the secretary or an
assistant secretary, or the executive officers corresponding thereto, and
under the corporate seal of each of the companies party to the agreement of
merger or consolidation or plan of exchange, verified by the affidavits of
such officers, setting forth all fees, commissions or other compensations,
or valuable considerations paid or to be paid, directly or indirectly, to
any person in any manner securing, aiding, promoting or assisting in any
such merger or consolidation or plan of exchange.
(Source: Laws 1967, p. 2406.)
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(215 ILCS 5/172) (from Ch. 73, par. 784)
Sec. 172.
Payment of
fees to officer or director prohibited.
(1) No director or officer of any company party to a merger or
consolidation or plan of exchange, except as fully expressed in the
agreement of merger or consolidation or plan of exchange shall receive any
fee, commission, other compensation or valuable consideration whatever,
directly or indirectly for in any manner aiding, promoting or assisting in
such merger or consolidation or plan of exchange.
(2) Any person violating the provisions of this Section shall be guilty
of a Class A misdemeanor.
(Source: P.A. 77-2699.)
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(215 ILCS 5/Art. XI heading) ARTICLE XI.
REINSURANCE
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(215 ILCS 5/173) (from Ch. 73, par. 785)
Sec. 173.
Reinsurance authorized.
(a) Subject to the provisions of this Article, any domestic company may,
by a reinsurance agreement, accept any part or all of any risks of the
kind which it is authorized to insure and it may cede all or any part of
its risks to another solvent company having the power to make such
reinsurance. It may take credit for the reserves on such ceded risks to
the extent reinsured subject to the exceptions provided in Sections
173.1 through 173.5.
(b) The purpose of this Article is to protect the interest of insureds,
claimants, ceding insurers, assuming insurers, and the public generally. The
legislature hereby declares its intent is to ensure adequate regulation of
insurers and reinsurers and adequate protection for those to whom they owe
obligations. In furtherance of that State interest, the legislature hereby
provides a mandate that upon the insolvency of a non-U.S. insurer or reinsurer
that provides security to fund its U.S. obligations in accordance with this
Article, the assets representing the security shall be maintained in the United
States and claims shall be filed and valued by the state insurance
official with regulatory oversight, and the assets shall be distributed in
accordance with the insurance laws of the state in which the trust is
domiciled that are applicable to the liquidation of domestic U.S. insurance
companies. The legislature declares that the matters contained in this Article
are fundamental to the business of insurance in accordance with 15 U.S.C
Sections 1011 through 1012.
(Source: P.A. 90-381, eff. 8-14-97.)
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(215 ILCS 5/173.1) (from Ch. 73, par. 785.1)
Sec. 173.1. Credit allowed a domestic ceding insurer.
(1) Except as otherwise provided under Article VIII 1/2 of this Code and
related provisions of the Illinois Administrative Code, credit for
reinsurance shall be allowed a domestic ceding insurer as
either an admitted asset or a deduction from liability on account of
reinsurance ceded only when the reinsurer meets the requirements of paragraph (A), (B), (B-5), (C), (C-5), (C-10), or (D) of this subsection (1).
Credit shall be allowed under paragraph (A), (B), or (B-5) of this subsection (1) only as respects
cessions of those kinds or classes of business in which the assuming insurer is
licensed or otherwise permitted to write or assume in its state of domicile, or
in the case of a U.S. branch of an alien assuming insurer, in the state through
which it is entered and licensed to transact insurance or reinsurance. Credit
shall be allowed under paragraph (B-5) or (C) of this subsection (1) only
if the applicable requirements of paragraph (E) of this subsection (1)
have been
satisfied.
(A) Credit shall be allowed when the reinsurance is | ||
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(B) Credit shall be allowed when the reinsurance is | ||
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(1) files with the Director evidence of its | ||
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(2) submits to this State's authority to examine | ||
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(3) is licensed to transact insurance or | ||
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(4) files annually with the Director a copy of | ||
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(5) maintains a surplus as regards policyholders | ||
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(B-5)(1) Credit shall be allowed when the reinsurance | ||
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(a) maintains a surplus as regards policyholders | ||
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(b) submits to the authority of this State to | ||
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(2) The requirement of item (a) of subparagraph (1) | ||
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(C)(1) Credit shall be allowed when the reinsurance | ||
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(2)(a) Credit for reinsurance shall not be granted | ||
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(i) the regulatory official of the state where | ||
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(ii) the regulatory official of another state | ||
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(b) The form of the trust and any trust amendments | ||
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(c) The trust shall remain in effect for as long as | ||
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No later than February 28 of each year, the assuming | ||
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(d) No later than February 28 of each year, an | ||
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(i) a copy of the form of the trust agreement | ||
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(ii) a copy of the annual and quarterly | ||
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(iii) any financial information provided to the | ||
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(iv) a copy of any annual and quarterly | ||
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(v) a copy of the information required to be | ||
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(vi) a written certification that the trust | ||
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(3) The following requirements apply to the following | ||
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(a) The trust fund for a single assuming insurer | ||
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(a-5) At any time after the assuming insurer has | ||
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(b)(i) In the case of a group including | ||
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(I) for reinsurance ceded under reinsurance | ||
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(II) for reinsurance ceded under reinsurance | ||
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(III) in addition to these trusts, the group | ||
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(ii) The incorporated members of the group shall | ||
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(iii) Within 90 days after its financial | ||
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(c) In the case of a group of incorporated | ||
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(i) have continuously transacted an insurance | ||
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(ii) maintain aggregate policyholders' | ||
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(iii) maintain a trust in an amount not less | ||
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(iv) in addition, maintain a joint trusteed | ||
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(v) within 90 days after its financial | ||
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(C-5) Credit shall be allowed when the reinsurance is | ||
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(1) In order to be eligible for certification, | ||
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(a) the assuming insurer must be domiciled | ||
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(b) the assuming insurer must maintain | ||
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(c) the assuming insurer must maintain | ||
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(i) Standard & Poor's; (ii) Moody's Investors Service; (iii) Fitch Ratings; (iv) A.M. Best Company; or (v) any other nationally recognized | ||
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(d) the assuming insurer must agree to submit | ||
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(e) the assuming insurer must agree to meet | ||
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(2) An association, including incorporated and | ||
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(a) the association shall satisfy its minimum | ||
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(b) the incorporated members of the | ||
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(c) within 90 days after its financial | ||
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(3) The Director shall create and publish a list | ||
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(a) In order to determine whether the | ||
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(b) Additional factors to be considered in | ||
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(i) the framework under which the | ||
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(ii) the structure and authority of the | ||
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(iii) the substance of financial and | ||
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(iv) the form and substance of financial | ||
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(v) the domiciliary regulator's | ||
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(vi) the history of performance by | ||
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(vii) any documented evidence of | ||
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(viii) any relevant international | ||
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(c) If, upon conducting an evaluation under | ||
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(d) The Director shall consider the list of | ||
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(e) U.S. jurisdictions that meet the | ||
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(f) If a certified reinsurer's domiciliary | ||
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(4) If an applicant for certification has been | ||
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(a) Any change in the certified reinsurer's | ||
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(b) The Director may withdraw recognition of | ||
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(c) The Director may withdraw recognition of | ||
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(5) The Director shall assign a rating to each | ||
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(a) The certified reinsurer's financial | ||
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(i) Ratings Category "Secure - 1" | ||
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(ii) Ratings Category "Secure - 2" | ||
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(iii) Ratings Category "Secure - 3" | ||
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(iv) Ratings Category "Secure - 4" | ||
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(v) Ratings Category "Secure - 5" | ||
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(vi) Ratings Category "Vulnerable - 6" | ||
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A failure to obtain or maintain at | ||
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(b) The business practices of the certified | ||
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(c) For certified reinsurers domiciled in the | ||
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(d) For certified reinsurers not domiciled in | ||
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(e) The reputation of the certified reinsurer | ||
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(f) Regulatory actions against the certified | ||
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(g) The report of the independent auditor on | ||
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(h) For certified reinsurers not domiciled in | ||
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(i) The liquidation priority of obligations | ||
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(j) A certified reinsurer's participation in | ||
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The maximum rating that a certified reinsurer may | ||
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(6) Based on the analysis conducted under item | ||
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(a) more than 15% of the certified | ||
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(b) the aggregate amount of reinsurance | ||
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(7) The Director shall post notice on the | ||
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(8) A certified reinsurer shall secure | ||
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(a) The amount of security required in order | ||
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Secure - 1: 0%. Secure - 2: 10%. Secure - 3: 20%. Secure - 4: 50%. Secure - 5: 75%. Vulnerable - 6: 100%. (b) Nothing in this subparagraph (8) shall | ||
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(c) In order for a domestic ceding insurer to | ||
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(d) If a certified reinsurer maintains a | ||
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(e) The minimum trusteed surplus requirements | ||
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(f) With respect to obligations incurred by a | ||
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(9)(a) In the case of a downgrade by a rating | ||
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(b) If the rating of a certified reinsurer is | ||
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(c) The Director may suspend, revoke, or | ||
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(d) For purposes of this subsection (1), a | ||
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(i) As used in this item (d), the term | ||
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(ii) If the Director continues to assign a | ||
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(e) Upon revocation of the certification of a | ||
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(f) Notwithstanding the change of a certified | ||
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(10) A certified reinsurer that ceases to assume | ||
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(11) Credit for reinsurance under this paragraph | ||
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(12) The Director shall comply with all reporting | ||
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(C-10)(1) Credit shall be allowed when the | ||
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(a) The assuming insurer must have its head | ||
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(i) a non-U.S. jurisdiction that is subject | ||
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(ii) a U.S. jurisdiction that meets the | ||
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(iii) a qualified jurisdiction, as determined | ||
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(b) The assuming insurer must have and | ||
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(c) The assuming insurer must have and | ||
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(d) The assuming insurer must provide adequate | ||
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(i) the assuming insurer must provide prompt | ||
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(ii) the assuming insurer must consent in | ||
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(iii) the assuming insurer must consent in | ||
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(iv) each reinsurance agreement must include | ||
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(v) the assuming insurer must confirm that it | ||
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(e) If requested by the Director, the assuming | ||
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(f) The assuming insurer must maintain a | ||
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(g) The assuming insurer's supervisory | ||
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(h) Nothing in this subparagraph precludes an | ||
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(2) The Director shall timely create and publish a | ||
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(a) The Director's list shall include any | ||
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(b) The Director may remove a jurisdiction from | ||
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(3) The Director shall timely create and publish | ||
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(4) If the Director determines that an assuming | ||
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(a) While an assuming insurer's eligibility is | ||
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(b) If an assuming insurer's eligibility is | ||
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(5) If subject to a legal process of | ||
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(6) Nothing in this paragraph shall limit or in any | ||
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(7) Credit may be taken under this paragraph only | ||
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(i) the date on which the assuming insurer has | ||
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(ii) the effective date of the new reinsurance | ||
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This subparagraph does not alter or impair a ceding | ||
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(8) Nothing in this paragraph shall authorize an | ||
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(9) Nothing in this paragraph shall limit or in any | ||
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(D) Credit shall be allowed when the reinsurance is | ||
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(E) If the assuming insurer is not licensed to | ||
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(1) that in the event of the failure of the | ||
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(2) to designate the Director or a designated | ||
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This provision is not intended to conflict with or | ||
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(F) If the assuming insurer does not meet the | ||
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(1) Notwithstanding any other provisions in the | ||
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(2) The assets shall be distributed by and claims | ||
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(3) If the state official with regulatory | ||
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(4) The grantor shall waive any rights otherwise | ||
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(G) If an accredited or certified reinsurer ceases to | ||
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(1) The Director must give the reinsurer notice | ||
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(a) the reinsurer waives its right to hearing; (b) the Director's order is based on | ||
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(c) the Director finds that an emergency | ||
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(2) While a reinsurer's accreditation or | ||
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(H) The following provisions shall apply concerning | ||
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(1) A ceding insurer shall take steps to manage | ||
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(2) A ceding insurer shall take steps to | ||
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(2) Credit for the reinsurance ceded by a
domestic
insurer to an assuming insurer not meeting the requirements of subsection
(1) of this Section shall be allowed in an amount not exceeding the assets or liabilities
carried by
the ceding insurer. The credit shall not exceed the amount of funds held
by or held in trust for the ceding insurer under a reinsurance contract with the assuming insurer
as security for the payment of obligations thereunder, if the security is
held in the United States subject to withdrawal solely by, and under the
exclusive control of, the ceding insurer; or, in the case of a trust, held
in a qualified United States financial institution, as defined in paragraph (B) of
subsection (3) of this Section. This security may be in the form of:
(A) Cash.
(B) Securities listed by the Securities Valuation | ||
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(C) Clean, irrevocable, unconditional, letters of | ||
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(D) Any other form of security acceptable to the | ||
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(3)(A) For purposes of paragraph (C) of subsection (2) of this Section, a "qualified United States
financial institution" means an institution that:
(1) is organized or, in the case of a U.S. office of | ||
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(2) is regulated, supervised, and examined by U.S. | ||
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(3) has been designated by either the Director or the | ||
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(4) is not affiliated with the assuming company.
(B) A "qualified United States financial institution" means, for
purposes of those provisions of this law specifying those institutions that
are eligible to act as a fiduciary of a trust, an institution that:
(1) is organized or, in the case of the U.S. branch | ||
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(2) is regulated, supervised, and examined by federal | ||
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(3) is not affiliated with the assuming company, | ||
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(C) Except as set forth in subparagraph (11) of paragraph (C-5) of subsection (1) of this Section as to cessions by certified reinsurers, this amendatory Act of the 100th General Assembly shall apply to all cessions after the effective date of this amendatory Act of the 100th General Assembly under reinsurance agreements that have an inception, anniversary, or renewal date not less than 6 months after the effective date of this amendatory Act of the 100th General Assembly.
(D) The Department shall adopt rules implementing the provisions of this Article.(Source: P.A. 102-578, eff. 7-1-22 (See Section 5 of P.A. 102-672 for effective date of P.A. 102-578).)
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(215 ILCS 5/173.2) (from Ch. 73, par. 785.2)
Sec. 173.2.
Reserve credit for liability assumed.
No credit shall be allowed as an admitted asset or as a deduction from
liability, to any ceding company for reinsurance unless the reinsurance is
payable by the assuming company on the basis of the liability of the ceding
company under the contract or contracts reinsured without diminution
because of the insolvency of the ceding company.
(Source: Laws 1965, p. 1077.)
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(215 ILCS 5/173.3) (from Ch. 73, par. 785.3)
Sec. 173.3.
Payment by assuming company.
(1) No such credit shall be allowed for reinsurance unless the
reinsurance agreement provides that payments by the assuming company shall
be made directly to the ceding company or to its liquidator, receiver, or
statutory successor, except where the contract specifically provides
another payee of such reinsurance in the event of the insolvency of the
ceding company or where the assuming company with the consent of the direct
insured or insureds has assumed such policy obligations of the ceding
company to the payees under such policies and in substitution for the
obligations of the ceding company to such payees.
(2) Except as provided in this Section, no assuming company may pay or
settle, or agree to pay or settle, any policy claim, or any portion
thereof, directly to or with a policyholder of any ceding company if an
Order of Rehabilitation or Liquidation has been entered against such ceding
company.
(Source: P.A. 77-1329.)
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(215 ILCS 5/173.4) (from Ch. 73, par. 785.4)
Sec. 173.4.
Assuming company may defend claims for insolvent ceding company.
Such reinsurance agreement may provide that the liquidator or receiver
of an insolvent ceding company shall give written notice of the pendency of
a claim against the insolvent ceding company on the policy or bond
reinsured within a reasonable time after such claim is filed in the
insolvency proceeding and that during the pendency of such claim any
assuming company may investigate such claim and interpose, at its own
expense, in the proceeding where such claim is to be adjudicated any
defense or defenses which it considers available to the ceding company or
its liquidator or receiver. The expense thus incurred by the assuming
company is chargeable against the insolvent ceding company as a part of the
expense of liquidation to the extent of a proportionate share of the
benefit which accrues to the ceding company solely as a result of the
defense undertaken by the assuming company.
Where two or more assuming companies are involved in the same claim and
a majority in interest elect to interpose a defense to such claim, the
expense shall be apportioned in accordance with the terms of the
reinsurance agreement as though such expense had been incurred by the
ceding company.
(Source: Laws 1965, p. 1077.)
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(215 ILCS 5/173.5) (from Ch. 73, par. 785.5)
Sec. 173.5.
Crediting of commissions from cancellable reinsurance.
Where the parties to a reinsurance contract cancel such contract within
90 days of its effective date without providing for a runoff of the
reinsurance in force at the date of cancellation, credit for commission
shall be allowed on the financial statement of the ceding company only for
that amount of such commission as is actually earned. In the case of any
cancellation of reinsurance contracts involving more than 20% of the ceding
company's premiums in force, the ceding company shall notify the Director
thereof in writing, stating the estimated amount of gross unearned premiums
and return commissions involved.
(Source: Laws 1965, p. 1077.)
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(215 ILCS 5/174) (from Ch. 73, par. 786)
Sec. 174. Kinds of
agreements requiring approval.
(1) The following kinds of reinsurance agreements shall not be entered into
by any domestic company unless such agreements are approved in writing by
the Director:
(a) Agreements of reinsurance of any such company | ||
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(b) Any agreement or agreements of reinsurance | ||
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(c) (Blank).
(2) An agreement which is not disapproved by the Director within thirty
days after its submission shall be deemed approved.
(Source: P.A. 98-969, eff. 1-1-15.)
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(215 ILCS 5/174.1) (from Ch. 73, par. 786.1)
Sec. 174.1.
Kinds of Agreements Prohibited.
No domestic stock company with
less than $5,000,000 capital and surplus nor domestic mutual or reciprocal company
with less than $5,000,000 surplus may assume as reinsurance any of the kind or
kinds of businesses enumerated in Class 2 or Class 3 of Section 4 of this
Code, except Class 2(a), and except for facultative reinsurance of specific
risks and assumption of risks from companies subject to "An Act
relating to local, mutual district, county and township insurance
companies", approved March 13, 1936, as amended. If approval of the
Director is obtained prior to the reinsurance
assumption, this prohibition shall not apply to any company organized and
authorized to do business in Illinois between July 1, 1981, and June 30,
1983, until January 1, 1989.
(Source: P.A. 84-671.)
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(215 ILCS 5/175) (from Ch. 73, par. 787)
Sec. 175.
Conditions
for approval.
Any reinsurance agreement requiring the written approval of the Director
under section 174 shall be approved by him if the terms thereof do not
injuriously affect the rights of policyholders of any of the companies
which are parties thereto. If the Director refuses to approve any such
agreement, he shall grant the company a hearing upon request.
(Source: Laws 1965, p. 1077.)
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(215 ILCS 5/176) (from Ch. 73, par. 788)
Sec. 176.
Pending
actions.
Whenever a company agrees to assume and carry out directly with the
policyholder any of the policy obligations of the ceding company under a
reinsurance agreement, any claim existing or action or proceeding pending
arising out of such policy, by or against the ceding company with respect
to such obligations may be prosecuted to judgment as if such reinsurance
agreement had not been made, or the assuming company may be substituted in
place of the ceding company.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/177) (from Ch. 73, par. 789)
Sec. 177.
Transfer
of deposits.
The provisions of section 170 applicable to the transfer of deposits
of legal reserves on policies of merged or consolidated companies shall
apply to the transfer of deposits of such reserves of a ceding company in
the case of a reinsurance agreement, and for the purposes of determining
the conditions and requirements for such transfer the assuming company
shall be regarded as a surviving or new company and the ceding company
shall be regarded as a company that has been merged or consolidated.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/178)
Sec. 178. (Repealed).
(Source: Laws 1937, p. 696. Repealed by P.A. 98-692, eff. 7-1-14; 98-969, eff. 1-1-15.)
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(215 ILCS 5/179) (from Ch. 73, par. 791)
Sec. 179.
Payment of
fees to officer or director prohibited.
(1) No director or officer of any company, party to a reinsurance
agreement, except as fully expressed in the reinsurance agreement, shall
receive any fee, commission, other compensation or valuable consideration
whatever, directly or indirectly, for in any manner aiding, promoting or
assisting in the negotiation of such reinsurance agreement.
(2) Any person violating the provisions of this section shall be guilty
of a Class A misdemeanor.
(Source: P.A. 77-2699.)
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(215 ILCS 5/179a)
Sec. 179a.
Managing general agent prohibition.
(a) No managing general agent, as defined in Section 141a, shall receive any
compensation or remuneration for, or in any manner profit from, obtaining or
arranging reinsurance for a domestic company with respect to business
underwritten by that managing general agent.
(b) Any person violating the provisions of this Section is guilty of a Class
A misdemeanor.
(Source: P.A. 88-364.)
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(215 ILCS 5/179b)
Sec. 179b.
Reinsurance committee.
Each domestic company that cedes any
reinsurance must establish and maintain a reinsurance committee with not fewer
than 3 members, at least one of which must be a member of the company's board
of directors. The committee shall review and approve all treaty reinsurance
placements and review and approve guidelines for facultative placements for the
company, with the
exception of a reinsurance agreement in which the aggregate premium ceded in
any one year is
less than 1% of the company's annual gross written premium.
The committee shall give special attention to reinsurers' financial
strength and performance record.
(Source: P.A. 88-364.)
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(215 ILCS 5/Art. XI.5 heading) ARTICLE XI 1/2.
PROTECTED CELL COMPANIES
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(215 ILCS 5/179A-1)
Sec. 179A-1.
Short title.
This Article may be cited as the Protected Cell
Company
Law.
(Source: P.A. 91-278, eff. 7-23-99.)
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(215 ILCS 5/179A-5)
Sec. 179A-5.
Purpose.
This Article is adopted to provide a basis for the
creation of protected cells by a domestic insurer
as one means of accessing alternative sources of capital and achieving the
benefits of insurance securitization. Investors in fully funded insurance
securitization transactions provide funds that are available to pay the
insurer's insurance obligations or to repay the investors or both. The
creation of protected cells is intended to be a means to achieve more
efficiencies in conducting insurance securitizations.
Under the
terms of the typical debt instrument underlying an insurance securitization
transaction, prepaid
principal is repaid to the investor on a specified maturity date with interest,
unless a trigger event
occurs. The insurance securitization proceeds secure both the protected
cell company's insurance obligations if a trigger event occurs,
as well as the
protected cell company's obligation to repay the insurance
securitization investors if a trigger event
does not occur. Insurance securitization transactions have
been performed
through alien companies
in order to utilize efficiencies available to alien companies that are not
currently available to
domestic companies. This Article is adopted in order to create more
efficiency in conducting
insurance securitization,
to allow domestic companies easier access to alternative sources of capital,
and to promote the
benefits of insurance securitization generally.
(Source: P.A. 91-278, eff. 7-23-99; 92-74, eff. 7-12-01.)
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(215 ILCS 5/179A-10)
Sec. 179A-10.
Definitions.
"Domestic company" means an insurance company domiciled in the State of
Illinois.
"Fully funded" means that, with respect to any exposure attributed to a
protected cell, the market value of the protected cell assets, on the date on
which the insurance securitization is effected, equals or exceeds the maximum
possible exposure attributable to the protected cell with respect to those
exposures.
"General account" means the assets and liabilities of a protected cell
company
other than
protected cell assets and protected cell liabilities.
"Indemnity trigger" means a transaction term by which relief of
the issuer's
obligation to repay
investors is triggered by its incurring a specified level of
losses under its insurance or
reinsurance contracts.
"Market value" has the meaning given that term in Article VIII of
this Code
(Investments of Domestic Companies).
"Non-indemnity trigger" means a transaction term by which relief of the
issuer's obligation to repay investors is triggered solely by some event or
condition other than the individual protected cell company incurring a
specified level of losses under its insurance or reinsurance contracts.
"Protected cell" means an identified pool of assets and liabilities of a
domestic company
segregated and insulated by means of this Article from the remainder of the
company's assets
and liabilities.
"Protected cell account" means a specifically identified bank or custodial
account established by
a protected cell company for the purpose of segregating the
protected cell assets of
one protected cell from the protected cell assets of other protected cells and
from the assets of the
protected cell company's general account.
"Protected cell assets" means all assets, contract rights, and general
intangibles identified with and attributable to
a
specific protected cell
of a protected cell company.
"Protected cell company" means a domestic company that has one or more
protected cells.
"Protected cell company insurance securitization"
means the issuance of debt instruments, the proceeds from which support the
exposures attributed to the protected cell, by a protected cell company where
repayment of principal or interest, or both, to investors pursuant to the
transaction terms is contingent upon the occurrence or nonoccurrence of an
event with respect to which the protected cell company is exposed to loss under
insurance or reinsurance contracts it has issued.
"Protected cell liabilities" means all liabilities and other obligations
identified with and
attributable to a specific
protected cell of a protected cell company.
(Source: P.A. 91-278, eff. 7-23-99; 92-74, eff. 7-12-01.)
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(215 ILCS 5/179A-15)
Sec. 179A-15.
Establishment of protected cells.
(a) A domestic company may,
with the prior written approval by the Director of a
plan of operation
submitted by the domestic company with respect to each protected cell,
establish one or more
protected cells in connection with an insurance securitization. Upon the
written approval by the Director of the plan of
operation, which shall
include, but not be limited to, the specific business and investment
guidelines
of the protected
cell, the protected cell company may, in accordance with the approved plan
of operation,
attribute to the
protected cell insurance obligations with
respect to
its insurance
business and obligations relating to the insurance securitization and
assets to fund those obligations. A protected cell shall have
its own distinct name
or designation, which shall include the words "protected cell". The protected
cell company
shall transfer all
assets attributable to a protected cell to one or more separately established
and identified
protected cell accounts bearing the name or designation of that protected cell.
Protected cell
assets shall be held in the protected cell accounts for the purpose of
satisfying the obligations of
that protected cell.
(b) All attributions of assets and
liabilities between a protected
cell and the general account shall be in accordance
with the
plan
of operation approved by the Director. No
other
attribution of assets or
liabilities may be made by a protected cell company
between the
protected cell company's general account and its
protected cells.
Any attribution of assets and
liabilities between the general account and a protected cell
or from investors in the form of principal on a debt instrument
issued by a
protected cell company shall be in cash or in readily marketable securities
with
established market values.
(c) The creation of a protected cell does not create, in respect of that
protected cell, a legal person
separate from the protected cell company. Amounts attributed to a protected
cell under this
Article, including
assets transferred to a protected cell account, are owned by the protected
cell company and
the protected cell company may
not be, nor hold itself out to be, a trustee with respect to those protected
cell assets of that
protected cell account. Notwithstanding the foregoing, the company may allow
for a security
interest to attach to protected cell assets or a protected cell account when in
favor of a creditor of
the protected cell and otherwise allowed under applicable law.
(d) This Article shall not be construed to prohibit the protected cell
company from
contracting with or
arranging for an investment advisor, commodity trading advisor, or other third
party to manage
the protected cell assets of a protected cell, provided that all remuneration,
expenses, and other
compensation of the third party advisor or manager are payable from the
protected cell assets of
that protected cell and not from the protected cell assets of other protected
cells or the assets of
the protected cell company's general account.
(e) A protected cell company shall
establish
administrative and
accounting procedures necessary to properly identify the one or more
protected cells of the
protected cell company and the protected cell assets and protected cell
liabilities
attributable to the protected cells. It shall be
the duty of the directors of a protected cell company to:
(1) keep protected cell assets and protected cell | ||
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(2) keep protected cell assets and protected cell | ||
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If this Section is violated,
the remedy of tracing shall
be
applicable to protected cell assets when commingled with protected cell assets
of other protected
cells or the assets of the protected cell company's general account.
The remedy of tracing shall not be construed as an exclusive remedy.
(f) The protected cell company shall, when
establishing a protected cell, attribute to the protected cell assets with a
value at least equal to the reserves and other insurance liabilities attributed
to that protected cell.
(Source: P.A. 91-278, eff. 7-23-99; 92-74, eff. 7-12-01.)
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(215 ILCS 5/179A-20)
Sec. 179A-20.
Use and operation of protected cells.
(a) The protected cell
assets of any protected
cell may not be charged with liabilities arising out of any other business the
protected cell company may
conduct. All contracts or other documentation reflecting protected cell
liabilities shall clearly indicate that only the
protected cell assets are available
for the satisfaction of those protected cell
liabilities.
(b) The income, gains, and losses, realized or unrealized, from
protected cell
assets and protected cell
liabilities must be credited to or charged against the protected
cell without
regard to other
income, gains, or losses of the protected cell company, including income,
gains, or losses of
other protected
cells. Amounts attributed to a protected cell and accumulations thereon may
be invested and
reinvested without regard to any requirements or limitations of Article VIII of
this Code
(Investments of Domestic Companies), and
the investments in a
protected cell or cells may not be taken into account in applying
the
investment limitations
otherwise applicable to the investments of the protected cell company.
(c) Assets
attributed to a
protected
cell must be valued at
their market value on the date of valuation, or if there is no readily
available market, then as
provided in the contract or the rules or other written documentation applicable
to
the protected cell.
(d) A protected cell company shall, in respect of any of its protected
cells,
engage in fully funded
indemnity-triggered insurance securitization to support in full the protected
cell exposures attributable to that protected cell. A
protected cell company
insurance securitization that is not
indemnity-triggered may qualify as an insurance securitization under the
terms of this Article only after the Director
adopts rules addressing the methods of:(i) funding of the portion of the risk
that is not indemnity based, (ii) accounting, and
disclosure, (iii) risk-based capital treatment, and (iv) assessing risk
associated with
such securitizations. A protected cell company
insurance securitization that is not fully funded, whether
indemnity triggered or non-indemnity triggered, is prohibited.
Protected cell assets may be used to pay interest
or other
consideration on any outstanding debt or other obligation attributable to that
protected cell, and
nothing in this subsection shall be construed or interpreted to prevent a
protected cell company from
entering into a swap agreement or other transaction for the account of the
protected cell that has the effect of
guaranteeing such
interest or other consideration.
(e) In all protected cell company
insurance
securitizations,
the
contracts or other documentation
effecting such transaction shall contain provisions identifying the protected
cell to which the
transaction will be attributed. In addition, the contracts or other
documentation shall
clearly disclose that the
assets of that protected cell, and only those assets, are available to pay the
obligations of
that protected cell.
Notwithstanding the foregoing, and subject to the provisions of this Article
and any other
applicable law or rule, the failure to include such language in the contracts
or other documentation shall not
be used as the sole basis by creditors, reinsurers, or other claimants to
circumvent the provisions
of this Article.
(f) A protected cell company may attribute to a
protected cell account only the insurance obligations relating to the protected
cell
company's general account. A protected cell
may not issue insurance or reinsurance contracts directly to
policyholders or reinsureds or have any obligation to the policyholders or
reinsureds of the protected cell company's general account.
(g) At the cessation of business of a protected cell, the
protected cell
company
shall voluntarily close out the protected cell account in accordance with a plan approved by the
Director.
(Source: P.A. 91-278, eff. 7-23-99; 92-74, eff. 7-12-01.)
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(215 ILCS 5/179A-25)
Sec. 179A-25.
Reach of creditors and other claimants.
(a) Protected cell assets are available only to
the
creditors of the protected cell company
who are creditors in
respect of that protected cell and entitled, in conformity
with the provisions of
this Article, to have recourse to the protected cell assets attributable to
that protected cell. Protected cell assets
shall be absolutely protected from the creditors of the protected cell
company who are not
creditors in respect
of that protected cell and who, accordingly, are not
entitled
to have
recourse to the protected
cell assets attributable to that protected cell. Creditors with respect to a protected
cell shall not be entitled to
have recourse against the protected cell assets of other protected cells or the
assets of the
protected cell company's general account.
Protected cell assets are available only to creditors of a
protected cell company after all protected cell liabilities have been
extinguished or otherwise provided for in accordance with the plan of operation
relating to that protected cell.
(b) When an obligation of a protected cell company to a person arises from a
transaction, or is otherwise imposed, in
respect of a protected cell:
(1) that obligation of the protected cell company | ||
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(2) that obligation of the protected cell company | ||
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(c) When an obligation of a protected cell company relates solely to the
general
account, the
obligation of the protected cell company shall extend only to, and that
creditor shall, in
respect of that
obligation, be entitled to have recourse only to, the assets of the protected
cell company's general
account.
(d) The activities, assets, and obligations relating to a protected cell are not
subject to the provisions
of Article XXXIII1/2 (Illinois Life and Health Guaranty Association Law) or
Article XXXIV
(Illinois
Insurance Guaranty Fund), and neither a protected cell nor a protected cell
company shall be assessed by or
otherwise be required to
contribute to any guaranty fund or guaranty association in this State with
respect to the activities, assets, or obligations of a protected cell.
Nothing
in this subsection
shall affect the activities or obligations of a company's general account.
(e) In no event shall the establishment of one or more protected cells alone
constitute or be deemed
to be a fraudulent conveyance, an intent by the protected cell company to
defraud creditors,
or
the carrying out
of business by the protected cell company for any other fraudulent purpose.
(Source: P.A. 91-278, eff. 7-23-99; 92-74, eff. 7-12-01.)
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(215 ILCS 5/179A-30)
Sec. 179A-30.
Rehabilitation and liquidation of
protected cell companies.
(a) Notwithstanding any contrary
provision in this Code, the rules promulgated
under this Code, or any
other applicable law or rule, upon any order of rehabilitation, conservation,
or
liquidation of a protected cell company, the receiver shall be
bound
to deal with the
protected cell company's assets and liabilities, including protected cell
assets and protected
cell liabilities, in
accordance with the requirements set forth in this Article.
(b) With respect to amounts recoverable under a protected cell company insurance securitization, the amount
recoverable by the
receiver shall not be reduced or diminished as a result of the entry of an
order of rehabilitation,
conservation, or
liquidation with respect to the protected cell company notwithstanding any
provisions to the
contrary in the contracts or other documentation governing the protected cell company
insurance securitization.
(Source: P.A. 91-278, eff. 7-23-99; 92-74, eff. 7-12-01.)
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(215 ILCS 5/179A-35)
Sec. 179A-35.
No transaction of an insurance business.
A protected cell insurance securitization shall not
be deemed to be an
insurance or reinsurance contract. An investor in a protected cell company
insurance securitization shall not, by
sole means of such investment, be deemed to be transacting an insurance
business in this State. The underwriters or selling agents (and their
partners, directors, officers, members, managers, employees, agents,
representatives, and advisors) involved in a protected cell company insurance
securitization shall not be deemed to be conducting an insurance or reinsurance
agency, brokerage, intermediary, advisory, or consulting business by virtue of
their activities in connection therewith.
(Source: P.A. 91-278, eff. 7-23-99; 92-74, eff. 7-12-01.)
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(215 ILCS 5/179A-40)
Sec. 179A-40.
Rules.
The Director may promulgate
reasonable rules as may be necessary to effectuate the purposes of this
Article.
(Source: P.A. 91-278, eff. 7-23-99.)
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(215 ILCS 5/Art. XIE heading) ARTICLE XIE.
Special Purpose Reinsurance Vehicle Law
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(215 ILCS 5/179E-1)
Sec. 179E-1.
Short title.
This Article may be cited as the Special Purpose
Reinsurance Vehicle Law.
(Source: P.A. 92-124, eff. 7-20-01.)
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(215 ILCS 5/179E-5)
Sec. 179E-5.
Purpose.
This Article is adopted to provide for the creation
of
Special
Purpose Reinsurance Vehicles ("SPRV") exclusively to facilitate the
securitization of one
or more ceding insurers' risk as a means of accessing alternative sources of
capital and
achieving the benefits of securitization. Investors in fully funded insurance
securitization
transactions provide funds that are available to the SPRV to secure the
aggregate limit under
an SPRV contract that provides coverage against the occurrence of a triggering
event. The
creation of SPRVs is intended to achieve greater efficiencies in conducting
insurance
securitizations, to diversify and broaden insurers' access to sources of risk
bearing capital,
and to make insurance securitization generally available on reasonable terms to
as many
U.S. insurers as possible.
Under the terms of the typical securities underlying an insurance
securitization
transaction, proceeds from the issuance of securities are repaid to the
investor on a specified
maturity date with interest or dividends unless a triggering event occurs. The
insurance
securitization proceeds are available to pay the SPRV's obligations to the
ceding insurer if
the triggering event occurs, as well as being available to satisfy the SPRV's
obligation to
repay the insurance securitization investors if a triggering event does not
occur. Insurance
securitization transactions have been performed by alien companies to utilize
efficiencies
available to those alien companies that are not currently available to domestic
companies.
This Article is adopted to allow more efficiency in conducting insurance
securitizations, to
allow ceding insurers easier access to alternative sources of risk
bearing capital,
and to promote the benefits of insurance securitization to U.S. insurers.
(Source: P.A. 92-124, eff. 7-20-01.)
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(215 ILCS 5/179E-10)
Sec. 179E-10.
Exemption from insurance laws within limitations.
(a) An SPRV is subject to the following:
(1) Articles I, XII 1/2, XXIV, XXV (Sections 408 and | ||
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(2) Sections 132.1 through 134, 137 through 140, | ||
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(b) No other provisions of this Code apply to an SPRV organized under this
Article,
except as otherwise provided in this Article.
(Source: P.A. 92-124, eff. 7-20-01.)
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(215 ILCS 5/179E-15)
Sec. 179E-15.
Definitions.
For purposes of this Article, the following
terms have the indicated meanings:
"Aggregate limit" means the maximum sum payable to the ceding insurer under
an SPRV contract.
"Ceding insurer" means one or more insurers or reinsurers under common
control that enters into an SPRV contract with an SPRV.
"Control" (including the terms "controlling," "controlled by" and "under
common control with") means the possession, direct or indirect, of the power to
direct or cause the direction of the management and policies of a person,
whether through the ownership of voting securities, by contract other than a
commercial contract for goods or non-management services, or otherwise, unless
the power is the result of an official position with or corporate office held
by the person. Control shall be presumed to exist if any person, directly or
indirectly, owns, controls, holds with the power to vote, or holds proxies
representing, 10% or more of the voting securities of any other person. This
presumption may be rebutted by a showing that control does not, in fact, exist.
Notwithstanding the foregoing, for purposes of this Article, the fact that an
SPRV exclusively provides reinsurance to a ceding insurer under an SPRV
contract shall not by itself be sufficient grounds for a finding that the SPRV
or the SPRV organizer or owner is controlled by or under common control with
the ceding insurer.
"Fair Value" means:
(1) as to cash, the amount thereof; and
(2) as to an asset other than cash:
(A) the amount at which that asset could be | ||
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(B) quoted market price for the asset in active | ||
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(C) if quoted market prices are not available, a | ||
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"Fully funded" means that, with respect to an SPRV contract, the fair value
of the assets held in trust by or on behalf of the SPRV under the SPRV contract
on the date on which the SPRV contract is effected, equals or exceeds the
aggregate limit as defined in this Article.
"Indemnity trigger" means a transaction term by which the SPRV's obligation
to pay the ceding insurer for losses covered by an SPRV contract is triggered
by the ceding insurer incurring a specified level of losses.
"Insolvency" or "insolvent" means that the SPRV is unable to pay its
obligations when they are due, unless those obligations are the subject of a
bona fide dispute.
"Non-indemnity trigger" means a transaction term by which the SPRV's
obligation to pay the ceding insurer under an SPRV contract arises from the
occurrence or existence of some event or condition other than the ceding
insurer incurring a specified level of losses under its insurance or
reinsurance contracts.
"Permitted investments" means those investments that meet the qualifications
set forth in Section 179E-85.
"Qualified U.S. financial institution" means, for purposes of meeting the
requirements of a trustee under this Article, a financial institution that is
eligible to act as a fiduciary of a trust, and that is:
(1) organized or, in the case of a U.S. branch or | ||
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(2) regulated, supervised, and examined by federal or | ||
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"Special purpose reinsurance vehicle" or "SPRV" means an entity, domiciled in
and organized under the laws of this State, that has received a limited
certificate of authority from the Director under this Article exclusively for
the limited purpose of entering into and effectuating SPRV insurance
securitizations, SPRV contracts, and other related transactions permitted by
this Article.
"SPRV contract" means a contract between the SPRV and the ceding insurer
pursuant to which the SPRV agrees to pay the ceding insurer an agreed amount
upon the occurrence of a triggering event.
"SPRV insurance securitization" means a package of related risk transfer
instruments and facilitating administrative agreements by which proceeds are
obtained by an SPRV through the issuance of securities, which proceeds are held
in trust pursuant to the requirements of this Article to secure the obligations
of the SPRV under an SPRV contract with one or more ceding insurers, wherein
the SPRV's obligation to return the full initial investment to the holders of
those securities, pursuant to the transaction terms, is contingent upon those
funds not being used to pay the obligations of the SPRV to the ceding insurers
under the SPRV Contract.
"SPRV organizer" means one or more persons who have organized or intend to
organize an SPRV under authority obtained pursuant to Section 179E-20.
"SPRV securities" means the securities issued by an SPRV.
"Triggering event" means an event or condition that, if and when it occurs or
exists, obligates the SPRV to make a payment to the ceding insurer under the
provisions of an SPRV contract.
(Source: P.A. 92-124, eff. 7-20-01.)
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(215 ILCS 5/179E-20)
Sec. 179E-20.
Limited certificate of authority.
(a) Within 30 days after receipt by the Director of a complete filing by the
prospective SPRV organizer for authority to form or acquire an SPRV, which
SPRV shall exist and operate expressly for the limited purposes set forth in
this
Article, the application shall be deemed approved and a limited certificate of
authority shall be issued, unless before the expiration of the 30-day period
the
Director approves or disapproves the application in writing.
A limited certificate of authority may not be issued unless the country or
state
of domicile of each ceding insurer has notified the Director in writing that
they have not disapproved the transaction.
A complete filing
of the
application must include the following:
(1) an affidavit verifying that each prospective SPRV | ||
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(2) a representation that the prospective SPRV | ||
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(3) the proposed name of the subject SPRV;
(4) biographical descriptions of each SPRV organizer | ||
| ||
(5) the source and form of the minimum capital to be | ||
| ||
(6) any persons with which the SPRV is or, upon | ||
| ||
(7) the names and biographical information of the | ||
| ||
(8) a plan of operation, consisting of a description | ||
| ||
(A) draft documentation or, at the discretion of | ||
| ||
(B) the investment strategy of the SPRV and a | ||
| ||
(C) a description of the method by which losses | ||
| ||
(D) a representation that the trust agreement and | ||
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(b) The Director may not approve the application or issue a limited
certificate
of authority until he or she has found that the proposed plan of operation
provides a
reasonable expectation of a successful operation, based on the proposed SPRV
organizer, directors, and officers being of known good character and that
there
is no good reason to believe that they are affiliated, directly or indirectly,
through
ownership, control, management, reinsurance transactions, or other insurance or
business relations with any person or persons known to have been involved in
the
improper manipulation of assets, accounts or reinsurance.
(c) Upon approval by the Director of the application and the issuance of a
limited certificate of authority, the SPRV may be acquired or formed and, in
accordance with the approved plan of operation, the SPRV may enter into
contracts
and conduct other activities within the parameters set forth in the filed plan
of
operation.
(d) The limited certificate of authority so issued shall state that the
SPRV's
authorization to be involved in the business of reinsurance is limited to only
the
reinsurance activities that the SPRV is allowed to conduct under this Article.
(e) The SPRV organizer must provide a complete set of the documentation
of
the
insurance securitization to the Director upon closing of the transactions
including, but not
limited to, an opinion of legal counsel with respect to compliance with this
and any other
applicable laws as of the effective date of the transaction. Any material
change of the
SPRV's plan of operation described in items (1) through (8) of subsection (a)
including, but
not limited to, the issuance of new securities to continue the securitization
activities of the
SPRV under this Article after expiration and full satisfaction of the initial
securitization
transactions, requires prior approval of the Director, however, a change in the
counterparty
to swap transactions for an existing securitization as allowed under this
Article shall not be
deemed a material change. Any material change that is not disapproved by the
Director in
writing within 15 days after its submission shall be deemed approved.
(Source: P.A. 92-124, eff. 7-20-01.)
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(215 ILCS 5/179E-25)
Sec. 179E-25.
Limited purpose of SPRV.
This Article authorizes SPRVs to be
created for the limited purpose of entering into insurance securitization
transactions with
investors and into related agreements to pay one or more ceding insurers agreed
upon
amounts under an SPRV contract upon the occurrence of triggering events related
to the
insurance business of the ceding insurer. An SPRV may not issue a contract for
assumption
of risk or indemnification of loss other than an SPRV contract as defined
herein.
(Source: P.A. 92-124, eff. 7-20-01.)
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(215 ILCS 5/179E-30)
Sec. 179E-30.
Approved transactions and operation of SPRVs.
(a) SPRVs authorized under this Article may at any given time enter into and
effectuate SPRV contracts with one or more ceding insurers, provided that the
SPRV
contracts obligate the SPRV to indemnify the ceding insurer for losses and that
contingent
obligations of the SPRV under the SPRV contracts are securitized in full
through a single
SPRV insurance securitization and are fully funded and secured with assets held
in trust in
accordance with the requirements of this Article pursuant to agreements
contemplated by
this Article and invested in a manner that meets the criteria set forth in
Section 179E-85 of
this Article.
(b) An SPRV may enter into such agreements with third parties and conduct
such business as is necessary to fulfill its obligations and administrative
duties
incident to the insurance securitization and the SPRV contract. The agreements
may include entering into swap agreements or other transactions that have the
objective of leveling timing differences in funding up-front or ongoing
transaction
expenses or managing credit or interest rate risk of the investments
in trust to
assure that the assets held in trust will be sufficient to satisfy
(i) payment or
repayment of the securities issued pursuant to an insurance securitization
transaction or (ii) the obligations of the SPRV under the SPRV contract. In
fulfilling
its function, the SPRV shall adhere to the following requirements and shall, to
the
extent of its powers, ensure that contracts obligating other parties to perform
certain
functions incident to its operations are substantively and materially
consistent with
the following requirements and guidelines:
(1) An SPRV shall have a distinct name, which shall | ||
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(2) Unless otherwise provided in the plan of | ||
| ||
(3) The assets of an SPRV must be preserved and | ||
| ||
(4) Assets of the SPRV that are pledged to secure | ||
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(5) The agreement governing any trust must create | ||
| ||
(6) The provisions for withdrawal by ceding insurers | ||
| ||
(A) the ceding insurer shall have the right to | ||
| ||
(B) no other statement or document need be | ||
| ||
(C) the trust agreement must indicate that it is | ||
| ||
(D) the trust agreement may not contain | ||
| ||
(E) no reference may be made to the fact that the | ||
| ||
(7) The trust agreement must be established for the | ||
| ||
(8) The trust agreement must provide for the trustee | ||
| ||
(A) receive assets and hold all assets in a safe | ||
| ||
(B) determine that all assets are in a form so | ||
| ||
(C) furnish to the SPRV, the Director, and the | ||
| ||
(D) notify the SPRV and the ceding insurer, | ||
| ||
(E) upon written demand of the ceding insurer, | ||
| ||
(F) allow no substitutions or withdrawals of | ||
| ||
(9) The trust agreement must provide that at least 30 | ||
| ||
(10) The trust agreement may be made subject to and | ||
| ||
(11) The trust agreement must prohibit invasion of | ||
| ||
(12) The trust agreement must provide that the | ||
| ||
(13) Notwithstanding the provisions of items (6)(C), | ||
| ||
(A) to pay or reimburse the ceding insurer | ||
| ||
(B) when the ceding insurer has received | ||
| ||
(i) losses and loss expenses paid by the | ||
| ||
(ii) reserves for losses reported and | ||
| ||
(iii) reserves for losses incurred but not | ||
| ||
(iv) reserves for loss expenses;
(v) reserves for unearned premiums; and
(vi) any other amounts that, together with | ||
| ||
The provisions to be included in the trust agreement | ||
| ||
(14) An SPRV contract
must contain provisions
that:
(A) require the SPRV to enter into a trust | ||
| ||
(B) stipulate that assets deposited in the trust | ||
| ||
(C) require the SPRV, before depositing assets | ||
| ||
(D) require that all settlements of account | ||
| ||
(E) stipulate that the SPRV and the ceding | ||
| ||
(i) to transfer all of those assets into the | ||
| ||
(ii) to pay any other amounts the ceding | ||
| ||
(15) The SPRV contract entered into by the SPRV may | ||
| ||
(A) at the time of the withdrawal, the SPRV | ||
| ||
(B) after the withdrawals and transfer, the fair | ||
| ||
(16) The investors in the SPRV must agree, and be | ||
| ||
(17) Assets held by an SPRV in trust must be valued | ||
| ||
(18) The proceeds from the sale of securities by the | ||
| ||
(19) An SPRV organized under this Article, may engage | ||
| ||
(20) The contracts or other documentation relating to | ||
| ||
(21) Under no circumstances may an SPRV be authorized | ||
| ||
(A) issue or otherwise administer primary | ||
| ||
(B) have any obligation to the policyholders or | ||
| ||
(C) enter into an SPRV contract with a person | ||
| ||
(D) assume or retain exposure to insurance or | ||
| ||
(22) At the cessation of business of an SPRV the | ||
| ||
(23) It is unlawful for an SPRV to loan or otherwise | ||
| ||
(Source: P.A. 92-124, eff. 7-20-01.)
|
(215 ILCS 5/179E-35)
Sec. 179E-35.
Powers.
(a) An SPRV authorized under this Article shall have the necessary
powers to enter
into contracts and to conduct such other commercial activities as are necessary
to fulfill the
purposes of this Article. Those activities may include, but are not limited
to, entering into
SPRV contracts, issuing securities of the SPRV and complying with the terms
thereof,
entering into trust, swap, and other agreements as may be necessary to
effectuate an
insurance securitization in compliance with the limitations and pursuant to the
authorities
granted to the SPRV under this Article or the plan of operation approved or
deemed
approved by the Director.
(b) An SPRV organized or doing business under this Article shall, by the
name
adopted by the SPRV, in law, be capable of suing or being sued, and may make or
enforce
contracts in relation to the business of the SPRV; may have and use a common
seal, and in
the name of the SPRV or by a trustee chosen by the board of directors, shall,
in law, be
capable of taking, purchasing, holding and disposing of real and personal
property for
carrying into effect the purposes of its organization; and may by its board of
directors,
trustees, officers, or managers, make by-laws and amendments thereto not
inconsistent with
the laws or the constitution of this State or of the United States, which
by-laws shall define
the manner of electing directors, trustees, or managers and officers of the
SPRV, together
with their qualifications and duties and fixing their term of office.
(Source: P.A. 92-124, eff. 7-20-01.)
|
(215 ILCS 5/179E-40)
Sec. 179E-40.
Affiliation.
Notwithstanding the provisions
of Article
VIII 1/2, the SPRV, the SPRV organizer, and subsequent debt or equity
investors in SPRV
securities shall not be deemed affiliates of the ceding insurer by virtue of
the SPRV contract
between the ceding insurer and the SPRV, the securities of the SPRV, or related
agreements
necessary to implement the SPRV insurance securitization.
An SPRV may not be controlled by, may not control, and may not be under common
control with any ceding insurer that is a party to an SPRV contract.
(Source: P.A. 92-124, eff. 7-20-01.)
|
(215 ILCS 5/179E-45)
Sec. 179E-45.
Capitalization.
An SPRV must have minimum initial capital of
not
less than $5,000. All of the initial capital must be received by the SPRV in
cash. The
minimum initial capital required and all other funds of the SPRV in excess of
its minimum
initial capital, including funds held in trust to secure the obligations of the
SPRV pursuant to
its obligations under the SPRV contracts, shall be invested as provided in
Section 179E-85.
(Source: P.A. 92-124, eff. 7-20-01.)
|
(215 ILCS 5/179E-50)
Sec. 179E-50.
Dividends.
An SPRV may not declare or pay dividends in any
form
to its owners unless the dividends do not decrease the capital of the SPRV
below $5,000,
and after giving effect to the dividends, the assets of the SPRV, including
assets held in trust
pursuant to the terms of the insurance securitization, are sufficient to meet
its obligations.
Dividends may be declared by the board of directors of the SPRV if the
declaration of
dividends would not violate the provisions of this Article or jeopardize the
fulfillment of the
obligations of the SPRV or the trustee pursuant to the SPRV insurance
securitization, the
SPRV contract or any related transaction.
(Source: P.A. 92-124, eff. 7-20-01.)
|
(215 ILCS 5/179E-55)
Sec. 179E-55.
Records and financial reports.
(a) The records of the SPRV must be maintained in this State and must be
available
for examination by the Department. The Director shall have the right to
examine the
records of an SPRV at any time. No later than 5 months after the fiscal year
end of the
SPRV, the SPRV must file with the Director an audit by a certified public
accounting firm
of the financial statements of the SPRV and the trust accounts.
(b) No later than March 1 of each year, an SPRV organized under this Article
must
file with the Director a statement of operations, including, but not limited
to, a statement of
income, a balance sheet, and a detailed listing of invested assets, including
identification of
assets held in trust to secure the SPRV's obligations under the SPRV contract,
for the year
ending the previous December 31. The statements shall be prepared in
accordance with
Section 136 of this Code on such forms and shall reveal such information as
shall be
required by the Director.
(c) An SPRV must keep its books and records in a manner so that its
financial
condition, affairs, and operations can be ascertained, its financial statements
filed with the
Director can be readily verified, and its compliance with the provisions of
this Article can be
determined. An SPRV may cause any or all of the books or records to be
photographed,
reproduced on film, or stored and reproduced electronically.
(d) All original books, records, documents, accounts, and vouchers, or
reproductions
of those items, must be preserved and kept available in this State for the
purpose of
examination and until authority to destroy or otherwise dispose of the records
is secured
from the Director. The original records may, however, be kept and maintained
outside this
State if, according to a plan adopted by the SPRV's board of directors and
approved by the
Director, it maintains other suitable records.
(Source: P.A. 92-124, eff. 7-20-01.)
|
(215 ILCS 5/179E-60)
Sec. 179E-60.
Officers and directors.
(a) The directors of an SPRV shall elect such officers they deem necessary
to
carry
out the purposes of the SPRV pursuant to this Article. The provisions of
Section 10 of this
Code relating to the indemnification of officers and directors apply to and
govern SPRVs
organized under this Article.
(b) An SPRV authorized to do business in this State must notify the Director
of
the
appointment or election of any new officers or directors within 30 days after
the
appointment or election.
(c) If, after notice and hearing afforded to the officer or director, and
after
a finding
that the officer or director is incompetent or untrustworthy or of known bad
character, the
Director shall order the removal of the person. If the SPRV does not comply
with a removal
order within 30 days, the Director may suspend that SPRV's limited certificate
of authority
until such time as the order is complied with.
(d) An SPRV may not make loans to any SPRV organizer, owner, director,
officer, manager, or affiliate.
(Source: P.A. 92-124, eff. 7-20-01.)
|
(215 ILCS 5/179E-65)
Sec. 179E-65.
Fees and taxes.
The Director may charge fees to reimburse
the
Director for expenses and costs incurred by the Department incident to the
examination of
financial statements and review of the plan of operation and to reimburse other
such
activities of the Director related to the formation and ongoing operation of an
SPRV. An
SPRV is not be subject to State premium or other State taxes incidental to the
operation of
its business as long as the business remains within the limitations of this
Article.
(Source: P.A. 92-124, eff. 7-20-01.)
|
(215 ILCS 5/179E-70)
Sec. 179E-70.
Dissolution.
An SPRV operating under this Article may be
dissolved
by a vote of its board of directors at any time after the Director has approved
that action. A
voluntary dissolution may not be effected or allowed until and unless all of
the obligations
of the SPRV pursuant to the insurance securitization have been fully and
finally satisfied
pursuant to their terms. In the case of voluntary dissolution, the disposition
of the affairs of
the SPRV (including the settlement of all outstanding obligations) shall be
made by the
officers or directors of the SPRV, and when the liquidation has been completed
and a final
statement, in acceptable form, filed with and approved, or deemed approved, by
the
Director, the provisions for voluntary dissolution under the laws of this State
shall be
followed to dissolve the SPRV.
(Source: P.A. 92-124, eff. 7-20-01.)
|
(215 ILCS 5/179E-75)
Sec. 179E-75.
Conservation, rehabilitation, or liquidation.
(a) The provisions of Articles XIII and XIII 1/2 apply to an SPRV, except
to
the
extent modified in this Section.
(b) Notwithstanding the provisions of Section 188 of this Code, the Director
may
apply by petition to the Circuit Court of Cook County, the Circuit Court of
Sangamon
County, or the circuit court of the county in which an SPRV has or last had its
principal
office for an order authorizing the Director to conserve, rehabilitate or
liquidate an
SPRV domiciled in
this State solely on one or more of the following grounds:
(1) there has been embezzlement, wrongful | ||
| ||
(2) the SPRV is insolvent and the holders of a | ||
| ||
The court shall not grant relief under item (1) of this subsection
unless, after notice
and a hearing, the Director, who has the burden of proof, establishes by clear
and
convincing evidence that the relief should be granted.
(c) Notwithstanding any contrary provision in this Code, the rules
promulgated
under this Code, or any other applicable law or rule, upon any order of
conservation,
rehabilitation, or liquidation of the SPRV, the receiver shall be bound to deal
with the
SPRV's assets and liabilities, in accordance with the requirements set forth in
this Article.
(d) With respect to amounts recoverable under an SPRV contract, the amount
recoverable by the receiver may not be reduced or diminished as a result of the
entry of an
order of conservation, rehabilitation, or liquidation with respect to the
ceding insurer
notwithstanding any provisions to the contrary in the contracts or other
documentation
governing the SPRV insurance securitization.
(e) Notwithstanding the provisions of Article XIII and XIII 1/2 of this
Code, any
application, petition, or temporary restraining order or injunction issued
under those
Articles, with respect to a ceding insurer shall not prohibit the transaction
of any business by
an SPRV, including any payment by an SPRV made pursuant to an SPRV security, or
any
action or proceeding against an SPRV or its assets.
(f) Notwithstanding the provisions of Articles XIII and XIII 1/2 of this
Code, the
commencement of a summary proceeding or other interim proceeding commenced
before a
formal delinquency proceeding with respect to an SPRV, and any order issued by
the court
thereunder, shall not prohibit:
(1) the payment by an SPRV made pursuant to an SPRV | ||
| ||
(2) the SPRV from taking any action required to make | ||
| ||
(g) Notwithstanding any other provision of Articles XIII and XIII 1/2 of
this Code or
other State law:
(1) a receiver of a ceding insurer may not avoid a | ||
| ||
(2) a receiver of an SPRV may not void a | ||
| ||
(h) With the exception of the fulfillment of the obligations under an SPRV
contract,
and notwithstanding any other provisions of this Article or other law of this
State to the
contrary, the assets of an SPRV, including assets held in trust, may not be
consolidated with
or included in the estate of a ceding insurer in any delinquency proceeding
against the
ceding insurer under this Article for any purpose, including, without
limitation, distribution
to creditors of the ceding insurer.
(i) Notwithstanding any other provision of this Article:
(1) A domiciliary receiver of an SPRV domiciled in | ||
| ||
(2) An ancillary proceeding may not be commenced or | ||
| ||
(Source: P.A. 92-124, eff. 7-20-01.)
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(215 ILCS 5/179E-80)
Sec. 179E-80.
SPRV not subject to guaranty funds, residual market, or
similar
arrangements.
(a) An SPRV or the activities, assets, and obligations relating to the SPRV
are
not
subject to the provisions of Articles XXXIII 1/2 and XXXIV of this Code, and
an SPRV may
not be assessed by or otherwise be required to contribute to any guaranty fund
or guaranty
association in this State with respect to the activities, assets, or
obligations of an SPRV or
the ceding insurer.
(b) An SPRV may not be required to participate in residual market, FAIR
plan, or
other similar plans to provide insurance coverage, take out policies, assume
risks, make
capital contributions, pay or be otherwise obligated for assessments,
surcharges, or fees, or
otherwise support or participate in such plans or arrangements.
(Source: P.A. 92-124, eff. 7-20-01.)
|
(215 ILCS 5/179E-85)
Sec. 179E-85.
Asset and investment limitations.
(a) Assets of the SPRV held in trust to secure obligations under the SPRV
contract
must at all times be held in:
(1) cash and cash equivalents;
(2) securities listed by the Securities Valuation | ||
| ||
(3) any other form of security acceptable to the | ||
| ||
(b) An SPRV may enter into swap agreements or other transactions that have
the
objective of leveling timing differences in funding of up-front or ongoing
transaction
expenses or managing credit or interest rate risk of the investments in the
trust to ensure that
the investments are sufficient to assure payment or repayment of:
(1) the securities (and related interest or principal | ||
| ||
(2) the SPRV's obligations under the SPRV contract.
(Source: P.A. 92-124, eff. 7-20-01.)
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(215 ILCS 5/179E-90)
Sec. 179E-90.
Credit for reinsurance for the SPRV contract.
An SPRV contract meeting the requirements under this Article shall be
granted credit for reinsurance treatment or shall otherwise qualify as an asset
or a reduction
from liability for reinsurance ceded by a domestic insurer to an assuming
insurer under
Section 173.1 of this Code for the benefit of the ceding insurer, provided and
only to the
extent that (i) the fair value of the assets held in trust for the benefit of
the ceding insurer
equal or exceed the obligations due and payable to the ceding insurer by the
SPRV under the
SPRV contract, (ii) the assets are held in trust in accordance with the
requirements set forth
in this Article, (iii) the assets are administered in the manner and pursuant
to arrangements
as set forth in this Article, and (iv) the assets are held or invested in one
or more of the
forms allowed in Section 179E-85.
(Source: P.A. 92-124, eff. 7-20-01.)
|
(215 ILCS 5/179E-95)
Sec. 179E-95.
Insurance securitization deemed not to be transaction of
insurance
business. The securities issued by the SPRV under an SPRV insurance
securitization shall
not be deemed to be insurance or reinsurance contracts. An investor in
securities issued
pursuant to an SPRV insurance securitization or any holder of those securities
shall not, by
sole means of the investment or holding, be deemed to be transacting an
insurance business
in this State. The underwriters or selling agents (and their partners,
directors, officers,
members, managers, employees, agents, representatives, and advisors) involved
in an SPRV
insurance securitization shall not be deemed to be conducting an insurance or
reinsurance
agency, brokerage, intermediary, advisory, or consulting business by virtue of
their activities
in connection therewith.
(Source: P.A. 92-124, eff. 7-20-01.)
|
(215 ILCS 5/179E-100)
Sec. 179E-100.
Authority to adopt rules.
The Director may promulgate rules
necessary to effectuate the purposes of this Article. Any rules so promulgated
will not
affect any existing SPRV insurance securitization in effect at the time of the
promulgation.
(Source: P.A. 92-124, eff. 7-20-01.)
|
(215 ILCS 5/Art. XII heading) ARTICLE XII.
DOMESTICATION OF
FOREIGN AND ALIEN COMPANIES
|
(215 ILCS 5/180) (from Ch. 73, par. 792)
Sec. 180.
Companies that may domesticate.
(1) Any domestic, foreign, or alien stock company, mutual company,
assessment legal reserve company, reciprocal, or fraternal benefit
society, authorized or which may be authorized to do business in this
State, may reorganize under the laws of this State (including a
reorganization as a captive insurance company under the laws of this
State), by complying with the provisions of this Article.
(2) As used in this Article: "reorganize" means reorganize, reincorporate,
or domesticate as an Illinois insurer; "reorganization" means reorganization,
reincorporation, or domestication as an Illinois insurer; "reorganized company"
means any company that has availed itself of the provisions of this Article,
and the reorganization of which has been effected as in this Article provided;
and "similar domestic company" means, in the case of an application for
reorganization as a domestic captive insurance company, a domestic captive
insurance company organized under Article VIIC.
(Source: P.A. 87-1216.)
|
(215 ILCS 5/181) (from Ch. 73, par. 793)
Sec. 181.
Articles of reorganization.
(1) The board of directors, trustees or other governing body of any such
company desiring to reorganize under this Article shall comply with all
laws and requirements of its domiciliary state or country with reference to
reorganization under the laws of another state or country.
(2) Such board of directors, trustees or other governing body shall
adopt a resolution approving articles of reorganization setting forth:
(a) the name of the company; and if the name of the company upon
reorganization is to be changed, the proposed name of the reorganized
company;
(b) the title of the act under which it was organized or incorporated;
(c) the matters required to be set forth in original articles of
incorporation of a similar domestic company;
(d) that it shall be bound by all the terms and provisions of this Code,
applicable to similar domestic companies organized or incorporated
thereunder; and
(e) such other particulars as are deemed necessary or advisable.
(Source: P.A. 86-632; 86-634; 86-1028.)
|
(215 ILCS 5/182) (from Ch. 73, par. 794)
Sec. 182.
Execution
of articles.
The articles of reorganization shall be executed in duplicate by the
president or vice-president, and secretary or assistant secretary of the
company, or the executive officers corresponding thereto, and shall be
acknowledged and sworn to.
(Source: Laws 1937, p. 696.)
|
(215 ILCS 5/183) (from Ch. 73, par. 795)
Sec. 183.
Certificate of Reorganization - Date Reorganization Effected.
(1) Upon the execution of the articles of reorganization there shall be
delivered to the Director
(a) two duplicate originals of the articles;
(b) a copy of the resolution of the board of directors, trustees or
other governing body, adopting said articles, duly certified by the
secretary of the company or officer corresponding thereto;
(c) information satisfactory to the Director that the company has
complied with all the laws
and requirements of the domiciliary state or country with
reference to the proposed reorganization and the protection of
policyholders; and
(d) securities of the kind and amount, if any, required as a deposit of
a similar domestic company doing the same kind or kinds of business
proposed to be done by the reorganized company.
(2) If the Director finds that the articles of reorganization are in
accordance with the provisions of this Article, and that the company has
complied with all provisions of this Code applicable to similar domestic
companies, he shall approve the articles of reorganization and shall forthwith file
one of the duplicate originals of the articles, together with the
resolution and certificate of reorganization and certificate of
authority, in his office, endorse upon the other duplicate
original, his approval thereof, and deliver it together with a certificate
of reorganization and a certificate of authority to the reorganized
company. Upon such filing, the reorganization of the company shall be effected.
(Source: P.A. 85-131.)
|
(215 ILCS 5/184) (from Ch. 73, par. 796)
Sec. 184.
Recording Articles of Reorganization.
The articles of reorganization, approved by the Director and returned to
the reorganized company, shall be recorded in the office of the recorder
in the county where the principal office of the reorganized company
is to be located.
(Source: P.A. 85-131.)
|
(215 ILCS 5/185) (from Ch. 73, par. 797)
Sec. 185.
Board of
directors, trustees, etc. to continue.
The directors, trustees, or members of any other governing body of the
company so reorganized, shall become the directors, trustees or members of
the governing body of the reorganized company and shall hold office until
their successors are elected or chosen in the manner provided therefor by
the articles of reorganization.
(Source: Laws 1937, p. 696.)
|
(215 ILCS 5/185.1) (from Ch. 73, par. 797.1)
Sec. 185.1.
Effect of Reorganization.
When the reorganization has been effected:
(a) The articles of reorganization shall be the articles of
incorporation of the reorganized company and said company shall continue
in existence as, and thereafter
be, a company of this State.
(b) The reorganized company shall make its reports in accordance with
the laws of this State and shall be subject to the exclusive regulation and
supervision by the Department of Insurance of this State and shall be subject
to regulation
and supervision by the Insurance Departments of other states and countries
as a foreign or alien company.
(c) The reorganized company shall have all of the rights, privileges,
immunities and powers and shall be subject to all of the duties and
liabilities granted or imposed by this Code
(except in the case of a domestic captive insurance company, which
shall have all of the rights, privileges, immunities and powers and shall
be subject to all of the duties and liabilities granted or imposed by
Article VIIC of this Code).
(d) The reorganized company shall thereupon and thereafter possess all
the rights, privileges, immunities, powers and franchises of a public as
well as a private nature, theretofore possessed by the company so
reorganized. Without limiting the generality of the foregoing, (i) the
agency appointments, licenses, certificates of authority and rates which
are in existence at the time of the reorganization of such reorganized
company takes effect shall continue in full force and effect;
(ii) all property, real, personal and mixed, and all debts due
on whatever account, including subscriptions to shares, assessments payable
from members or policyholders, and all other choses in action, and all and
every other interest of, or belonging to or due to the company so
reorganized, shall be deemed to be transferred to and vested in the
reorganized company without further act or deed; and (iii) the title to any
real estate or any interest therein theretofore vested in the company so
reorganized, shall not revert or be in any way impaired by reason of such
reorganization.
(e) The reorganized company shall thenceforth be responsible and liable
for all the liabilities and obligations of the company so reorganized. Any
claim existing, or action or proceeding pending by or against the company
so reorganized, may be prosecuted to judgment as if such reorganization had
not taken place, or such reorganized company may be substituted in its
place. Neither the rights of creditors nor any liens upon the property of
the company so reorganized, shall be impaired by such reorganization, but
such liens shall be limited to the property upon which they were liens
immediately prior to the reorganization, unless otherwise provided in the
articles of reorganization.
(Source: P.A. 85-131.)
|
(215 ILCS 5/185.2) (from Ch. 73, par. 797.2)
Sec. 185.2.
Conversion to Foreign Insurer.
Any domestic insurer may,
upon the approval of the Director, transfer its domicile to any other state
in which it is admitted to transact the business of insurance, and upon
such a transfer shall cease to be a domestic insurer. The Director shall
approve any such proposed transfer unless he shall determine such transfer
is not in the interest of the policyholders of this State.
(Source: P.A. 85-131.)
|
(215 ILCS 5/Art. XII.5 heading) ARTICLE XII 1/2.
CORRECTIVE ORDERS
|
(215 ILCS 5/186.1) (from Ch. 73, par. 798.1)
Sec. 186.1.
Supervision by the Director.
(1)If the Director
determines that any domestic insurance company is operating in a manner,
that could lead to, or is in, a financial condition, which if continued
would make it hazardous to the public, and its policyholders, the Director
may issue an order:
(a) notifying the company and its Board of Directors of his
determination and setting forth the specific deficiencies leading to the determination;
(b) setting forth the specific action required or prohibited to correct
the cited deficiencies; and
(c) ordering the company to comply with the Director's order within such
reasonable time as the Director shall prescribe.
(2) Operation or financial condition deficiencies supporting the
Director's determination under subsection (1) may include, but are not
limited to, the following:
(a) The company has failed to maintain a relationship of policyholder
surplus to premium writings or policyholder surplus to claim and unearned
premium reserves which provides a reasonable margin of safety for the
policyholders considering the classes of insurance the company is writing.
(b) The company's asset liquidity is not adequate to provide orderly
payment of its obligations.
(c) The company's current or projected net income is inadequate to meet
its present or projected obligations.
(d) The company has a history of claim reserve inadequacy which affects
the reliability of its financial statements.
(e) The company has failed to maintain adequate books and records or has
otherwise conducted its insurance operation in a manner which impairs the
Director's ability to determine its true financial condition.
(3) If a company fails to comply with the Director's order issued
pursuant to subsection (1) within the time prescribed for such compliance
the Director may institute proceedings for the conservation, rehabilitation
or liquidation of the company under Article XIII of this Code.
(4)(a) The Director may require that the company prepare and file a plan
to correct the deficiencies cited by the Director in his order within such
time as the Director may prescribe. A corrective order may require,
prohibit or permit certain acts subject to conditions including the
Director's prior approval. The scope of a corrective order may relate to
but shall not be limited to:
(i) the disposition, recovery or mix of assets;
(ii) the assumption or cession of reinsurance, including reinsurance of
outstanding risks;
(iii) lending and borrowing;
(iv) investments;
(v) restricting underwriting and marketing activities.
(b) The Director may require that any company under such corrective
order direct any certified public accountants, consulting actuary or
financial consultant retained by the company to prepare for the Director
such reports, accounting data and such other reports as the Director may
reasonably require to assist in carrying out the responsibilities of the
Director under this Section.
(5)(a) Any company subject to an order under subsections (1) or (4) may
request a hearing before the Director to review that order. Such request
shall be made in writing within 10 days of the receipt of such order, shall
state the company's objections to the order, and shall be addressed to the
Director. Such hearing shall be convened not less than 10 days nor more
than 20 days after receipt of the written request for hearing unless
otherwise agreed to by the company. The Director shall make a final
determination within 10 days after the conclusion of the hearing. The
Director shall hold all hearings under this subsection privately in
accordance with subsection (6) of this Section. The pendency of a hearing
or pendency of the Director's final determination shall not stay the effect
of the Director's order.
(b) After the Director's final determination pursuant to any hearing
under this subsection, any party to the proceedings whose interests are
affected by the Director's final determination shall be entitled to
judicial review of such final determination pursuant to the provisions of
the "Administrative Review Law".
Notwithstanding the availability of administrative remedies or judicial
review under the "Administrative Review Law", a company which is subject to
an order of the Director under this Section shall be entitled to immediate
judicial review and injunctive relief in the Circuit Court of Cook County
or the Circuit Court of Sangamon County upon satisfying the court:
(i) that accepting the facts set forth in the order as true, the order
is arbitrary or capricious;
(ii) that the company's interests are substantially impaired by the order; and
(iii) that the company will suffer permanent injury in the absence of
immediate injunctive relief.
(6) All administrative and judicial proceedings arising under this Article
shall be held privately unless a public hearing is requested by the
company, and all records of the company, and all records of the Department
concerning the company, so far as they pertain to or are a
part of the record of the proceedings, shall be and remain confidential,
unless the company requests otherwise. Such records shall not be subject
to public disclosure under "The Illinois Freedom of Information Act", certified
December 27, 1983, as amended, or otherwise, nor shall such records be
subject to subpoena by third parties, unless the company and Director
consent to such disclosure or release under subpoena.
(7) The powers vested in the Director by this Section are additional to
any and all other powers and remedies vested in the Director by law, and
nothing herein contained shall prohibit the Director from proceeding under
any other applicable law or under this Section in conjunction with any other law.
(Source: P.A. 84-715.)
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(215 ILCS 5/186.2) (from Ch. 73, par. 798.2)
Sec. 186.2.
(1) Any officer, manager, director, trustee, owner,
employee, or agent of any insurer, or any other person with authority over
or in charge of any segment of the company's affairs, shall cooperate with
the Director in any proceeding under this Article or any investigation
preliminary to the proceeding. The term "person" as used in this Section
shall include any person who exercises control directly or indirectly over
activities of the company through any holding company or other affiliate
of the company. To "cooperate" shall include, but shall not be limited to, the following:
(a) to reply promptly in writing to any inquiry from the Director of
Insurance requesting such a reply; and
(b) to make available to the Director any books, accounts, documents, or
other records or information or property of or pertaining to the company
and in such person's possession, custody or control.
(2) No person shall obstruct or interfere with the Director in the
conduct of any proceeding under Sections 186.1 and 186.2 or any
investigation preliminary or incidental thereto.
(3) This Section shall not be construed to abridge otherwise existing
legal rights, including the right to contest any order issued under this Code.
(4) Any person who obstructs or interferes with the Director in the
conduct of any proceeding or investigation under this Article, or who
violates any valid order issued under this Article shall be subject to
civil forfeitures, fines or penalties pursuant to Sections 134, 149, 403A
and 505.1 of this Code.
(Source: P.A. 84-715.)
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(215 ILCS 5/Art. XIII heading) ARTICLE XIII.
REHABILITATION, LIQUIDATION, CONSERVATION AND DISSOLUTION OF
COMPANIES
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(215 ILCS 5/187) (from Ch. 73, par. 799)
Sec. 187. Scope of Article.
(1) This Article shall apply to every corporation, association, society,
order, firm, company, partnership, individual, and aggregation of
individuals to which any Article of this Code is applicable, or which is
subject to examination, visitation or supervision by the Director under any
provision of this Code or under any law of this State, or which is engaging
in or proposing or attempting to engage in or is representing that it is
doing an insurance or surety business, or is undertaking or proposing or
attempting to undertake to provide or arrange for health care services as a
health care plan as defined in subsection (7) of Section 1-2 of the Health
Maintenance Organization Act, including the exchanging of reciprocal or
inter-insurance contracts between individuals, partnerships and corporations in
this State, or which is in the process of organization for the purpose of doing
or attempting or intending to do such business, anything as to any such
corporation, association, society, order, firm, company, partnership,
individual or aggregation of individuals provided in this Code or elsewhere in
the laws of this State to the contrary notwithstanding.
(2) The word "company" as used in this Article includes all of the
corporations, associations, societies, orders, firms, companies,
partnerships, and individuals specified in subsections
(1), (4), and (5) of this Section and
agents, managing general agents, brokers, premium finance companies,
insurance holding companies, and all other non-risk bearing entities or persons
engaged in any aspect of the business of insurance on behalf of an insurer
against which a receivership proceeding has been or is being filed under this
Article, including, but not limited to, entities or persons that provide
management, administrative, accounting, data processing, marketing,
underwriting, claims handling, or any other similar services to that insurer,
whether or not those entities are licensed to engage in the business of
insurance in Illinois, if the
entity or person is an affiliate of that insurer.
(3) The word "court" shall mean the court before which the
conservation, rehabilitation, or liquidation proceeding of the company is
pending, or the judge presiding in such proceedings.
(4) The word "affiliate" as used in this Article means a person that
directly, or indirectly through one or more intermediaries, controls, is
controlled by, or is under common control with, the person specified.
(5) The word "person" as used in this Article means an individual, an
aggregation
of individuals, a partnership, or a corporation.
(6) The word "assets" as used in this Article includes all deposits and
funds of a special or trust nature.
(7) The words "receivership proceedings" mean any conservation,
rehabilitation, liquidation, or ancillary receivership.
(8) "Netting agreement", as used in this Article, means (a) a contract or agreement (including terms and conditions incorporated by reference therein), including a master agreement (which master agreement, together with all schedules, confirmations, definitions, and addenda thereto and transactions under any thereof, shall be treated as one netting agreement), that documents one or more transactions between the parties to the agreement for or involving one or more qualified financial contracts and that provides for the netting, liquidation, setoff, termination, acceleration, or close out under or in connection with one or more qualified financial contracts or present or future payment or delivery obligations or payment or delivery entitlements thereunder (including liquidation or close-out values relating to such obligations or entitlements) among the parties to the netting agreement; (b) any master agreement or bridge agreement for one or more master agreements described in paragraph (a) of this subsection (8); or (c) any security agreement or arrangement or other credit enhancement or guarantee or reimbursement obligation related to any contract or agreement described in paragraph (a) or (b) of this subsection (8); provided that any contract or agreement described in paragraphs (a) or (b) of this subsection (8) relating to agreements or transactions that are not qualified financial contracts shall be deemed to be a netting agreement only with respect to those agreements or transactions that are qualified financial contracts. (9) "Qualified financial contract" means any commodity contract, forward contract, repurchase agreement, securities contract, swap agreement, or any similar agreement that the Director determines by regulation, resolution, or order to be a qualified financial contract for the purposes of this Act. (a) "Commodity contract" means: (1) a contract for the purchase or sale of a | ||
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(2) an agreement that is subject to regulation | ||
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(3) an agreement or transaction that is subject | ||
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(4) any combination of the agreements or | ||
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(5) any option to enter into an agreement or | ||
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(b) "Forward contract", "repurchase agreement", | ||
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(Source: P.A. 96-1450, eff. 8-20-10.)
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(215 ILCS 5/188) (from Ch. 73, par. 800)
Sec. 188.
Grounds for rehabilitation and liquidation of a domestic
company or an unauthorized foreign or alien company. Whenever any
domestic company or any unauthorized foreign or alien company:
1. is insolvent;
2. has failed or refused to submit its books, papers, | ||
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3. has concealed, removed, altered, destroyed or | ||
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4. has failed or refused to observe an order of the | ||
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5. has, by articles of consolidation, contract of | ||
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6. is found to be in such condition that its further | ||
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7. has violated its charter or any law of this State | ||
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8. has an officer who has refused upon reasonable | ||
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9. is found to be in such condition that it could not | ||
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10. has ceased for the period of one year to transact | ||
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11. has commenced, or has attempted to commence, any | ||
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12. is a party, whether plaintiff or defendant in any | ||
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13. consents by a majority of its directors, | ||
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14. has not organized and obtained a certificate | ||
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15. has failed or refused to pay any valid final | ||
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sufficient grounds shall be deemed to exist for the commencement of
rehabilitation or liquidation proceedings.
With respect to a domestic company, the Director must report, and with
respect to an unauthorized foreign or alien company, the Director may
report any such case to the Attorney General of this State whose duty it
shall be to apply forthwith by complaint on relation of the Director in the
name of the People of the State of Illinois, as plaintiff, to the Circuit
Court of Cook County, the Circuit Court of Sangamon County, or the circuit
court of the county in which such company has, or last had its principal
office, for an order to rehabilitate or liquidate the defendant company as
provided in this Article, and for such other relief as the nature of the
case and the interests of its policyholders, creditors, members,
stockholders or the public may require.
When, upon investigation, the Director finds that
a company is engaged in any aspect of the business of insurance on behalf
of or in association with any domestic insurance company, against which a
receivership proceeding has been or is being filed under this Article, in a manner that appears to be detrimental to
policyholders, creditors, members, shareholders, or the
public, the Director may report such case to the Attorney
General of this State, whose duty it is to apply forthwith by complaint
on relation of the Director in the name of the People of the State of
Illinois, as plaintiff, to the court in which the
receivership proceeding is pending
for an order to appoint the Director as receiver to assume control of the
assets and operation of the company pending a complete investigation and
determination of the rights of the policyholders, creditors, members,
shareholders, and the
general public.
(Source: P.A. 92-140, eff. 7-24-01.)
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(215 ILCS 5/188.1) (from Ch. 73, par. 800.1)
Sec. 188.1.
Provisions for conservation of assets of a domestic,
foreign, or alien company.
(1) Upon the filing by the Director of a verified complaint alleging
(a) that with respect to a domestic, foreign, or alien company,
whether authorized or unauthorized, a condition exists that
would justify a court order for proceedings under Section 188, and
(b) that the interests of creditors, policyholders or the public will
probably be endangered by delay, then the circuit court of Sangamon or Cook
County or the circuit court of the county in which such company has or last
had its principal office shall enter forthwith without a hearing or
prior
notice an order
directing the director to take possession and control of the property,
business, books, records, and accounts of the company, and of the premises
occupied by it for the transaction of its business, or such part of each as
the complaint shall specify, and enjoining the company and its officers,
directors, agents, servants, and employees from disposition of its property
and from transaction of its business except with the concurrence of the
Director until the further order of the court.
Copies of the verified complaint and the seizure order shall be
served upon the company.
(2) The order shall continue in force and effect for such time as the
court deems necessary for the Director to ascertain the condition and
situation of the company. On motion of either party or on its own motion,
the court may from time to time hold such hearings as it deems desirable,
and may extend, shorten, or modify the terms of, the seizure order. So far
as the court deems it possible, the parties shall be given adequate notice
of such hearings. As soon as practicable, the court shall vacate the
seizure order or terminate the conservation proceedings of the company,
either when the Director has failed to institute proceedings
under Section 188 having a reasonable opportunity to do so, or upon an
order of the court pursuant to such proceedings.
(3) Entry of a seizure order under this section shall not constitute an
anticipatory breach of any contract of the company.
(4) The court may hold all hearings in conservation proceedings
privately in chambers, and shall do so on request of any officer of the
company proceeded against.
(5) In conservation proceedings and judicial reviews thereof, all
records of the company, other documents, and all insurance department files
and court records and papers, so far as they pertain to and are a part of
the record of the conservation proceedings, shall be and remain
confidential except as is necessary to obtain compliance therewith, unless
and until the court, after hearing arguments in chambers from the Director
and the company, shall decide otherwise, or unless the company requests
that the matter be made public.
(6) Any person having possession of and refusing to deliver any of the
property, business, books, records or accounts of a company against which a
seizure order has been issued shall be guilty of a Class A misdemeanor.
(Source: P.A. 89-206, eff. 7-21-95.)
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(215 ILCS 5/188.2) Sec. 188.2. Grounds for and provisions applicable to rehabilitation or liquidation
of a domestic company that is a covered financial company under the
federal Dodd-Frank Wall Street Reform and Consumer Protection Act. (a) The provisions of this Section apply in accordance with Title II of the federal Dodd-Frank Wall Street Reform and Consumer Protection Act,
P.L. 111-203, with respect to an insurance company that is a covered financial company,
as that term is defined under 12 U.S.C. 5381. (b) The Director may file a complaint for an order of rehabilitation or liquidation pursuant to
Section 188 of this Code on any of the following grounds: (1) upon a determination and notification given by | ||
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(2) upon an order of the United States District Court | ||
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(3) a petition by the Secretary of the Treasury of | ||
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(c) Notwithstanding any other provision in this Article, this Code, or any other law, after notice to the
insurance company, the receivership court may grant an order on the complaint for
rehabilitation or liquidation within 24 hours after the filing of a complaint pursuant to this
Section. (d) If the receivership court does not make a determination on a complaint for rehabilitation or liquidation
filed by the Director pursuant to this Section within 24 hours after its filing, then it shall be
deemed granted by operation of law upon the expiration of the 24-hour period. At the time
that an order is deemed granted under this Section, the provisions of Article XIII of this Code
shall be deemed to be in effect, and the Director shall be deemed to be affirmed as receiver and have all of the applicable powers provided by this Code, regardless of whether an order
has been entered. The receivership court shall expeditiously enter an order of rehabilitation
or liquidation that: (1) is effective as of the date that it is deemed | ||
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(2) conforms to the provisions for rehabilitation or | ||
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(e) Any order of rehabilitation or liquidation made pursuant to this Section shall not be subject to
any stay or injunction pending appeal. (f) Nothing in this Section shall be construed to supersede or impair any other power or
authority of the Director or the court under this Article or Code.
(Source: P.A. 98-136, eff. 8-2-13.) |
(215 ILCS 5/189) (from Ch. 73, par. 801)
Sec. 189. Injunction. The court shall have jurisdiction, upon, or at any time after the
filing
of the complaint to issue an injunction restraining such company and its
officers, agents, directors, employees and all other persons from
transacting any company business or disposing of its property until the
further order of the court. The court may also restrain all persons,
companies, and
entities from bringing or further prosecuting all actions and proceedings at
law or in equity or otherwise, whether in this State or elsewhere, against the
company or its assets or property or the Director except insofar as those
actions or proceedings arise in or are brought in the conservation,
rehabilitation, or liquidation proceeding. The court may issue such other
injunctions or
enter such other orders as may be deemed necessary to prevent interference
with the proceedings, or with the Director's possession and control or
title, rights or interests as herein provided or to prevent interference
with the conduct of the business by the Director, and may issue such other
injunctions or enter such other orders as may be deemed necessary to
prevent waste of assets or the obtaining, asserting, or enforcing of
preferences, judgments,
attachments, or other like liens, including common law retaining
liens, or
the making of any levy against such
company or its property and assets while in the possession and control of
the Director. The court may issue any other injunctions or enter any other
orders that are necessary to protect enrollees in accordance with subsection
(c) of Section 5-6 of the Health Maintenance Organization Act. Any
injunction
issued under this article may be served and
enforced as in other civil proceedings, but no bond or other security shall
be required of the plaintiff, either for costs or for any injunction. The provisions of this Section are subject to the exclusion set forth in subsection (o) of Section 204 of this Article.
(Source: P.A. 100-89, eff. 8-11-17.)
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(215 ILCS 5/190) (from Ch. 73, par. 802)
Sec. 190.
Practice, hearing, order and appeal.
(1) The defendant company shall appear within 10 days after the service
of the summons as in this Article provided, exclusive of the day of
service. If, on the return day of the summons the defendant shall enter its
appearance in the action and apply for further time in which to answer, the
court shall, upon request of the defendant, extend the time for answering
for a period not to exceed 10 days from said return day. If the defendant
fails to answer on the return day or within the time granted, or fails to
appear, the court shall proceed to hear and determine the cause as herein
provided.
(2) The court, on the return day of the summons as originally fixed or
extended hereunder, shall set the cause for hearing on some day not
exceeding 20 days from the return day, or the extended return day as herein
provided.
(3) No motions or other pleadings, whether to dissolve, modify or
continue any injunction or otherwise, shall be filed by, or permitted on
behalf of the defendant prior to the filing of an answer to the complaint.
All pleadings shall be filed within the time herein provided.
(4) The pleadings and proceedings insofar as not otherwise regulated by
this Article, shall be as in other civil proceedings.
(5) Upon the hearing, at which the complaint and any exhibits filed
therewith shall be received as prima facie evidence of the facts therein
recited, the court shall enter an order either dismissing the complaint or
finding that sufficient cause exists for rehabilitation or liquidation and
directing the Director to take possession of the property, business and
affairs of such company and to rehabilitate or liquidate the same as the
case may be. The Director shall be responsible on his official bond for all
assets coming into his possession.
(6) An appeal, if taken from such order, shall be prosecuted on an expedited
basis as provided for in such cases by Illinois Supreme Court Rule 307.
(7) A claim for attorneys' fees incurred by the company in contesting its
conservation, rehabilitation, or liquidation may be filed in the proceedings,
and the claim may be allowed upon a showing that (i) the attorneys' fees
incurred are reasonable; (ii) the board of directors of the company incurred
such attorneys' fees based upon their best knowledge, information, and belief
formed after reasonable inquiry indicating such contention is well grounded in
fact and is warranted by existing law or a good faith argument of the
extension, modification, or reversal of existing law; and (iii) the contention
is not pursued for any improper purpose, including harassment, unnecessary
delay in the proceedings, or waste of estate
assets. Such claims, if allowed, shall be accorded a priority of distribution
under paragraph (g) of subsection (1) of Section 205. This
subsection (7)
applies to all liquidation, rehabilitation, or conservation proceedings that
are pending on the effective date of this amendatory Act of 1993 and to all
future liquidation, rehabilitation, or conservation proceedings.
(Source: P.A. 88-297; 88-670, eff. 12-2-94; 89-206, eff. 7-21-95.)
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(215 ILCS 5/190.1) (from Ch. 73, par. 802.1)
Sec. 190.1. Appeal of order directing liquidation - special claims procedure.
(1) Within 5 days of the effective date of this amendatory Act of 1982,
or, if later, within 5 days after the filing of a notice of appeal of an
order of liquidation, which order has not been stayed, the Director shall
present for the circuit court's approval a plan for the continued performance
of the defendant company's policy claims obligations, including the duty
to defend insureds under liability insurance policies, during the pendency
of an appeal. Such plan shall provide for the continued performance and
payment of policy claims obligations in the normal course of events, notwithstanding
the grounds alleged in support of the order of liquidation including the
ground of insolvency. In the event the defendant company's financial condition
will not, in the judgment of the Director, support the full performance
of all policy claims obligations during the appeal pendency period, the
plan may prefer the claims of certain policyholders and claimants over creditors
and interested parties as well as other policyholders and claimants, as
the Director finds to be fair and equitable considering the relative circumstances
of such policyholders and claimants. The circuit court shall examine the
plan submitted by the Director and if it finds the plan to be in the best
interests of the parties, the circuit court shall approve the plan.
No action shall lie against the Director or any of his deputies, agents,
clerks, assistants or attorneys by any party based on preference in an appeal
pendency plan approved by the circuit court.
(2) The appeal pendency plan shall not supersede or affect the obligations
of any insurance guaranty fund which under its own state law is required
to pay covered claims obligations during the appeal pendency period.
(Source: P.A. 96-1000, eff. 7-2-10.)
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(215 ILCS 5/191) (from Ch. 73, par. 803)
Sec. 191.
Title to property of company.
The Director and his successor and successors in office shall be vested
by operation of law with the title to all property, contracts, and rights
of
action of the company as of the date of the order directing rehabilitation
or liquidation. The Director is entitled to immediate possession and control
of all property, contracts, and rights of action of the company, and is further
authorized and directed to remove any and all records and property of the
company to the Director's possession and control or to such other place as may
be convenient for the purposes of efficient and orderly administration of the
rehabilitation or liquidation. All persons, companies, and entities shall
immediately release their possession and control of any and all property,
contracts, and rights of action of the company to the Director including, but
not limited to, bank accounts and bank records, premium and related records,
and claim, underwriting, accounting, and litigation files. The entry of an
order of rehabilitation or liquidation creates an estate that comprises all of
the liabilities and assets of the company. The filing or recording of such
order in the office of the
recorder or the Registrar of Titles in any county of this State
shall impart the same notice that a deed, bill of sale or other evidence of
title duly filed for record by such company would have imparted.
(Source: P.A. 89-206, eff. 7-21-95.)
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(215 ILCS 5/192) (from Ch. 73, par. 804)
Sec. 192.
Duties of
Director as rehabilitator; termination.
(1) Upon the entry of an order directing rehabilitation, the Director
shall immediately proceed to conduct the business of the company and take
such steps towards removal of the causes and conditions which have made
such proceedings necessary as may be expedient.
(2) The Director is authorized to deal with the property and business of
the company in his name as Director, or, if the Court shall so order, in
the name of the company. The Director may, subject to the approval
of the Court, sell
or otherwise dispose of the real and personal property, or any part
thereof, and sell or compromise all doubtful or uncollectible debts or
claims owing to the company in any rehabilitation proceeding now
pending or hereafter instituted, except that whenever the value of any real
or personal property or the amount of any such debt owing to the company does
not exceed $25,000, the Director may sell, dispose of, compromise, or compound
the same upon such terms as the Director deems to be in the best interest of
the company without obtaining approval of the court unless otherwise directed
by the court. The Director may solicit contracts whereby a solvent company
agrees to assume, in whole or in part, or upon a modified basis, the
liabilities of a company in rehabilitation in a manner consistent with
subsection (4) of Section 193 of this Code.
(3) The Director may bring any action, claim, suit, or proceeding against
any director or officer of the company or against any other person with respect
to that person's dealings with the company including, but not limited to,
prosecuting any action, claim, suit, or proceeding on behalf of the creditors,
members, policyholders, or shareholders of the company. Nothing in this
subsection shall be construed to affect the standing of the Illinois Insurance
Guaranty Fund, the Illinois Life and Health Insurance Guaranty Association, or
the Illinois Health Maintenance Organization Guaranty Association to sue or be
sued under applicable law.
(4) If at any time the Director finds that it is in the best
interests
of policyholders, creditors and the company to effect a plan of
mutualization or rehabilitation, the Director may submit such plan
to the court for
its approval. Such plan, in addition to any other terms and provisions as
may by the Director be deemed necessary or advisable, may include a
provision imposing liens upon the net equities of policyholders of the
company, and in the case of life companies, a provision imposing a
moratorium upon the loan or cash surrender values of the policies, for such
period and to such an extent as may be necessary. Notice of the hearing
upon any such plan shall be given in the manner as may be fixed by the
court and upon such hearing the court may either approve or disapprove the
plan or modify it in such manner and to such extent as to the court shall
seem appropriate.
(5) Where in such proceedings the Court has entered an order
for the
filing of claims and it subsequently appears that the total amount of all
allowable claims exceed the assets in the possession of the Rehabilitator,
the Court may upon the application of the Director authorize a distribution
of assets in accordance with the applicable provisions of Section 210.
The Director may at such time apply under this Section for an order
dissolving the company in accordance with the applicable provisions of
Section 196.
(6) If at any time the Director finds that the causes and
conditions
which made such proceeding necessary have been removed he may petition the
court for an order terminating the conduct of the business by the Director
and permitting such company to resume possession of its property and the
conduct of its business and for a full discharge of all liability and
responsibility of the Director. No order for the return to such company of
its property and business shall be granted unless the court after a full
hearing determines that the purposes of the proceeding have been fully
accomplished.
(Source: P.A. 89-206, eff. 7-21-95; 90-381, eff. 8-14-97.)
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(215 ILCS 5/193) (from Ch. 73, par. 805)
Sec. 193.
Duties of
Director as liquidator; sales; reinsurance.
(1) Upon the entry of an order directing liquidation, the Director shall
immediately proceed to liquidate the property, business, and affairs of the
company. The Director is hereby authorized to deal with the
property, business, and affairs of
the company in his name as Director, or, if the court shall so order, in
the name of the company.
(2) The Director may, subject to the approval of the court, sell
or otherwise
dispose of the real and personal property, or any part thereof, and sell or
compromise all debts or claims owing to
the
company, except that
whenever the value of any real or personal property or the amount of any debt
owing to the
company does not exceed $25,000, the Director may sell, dispose
of,
compromise, or compound the
same upon such terms as the Director deems to
be in the best interest of the company
without obtaining approval of the court.
(3) The Director may bring any action, claim, suit, or proceeding
against any director or officer of the company or against any other person
with respect to that person's dealings with the company including, but not
limited to, prosecuting any action, claim, suit, or proceeding on behalf of the
creditors, members, policyholders, or shareholders of
the company. Nothing in this subsection shall be construed to affect the
standing of the Illinois Insurance Guaranty Fund, the Illinois Life and Health
Insurance Guaranty Association, or the Illinois Health Maintenance Organization
Guaranty Association to sue or be sued under applicable law.
(4) In order to preserve so far as possible the rights and interests of
the policyholders of the company whose contracts were cancelled by the
liquidation order and of such other creditors as may be possible, the
Director may solicit a contract or contracts whereby a solvent company or
companies will agree to assume in whole, or in part, or upon a modified
basis, the liabilities owing to said former policyholders or creditors. The
Director may, subject to Section 531.08(h) of this Code or Section 6-8 of
the Health Maintenance Organization Act, cede or reinsure
all or so much as may be necessary of the
in-force business to another company using assets of the liquidated company
to pay therefor in preference to satisfying other obligations or creditors.
The Director may assign any rights or interests of the company to receive
reinsurance proceeds for losses to the Illinois Life and Health Insurance
Guaranty Association, the Illinois Health Maintenance Organization Guaranty
Association or any similar organization in any other state. If,
after a full hearing upon a petition filed by the Director, the court
shall find that the Director endeavored to obtain the best contract for the
benefit of said parties in interest, and if the said Director shall report
to the court that he is ready and willing to enter into a contract and
submit a copy thereof to the court, the court shall examine the procedure
and acts of the Director, and if the court shall find that the best
possible contract in the interests of said parties has been obtained and
that it is best for the interests of said parties that said contract be
entered into, the court shall by written order approve the acts of the
Director and authorize him to execute said contract.
(5) In recognition of the rights of policyholders whose "claims
made" contracts were cancelled by the liquidation order, he may, in his
discretion, permit such policyholders to purchase an extended discovery
period which is subject to the limitations in this Article. The
policyholder shall pay to the liquidator a premium which is appropriate for
the rights purchased as determined by the liquidator and approved by the
court. No extended discovery period purchased before or after the entry of
the liquidation order shall extend the time to file claims as set by the
court pursuant to Section 208 of this Code. Claims accruing by virtue of
such extended discovery period shall be treated as any other claim under
Article XXXIV of this Code, and shall be subject to the limitations,
exclusions and conditions in the Illinois Insurance Guaranty Fund Act and
in the laws governing similar organizations in other states.
(6) The Director is authorized to cancel policies, bonds, and contracts of
insurance subject to court approval.
(7) All persons, companies, and entities shall immediately turn over to
the Director all unearned premium that has been collected by or on behalf of
the company and all earned premium owing the company unless otherwise directed
in writing by the Director or by court order. Within 30 days of the date of a
written request of
the Director, those persons, companies, and entities shall
submit affidavits verifying amounts collected by, on behalf
of, or due and owing the company and further shall provide copies of all
premium fund trust account information and such other applicable documentation
as requested by the Director. Nothing in this subsection shall be construed to
affect the rights of (i) the Illinois Life and Health Insurance Guaranty
Association to collect premium under item (6) of Section 531.08 of this Code or
(ii) the Illinois Health Maintenance Organization Guaranty Association to
collect premium under item (11) of Section 6-8 of the Health Maintenance
Organization Act.
(8) The amount recoverable by the Director from a reinsurer shall not be
reduced or diminished as a result of the entry of an order of liquidation
notwithstanding any provision in the reinsurance contract or other such
agreement. Payment made by a reinsurer to or on behalf of an insured of the
company shall not diminish the reinsurer's obligation to the company except
when the reinsurance agreement lawfully provides for payment to or on behalf of
the company's insured by the reinsurer. All reinsurance contracts to which the
company is a party, which do
not contain the provisions required with respect to the obligation of a
reinsurer in the event of insolvency of the reinsured to obtain credit for
reinsurance or pursuant to other applicable statutes, shall contain or be
construed to contain all of the following provisions:
(a) Upon the entry of an order of liquidation and | ||
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(b) The Director shall give written notice or arrange | ||
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(Source: P.A. 88-297; 89-206, eff. 7-21-95.)
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(215 ILCS 5/194) (from Ch. 73, par. 806)
Sec. 194.
Rights and
liabilities of creditors fixed upon liquidation.
(a) The rights and liabilities of the company and of its creditors,
policyholders, stockholders or members and all other persons interested in
its assets, except persons entitled to file contingent claims, shall be
fixed as of the date of the entry of the Order directing liquidation or
rehabilitation unless otherwise provided by Order of the Court. The rights
of claimants entitled to file
contingent claims or to have their claims estimated shall be determined as
provided in Section 209.
(b) The Director may,
within 2 years after the entry of an order for
rehabilitation or liquidation or within such further time as applicable law
permits, institute an action, claim, suit, or proceeding
upon any cause of action against which the period of limitation fixed
by applicable law has not expired at the time of filing of the complaint upon
which the order is entered.
(c) The time between the
filing of a complaint for conservation, rehabilitation, or liquidation against
the company and the denial of the complaint shall not be considered to be a
part of the time within which any action may be commenced against the company.
Any action against the company that might have been commenced when the
complaint was filed may be commenced for at least 180 days after the complaint
is denied.
(Source: P.A. 88-297; 89-206, eff. 7-21-95.)
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(215 ILCS 5/195) (from Ch. 73, par. 807)
Sec. 195.
Borrowing
on the pledge of assets.
For the purpose of facilitating the rehabilitation, liquidation,
conservation or dissolution provided for by this article, the Director may,
subject to the approval of the court, borrow money and execute, acknowledge
and deliver certificates of indebtedness upon such terms and entitled to
such liens and priorities as may be fixed by the court, or notes or other
evidence of indebtedness therefor and secure the repayment of the same by
the mortgage, pledge, assignment, transfer in trust or hypothecation or any
or all of the property whether real, personal or mixed of the company
against which a proceeding has been brought under this article. Subject to
the approval of the court, he shall also have power to take any and all
other action necessary and proper to consummate any such loans and to
provide for the repayment thereof. The Director shall incur no personal
liability by virtue of any loan made pursuant to this section.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/196) (from Ch. 73, par. 808)
Sec. 196.
Order of dissolution.
If the company against whom the complaint
for liquidation is filed
is a
corporation and the complaint prays for dissolution of such company, the
court shall have jurisdiction either before or after final liquidation of
the property, business and affairs of such company, after service of
summons and complaint as above stated and a full hearing, to enter a judgment
dissolving such company, and if an order of liquidation has been entered
against a company, the court shall have jurisdiction, upon the petition of the
Director, to enter an order dissolving the company. The court may likewise,
regardless of whether an
order of liquidation is sought or has been obtained, upon proper complaint
or petition by the Director, order dissolution of a company where it has
failed to qualify for a certificate of authority authorizing it to commence
the transaction of its business, or where a company has no assets and no
means for payment of liabilities.
(Source: P.A. 89-206, eff. 7-21-95.)
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(215 ILCS 5/197) (from Ch. 73, par. 809)
Sec. 197.
Rights, powers, and duties ancillary to domiciliary proceeding.
The rights, powers, and duties of the Director as conservator,
rehabilitator, or liquidator, with reference to the assets of a foreign or
alien company, whether authorized or unauthorized, shall be ancillary to
the rights, powers and duties imposed upon any receiver or other person, if
any, in charge of the property, business and affairs of such company in its
domiciliary state or country.
(Source: P.A. 86-1154; 86-1156.)
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(215 ILCS 5/198) (from Ch. 73, par. 810)
Sec. 198.
Service of
summons and return.
(1) Upon the filing of a complaint, summons shall forthwith issue,
returnable in 3 days after its date, and a copy of the summons together
with the complaint in any proceeding under this article shall be served
upon the company named in such complaint by delivering the same to its
president, vice president, secretary, treasurer, director, or to its
managing agent, or if the company lack any of the aforesaid officers, or
they cannot be found within the State, to the officer performing
corresponding functions under another name; if it be a Lloyds, reciprocal
or inter-insurance exchange, by delivering such summons and copy of the
complaint to the duly designated attorney-in-fact.
(2) When it is satisfactorily proved by the report of an examiner of the
department made in accordance with the provisions of this Code, or by
affidavit if anyone familiar with the facts, that the officers, directors,
trustees or managing agents or members of any company named in said
complaint upon whom service is required to be made as above provided, have,
or if a Lloyds, reciprocal or inter-insurance exchange be named in the
complaint, that the duly designated attorney-in-fact, has, departed from
the State or keep themselves or himself concealed therein, or if such of
the persons residing in this State and upon whom service is required to be
made as above provided have resigned from their offices, or that service
cannot be made immediately by the exercise of reasonable diligence, such
service may be had by the mailing of a copy of the complaint and summons to
the last known address of the company, or by publication in such form and
in such manner as the court shall order.
(Source: Laws 1959, p. 1422.)
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(215 ILCS 5/199) (from Ch. 73, par. 811)
Sec. 199.
Removal of
proceedings to Sangamon or Cook county.
In the event an order is entered directing liquidation, rehabilitation
or conservation, the Director may remove the property and assets of the
company to the county of Sangamon or to the county of Cook. In the event of
such removal or contemplated removal the court shall upon proper petition
showing the necessity therefor, filed by the Director, order the clerk of
the court wherein such proceeding was commenced to make a full transcript
of the petition for removal and the order thereon and to transmit the same
together with all papers theretofore filed in the cause, to the Clerk of
the Circuit Court of the county of Sangamon or to the Clerk of the Circuit
Court of the county of Cook, as the case may be, and the proceeding shall
thereafter be conducted in the same manner as if it had been commenced in
the county to which the cause is transferred.
(Source: Laws 1965, p. 3563.)
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(215 ILCS 5/200) (from Ch. 73, par. 812)
Sec. 200.
Examinations.
The pendency of any proceeding under this Article shall in no way affect
the power and authority of the Director to conduct any examination provided
for in Sections 132 through 132.7, in connection with the
business, conduct or affairs
of the company sought to be liquidated, rehabilitated or conserved.
An annual audit of any business having assets of more than $500,000 which
is under liquidation or rehabilitation pursuant to this Act shall be performed
by an independent outside certified public accountant, who is currently
engaged in the conduct of audits under the Illinois State Auditing Act.
The cost of this audit shall be paid by the Director out of the assets of
the business being liquidated or rehabilitated.
An annual audit of any special deputy appointed under Section 202
shall be conducted by an independent, outside certified public accountant
performing the audits provided for in the preceding paragraph. The cost of
this audit shall be allocated among the estates of the companies in
conservation, rehabilitation, or liquidation
on the basis of allocation methods established by the Director. The
Illinois Auditor General may, at his option, participate in the audit of
any special deputy.
Copies of all audits prepared under this Section shall be promptly provided
after completion to the Governor, to the Illinois Auditor General,
and to the majority and minority leaders of the Senate and the House of
Representatives.
(Source: P.A. 89-97, eff. 7-7-95.)
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(215 ILCS 5/201) (from Ch. 73, par. 813)
Sec. 201.
Who may apply for appointment of receiver or liquidator.)
No order or judgment enjoining, restraining or interfering with
the prosecution of the business of any company, or for the appointment
of a temporary or permanent receiver, rehabilitator or liquidator of a
domestic company, or receiver or conservator of a foreign or alien
company, shall be made or granted otherwise than upon the complaint of
the Director represented by the Attorney General as provided in this
article, except in an action by a judgment creditor or in proceedings
supplementary thereto after notice that a final judgment has been
entered and that the judgment creditor intends to file a complaint
praying for any of the relief in this section mentioned, has been served
upon the Director at least 30 days prior to the filing of such complaint
by such judgment creditor.
(Source: P.A. 84-546.)
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(215 ILCS 5/202) (from Ch. 73, par. 814)
Sec. 202.
Appointment of special deputies; employees and professional advisors;
contracts; qualified immunity.
(a) For the purpose of assisting the Director in the performance of the
Director's duties under Articles VII, XIII, and XIII 1/2 of this Code, the
Director has authority to appoint one or more special deputies as
the Director's agent or agents, and clerks, assistants, attorneys, and other
personnel as the Director may deem necessary and to delegate to each such
person authority to assist the Director as the Director may consider
appropriate. The compensation of each special deputy, clerk,
assistant, attorney, and other designated personnel shall be fixed and paid
by the Director. The Director shall also have the authority to retain and
pay
attorneys, actuaries, accountants, consultants, and such other persons as
the Director may deem necessary and appropriate. The Director shall fix the
rate of compensation of these attorneys, actuaries, accountants, consultants,
and other persons subject to the approval of the court. The Director,
however, has the authority to fix, without the approval of the court, the rate
of compensation of attorneys, actuaries, accountants, consultants, and other
persons that he considers necessary and appropriate if the Director determines
that the projected expenditure for professional fees to each such person will
not exceed $20,000 per company in any calendar year.
(b) The special deputies may enter into leases or contracts for the
procurement of real or personal property, and on such terms and conditions
as the Director may deem necessary or advisable for the purpose of
performing the Director's duties under Articles VII, XIII, and XIII 1/2 of
this Code. Any such lease or contract that requires an aggregate
expenditure in excess of $150,000 shall be subject to the approval of the
court before which is pending the delinquency proceeding of the estate of
the company on whose behalf the lease or contract is entered into. In the
event that the lease or contract is entered into on behalf of 2 or more
companies, the delinquency proceedings of the 2 or more companies shall be
consolidated for the sole purpose of obtaining approval of the lease or
contract from the court before which is pending the delinquency proceeding
of the estate of the company that, in the judgment of the Director at the
time of application for approval, is to bear the largest portion of the
amounts to be expended under the lease or contract under the allocation
methods established by the Director under subsection (c)(1) of this Section.
(c) (1) The compensation of the persons appointed by the Director and
the attorneys, actuaries, accountants, consultants, and other persons
retained by the Director, the payments under the leases or contracts
described in subsection (b) of this Section, and all other expenses of taking possession
of the property and the administration of the company and its property
shall be paid (i) out of the funds or assets of the company on whose behalf
the compensation, payments, or expenses were incurred or (ii) in the event
that the compensation, payments, or expenses were, in the judgment of the
Director, incurred in behalf of 2 or more companies, out of the assets of
those companies on the basis of allocation methods established by the Director.
(2) Notwithstanding the foregoing provisions of this subsection (c),
the salary of the special deputies, together with the salaries or fees of
those clerks, assistants, attorneys, actuaries, accountants, consultants,
or other persons appointed or retained by the Director under this Section,
and the other expenses of taking possession of the property and the
administration of the company and its property, may be paid out of
amounts appropriated to the Department of Insurance. Any amounts paid
under this Section from appropriated funds shall be repaid to the State
treasury from any available funds or assets of the company on whose behalf
the expenses were incurred, subject to the approval of the court before
which is pending the delinquency proceeding of the company.
(d) (1) For each calendar quarter or other period
as the court may determine, the Director shall file with the court before
which is pending the
delinquency proceeding of each company in liquidation or rehabilitation a
report for the period reflecting the company's (i) cash and invested assets
held by the Director at the beginning of the period, (ii) cash receipts,
(iii) cash disbursements for payments of salaries, compensation,
professional fees, and all other expenses of administration of the company
and its property, (iv) all other cash disbursements, and (v) cash and
invested assets held by the Director at the end of the period; provided
that the report need not be filed more than once for each calendar year if
the cash and invested assets of the company are less than $250,000.
For each such period, the Director shall file with the court a similar report
for each company in conservation, except that this report shall reflect
only those cash disbursements for payments of salaries, compensation,
professional fees, and all other expenses of the administration of the
company and its property.
(2) No party to the proceedings may object to any aspect of that
report unless the basis of the party's objection is set forth in a motion
filed with the court not later than 30 days after the filing of the report.
In the event that objections to the report are filed, the Director shall
have 15 days to file a response to the objections, and a hearing on the
matter shall be held at the earliest possible date consistent with the
schedule of the court. Any hearing on objections shall be limited solely to the
specific objections raised in the original motion.
(e) (1) For purposes of this subsection (e):
"Receiver" means the Director in his or her capacity
as the liquidator, rehabilitator, or conservator of a company in
liquidation, rehabilitation, or conservation.
"Director as trustee" means the Director when appointed as trustee under
this Article.
"Employees" means all present and former special deputies
appointed by the Director and all persons that the Director or special
deputies may appoint or employ or may have appointed or employed to assist
in the liquidation, rehabilitation, or conservation of a company.
"Employees" shall not include any attorneys, accountants, auditors, or
other professional persons or firms (or their employees) who are
retained as independent contractors by either the Director or by any
special deputy appointed under
this Section.
"Advisors" means all persons that the Director may appoint or
may have appointed under Section 202.1.
(2) If a cause of action is commenced against the receiver,
the Director as trustee, employees, or advisors, either personally or in
their official
capacity, alleging property damage, property loss, personal injury, or other
civil liability arising out of any act, error, or omission of the receiver,
the Director as trustee, employees, or advisors committed within the scope
of their duties or
employment involving a company in liquidation, rehabilitation, or
conservation, the receiver, the Director as trustee, employees, or advisors
shall be indemnified out
of the assets of the company for all expenses, attorneys' fees, judgments,
settlements, decrees, fines, penalties, or amounts paid in satisfaction of
or incurred in the defense of the cause of action unless it is determined
upon a final adjudication on the merits that the act, error, or omission of
the receiver, the Director as trustee, employees, advisors, or the court
giving rise to the claim
was not within the scope of his or her duties or employment or was caused
by intentional, wilful, or wanton misconduct. Any payments out of the
assets of the company under this subsection (e) shall be
subject to the prior approval of the court before which is pending the
delinquency proceeding of the company.
The court shall be entitled to indemnification under Section 2 of
the Representation and Indemnification of State Employees Act.
Attorneys' fees and expenses incurred in defending an action
against the receiver, the Director as trustee, employees, or advisors for
which indemnity is
available under this part (2) may, upon the approval of the
receiver and the court before which is pending the delinquency proceeding
of the company, be paid from the assets of the company's estate in advance
of the final disposition of the action upon receipt of an undertaking by or
on behalf of the receiver, the Director as trustee, employees, or advisors
to pay that amount, if it
shall ultimately be determined upon a final adjudication on the merits that
he or she is not entitled to be indemnified under this part (2).
Any indemnification, expense payments, and attorneys' fees from the
company's assets for actions against the receiver, the Director as trustee,
employees, or advisors
under this part (2) shall be considered an administrative
expense of the estate.
In the event of actual or threatened litigation against the
receiver, the Director as trustee, employees, or advisors for which
indemnity is available under this
part (2), a reasonable amount of funds, which in the judgment of
the Director may be needed to provide indemnity, may be segregated and
reserved from the assets of the company as security for the payment of
indemnity until all applicable statutes of limitations shall have run and
all actual or threatened actions against the receiver, the Director as
trustee, employees, or
advisors have been completely and finally resolved.
(3) Nothing contained or implied in this subsection (e) shall
operate, or be construed or applied, to deprive the Director, receiver, the
Director as trustee, the
company's estate, any employee, any advisor or the court of any defense,
claim, or right of immunity
heretofore available.
(Source: P.A. 88-297; 89-206, eff. 7-21-95.)
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(215 ILCS 5/202.1) (from Ch. 73, par. 814.1)
Sec. 202.1.
The Director may, with the approval of the court, appoint
an Advisory Committee, consisting of policyholders, claimants, or other
creditors, including Guaranty Funds and Guaranty Associations, should the
Director deem it necessary to the proper performance of his
responsibilities under this Article and Article XIII 1/2. The Committee
shall serve at the pleasure of the Director and shall serve without
compensation other than reimbursement for travel
and per diem living expenses incurred in attending committee meetings. No
other committees of any nature shall be appointed by the Director or the
court in any proceeding conducted under this Article and Article XIII 1/2.
(Source: P.A. 86-1155; 86-1156.)
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(215 ILCS 5/203) (from Ch. 73, par. 815)
Sec. 203.
Exemption
from filing fees.
The Director shall not be required to pay any fee to any public officer
for filing, recording or in any manner authenticating any paper or
instrument relating to any proceeding under this article, nor for services
rendered by any public officer for serving any process; but such fees and
costs may be taxed as costs against the defendant in the suit by order of
the court and paid to such public officer.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/204) (from Ch. 73, par. 816)
Sec. 204. Prohibited and voidable transfers and liens.
(a)(1) A preference is a transfer of any of the property of a company
to or for the benefit of a creditor, for or on account of an antecedent
debt, made or suffered by the company within 2 years before
the
filing of
a complaint under this Article, the effect of which may be to
enable the creditor to obtain a greater percentage of this debt than
another creditor of the same class would receive.
(2) Any preference may be avoided by the Director as rehabilitator,
liquidator, or conservator if:
(A) the company was insolvent at the time of the | ||
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(B) the transfer was made within 4 months before the | ||
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(3) Where the preference is voidable, the Director as rehabilitator,
liquidator, or conservator may recover the property or, if it has been
converted, its value from any person who has received or converted the
property; except where a bona fide purchaser or lienor has given less than
fair equivalent value, the purchaser or lienor shall have a lien upon the
property to the extent of the consideration actually given. Where a
preference by way of lien or security title is voidable, the court may on
due notice order the lien or title to be preserved for the benefit of the
estate, in which event the lien or title shall pass to the Director as
rehabilitator or liquidator.
(b)(1) A transfer of property other than real property shall be deemed
to be made or suffered when it becomes so far perfected that no subsequent
lien obtainable by legal or equitable proceedings on a simple contract
could become superior to the rights of the transferee.
(2) A transfer of real property shall be deemed to be made or suffered
when it becomes so far perfected that no subsequent bona fide purchaser
from the company could obtain rights superior to the rights of the transferee.
(3) A transfer that creates an equitable lien shall not be deemed to be
perfected if there are available means by which a legal lien could be created.
(4) A transfer not perfected before the filing of a complaint shall
be deemed to be made immediately before the filing of the complaint.
(5) The provisions of this subsection apply whether or not there are or
were creditors who might have obtained liens or persons who might have
become bona fide purchasers.
(c) For purposes of this Section:
(1) A lien obtainable by legal or equitable | ||
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(2) A lien obtainable by legal or equitable | ||
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(d) A transfer of property for or on account of a new and
contemporaneous consideration which is deemed under subsection (b) of this
Section to be made or suffered after the transfer because of delay in
perfecting it does not thereby become a transfer for or on account of an
antecedent debt if any acts required by the applicable law to be performed
in order to perfect the transfer as against liens or bona fide purchasers'
rights are performed within 21 days or any period expressly allowed
by the law, whichever is less. A transfer to secure a future loan, if the
loan is actually made, or a transfer that becomes security for a future
loan, shall have the same effect as a transfer for or on account of a new
and contemporaneous consideration.
(e) If any lien deemed voidable under part (2) of subsection
(a) of this Section has been dissolved by the furnishing of a bond or other
obligation, the surety on which has been indemnified directly or indirectly
by the transfer of or the creation of a lien upon any property of a company
before the filing of a complaint under this Article, the indemnifying
transfer or lien shall also be deemed voidable.
(f) The property affected by any lien deemed voidable under subsections
(a) and (e) of this Section shall be discharged from the lien, and that
property and any of the indemnifying property transferred to or for the
benefit of a surety shall pass to the Director as rehabilitator or
liquidator, except that the court may, on due notice, order any such lien to
be preserved for the benefit of the estate and the court may direct that
such conveyance be executed as may be proper or adequate to
evidence the title of the Director as
rehabilitator or liquidator.
(g) The court shall have summary jurisdiction over any proceeding by the
Director as rehabilitator, liquidator, or conservator to hear and determine
the rights of any parties under this Section. Reasonable notice of any
hearings in the proceeding shall be given to all parties in interest,
including the obligee of a releasing bond or other life obligation. Where an
order is entered for the recovery of indemnifying property in kind
or for the avoidance of
an indemnifying lien, the court, upon application of any party in interest,
shall in the same proceeding ascertain the value of the property or lien,
and if the value is less than the amount for which the property is
indemnity or than the amount of the lien, the transferee or lienholder may
elect to retain the property or lien upon payment of its value, as
ascertained by the court, to the Director as rehabilitator, liquidator, or
conservator, within such reasonable times as the court shall fix.
(h) The liability of the surety under the releasing bond or other similar
obligation shall be discharged to the extent of the value of the
indemnifying property recovered or the indemnifying lien nullified and
avoided by the Director as
rehabilitator, liquidator, or conservator. Where the property is retained
under subsection (g) of this Section, the liability shall be discharged to
the extent of the amount paid to the
Director as rehabilitator, liquidator, or conservator.
(i) If a creditor has been preferred and thereafter in good faith gives
the company further credit without security of any kind, for property which
becomes a part of the company's estate, the amount of the new credit
remaining unpaid at the time of the petition may be set off against the
preference which would otherwise be recoverable from the creditor.
(j) If a company shall, directly or indirectly, within 4 months
before the filing of a complaint under this Article, or at any time in
contemplation of such a proceeding, pay money or transfer property to any
attorney for services rendered or to be rendered, the transactions may be
examined by the court on its own motion or shall be examined by the court
on petition of the
Director as rehabilitator, liquidator, or conservator and shall be held
valid only to the extent of a reasonable amount to be determined by the
court, and the excess may be recovered by the Director as rehabilitator,
liquidator, or conservator for the benefit of the estate provided that where
the attorney is in a position of influence in the company or an affiliate
thereof payment of any money or the transfer of any property to the
attorney for services rendered or to be rendered shall be governed by
item (B) of part (2) of subsection (a) of this Section.
(k)(1) An officer, director, manager, employee,
shareholder,
member, subscriber,
attorney, or other person acting on behalf of the company who
knowingly
participates in giving any preference when that officer, director, manager,
employee,
shareholder, member, subscriber, attorney, or other person has reasonable
cause to believe the company is or is about to become insolvent at the time
of the preference shall be personally liable to the Director as
rehabilitator, liquidator, or conservator for the amount of the preference.
There is a reasonable cause to so believe
if the transfer was made within 4 months before the date of filing of the
complaint.
(2) A person receiving any property from the company or the
benefit
thereof as a preference voidable under subsection (a) of this Section
shall be personally liable therefor and shall be bound to account to the
Director as rehabilitator, liquidator, or conservator.
(3) Nothing in this Section shall prejudice any other claim by the
Director as rehabilitator, liquidator, or conservator against any person.
(l) For purposes of this Section, the company is presumed to have been
insolvent on and during the 4 month period immediately preceding the date
of the filing of the complaint.
(m) The Director as rehabilitator, liquidator, or conservator may not
avoid a transfer under this Section to the extent that the transfer was:
(A) Intended by the company and the creditor to or | ||
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(B) In payment of a debt incurred by the company in | ||
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(C) In the case of a transfer by a company where the | ||
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(D) Of money or other property arising under or | ||
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(n) The Director as rehabilitator, liquidator, or conservator may avoid
any transfer of or lien upon the property of a company that the estate of the
company or a policyholder, creditor, member, or stockholder of the company
may have avoided, and the Director as rehabilitator, liquidator, or conservator
may recover and collect the property so transferred or its value from the
person to whom it was transferred unless the property was transferred to a
bona fide holder for value before the filing of the complaint. The Director
as rehabilitator, liquidator, or conservator shall be deemed a creditor for
purposes of pursuing claims under the Uniform Fraudulent Transfer Act.
(o) Notwithstanding any provision of this Article to the contrary, a Federal Home Loan Bank shall not be stayed, enjoined, or prohibited from exercising or enforcing any right or cause of action regarding collateral pledged under any security agreement or any pledge, security, collateral or guarantee agreement, or any other similar arrangement or credit enhancement relating to a Federal Home Loan Bank security agreement. (Source: P.A. 100-89, eff. 8-11-17.)
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(215 ILCS 5/205) (from Ch. 73, par. 817)
Sec. 205. Priority of distribution of general assets.
(1) The priorities of distribution of general assets from the
company's estate is to be as follows:
(a) The costs and expenses of administration, | ||
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(i) The reasonable expenses of the Illinois | ||
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(ii) The expenses expressly approved or ratified | ||
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(1) the actual and necessary costs of | ||
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(2) reasonable compensation for all services | ||
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(3) any necessary filing fees; (4) the fees and mileage payable to witnesses; (5) unsecured loans obtained by the receiver; | ||
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(6) expenses approved by the conservator or | ||
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Any unsecured loan falling under item (5) of | ||
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(b) Secured claims, including claims for taxes and | ||
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(c) Claims for wages actually owing to employees for | ||
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(d) Claims by policyholders, beneficiaries, and | ||
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(e) Claims by policyholders, beneficiaries, and | ||
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(f) Any other claims due the federal government.
(g) All other claims of general creditors not falling | ||
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(h) Claims of guaranty fund certificate holders, | ||
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(i) Proprietary claims of shareholders, members, or | ||
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Every claim under a written agreement, statute, or rule providing that the
assets in a separate account are not chargeable with the liabilities arising
out of any other business of the insurer shall be satisfied out of the funded
assets in the separate account equal to, but not to exceed, the reserves
maintained in the separate account under the separate account agreement, and to
the extent, if any, the claim is not fully discharged thereby, the remainder
of the claim shall be treated as a priority level (d) claim under paragraph
(d) of this subsection to the extent that reserves have been established in the
insurer's general account pursuant to statute, rule, or the separate account
agreement.
For purposes of this provision, "separate account policies, contracts, or
agreements" means any policies, contracts, or agreements that provide for
separate accounts as contemplated by Section 245.21.
To the extent that any assets of an insurer, other than those assets properly
allocated to and maintained in a separate account, have been used to fund or
pay any expenses, taxes, or policyholder benefits that are attributable to a
separate account policy, contract, or agreement that should have been paid by a
separate account prior to the commencement of receivership proceedings, then
upon the commencement of receivership proceedings, the separate accounts
that benefited from this payment or funding shall first be used to repay or
reimburse the company's general assets or account for any unreimbursed net sums
due at the commencement of receivership proceedings prior to the application of
the separate account assets to the satisfaction of liabilities or the
corresponding separate account policies, contracts, and agreements.
To the extent, if any, reserves or assets maintained in the separate account
are in excess of the amounts needed to satisfy claims under the separate
account contracts, the excess shall be treated as part of the general assets of
the insurer's estate.
(2) Within 120 days after the issuance of an Order of Liquidation with a
finding of insolvency against a domestic company, the Director shall make
application to the court requesting authority to disburse funds to the
Illinois Insurance Guaranty Fund, the Illinois Life and Health Insurance
Guaranty Association, the Illinois Health Maintenance Organization Guaranty
Association, and similar organizations in other states from time to time out
of the company's marshaled assets as funds
become available in amounts equal to disbursements made by the
Illinois Insurance Guaranty Fund, the Illinois Life and Health Insurance
Guaranty Association, the Illinois Health Maintenance Organization Guaranty
Association, and similar organizations in other states
for covered claims obligations on the presentation of evidence that such
disbursements have been made by the Illinois Insurance
Guaranty Fund, the Illinois Life and Health Insurance Guaranty
Association, the Illinois Health Maintenance Organization Guaranty Association,
and similar organizations in other states.
The Director shall establish procedures for the ratable allocation and
distribution of disbursements to the Illinois Insurance Guaranty Fund,
the Illinois Life and Health Insurance Guaranty Association, the Illinois
Health Maintenance Organization Guaranty Association, and
similar organizations in other states. In determining the amounts available
for disbursement, the Director shall reserve sufficient assets for the
payment of the expenses of administration described in paragraph (1)(a)
of this Section. All funds available for disbursement after the establishment
of the prescribed reserve shall be promptly distributed. As a condition
to receipt of funds in reimbursement of covered claims obligations,
the Director shall secure from the Illinois Insurance Guaranty Fund,
the Illinois Life and Health Insurance Guaranty Association, the Illinois
Health Maintenance Organization Guaranty Association, and
each similar organization in other states, an agreement to return to the
Director on demand funds previously received as may be required to pay claims
of secured creditors and claims falling within the priorities established
in paragraphs (a), (b), (c), and (d) of subsection (1) of
this Section in accordance
with such priorities.
(3) The changes made in this Section by this amendatory Act of the 100th General Assembly apply to all liquidation,
rehabilitation, or conservation proceedings that are pending on the effective date of this amendatory
Act of the 100th General Assembly and to all future liquidation, rehabilitation, or conservation proceedings. (4) The provisions of this Section are severable under Section 1.31 of
the Statute on Statutes.
(Source: P.A. 100-410, eff. 8-25-17; 101-652, eff. 1-1-23.)
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(215 ILCS 5/205.1)
Sec. 205.1. Policyholder collateral, deductible reimbursements, and other policyholder obligations. (a) Any collateral held by, for the benefit of, or assigned to the insurer or the Director as rehabilitator or liquidator to secure the obligations of a policyholder under a deductible agreement shall not be considered an asset of the estate and shall be maintained and administered by the Director as rehabilitator or liquidator as provided in this Section and notwithstanding any other provision of law or contract to the contrary. (b) If the collateral is being held by, for the benefit of, or assigned to the insurer or subsequently the Director as rehabilitator or liquidator to secure obligations under a deductible agreement with a policyholder, subject to the provisions of this Section, the collateral shall be used to secure the policyholder's obligation to fund or reimburse claims payment within the agreed deductible amount. (c) If a claim that is subject to a deductible agreement and secured by collateral is not covered by any guaranty association or the Illinois Insurance Guaranty Fund and the policyholder is unwilling or unable to take over the handling and payment of the non-covered claims, the Director as rehabilitator or liquidator shall adjust and pay the non-covered claims utilizing the collateral but only to the extent the available collateral after allocation under subsection (d), is sufficient to pay all outstanding and anticipated claims. If the collateral is exhausted and the insured is not able to provide funds to pay the remaining claims within the deductible after all reasonable means of collection against the insured have been exhausted, the Director's obligation to pay such claims from the collateral as the rehabilitator or liquidator terminates, and the remaining claims shall be claims against the insurer's estate subject to complying with other provisions in this Article for the filing and allowance of such claims. When the liquidator determines that the collateral is insufficient to pay all additional and anticipated claims, the liquidator may file a plan for equitably allocating the collateral among claimants, subject to court approval. (d) To the extent that the Director as rehabilitator or liquidator is holding collateral provided by a policyholder that was obtained to secure a deductible agreement and to secure other obligations of the policyholder to pay the insurer, directly or indirectly, amounts that become assets of the estate, such as reinsurance obligations under a captive reinsurance program or adjustable premium obligations under a retrospectively rated insurance policy where the premium due is subject to adjustment based upon actual loss experience, the Director as rehabilitator or liquidator shall equitably allocate the collateral among such obligations and administer the collateral allocated to the deductible agreement pursuant to this Section. With respect to the collateral allocated to obligations under the deductible agreement, if the collateral secured reimbursement obligations under more than one line of insurance, then the
collateral shall be equitably allocated among the various lines based upon the estimated ultimate exposure within the deductible amount for each line. The Director as rehabilitator or liquidator shall inform the guaranty association or the Illinois Insurance Guaranty Fund that is or may be obligated for claims against the insurer of the method and details of all the foregoing allocations. (e) Regardless of whether there is collateral, if the insurer has contractually agreed to allow the policyholder to fund its own claims within the deductible amount pursuant to a deductible agreement, either through the policyholder's own administration of its claims or through the policyholder providing funds directly to a third party administrator who administers the claims, the Director as rehabilitator or liquidator shall allow such funding arrangement to continue and, where applicable, will enforce such arrangements to the fullest extent possible. The funding of such claims by the policyholder within the deductible amount will act as a bar to any claim for such amount in the liquidation proceeding, including but not limited to any such claim by the policyholder or the third party claimant. The funding will extinguish both the obligation, if any, of any guaranty association or the Illinois Insurance Guaranty Fund to pay such claims within the deductible amount, as well as the obligations, if any, of the policyholder or third party administrator to reimburse the guaranty association or the Illinois Insurance Guaranty Fund. No charge of any kind shall be made by the Director as rehabilitator or liquidator against any guaranty association or the Illinois Insurance Guaranty Fund on the basis of the policyholder funding of claims payment made pursuant to the mechanism set forth in this subsection. (f) If the insurer has not contractually agreed to allow the policyholder to fund its own claims within the deductible amount, to the extent a guaranty association or the Illinois Insurance Guaranty Fund is required by applicable state law to pay any claims for which the insurer would be or would have been entitled to reimbursement from the policyholder under the terms of the deductible agreement and to the extent the claims have not been paid by a policyholder or third party, the Director as rehabilitator or liquidator shall promptly bill the policyholder for such reimbursement and the policyholder will be obligated to pay such amount to the Director as rehabilitator or liquidator for the benefit of the guaranty association or the Illinois Insurance Guaranty Fund that paid such claims. Neither the insolvency of the insurer, nor its inability to perform any of its obligations under the deductible agreement, shall be a defense to the policyholder's reimbursement obligation under the deductible agreement. When the policyholder reimbursements are collected, the Director as rehabilitator or liquidator shall promptly reimburse the guaranty association or the Illinois Insurance Guaranty Fund for claims paid that were subject to the deductible. If the policyholder fails to pay the amounts due within 60 days after such bill for such reimbursements is due, the Director as rehabilitator or liquidator shall use the collateral to the extent necessary to reimburse the guaranty association or the Illinois Insurance Guaranty Fund, and, at the same time, may pursue other collections efforts against the policyholder. If more than one guaranty association or the Illinois Insurance Guaranty Fund has a claim against the same collateral and the available collateral (after allocation under subsection (d)), along with billing and collection efforts, are together insufficient to pay each guaranty association or the Illinois Insurance Guaranty Fund in full, then the Director as rehabilitator or liquidator will pro-rate payments to each guaranty association or the Illinois Insurance Guaranty Fund based upon the relationship the amount of claims each guaranty association or the Illinois Insurance Guaranty Fund has paid bears to the total of all claims paid by such guaranty association or the Illinois Insurance Guaranty Fund. (g) Director's duties and powers as rehabilitator or liquidator. (1) The Director as rehabilitator or liquidator is | ||
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(2) With respect to claim payments made by any | ||
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(3) The Director as rehabilitator or liquidator shall | ||
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(h) The Illinois Circuit Court having jurisdiction over the liquidation proceedings shall have jurisdiction to resolve disputes arising under this provision. (i) Nothing in this Section is intended to limit or adversely affect any right the guaranty associations or the Illinois Insurance Guaranty Fund may have under applicable state law to obtain reimbursement from certain classes of policyholders for claims payments made by such guaranty associations or the Illinois Insurance Guaranty Fund under policies of the insolvent insurer, or for related expenses the guaranty associations or the Illinois Insurance Guaranty Fund incur. (j) This Section applies to all receivership proceedings under Article XIII that either (1) commence on or after the effective date of this amendatory Act of the 93rd General Assembly or (2) are on file or open on the effective date of this amendatory Act of the 93rd General Assembly and in which an Order of Liquidation is entered on or after May 1, 2004. However, this Section applies to rehabilitation proceedings only to the extent that guaranty associations are required to pay claims and does not apply to receivership proceedings in which only an order of conservation has been entered. (k) For purposes of this Section, a "deductible agreement" is any combination of one or more policies, endorsements, contracts, or security agreements, which provide for the policyholder to bear the risk of loss within a specified amount per claim or occurrence covered under a policy of insurance, and may be subject to the aggregate limit of policyholder reimbursement obligations. This
Section shall not apply to first party claims, or to claims funded by a guaranty association or the Illinois Insurance Guaranty Fund in excess of the deductible unless subsection (e) above applies. The term "non-covered claim" shall mean a claim that is subject to a deductible agreement and is not covered by a guaranty association or the Illinois Insurance Guaranty Fund.
(Source: P.A. 93-1028, eff. 8-25-04; 94-248, eff. 7-19-05.) |
(215 ILCS 5/206) (from Ch. 73, par. 818)
Sec. 206.
Set-offs
or counterclaims.
In all cases of mutual debts or mutual credits between the company and
another person, such credits and debts shall be set off or counterclaimed
and the balance only shall be allowed or paid, provided, however, that no
set-off or counterclaim shall be allowed in favor of any person where
(a) the obligation of the company to such person was purchased by or
transferred to such person with a view of its being used as a set-off or
counterclaim, or
(b) the obligation of such person is to pay an assessment levied against
the members or subscribers of any company which issued assessable policies,
or to pay a balance upon a subscription to the shares of a stock company.
No set-off shall be allowed in favor of an insurance agent or broker
against his account with the company, for the unearned portion of the
premium on any cancelled policy, unless that policy was cancelled prior to
the entry of the Order of Liquidation or Rehabilitation, and unless the
unearned portion of the premium on that cancelled policy was refunded or
credited to the assured or his representative prior to the entry of the
Order of Liquidation or Rehabilitation.
(Source: Laws 1967, p. 789.)
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(215 ILCS 5/206.1) Sec. 206.1. Qualified financial contracts. (a) Notwithstanding any other provision of this Article, including any other provision of this Article permitting the modification of contracts, or other law of a state, no person shall be stayed or prohibited from exercising: (1) a contractual right to cause the termination, | ||
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(A) the insolvency, financial condition, or | ||
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(B) the commencement of a formal delinquency | ||
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(2) any right under a pledge, security, collateral, | ||
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(3) subject to any provision of Section 206 of this | ||
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(4) if a counterparty to a master netting agreement | ||
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(b) Upon termination of a netting agreement or qualified financial contract, the net or settlement amount, if any, owed by a nondefaulting party to an insurer against which an application or petition has been filed under this Code shall be transferred to or on the order of the receiver for the insurer, even if the insurer is the defaulting party, notwithstanding any walkaway clause in the netting agreement or qualified financial contract. For the purposes of this subsection (b), the term "walkaway clause" means a provision in a netting agreement or a qualified financial contract that, after calculation of a value of a party's position or an amount due to or from one of the parties in accordance with its terms upon termination, liquidation, or acceleration of the netting agreement or qualified financial contract, either does not create a payment obligation of a party or extinguishes a payment obligation of a party in whole or in part solely because of the party's status as a nondefaulting party. Any limited 2-way payment or first method provision in a netting agreement or qualified financial contract with an insurer that has defaulted shall be deemed to be a full 2-way payment or second method provision as against the defaulting insurer. Any such property or amount shall, except to the extent that it is subject to one or more secondary liens or encumbrances or rights of netting or setoff, be a general asset of the insurer. (c) In making any transfer of a netting agreement or qualified financial contract of an insurer subject to a proceeding under this Code, the receiver shall either: (1) transfer to one party (other than an insurer | ||
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(A) all rights and obligations of each party | ||
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(B) all property, including any guarantees or | ||
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(2) transfer none of the netting agreements, | ||
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(d) If a receiver for an insurer makes a transfer of one or more netting agreements or qualified financial contracts, then the receiver shall use its best efforts to notify any person who is party to the netting agreements or qualified financial contracts of the transfer by 12:00 noon (the receiver's local time) on the business day following the transfer. For the purposes of this subsection (d), "business day" means a day other than a Saturday, Sunday, or any day on which either the New York Stock Exchange or the Federal Reserve Bank of New York is closed. (e) Notwithstanding any other provision of this Article, a receiver may not avoid a transfer of money or other property arising under or in connection with a netting agreement or qualified financial contract (or any pledge, security, collateral, or guarantee agreement or any other similar security arrangement or credit support document relating to a netting agreement or qualified financial contract) that is made before the commencement of a formal delinquency proceeding under this Article. (f) The following provisions shall apply concerning disaffirmance and repudiation: (1) In exercising the rights of disaffirmance or | ||
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(A) disaffirm or repudiate all netting agreements | ||
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(B) disaffirm or repudiate none of the netting | ||
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(2) Notwithstanding any other provision of this | ||
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(g) The term "contractual right", as used in this Section, includes any right set forth in a rule or bylaw of a derivatives clearing organization, as defined in the Commodity Exchange Act; a multilateral clearing organization, as defined in the Federal Deposit Insurance Corporation Improvement Act of 1991; a national securities exchange; a national securities association; a securities clearing agency; a contract market designated under the Commodity Exchange Act; a derivatives transaction execution facility registered under the Commodity Exchange Act; or a board of trade, as defined in the Commodity Exchange Act or in a resolution of the governing board thereof and any right, whether or not evidenced in writing, arising under statutory or common law or under law merchant or by reason of normal business practice. (h) The provisions of this Section shall not apply to persons who are affiliates of the insurer that is the subject of the proceeding. (i) All rights of counterparties under this Article shall apply to netting agreements and qualified financial contracts entered into on behalf of the general account or separate accounts if the assets of each separate account are available only to counterparties to netting agreements and qualified financial contracts entered into on behalf of that separate account.
(Source: P.A. 96-1450, eff. 8-20-10.) |
(215 ILCS 5/207.1) (from Ch. 73, par. 819.1)
Sec. 207.1.
Contingent Liability Policies.
Upon the entry of an order of liquidation any provision in the policies
of a company providing for a contingent liability of the policyholders
shall become void.
(Source: P.A. 76-715.)
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(215 ILCS 5/208) (from Ch. 73, par. 820)
Sec. 208.
Time to
file claims.
(1) When in a liquidation, rehabilitation, or conservation
proceeding
against an insurer under this Article an order has been entered for the
filing of claims, all persons who may have claims against such insurer
shall present the same to the Liquidator, Rehabilitator or Conservator, as
the case may be, at a place specified in the notice for filing of claims
within such time as may be fixed by order of the Court. The Director shall
notify all persons who may have claims against such insurer as disclosed by
its books and records, to present the same to him within the time as fixed.
The last date for the filing of proof of claim shall be specified in the
notice. Such notice shall be given in a manner determined by the Court. The
Director shall also cause a notice specifying the last day for filing of
claims to be published once a week for three consecutive weeks in a
newspaper published in the county where such proceedings are pending and in
such other newspapers as he may deem advisable.
(2) Proofs of claim on good cause shown may be filed after the
date specified, but except as provided in subsection (3), no such claim
shall share in the distribution of
assets until all allowed claims proofs of which have been filed before said
date, have been paid in full.
(3) The Director may deem proofs of claim filed after the date specified
as timely filed when the claimant shows to the Director's reasonable
satisfaction
that (i) the claimant had no actual knowledge of the date before it had passed,
(ii) a proof of claim was not sent to the claimant until after the date had
passed, and (iii) the Director knew of the claimant's existence and correct
address before the date had passed. Any such claim shall share in the
distribution of assets under Section 205.
(Source: P.A. 88-297.)
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(215 ILCS 5/209) (from Ch. 73, par. 821)
Sec. 209. Proof and allowance of claims.
(1) The following provisions shall apply concerning proof and allowance of claims: (a) Proof of claim shall consist of a statement | ||
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(i) the particulars of the claim including the | ||
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(ii) the identity and amount of the security on | ||
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(iii) the payments made on the debt, if any; (iv) that the sum claimed is justly owing and | ||
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(v) any right of priority of payment or other | ||
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(vi) the name and address of the claimant and the | ||
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(vii) the claimant's social security or federal | ||
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(b) The Director may require that a prescribed form | ||
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(c) At any time the Director may require the claimant | ||
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(2) Whenever
a claim is based upon a document, the document, unless
lost or destroyed, shall be filed with the proof of claim. If the document is
lost or destroyed, a statement of that fact and of
the
circumstances of the loss or destruction shall be included in
the proof of claim.
A claim may be allowed even if contingent or unliquidated as of the date
fixed by the court
pursuant to subsection (a) of Section 194 if it is filed in accordance with
this subsection. Except as otherwise provided in subsection (7), a proof of
claim required under this Section must identify a known loss or occurrence.
(3) Upon the liquidation, rehabilitation, or conservation of
any
company which has issued policies insuring the lives of persons, the
Director shall, within a reasonable time, after the last day set for the
filing of claims, make a list of the persons who have not filed proofs of
claim with him and whose rights have not been reinsured, to whom it appears
from the books of the company, there are owing amounts on such policies and
he shall set opposite the name of each person such amount so owing to such
person. The Director shall incur no personal liability by reason of any
mistake in such list. Each person whose name shall appear upon said list
shall be deemed to have duly filed prior to the last day set for filing of
claims a proof of claim for the amount set opposite his name on said list.
(4)(a) When a Liquidation, Rehabilitation, or
Conservation Order has been entered in a proceeding against an insurer under
this Code, any insured under an insurance policy shall have
the right to file a contingent claim. The Court at the time of the entry of
the Order of Liquidation, Rehabilitation or Conservation shall fix the final
date for the liquidation of insureds' contingent claims, but
in no event
shall said date be more than 3 years after the last day fixed for the filing of
claims, provided, such date may be extended by the Court on petition of the
Director should the Director determine that such extension will not delay
distribution of assets under Section 210. Such a contingent claim
shall be allowed if such claim is liquidated and the insured
claimant presents evidence of payment of such claim to the Director on or
before the last day fixed by the Court.
(b) When an insured has been unable to liquidate its claim under paragraph
(a) of this subsection (4), the insured may have its claim allowed by
estimation if (i) it may be reasonably inferred from the proof presented upon
the claim that a claim exists under the policy; (ii) the insured has furnished
suitable proof, unless the court for good cause shown shall otherwise direct,
that no further valid claims against the insurer arising out of the cause of
action other than those already presented can be made, and (iii) the total
liability of the insurer to all claimants arising out of the same act shall be
no greater than its total liability would be were it not in liquidation,
rehabilitation, or conservation.
(5) The obligation of the insurer, if any, to defend or continue the
defense
of any claim or suit under a liability insurance policy shall terminate on
the entry of the Order of Liquidation, Rehabilitation or Conservation,
except during the appeal of an Order of Liquidation as provided by Section
190.1 or, unless upon the petition of the Director, the court directs
otherwise. Insureds may include in contingent claims reasonable attorneys
fees for services rendered subsequent to the date of Liquidation,
Rehabilitation or Conservation in defense of claims or suits covered by the
insured's policy provided such attorneys fees have actually been paid by the
assured and evidence of payment presented in the manner required for insured's
contingent claims.
(6) When a liquidation, rehabilitation, or
conservation order has been
entered in a proceeding against
an insurer under this Code, any person who has a cause of action against an
insured of the insurer under an insurance
policy issued by the insurer shall have the right to file a
claim in the proceeding, regardless of the fact that the claim
may be contingent, and the claim may be allowed by estimation (a) if it may be
reasonably, inferred from proof presented upon the claim
that the claimant would be able to obtain a judgment upon
the cause of action against the insured; and (b) if
the person has furnished
suitable proof, unless the court for
good cause shown shall otherwise direct, that no further valid claims
against the insurer arising out of the cause of
action other than those
already presented can be made, and (c) the total liability of
the
insurer to all claimants arising out of the same act shall
be no greater than its total liability would be were it not in liquidation,
rehabilitation, or
conservation.
(7) Contingent or unliquidated general creditors' and ceding insurers'
claims that are not made absolute and liquidated by the last day fixed by the
court pursuant to subsection (4) may be determined and allowed by estimation.
Any such estimate shall be based upon an actuarial evaluation made
with reasonable actuarial certainty or upon another accepted method of valuing
claims with reasonable certainty and, with respect to ceding insurers' claims,
may include an estimate of incurred but not reported losses.
(7.5) (a) The estimation and allowance of the loss development on a known loss or occurrence shall trigger a reinsurer's obligation to pay pursuant to its reinsurance contract with the insolvent company, provided that the allowance is made in accordance with paragraph (b) of subsection (4) or subsection (6). The Director shall have the authority to exercise all available remedies on behalf of the insolvent company to marshal these reinsurance recoverables. (b) That portion of any estimated and allowed contingent claim that is attributable to claims incurred but not reported to the insolvent company's reinsured shall not be billable to the insolvent company's reinsurers, except to the extent that (A) such claims develop into known losses or occurrences and become billable under paragraph (a) of this subsection or (B) the reinsurance contract specifically provides for the payment of such losses or reserves. (c) Notwithstanding any other provision of this Code, the liquidator may negotiate a voluntary commutation and release of all obligations arising from reinsurance contracts or other agreements.
(8) No judgment against such an insured or an
insurer taken after the date of the entry of the liquidation,
rehabilitation, or conservation order shall be considered in the
proceedings
as evidence of liability, or of the amount of damages, and no judgment
against an insured or an insurer taken by default, or by collusion prior to
the entry of the liquidation order shall be considered as conclusive
evidence in the proceeding either of the liability of such insured to such
person upon such cause of action or of the amount of damages to which such
person is therein entitled.
(9) The value of securities held by secured creditors shall be
determined by converting the same into money according to the terms of the
agreement pursuant to which such securities were delivered to such
creditors, or by such creditors and the Director by agreement, or by the
court, and the amount of such value shall be credited upon the claims of
such secured creditors and their claims allowed only for the balance.
(10) Claims of creditors or policyholders who have received
preferences
voidable under Section 204 or to whom conveyances or transfers,
assignments or incumbrances have been made or given which are void under
Section 204, shall not be allowed unless such creditors or policyholders
shall surrender such preferences, conveyances, transfers, assignments or
incumbrances.
(11)(a) When the Director denies a claim or allows a claim for less than
the amount requested by the claimant, written notice of the determination and
of the right to object shall be given promptly to the claimant or the
claimant's representative by first class mail at the address shown on the
proof of claim. Within 60 days from the mailing of the notice, the claimant
may
file his written objections with the Director. If no such filing is made on a
timely basis, the claimant may not further object to the determination.
(b) Whenever objections are filed with the Director and he does not alter
his determination as a result of the objection and the claimant continues to
object, the Director shall petition the court for a hearing as soon as
practicable and give notice of the hearing by first class mail to the claimant
or his representative and to any other persons known by the Director to be
directly affected, not less than 10 days before the date of the hearing.
(12) The Director shall review all claims duly filed in the liquidation,
rehabilitation, or conservation proceeding, unless otherwise directed by the
court, and shall make such further investigation as he considers necessary.
The Director may compound, compromise, or in any other manner negotiate the
amount for which claims will be recommended to the court. Unresolved disputes
shall be determined under subsection (11).
(13)(a) The Director shall present to the court reports of claims reviewed
under subsection (12) with his recommendations as to each claim.
(b) The court may approve or disapprove any recommendations contained in the
reports of claims filed by the Director, except that the Director's agreements
with claimants shall be accepted as final by the court on claims settled for
$10,000 or less.
(14) The changes made in this Section by this amendatory Act of 1993
apply to
all
liquidation, rehabilitation, or
conservation proceedings that are pending on the effective date of this
amendatory Act of 1993 and to all future liquidation, rehabilitation, or
conservation proceedings,
except that the changes made to the provisions of
this Section by this amendatory Act of 1993 shall not apply to any company
ordered into liquidation on or before January 1, 1982.
(15) The changes made in this Section by this amendatory Act of the 93rd General Assembly do not apply to any company ordered into liquidation on or before January 1, 2004.
(Source: P.A. 96-1450, eff. 8-20-10.)
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(215 ILCS 5/210) (from Ch. 73, par. 822)
Sec. 210. Distribution of assets; priorities; unpaid dividends.
(1) Any time after the last day fixed for the filing of
proofs of claims in the liquidation of a company, the court may, upon the
application of the Director authorize him to declare out of the funds
remaining in his hands, one or more dividends upon all claims allowed in
accordance with the priorities established in Section 205.
(2) Where there has been no adjudication of insolvency, the Director
shall pay all allowed claims in full in accordance with the priorities set
forth in Section 205. The director shall not be chargeable for any
assets so distributed to any claimant who has failed to file a proper proof
of claim before such distribution has been made.
(3) When subsequent to an adjudication of insolvency, pursuant to Section
208, a surplus is found to exist after the payment in full of all allowed
claims falling within the priorities set forth in paragraphs (a), (b), (c),
(d),
(e), (f) and (g) of subsection (1) of Section 205 and which have been duly
filed prior to the last date fixed for the filing thereof, and after the
setting aside of a reserve for all additional costs and expenses of the
proceeding, the court shall set a new date for the filing of claims. After the
expiration of the new date, all allowed claims filed on or before said new date
together with all previously allowed claims falling within the priorities set
forth in paragraphs (h) and (i) of subsection (1) of Section 205 shall be paid
in accordance with the priorities set forth in Section 205.
(4) Dividends remaining unclaimed or unpaid in the hands of the
Director for 6 months after the final order of distribution may be
by him deposited in one or more savings and loan associations, State or
national banks, trust companies or savings banks to the credit of the Director,
whomsoever he may be, in trust for the person entitled thereto, but no such
person shall be entitled to any interest upon such deposit. All such deposits
shall be entitled to priority of payment in case of the insolvency or voluntary
or involuntary liquidation of the depositary on an equality with any other
priority given by the banking law. Any such funds together with interest, if
any, paid or credited thereon, remaining and unclaimed in the hands of the
Director in Trust after 2 years shall be presumed abandoned and reported and
delivered to the State Treasurer and become subject to the provisions of the Revised
Uniform Unclaimed Property Act.
(Source: P.A. 100-22, eff. 1-1-18.)
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(215 ILCS 5/211.1)
Sec. 211.1.
Termination of proceedings.
(a) When all assets justifying the
expense of collection and distribution have been marshaled and distributed
under this Code, the Director as liquidator shall petition the court to
terminate the liquidation proceedings and to close the estate. The court may
grant such other relief as may be appropriate, including a full discharge of
all
liability and responsibility of the
liquidator, a reservation of assets for administrative expenses incurred in the
closing of the estate, and the maintenance and destruction of records.
(b) Subject to the approval of the court, after the completion of all
postclosure activities for which moneys
were reserved, the Director is authorized to destroy company records and
documents notwithstanding any other applicable statutes and any remaining
reserved
assets that are provided for in subsection (a) and that may not be practicably
or
economically distributed to claimants shall be deposited into a segregated
account
to be known as the Closed Estate Fund Trust Account.
The Director may use moneys held in the account for paying the administrative
expenses of companies
subject
to this Article that lack sufficient assets to allow the Director to perform
his duties and obligations under this Article. An annual audit of
the Closed Estate Fund Trust Account shall be performed in accordance with
Section 200 of this Code regardless of its balance.
(c) The Director may petition the court to reopen the proceedings for
good cause shown, including the marshaling of additional assets, and the court
may enter such other orders as may be deemed appropriate.
(Source: P.A. 88-297; 89-206, eff. 7-21-95.)
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(215 ILCS 5/212.1)
Sec. 212.1.
Subpoena and document production.
The court shall have
jurisdiction, upon, or at any time after the filing of the complaint, upon the
petition of the
Director to subpoena witnesses and
compel their attendance, administer oaths, examine any person under oath and
compel any person to subscribe to his or her testimony after it has been
correctly reduced to writing, and to require the production of any books,
papers, records, or other documents.
(Source: P.A. 88-297.)
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(215 ILCS 5/213.5)
Sec. 213.5.
Severability.
The provisions of this Article are severable
under Section 1.31 of the Statute on Statutes.
(Source: P.A. 89-206, eff. 7-21-95.)
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(215 ILCS 5/221) (from Ch. 73, par. 833)
Sec. 221.
Continuation of existing proceedings.
Every proceeding heretofore commenced under "An Act in relation to
delinquent insurance companies, associations and societies," approved June
26, 1925, as from time to time amended, which is repealed by this Code
shall be continued as if said Act had not been repealed, but assessments
against members or subscribers of any company which has issued assessable
policies or contracts of insurance may be made in accordance with Section
193.
(Source: P.A. 83-333.)
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(215 ILCS 5/Art. XIII.5 heading) ARTICLE XIII 1/2.
UNIFORM PROVISIONS FOR LIQUIDATION
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(215 ILCS 5/221.1) (from Ch. 73, par. 833.1)
Sec. 221.1.
Definitions.
For the purposes of Sections 221.1 to 221.10, both inclusive, the
following terms have the following meanings;
(1) "Reciprocal State" means a state wherein:
(a) it is provided by law that the insurance supervisory or other
administrative agency of the state shall conduct or wind up the affairs of
delinquent companies under judicial supervision and shall be vested with
title to all of the assets of any domestic company against which a
delinquency proceeding has been commenced, and
(b) in substance and effect the provisions of Sections 221.1 to 221.10,
both inclusive are in force.
(2) "Insurer" means any person, firm, corporation, association, or
aggregation of persons doing or proposing to do an insurance business and
subject to the insurance supervisory authority of, or to liquidation,
rehabilitation, reorganization or conservation by, the commissioner of
insurance or equivalent insurance supervisory official of the state.
(3) "Delinquency proceeding" means any proceeding commenced against an
insurer for the purpose of liquidating, rehabilitating, reorganizing or
conserving such insurer.
(4) "Domiciliary state" means the state in which an insurer is
incorporated or organized or, in the case of an insurer incorporated or
organized in a foreign country, the state in which such insurer, having
become authorized to do business in such state has, at the commencement of
delinquency proceedings the largest amount of its trusteed assets and
deposits for the benefit of its policy holder or policy holders and
creditors in the United States; and "domiciliary insurer" means an insurer
in its domiciliary state.
(5) "Ancillary state" means any state other than a domiciliary state.
(6) "General Assets" means all property, real or personal, not
specifically mortgaged, pledged, deposited as security or otherwise
encumbered, and as to such specifically encumbered property the term
includes all in excess of the amount necessary to discharge the sum or sums
secured.
(7) "Preferred claim" means any claim with respect to which the law of a
state or of the United States accords priority of payment from the general
assets of the insurer.
(8) "Special deposit claim" means any claims secured generally by a
deposit of a fund or property or bond which deposit has been made to secure
the payment of all claims of a particular description or all claims of
persons resident in a particular state. The term does not include claims
which are secured by deposit for the benefit or protection of all claimants
against the insurer in the United States.
(9) "Secured claim" means any claim secured individually by mortgage,
trust, deed, pledge, deposit as security, escrow or otherwise. The term
also includes claims which prior to the commencement of delinquency
proceedings in the state of the insurer's domicile have become liens upon
specific assets by reason of judicial process.
(10) "State" means any state or territory of the United States, and the
District of Columbia.
(11) "Foreign country" means territory outside of any state, as defined.
(12) "Receiver" means receiver, liquidator, rehabilitator or conservator
as the context may require.
In addition to and notwithstanding any other provisions of law, this
Article shall apply to the administration by the Director of the affairs of
delinquent domestic companies with respect to matters affecting or related
to reciprocal states, and shall also apply to matters affecting or related
to this State in the administration by the Director of the affairs of
delinquent companies domiciled in reciprocal states and authorized to
transact business in this State.
(Source: Laws 1941, vol. 1, p. 832.)
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(215 ILCS 5/221.2) (from Ch. 73, par. 833.2)
Sec. 221.2.
Ancillary delinquency proceedings.
After the commencement of delinquency proceedings in a reciprocal state
against an insurer domiciliary in such state, a court of competent
jurisdiction in this State shall on the petition of the Director of
Insurance
of this State appoint such Director of Insurance as ancillary receiver in
this State of such insurer. The Director of Insurance shall file such
petition (a) if he finds that there are sufficient assets of such insurer
located in this State to justify the appointment of an ancillary receiver
or (b) if 10 or more persons resident in a state having claims
against
such insurer file a petition or petitions in writing with the Director
requesting the appointment of such ancillary receiver. As ancillary
receiver the Director shall have the right to sue for and reduce to
possession the assets of such insurer in this State, and, subject to the
rights of the domiciliary receiver, he shall have the same powers and be
subject to the same duties with respect to such assets, as are possessed by
a receiver of a domiciliary insurer under the laws of this State. The
domiciliary receiver of an insurer domiciled in a reciprocal state shall,
except as to special deposits and security on secured claims pursuant to
Section 221.7, be vested by operation of law with the title to all of the
assets, property, contracts, agents' balances, and all of the books, accounts
and other records of the insurer located in this State; and shall have the
immediate right to recover balances due from resident agents and to obtain
possession of any books and records of the insurer found in this State.
(Source: P.A. 89-206, eff. 7-21-95.)
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(215 ILCS 5/221.3) (from Ch. 73, par. 833.3)
Sec. 221.3.
Filing and proving of claims of non-residents against delinquent domiciliary
insurers.
In any delinquency proceeding begun in this state against a domiciliary
insurer of this state, claimants residing in a reciprocal ancillary state
may file claims either with the ancillary receiver, if any, or with the
domiciliary receiver. All such claims must be filed on or before the last
date fixed for the filing of claims in the domiciliary delinquency
proceedings.
In any such proceeding controverted claims belonging to claimants
residing in ancillary states may either (a) be proved in this state as
provided by law, or (b) if ancillary proceedings have been commenced in
such ancillary state, may be proved in such ancillary proceedings. In the
event a claimant elects to prove his claim in ancillary proceedings, and,
if notice of the claim and opportunity to appear and be heard is afforded
the domiciliary receiver of this state, such claim, when allowed by the
court in the ancillary state, shall be accepted in this state as final and
conclusive as to its amount, and shall also be accepted as final and
conclusive as to its priority, if any, as against special deposits or other
security located within the ancillary state.
(Source: Laws 1941, vol. 1, p. 832.)
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(215 ILCS 5/221.4) (from Ch. 73, par. 833.4)
Sec. 221.4.
Proof of
claims of residents in connection with delinquency proceedings in other
states.
If a delinquency proceeding is commenced in a reciprocal state against
an insurer domiciliary in such state, claimants against such insurer who
reside within this State may file claims either with the ancillary
receiver, if any, appointed in this State or with the domiciliary receiver.
All such claims must be filed on or before the last date fixed for the
filing of claims in the domiciliary delinquency proceeding.
In any such proceeding controverted claims belonging to claimants
residing in this State may either (a) be proved in the domiciliary state as
provided by the law of such state, or (b) if ancillary proceedings have
been commenced in this State, be proved in such ancillary proceedings. In
the event that any such claimant elects to prove his claim in this State,
he shall file his claim with the ancillary receiver in the manner provided
by the law of this State for the proving of claims against domiciliary
insurers, and he shall give, or cause to be given, at least 40 days prior to
the date of hearing, notice to the receiver
in the domiciliary state, either by mail or otherwise in writing that such
claim is being made to such ancillary receiver and the nature and the
amount thereof. The domiciliary receiver shall be entitled to appear or to
be represented in any proceeding in this State involving the adjudication
of the claim. The allowance of the claim by the courts of this State shall
be final and conclusive both as to its amount and also as to its priority,
if any, against special deposits or other security located within this
State.
(Source: P.A. 89-206, eff. 7-21-95.)
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(215 ILCS 5/221.5) (from Ch. 73, par. 833.5)
Sec. 221.5.
Priority of preferred claims.
In any delinquency proceeding against a domiciliary insurer of this
state, claims owing to residents of ancillary reciprocal states shall be
deemed preferred claims if, and only if, like claims are preferred under
the laws of this state. All such claims whether owing to residents or
non-residents shall be given equal priority of payment from general assets.
No law of an ancillary state providing for preferred claims against the
general assets of insurers shall be recognized as against the assets of
delinquent domiciliary insurers of this state regardless of where such
assets may be located.
In any delinquency proceeding against an insurer domiciliary in a
reciprocal state, claims owing to residents of this state shall be
preferred if, and only if, like claims are preferred by the laws of such
other state.
(Source: Laws 1941, vol. 1, p. 832.)
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(215 ILCS 5/221.6) (from Ch. 73, par. 833.6)
Sec. 221.6.
Priority of special deposit claims.
The owners of special deposit claims against an insurer for which a
receiver has been appointed in a delinquency proceeding in this or any
reciprocal state shall be given priority against their several special
deposits in accordance with the provisions of the statutes requiring the
creation and maintenance of such special deposits. If there be a deficiency
in any such special deposit so that the claims secured thereby are not
fully discharged therefrom, the claimants may share in the general assets,
but such sharing shall be deferred until general creditors, and also
claimants against other special deposits who have received a small
percentage from their respective special deposits, have been paid
percentages of their claims equal to the percentage paid from such special
deposit, it being the purpose and intent of this provision to equalize to
this extent the advantage gained by the security provided by such special
deposits.
(Source: Laws 1941, vol. 1, p. 832.)
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(215 ILCS 5/221.7) (from Ch. 73, par. 833.7)
Sec. 221.7.
Priority
of secured claims.
The owner of a secured claim against an insurer for which a receiver has
been appointed in a delinquency proceeding in this or any reciprocal state
may surrender his security and file his claim as a general creditor, or
such secured claim may be discharged by resort to the security, in which
case the deficiency, if any, shall be treated as a claim against the
general assets of the insurer on the same basis as claims of unsecured
creditors. If the amount of the deficiency has been adjudicated in ancillary
proceedings as provided in this Article, that amount shall be conclusive;
otherwise the amount of such deficiency shall be ascertained and determined in
the delinquency proceeding in the domiciliary state of such insurer.
(Source: P.A. 89-206, eff. 7-21-95.)
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(215 ILCS 5/221.8) (from Ch. 73, par. 833.8)
Sec. 221.8.
Right of
domiciliary receiver to residium of assets of insurers domiciled in
ancillary states.
The ancillary receiver of assets in this State of insurers domiciliary
in reciprocal states and subject to delinquency proceedings therein shall,
as soon as practicable, arrange the liquidation or other disposition of
special deposit claims and secured claims proved in the ancillary
proceedings in this State, and all remaining assets, after payment of
expenses he shall promptly transfer to the domiciliary receiver.
The domiciliary receiver of a reciprocal state may sue the ancillary
receiver of this State in the courts of this State for the purpose of
collecting or obtaining any assets of the insurer to which he or she may be
entitled under the laws of this State,
and, if no
ancillary receiver be appointed in this State, such domiciliary receiver
may collect or reduce to possession, in this State, and may sue in the
courts of this State to obtain, any assets of such delinquent insurer
located in this State, to which he or she may be entitled under the laws of
this State.
(Source: P.A. 89-206, eff. 7-21-95.)
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(215 ILCS 5/221.9) (from Ch. 73, par. 833.9)
Sec. 221.9.
Attachment and garnishment of assets.
In the event of the commencement of delinquency proceedings in any
reciprocal state no action or proceeding in the nature of an attachment,
garnishment, execution or otherwise, shall be commenced in the courts of
this state against such delinquent insurer or its assets.
(Source: Laws 1941, vol. 1, p. 832.)
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(215 ILCS 5/221.10) (from Ch. 73, par. 833.10)
Sec. 221.10.
Declaration of purpose.
The purpose of Sections 221.1 to 221.10, both inclusive is to promote
uniformity in the liquidation, rehabilitation, reorganization or
conservation of insurers doing business in more than one state. It is
intended that Sections 221.1 to 221.10, both inclusive shall be liberally
construed to the end that so far as possible the assets of such insurers
shall be equally and uniformly conserved in all states, and that claimants
against such insurers shall receive equal and uniform treatment
irrespective of residence or the place of the acts or contracts upon which
their claims are based. The provisions of Sections 221.1 to 221.10, both
inclusive shall be effective only with respect to this state and other
states in which (a) it is provided by law that only the Insurance
Commissioner or equivalent supervisory official of the State shall be
vested with title to the assets of, and shall wind up the affairs of,
delinquent insurers under judicial supervision; and (b) in substance and
effect the provisions of Sections 221.1 to 221.10, both inclusive, are in
force. The provisions of Sections 221.1 to 221.10, both inclusive, insofar
as applicable to any insurer incorporated or organized in a foreign
country, shall apply only to the assets, liabilities and business of such
insurer within the several states.
(Source: Laws 1941, vol. 1, p. 832.)
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(215 ILCS 5/221.11) (from Ch. 73, par. 833.11)
Sec. 221.11.
Proceedings governed by Civil Practice Law and
Supreme Court Rules.)
The rules of practice, the course and method of procedure in circuit
courts as established by the Civil Practice Law and Supreme
Court Rules and any
amendments thereto are adopted for the purposes of this Article except
where other procedures or rules are in this Article expressly provided.
Appeals may be taken as in other civil cases.
(Source: P.A. 82-783.)
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(215 ILCS 5/221.12) (from Ch. 73, par. 833.12)
Sec. 221.12.
Sections 211, 212, 213, 214, 215, 216, 217, 218, 219 and 220, each inclusive, are repealed; provided, however, that every proceeding
heretofore commenced under such sections shall be continued as though such
sections had not been repealed.
(Source: Laws 1941, vol. 1, p. 832.)
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(215 ILCS 5/221.13) (from Ch. 73, par. 833.13)
Sec. 221.13.
Uniformity of interpretation.
Sections 221.1 to 221.12 each inclusive, of this Article shall be so
interpreted and construed as to effectuate their general purpose to make
uniform the law of those states that enact the Uniform Reciprocal
Liquidation Act.
(Source: Laws 1941, vol. 1, p. 832.)
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(215 ILCS 5/Art. XIV heading) ARTICLE XIV.
LEGAL RESERVE LIFE INSURANCE
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(215 ILCS 5/222) (from Ch. 73, par. 834)
Sec. 222.
Scope of
article.
This article shall apply to all stock and mutual legal reserve life
companies, and to the extent provided in section 281 to assessment legal
reserve life companies, authorized to transact in this State the kind or
kinds of business described in Class 1 of section 4.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/223) (from Ch. 73, par. 835)
Sec. 223. Director to value policies - Legal standard of valuation.
(1) For policies and contracts issued prior to the operative date of the Valuation Manual, the Director shall annually value, or cause to be valued, the
reserve liabilities (hereinafter called reserves) for all outstanding
life insurance policies and annuity and pure endowment contracts of
every life insurance company doing business in this State, except that
in the case of an alien company, such valuation shall be limited to its
United States business. In calculating such reserves, he may use group methods
and approximate averages for fractions of a year or otherwise. In lieu
of the valuation of the reserves herein required of any foreign or alien
company, he may accept any valuation made, or caused to be made, by the
insurance supervisory official of any state or other jurisdiction when
such valuation complies with the minimum standard provided in this Section. The provisions set forth in this subsection (1) and in subsections (2), (3), (4), (5), (6), and (7) of this Section shall apply to all policies and contracts, as appropriate, subject to this Section issued prior to the operative date of the Valuation Manual. The provisions set forth in subsections (8) and (9) of this Section shall not apply to any such policies and contracts. For policies and contracts issued on or after the operative date of the Valuation Manual, the Director shall annually value, or cause to be valued, the reserve liabilities (reserves) for all outstanding life insurance contracts, annuity and pure endowment contracts, accident and health contracts, and deposit-type contracts of every company issued on or after the operative date of the Valuation Manual. In lieu of the valuation of the reserves required of a foreign or alien company, the Director may accept a valuation made, or caused to be made, by the insurance supervisory official of any state or other jurisdiction when the valuation complies with the minimum standard provided in this Section. The provisions set forth in subsections (8) and (9) of this Section shall apply to all policies and contracts issued on or after the operative date of the Valuation Manual.
Any such company which adopts at any time a standard of
valuation producing greater aggregate reserves than those calculated
according to the minimum standard provided under this Section may adopt a lower standard of valuation, with the approval
of the Director, but not lower
than the minimum herein provided, however, that, for the purposes of this
subsection, the holding of additional reserves previously determined by the appointed actuary to be necessary to render the opinion required by
subsection (1a) shall not be deemed to be the adoption of a higher standard
of valuation. In the valuation of policies the
Director shall give no consideration to, nor make any deduction because
of, the existence or the possession by the company of
(a) policy liens created by any agreement given or | ||||||||||||||||||
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(b) policy liens created by any agreement entered | ||||||||||||||||||
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(1a) This subsection shall become operative at the end of the first
full calendar year following the effective date of this amendatory Act of 1991.
(A) General.
(1) Prior to the operative date of the Valuation | ||||||||||||||||||
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(2) The opinion shall be submitted with the | ||||||||||||||||||
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(3) The opinion shall apply to all business in | ||||||||||||||||||
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(4) The opinion shall be based on standards | ||||||||||||||||||
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(5) In the case of an opinion required to be | ||||||||||||||||||
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(6) For the purpose of this Section, "qualified | ||||||||||||||||||
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(7) Except in cases of fraud or willful | ||||||||||||||||||
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(8) Disciplinary action by the Director against | ||||||||||||||||||
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(9) A memorandum, in form and substance | ||||||||||||||||||
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(10) If the insurance company fails to provide a | ||||||||||||||||||
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(11) Any memorandum in support of the opinion, | ||||||||||||||||||
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(B) Actuarial analysis of reserves and assets | ||||||||||||||||||
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(1) Every life insurance company, except as | ||||||||||||||||||
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(2) The Director may provide by regulation for a | ||||||||||||||||||
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(1b) Actuarial Opinion of Reserves after the Operative Date of the Valuation Manual. (A) General. (1) Every company with outstanding life insurance | ||||||||||||||||||
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(2) The opinion shall be submitted with the | ||||||||||||||||||
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(3) The opinion shall apply to all policies and | ||||||||||||||||||
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(4) The opinion shall be based on standards | ||||||||||||||||||
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(5) In the case of an opinion required to be | ||||||||||||||||||
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(6) Except in cases of fraud or willful | ||||||||||||||||||
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(7) Disciplinary action by the Director against | ||||||||||||||||||
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(8) A memorandum, in a form and substance as | ||||||||||||||||||
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(9) If the insurance company fails to provide a | ||||||||||||||||||
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(B) Every company with outstanding life insurance | ||||||||||||||||||
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(2) This subsection shall apply to only those policies and contracts
issued prior to the operative date of Section 229.2 (the Standard
Non-forfeiture Law).
(a) Except as otherwise in this Article provided, the | ||||||||||||||||||
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(b) Policies issued prior to January 1, 1908, may | ||||||||||||||||||
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(i) first insurance year 50% thereof;
(ii) second insurance year 65% thereof;
(iii) third insurance year 75% thereof;
(iv) fourth insurance year 85% thereof;
(v) fifth insurance year 95% thereof.
(c) If the premium charged for the first policy year | ||||||||||||||||||
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(d) The legal minimum standard for the valuations of | ||||||||||||||||||
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(e) The Director may vary the standards of interest | ||||||||||||||||||
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(f) The legal minimum standard for valuation of | ||||||||||||||||||
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(g) The legal minimum standard for the valuation of | ||||||||||||||||||
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(h) Reserves for all such policies and contracts may | ||||||||||||||||||
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(3) This subsection shall apply to only those policies and contracts
issued on or after January 1, 1948 or such earlier operative date of
Section 229.2 (the Standard Non-forfeiture Law) as shall have been
elected by the insurance company issuing such policies or contracts.
(a) Except as otherwise provided in subsections (4), | ||||||||||||||||||
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(i) The Commissioners 1941 Standard Ordinary | ||||||||||||||||||
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(ii) For all Industrial Life Insurance policies | ||||||||||||||||||
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(iii) For Individual Annuity and Pure Endowment | ||||||||||||||||||
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(iv) For Group Annuity and Pure Endowment | ||||||||||||||||||
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(v) For Total and Permanent Disability Benefits | ||||||||||||||||||
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(vi) For Accidental Death benefits in or | ||||||||||||||||||
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(vii) For Group Life Insurance, life insurance | ||||||||||||||||||
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(b) Except as otherwise provided in paragraph (f) of | ||||||||||||||||||
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(A) A net level annual premium equal to the | ||||||||||||||||||
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(B) A net one year term premium for such benefits | ||||||||||||||||||
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For any life insurance policy issued on or after | ||||||||||||||||||
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Reserves according to the Commissioners reserve | ||||||||||||||||||
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(c) In no event shall a company's aggregate reserves | ||||||||||||||||||
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(d) In no event shall the aggregate reserves for all | ||||||||||||||||||
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(e) Reserves for any category of policies, contracts | ||||||||||||||||||
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(f) If in any contract year the gross premium charged | ||||||||||||||||||
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For any life insurance policy issued on or after | ||||||||||||||||||
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(g) In the case of any plan of life insurance which | ||||||||||||||||||
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(i) be appropriate in relation to the benefits | ||||||||||||||||||
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(ii) be computed by a method which is consistent | ||||||||||||||||||
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(4) Except as provided in subsection (6), the minimum standard of valuation for individual annuity and pure endowment contracts issued
on or after the operative date of this subsection, as defined herein, and
for all annuities and pure endowments purchased on or after such operative
date under group annuity and pure endowment contracts shall be the
Commissioners Reserve valuation methods defined in paragraph (b) of
subsection (3) and subsection (5) and the following tables and interest rates:
(a) For individual single premium immediate annuity | ||||||||||||||||||
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(b) For individual and pure endowment contracts other | ||||||||||||||||||
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(c) For all annuities and pure endowments purchased | ||||||||||||||||||
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After September 8, 1977, any company may file with the Director a written
notice of its election to comply with the provisions of this subsection
after a specified date before January 1, 1979, which shall be the operative
date of this subsection for such company; provided, a company may elect a
different operative date for individual annuity and pure endowment
contracts from that elected for group annuity and pure endowment contracts.
If a company makes no election, the operative date of this subsection for
such company shall be January 1, 1979.
(5) This subsection shall apply to all annuity and pure endowment contracts
other than group annuity and pure endowment contracts purchased under a
retirement plan or plan of deferred compensation, established or maintained
by an employer (including a partnership or sole proprietorship) or by an
employee organization, or by both, other than a plan providing individual
retirement accounts or individual retirement annuities under Section 408
of the Internal Revenue Code, as now or hereafter amended.
Reserves according to the Commissioners annuity reserve method for
benefits under annuity or pure endowment contracts, excluding any
disability and accidental death benefits in such contracts, shall be the
greatest of the respective excesses of the present values, at the date of
valuation, of the future guaranteed benefits, including guaranteed
nonforfeiture benefits, provided for by such contracts at the end of each
respective contract year, over the present value, at the date of valuation,
of any future valuation considerations derived from future gross
considerations, required by the terms of such contract, that become payable
prior to the end of such respective contract year. The future guaranteed
benefits shall be determined by using the mortality table, if any, and the
interest rate, or rates, specified in such contracts for determining
guaranteed benefits. The valuation considerations are the portions of the
respective gross considerations applied under the terms of such contracts
to determine nonforfeiture values.
(6)(a) Applicability of this subsection. The interest rates used
in determining the minimum standard for the valuation of
(A) all life insurance policies issued in a | ||||||||||||||||||
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(B) all individual annuity and pure endowment | ||||||||||||||||||
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(C) all annuities and pure endowments purchased in a | ||||||||||||||||||
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(D) the net increase in a particular calendar year | ||||||||||||||||||
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shall be the calendar year statutory valuation interest rates, as defined
in this subsection.
(b) Calendar Year Statutory Valuation Interest Rates.
(i) The calendar year statutory valuation | ||||||||||||||||||
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(A) For life insurance,
I = .03 + W (R1 - .03) + W/2 (R2 - .09).
(B) For single premium immediate annuities | ||||||||||||||||||
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I = .03 + W (R - .03) or with prior | ||||||||||||||||||
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For the purposes of this subparagraph (i), "I" | ||||||||||||||||||
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(C) For other annuities with cash settlement | ||||||||||||||||||
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(D) For other annuities with no cash | ||||||||||||||||||
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(E) For other annuities with cash settlement | ||||||||||||||||||
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(ii) If the calendar year statutory valuation | ||||||||||||||||||
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(c) Weighting Factors.
(i) The weighting factors referred to in the | ||||||||||||||||||
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(A) Weighting Factors for Life Insurance.
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For life insurance, the guarantee duration is | ||||||||||||||||||
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(B) The weighting factor for single premium | ||||||||||||||||||
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(C) The weighting factors for other annuities | ||||||||||||||||||
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(1) For annuities and guaranteed interest | ||||||||||||||||||
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(2) For annuities and guaranteed interest | ||||||||||||||||||
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(3) For annuities and guaranteed interest | ||||||||||||||||||
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(4) For other annuities with cash | ||||||||||||||||||
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(5) The plan types used in the above | ||||||||||||||||||
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Plan Type A is a plan under which the | ||||||||||||||||||
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Plan Type B is a plan under which the | ||||||||||||||||||
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Plan Type C is a plan under which the | ||||||||||||||||||
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(6) A company may elect to value | ||||||||||||||||||
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(d) Reference Interest Rate. The reference interest | ||||||||||||||||||
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(A) For all life insurance, the reference | ||||||||||||||||||
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(B) For single premium immediate annuities and | ||||||||||||||||||
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(C) For annuities with cash settlement options | ||||||||||||||||||
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(D) For other annuities with cash settlement | ||||||||||||||||||
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(E) For annuities with no cash settlement options | ||||||||||||||||||
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(F) For annuities with cash settlement options | ||||||||||||||||||
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(G) For annuities valued by a formula based on | ||||||||||||||||||
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(e) Alternative Method for Determining Reference | ||||||||||||||||||
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(7) Minimum Standards for Accident and Health (Disability, Accident and Sickness) Insurance Contracts. The Director shall promulgate a regulation containing the minimum
standards applicable to the valuation of health (disability, sickness and
accident) plans which are issued prior to the operative date of the Valuation Manual. For accident and health (disability, accident and sickness) insurance contracts issued on or after the operative date of the Valuation Manual, the standard prescribed in the Valuation Manual is the minimum standard of valuation required under subsection (1). (8) Valuation Manual for Policies Issued On or After the Operative Date of the Valuation Manual. (a) For policies issued on or after the operative | ||||||||||||||||||
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(b) The operative date of the Valuation Manual is | ||||||||||||||||||
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(i) The Valuation Manual has been adopted by the | ||||||||||||||||||
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(ii) The Standard Valuation Law, as amended by | ||||||||||||||||||
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(iii) The Standard Valuation Law, as amended by | ||||||||||||||||||
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(c) Unless a change in the Valuation Manual specifies | ||||||||||||||||||
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(i) at least three-fourths of the members of the | ||||||||||||||||||
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(ii) members of the NAIC representing | ||||||||||||||||||
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(d) The Valuation Manual must specify all of the | ||||||||||||||||||
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(i) Minimum valuation standards for and | ||||||||||||||||||
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(A) the Commissioners reserve valuation | ||||||||||||||||||
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(B) the Commissioners annuity reserve | ||||||||||||||||||
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(C) minimum reserves for all other policies | ||||||||||||||||||
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(ii) Which policies or contracts or types of | ||||||||||||||||||
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(iii) For policies and contracts subject to a | ||||||||||||||||||
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(A) Requirements for the format of reports to | ||||||||||||||||||
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(B) Assumptions shall be prescribed for risks | ||||||||||||||||||
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(C) Procedures for corporate governance and | ||||||||||||||||||
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(iv) For policies not subject to a | ||||||||||||||||||
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(A) be consistent with the minimum standard | ||||||||||||||||||
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(B) develop reserves that quantify the | ||||||||||||||||||
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(v) Other requirements, including, but not | ||||||||||||||||||
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(vi) The data and form of the data required under | ||||||||||||||||||
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(e) In the absence of a specific valuation | ||||||||||||||||||
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(f) The Director may engage a qualified actuary, at | ||||||||||||||||||
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(g) The Director may require a company to change any | ||||||||||||||||||
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(9) Requirements of a Principle-Based Valuation. (a) A company must establish reserves using a | ||||||||||||||||||
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(i) Quantify the benefits and guarantees, and the | ||||||||||||||||||
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(ii) Incorporate assumptions, risk analysis | ||||||||||||||||||
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(iii) Incorporate assumptions that are derived in | ||||||||||||||||||
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(A) The assumption is prescribed in the | ||||||||||||||||||
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(B) For assumptions that are not prescribed, | ||||||||||||||||||
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(1) be established utilizing the | ||||||||||||||||||
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(2) to the extent that company data is | ||||||||||||||||||
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(iv) Provide margins for uncertainty, including | ||||||||||||||||||
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(b) A company using a principle-based valuation for | ||||||||||||||||||
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(i) Establish procedures for corporate governance | ||||||||||||||||||
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(ii) Provide to the Director and the board of | ||||||||||||||||||
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(iii) Develop and file with the Director upon | ||||||||||||||||||
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(c) A principle-based valuation may include a | ||||||||||||||||||
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(10) Experience Reporting for Policies In Force On or After the Operative Date of the Valuation Manual. A company shall submit mortality, morbidity, policyholder behavior, or expense experience and other data as prescribed in the Valuation Manual. (11) Confidentiality. (a) For the purposes of this subsection (11), | ||||||||||||||||||
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(i) A memorandum in support of an opinion | ||||||||||||||||||
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(ii) All documents, materials, and other | ||||||||||||||||||
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(iii) Any reports, documents, materials, and | ||||||||||||||||||
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(iv) Any principle-based valuation report | ||||||||||||||||||
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(v) Any documents, materials, data, and other | ||||||||||||||||||
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(b) Privilege for and Confidentiality of Confidential | ||||||||||||||||||
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(i) Except as provided in this subsection (11), a | ||||||||||||||||||
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(ii) Neither the Director nor any person who | ||||||||||||||||||
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(iii) In order to assist in the performance of | ||||||||||||||||||
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(iv) The Director may receive documents, | ||||||||||||||||||
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(v) The Director may enter into agreements | ||||||||||||||||||
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(vi) No waiver of any applicable privilege or | ||||||||||||||||||
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(vii) A privilege established under the law of | ||||||||||||||||||
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(viii) In this subsection (11), "regulatory | ||||||||||||||||||
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(c) Notwithstanding paragraph (b) of this subsection | ||||||||||||||||||
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(i) may be subject to subpoena for the purpose of | ||||||||||||||||||
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(ii) may otherwise be released by the Director | ||||||||||||||||||
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(iii) once any portion of a memorandum in support | ||||||||||||||||||
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(12) Exemptions. (a) The Director may exempt specific product forms or | ||||||||||||||||||
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(i) the Director has issued an exemption in | ||||||||||||||||||
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(ii) the company computes reserves using | ||||||||||||||||||
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(b) For any company granted an exemption under this | ||||||||||||||||||
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(13) Definitions.
For the purposes of this Section, the following definitions shall apply beginning on the operative date of the Valuation Manual: "Accident and health insurance" means contracts that incorporate morbidity risk and provide protection against economic loss resulting from accident, sickness, or medical conditions and as may be specified in the Valuation Manual. "Appointed actuary" means a qualified actuary who is appointed in accordance with the Valuation Manual to prepare the actuarial opinion required in paragraph (b) of subsection (1) of this Section. "Company" means an entity that (a) has written, issued, or reinsured life insurance contracts, accident and health insurance contracts, or deposit-type contracts in this State and has at least one such policy in force or on claim or (b) has written, issued, or reinsured life insurance contracts, accident and health insurance contracts, or deposit-type contracts in any state and is required to hold a certificate of authority to write life insurance, accident and health insurance, or deposit-type contracts in this State. "Deposit-type contract" means contracts that do not incorporate mortality or morbidity risks and as may be specified in the Valuation Manual. "Life insurance" means contracts that incorporate mortality risk, including annuity and pure endowment contracts, and as may be specified in the Valuation Manual. "NAIC" means the National Association of Insurance Commissioners. "Policyholder behavior" means any action a policyholder, contract holder, or any other person with the right to elect options, such as a certificate holder, may take under a policy or contract subject to this Section including, but not limited to, lapse, withdrawal, transfer, deposit, premium payment, loan, annuitization, or benefit elections prescribed by the policy or contract, but excluding events of mortality or morbidity that result in benefits prescribed in their essential aspects by the terms of the policy or contract. "Principle-based valuation" means a reserve valuation that uses one or more methods or one or more assumptions determined by the insurer and is required to comply with subsection (9) of this Section as specified in the Valuation Manual. "Qualified actuary" means an individual who is qualified to sign the applicable statement of actuarial opinion in accordance with the American Academy of Actuaries qualification standards for actuaries signing such statements and who meets the requirements specified in the Valuation Manual. "Tail risk" means a risk that occurs either where the frequency of low probability events is higher than expected under a normal probability distribution or where there are observed events of very significant size or magnitude. "Valuation Manual" means the manual of valuation instructions adopted by the NAIC as specified in this Section or as subsequently amended. (Source: P.A. 99-162, eff. 1-1-16.)
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(215 ILCS 5/224) (from Ch. 73, par. 836)
Sec. 224. Standard provisions for life policies.
(1) After the
first day of July, 1937, no policy of life insurance other than
industrial, group or annuities and pure endowments with or without
return of premiums or of premiums and interest, may be issued or
delivered in this State, unless such policy contains in substance the
following provisions:
(a) A provision that all premiums after the first | ||
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(b) A provision that the insured is entitled to a | ||
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(c) A provision that the policy, together with the | ||
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(d) A provision that if it is found at any time | ||
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(e) A provision that the policy shall participate | ||
| ||
(f) A provision that after the policy has been in | ||
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(g) A provision for nonforfeiture benefits and cash | ||
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(h) A table showing in figures the loan values and | ||
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(i) A provision that in event of default in premium | ||
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(j) A provision that when a policy is a claim by the | ||
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(k) If the policy provides for payment of its | ||
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(l) Interest shall accrue on the proceeds payable | ||
| ||
(1) the date that due proof of death is received | ||
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(2) the date that the company receives sufficient | ||
| ||
(3) the date that legal impediments to payment of | ||
| ||
This provision need not appear in the policy, however, | ||
| ||
(m) Title on the face and on the back of the policy | ||
| ||
(n) A provision, or a notice attached to the policy, | ||
| ||
(2) In the case of the replacement of life insurance, as defined in the
rule promulgated by the Director, the replacing insurer shall either (1)
delay the issuance of its policy for not less than 20 days from the date
it has transmitted a policy summary to the existing insurer, or (2) provide
in a form titled "Notice Regarding Replacement of Life Insurance", as well
as in its policy, or in a separate notice delivered with the policy, that
the insured has the right to an unconditional refund of all premiums paid,
and that such right may be exercised within a period of 20 days commencing
from the date of delivery of such policy. Where option (2) is exercised,
the replacing insurer shall also transmit a policy summary to the existing
insurer within 3 working days after the date the replacement policy is issued.
(3) Any of the foregoing provisions or portions thereof not
applicable to single premium or nonparticipating or term policies shall
to that extent not be incorporated therein. This Section shall not
apply to policies of reinsurance nor to policies issued or granted
pursuant to the nonforfeiture provisions prescribed in subparagraph (g)
of paragraph (1) of this Section.
(Source: P.A. 97-527, eff. 8-23-11.)
|
(215 ILCS 5/224.05) Sec. 224.05. Military personnel in military service; no lapse of life insurance policy. (a) Except as provided in subsection (b), this Section shall apply to any individual life insurance policy insuring the life of a resident of Illinois who is a member of any component of the U.S. Armed Forces or the National Guard of any state, the District of Columbia, a commonwealth, or a territory of the United States who has entered any full-time training or duty which the service member was ordered to report by the President, Governor of a state, commonwealth, or territory of the United States, or other appropriate military authority, if the life insurance policy meets both of the following conditions: (1) The policy has been in force for at least 180 | ||
| ||
(2) The policy has been brought within the | ||
| ||
(b) This Section does not apply to any policy that was cancelled or that had lapsed for the nonpayment of premiums prior to the commencement of the insured's period of military service. (c) An individual life insurance policy described in this Section shall not lapse or be forfeited for the nonpayment of premiums during the military service of a service member in excess of 29 consecutive days during the 2-year period subsequent to the end of the member's period of military service. (d) In order to be eligible for the benefits granted to service members under this Section, a service member must provide the life insurance company with a copy of the orders calling the service member to military service and of any orders further extending the service member's period of service.
(e) This Section does not limit a life insurance company's enforcement of provisions in the insured's policy relating to naval or military service in time of war.
(f) A violation of this Section constitutes a civil rights violation under the Illinois Human Rights Act. All proceeds from the collection of any civil penalty imposed under this subsection shall be deposited into the Illinois Military Family Relief Fund.
(Source: P.A. 97-913, eff. 1-1-13.) |
(215 ILCS 5/224.1) (from Ch. 73, par. 836.1)
Sec. 224.1.
Employer insurable interest.
Notwithstanding any other
Section of this Code, an employer or an employer sponsored trust for the
benefit of its employees has an insurable interest in the lives of the
employer's directors, officers, managers, nonmanagement employees, and
retired employees and may insure those lives on an individual or group
basis with the consent of the insured. The consent requirement will be
satisfied if the insured is provided written notice of the coverage and
does not reject such coverage within 30 days of receipt of such notice. The
extent of the employer's or the trust's insurable interest for nonmanagement
and retired employees shall be limited to an amount commensurate with the
employer's projected unfunded liabilities to nonmanagement and retired
employees for welfare benefit plans, as defined by the Employee Retirement
Income Security Act of 1974, Public Law 93-406, 88 Stat. 829, calculated
according to accepted actuarial principles. An insurable interest must exist
at the time the contract of life or disability insurance becomes effective, but
need not exist at the time the loss occurs. An employer shall not retaliate in
any manner against an employee or a retired employee for refusing consent to be
insured. The proceeds of any policy or certificate issued pursuant to this
Section are exempt from the claims of any creditor or dependent of the insured.
As used herein, "employer" means an individual, sole proprietorship,
partnership, firm, corporation, association, or any other legal entity that has
one or more employees and is legally doing business in this State.
(Source: P.A. 87-936.)
|
(215 ILCS 5/225) (from Ch. 73, par. 837)
Sec. 225.
Prohibited
Provisions for Life Policies.
(1) After the effective date of this Code no policy of life insurance
may be issued or delivered in this State if it includes any of the
following provisions:
(a) A provision limiting the time within which any action may be commenced
to less than 3 years after the cause of action
accrues.
(b) A provision by which the policy purports to be issued or take effect
more than 6 months before the original application for the insurance was
made, but this provision does not apply in any case of a transfer from one
form of policy to another in connection with which the policy owner
receives credit for any reserve accumulation under the form of policy from
which the transfer was made.
(c) A provision for any mode of settlement at maturity after the
expiration of the contestable period of the policy of less value than the
amount insured plus dividend additions, if any,
less any indebtedness to the company on or secured by the policy, and less
any premium that may by the terms of the policy be deducted, except as
permitted by clause (c) of subsection (1) of Section 224.
(d) A provision for forfeiture of the policy for failure to repay any
loan on the policy, or to pay interest on such loan, while the total
indebtedness on the policy, including interest, is less than the loan value
thereof.
(e) A provision to the effect that the agent soliciting the insurance is
the agent of the person insured under the policy, or making the acts or
representations of such agent binding upon the person so insured under the
policy.
(f) A provision limiting the amount payable under a policy by reason of
death occurring after the expiration of the contestable period to less than
the face amount thereof on account of the kind or character of disease
causing the insured's death.
(2) The provisions of this section do not apply to policies of
reinsurance, nor to policies issued or granted under the nonforfeiture
provisions prescribed in clause (g) of subsection (1) of Section 224.
(Source: P.A. 83-345.)
|
(215 ILCS 5/226) (from Ch. 73, par. 838)
Sec. 226.
Standard
provisions for annuities and pure endowment contracts. (1) After the effective
date of this Section and any amendments thereto no annuity
or pure endowment
contract, except in case of reversionary annuities, survivorship annuities
or annuities contracted by an employer on behalf of his employees, shall be
issued or delivered in this State unless it contains in substance the
following provisions:
(a) A provision that there shall be a period of grace, either of thirty
days or of one month, within which any stipulated payment to the company
falling due after the first year may be made, subject at the option of the
company, to an interest charge thereon at a rate to be specified in the
contract but not exceeding six per centum per annum for the number of days
of grace elapsing before such payment, during which period of grace, the
contract shall continue in full force; but in case a claim arises under the
contract on account of death during the said period of grace before the
overdue payment to the company or the deferred payments of the current
contract year, if any, are made, the amount of such payments, with interest
on any overdue payments, may be deducted from any amount payable under the
contract in settlement.
(b) If statements, other than those relating to age and identity, are
required as a condition to issuing the contract, a provision that the
contract shall be incontestable after it has been in force during the
lifetime of the person or each of the persons as to whom such statements
are required, for a period of two years from its date of issue, except
where stipulated payments to the company have not been made and except for
violations of the conditions of the contract relating to military or naval
service in time of war and except, at the option of the company, with
respect to provisions relative to benefits in the event of total and
permanent disability and provisions which grant insurance specifically
against death by accident.
(c) A provision that such a contract shall constitute the entire
contract between the parties, but if the company desires to make the
application a part of the contract it may do so, provided a copy of such
application shall be endorsed upon or attached to such contract when
issued, and in such case such contract shall contain a provision that it,
together with the application therefor, shall constitute the entire
contract between the parties.
(d) A provision that if the age or ages of the person or persons upon
whose life or lives the contract is based, or any of them, have been
misstated, the amount payable under the contract shall be such as the
stipulated payments to the company would have purchased at the correct age
or ages.
(e) If the contract is participating, a provision that the divisible
surplus shall be apportioned annually and dividends shall be payable in
cash or shall be applicable to any stipulated payment or payments to the
company under the contract.
(f) A provision that after the contract has been in force for three
years, if it shall, by its terms, lapse because any stipulated payment to
the company shall not have been made, the reserve on such contract,
exclusive of the reserve on account of total and permanent disability and
additional accidental death benefits, computed according to the standard
adopted by the company and in accordance with section 223, shall after
deducting not more than one-fifth of the said entire reserve and any
indebtedness to the company under the contract, be applied as a net single
payment according to said standard, for the purchase of a paid-up annuity
or a pure endowment contract, which may be nonparticipating and which
shall be payable by the company under the same terms and conditions as the
original contract, except as to amount.
(g) A provision that the contract may be reinstated at any time within
one year from the date of default in making stipulated payments to the company,
but all overdue stipulated payments and any indebtedness to the company
on the contract shall be paid or reinstated, with interest thereon at a
rate to be specified in the contract but not exceeding six per centum per
annum payable annually, and in cases where applicable, a company may also
include a requirement of evidence of insurability satisfactory to the company.
(h) A provision, or a notice attached to the contract, to the effect
that during a period of 10 days from the date the contract is delivered
to the contract-owner
it may be surrendered to the insurer together with a written request for
cancellation of the contract, and that in such event, with the exception
of a variable annuity contract, the insurer will refund any premium paid
for the contract, including any contract fees or other charges. Cancellation
under a variable annuity contract shall entitle a person to an amount equal
to the sum of (i) the difference between the premiums paid including any
contract fees or other services and the amounts allocated to any separate
accounts under the contract and (ii) the cash value of the contract or,
if the contract does not have a cash value, the reserve for the contract,
on the date the return contract is received by the insurer or its agent. The Director
may by rule exempt specific types of contracts from this paragraph.
(2) Any overpayment by the company on account of misstatement of age,
shall be charged against the current or next succeeding payment or payments
to be made by the company under the contract, with interest thereon at a
rate to be specified in the contract but not exceeding six per centum per annum.
(3) A company may provide, in lieu of the paid-up values provided in
clause (f) of subsection (1), for a paid-up annuity or pure endowment
contract in an amount bearing the same proportion to the original annuity
or pure endowment contract as the number of stipulated payments which shall
have been made to the company shall bear to the total number of stipulated
payments required to be made to the company under contract, and if there be
any indebtedness to the company under the contract the amount of such
paid-up annuity or pure endowment shall be reduced by an amount bearing the
same proportion to such paid-up annuity or pure endowment as such
indebtedness bears to the cash value on such paid-up annuity or pure
endowment, computed according to the standard adopted by the company in
accordance with section 223.
(Source: P.A. 82-594.)
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(215 ILCS 5/226.1) (from Ch. 73, par. 838.1)
Sec. 226.1.
Entitled annuity payment options.
Annuity contracts and
funding agreements may be
issued without a life contingency annuity payment option in the following
circumstances: (1) to fund benefits under an employee benefit plan as
defined in the Employee Retirement Income Security Act of 1974, as now or
hereafter amended; (2) to fund the activities of an organization exempt
from taxation under Internal Revenue Code Section 501(c), as now or
hereafter amended; (3) to fund a program of a governmental entity or of an
agency or instrumentality thereof; (4) to fund an agreement providing for
periodic payments entered into in satisfaction of a claim; or (5) to fund a
program of an institution having assets in excess of $25,000,000.
(Source: P.A. 92-875, eff. 1-3-03.)
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(215 ILCS 5/227) (from Ch. 73, par. 839)
Sec. 227.
Standard
provisions for reversionary or survivorship annuity contracts.
(1) After the effective date of this Code no contract for a reversionary
annuity or survivorship annuity shall be issued or delivered in this State
unless it contains in substance the following provisions:
(a) The provisions of clauses (a), (b), (c), (d) and (e) of subsection
(1) of section 226, except that under said clause (a) the company may at
its option provide for an equitable reduction of the amount of the annuity
payments in settlement of an overdue or deferred payment in lieu of
providing for a deduction of such payments from an amount payable upon a
settlement under the contract.
(b) A provision that the contract may be reinstated at any time within
three years from the date of default in making stipulated payments to the
company, upon production of evidence of insurability satisfactory to the
company, provided that all overdue payments and any indebtedness to the
company on account of the contract shall be paid or reinstated with
interest thereon at a rate to be specified in the contract but not
exceeding six per centum per annum payable annually.
(2) Any of the foregoing provisions or portions thereof contained in
this section and in section 226 not applicable to non-participating
contracts nor to contracts for which a single stipulated payment to the
company is made, shall, to that extent, not be incorporated therein.
(3) The provisions of this section and section 226 shall not apply to
contracts of re-insurance nor to contracts for deferred annuities or
reversionary annuities included in life insurance policies.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/228) (from Ch. 73, par. 840)
Sec. 228.
Industrial
Life Insurance Defined.
As used in this Code "industrial life insurance" means either that form
of life insurance under which the premiums are payable monthly or more often if the face
amount of insurance provided in the policy does not exceed $2,500 and the
words "industrial policy" are printed in prominent type on the face of the
policy. Any life company authorized to do business in this State may issue
industrial policies.
(Source: P.A. 82-498.)
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(215 ILCS 5/229) (from Ch. 73, par. 841)
Sec. 229.
Standard
Provisions for Industrial Life Insurance. (1) After the effective date
of this Section and any amendments thereto, no policy of industrial life
insurance shall be issued or delivered in this State, unless the same shall
contain in substance the following provisions, and shall be subject to the
other provisions of this section:
(a) A provision that the insured is entitled to a grace period of four
weeks within which the payment of any premium after the first, may be made,
during which period of grace the policy shall continue in full force but in
case the policy becomes a claim during said grace period before the overdue
premiums are paid, the amount of overdue premiums may be deducted in any
settlement under the policy.
(b) A provision that the policy shall contain the entire contract
between the parties, nothing to be incorporated therein by reference to any
constitution, bylaws, rules, application or other writing unless endorsed
upon or attached to the policy.
(c) A provision that the policy shall be incontestable after it shall
have been in force during the lifetime of the insured for a specified
period, not more than two years from its date, except for nonpayment of
premiums and except for violation of the conditions of the policy relating
to naval or military service in time of war and except as to provisions
relating to benefits in the event of total and permanent disability and
those granting additional insurance specifically against death by accident.
(d) A provision that if it shall be found at any time before final
settlement on the policy that the age of the insured (or the age of any
other person considered in determining the premium) has been misstated, the
amount payable under the policy shall be such as the premium would have
purchased at the correct age or ages at the time the policy was issued.
(e) If a participating policy a provision indicating the conditions
under which the company shall annually ascertain and apportion any
divisible surplus accruing on the policy.
(f) A provision for nonforfeiture benefits in accordance with the
requirements of section 229.1 (2) or section 229.2.
(g) If more than one option is provided, a provision as to which of such
options shall apply in the event of the insured's failure to notify the
company of his selection of an option.
(h) A provision for cash surrender values in accordance with the
requirements of section 229.1 (2) or section 229.2.
(i) A provision that the policy may be reinstated, if not surrendered
for its cash value or if the period of extended term insurance has not
expired, within one year from the date of default in payment of premiums
upon presentation of evidence satisfactory to the company of the
insurability of the insured and the payment of arrears of premiums and the
payment or reinstatement of any other indebtedness to the company upon said
policy, with interest on said premiums and indebtedness at a rate not
exceeding six per centum per annum payable annually.
(j) A table showing in figures the nonforfeiture options available
under the policy every year upon default in payment of premiums during at
least the first twenty years of the policy, and a provision that the
company will furnish upon request an extension of such table beyond the
years shown in the policy.
(k) A provision that when a policy shall become a claim by the death of
the insured, settlement shall be made upon receipt of due proof of death
and not later than two months after the receipt of such proof.
(l) Title on the face of the policy clearly and correctly describing its
form.
(m) A provision, or a notice attached to the policy, to the effect that
during a period of 10 days from the date the policy is delivered to the
policy owner it may be surrendered to the insurer together with a written
request for cancellation of the policy, and that in such event the insurer
will refund any premium paid for the policy, including any policy fees or
other charges. The Director
may by rule exempt specific types of policies from this paragraph.
(2) Any of the provisions of subsection (1) or portions thereof not
applicable to nonparticipating or term policies shall to that extent not
be incorporated therein. The provisions of this section shall not apply to
policies issued or granted pursuant to the nonforfeiture provisions
prescribed in clauses (f), (g) and (h) of subsection (1).
(3) Upon proper written request, a named beneficiary shall be designated
in, or be endorsed on, the policy, to receive the benefits thereof on the
death of the insured, and there shall be reserved the power to change the
beneficiary at any time upon proper written request to the company at its
home office, accompanied by the policy for endorsement of the change
thereon by the company. The company shall have the right to refuse to
designate a beneficiary if evidence satisfactory to the company of such
beneficiary's insurable interest in the life of the insured is not
furnished on request. The policy may provide in substance that any payment
thereunder may be made or any nonforfeiture benefit may be granted to the
insured or to the insured's estate or to any relative by blood or
connection by marriage of the insured, or, to the extent of such portion of
any payment under the policy as may reasonably appear to the company to be
due to such person, to any other person equitably entitled thereto by
reason of having incurred expense occasioned by the maintenance or illness
or burial of the insured. If the policy shall be in force at the death of
the insured, the proceeds thereof shall be payable to the named beneficiary
if living, but unless proof of claim in the manner and form required by the
policy, accompanied by delivery of the policy for surrender, has been made
by such beneficiary within fifteen days after the death of the insured,
then upon the expiration of said fifteen days, or if the beneficiary is the
estate of the insured, or is a minor, or is not legally qualified to give a
valid release or dies before the insured, the company may pay to any person
permitted by the policy.
(Source: P.A. 82-594.)
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(215 ILCS 5/229.1) (from Ch. 73, par. 841.1)
Sec. 229.1.
Non-forfeiture benefits and cash surrender values in policies issued prior
to the operative date of section 229.2.
(1) This subsection shall apply only to policies of life insurance
(other than Industrial life insurance) issued prior to the operative date
of section 229.2 (the Standard Non-forfeiture Law.)
The non-forfeiture benefit referred to in clause (g) of section 224
shall be available to the insured in event of default in premium payments,
after premiums shall have been paid for three years, and shall be a
stipulated form of insurance, effective from the due date of the defaulted
premium, the net value of which shall not be less than the reserve at the
date of default on the policy and on dividend additions thereto, if any,
exclusive of the reserve on account of total and permanent disability and
additional accidental death benefits (the policy to specify the mortality
table, rate of interest and method of valuation adopted for computing such
reserve), less a specified maximum percentage (not more than two and
one-half) of the amount insured by the policy and of existing dividend
additions thereto, if any, and less any existing indebtedness to the
company on or secured by the policy, the exact percentage to be specified
for each year for which required values are not included in the policy; if
more than one option is provided, the policy to specify which of such
options shall apply in the event of the insured's failure to notify the
company of his selection of an option. The policy shall provide that it may
be surrendered to the company at its home office within the period of grace
after the due date of the defaulted premium for a specified cash value not
less than the above prescribed minimum value of the stipulated form of
insurance; and any policy may also provide that the company may defer
payment for not more than six months after the application therefor is
made. Provided that any policy may also contain a provision that in event
of default in a premium payment before such options become available the
reserve on any dividend additions then in force may at the option of the
company be paid in cash or applied as a net premium to the purchase of
paid-up term insurance for any amount not in excess of the face of the
original policy. This subsection shall not apply to term insurance of
twenty years or less, but such term policy shall specify the mortality
table, rate of interest and method of valuation adopted for computing
reserves.
(2) This subsection shall apply only to policies of Industrial life
insurance issued prior to the operative date of section 229.2 (the Standard
Non-forfeiture Law).
The non-forfeiture benefit referred to in clause (f) of section 229,
shall be available in event of default in premium payments after premiums
shall have been paid for five full years, and shall be a stipulated form of
insurance effective from the due date of the defaulted premium, the net
value of which shall not be less than the reserve on the policy at the end
of the last completed quarter of the policy year for which premiums have
been paid, and all dividend additions thereto, if any, exclusive of any
reserve on total and permanent disability and additional accidental death
benefits, (the policy to specify the mortality table, rate of interest and
method of valuation adopted for computing such reserve), less a maximum
percentage (not more than two and one-half per centum) of the amount
insured by the policy and of existing dividend additions thereto, if any,
and less any existing indebtedness to the company on or secured by the
policy. The policy shall also specify said percentage, or other rule of
calculation so as to permit determination of the values, to be specified
for each year for which required values are not included in the policy. The
cash surrender value referred to in clause (h) of section 229, shall be
available upon surrender of the policy to the company at its home office
within the period of grace after the due date of the defaulted premium and
shall be not less than the above prescribed minimum value of the stipulated
form of insurance; provided that the company may defer payment for not more
than six months after the application therefor is made. This subsection
shall not apply to term insurance of twenty years or less but such term
policy shall specify the mortality table, rate of interest and method of
valuation adopted for computing reserves.
(Source: Laws 1943, Vol. 1, p. 824.)
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(215 ILCS 5/229.2) (from Ch. 73, par. 841.2)
Sec. 229.2. Standard Non-forfeiture Law for Life Insurance. (1) No policy
of life insurance, except as stated in subsection (8),
shall be delivered or issued for delivery in this
State unless it contains in
substance the following provisions or corresponding provisions which in
the opinion of the Director are at least as favorable to the defaulting
or surrendering policyholder and are essentially in compliance with subsection
(7) of this law:
(i) That, in the event of default in any premium payment, the
company will grant, upon proper request not later than 60 days after the
due date of the premium in default, a paid-up nonforfeiture
benefit on
a plan stipulated in the policy, effective as of such due date, of such
amount as may be hereinafter specified. In lieu of such
stipulated paid-up nonforfeiture benefit, the company may substitute, upon
proper request not later than 60 days after the due date of the premium
in default, an actuarially equivalent alternative paid-up nonforfeiture
benefit which provides a greater amount or longer period of death benefits
or, if applicable, a greater amount or earlier payment of endowment benefits.
(ii) That, upon surrender of the policy within 60 days after the due
date of any premium payment in default after premiums have been paid for
at least 3 full years in the case of Ordinary insurance or 5 full years
in the case of Industrial insurance, the company will pay, in lieu of
any paid-up nonforfeiture benefit, a cash surrender value of such
amount as may be hereinafter specified.
(iii) That a specified paid-up nonforfeiture benefit
shall become
effective as specified in the policy unless the person entitled to make
such election elects another available option not later than 60 days
after the due date of the premium in default.
(iv) That, if the policy shall have become paid-up by completion of
all premium payments or if it is continued under any paid-up
nonforfeiture benefit which became effective on or
after the third
policy anniversary in the case of Ordinary insurance or the fifth policy
anniversary in the case of Industrial insurance, the company will pay,
upon surrender of the policy within 30 days after any policy
anniversary, a cash surrender value of such amount as may be hereinafter
specified.
(v) In the case of policies which cause on a basis guaranteed in the
policy unscheduled changes in benefits or premiums, or which provide an
option for changes in benefits or premiums other than a change to a new
policy, a statement of the mortality table, interest rate, and method used
in calculating cash surrender values and the paid-up nonforfeiture benefits
available under the policy. In the case of all other policies,
a statement of the mortality table and interest rate used in
calculating the cash surrender values and the paid-up nonforfeiture
benefits available under the policy, together with a table showing the
cash surrender value, if any, and paid-up nonforfeiture
benefit, if
any, available under the policy on each policy anniversary either during
the first 20 policy years or during the term of the policy, whichever is
shorter, such values and benefits to be calculated upon the assumption
that there are no dividends or paid-up additions credited to the policy
and that there is no indebtedness to the company on the policy.
(vi) A statement that the cash surrender values and the paid-up
nonforfeiture benefits available under the policy
are not less than the
minimum values and benefits required by or pursuant to the insurance law
of the state in which the policy is delivered; an explanation of the
manner in which the cash surrender values and the paid-up nonforfeiture
benefits are altered by the existence of any paid-up additions credited
to the policy or any indebtedness to the company on the policy; if a
detailed statement of the method of computation of the values and
benefits shown in the policy is not stated therein, a statement that
such method of computation has been filed with the insurance supervisory
official of the state in which the policy is delivered; and a statement
of the method to be used in calculating the cash surrender value and
paid-up nonforfeiture benefit available under the
policy on any policy
anniversary beyond the last anniversary for which such values and
benefits are consecutively shown in the policy.
Any of the foregoing provisions or portions thereof not applicable by
reason of the plan of insurance may, to the extent inapplicable, be
omitted from the policy.
The company shall reserve the right to defer the payment of any cash
surrender value for a period of 6 months after demand therefor with
surrender of the policy.
(2) (i) Any cash surrender value available under the policy in the event
of default in a premium payment due on any policy anniversary, whether
or not required by subsection (1), shall be an amount not less than the
excess, if any, of the present value, on such anniversary, of the future
guaranteed benefits which would have been provided for by the policy,
including any existing paid-up additions, if there had been no default,
over the sum of (i) the then present value of the adjusted premiums as
defined in subsections 4, 4(a), 4(b) and 4(c), corresponding
to premiums which
would have fallen due on and after such anniversary, and (ii) the amount
of any indebtedness to the company on the policy.
(ii) For any policy issued on or after the operative date of subsection
4(c), which provides supplemental life insurance or annuity benefits at
the option of the insured for an identifiable additional premium by rider
or supplemental policy provision,
the cash surrender value shall be an amount not less than the sum of the
cash surrender value as determined in paragraph (i) for an otherwise similar
policy issued at the same age without such rider or supplemental policy
provision and the cash surrender value as determined in such paragraph for
a policy which provides only the benefits otherwise provided by such rider
or supplemental policy provision.
(iii) For any family policy issued on or after the operative date of subsection
4(c), which defines a primary insured and provides term insurance on the
life of the spouse of the primary insured expiring before the spouse attains
age 71, the cash surrender value shall be an amount not less than the sum
of the cash surrender value as determined in paragraph (i) for an otherwise
similar policy issued at the same age without such term insurance on the
life of the spouse and the cash surrender value as determined in such paragraph
for a policy which provides only the benefits otherwise provided by such
term insurance on the life of the spouse.
(iv) Any cash surrender
value available within 30 days after any policy anniversary under any
policy paid up by completion of all premium payments or any policy
continued under any paid-up nonforfeiture benefit, whether or not
required by subsection (1), shall be an amount not less than the present
value, on such anniversary, of the future guaranteed benefits provided
for by the policy, including any existing paid-up additions, decreased
by any indebtedness to the company on the policy.
(3) Any paid-up nonforfeiture benefit available
under the policy in
the event of default in a premium payment due on any policy anniversary
shall be such that its present value as of such anniversary shall be at
least equal to the cash surrender value then provided for by the policy,
or if none is provided for, that cash surrender value which would have
been required by this section in the absence of the condition that
premiums shall have been paid for at least a specified period.
(4) This subsection (4) shall not apply to policies issued on or after
the operative date of subsection (4c). Except as provided in the third
paragraph of this subsection,
the adjusted premiums for any policy shall be calculated on an annual
basis and shall be such uniform percentage of the respective premium
specified in the policy for each policy year, excluding any extra
premiums charged because of impairments or special hazards, that the
present value, at the date of issue of the policy, of all such adjusted
premiums shall be equal to the sum of (i) the then present value of the
future guaranteed benefits provided for by the policy; (ii) 2% of the
amount of insurance, if the insurance be uniform in amount, or of the
equivalent uniform amount, as hereinafter defined, if the amount of
insurance varies with duration of the policy; (iii) 40% of the adjusted
premium for the first policy year; (iv) 25% of either the adjusted
premium for the first policy year or the adjusted premium for a whole
life policy of the same uniform or equivalent uniform amount with
uniform premiums for the whole of life issued at the same age for the
same amount of insurance, whichever is less. Provided, however, that in
applying the percentages specified in (iii) and (iv) above, no adjusted
premium shall be deemed to exceed 4% of the amount of insurance or
uniform amount equivalent thereto. The date of issue of a policy for the
purpose of this subsection shall be the date as of which the rated age
of the insured is determined.
In the case of a policy providing an amount of insurance varying with
duration of the policy, the equivalent uniform amount thereof for the
purpose of this subsection shall be deemed to be the level amount of
insurance, provided by an otherwise similar policy, containing the same
endowment benefit or benefits, if any, issued at the same age and for
the same term, the amount of which does not vary with duration and the
benefits under which have the same present value at the inception of the
insurance as
the benefits under the policy; provided, however, that in the case of a
policy providing a varying amount of insurance issued on the life of a
child under age 10, the equivalent uniform amount may be computed as
though the amount of insurance provided by the policy prior to the
attainment of age 10 were the amount provided by such policy at age 10.
The adjusted premiums for any policy providing term insurance
benefits by rider or supplemental policy provision shall be equal to (a)
the adjusted premiums for an otherwise similar policy issued at the same
age without such term insurance benefits, increased, during the period
for which premiums for such term insurance benefits are payable, by (b)
the adjusted premiums for such term insurance, the foregoing items (a)
and (b) being calculated separately and as specified in the first 2
paragraphs of this subsection except that, for the purposes of (ii),
(iii) and (iv) of the first such paragraph, the amount of insurance or
equivalent uniform amount of insurance used in the calculation of the
adjusted premiums referred to in (b) shall be equal to the excess of the
corresponding amount determined for the entire policy over the amount
used in the calculation of the adjusted premiums in (a).
Except as otherwise provided in subsections (4a) and (4b), all
adjusted premiums and present values referred to in this section shall
for all policies of Ordinary insurance be calculated on the basis of the
Commissioners 1941 Standard Ordinary Mortality Table, provided that for
any category of Ordinary insurance issued on female risks adjusted
premiums and present values may be calculated according to an age not
more than 3 years younger than the actual age of the insured, and such
calculations for all policies of Industrial insurance shall be made on
the basis of the 1941 Standard Industrial Mortality Table. All
calculations shall be made on the basis of the rate of interest, not
exceeding 3 1/2% per annum, specified in the policy for calculating cash
surrender values and paid-up nonforfeiture benefits.
Provided, however,
that in calculating the present value of any paid-up term insurance with
accompanying pure endowment, if any, offered as a nonforfeiture
benefit, the rates of mortality assumed may be not more than 130% of the
rates of mortality according to such applicable table. Provided,
further, that for insurance issued on a substandard basis, the
calculation of any such adjusted premiums and present values may be
based on such other table of mortality as may be specified by the
company and approved by the Director.
(4a) This subsection (4a) shall not apply to Ordinary policies issued
on or after the operative date of subsection (4c). In the case of Ordinary
policies issued on or after the
operative date of this subsection (4a) as defined herein, all adjusted
premiums and present values referred to in this Section shall be
calculated on the basis of the Commissioners 1958 Standard Ordinary
Mortality Table and the rate of interest specified in the policy for calculating
cash surrender values and
paid-up nonforfeiture benefits, provided that such
rate of interest shall not exceed 3 1/2% per annum except that a rate of
interest not exceeding 5 1/2% per annum may be used for policies issued
on or after September 8, 1977, except that for any single premium
whole life or endowment insurance policy a rate of interest not exceeding
6 1/2% per annum may be used and provided that for any category of
Ordinary insurance issued on female risks, adjusted premiums and present
values may be calculated according to an age not more than 6 years
younger than the actual age of the insured. Provided, however, that in
calculating the present value of any paid-up term insurance with
accompanying pure endowment, if any, offered as a nonforfeiture
benefit, the rates of mortality assumed may be not more than those shown
in the Commissioners 1958 Extended Term Insurance Table. Provided,
however, that for insurance issued on a substandard basis, the
calculation for any such adjusted premiums and present values may be
based on such other table of mortality as may be specified by the
company and approved by the Director. After the effective date of this
subsection (4a), any company may file with the Director written notice
of its election to comply with the provisions of this subsection after a
specified date before January 1, 1966. After the filing of such notice,
then upon such specified date (which shall be the operative date of this
subsection for such company), this subsection shall become operative
with respect to the Ordinary policies thereafter issued by such company.
If a company makes no such election, the operative date of this
subsection for such company shall be January 1, 1966.
(4b) This subsection (4b) shall not apply to Industrial policies issued
on or after the operative date of subsection (4c). In the case of Industrial
policies issued on or after the
operative date of this subsection (4b) as defined herein, all adjusted
premiums and present values referred to in this Section shall be
calculated on the basis of the Commissioners 1961 Standard Industrial
Mortality Table and the rate of interest specified in the policy for calculating
cash surrender values and
paid-up nonforfeiture benefits, provided that such
rate of interest shall not exceed 3 1/2% per annum except that a rate of
interest not exceeding
5 1/2% per annum may be used for policies issued on or after September
8, 1977, except
that for any single premium whole life or endowment insurance policy a rate
of interest not exceeding 6 1/2% per annum may be used. Provided, however,
that in calculating
the present value of any paid-up term insurance with accompanying pure
endowment, if any, offered as a nonforfeiture benefit,
the rates of
mortality assumed may be not more than those shown in the Commissioners
1961 Industrial Extended Term Insurance Table. Provided, further, that
for insurance issued on a substandard basis, the calculations of any
such adjusted premiums and present values may be based on such other
table of mortality as may be specified by the company and approved by
the Director. After the effective date of this subsection (4b), any
company may file with the Director a written notice of its election to
comply with the provisions of this subsection after a specified date
before January 1, 1968. After the filing of such notice, then upon such
specified date (which shall be the operative date of this subsection for
such company), this subsection shall become operative with respect to
the Industrial policies thereafter issued by such company. If a company
makes no such election, the operative date of this subsection for such
company shall be January 1, 1968.
(4c)(a) This subsection shall apply to all policies issued on or after
its operative date. Except as provided in paragraph (g), the adjusted premiums
for any policy shall be calculated on an annual basis and shall be such
uniform percentage of the respective premiums specified in the policy for
each policy year, excluding amounts payable as extra premiums to cover impairments
or special hazards and any uniform annual contract charge or policy fee
specified in the policy in a statement of the method to be used in calculating
the cash surrender value and paid-up nonforfeiture benefits of the policy,
that the present value, at the date of issue of the policy, of all adjusted
premiums shall be equal to the sum of (i) the then present value of the
future guaranteed benefits provided for by the policy; (ii) 1% of either
the amount of insurance, if the insurance is uniform in amount, or the average
amount of insurance at the beginning of each of the first 10 policy years;
and (iii) 125% of the nonforfeiture net level premium as hereinafter defined.
In applying the percentage specified in (iii), however,
no nonforfeiture net level premium shall exceed 4% of either the amount
of insurance, if the insurance is uniform in amount, or the average amount
of insurance at the beginning of each of the first 10 policy years. The
date of issue of a policy for the purpose of this subsection is the date
as of which the rated age of the insured is determined.
(b) The nonforfeiture net level premium equals the present value, at the
date of issue of the policy, of the guaranteed benefits provided for by
the policy divided by the present value, at the date of issue of the policy,
of an annuity of one per annum payable on the date of issue of the policy
and on each anniversary of such policy on which a premium falls due.
(c) In the case of a policy which causes, on a basis guaranteed in such
policy, unscheduled changes in benefits or premiums, or which provides an
option for changes in benefits or premiums other than a change to a new
policy, adjusted premiums and present values shall initially be calculated
on the assumption that future benefits and premiums do not change from those
stipulated at the date of issue of such policy. At the time of any such
change in the benefits or premiums, the future adjusted premiums, nonforfeiture
net level premiums and present values shall be recalculated on the assumption
that future benefits and premiums do not change from those stipulated by
such policy immediately after the change.
(d) Except as otherwise provided in paragraph (g), the recalculated future
adjusted premiums for any policy shall be such uniform percentage of the
respective future premiums specified in the policy for each policy year,
excluding amounts payable as extra premiums to cover impairments and special
hazards and any uniform annual contract charge or policy fee specified in
the policy in a statement of the method to be used in calculating the cash
surrender values and paid-up nonforfeiture benefits, that the present value,
at the time of change to the newly defined benefits or premiums, of all
such future adjusted premiums shall be equal to the excess of (A) the sum
of (i) the then present value of the then future guaranteed benefits provided
for by the policy and (ii) the additional expense allowance, if any, over
(B) the then cash surrender value, if any, or present value of any paid-up
nonforfeiture benefit under the policy.
(e) The additional expense allowance at the time of the change to the
newly defined benefits or premiums shall be the sum of
(i) 1% of the excess, if positive, of the average amount of insurance at
the beginning of each of the first 10 policy years subsequent to the change
over the average amount of insurance prior to the change at the beginning
of each of the first 10 policy years subsequent to the time of the most
recent previous change, or, if there has been no previous change, the date
of issue of the policy; and (ii) 125% of the increase, if positive, in
the nonforfeiture net level premium.
(f) The recalculated nonforfeiture net level premium equals the result
obtained by dividing X by Y, where
(i) X equals the sum of
(A) the nonforfeiture net level premium applicable prior to the change
times the present value of an annuity of one per annum payable on each anniversary
of the policy on or subsequent to the date of the change on which a premium
would have fallen due had the change not occurred, and
(B) the present value of the increase in future guaranteed benefits provided
for by the policy; and
(ii) Y equals the present value of an annuity of one per annum payable
on each anniversary of the policy on or subsequent to the date of change
on which a premium falls due.
(g) Notwithstanding any other provisions of this subsection to the contrary,
in the case of a policy issued on a substandard basis which provides reduced
graded amounts of insurance so that, in each policy year, such policy has
the same tabular mortality cost as an otherwise similar policy issued on
the standard basis which provides higher uniform amounts of insurance, adjusted
premiums and present values for such substandard policy may be calculated
as if it were issued to provide such higher uniform amounts of insurance
on the standard basis.
(h) All adjusted premiums and present values referred to in this Section
shall for all policies of ordinary insurance be calculated on the basis
of the Commissioners 1980 Standard Ordinary Mortality Table or, at the election
of the company for any one or more specified plans of life
insurance, the Commissioners 1980 Standard Ordinary Mortality Table with
Ten-Year Select Mortality Factors. All adjusted premiums and present values
referred to in this Section shall for all policies of Industrial insurance
be calculated on the basis of the Commissioners 1961 Standard Industrial
Mortality Table. All adjusted premiums and present values referred to in
this Section for all policies issued in a particular calendar year shall
be calculated on the basis of a rate of interest not exceeding
the nonforfeiture interest rate as defined in this subsection for policies
issued in that calendar year. The provisions of this paragraph are subject
to the provisions set forth in subparagraphs (i) through (vii).
(i) At the option of the company, calculations for all policies issued
in a particular calendar year may be made on the basis of a rate of interest
not exceeding the nonforfeiture interest rate, as defined in this subsection,
for policies issued in the immediately preceding calendar year.
(ii) Under any paid-up nonforfeiture benefit, including any paid-up dividend
additions, any cash surrender value available, whether or not required by
subsection (1), shall be calculated on the basis of the mortality table
and rate of interest used in determining the amount of such paid-up nonforfeiture
benefit and paid-up dividend additions, if any.
(iii) A company may calculate the amount of any guaranteed paid-up nonforfeiture
benefit, including any paid-up additions under the policy, on the basis
of an interest rate no lower than that specified in the policy for calculating
cash surrender values.
(iv) In calculating the present value of any paid-up term insurance with
an accompanying pure endowment, if any, offered as a nonforfeiture benefit,
the rates of mortality assumed may be not more than those shown in the Commissioners
1980 Extended Term Insurance Table for policies of ordinary insurance and
not more than the Commissioner 1961 Industrial Extended Term Insurance Table
for policies of industrial insurance.
(v) For insurance issued on a substandard basis, the calculation of any
such adjusted premiums and present values may be based on appropriated modifications
of the aforementioned tables.
(vi) For policies issued prior to the operative date of the Valuation Manual, any Commissioners Standard Mortality Table adopted after 1980 by the National Association
of Insurance Commissioners and approved by regulations promulgated
by the Director for use in determining the minimum nonforfeiture standard
may be substituted for the Commissioners 1980 Standard Ordinary Mortality
Table with or without Ten-Year Select Mortality Factors or for the Commissioners
1980 Extended Term Insurance Table.
For policies issued on or after the operative date of the Valuation Manual, the Valuation Manual shall provide the Commissioners Standard Ordinary Mortality Table for use in determining the minimum nonforfeiture standard that may be substituted for the Commissioners 1980 Standard Ordinary Mortality Table with or without Ten-Year Select Mortality Factors or for the Commissioners 1980 Extended Term Insurance Table. If the Director approves by regulation any Commissioners Standard Ordinary Mortality Table adopted by the National Association of Insurance Commissioners for use in determining the minimum nonforfeiture standard for policies issued on or after the operative date of the Valuation Manual, then that minimum nonforfeiture standard supersedes the minimum nonforfeiture standard provided by the Valuation Manual. (vii) For policies issued prior to the operative date of the Valuation Manual, any Commissioners Standard Industrial Mortality Table adopted after 1980 by the National
Association of Insurance Commissioners and approved by regulations promulgated
by the Director for use in determining the minimum nonforfeiture standard
may be substituted for the Commissioners 1961 Standard Industrial Mortality
Table or the Commissioners 1961 Industrial Extended Term Insurance Table.
For policies issued on or after the operative date of the Valuation Manual, the Valuation Manual shall provide the Commissioners Standard Industrial Mortality Table for use in determining the minimum nonforfeiture standard that may be substituted for the Commissioners 1961 Standard Industrial Mortality Table or the Commissioners 1961 Industrial Extended Term Insurance Table. If the Director approves by regulation any Commissioners Standard Industrial Mortality Table adopted by the National Association of Insurance Commissioners for use in determining the minimum nonforfeiture standard for policies issued on or after the operative date of the Valuation Manual, then that minimum nonforfeiture standard supersedes the minimum nonforfeiture standard provided by the Valuation Manual. (i) The nonforfeiture interest rate is defined as follows: (i) For policies issued prior to the operative date | ||
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(ii) For policies issued on and after the operative | ||
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(j) Notwithstanding any other provision in this Code to the contrary,
any refiling of nonforfeiture values or their methods of computation for
any previously approved policy form which involves only a change in the
interest rate or mortality table used to compute nonforfeiture values shall
not require refiling of any other provisions of that policy form.
(k) After the effective date of this subsection, any company may, with
respect to any category of insurance, file with the Director a written notice
of its election to comply with the provisions of this subsection after a
specified date before January 1, 1989. That date
shall be the operative date of this subsection for that category of insurance
for such company. If
a company makes no such election, the operative date of this subsection
for that category of insurance issued by such company shall be January 1, 1989.
(5) In the case of any plan of life insurance which provides for future
premium determination, the amounts of which are to be determined by the
insurance company based on then estimates of future experience, or in the
case of any plan of life insurance which is of such a nature that minimum
values cannot be determined by the methods described in subsections (1),
(2), (3), (4), (4a), (4b) or (4c), then
(a) the Director shall satisfy himself that the benefits provided under
such plan are substantially as favorable to policyholders and insured parties
as the minimum benefits otherwise required by subsections (1), (2), (3),
(4), (4a), (4b) or (4c);
(b) the Director shall satisfy himself that the benefits and the pattern
of premiums of that plan are not such as to mislead prospective policyholders
or insured parties; and
(c) the cash surrender values and paid-up nonforfeiture benefits provided
by such plan shall not be less than the minimum values and benefits computed
by a method consistent with the principles of this Standard Nonforfeiture
Law for Life Insurance, as determined by regulations promulgated by the Director.
(6) Any cash surrender value and any paid-up nonforfeiture benefit,
available under the policy in the event of default in a premium payment
due at any time other than on the policy anniversary, shall be
calculated with allowance for the lapse of time and the payment of
fractional premiums beyond the last preceding policy anniversary. All
values referred to in subsections (2), (3), (4), (4a), (4b)
and (4c) may be
calculated upon the assumption that any death benefit is payable at the
end of the policy year of death. The net value of any paid-up additions,
other than paid-up term additions, shall be not less than the amounts
used to provide such additions. Notwithstanding the provisions of
subsection (2), additional benefits payable (i) in the event of death or
dismemberment by accident or accidental means, (ii) in the event of
total and permanent disability, (iii) as reversionary annuity or
deferred reversionary annuity benefits, (iv) as term insurance benefits
provided by a rider or supplemental policy provision to which, if issued
as a separate policy, this section would not apply, (v) as term
insurance on the life of a child or on the lives of children provided in
a policy on the life of a parent of the child, if such term insurance
expires before the child's age is 26, is uniform in amount after the
child's age is one, and has not become paid-up by reason of the death of
a parent of the child, and (vi) as other policy benefits additional to
life insurance and endowment benefits, and premiums for all such
additional benefits, shall be disregarded in ascertaining cash surrender
values and nonforfeiture benefits required by this section, and no such
additional benefits shall be required to be included in any paid-up
nonforfeiture benefits.
(7) This subsection shall apply to all policies issued on or after January
1, 1987. Any cash surrender value available under the policy in the event
of default in a premium payment due on any policy anniversary shall be in
an amount which does not differ by more than .2% of either the amount of
insurance if the insurance is uniform in amount, or the average amount of
insurance at the beginning of each of the first 10 policy years, from the
sum of (a) the greater of zero and the basic cash value hereinafter specified
and (b) the present value of any existing paid-up additions less the amount
of any indebtedness to the company under the policy.
The basic cash value equals the present value, on such anniversary, of
the future guaranteed benefits which would have been provided for by the
policy, excluding any existing paid-up additions and before deduction of
any indebtedness to the company, if there had been no default, less the
then present value of the nonforfeiture factors, as hereinafter defined,
corresponding to premiums which would have fallen due on and after such
anniversary. The effects on the basic cash value of supplemental life insurance
or annuity benefits or of family coverage, as described in subsection (2)
or (4), whichever is applicable, shall, however, be the same as are the
effects specified in subsection (2) or (4), whichever is applicable, on
the cash surrender values defined in that subsection.
The nonforfeiture factor for each policy year equals a percentage of the
adjusted premium for the policy year, as defined in subsection (4) or (4c),
whichever is applicable. Except as is required by the next succeeding sentence
of this paragraph, such percentage
(a) shall be the same percentage for each policy year between the second
policy anniversary and the later of (i) the fifth policy anniversary and
(ii) the first policy anniversary at which there is available under the
policy a cash surrender value in an amount, before including any paid-up
additions and before deducting any indebtedness, of at least .2% of either
the amount of insurance, if the insurance is uniform in amount, or the average
amount of insurance at the beginning of each of the first 10 policy years; and
(b) shall be such that no percentage after the later of the 2 policy anniversaries
specified in the preceding item (a) may apply to fewer than 5 consecutive policy years.
No basic cash value may be less than the value which would be obtained
if the adjusted premiums for the policy, as defined in subsection (4) or
(4c), whichever is applicable, were substituted for the nonforfeiture factors
in the calculation of the basic cash value.
All adjusted premiums and present values referred to in this subsection
shall for a particular policy be calculated on the same mortality and interest
bases as those used in accordance with the other
subsections of this law. The cash surrender values referred to in this
subsection shall include any endowment benefits provided for by the policy.
Any cash surrender value available other than in the event of default in
a premium payment due on a policy anniversary, and the amount of any paid-up
nonforfeiture benefit available under the policy in the event of default
in a premium payment shall be determined in manners consistent with the
manners specified for determining the analogous minimum amounts in subsections
1, 2, 3, 4c, and 6. The amounts of any cash surrender values and of any
paid-up nonforfeiture benefits granted in connection with additional benefits
such as those listed as items (i) through (vi) in subsection (6) shall conform
with the principles of this subsection (7).
(8) This Section shall not apply to any of the following:
(a) reinsurance,
(b) group insurance,
(c) a pure endowment,
(d) an annuity or reversionary annuity contract,
(e) a term policy of uniform amount, which provides no guaranteed nonforfeiture
or endowment benefits, or renewal thereof, of 20 years or
less expiring before age 71, for which uniform premiums are payable
during the entire term of the policy,
(f) a term policy of
decreasing amount, which provides no guaranteed nonforfeiture or endowment
benefits, on which each adjusted premium, calculated as
specified in subsections (4), (4a), (4b) and (4c), is less
than the adjusted
premium so calculated, on a term policy of uniform
amount, or renewal thereof, which provides no guaranteed nonforfeiture or
endowment benefits, issued at the same
age and for the same initial amount of insurance and for a term of 20
years or less expiring before age 71, for which uniform premiums are payable
during the entire term of the policy,
(g) a policy, which provides no guaranteed nonforfeiture or endowment
benefits, for which no cash surrender value, if any, or present value of
any paid-up nonforfeiture benefit, at the beginning of any policy year,
calculated as specified in subsections (2), (3), (4), (4a), (4b) and (4c),
exceeds 2.5% of the amount of insurance at the beginning of the same policy year,
(h) any policy
which shall be delivered outside this State through an agent or other
representative of the company issuing the policy.
For purposes of determining the applicability of this Section, the age
of expiry for a joint term life insurance policy shall be the age of expiry
of the oldest life.
(9) For the purposes of this Section: "Operative date of the Valuation Manual" means the January 1 of the first calendar year that the Valuation Manual is effective. "Valuation Manual" has the same meaning as set forth in Section 223 of this Code. (Source: P.A. 99-162, eff. 1-1-16.)
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(215 ILCS 5/229.3) (from Ch. 73, par. 841.3)
Sec. 229.3.
Loan provisions in policies.
In the case of those policies issued prior to the operative date of
Section 229.2 (the Standard Non-forfeiture Law) the loan value referred
to in clause (f) of section 224 shall be the reserve at the end of the
current policy year on the policy and on the dividend additions thereto, if
any, exclusive of the reserve on account of total and permanent disability
and additional accidental death benefits, less a specified maximum
percentage (not more than two and one-half) of the amount insured by the
policy and of any dividend additions thereto (the policy to specify the
mortality table, rate of interest and method of valuation adopted for
computing such reserve), the exact percentage to be specified for each year
for which required values are not included in the policy. The policy may
also provide that such loan may be deferred for not exceeding six months
after the application therefor is made.
(2) In the case of policies issued on or after the operative date of
Section 229.2 (the Standard Non-forfeiture Law) the loan value referred to
in clause (f) of section 224 shall be the cash surrender value at the end
of the current policy year as required by section 229.2. The company shall
reserve the right to defer such loan, except when made to pay premiums, for
six months after application therefor is made.
(Source: Laws 1943, vol. 1, p. 824.)
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(215 ILCS 5/229.4) (from Ch. 73, par. 841.4)
Sec. 229.4. (Repealed).(Source: P.A. 93-873, eff. 8-6-04. Repealed internally, eff. 7-1-06.)
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(215 ILCS 5/229.4a)
Sec. 229.4a. Standard Nonforfeiture Law for Individual Deferred
Annuities. (1)
Title.
This Section shall be known as the Standard Nonforfeiture Law for Individual Deferred Annuities. (2) Applicability.
This Section shall not apply to any reinsurance, group annuity purchased under a retirement plan or plan of deferred compensation established or maintained by an employer (including a partnership or sole proprietorship) or by an employee organization, or by both, other than a plan providing individual retirement accounts or individual retirement annuities under Section 408 of the Internal Revenue Code, as now or hereafter amended, premium deposit fund, variable annuity, investment annuity, immediate annuity, any deferred annuity contract after annuity payments have commenced, or reversionary annuity, nor to any contract which shall be delivered outside this State through an agent or other representative of the company issuing the contract. (3) Nonforfeiture Requirements. (A) In the case of contracts issued on or after the | ||
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(i) That upon cessation of payment of | ||
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(ii) If a contract provides for a lump sum | ||
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(iii) A statement of the mortality table, if any, | ||
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(iv) A statement that any paid-up annuity, cash | ||
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(B) Notwithstanding the requirements of this Section, | ||
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(4) Minimum values. The minimum values as specified in subsections (5), (6), (7), (8), and (10) of any paid-up annuity, cash surrender, or death benefits available under an annuity contract shall be based upon minimum nonforfeiture amounts as defined in this subsection.
(A)(i) The minimum nonforfeiture amount at any time | ||
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(a) Any prior withdrawals from or partial | ||
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(b) An annual contract charge of $50, accumulated | ||
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(c) Any premium tax paid by the company for the | ||
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(d) The amount of any indebtedness to the company | ||
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(ii) The net considerations for a given contract year | ||
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(B) The interest rate used in determining minimum | ||
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(i) The 5-year Constant Maturity Treasury Rate | ||
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(ii) Reduced by 125 basis points; (iii) Where the resulting interest rate is not | ||
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(iv) The interest rate shall apply for an initial | ||
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(C) During the period or term that a contract | ||
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(D) The Director may adopt rules to implement the | ||
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(5) Computation of Present Value.
Any paid-up annuity benefit available under a contract shall be such that its present value on the date annuity payments are to commence is at least equal to the minimum nonforfeiture amount on that date. Present value shall be computed using the mortality table, if any, and the interest rates specified in the contract for determining the minimum paid-up annuity benefits guaranteed in the contract. (6) Calculation of Cash Surrender Value.
For contracts that provide cash surrender benefits, the cash surrender benefits available prior to maturity shall not be less than the present value as of the date of surrender of that portion of the maturity value of the paid-up annuity benefit that would be provided under the contract at maturity arising from considerations paid prior to the time of cash surrender reduced by the amount appropriate to reflect any prior withdrawals from or partial surrenders of the contract, such present value being calculated on the basis of an interest rate not more than 1% higher than the interest rate specified in the contract for accumulating the net considerations to determine maturity value, decreased by the amount of any indebtedness to the company on the contract, including interest due and accrued, and increased by any existing additional amounts credited by the company to the contract. In no event shall any cash surrender benefit be less than the minimum nonforfeiture amount at that time. The death benefit under such contracts shall be at least equal to the cash surrender benefit. (7) Calculation of Paid-up Annuity Benefits.
For contracts that do not provide cash surrender benefits, the present value of any paid-up annuity benefit available as a nonforfeiture option at any time prior to maturity shall not be less than the present value of that portion of the maturity value of the paid-up annuity benefit provided under the contract arising from considerations paid prior to the time the contract is
surrendered in exchange for, or changed to, a deferred paid-up annuity, such present value being calculated for the period prior to the maturity date on the basis of the interest rate specified in the contract for accumulating the net considerations to determine maturity value, and increased by any additional amounts credited by the company to the contract. For contracts that do not provide any death benefits prior to the commencement of any annuity payments, present values shall be calculated on the basis of such interest rate and the mortality table specified in the contract for determining the maturity value of the paid-up annuity benefit. However, in no event shall the present value of a paid-up annuity benefit be less than the minimum nonforfeiture amount at that time. (8) Maturity Date.
For the purpose of determining the benefits calculated under subsections (6) and (7), in the case of annuity contracts under which an election may be made to have annuity payments commence at optional maturity dates, the maturity date shall be deemed to be the latest date for which election shall be permitted by the contract, but shall not be deemed to be later than the anniversary of the contract next following the annuitant's seventieth birthday or the tenth anniversary of the contract, whichever is later. (9) Disclosure of Limited Death Benefits.
A contract that does not provide cash surrender benefits or does not provide death benefits at least equal to the minimum nonforfeiture amount prior to the commencement of any annuity payments shall include a statement in a prominent place in the contract that such benefits are not
provided. (10) Inclusion of Lapse of Time Considerations.
Any paid-up annuity, cash surrender, or death benefits available at any time, other than on the contract anniversary under any contract with fixed scheduled considerations, shall be calculated with allowance for the lapse of time and the payment of any scheduled considerations beyond the beginning of the contract year in which cessation of payment of considerations under the contract occurs. (11) Proration of Values; Additional Benefits.
For a contract which provides, within the same contract by rider or supplemental contract provision, both annuity benefits and life insurance benefits that are in excess of the greater of cash surrender benefits or a return of the gross considerations with interest, the minimum nonforfeiture benefits shall be equal to the sum of the minimum nonforfeiture benefits for the annuity portion and the minimum nonforfeiture benefits, if any, for the life insurance portion computed as if each portion were a separate contract. Notwithstanding the provisions of subsections (5), (6), (7), (8), and (10), additional benefits payable in the event of total and permanent disability, as reversionary annuity or deferred reversionary annuity benefits, or as other policy benefits additional to life insurance, endowment, and annuity benefits, and considerations for all such additional benefits, shall be disregarded in ascertaining the minimum nonforfeiture amounts,
paid-up annuity, cash surrender, and death benefits that may be required under this Section. The inclusion of such benefits shall not be required in any paid-up benefits, unless the additional benefits separately would require minimum nonforfeiture amounts, paid-up annuity, cash surrender, and death benefits. (12) Rules. The Director may adopt rules to implement the provisions of this Section. (13) Effective Date. After August 6, 2004 (the effective date of Public Act 93-873), a company may elect to apply its provisions to annuity
contracts on a contract form-by-contract form basis before July 1, 2006. In all other instances, this Section shall become operative with respect to annuity contracts issued by the company on or after July 1, 2006.
(14) (Blank).
(Source: P.A. 102-775, eff. 5-13-22; 103-154, eff. 6-30-23.) |
(215 ILCS 5/229.5) (from Ch. 73, par. 841.5)
Sec. 229.5.
Policy loan interest rates.
(a) As used in this Section,
unless the context requires otherwise:
(1) "Policy" includes certificates issued by a fraternal benefit society
and annuity contracts which provide for policy loans.
(2) "Policy loan" includes any premium loan made under a policy to pay
one or more premiums that were not paid to the life insurer as they became due.
(3) "Policyholder" includes the owner of the policy or the person designated
to pay premiums as shown on the records of the life insurer.
(4) "Published Monthly Average" means:
(i) Moody's Corporate Bond Yield Average - Monthly Average Corporates
as published by Moody's Investors Service, Inc., or any successor thereto; or
(ii) In the event that Moody's Corporate Bond Yield Average - Monthly Average
Corporates is no longer published, a substantially similar average, established
by regulation issued by the Director.
(b) Maximum rate of interest on policy loans.
(1) Policies issued on or after the effective date of this amendatory
Act of 1981 shall provide for policy loan interest rates as follows:
(i) A provision permitting a maximum interest rate of not more than 8% per annum; or
(ii) A provision permitting an adjustable maximum interest rate established
from time to time by the life insurer as permitted by law.
(2) The rate of interest charged on a policy loan made under subsection
(1)(ii) shall not exceed the higher of the following:
(i) The Published Monthly Average for the calendar month ending 2 months
before the date on which the rate is determined; or
(ii) The rate used to compute the cash surrender values under the policy
during the applicable period plus 1% per annum.
(3) If the maximum rate of interest is determined pursuant to clause
(ii) of paragraph (1) of this subsection (b), the policy shall contain a
provision setting forth the frequency at which the rate is to be determined
for that policy.
(4) The maximum rate for each policy must be determined at regular intervals
at least once every 12 months, but not more frequently than once in any
3 month period. At the intervals specified in the policy:
(i) The rate being charged may be increased whenever such change as determined
under paragraph (2) of this subsection (b) would increase that rate by 1/2%
or more per annum.
(ii) The rate being charged must be reduced whenever such reduction as
determined under paragraph (2) of this subsection (b) would decrease that
rate by 1/2% or more per annum.
(5) The life insurer shall:
(i) notify the policyholder at the time a cash loan is made of the initial
rate of interest on the loan;
(ii) notify the policyholder with respect to premium loans of the initial
rate of interest on the loan as soon as it is reasonably practical to do
so after making the initial loan. Notice need not be given to the policyholder
when a further premium loan is added, except as provided in (iii) below;
(iii) send to policyholders with loans a reasonable advance notice of
any increase in the rate; and
(iv) include in the notices required above the substance of the pertinent
provisions of paragraph (1) and (3) of this subsection (b).
(6) The loan value of the policy shall be determined in accordance with
Section 229.3, but no policy shall terminate in a policy year as the sole
result of change in the interest rate during that policy year, and the
life insurer shall maintain coverage during that policy year until such
time as it would otherwise have terminated if there had been no change in
the interest rate during that policy year.
(7) The substance of the pertinent provisions of paragraphs (1) and (3)
of this subsection (b) shall be set forth in the policies to which they apply.
(8) For purposes of this Section, the rate of interest on policy loans
permitted under this Section includes the interest rate charged on
reinstatement
of policy loans for the period during and after any lapse of a policy.
(9) No other provisions of law shall apply to policy loan interest rates
unless made specifically applicable to such rates.
(c) The provisions of this Section shall not apply to any insurance contract
issued before the effective date of this amendatory Act of 1981, unless the
policyholder agrees in writing to the applicability of such provisions.
(Source: P.A. 83-1362.)
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(215 ILCS 5/230.1) (from Ch. 73, par. 842.1)
Sec. 230.1.
Group Insurance Definition.
Except as provided in Section
230.2, no policy of group life insurance shall be delivered in this State
unless it conforms to one of the following descriptions:
(A) A policy issued to an employer, or to the trustees of a fund established
by an employer, which employer or trustees shall be deemed the policyholder,
to insure employees of the employer for the benefit of persons other than the
employer, subject to the following requirements:
(1) The employees eligible for insurance under the policy shall be all
of the employees of the employer, or all of any class or classes thereof.
The policy may provide that the term "employees" shall include the employees
of one or more subsidiary corporations, and the employees, individual proprietors,
and partners of one or more affiliated corporations, proprietorships or
partnerships if the business of the employer and of such affiliated corporations,
proprietorships, or partnerships is under common control. The policy may
provide that the term "employees" shall include the individual proprietor
or partners if the employer is an individual proprietorship or partnership.
The policy may provide that the term "employees" shall include retired employees
and directors of a corporate employer. A policy issued to insure the employees
of a public body may provide that the term "employees" shall include elected
or appointed officials.
(2) The premium for the policy shall be paid either from the employer's
funds or from funds contributed by the insured employees, or from both.
Except as provided in paragraph (3) of this subsection (A), a policy on
which no part of the premium is to be derived from funds contributed by
the insured employees must insure all eligible employees, except those who
reject such coverage in writing.
(3) An insurer may exclude or limit the coverage on any person as to whom
evidence of individual insurability is not satisfactory to the insurer.
(B) A policy issued to a creditor or its parent holding company or to
a trustee or trustees or agent designated by two or more creditors, which
creditor, holding company, affiliate, trustee, trustees, or agent shall
be deemed the policyholder, to insure debtors of the creditor, or creditors,
subject to the following requirements:
(1) The debtors eligible for insurance under the policy shall be all of
the debtors of the creditor or creditors, or all of any class or classes
thereof. The policy may provide that the term "debtors" shall include (i)
borrowers of money or purchasers or lessees of goods, services, or property
for which payment is arranged through a credit transaction; (ii) the debtors
of one or more subsidiary corporations; and (iii) the debtors of one or
more affiliated corporations, proprietorships, or partnerships if the business
of the policyholder and of such affiliated corporations, proprietorships,
or partnerships is under common control.
(2) The premium for the policy shall be paid either from the creditor's
funds, or from charges collected from the insured debtors, or from both. Except
as provided in paragraph (3) of this subsection (B), a policy on which no
part of the premium is to be derived from the funds contributed by insured
debtors specifically for their insurance must insure all eligible debtors.
(3) An insurer may exclude any debtors as to whom evidence of individual
insurability is not satisfactory to the insurer.
(4) The amount of the insurance on the life of any debtor shall at no
time exceed the greater of the scheduled or actual amount of unpaid indebtedness
to the creditor.
(5) The insurance may be payable to the creditor or any successor to the
right, title, and interest of the creditor. Such payment shall reduce or
extinguish the unpaid indebtedness of the debtor to the extent of such payment.
Whenever the amount of insurance payable exceeds the amount of outstanding
indebtedness the excess benefit shall be payable to the person otherwise contractually
or legally entitled thereto; if there be no person determined to be so entitled,
such excess shall be paid to the estate of the insured person.
(6) Notwithstanding the provisions of the above paragraphs, insurance
on agricultural credit transaction commitments may be written up to the
amount of the loan commitment on a non-decreasing or level term plan. Insurance
on educational credit transaction commitments may be written up to the amount
of the loan commitment less the amount of any repayments made on the loan.
(C) A policy issued to a labor union, or similar employee organization,
which shall be deemed to be the policyholder, to insure members of such
union or organization for the benefit of persons other than the union or
organization or any of its officials, representatives, or agents, subject
to the following requirements:
(1) The members eligible for insurance under the policy shall be all of
the members of the union or organization, or all of any class or classes thereof.
(2) The premium for the policy shall be paid either from funds of the
union or organization, or from the funds contributed by the insured members
specifically for their insurance, or from both. Except as provided in paragraph
(3) of this subsection (C), a policy on which no part of the premium is
to be derived from funds contributed by the insured members specifically
for their insurance must insure all eligible members, except those who reject
such coverage in writing.
(3) An insurer may exclude or limit the coverage on any person as to whom
evidence of individual insurability is not satisfactory to the insurer.
(D) A policy issued to a trust or to the trustees of a fund established
by two or more employers, or by one or more labor unions or similar employee
organizations, or by one or more employers and one or more labor unions
or similar employee organizations, which trust or trustees shall be deemed
the policyholder, to insure employees of the employers or members of the
unions or organizations for the benefit of persons other than the employers
or the unions or organizations, subject to the following requirements:
(1) The persons eligible for insurance shall be all employees of the employers
or all of the members of the unions or organizations, or all of any class
or classes thereof. The policy may provide that the term "employees" shall
include retired employees, the individual proprietor or partners if an employer
is an individual proprietorship or a partnership, and directors of a corporate
employer. The policy may provide that the term "employees" shall include
the trustees or their employees, or both, if their duties are principally
connected with such trusteeship.
(2) The premium for the policy shall be paid from funds contributed by
the employer or employers of the insured persons, or by the union or unions
or similar employee organizations, or by both, or from funds contributed
by the insured persons or from both the insured persons and the employer
or union or similar employee organizations. Except as provided in paragraph
(3) of this subsection
(D), a policy on which no part of the premium is to be derived from funds
contributed by the insured persons
specifically for their insurance must insure all eligible persons, except
those who reject such coverage in writing.
(3) An insurer may exclude or limit the coverage on any person as to whom
evidence of individual insurability is not satisfactory to the insurer.
(E) A policy issued to an association or to a trust or to the trustees
of a fund established, created, or maintained for the benefit of members
of one or more associations. The association or associations shall have
at the outset a minimum of 100 persons; shall have been organized and maintained
in good faith for purposes other than that of obtaining insurance; shall
have been in active existence for at least two years; and shall have a constitution
and by-laws which provides that (i) the association or associations hold
regular meetings not less than annually to further purposes of the members,
(ii) except for credit unions, the association or associations collect dues
or solicit contributions from members, and (iii) the members have voting
privileges and representation on the governing board and committees. The
policy shall be subject to the following requirements:
(1) The policy may insure members of such association or associations,
employees thereof or employees of members, or one or more of the preceding
or all of any class or classes thereof for the benefit of persons other
than the employee's employer.
(2) The premium for the policy shall be paid from funds contributed by
the association or associations, or by employer members, or by both, or
from funds contributed by the covered persons or from both the covered persons
and the association, associations, or employer members.
(3) Except as provided in paragraph (4) of this subsection (E), a policy
on which no part of the premium is to be derived from funds contributed
by the covered persons specifically for the insurance must insure all eligible
persons, except those who reject such coverage in writing.
(4) An insurer may exclude or limit the coverage of any person as to whom
evidence of individual insurability is not satisfactory to the insurer.
(Source: P.A. 83-1465.)
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(215 ILCS 5/230.2) (from Ch. 73, par. 842.2)
Sec. 230.2.
Limits of Group Life Insurance.
Group life insurance offered
to a resident of this State under a group life insurance policy issued to
a group other than one described in Section 230.1 shall be subject to the
following requirements:
(A) No such group life insurance policy shall be delivered in this State
unless the Director finds that:
(1) The issuance of such group policy is not contrary to the best interest
of the public;
(2) The issuance of the group policy would be actuarially sound;
(3) The issuance of the group policy would result in economies of acquisition
or administration; and
(4) The benefits are reasonable in relation to the premiums charged.
(B) No such group life insurance coverage may be offered in this State
by an insurer under a policy issued in another State unless this State or
another State having requirements substantially similar to those contained
in subsection (A) of this Section has made a determination that such requirements
have been met.
(C) The premium for the policy shall be paid either from the policyholder's
funds or from funds contributed by the covered persons, or from both.
(D) An insurer may exclude or limit coverage on any person as to whom
evidence of individual insurability is not satisfactory to the insurer.
(Source: P.A. 83-598.)
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(215 ILCS 5/230.3) (from Ch. 73, par. 842.3)
Sec. 230.3.
Dependent Group Life Insurance.
Except for a policy issued
under subsection (B) of Section 230.1, a group life insurance policy may
be extended to insure the employees or members against loss due to the death
of their spouses and dependent children, or any class or classes thereof,
subject to the following:
(A) The premium for the insurance shall be paid either from funds
contributed by the employer, union, association, or other person to whom the
policy has been issued, or from funds contributed by the covered persons, or
from both. Except as provided in subsection (B) of this Section, a policy on
which no part of the premium for the spouse's and dependent child's coverage is
to be derived from funds contributed by the covered persons must insure all
eligible employees or members with respect to their spouses and dependent
children, or any class or classes thereof.
(B) An insurer may exclude or limit the coverage on any spouse or dependent
child as to whom evidence of individual insurability is not satisfactory to the
insurer.
(C) The amount of insurance for any covered spouse or dependent child under
the policy may not exceed 100% of the amount of insurance for which the
employee or member is insured.
(Source: P.A. 88-400.)
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(215 ILCS 5/231.1) (from Ch. 73, par. 843.1)
Sec. 231.1. Group Life Insurance Standard Provision. No policy of group
life insurance shall be delivered in this State unless it contains in substance
the following provisions, or provisions which in the opinion of the Director
are more favorable to the persons insured, or at least as favorable to the
persons insured and more favorable to the policyholder, provided, however,
(a) that provisions (F) to (K) inclusive shall not apply to policies insuring
the lives of debtors; (b) that the standard provisions
required for individual life insurance policies shall not apply to group
life insurance policies; and (c) that if the group life insurance policy
is on a plan of insurance other than the term plan, it shall contain a nonforfeiture
provision which in the opinion of the Director is equitable to the insured
persons and to the policyholder, but nothing herein shall be construed to
require that group life insurance policies contain the same nonforfeiture
provisions as are required for individual life insurance policies:
(A) A provision that the policyholder is entitled to a grace period of
31 days for the payment of any premium due except the first, during which
grace period the death benefit coverage shall continue in force, unless
the policyholder shall have given the insurer written notice of discontinuance
in advance of the date of discontinuance and in accordance with the terms
of the policy. The policy may provide that the policyholder shall be liable
to the insurer for the payment of a pro rata premium for the time the policy
was in force during such grace period.
(B) A provision that validity of the policy shall not be contested, except
for nonpayment of premiums, after it has been in force for two years from
its date of issue; and that no statement made by any person insured under
the policy relating to his insurability shall be used in contesting the
validity of the insurance with respect to which such statement was made
after such insurance has been in force prior to the contest for a period
of two years during such person's lifetime nor unless it is contained in
a written instrument signed by him; provided, however, that no such provision
shall preclude the assertion at any time of defenses based upon provisions
in the policy which relate to eligibility for coverage.
(C) A provision that a copy of the application, if any, of the policyholder
shall be attached to the policy when issued, and that all statements made by
the policyholder shall be deemed representations and not warranties, and
that no statement made by any person insured shall be used in any contest
unless a copy of the instrument containing the statement
is or has been furnished to such person or, in the event of death or incapacity
of the insured person, to his beneficiary or personal representative.
(D) A provision setting forth the conditions, if any, under which the
insurer reserves the right to require a person eligible for insurance to
furnish evidence of individual insurability satisfactory to the insurer
as a condition to part or all of his coverage.
(E) A provision specifying an equitable adjustment of premiums or of benefits
or of both to be made in the event the age of a person insured has been
misstated, such provision to contain a clear statement of the method of
adjustment to be made.
(F) A provision that any sum becoming due by reason of the death of the
person insured shall be payable to the beneficiary designated by the person
insured, except that where the policy contains conditions pertaining to
family status the beneficiary may be the family member specified by the
policy terms, subject to the provisions of the policy in the event there
is no designated beneficiary, as to all or any part of such sum, living
at the death of the person insured, and subject to any right reserved by
the insurer in the policy and set forth in the certificate to pay at its
option a part of such sum not exceeding $2,000 to any person appearing to
the insurer to be equitably entitled thereto by reason of having incurred
funeral or other expenses incident to the last illness or death of the person insured.
(G) A provision that the insurer will issue to the policyholder for delivery
to each person insured a certificate setting forth a statement as to the
insurance protection to which he is entitled, to whom the insurance benefits
are payable, a statement as to any dependent's coverage included in such
certificate, and the rights and conditions set forth in provisions (H),
(I), (J) and (K) following.
(H) A provision that if the insurance, or any portion of it, on a person
covered under the policy or on the dependent of a person covered, ceases
because of termination of employment or of membership in the class or classes
eligible for coverage under the policy, such person shall be entitled to
have issued to him by the insurer, without evidence of insurability, an
individual policy of life insurance without disability or other supplementary
benefits, unless such right to convert such coverage was provided for
in the group policy and is applied for in the application for conversion,
provided that an application for the individual policy shall be made,
and the first premium paid to the insurer, within 31 days after such termination,
and provided further that:
(1) the individual policy may, at the option of such | ||
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(2) the individual policy shall be in an amount equal | ||
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(3) the premium on the individual policy shall be at | ||
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(4) If any individual insured under a group life | ||
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Subject to the same conditions set forth above the conversion privilege
shall be available (i) to a surviving dependent, if any, at the death of
the employee or member, with respect to the coverage under the group policy
which terminates by reason of such death and (ii) to the dependent of the
employee or member upon termination of coverage of the dependent, while
the employee or member remains under the group policy, by reason of the
dependent ceasing to be a qualified family member under the group policy.
(I) A provision, except in the case of a policy described in paragraph
(B) of Section 230.1, that the termination of the employment of an employee
or the membership of a member shall not terminate the insurance of such
employee or member under the group policy until the expiration of such period
for which the premium for such employee or member has been paid, not exceeding 31 days.
(J) A provision that from time to time all new employees or members eligible
for insurance and desiring the same shall be added to the group or class
thereof originally insured.
(K) A provision that if the group policy terminates or is
amended so as to terminate the insurance of any class of insured persons,
every person insured thereunder at the date of such termination whose insurance
terminates, including the insured dependent of a covered person, and who
has been so insured for at least five years prior to such termination date shall be
entitled to have issued by the insurer an individual policy of life insurance,
subject to the same conditions and limitations as are provided by provision
(H) above, except that the group policy may provide that the amount of such
individual policy shall not exceed the smaller of (a) the amount of the
person's life insurance protection ceasing because of the termination or amendment of
the group policy, less the amount of any life insurance for which he is
or becomes eligible under a group policy issued or reinstated by the same
or another insurer within 31 days after such termination, or (b) $10,000.
(L) A provision that if a person insured under the group policy, or the
insured dependent of a covered person, dies during the period within which
the individual would have been entitled to have an individual policy issued
in accordance with provisions (H) or (I) above and before such an individual
policy shall have become effective, the amount of life insurance which he
would have been entitled to have issued under such individual policy shall
be payable as a claim under the group policy, whether or not application
for the individual policy or the payment of the first premium therefor has been made.
(M) If active employment is a condition of insurance, a provision
that an insured may continue coverage during the insured's total disability
by timely payment to the policyholder of that portion, if any, of the premium
that would have been required from the insured had total disability not
occurred. The continuation shall be on a premium paying basis for a period
of six months from the date on which the total disability started, but not
beyond the earlier of (a) approval by the insurer of continuation of the
coverage under any disability provision which the group insurance policy
may contain or (b) the discontinuance of the group insurance policy.
(N) If active employment is a condition of insurance, in the case of a policy of group life insurance replacing another policy of group life insurance in force with another insurance carrier immediately prior to the effective date of the new policy, a provision preventing loss of coverage, subject to premium payments, for those active employees who are not actively at work on the effective date of the new policy if the following conditions are met: (1) the active employee was insured under the prior | ||
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(2) the active employee is not actively at work on | ||
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(3) the active employee is a member of an eligible | ||
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(4) the active employee is not receiving or | ||
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(O) If active employment is a condition of insurance, a provision that for active employees receiving or eligible to receive benefits under provision (N) the continued coverage will remain in effect until the earliest of the following: (1) the date the employee returns to active work; (2) the date that coverage under the prior | ||
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(3) the date that coverage would otherwise end | ||
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(4) a date no less than 6 months after the | ||
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(5) the date the employee is covered or is eligible | ||
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(P) If active employment is a condition of insurance, a provision that the replacing carrier's obligations under provisions (N) and (O) may be limited to the amount for which the employee was covered under the prior carrier's group life insurance policy and may be reduced by any amounts payable under the prior carrier's group life insurance policy. (Q) In the case of a policy insuring the lives of debtors,
a provision that the insurer will furnish to the policyholder for delivery
to each debtor insured under the policy a certificate of insurance describing
the coverage and specifying that the death benefit shall first be applied
to reduce or extinguish the indebtedness. Whenever the amount of insurance
payable exceeds the amount of outstanding indebtedness the excess benefit
shall be payable to the person otherwise contractually or legally entitled
thereto; if there be no person determined to be so entitled, such excess
shall be paid to the estate of the insured person.
(Source: P.A. 102-367, eff. 1-1-22; 102-743, eff. 5-6-22.)
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(215 ILCS 5/232) (from Ch. 73, par. 844)
Sec. 232.
Extension
of time and modification of standard provisions.
(1) Any company authorized to transact business in this State on the
effective date of this Code may continue to issue policies and contracts of
the kind or kinds it was permitted to issue immediately prior to such
effective date, until December 31, 1937.
(2) Policies and contracts may be issued and delivered in this State
which contain provisions more favorable to the holders of such policies or
contracts than the standard provisions required by this article. No
domestic company and holder of a policy or contract shall after the
effective date of this Code enter into any agreement to waive or modify in
whole or in part a standard provision required by this Code or any prior
law of this State, for the benefit of such holder, unless the agreement be
approved by a court in a proceeding under Article XIII.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/233) (from Ch. 73, par. 845)
Sec. 233.
Participating and non-participating policies.
After the calendar year during which this Code becomes effective, no
life company authorized to do business in this State shall issue both
participating and non-participating policies unless at least ninety per
centum of the profits on its participating policies shall inure to the
benefit of the participating policyholders. Any company having in force
both participating and non-participating policies shall keep a separate
accounting for each class of business and shall make and include in the
annual statement to be filed with the Director each year a separate
statement showing the gains, losses and expenses properly attributable to
each of such classes and also showing the manner in which any general
outlay of expense of the company has been apportioned to each except that
this provision shall not apply to any company in which ninety per centum or
more of the business in force is either participating or non-participating.
This section shall not apply to business done by such life company outside
this state, nor to paid-up, or temporary insurance or pure endowment
benefits issued or granted pursuant to the non-forfeiture provision
prescribed in clause (g) of sub-section (1) of Section 224 nor to
annuities or policies of reinsurance.
(Source: Laws 1957, p. 607.)
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(215 ILCS 5/234) (from Ch. 73, par. 846)
Sec. 234.
Notice of
premium required.
(1) No life company doing business in this State shall declare any
policy forfeited or lapsed within six months after default in payment of
any premium installment or interest or any portion thereof, nor shall any
such policy be forfeited or lapsed by reason of nonpayment when due of any
premium, installment or interest, or any portion thereof, required by the
terms of the policy to be paid, within six months from the default in
payment of such premium, installment or interest, unless a written or
printed notice stating the amount of such premium, installment, interest or
portion thereof due on such policy, the place where it shall be paid and
the person to whom the same is payable, shall have been duly addressed and
mailed with the required postage affixed, to the person whose life is
insured, or the assignee of the policy, (if notice of the assignment has
been given to the company) at his last known post office address, at least
fifteen days and not more than forty-five days prior to the day when the
same is due and payable, before the beginning of the period of grace,
except that in any case in which a parent insures the life of his minor
child, the company may send notice of premium due to the parent. Such
notice shall also state that unless such premium or other sums due shall be
paid to the company or its agents the policy and all payments thereon will
become forfeited and void, except as to the right to a surrender value or
paid-up policy as provided for by the policy. The affidavit of any officer,
clerk or agent of the company or of any one authorized to mail such notice
that the notice required by this section bearing the required postage has
been duly addressed and mailed shall be presumptive evidence that such
notice has been duly given.
(2) This section shall not apply to cancellable accident and health
policies which are renewable at the option of the company nor shall it
apply to group policies, industrial life policies, or to any policies upon
which premiums are payable monthly or at shorter intervals.
(Source: Laws 1961, p. 3852.)
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(215 ILCS 5/234.1) (from Ch. 73, par. 846.1)
Sec. 234.1.
(Notice of the Enactment of a Non-Forfeiture Option.) No life
company doing business in this State may enact a non-forfeiture option,
unless a notice is given to the policyowner which explains this action and
refers the policyowner to the other available options, if any, under the
provisions of the policy. Evidence of this notice shall be maintained by the insurer.
(Source: P.A. 80-566.)
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(215 ILCS 5/235) (from Ch. 73, par. 847)
Sec. 235.
Extension
of time for payment of life premium.
A life company may enter into subsequent agreements in writing with the
insured, which need not be attached to the policy, to extend the time for
the payment of any premium or part thereof, upon condition that failure to
comply with the terms of such agreement shall cause the policy to lapse as
provided in said agreement or in the policy. Subject to such lien as may be
created to secure any indebtedness contracted by the insured in
consideration of the extension, such agreement shall not impair any right
existing under the policy.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/235.1) Sec. 235.1. Notice of cancellation; secondary addressee. (a) A life company issuing an individual life insurance contract on or after January 1, 2022 shall notify an applicant, in writing on a form prescribed by the company at the time of application for the policy, of the applicant's right to designate a secondary addressee to receive notice of cancellation of the policy based on nonpayment of premium. The applicant may make such designation at the time of application for such policy or at any time such policy is in force by submitting a written notice to the insurer containing the name and address of the secondary addressee. (b) The insurer's transmission to a secondary addressee of a copy of a notice of cancellation based on nonpayment of premium shall be in addition to the transmission of the original document to the policyholder. The copy of the notice of cancellation transmitted to the secondary addressee shall be made in the same manner and form required for the transmission of the notice to the policyholder. (c) The designation of a secondary addressee shall not constitute acceptance of any liability on the part of the secondary addressee or insurer for services provided to the policyholder. (d) This Section does not apply to any individual life insurance contract under which premiums are payable monthly or more frequently and are regularly collected by a licensed agent or are paid by credit card or any preauthorized check processing or automatic debit service of a financial institution. (e) Nothing in this Section shall prohibit an applicant or policyholder from designating a life insurance agent of record as his or her secondary addressee.
(Source: P.A. 102-542, eff. 1-1-22.) |
(215 ILCS 5/236) (from Ch. 73, par. 848)
Sec. 236. Discrimination prohibited.
(a) No life company doing business in this State shall make or permit any
distinction or discrimination in favor of individuals among insured
persons of the same class and equal expectation of life in the issuance
of its policies, in the amount of
payment of premiums or rates charged for policies of insurance, in the
amount of any dividends or other benefits payable thereon, or in any
other of the terms and conditions of the contracts it makes.
(b) No life company shall make or permit any distinction or discrimination
against individuals
with disabilities in
the amount of payment
of premiums or rates charged for policies of life insurance, in the amount
of any dividends or death benefits payable thereon, or in any other terms
and conditions of the contract it makes unless the rate differential is
based on sound actuarial principles and a reasonable system of classification
and is related to actual or reasonably anticipated experience directly
associated with the disability.
(c) No life company shall refuse to insure, or refuse to continue to insure,
or limit the amount or extent or kind of coverage available to an
individual, or charge an individual a different rate for the same coverage
solely because of blindness or partial blindness. With respect to all
other conditions, including the underlying cause of the blindness or
partial blindness, persons who are blind or partially blind shall be
subject to the same standards of sound actuarial principles or actual or
reasonably anticipated experience as are sighted persons. Refusal to
insure includes denial by an insurer of disability insurance coverage on
the grounds that the policy defines "disability" as being presumed in the
event that the insured loses his or her eyesight. However, an insurer may
exclude from coverage disabilities consisting solely of blindness or
partial blindness when such condition existed at the time the policy was issued.
(d) No life company shall refuse to insure or to continue to insure an
individual solely because of the individual's status as a member of the
United States Air Force, Army, Coast Guard, Marines, or Navy or solely because
of the individual's status as a member
of the National Guard or Armed Forces Reserve.
(e) An insurer or producer authorized to issue policies of insurance in this State may not make a distinction or otherwise discriminate between persons, reject an applicant, cancel a policy, or demand or require a higher rate of premium for reasons based solely upon an applicant's or insured's past lawful travel experiences or future lawful travel plans. This subsection (e) does not prohibit an insurer or producer from excluding or limiting coverage under a policy or refusing to offer the policy based upon past lawful travel or future lawful travel plans or from charging a different rate for that coverage when that action is based upon sound actuarial principles or is related to actual or reasonably expected experience and is not based solely on the destination's inclusion on the United States Department of State's travel warning list.(Source: P.A. 99-143, eff. 7-27-15.)
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(215 ILCS 5/237) (from Ch. 73, par. 849)
Sec. 237.
Illegal inducements - Penalty.
No life company authorized to do business in this State shall issue
or deliver in this State or permit its agents, officers or employees to
issue or deliver in this State as an inducement to insurance or in
connection therewith, any agency company shares or other capital shares,
benefit certificates or shares in any common law corporation, securities
of any special or advisory board, or other contracts of any kind
promising returns and profits as an inducement to insurance; and no life
company shall be authorized to do business in this State which issues or
permits its agents, officers or employees to issue in this State or in
any other state, agency company shares or other capital shares or
benefit certificates or shares in any common law corporation or
securities of any special advisory board or other contracts of any kind
promising returns and profits as an inducement to insurance; and no
corporation acting as an agent of a life company, or any of its agents,
officers or employees shall be permitted to sell, agree or offer to
sell, or give or offer to give directly or indirectly, in any manner
whatsoever, as an inducement to insurance or in connection therewith,
any shares, securities, bonds or agreements of any form or nature
promising returns and profits as an inducement to insurance or in
connection therewith. It shall be the duty of the Director upon due
proof after notice and hearing to revoke the certificate of authority of
any company or the license of any agent so offending, or suspend such
license or certificate of authority 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 five hundred dollars, 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 or certificate of authority of such insurance company or agent
for any period of time up to, but not exceeding a period of, two years
if he finds that any such company or agent thereof has violated any of
the provisions of this section.
(Source: Laws 1957, p. 1530.)
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(215 ILCS 5/238) (from Ch. 73, par. 850)
Sec. 238. Exemption.
(a) All proceeds payable because of the death of the insured and the
aggregate net cash value of any or all life and endowment policies and
annuity contracts payable to a wife or husband of the insured, or to a
child, parent or other person dependent upon the insured, whether the power
to change the beneficiary is reserved to the insured or not, and whether
the insured or his estate is a contingent beneficiary or not, shall be
exempt from execution, attachment, garnishment or other process, for the
debts or liabilities of the insured incurred subsequent to the effective
date of this Code, except as to premiums paid in fraud of creditors within
the period limited by law for the recovery thereof.
(b) Any insurance company doing business
in this State and governed by this Code shall encumber or surrender
accounts as defined in Section 10-24 of the Illinois Public Aid Code held by
the insurance company owned by any responsible relative who is subject to a
child support lien, upon notice of the lien or levy by the Department of Healthcare and Family Services
(formerly Illinois Department
of Public Aid) or its successor agency
pursuant to Section 10-25.5 of the Illinois Public Aid Code, or upon
notice of interstate lien from any other state's agency responsible for
implementing the child support enforcement program set forth in Title IV, Part
D of the
Social Security Act.
This Section does not prohibit the furnishing of information in accordance
with the federal Personal Responsibility and Work Opportunity Reconciliation
Act of 1996. Any insurance company governed by this Code shall enter into an
agreement for data exchanges with the Department of Healthcare and Family Services provided the
Department of Healthcare and Family Services
pays to the insurance company a reasonable fee not to exceed its
actual cost incurred. An insurance company providing
information in accordance with this item shall not be liable to any owner of an
account as defined in Section 10-24 of the Illinois Public Aid Code or other
person for any disclosure of information to the Department of Healthcare and Family Services (formerly
Department of Public Aid), for
encumbering or surrendering any accounts as defined in Section 10-24 of the
Illinois Public Aid Code held by the insurance company
in response to a lien
or order to withhold and deliver issued by a State agency, or for any other
action taken pursuant to this item, including individual or mechanical errors,
provided the action does not constitute gross negligence or willful misconduct.
An insurance company shall have no obligation to hold, encumber, or
surrender any accounts as defined in Section 10-24 of the Illinois Public Aid
Code until
it has been served with a subpoena, summons, warrant, court or administrative
order, lien, or levy requiring that action.
(Source: P.A. 95-331, eff. 8-21-07.)
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(215 ILCS 5/238.1)
Sec. 238.1. Data exchanges;
administrative liens.
(a) Any insurance company
doing business in the State and governed by
this Code shall enter into an agreement for data exchanges
with the Department of Healthcare and Family Services
for the purpose of locating accounts as defined in Section 10-24 of the
Illinois Public Aid Code of responsible relatives to
satisfy past-due child support owed by responsible
relatives under an order for support entered by a court or
administrative body of this or any other State on behalf
of resident or non-resident persons.
(b) Notwithstanding any provisions in this Code to the
contrary, an insurance company shall not be liable to any person:
(1) for any disclosure of information to the | ||
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(2) for encumbering or surrendering any accounts as | ||
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(3) for any other action taken in good faith to | ||
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(Source: P.A. 95-331, eff. 8-21-07.)
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(215 ILCS 5/239) (from Ch. 73, par. 851)
Sec. 239.
Misrepresentations-Penalty.
No agent, examining physician, or other person shall knowingly or
wilfully make any false or fraudulent statement or representation in, or
with reference, to any application for life insurance, or shall make any
such statement or representation for the purpose of obtaining any fees,
commission, money or benefit from or in any life company. Any person who
violates any of the provisions of this section shall be guilty of a Class A
misdemeanor.
(Source: P.A. 77-2699.)
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(215 ILCS 5/240) (from Ch. 73, par. 852)
Sec. 240.
Premium
deposit reserve.
A life company may contract for or accept premium deposits, other than
premiums stated in the policy. The unused accumulation from such shall be
held and accounted for as a premium deposit reserve, and in such case the
policy or an endorsement thereon shall provide for the manner of
application of the premium deposit reserve to the payment of premiums in
default and for the disposition of such reserve if it is not sufficient to
pay the next premium. Such premium deposit reserve shall be available as an
addition to the loan and cash surrender values, shall be paid with other
benefits upon death or maturity of the policy, and shall be paid to the
insured whenever the cash surrender value with the premium deposit reserve
shall equal or exceed the original amount of insurance, but no part of the
premium deposit reserve may be paid to the insured during the continuance
of the policy except at such times or in such amounts as specified in the
policy or in endorsements thereon.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/241) (from Ch. 73, par. 853)
Sec. 241.
Trust
settlements.
Any domestic life company shall have the power to hold the proceeds of
any policy issued by it under a trust or other agreement upon such terms
and restrictions as to revocation by the policyholder and control by
beneficiaries, and with such exemptions from the claims of creditors of
beneficiaries other than the policyholder as shall have been agreed to in
writing by such company and the policyholder. Upon maturity of a policy in
the event the policyholder has made no such agreement, the company shall
have power to hold the proceeds of the policy under an agreement with the
beneficiaries. Such company shall not be required to segregate funds so
held but may hold them as part of its general company assets. A foreign or
alien company, when authorized by its charter or the laws of its domicile,
may exercise any such powers in this State.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/242) (from Ch. 73, par. 854)
Sec. 242.
Rights of
minors.
Any minor of the age of fifteen years or more may, notwithstanding such
minority, contract for life, 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 5/243) (from Ch. 73, par. 855)
Sec. 243.
Contingency reserves.
(1) Any domestic life company may accumulate and maintain in addition to
an amount equal to the net value of its participating policies computed
according to the standard adopted by it under section 223, a contingency
reserve not exceeding the following respective percentages of said net
values, to-wit:
(a) When said net values are less than one hundred thousand dollars,
twenty per centum thereof or the sum of ten thousand dollars, whichever is
the greater.
(b) When said net values are greater than one hundred thousand dollars
the percentage thereof measuring the contingency reserve shall decrease
one-half of one per centum for each one hundred thousand dollars of said
net values up to one million dollars; one-half of one per centum for each
additional one million dollars up to ten million dollars; one-half of one
per centum for each additional two million, five hundred thousand dollars
up to fifteen million dollars; and, if said net values equal or exceed the
last mentioned amount, the contingency reserve shall not exceed ten per
centum thereof.
(2) As the net values of said policies increase and the maximum
percentage measuring the contingency reserve decreases the company may
maintain any contingency reserve accumulated under this section, although
it may exceed the maximum percentage herein prescribed, but may not add to
the contingency reserve when the addition will bring it beyond the maximum
percentage.
(3) Nothing herein contained shall be construed to affect any existing
surplus or contingency reserves held by any such company except that
whenever the existing surplus and contingency reserves, exclusive of said
net values and of all accumulations held on account of existing deferred
dividend policies or groups of such policies, shall exceed the limit above
mentioned it shall not be entitled to maintain any additional contingency
reserve. However, for cause shown the Director may at any time and from
time to time permit any company to accumulate and maintain a contingency
reserve in excess of the limit above mentioned for a prescribed period not
exceeding one year under any one permission, by filing in his office a
decision stating his reasons therefor and causing the same to be published
in his next annual report.
(4) This section shall not be construed as preventing the accumulation
from the non-participating business of a contingency reserve for the
benefit of non-participating policies.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/244) (from Ch. 73, par. 856)
Sec. 244.
Limitation
of expenses for life companies.
(1) No life company authorized to do business in this State shall make
or incur acquisition expenses in any calendar year after the calendar year
during which this Code becomes effective amounting to more than the first
year's gross premiums nor shall such company make or incur renewal expenses
on policies issued after such year in any of the nine succeeding renewal
years following each year's new business in excess of 10% of the gross
renewal premiums, unless the company collects renewal premiums in person in
which case such renewal expense applicable to such policies for as long as
such premiums are collected in person shall not exceed 20%, except that
renewal expenses in excess of such 10% limitation relative to the 9
succeeding renewal years may be made or incurred if such excess in any year
be included with acquisition expenses made or incurred during that calendar
year. After the tenth policy year the annual maximum renewal expenses shall
not exceed 3% of such gross annual renewal premiums, unless the company
collects renewal premiums in person in which case such renewal expense
applicable to such policies for as long as such premiums are collected in
person shall not exceed 13%, but a company may pay renewal expenses after
the tenth policy year in excess of 3% if such excess is charged to the
renewal expense of that calendar year within the limitation provided
herein.
(2) In computing such acquisition expenses there shall be included all
commissions and other valuable considerations paid or payable to or for
agents, and other expenses made or incurred in acquiring new business,
except medical examination and inspection fees and the normal overhead
expenses of operation at the home office. In computing such renewal
expenses there shall be included commissions and other valuable
considerations paid or payable to or for agents, and all other expenses
made or incurred for the collection of such renewal premiums, except the
normal overhead expenses of operation at the home office.
(3) This Section shall not apply to accident and health or industrial
business written by any companies.
(Source: Laws 1967, p. 3359.)
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(215 ILCS 5/244.1) (from Ch. 73, par. 856.1)
Sec. 244.1.
Whenever the financial condition of any company transacting the kinds of
business authorized in Class 1 of Section 4, when reviewed in conjunction
with the kinds and nature of risks insured, the loss experience and
ownership of the company and the ratio of annual premium volume to the
incurred acquisition expenses, indicates a condition such that the
continued operation of the company might be hazardous to its policyholders,
creditors or the general public, then the Director may, after notice and
hearing, order the company to take such action as may be reasonably
necessary to rectify the existing condition, including but not necessarily
limited to one or more of the following steps:
(a) to reduce the loss exposure by reinsurance;
(b) to reduce the volume of new business being | ||
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(c) to reduce general or acquisition expenses by | ||
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(d) to suspend the writing of new business for a | ||
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(e) to increase the company's surplus by a | ||
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(Source: P.A. 77-1514.)
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(215 ILCS 5/245) (from Ch. 73, par. 857)
Sec. 245.
Salaries; pensions.
(1) No domestic life company shall directly or indirectly pay any
salary, compensation or emolument to any officer, trustee or director
thereof, or any salary, compensation or emolument amounting in any year
to more than $200,000 to any person, firm or corporation,
unless such
payment be first authorized by a vote of the board of directors of such
company, which vote shall be duly recorded in the records of the
company. No such domestic life company shall make any agreement with any
of its officers, trustees or salaried employees whereby it agrees that
for any services rendered or to be rendered he shall receive any salary,
compensation or emolument, directly or indirectly, that will extend
beyond a period of three years from the date of such agreement except
that payment of an amount not in excess of 20% of the salary of any of
its officers, trustees, or salaried employees may by written agreement
be deferred beyond such period of three years, which agreement may
include conditions to be met by such officer, trustee, or salaried
employee before payment will be made. The limitation as to time
contained herein shall not apply to a contract for renewal commissions
with any such officer, trustee or salaried employee who is also an agent
of the company nor shall such limitation be construed as preventing a
domestic company from entering into contracts with its agents for the
payment of renewal commissions.
(2) No such life company shall grant any pension to any officer,
director or trustee thereof or to any member of his family after his
death except that it may provide a pension pursuant to the terms of the
uniform retirement plan adopted by the board of directors and for any person
who is or has been a salaried officer or
employee of such company and who may retire by reason of age or
disability.
(3) No such company shall hereafter create or establish any account
or fund for the purpose of promoting the health or welfare of its
employees except from annual accretions to earned surplus computed in
the manner provided by this Code. Contributions to such fund by any
company in any calendar year shall not exceed 15% of the accretion to
earned surplus in such calendar year. Before such account or fund shall
be established, maintained or operated, the plan for such account or
fund and its method of operation shall be approved by the board of
directors of the company, and submitted to the shareholders in the case
of a stock company, or members in the case of a mutual company, at a
special meeting called for the purpose of considering such plan.
Contributions to the fund from sources other than the company may be
provided for in the operation of the plan. No amount held in such fund
or account whether contributed by the company or from any other source
shall be considered an admitted asset as defined in this Code, nor
considered in determining the solvency of such company, nor be subject to
the provisions of this Code.
(Source: P.A. 91-549, eff. 8-14-99.)
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(215 ILCS 5/245.1) (from Ch. 73, par. 857.1)
Sec. 245.1. Assignability of life insurance.
No provision of the Illinois Insurance Code, or any other law prohibits
an insured under any policy of life 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 thereunder and to have
an individual policy issued in accordance with paragraphs (G), (H), and (K) of Section 231.1 of the Illinois Insurance Code. 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 in
accordance with paragraphs (d) and (g) of Section 231 before receipt of
notice of the assignment. This amendatory Act of 1969 acknowledges,
declares and codifies the existing right of assignment of interests under
life insurance policies.
(Source: P.A. 98-969, eff. 1-1-15.)
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(215 ILCS 5/245.2) (from Ch. 73, par. 857.2)
Sec. 245.2.
Not-for-profit organizations; beneficiary of insurance on
member's life. Members of not-for-profit organizations that are exempt
from taxation as described in paragraph (3), (4), (5), (9), or (10) of
subsection (c) of Section 501 of the Internal Revenue Code or either past
or present individual or family donors to a not-for-profit organization
may obtain life insurance policies naming the not-for-profit organization
as the irrevocable sole beneficiary of the policy. The not-for-profit
organization, as the sole beneficiary of the policy, may continue to pay
the premiums to the issuing insurance company where the donor discontinues
the premium payments and continuance of the policy is a prudent investment.
(Source: P.A. 87-770.)
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(215 ILCS 5/245.3) Sec. 245.3. Irrevocable assignment of life insurance to a funeral home. An insured or any other person who may be the owner of rights under a policy of life insurance may make an irrevocable assignment of all or a part of his or her rights under the policy to a funeral home in accordance with Section 2b of the Illinois Funeral or Burial Funds Act. Subject to the terms of the policy or a contract relating to the policy, including, but not limited to, a prepaid funeral or burial contract, an irrevocable assignment by an insured or other owner of rights under a policy made before or after the effective date of this amendatory Act of the 102nd General Assembly is valid for the purpose of vesting in the assignee, in accordance with the policy or contract as to the time at which it is effective, all rights assigned. That irrevocable assignment is, however, without prejudice to the company on account of any payment it makes. The insurance company shall within 15 business days notify the funeral home and owner of the policy of its receipt of the form. A policy owner who executes a designation of beneficiary form pursuant to Section 2b of the Illinois Funeral or Burial Funds Act also irrevocably waives and cannot exercise the following rights: (1) The right to collect from the insurance company | ||
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(2) The right to surrender the policy and receive the | ||
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(3) The right to obtain a policy loan. (4) The right to designate as primary beneficiary of | ||
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(5) The right to collect or receive income, | ||
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This amendatory Act of the 102nd General Assembly acknowledges, declares, and codifies the existing right of assignment of interests under life insurance policies.
(Source: P.A. 102-959, eff. 5-27-22.) |
(215 ILCS 5/Art. XIV.5 heading) ARTICLE XIV 1/2.
SEPARATE ACCOUNTS
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(215 ILCS 5/245.21) (from Ch. 73, par. 857.21)
Sec. 245.21. Establishment of separate accounts by domestic companies
organized to do a life, annuity, or accident and health insurance business. A
domestic company, including for the purposes of this
Article all domestic fraternal benefit
societies, may, for authorized
classes of insurance, establish one or more
separate accounts, and may allocate thereto amounts (including without
limitation proceeds applied under optional modes of settlement or under
dividend options) to provide for life, annuity, or accident and health
insurance (and benefits
incidental thereto), payable in fixed or variable amounts or both, subject
to the following:
(1) The income, gains and losses, realized or | ||
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(2) Except as may be provided with respect to | ||
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(3) Except with the approval of the Director and | ||
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(4) Unless otherwise approved by the Director, assets | ||
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(5) Amounts allocated to a separate account under | ||
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(6) No sale, exchange or other transfer of assets may | ||
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(7) To the extent a company considers it necessary to | ||
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(Source: P.A. 98-39, eff. 6-28-13.)
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(215 ILCS 5/245.22) (from Ch. 73, par. 857.22)
Sec. 245.22.
Any contract providing benefits payable in variable amounts delivered or
issued for delivery in this State must contain a statement of the essential
features of the procedures to be followed by the insurance company in
determining the dollar amount of the variable benefits. Any such contract
under which the benefits vary to reflect investment experience, including a
group contract and any certificate in evidence of variable benefits issued
thereunder, must state that such dollar amount will so vary and must
contain on its first page a statement to the effect that the benefits
thereunder are on a variable basis.
(Source: P.A. 77-1572.)
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(215 ILCS 5/245.23) (from Ch. 73, par. 857.23)
Sec. 245.23.
No company may deliver or issue for delivery within this State variable
contracts unless it is authorized or organized to do a
life, annuity, or accident and health insurance business in this State, and the Director is satisfied that its
condition or method of operation in connection with the issuance of such
contracts will not render its operation hazardous to the public or its
policyholders in this State. In this connection, the Director may consider
among other things:
(a) The history and financial condition of the company;
(b) The character, responsibility and fitness of the officers and
directors of the company; and
(c) The law and regulation under which the company is authorized in its
state of domicile to issue variable contracts.
If the company is a subsidiary of an authorized insurance
company, or
affiliated with such a company through common management or ownership, it
may be deemed by the Director to have met the requirements of this Section
if either it or the parent or the affiliated company meets the requirements
of this Section.
(Source: P.A. 90-381, eff. 8-14-97.)
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(215 ILCS 5/245.24) (from Ch. 73, par. 857.24)
Sec. 245.24.
Notwithstanding any other provision of law, the Director has sole
authority to regulate the issuance and sale of variable contracts, and to
promulgate such reasonable rules and regulations as may be appropriate to
carry out the purposes and provisions of this Article.
(Source: P.A. 77-1572.)
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(215 ILCS 5/245.25) (from Ch. 73, par. 857.25)
Sec. 245.25.
Except for subparagraphs (1)(a), (1)(f), (1)(g) and (3) of
Section
226 of the Illinois Insurance Code, in the case of a variable annuity
contract and subparagraphs (1)(b), (1)(f), (1)(g), (1)(h), (1)(i), and
(1)(k) of Section 224, subparagraph (1)(c) of Section 225, and
subparagraph (h) of Section 231 in the case of a variable life insurance
policy, except for Sections 357.4, 357.5, 367e, and 367e.1 in the
case of a variable
health insurance policy, and except as otherwise provided in this Article,
all pertinent
provisions of the Illinois Insurance Code which are appropriate to those
contracts apply to separate accounts and
contracts relating thereto. Any individual variable life insurance
contract, delivered or issued for delivery in this State, must contain
grace, reinstatement and non-forfeiture provisions appropriate to such a
contract. Any individual variable annuity contract, delivered or issued for
delivery in this State, must contain grace and reinstatement provisions
appropriate to such a contract. Any group variable life insurance contract,
delivered or issued for delivery in this State, must contain a grace
provision appropriate to such a contract. A group variable health insurance
contract delivered or issued for delivery in this State must contain a
continuation of group coverage provision appropriate to the contract. The
reserve liability for
variable contracts must be established in accordance with actuarial
procedures that recognize the variable nature of the benefits provided and
any mortality guarantees.
(Source: P.A. 93-477, eff. 1-1-04.)
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(215 ILCS 5/245.60) (from Ch. 73, par. 857.60)
Sec. 245.60.
Whenever the Director finds that there has been a violation of
this Article or of any rules or regulations issued pertaining thereto, and
after written notice thereof and hearing given to the company or other
person authorized or licensed by the Director, he shall set forth his
findings, together with an order for compliance by a specific date. Such
order shall be binding on the company and other persons authorized or
licensed by the Director on the date specified unless sooner withdrawn by
the Director or a stay thereof has been ordered by a court of competent
jurisdiction.
(Source: Laws 1963, p. 1137.)
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(215 ILCS 5/245.61) (from Ch. 73, par. 857.61)
Sec. 245.61.
(Repealed).
(Source: Laws 1963, p. 1137. Repealed by P.A. 90-381, eff. 8-14-97.)
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(215 ILCS 5/245.62) (from Ch. 73, par. 857.62)
Sec. 245.62.
(Repealed).
(Source: P.A. 77-1572. Repealed by P.A. 90-381, eff. 8-14-97.)
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(215 ILCS 5/Art. XV heading) ARTICLE XV.
REGISTRATION OF POLICIES
AND DEPOSIT OF RESERVES
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(215 ILCS 5/246) (from Ch. 73, par. 858)
Sec. 246.
Scope of
article.
This article shall apply to companies that issued the policies or
annuity bonds, and to the policies or annuity bonds, referred to in an Act
entitled: "An Act to provide for the deposit of reserve and the
registration of policies and annuity bonds by life insurance companies of
this State," approved April 18, 1899. Such policies or annuity bonds are
referred to in this article as "policies."
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/247) (from Ch. 73, par. 859)
Sec. 247.
Deposit of
reserves on registered policies.
Any company heretofore making deposits and registering policies pursuant
to the act mentioned in section 246 shall keep and maintain such deposit
with the Director in securities which are authorized for investment by life
insurance companies under this Code. Certificates of purchase acquired by
any company through foreclosure proceedings instituted by it upon mortgages
in which its funds have been lawfully invested, and duly recorded
conveyances of unencumbered improved real estate lawfully acquired by any
company, accompanied by satisfactory evidence of ownership thereof shall
likewise be eligible for deposit. The Director shall hold the title to such
real estate so conveyed to him in trust until other satisfactory securities
in lieu thereof have been deposited with him whereupon he shall reconvey
the same to such company. The Director may cause such real estate to be
valued and the company shall pay the reasonable expenses incurred in such
valuation.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/248) (from Ch. 73, par. 860)
Sec. 248.
Registration of new policies prohibited.
After the effective date of this Code the Director shall not register
any new policies that are issued by any company, nor accept any deposits
covering reserves on business thereafter written.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/249) (from Ch. 73, par. 861)
Sec. 249.
Valuation of registered policies.
The Director shall keep such a record of the policies that have been
issued pursuant to the act mentioned in section 246 as to enable him to
compute their value at any time. Upon written proof attested by the
president or vice-president and secretary of the company which shall have
issued such policies that any of them have been commuted or terminated, the
Director shall indicate such commutation or cancellation upon such record.
The reserve value of all policies, according to the standard prescribed in
this Code for the valuation of policies of life insurance companies, when
the first premium shall have been paid thereon, less the amount of any
liens, (as set forth in a statement showing kind, nature and amount,
attested by the president or vice-president and secretary of the company
issuing the policies against which such liens exist) not exceeding such
value as the company may have against such policies shall be entered in the
record aforesaid at the time such record is made. On the first day of
January of each year, or within sixty days thereafter, the Director shall
cause the registered policies of each company to be carefully revalued, and
the reserve value thereof at the time fixed for such valuation, less any
liens, (as set forth in a statement showing kind, nature and amount,
attested by the president or vice-president and secretary of the company
issuing the policies against which such liens exist) not exceeding such
reserve value as the company may have against such policies shall be
entered upon the record. It shall be the duty of
the Director to cancel mutilated policies issued by said companies prior to
the effective date of this Code, and register in lieu thereof other
policies of like tenor and date.
(Source: P.A. 87-757.)
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(215 ILCS 5/250) (from Ch. 73, par. 862)
Sec. 250.
Additional
deposits.
Each company which shall have made the deposit provided for by the act
mentioned in section 246, shall make additional deposits from time to
time in amounts of not less than five thousand dollars of securities which
are authorized investments for life insurance companies under this Code, so
that the market value of the securities deposited shall always be equal to
the reserve value of the policies heretofore registered by said company,
less such liens (not exceeding such net value) as the company may have
against them.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/251) (from Ch. 73, par. 863)
Sec. 251.
Record of
securities-Deficit-When insolvent.
The Director shall keep a record of the securities deposited by each
company and when furnishing the annual certificate of valuation mentioned
in section 249, he shall enter thereon the amount and market value of
such securities deposited by such company. If at any time it shall appear
from such certificate or otherwise that the value of the securities held on
deposit is less than the reserve value of the registered policies
theretofore issued by such company, less such liens (not exceeding such
reserve value) as the company may have against them, and the company shall
fail or neglect to make good such deposit within sixty days, after written
notice by the Director, it shall be deemed to be insolvent and shall be
proceeded against in the manner provided in Article XIII.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/252) (from Ch. 73, par. 864)
Sec. 252.
May
increase deposit-Withdrawal of securities-Right to income.
Any such company may increase its deposits at any time by making
additional deposits of not less than five thousand dollars of securities
which are authorized investments for life companies under this Code. Any
company whose deposits exceed the reserve of all registered policies it has
in force, less such liens (not exceeding such reserve value) as the company
may hold against them, may withdraw such excess, or it may withdraw any of
said securities at any time by depositing in their stead securities of
equal value and authorized under this Code. So long as said company shall
remain solvent and maintain its deposits, as herein provided, it may
collect the interest, coupons, rents, and other income on the securities
deposited as the same may accrue.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/253) (from Ch. 73, par. 865)
Sec. 253.
Deposits
kept separate.
The securities deposited with the Director pursuant to the act mentioned
in section 246, shall be kept in the same manner but separate from other
deposits of the company.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/Art. XVI heading) ARTICLE XVI.
ASSESSMENT LEGAL RESERVE LIFE COMPANIES
(Repealed by P.A. 98-692, eff. 7-1-14; 98-969, eff. 1-1-15)
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(215 ILCS 5/Art. XVII heading) ARTICLE XVII.
FRATERNAL BENEFIT SOCIETIES
(Article scheduled to be repealed on January 1, 2027)
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(215 ILCS 5/282.1) (from Ch. 73, par. 894.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 282.1.
Fraternal benefit societies.
Any incorporated society,
order or supreme lodge without capital stock, including one exempted under
the provisions of Section 315.5(a) of this amendatory Act whether incorporated or
not, organized solely for the benefit of its members and their
beneficiaries and not for profit, operated on a lodge system with
ritualistic form of work, having a representative form of government and
providing benefits in accordance with this amendatory Act is hereby declared
to be a fraternal benefit society.
(Source: P.A. 84-303.)
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(215 ILCS 5/283.1) (from Ch. 73, par. 895.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 283.1.
Lodge system.
(a) A society is operating on the lodge
system if it has a supreme governing body and subordinate lodges into which
members are elected, initiated or admitted in accordance with its laws,
rules and ritual. Subordinate lodges shall be required by the laws of the
society to hold regular meetings at least once in each month in furtherance
of the purposes of the society.
(b) A society may, at its option, organize and operate lodges for
children under the minimum age for adult membership. Membership and
initiation in local lodges shall not be required of such children nor
shall they have a voice or vote in the management of the society.
(Source: P.A. 84-303.)
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(215 ILCS 5/284.1) (from Ch. 73, par. 896.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 284.1.
Representative form of government.
A society has a
representative form of government when:
(a) It has a supreme governing body constituted in | ||
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(1) Assembly. The supreme governing body is an | ||
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(2) Direct Election. The supreme governing body | ||
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(b) The officers of the society are elected either by | ||
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(c) Only benefit members are eligible for election to | ||
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(d) Each voting member has one vote; no vote may be | ||
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(Source: P.A. 84-303.)
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(215 ILCS 5/285.1) (from Ch. 73, par. 897.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 285.1.
Definitions.
Whenever used in this amendatory Act:
(a) "Benefit contract" shall mean the agreement for provision of
benefits authorized by Section 297.1 of this amendatory Act as that agreement is
described in Section 300.1 of this amendatory Act;
(b) "Benefit member" shall mean an adult member who is designated by the
laws or rules of the society to be a benefit member under a benefit contract;
(c) "Certificate" shall mean the document issued as written evidence of
the benefit contract;
(d) "Premiums" shall mean premiums, rates, dues or other required
contributions, by whatever name known, which are payable under the certificate;
(e) "Laws" shall mean the society's articles of incorporation,
constitution and bylaws, however designated;
(f) "Life insurer" shall mean an insurance company authorized to
transact in this State the insurance business classified as Class 1, Clause
(a) or (b) in Section 4 of this Code;
(g) "Rules" shall mean all rules, regulations or resolutions adopted by
the supreme governing body or board of directors which are intended to
have general application to the members of the society;
(h) "Society" shall mean fraternal benefit society, unless otherwise indicated; and
(i) "Lodge" shall mean subordinate member units of the society, known as
camps, courts, councils, branches or by any other designation.
(Source: P.A. 84-303.)
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(215 ILCS 5/286.1) (from Ch. 73, par. 898.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 286.1. Purposes and powers. (a) A society shall operate for the
benefit of members and their beneficiaries by:
(1) Providing benefits as specified in Section 297.1 | ||
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(2) Operating for one or more social, intellectual, | ||
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(b) Every society shall have the power to adopt laws and rules for the
government of the society, the admission of its members and the management
of its affairs. It shall have the power to change, alter, add to or amend
such laws and rules and shall have such other powers as are necessary and
incidental to carrying into effect the objects and purposes of the society.
(c) A domestic society that provides any of the benefits specified in Section 297.1 of this Code must be governed by a board of directors and managed by qualified officers subject to the following requirements: (1) The laws of a society must provide that: (i) the board of directors shall have the powers | ||
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(ii) the board of directors may remove a director | ||
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After the effective date of this amendatory Act of | ||
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(2) A person convicted of a felony may not be a | ||
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(3) A society shall provide information regarding | ||
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(4) Each newly elected director of a domestic society | ||
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(5) At least annually, the board of directors shall | ||
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(6) Each domestic society shall establish an audit | ||
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(Source: P.A. 98-814, eff. 1-1-15.)
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(215 ILCS 5/287.1) (from Ch. 73, par. 899.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 287.1.
Qualifications for membership.
(a) A society shall specify
in its laws or rules:
(1) eligibility standards for each and every class of | ||
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(2) the process for admission to membership for each | ||
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(3) the rights and privileges of each membership | ||
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(b) A society may also admit social members who shall have no voice or
vote in the management of the insurance affairs of the society.
(c) Membership rights in the society are personal to the member and are
not assignable.
(Source: P.A. 84-303.)
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(215 ILCS 5/288.1) (from Ch. 73, par. 900.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 288.1.
Location of office, meetings, communications to members,
grievance procedures. (a) The principal office and place of business of any
domestic society shall be located in this State. The meetings of its
supreme governing body may be held in any state, district, province or
territory wherein such society has at least one subordinate lodge, or in
such other location as determined by the supreme governing body, and all
business transacted at such meeting shall be as valid in all respects as if
such meetings were held in this State. The minutes of the proceedings of
the supreme governing body and of the board of directors shall be in the English language.
(b)(1) A society may provide in its laws for an official publication in
which any notice, report or statement required by law to be given to
members, including notice of election, may be published. Such required
reports, notices and statements shall be printed conspicuously in the
publication. If the records of a society show that 2 or more members have
the same mailing address, an official publication mailed to one member
is deemed to be mailed to all members at the same address unless a member
requests a separate copy.
(2) Not later than June 1 of each year, a synopsis of the society's
annual statement providing an explanation of the facts concerning the
condition of the society thereby disclosed shall be printed and mailed to
each benefit member of the society or, in lieu thereof, such synopsis may
be published in the society's official publication.
(c) A society may provide in its laws or rules for grievance or complaint
procedures for members.
(Source: P.A. 84-303.)
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(215 ILCS 5/289.1) (from Ch. 73, par. 901.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 289.1.
Personal liability.
(a) The officers and members of the
supreme governing body or any subordinate body of a society shall not be
personally liable for any benefits provided by a society.
(b) Any person may be indemnified and reimbursed by any society for
expenses reasonably incurred by, and liabilities imposed upon, such person
in connection with or arising out of any action, suit or proceeding,
whether civil, criminal, administrative or investigative, or threat
thereof, in which the person may be involved by reason of the fact that he
or she is or was a director, officer, employee or agent of the society or
of any firm, corporation or organization which he or she served in any
capacity at the request of the society. A person shall not be so
indemnified or reimbursed (1) in relation to any matter in such action,
suit or proceedings as to which he or she shall finally be adjudged to be
or have been guilty of breach of a duty as a director, officer, employee or
agent of the society; or (2) in relation to any matter in such action, suit
or proceeding, or threat thereof, which has been made the subject of a
compromise settlement; unless in either such case the person acted in good
faith for a purpose the person reasonably believed to be in or not opposed
to the best interests of the society and, in a criminal action or
proceeding, in addition, had no reasonable cause to believe that his or her
conduct was unlawful. The determination whether the conduct of such person
met the standard required in order to justify indemnification and
reimbursement in relation to any matter described in subpoints (1) or (2)
of the preceding sentence may only be made by the supreme governing body or
board of directors by a majority vote of a quorum consisting of persons who
were not parties to such action, suit or proceeding or by a court of
competent jurisdiction. The termination of any action, suit or proceeding
by judgment, order, settlement, conviction or upon a plea of no contest
as to such person shall not in itself create a conclusive presumption that
the person did not meet the standard of conduct required in order to
justify indemnification and reimbursement. The foregoing right of
indemnification and reimbursement shall not be exclusive of other rights to
which such person may be entitled as a matter of law and shall inure to the
benefit of his or her heirs, executors and administrators.
(c) A society shall have power to purchase and maintain insurance on
behalf of any person who is or was a director, officer, employee or agent
of the society, or who is or was serving at the request of the society as a
director, officer, employee or agent of any other firm, corporation or
organization against any liability asserted against such person and
incurred by him or her in any such capacity or arising out of his or her
status as such, whether or not the society would have the power to
indemnify the person against such liability under this Section.
(Source: P.A. 84-303.)
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(215 ILCS 5/290.1) (from Ch. 73, par. 902.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 290.1.
Waiver.
The laws of the society may provide that no
subordinate body, nor any of its subordinate officers or members, shall have
the power or authority to waive any of the provisions of the laws of the
society. Such provisions shall be binding on the society and every member
and beneficiary of a member.
(Source: P.A. 84-303.)
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(215 ILCS 5/291.1) (from Ch. 73, par. 903.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 291.1. Organization. A domestic society organized on or after
January 1, 1986 (the effective date of Public Act 84-303) shall be formed as follows:
(a) Seven or more citizens of the United States, a | ||
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(1) The proposed corporate name of the society, | ||
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(2) The place where its principal office shall be | ||
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(3) The purposes for which it is being formed and | ||
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(4) The names and residences of the incorporators | ||
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(b) Duplicate originals of the articles of | ||
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(c) No preliminary certificate of authority issued | ||
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(d) Upon receipt of a preliminary certificate of | ||
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(1) Actual bona fide applications for benefits | ||
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(2) At least 10 subordinate lodges have been | ||
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(3) There has been submitted to the Director, | ||
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(4) It shall have been shown to the Director, by | ||
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(5) In the case of a domestic society that is | ||
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(i) maintains a minimum surplus of | ||
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(ii) meets any other requirements as | ||
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(e) The Director may make such examination and | ||
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(f) Any incorporated society authorized to transact | ||
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(Source: P.A. 102-558, eff. 8-20-21.)
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(215 ILCS 5/292.1) (from Ch. 73, par. 904.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 292.1.
Amendments to Laws.
(a) A domestic society may amend its laws in
accordance with the provisions thereof by action of its supreme governing body
at any regular or special meeting thereof or, if its laws so provide, by
referendum. Such referendum may be held in accordance with the provisions
of its laws by the vote of the voting members of the society, by the vote
of delegates or representatives of voting members or by the vote of local
lodges. A society may provide for voting by mail. No amendment submitted for
adoption by referendum shall be adopted unless, within 6 months from the
date of submission thereof, a majority of the members voting shall have
signified their consent to such amendment by one of the methods herein
specified.
(b) No amendment to the laws of any domestic society shall
take effect unless approved by the Director, who shall approve such
amendment if the Director finds that it has been duly adopted and is not
inconsistent with any requirement of the laws of this State or with the
character, objects and purposes of the society. Unless the Director shall
disapprove any such amendment within 60 days after the filing of same,
such amendment shall be considered approved. The approval or disapproval of
the Director shall be in writing and mailed to
the society. In case the
Director disapproves such amendment, the reasons therefor shall be stated
in such written notice.
(c) Within 90 days from the approval thereof by the Director, all
such amendments, or a synopsis thereof, shall be furnished to all members
of the society either by mail or by publication in full in the official
publication of the society. The affidavit of any officer of the society or
of anyone authorized by it to mail any amendments or synopsis thereof,
stating facts which show that same have been duly addressed and mailed,
shall be prima facie evidence that such amendments, or a synopsis thereof,
have been furnished the addressee.
(d) Every foreign or alien society authorized to do business in this
State shall file with the Director a certified copy of all amendments of, or
additions to, its laws within 90 days after the enactment of same.
(e) Printed copies of the laws as amended, certified by the secretary or
corresponding officer of the society, shall be prima facie evidence of the
legal adoption thereof.
(Source: P.A. 84-303.)
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(215 ILCS 5/293.1) (from Ch. 73, par. 905.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 293.1.
Institutions.
A society may create, maintain and operate, or
may establish organizations to operate, not for profit institutions to
further the purposes permitted by Section 286.1 of this amendatory Act. Such
institutions may furnish services free or at a reasonable charge. Any real
or personal property owned, held or leased by the society for this purpose
shall be reported in every annual statement. Admitted asset status of such
real or personal property shall be in accordance with Section 302.1 of this
amendatory Act.
(Source: P.A. 84-303.)
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(215 ILCS 5/294.1) (from Ch. 73, par. 906.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 294.1. Reinsurance. (a) A domestic society may enter into reinsurance
transactions only in accordance with Article XI of this Code.
(b) A domestic society may reinsure the risks of another society in connection with a merger transaction with approval by the Director. (Source: P.A. 98-814, eff. 1-1-15.)
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(215 ILCS 5/295.1) (from Ch. 73, par. 907.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 295.1.
Consolidations and mergers.
A domestic society may enter
into agreements of consolidation or merger only in accordance with Article
X of this Code.
(Source: P.A. 84-303.)
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(215 ILCS 5/295.2) (Section scheduled to be repealed on January 1, 2027) Sec. 295.2. Maintenance of solvency. (a) In the event a domestic society has an authorized control level event described in Section 35A-25 of this Code under circumstances the Director determines will not be promptly remedied, the Director may, in addition to all other actions required or permitted by subsection (b) of Section 35A-25 of this Code, issue an order declaring the domestic society to be in hazardous condition and ordering that all steps be taken to remedy such condition pursuant to this Section. (b) A domestic society may negotiate an agreement to transfer members, certificates, and other assets and liabilities of the society, in whole or in part, to another organization through merger, consolidation, assumption, or other means. Such transfer shall be concluded within the timeframe established by the Director and subject to approval by the Director. Such transfer agreement shall be deemed fully approved by the domestic society upon majority vote of its board of directors. Such transfer shall be effective notwithstanding the provisions of Section 295.1 of this Code or any other law or regulation or laws of the domestic society requiring another form of notice to or approval by members, which shall be superseded by this Section. (c) In the event of an agreement to transfer under this Section to an organization without a certificate of authority in this State, the Director may grant a limited certificate of authority to such organization, upon request, if the organization does not apply for and obtain a certificate of authority to transact business in this State. Such limited certificate of authority shall grant the organization authority to service the certificates following the transfer and fulfill all obligations owed to certificate holders but not to otherwise transact insurance business in this State. (d) The board of directors of a domestic society may suspend or modify its qualifications for membership as necessary or appropriate to facilitate an agreement to transfer under this Section, notwithstanding the laws of the society, or any other law or regulation to the contrary.
(Source: P.A. 98-814, eff. 1-1-15.) |
(215 ILCS 5/296.1) (from Ch. 73, par. 908.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 296.1.
Conversion of fraternal benefit society to mutual life
insurance company. (a) Any society subject to the provisions of this
amendatory Act possessed of admitted assets in excess of all liabilities at least
equal to the minimum surplus required of a new mutual legal reserve life
company under Section 43 of this Code transacting the same kind or kinds of
business may, at its option, without reincorporation, adopt and become
subject to the provisions of Article III of this Code, in lieu of this amendatory Act.
(b) The board of directors of the society shall approve such proposed
amendments to the articles of incorporation, the constitution and bylaws
of the society as may be necessary or desirable to make the same conform to
the articles of incorporation and bylaws of a mutual legal reserve life
company, in accordance with the requirements of Article III of this Code.
(c) The board of directors of the society shall then submit such
proposed amendments to the Director together with: (1) a copy of the notice
to be given to members and lodges as herein provided; (2) a current
financial statement of the society showing assets, liabilities and surplus
valued in accordance with the requirements of Article III; and (3) the
proposed plan for transition from a fraternal society to a mutual legal
reserve company, including, if pertinent, the following: dissolution of the
lodge system; disposition of property held for the benefit of lodges;
changes in the amount, calculation and collection of future premiums on
policies; the method of selection of officers and board of directors or
trustees to manage and control the mutual company until the regular annual
meeting of its members; and such other changes as may be necessary to an
orderly transition. If the Director finds that: (a) the amendments, notice
and plan are in accordance with the provisions of this amendatory Act and not
inconsistent with the laws and the Constitutions of this State and the
United States; (b) the society has a surplus which, when calculated in
accordance with the requirements of Article III of this Code, is at least
equal to the original surplus required under Article III of a mutual legal
reserve life company transacting the same kind or kinds of business; and (c)
no reasonable objection exists to such conversion, the Director shall,
within a reasonable time, authorize the sending of notices and further
proceedings hereunder.
(d) After the Director has given such authority, the board of directors
of the society shall then submit the proposed amendments and plan of
transition, as so approved, to the supreme governing body of such society at
any regular or special meeting thereof, provided a copy of such amendments
and plan have been included in or enclosed with the notice of such meeting,
which notice shall be given as provided in the laws of the society for the
convening of such supreme governing body in regular or special session as
the case may be. At least 90 days prior to the date of such regular or
special meeting, as the case may be, a notice describing the purpose of
the proposed amendments, and including therein or enclosing therewith a
copy of such amendments and plan of transition, all as approved by the
Director, shall be mailed to each lodge or local body of the society
qualified to choose a delegate or delegates to said meeting and also to
each member of the society; for the purpose of this notice the lodges or
local bodies and the members and the addresses of same shall be taken as
those shown by the records of the society as of a date not earlier than 120
days prior to the date set for such meeting. The affidavit of
any officer, clerk or agent of the company, or of anyone authorized to mail
such notices, that the notices required by this Section bearing the required
postage have been duly addressed and mailed shall, upon final approval by
the Director of the proceedings hereunder, constitute conclusive evidence
that such notice has been duly given in accordance herewith.
(e) The affirmative votes of 2/3 of the members of such supreme
governing body present at such meeting shall be necessary for the adoption
of amendments and the plan of transition under this Section, provided,
however, that 2/3 of the elective members present shall vote in
favor thereof; the amendments and plan adopted shall be submitted to the
Director for his final approval. If the Director shall find that the
amendments and plan and the adoption thereof are in accordance with this
Section he shall approve the same, and, not less than 30 days nor more
than 60 days after such approval, he shall issue a certificate of
authority authorizing the company to do business subject to and entitled to
the benefits of Article III of this Code. Upon issuance of such
certificate, any right in the society to assess its members shall expire and
any provision for an assessment contained in the policies issued by the
society shall become thenceforth unenforceable, null and void.
(Source: P.A. 84-303.)
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(215 ILCS 5/297.1) (from Ch. 73, par. 909.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 297.1. Benefits. (a) A society may provide the following contractual
benefits in any form:
(1) Death benefits;
(2) Endowment benefits;
(3) Annuity benefits;
(4) Temporary or permanent disability benefits;
(5) Hospital, medical or nursing benefits;
(6) Monument or tombstone benefits to the memory of | ||
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(7) Such other benefits as authorized for life | ||
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(b) A society shall specify in its rules those persons who may be
issued, or covered by, the contractual benefits in subsection (a),
consistent with providing benefits to members and their dependents.
A society may provide benefits on the lives of children under the minimum age
for adult membership upon application of an adult person. (c) After the effective date of this amendatory Act of the 98th General Assembly, a society shall provide an applicant for contractual benefits a disclosure statement that reads substantially as follows: ". . . . . . .(name of the society) is licensed to do | ||
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The statement must appear immediately above the applicant's signature on the society's membership application or certificate or policy application, in uppercase and bold type or boxed.
(Source: P.A. 98-814, eff. 1-1-15.)
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(215 ILCS 5/298.1) (from Ch. 73, par. 910.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 298.1.
Beneficiaries.
(a) The owner of a benefit contract shall
have the right at all times to change the beneficiary or beneficiaries in
accordance with the laws or rules of the society unless the owner waives
this right by specifically requesting in writing that the beneficiary
designation be irrevocable. A society may, through its laws or rules, limit
the scope of beneficiary designations and shall provide that no revocable
beneficiary shall have or obtain any vested interest in the proceeds of any
certificate until the certificate has become due and payable in conformity
with the provisions of the benefit contract.
(b) A society may make provision for the payment of funeral benefits to
the extent of such portion of any payment under a certificate as might
reasonably appear to be due to any person equitably entitled thereto by
reason of having incurred expense occasioned by the burial of the member,
provided the portion so paid shall not exceed the sum of $2000.
(c) If, at the death of any person insured under a benefit contract,
there is no lawful beneficiary to whom the proceeds shall be payable, the
amount of such benefit, except to the extent that funeral benefits may be
paid as hereinbefore provided, shall be payable to the personal
representative of the deceased insured, provided that if the owner of the
certificate is other than the insured, such proceeds shall be payable to such owner.
(Source: P.A. 84-303.)
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(215 ILCS 5/299.1a) (from Ch. 73, par. 911.1a)
(Section scheduled to be repealed on January 1, 2027)
Sec. 299.1a. Benefits not attachable.
(a) No money or other charity, relief
or aid to be paid, provided or rendered by any society shall be liable to
attachment, garnishment or other process or to be seized, taken,
appropriated or applied by any legal or equitable process or operation of
law to pay any debt or liability of a member or beneficiary, or any other
person who may have a right thereunder, either before or after payment by the
society.
(b) Any benefit association doing
business in
this State and governed by this Article XVII shall encumber or surrender
accounts as defined in Section 10-24 of the Illinois Public Aid Code
held by the benefit
association owned by any responsible relative who is subject to a child
support lien,
upon notice of the lien or levy by the Department of Healthcare and Family Services (formerly Illinois Department of Public Aid)
or its successor agency pursuant to Section 10-25.5 of the Illinois Public Aid
Code, or upon notice of interstate lien from any other state's agency
responsible for implementing the child support enforcement program set forth in
Title IV, Part D of the Social Security Act.
This Section shall not prohibit the furnishing of information in
accordance
with the federal
Personal Responsibility and Work Opportunity Reconciliation Act of 1996.
Any benefit association governed by this Article XVII shall enter into an
agreement for data
exchanges with the Department of Healthcare and Family Services
provided the Department of Healthcare and Family Services pays to the benefit association a reasonable fee not to exceed its
actual cost incurred. A benefit association providing
information in accordance with this item shall not be liable to any account
holder or other person for any disclosure of information to a State agency, for
encumbering or surrendering any accounts as defined in Section 10-24 of the
Illinois Public Aid Code held by the benefit association
in response to a lien
or order to withhold and deliver issued by a State agency, or for any other
action taken pursuant to this item, including individual or mechanical errors,
provided the action does not constitute gross negligence or willful misconduct.
A benefit association shall have no obligation to hold, encumber, or
surrender accounts until
it has been served with a subpoena, summons, warrant, court or administrative
order, lien, or levy requiring that action.
(Source: P.A. 95-331, eff. 8-21-07.)
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(215 ILCS 5/299.1b)
(Section scheduled to be repealed on January 1, 2027)
Sec. 299.1b. Data exchanges;
administrative liens.
(a) Any benefit
association doing business in the State and governed by
this Code shall enter into an agreement for data exchanges
with the Department of Healthcare and Family Services
for the purpose of locating accounts as defined in Section 10-24 of the
Illinois Public Aid Code of responsible relatives to
satisfy past-due child support owed by responsible
relatives under an order for support entered by a court or
administrative body of this or any other State on behalf
of resident or non-resident persons.
(b) Notwithstanding any provisions in this Code to the
contrary, a benefit association
shall not be liable to any person:
(1) for any disclosure of information to the | ||
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(2) for encumbering or surrendering any accounts as | ||
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(3) for any other action taken in good faith to | ||
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(Source: P.A. 95-331, eff. 8-21-07.)
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(215 ILCS 5/300.1) (from Ch. 73, par. 912.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 300.1. The benefit contract. (a) Every society authorized to do
business in this State shall issue to each owner of a benefit contract a
certificate specifying the amount of benefits provided thereby. The
certificate, together with any riders or endorsements attached thereto,
the laws of the society, the application for membership, the application
for insurance and declaration of insurability, if any, signed by the
applicant and all amendments to each thereof shall constitute the benefit
contract, as of the date of issuance, between the society and the owner,
and the certificate shall so state. A copy of the application for insurance
and declaration of insurability, if any, shall be endorsed upon or attached
to the certificate. All statements on the application shall be
representations and not warranties. Any waiver of this provision shall be void.
(b) Any changes, additions or amendments to the laws of the society duly
made or enacted subsequent to the issuance of the certificate shall bind
the owner and the beneficiaries and shall govern and control the benefit
contract in all respects the same as though such changes, additions or
amendments had been made prior to and were in force at the time of the
application for insurance, except that no change, addition or amendment
shall destroy or diminish benefits which the society contracted to give the
owner as of the date of issuance.
(c) Any person upon whose life a benefit contract is issued prior to
attaining the age of majority shall be bound by the terms of the
application and certificate and by all the laws and rules of the society to
the same extent as though the age of majority had been attained at the
time of application.
(d) A society shall provide in its laws and its certificates that, if its
reserves as to all or any class of certificates become impaired, its board of
directors or corresponding body may require that there shall be paid by
the owner to the society an assessment in the amount of the owner's equitable proportion of
such deficiency as ascertained by its board, and that, if the payment is not
made, either (1) it shall stand as an indebtedness against the certificate
and draw interest not to exceed the rate specified for certificate loans
under the certificates; or (2) in lieu of or in combination with (1), the
owner may accept a proportionate reduction in benefits under the
certificate. However, in no event may an assessment obligation be forgiven, credited, or repaid by whatever means or however labeled by the society in lieu of collection or reduction in benefits, unless provided to all society members and approved in writing by the Director, except that the forgiveness or repayment of any assessments issued by a society that remain outstanding as of January 1, 2015 (the effective date of Public Act 98-814) may be forgiven or repaid by any manner or plan certified by an independent actuary and filed with the Director to make reasonable and adequate provision for the forgiveness or repayment of the assessment to all society members. Notwithstanding the foregoing, a society may fully repay, credit, or forgive an assessment from the date of death of any life insured under a certificate so long as the plan to forgive or repay the assessment is certified by an independent actuary and filed with the Director to make reasonable and adequate provision for the forgiveness or repayment of the assessment to all assessed society members as a result of the death. The society may specify the manner of the election and which
alternative is to be presumed if no election is made. No such assessment shall take effect unless a 30-day notification has been provided to the Director, who shall have the ability to disapprove the assessment only if the Director finds that such assessment is not in the best interests of the benefit members of the domestic society. Disapproval by the Director shall be made within 30 days after receipt of notice and shall be in writing and mailed to the domestic society. If the Director disapproves the assessment, the reasons therefor shall be stated in the written notice.
(e) Copies of any of the documents mentioned in this Section, certified
by the secretary or corresponding officer of the society, shall be received
in evidence of the terms and conditions thereof.
(f) No certificate shall be delivered or issued for delivery in this
State unless a copy of the form has been filed with the Director in the
manner provided for like policies issued by life insurers in this State.
Every life, accident, health or disability insurance certificate and every
annuity certificate issued on or after one year from January 1, 1986 (the effective date of Public Act 84-303)
shall meet the standard contract provision requirements not
inconsistent with Public Act 84-303 for like policies issued by life insurers in
this State except that a society may provide for a grace period for payment
of premiums of one full month in its certificates. The certificate shall
also contain a provision stating the amount of premiums which are payable
under the certificate and a provision reciting or setting forth the
substance of any sections of the society's laws or rules in force at the
time of issuance of the certificate which, if violated, will result in the
termination or reduction of benefits payable under the certificate. If the
laws of the society provide for expulsion or suspension of a member, the
certificate shall also contain a provision that any member so expelled or
suspended, except for nonpayment of a premium or within the contestable
period for material misrepresentation in the application for membership or
insurance, shall have the privilege of maintaining the certificate in force
by continuing payment of the required premium.
(g) Benefit contracts issued on the lives of persons below the society's
minimum age for adult membership may provide for transfer of control or
ownership to the insured at an age specified in the certificate. A society
may require approval of an application for membership in order to effect
this transfer and may provide in all other respect for the regulation,
government and control of such certificates and all rights, obligations and
liabilities incident thereto and connected therewith. Ownership rights
prior to such transfer shall be specified in the certificate.
(h) A society may specify the terms and conditions on which benefit
contracts may be assigned.
(Source: P.A. 101-81, eff. 7-12-19.)
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(215 ILCS 5/301.1) (from Ch. 73, par. 913.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 301.1.
Nonforfeiture benefits, cash surrender values, certificate
loans and other options. (a) For certificates issued prior to one year
after the effective date of this amendatory Act, the value of every paid-up
nonforfeiture benefit and the amount of any cash surrender value, loan or
other option granted shall comply with the provisions of law applicable
immediately prior to the effective date of this amendatory Act.
(b) For certificates issued on or after one year from the effective date
of this amendatory Act for which reserves are computed on the Commissioner's
1941 Standard Ordinary Mortality Table, the Commissioner's 1941 Standard
Industrial Table, the Commissioner's 1958 Standard Ordinary Mortality
Table, the Commissioner's 1980 Standard Mortality Table or any more
recent table made applicable to life insurers, every paid-up nonforfeiture
benefit and the amount of any cash surrender value, loan or other option
granted shall not be less than the corresponding amount ascertained in
accordance with the laws of this State applicable to life insurers issuing
policies containing like benefits based upon such tables.
(Source: P.A. 84-303.)
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(215 ILCS 5/302.1) (from Ch. 73, par. 914.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 302.1.
Investments and admitted assets.
A domestic society shall
invest its funds only in such investments as are authorized by the laws of
this State for the investment of assets of life insurers and subject to the
limitations thereon. Any foreign or alien society permitted or seeking to
do business in this State which invests its funds in accordance with the
laws of the state, district, territory, country or province in which it is
incorporated shall be held to meet the requirements of this Section for
the investment of funds. Admitted assets in addition to investments
authorized by this Section and Article VIII and Article VIII 1/2 of this
Code shall be in accordance with Section 3.1 of this Code.
(Source: P.A. 84-303.)
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(215 ILCS 5/303.1) (from Ch. 73, par. 915.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 303.1.
Funds.
(a) All assets shall be held, invested and disbursed
for the use and benefit of the society, and no member or beneficiary shall
have or acquire individual rights therein or become entitled to any
apportionment on the surrender of any part thereof except as provided in
the benefit contract.
(b) A society may create, maintain, invest, disburse and apply any
special fund or funds necessary to carry out any purpose permitted by the
laws of such society.
(c) A society may, pursuant to resolution of its supreme governing body,
establish and operate one or more separate accounts and issue contracts on
a variable basis, subject to the provisions of Article XIV 1/2 of this
Code. To the extent the society deems it necessary in order to comply with
any applicable federal or State law, or any rules issued thereunder, the
society may adopt special procedures for the conduct of the business and
affairs of a separate account; may, for persons having beneficial interests
therein, provide special voting and other rights, including without
limitation special rights and procedures relating to investment policy,
investment advisory services, selection of certified public accountants
and selection of a committee to manage the business and affairs of the
account; and may issue contracts on a variable basis to which subsection
300.1(b) and 300.1(d) of this amendatory Act shall not apply.
(Source: P.A. 84-303.)
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(215 ILCS 5/304.2) (from Ch. 73, par. 916.2)
(Section scheduled to be repealed on January 1, 2027)
Sec. 304.2.
Taxation.
Every society organized or licensed under this
amendatory Act is hereby declared to be a charitable and benevolent institution,
and all of its funds shall be exempt from all and every State, county,
district, municipal and school tax other than taxes on real estate and office equipment.
(Source: P.A. 84-303.)
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(215 ILCS 5/305.1) (from Ch. 73, par. 917.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 305.1.
Valuation.
(a) Standards of valuation for certificates
issued prior to one year after the effective date of this amendatory Act shall be
those provided by the laws applicable immediately prior to the effective
date of this amendatory Act.
(b) The minimum standards of valuation for certificates issued on or
after one year from the effective date of this amendatory Act shall be based on
the following tables:
(1) For certificates of life insurance - the | ||
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(2) For annuity and pure endowment certificates, for | ||
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All of the above shall be under valuation methods and standards including,
but not limited to, interest assumptions in accordance with the laws of
this State applicable to life insurers issuing policies containing like benefits.
(c) The Director may, in his or her discretion, accept other standards
for valuation if the Director finds that the reserves produced thereby will
not be less in the aggregate than reserves computed in accordance with the
minimum valuation standard herein prescribed. The Director may, in his or
her discretion, vary the standards of mortality applicable to all benefit
contracts on substandard lives or other extra-hazardous lives by any
society authorized to do business in this State.
(d) Any society, with the consent of the Commissioner of Insurance of the
state of domicile of the society and under such conditions, if any, which
the Commissioner may impose, may establish and maintain reserves on its
certificates in excess of the reserves required thereunder, but the
contractual rights of any benefit member shall not be affected thereby.
(Source: P.A. 84-303.)
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(215 ILCS 5/306.1) (from Ch. 73, par. 918.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 306.1.
Reports.
Every society transacting business in this State
shall annually, on or before the first day of March, unless for cause shown
such time has been extended by the Director, file with the Director a true
statement of its financial condition, transactions and affairs for the
preceding calendar year in accordance with Section 136 of this Code. The
statement shall be in general form and context as approved by the National
Association of Insurance Commissioners for fraternal benefit societies and
as supplemented by additional information required by the Director.
(Source: P.A. 84-303.)
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(215 ILCS 5/307.1) (from Ch. 73, par. 919.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 307.1.
Annual license.
Societies which were authorized to transact
business in this State prior to the effective date of this amendatory Act may
continue such business until the first day of July next succeeding the
effective date of this amendatory Act. The authority of such societies and all
societies hereafter issued certificates of authority may thereafter be
renewed annually, but in all cases to terminate on the first day of the
succeeding July. A certified copy or duplicate of such certificate of
authority shall be prima facie evidence that the licensee is a fraternal
benefit society within the meaning of this amendatory Act.
(Source: P.A. 84-303.)
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(215 ILCS 5/308.1) (from Ch. 73, par. 920.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 308.1.
Examination of societies - adverse publications.
(a) The
Director, or any person he or she may appoint, may examine any domestic,
foreign or alien society transacting or applying for admission to transact
business in this State in the same manner as authorized for examination of
domestic, foreign or alien insurance companies. Requirements of notice and
an opportunity to respond before findings are made public as provided in
the laws regulating insurance companies shall also be applicable to the
examination of societies.
(b) The expense of each examination and of each valuation, including
compensation and actual expense of examiners, shall be paid by the society
examined or whose certificates are valued, upon statements furnished by the Director.
(Source: P.A. 84-303.)
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(215 ILCS 5/309.1) (from Ch. 73, par. 921.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 309.1.
Foreign or alien society - admission.
No foreign or alien
society shall transact business in this State without a certificate of
authority issued by the Director in accordance with Article VI of this
Code. Any such society desiring admission to this State shall comply
substantially with the requirements and limitations of this amendatory Act
applicable to domestic societies.
(Source: P.A. 84-303.)
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(215 ILCS 5/310.1) (from Ch. 73, par. 922.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 310.1.
Suspension, revocation or refusal to renew certificate of
authority.
(a) Domestic Societies. When, upon investigation, the Director
is satisfied that any domestic society transacting business under this
amendatory Act has exceeded its powers or has failed to comply with any
provisions of this amendatory Act or is conducting business fraudulently or in
a
way hazardous to its members, creditors or the public or is not carrying
out its contracts in good faith, the Director shall notify the society of
his or her findings, stating in writing the grounds of his or her
dissatisfaction, and, after reasonable notice, require the society on a date
named to show cause why its certificate of authority should not be revoked
or suspended or why such society should not be fined as hereinafter
provided or why the Director should not proceed against the society under
Article XIII of this Code. If, on the date named in said notice, such
objections have not been removed to the satisfaction of the Director
or if the society does not present good and sufficient reasons why its
authority to transact business in this State should not at that time be
revoked or suspended or why such society should not be fined as
hereinafter provided, the Director may revoke the authority of the society to
continue business in this State and proceed against the society under
Article XIII of this Code or suspend such certificate of authority for any
period of time up to, but not to exceed, 2 years; or may by order require
such society to pay to the people of the State of Illinois a penalty in a
sum not exceeding $10,000, and, upon the failure of such
society to pay such penalty within 20 days after the mailing of such
order, postage prepaid, registered and addressed to the last known place
of business of such society, unless such order is stayed by an order of a
court of competent jurisdiction, the Director may revoke or suspend the
license of such society for any period of time up to, but not exceeding, a
period of 2 years.
(b) Foreign or alien societies. The Director shall suspend, revoke or
refuse to renew certificates of authority in accordance with Article VI of this
Code.
(Source: P.A. 93-32, eff. 7-1-03.)
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(215 ILCS 5/311.1) (from Ch. 73, par. 923.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 311.1.
Injunction proceedings.
(a) Upon the refusal or neglect of
any society to make the annual report, as provided in this amendatory Act, or in
case any such society shall exceed its powers or shall conduct its business
fraudulently or is not carrying out its contracts in good faith or shall
be 30 days in arrears in the payment of death or disability claims,
endowments or annuities after the same have been allowed by the board of
directors or other person or persons whose duty it is to pass upon such
claims and after establishment of the interest and competency of the payee
to receive, receipt and acquit for payment, provided that such claim shall
be approved or disapproved within 60 days after receipt of due proof of
loss or death or, after one year's existence, shall have a membership of
less than 500 or shall determine to discontinue business or shall
fail to comply with any of the provisions of this amendatory Act, the Director shall
immediately commence, or cause to be commenced, an action against such society
under Article XIII of this Code and to enjoin the same from carrying on
any business, and an injunction may be granted, upon proper showing by the
Director, in any circuit court in this State; provided, however, that no
injunction against any society within this State or application for or
appointment of a receiver or action to prevent any society from carrying
on business in this State shall be made or granted by any court except on
the application of the Director and after written notice duly made and served
upon the chief executive officer of such society within this State, or, if
incorporated under the laws of another state, then such notice may be served
by sending the same to the president or secretary of the society by registered
mail at the home office of the society, and a full hearing before such court,
whether the party seeking such relief be the State, member of such society
or any other person whatsoever.
(b) If the court shall find that such society so enjoined was in default as
charged and the violation complained of shall have been corrected and the
injunction dissolved, the society may continue in business provided it
shall have satisfied the Director that it has paid the costs of the action.
Any officer, agent or person acting for any society or subordinate body
thereof within this State and who shall transact any business for such
society contrary to the provisions of such injunction or prohibition while
such society shall be so enjoined or prohibited from doing business
pursuant to this amendatory Act shall be deemed guilty of a Class A misdemeanor.
(Source: P.A. 84-303.)
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(215 ILCS 5/312.1) (from Ch. 73, par. 924.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 312.1.
Salaries.
No domestic society shall pay any salary,
compensation or emolument to any officer, trustee or director thereof, nor
any salary, compensation or emolument amounting in any year to more than
$40,000 to any person, firm or corporation, unless such payment be
first authorized by the supreme governing body or the board of directors or
corresponding body. No such society shall make any agreement with any of
its officers, trustees or directors or salaried employees whereby it agrees
that for any service rendered or to be rendered he shall receive any
salary, compensation or emolument that will extend beyond a
period of 4 years from the date of such agreement, provided that payment of
an amount not in excess of 20% of the salary of any of its officers,
directors or salaried employees may by written agreement be deferred
beyond such period of 4 years, which agreement may include conditions to
be met by such officers, directors or salaried employees before payment
will be made, and provided further that a domestic society may enter
into contracts with its producer for the payment of renewal commissions. No
such society shall enter into a special contract which will compensate any
officer, trustee or director based on a percentage of premiums collected by
the society or on a percentage of the entire insurance business of the
society. No such society shall grant any pension to any officer, trustee or
director thereof or to any member of his family after his death except
that it may provide a pension pursuant to the terms of a uniform retirement
plan adopted by the board of directors.
(Source: P.A. 84-303.)
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(215 ILCS 5/313.1) (from Ch. 73, par. 925.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 313.1.
Licensing of producers.
(a) Except as otherwise provided
in this Section, producers of societies shall be subject to the provisions
of Article XXXI of this Code.
(b) No examination or license shall be required of any regular salaried
officer, employee or member of a licensed society who devotes substantially
all of his or her services to activities other than the solicitation of
fraternal benefit contracts from the public and who receives for the
solicitation of such contracts no commission or other compensation
directly dependent upon the amount of business obtained.
(c) Any producer, representative or member of a society who devotes or
intends to devote less than 50% of such person's time to the
solicitation and procurement of benefit contracts for such society shall be
exempt from the requirements of subsection (a). Any person who in the
preceding calendar year has solicited and procured life insurance contracts
on behalf of any society in an amount of insurance in excess of $100,000
or, in the case of any other kind or kinds of insurance which the society
might write, on the persons of more than 25 individuals and who has
received or will receive a commission or other compensation therefor shall
be presumed to be devoting, or intending to devote, 50% of time
to the solicitation or
procurement of benefit contracts for such society.
(Source: P.A. 84- 303.)
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(215 ILCS 5/314.1) (from Ch. 73, par. 926.1)
(Section scheduled to be repealed on January 1, 2027)
Sec. 314.1.
Unfair methods of competition and unfair and deceptive
acts and practices. Every society authorized to do business in this State
shall be subject to the provisions of Article XXVI of this Code, provided,
however, that nothing in such provisions shall be construed as applying to
or affecting the right of any society to determine its eligibility
requirements for membership or be construed as applying to or affecting
the offering of benefits exclusively to members or persons eligible for
membership in the society by a subsidiary corporation or affiliated
organization of the society.
(Source: P.A. 84-303.)
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(215 ILCS 5/315.2) (from Ch. 73, par. 927.2)
(Section scheduled to be repealed on January 1, 2027)
Sec. 315.2.
Service of process.
(a) Every society authorized to do
business in this State shall appoint in writing the Director and each
successor in office to be its true and lawful attorney upon whom all lawful
process in any action or proceeding against it shall be served and shall
agree in such writing that any lawful process against it which is served on
said attorney shall be of the same legal force and validity as if served
upon the society and that the authority shall continue in force so long as
any liability remains outstanding in this State. Copies of such
appointment, certified by said Director, shall be deemed sufficient evidence
thereof and shall be admitted in evidence with the same force and effect as
the original thereof might be admitted.
(b) Service shall be made by delivering to and leaving with the Director
duplicate copies of such process with payment of the fee prescribed by this
Code and the service thereof shall constitute sufficient service upon the
society. When legal process against a society is served upon the Director,
the Director shall forthwith forward one of the duplicate copies, by
certified or registered mail prepaid, to the society. No such service shall
require a society to file its answer, pleading or defense in less than
30 days from the date of mailing the copy of the service to a society
unless otherwise ordered by the court. Legal process shall not be served
upon a society except in the manner herein provided.
(Source: P.A. 84-303.)
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(215 ILCS 5/315.3) (from Ch. 73, par. 927.3)
(Section scheduled to be repealed on January 1, 2027)
Sec. 315.3.
Review.
The provisions of the Administrative Review Law,
and all amendments and modifications thereof, and the rules adopted
pursuant thereto shall apply to and govern all proceedings for the
judicial review of final administrative decisions of the Department.
(Source: P.A. 84-303.)
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(215 ILCS 5/315.4) (from Ch. 73, par. 927.4)
(Section scheduled to be repealed on January 1, 2027)
Sec. 315.4.
Penalties.
(a) Any person who willfully makes a false or
fraudulent statement in or relating to an application for membership or for
the purpose of obtaining money from, or a benefit in, any society shall upon
conviction be fined not less than $200 nor more than $10,000 or be subject to
imprisonment in the county jail not less than 30 days nor more than one
year, or both.
(b) Any person who willfully makes a false or fraudulent statement in any
verified report or declaration under oath required or authorized by this
amendatory Act, or of any material fact or thing contained in a sworn statement
concerning the death or disability of an insured for the purpose of
procuring payment of a benefit named in the certificate, shall be guilty of
perjury and shall be subject to the penalties therefor prescribed by law.
(c) Any person who solicits membership for, or in any manner assists in
procuring membership in, any society not licensed to do business in this
State shall upon conviction be fined not less than $100 nor more
than $400.
(d) Any person guilty of a willful violation of, or neglect or refusal
to comply with, the provisions of this amendatory Act for which a penalty is
not
otherwise prescribed shall upon conviction be subject to a fine
not exceeding $10,000.
(Source: P.A. 93-32, eff. 7-1-03.)
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(215 ILCS 5/315.5) (from Ch. 73, par. 927.5)
(Section scheduled to be repealed on January 1, 2027)
Sec. 315.5.
Exemption of certain societies.
(a) Nothing contained in
this amendatory Act shall be so construed as to affect or apply to:
(1) grand or subordinate lodges of societies, orders | ||
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(2) orders, societies or associations which admit to | ||
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(3) domestic societies which limit their membership | ||
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(4) domestic societies or associations of a purely | ||
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(b) Any such society or association described in subsections (a)(3) or
(a)(4) supra which provides for death or disability benefits for which
benefit certificates are issued and any such society or association
included in subsection (a)(4) which has more than 1000 members
shall not be exempted from the provisions of this amendatory Act but shall
comply with all requirements thereof.
(c) No society which, by the provisions of this Section, is exempt from
the requirements of this amendatory Act, except any society described in
subsection (a)(2) supra, shall give or allow, or promise to give or allow,
to any person any compensation for procuring new members.
(d) Every society which provides for benefits in case of death or
disability resulting solely from accident and which does not obligate
itself to pay natural death or sick benefits shall have all of the
privileges and be subject to all the applicable provisions and regulations
of this amendatory Act except that the provisions thereof relating to medical
examination, valuations of benefit certificates and incontestability
shall not apply to such society.
(e) The Director may require from any society or association, by
examination or otherwise, such information as will enable the Director to
determine whether such society or association is exempt from the provisions
of this amendatory Act.
(f) Societies exempted under the provisions of this Section shall
also be exempt from all other provisions of the insurance laws of this State.
(Source: P.A. 86-187.)
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(215 ILCS 5/315.6) (from Ch. 73, par. 927.6)
(Section scheduled to be repealed on January 1, 2027)
Sec. 315.6. Application of other Code provisions. Unless otherwise
provided in this amendatory Act, every fraternal benefit society shall be
governed
by this amendatory Act and shall be exempt from all other provisions of the
insurance laws of this State not only in governmental relations with the
State but for every other purpose, except for those provisions specified in
this amendatory Act and except as follows:
(a) Sections 1, 2, 2.1, 3.1, 117, 118, 132, 132.1, | ||
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(b) Articles VIII 1/2, XII, XII 1/2, XIII, XXIV, and | ||
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(Source: P.A. 98-814, eff. 1-1-15.)
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(215 ILCS 5/315.7) (from Ch. 73, par. 927.7)
(Section scheduled to be repealed on January 1, 2027)
Sec. 315.7.
Severability.
If any provision of this amendatory Act or the
application of such provision to any circumstance is held invalid, the
remainder of the amendatory Act or the application of the provision to other
circumstances shall not be affected thereby.
(Source: P.A. 84-303.)
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(215 ILCS 5/315.9) (Section scheduled to be repealed on January 1, 2027) Sec. 315.9. Voluntary dissolution. Upon application to the Director, a domestic society may request that it be dissolved and that its existence be terminated. The application shall demonstrate that the applicant has satisfied its members' certificate obligations or that it has transferred such obligations to another organization, domestic or foreign, by means of assumption or bulk reinsurance or otherwise, and that the domestic society's supreme governing body has approved the termination and dissolution. The application shall contain any other information required by the Director. Any limitation related to reinsurance by a domestic society shall not apply to reinsurance entered into in conjunction with the transfer of members' certificate obligations as a part of a voluntary dissolution. Upon approval of the application by the Director, the domestic society shall be deemed dissolved and its existence terminated as of the date set forth in the application.
(Source: P.A. 98-814, eff. 1-1-15.) |
(215 ILCS 5/Art. XVIII heading) ARTICLE XVIII.
MUTUAL BENEFIT ASSOCIATIONS
(Repealed by P.A. 98-969, eff. 1-1-15)
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(215 ILCS 5/Art. XIX heading) ARTICLE XIX.
BURIAL SOCIETIES
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(215 ILCS 5/338) (from Ch. 73, par. 950)
Sec. 338.
Scope of
Article.
(1) This Article shall apply to:
(a) all societies organized or operating, prior to | ||
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(b) any person, firm, corporation, society, or | ||
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(2) Each person, firm, corporation, society or association mentioned in
subsection (1) is referred to in this Article as a "burial society" and
subscribers to and certificate holders of such a society are referred to in
this Article as "members."
(Source: P.A. 91-357, eff. 7-29-99.)
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(215 ILCS 5/339) (from Ch. 73, par. 951)
Sec. 339.
Present
authorized burial societies may transact business.
Every society organized prior to the effective date of this amendatory
Act of 1959 and which society on that date was transacting business under a
certificate of authority issued by the Director may continue to transact
such business subject to the provisions of this article, but except as
provided in Section 336a no person, firm, corporation, society or
association shall enter business as a burial society after the effective
date of this amendatory Act of 1959.
(Source: Laws 1959, p. 1150.)
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(215 ILCS 5/340) (from Ch. 73, par. 952)
Sec. 340.
Article of
Incorporation.
The articles of incorporation of a burial society shall state:
(a) The corporate name which shall not resemble the name of any existing
society or corporation organized under the laws of this State or authorized
to transact business therein as to mislead the public or cause confusion,
the purpose for which it is formed and the place in this State where its
principal office is located;
(b) The mode and manner in which the corporate powers of the society
shall be exercised; the manner of electing directors; the number of
directors which shall not be less than 3 nor more than 7; terms of office
of directors which shall be not more than 4 years; the manner of electing
officers and filling vacancies and such other particulars as may be
necessary to explain and manifest the object and purpose of the society and
the manner in which it is to be conducted.
A copy of the by-laws and forms of applications for members and a copy
of all forms of policies or certificates, literature and advertisements
shall be filed with the Director.
The Director shall examine the articles of incorporation and other
papers so filed with him and if he finds no objection thereto he shall
submit the articles of incorporation to the Attorney General for
examination and if found by the Attorney General to be in accordance with
the provisions of this Code and not inconsistent with the laws and
constitution of this State and of the United States, he shall certify to
the same and deliver it back to the Director who shall cause the articles
to be recorded in his records and issue to the incorporators a certified
copy thereof, and thereupon such incorporators and their associates shall
become and be a body corporate with the power to sue and be sued, contract
and be contracted with, adopt by-laws not in conflict with the provisions
of this Code, adopt a seal and do such other acts, subject to the
provisions and restrictions of this Code, as shall be needful to accomplish
the purposes of its organization. The management of the affairs of the
society shall at all times be vested in the board of directors.
(Source: P.A. 82-498.)
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(215 ILCS 5/341) (from Ch. 73, par. 953)
Sec. 341.
Deposit
required.
(1) A burial society shall maintain with the Director a
deposit of
cash or securities in an amount of at least $1,000. A
society having a membership of more than 2,500
members and
less than 5,000 members shall maintain a deposit with the
Director
of $5,000. A society having a
membership of
more than 5,000 members and less than 10,000 members shall
maintain a
deposit with the Director of $10,000. A society
having more
than 10,000 members shall maintain a deposit with the
Director of $10,000 and an additional $1,000 for
each 1,000 members in excess of 10,000.
(2) All deposits as required herein shall be in cash or in securities
permitted by section 346.
(3) The Director may release the required deposit of cash or securities
upon receipt of
an order of a court having proper jurisdiction or
upon: (i) certification by the burial society that it has no outstanding
creditors, policyholders, certificate holders, or member obligations in effect
and no plans to engage in the business of insurance; (ii) receipt of a lawful
resolution of the burial society's board of directors effecting the surrender
of its articles of incorporation for administrative dissolution by the
Director; and (iii) receipt of the name and forwarding address for each of the
final officers and directors of the burial society, together with a plan of
dissolution approved by the Director.
(Source: P.A. 92-75, eff. 7-12-01.)
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(215 ILCS 5/342) (from Ch. 73, par. 954)
Sec. 342.
Officers
bond.
The officer or officers of the society entrusted with the custody of its
funds shall give bond to the association in double the amount of the
minimum deposit required by this article, but in no event less than Two
Thousand ($2,000) Dollars or more than Five Thousand ($5,000) Dollars,
conditioned upon the faithful performance of his or their duties and
accounting for the funds entrusted to his or their custody.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/343) (from Ch. 73, par. 955)
Sec. 343.
Certificate form.
(1) Every burial society shall issue a certificate of membership to
each member, agreeing to pay upon death a specified sum of money not to
exceed $1,000, which specified amount shall not be
diminished during the existence of the contract. The form of certificate
shall be submitted to the Director for his or her approval before the same
shall be issued. Each certificate issued after the effective date of
this Code, shall contain the following provisions, and shall be printed
in clear readable type of uniform size except that the words in capital
letters in the following form may be in larger type:
............, Illinois.
Certificate Number
..................
..............................
(A Burial Insurance Society)
Incorporated under the Illinois Insurance Code.
HEREBY INSURES the life of ...., hereinafter called the Member.
The society hereby agrees to pay to .... Beneficiary, the sum of $....,
upon receipt of due proof of the death of the member, such
payment to be paid only in lawful money of the United States.
This certificate is issued in consideration of the application and
the payment in advance of a first .... premium of .... which maintains
this certificate in force for a period ending .... following its date of
issue, and the payment of a like sum on the .... day of each ....
thereafter during the lifetime of the member.
CHANGE OF BENEFICIARY. The member may change the beneficiary at any
time by giving notice at the principal office of the society.
INCONTESTABLE CLAUSE. This certificate shall be incontestable after
it has been in force during the life-time of the member for 2 years
except for non-payment of premiums provided herein.
GRACE PERIOD. A grace period of 30 days shall be allowed for the
payment of any premium after the first, during which time this
certificate shall be continued in full force. Should the member die
during such grace period, the unpaid premium may be deducted from the
amount otherwise payable. This certificate shall be regarded and
accepted by the society and the member as cancelled and terminated upon
failure to pay any premium before the expiration of the grace period.
REINSTATEMENT. This certificate, after default in payment of any
premium, may be reinstated at the discretion of the Board of Directors
upon the member furnishing to the society satisfactory evidence of good
health and paying the delinquent premiums.
CONTRACT. This certificate and the application therefor, a copy of which
is attached hereto, shall constitute the entire contract with the member.
MISSTATEMENT OF AGE. If the age of the member has been misstated, the
amount payable under the certificate shall be such as the member would
have been entitled to at the true age.
IN WITNESS WHEREOF, the society has caused this certificate to
be signed by its duly authorized officers, on (insert date), which shall be the effective date of this certificate.
.................
(Secretary)
.................
(President)
(2) If the society is operating on an assessment plan, it may
substitute in lieu of the word premium the word assessment in each case
and may substitute in lieu of the consideration clause contained in the
form the following:
This certificate is issued in consideration of the application and
the payment in advance of the first .... assessment and the further
payment of such assessments as may be levied from time to time during
the lifetime of the member.
(Source: P.A. 91-357, eff. 7-29-99.)
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(215 ILCS 5/344) (from Ch. 73, par. 956)
Sec. 344.
Burial
benefit payable in lawful money.
No society operating under or by virtue of this article shall pay a
burial benefit or award other than in lawful money of the United States and
any provision in any contract to the contrary shall be of no effect, nor
shall any member of any society or representative or beneficiary of such
member be required as a condition of his becoming a member, or otherwise,
to purchase funeral supplies or burial services from any specified or
designated person, firm or corporation so as to deprive the representative,
beneficiary or family of any such member from procuring or purchasing said
supplies and services in the open market.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/345) (from Ch. 73, par. 957)
Sec. 345.
Society
and directors or officers may not advertise funeral supplies.
No burial society nor any officer, director or agent of any burial
society shall offer or make any oral or written agreement to furnish, or
shall distribute or cause to be distributed any literature or advertising
of any kind whatsoever which offers or purports to offer, funeral supplies
of any kind in lieu of the cash payment upon the death of a member. Upon
any violation of this section by any society, or officer, director or agent
thereof, the Director shall proceed to liquidate such society in accordance
with the provisions of Article XIII.
(Source: Laws 1937, p. 689.)
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(215 ILCS 5/346) (from Ch. 73, par. 958)
Sec. 346.
Benefit account and expense account.
(1) All burial societies shall charge a premium or levy an
assessment to be paid by the members. Unless the society
maintains reserves meeting the standards of Article XIV on its benefit
certificates, the society shall not use more
than sixty-five per centum of such premium or assessment for the purpose
of paying commissions, salaries and other expenses of operation, and the
surplus and legal reserves shall constitute the benefit account of
the society and shall be
retained in cash or be invested in accordance with Article VIII.
(2) No society shall invest in or loan upon any bond or note secured
by mortgage or trust deed on real estate if an officer or director of
such society has any financial interest in the real estate upon which
the loan is made.
(Source: P.A. 86-753.)
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(215 ILCS 5/347) (from Ch. 73, par. 959)
Sec. 347.
Failure to
maintain deposit-Payment of claims.
All claims filed with a society shall be approved or disapproved within
sixty days after receipt of due proof of death and, if approved, shall be
paid within thirty days after such approval. The Director shall proceed
under Article XIII to liquidate any society which shall fail to maintain
the deposit required by this article, or shall conduct its business
fraudulently, or is not carrying out its contracts in good faith, or shall
be thirty days or more in arrears in payment of death claims after the same
have been allowed by the board of directors, or has violated any of the
provisions of this article.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/348) (from Ch. 73, par. 960)
Sec. 348.
Amendment
of articles.
The articles of incorporation of any society, subject to the provisions
of this article, may be amended by proper resolutions adopted by the Board
of Directors.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/349) (from Ch. 73, par. 961)
Sec. 349.
Penalties.
Any society or any officer or agent of any society who violates any of
the provisions of this article shall be guilty of a petty offense.
(Source: P.A. 77-2699.)
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(215 ILCS 5/351) (from Ch. 73, par. 963)
Sec. 351.
Application of article and other code provisions.
(1) This article shall not apply to fraternal or fraternal benefit
societies, assessment life and accident associations existing or
operating under or by virtue of any statute of this State, societies
that pay sick or disability benefits and limit their membership to a
particular class of persons or to the employees of a designated person,
firm or corporation nor shall this article apply to any burial insurance
society composed exclusively of the employees of any department of any
municipal, county, state or national government.
(2) Unless otherwise provided in this article every burial society
shall be subject to other applicable provisions of this Code.
Unless specifically exempted by the Director of Insurance every
society not operating on the true assessment plan shall adopt a
standard of valuation approved by the Director.
(Source: P.A. 80-624.)
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(215 ILCS 5/Art. XIXA heading) ARTICLE XIXA.
LONG-TERM CARE INSURANCE
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(215 ILCS 5/351A-1) (from Ch. 73, par. 963A-1)
Sec. 351A-1.
Definitions.
Unless the context requires otherwise, in this
Article:
(a) "Long-term care insurance" means any accident and health insurance
policy or rider advertised, marketed, offered or designed to provide
coverage for not less than 12 consecutive months for each covered person on
an expense incurred, indemnity, prepaid or other basis, for one or more
necessary or medically necessary diagnostic, preventive, therapeutic,
rehabilitative, maintenance, or personal care services, provided in a
setting other than an acute care unit of a hospital. Such term includes
group and individual annuities and life insurance policies or riders which
provide directly or which supplement long-term care insurance. The term also
includes a policy or rider that provides for payment of benefits based upon
cognitive impairment or the loss of functional capacity. The term shall also
include qualified long-term care insurance contracts. Long-term
care insurance may be issued by insurers, fraternal benefit societies,
nonprofit health, hospital, and medical service corporations, prepaid
health plans, health maintenance organizations or any similar organization
to the extent they are otherwise authorized to issue life or health
insurance. Long-term care insurance shall not include any insurance policy
which is offered primarily to provide basic Medicare supplement coverage,
basic hospital expense coverage, basic medical-surgical expense coverage,
hospital confinement indemnity coverage, major medical expense coverage,
disability income protection coverage, accident only coverage, specified
disease or specified accident coverage, or limited benefit health coverage.
Long-term care insurance may include benefits for care and treatment in
accordance with the tenets and practices of any established church or
religious denomination which teaches reliance on spiritual treatment
through prayer for healing.
(b) "Applicant" means:
(1) In the case of an individual long-term care | ||
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(2) In the case of a group long-term care insurance | ||
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(c) "Certificate" means, for the purposes of this Article, any
certificate issued under a group long-term care insurance policy, which
policy has been delivered or issued for delivery in this State.
(d) "Director" means the Director of Insurance of this State.
(e) "Group long-term care insurance" means a long-term care insurance
policy which is delivered or issued for delivery in this State and issued
to one of the following:
(1) One or more employers or labor organizations, or | ||
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(2) Any professional, trade or occupational | ||
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(A) is composed of individuals all of whom are or | ||
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(B) has been maintained in good faith for | ||
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(3) An association or a trust or the trustee or | ||
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(A) the association or associations hold regular | ||
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(B) except for credit unions, the association or | ||
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(C) the members have voting privileges and | ||
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Thirty days after such filing the association or | ||
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(4) A group other than as described in paragraph (1), | ||
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(A) the issuance of the group policy is not | ||
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(B) the issuance of the group policy would result | ||
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(C) the benefits are reasonable in relation to | ||
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(f) "Policy" means, for the purposes of this Article, any policy, contract,
subscriber agreement, rider or endorsement delivered or issued for delivery
in this State by an insurer, fraternal benefit society, nonprofit health,
hospital, or medical service corporation, prepaid health plan, health
maintenance organization or any similar organization.
(g) "Qualified long-term care insurance contract" or "federally
tax-qualified long-term care insurance contract" means an individual or group
insurance contract that meets the requirements of Section 7702B(b) of the
Internal Revenue Code of 1986, as amended, as follows:
(1) The only insurance protection provided under the | ||
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(2) The contract does not pay or reimburse expenses | ||
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(3) The contract is guaranteed renewable within the | ||
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(4) The contract does not provide for a cash | ||
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(5) All refunds of premiums and all policyholder | ||
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(6) The contract meets the consumer protection | ||
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"Qualified long-term care insurance contract" or "federally tax-qualified
long-term care insurance contract" also means the portion of a life insurance
contract that provides long-term care insurance
coverage by rider or as part of the contract and that satisfies the
requirements of Sections 7702B(b) and 7702B(e) of the Internal Revenue Code of
1986,
as amended.
(Source: P.A. 92-148, eff. 7-24-01.)
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(215 ILCS 5/351A-2) (from Ch. 73, par. 963A-2)
Sec. 351A-2.
Group policy issued in another state.
No group long-term
care insurance coverage may be offered to a resident of this State under a
group policy issued in another state to a group described in paragraph (4)
of subsection (e) of Section 351A-1, unless the Director determines that
this State or another state having statutory and regulatory long-term care
insurance requirements substantially similar to those adopted in this State
has made a determination that such requirements have been met.
(Source: P.A. 85-1172; 85-1174; 85-1440.)
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(215 ILCS 5/351A-3) (from Ch. 73, par. 963A-3)
Sec. 351A-3.
Disclosures.
The Director may adopt rules that include
standards for full and fair disclosure setting forth the manner, content,
and required disclosures for the sale of long-term care insurance policies,
terms of renewability, initial and subsequent conditions of eligibility,
nonduplication of coverage provisions, coverage of dependents, preexisting
conditions, termination of insurance, continuation or conversion,
probationary periods, limitations, exceptions, reductions, elimination
periods, requirements for replacement, recurrent conditions, and
definitions of terms.
(Source: P.A. 85-1172; 85-1174; 85-1440.)
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(215 ILCS 5/351A-4) (from Ch. 73, par. 963A-4)
Sec. 351A-4.
Limitation.
No long-term care insurance policy may:
(1) Be cancelled, nonrenewed or otherwise terminated | ||
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(2) Contain a provision establishing a new waiting | ||
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(3) Provide coverage for skilled nursing care only or | ||
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(Source: P.A. 92-148, eff. 7-24-01.)
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(215 ILCS 5/351A-4.5)
Sec. 351A-4.5.
Long-term care; coverages.
Nothing in this Code prohibits
an insurance company from offering a long-term care insurance
policy that provides for (1) reimbursement
of paid premiums in the event of cancellation or (2) reduced benefits in the
event the policyholder discontinues premium payments.
(Source: P.A. 88-290.)
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(215 ILCS 5/351A-5) (from Ch. 73, par. 963A-5)
Sec. 351A-5.
Preexisting condition.
(a) No long-term care insurance
policy or certificate other than a policy or certificate thereunder issued
to a group as defined in paragraph (1) of subsection (e) of Section 351A-1
shall use a definition of "preexisting condition" which is more restrictive
than the following: Preexisting condition means the existence of symptoms
which would cause an ordinarily prudent person to seek diagnosis, care or
treatment, or a condition for which medical advice or treatment was
recommended by, or received from a provider of health care services, within
6 months preceding the effective date of coverage for an insured person.
(b) No long-term care insurance policy or certificate other than a
policy or certificate thereunder issued to a group as defined in paragraph
(1) subsection (e) of Section 351A-1 may exclude coverage for a loss or
confinement which is the result of a preexisting condition unless such loss
or confinement begins within 6 months following the effective date of
coverage of an insured person.
(c) The Director may extend the limitation periods set forth in
subsections (a) and (b) of this Section as to specific age group categories
in specific policy forms upon finding that the extension is in the best
interest of the public.
(d) The definition of "preexisting condition" does not prohibit an
insurer from using an application form designed to elicit the complete
health history of an applicant, and, on the basis of the answers on that
application, from underwriting in accordance with that insurer's
established underwriting standards. Unless otherwise provided in the
policy or certificate, a preexisting condition, regardless of whether it is
disclosed on the application, need not be covered until the waiting period
described in subsection (b) of this Section expires. No long-term care
insurance policy or certificate may exclude or use waivers or riders of any
kind to exclude, limit or reduce coverage or benefits for specifically
named or described preexisting diseases or physical conditions beyond the
waiting period described in subsection (b) of this Section.
(Source: P.A. 85-1172; 85-1174; 85-1440.)
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(215 ILCS 5/351A-6) (from Ch. 73, par. 963A-6)
Sec. 351A-6.
Prior hospitalization; institutionalizations.
(a) On and after the effective date of this amendatory Act of 1989, no
long-term care insurance policy may be delivered or issued for delivery in
this State if such policy:
(1) conditions eligibility for any benefits on a | ||
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(2) conditions eligibility for benefits provided in | ||
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(b) Beginning one year after the effective date of this amendatory Act
of 1989, a long-term care insurance policy containing any limitations or
conditions for eligibility other than those prohibited above in subsection
(a) shall clearly label in a separate paragraph of the policy or
certificate entitled "Limitations or Conditions on Eligibility for
Benefits" such limitations or conditions, including any required number of
days of confinement.
(1) A long-term care insurance policy containing a | ||
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(2) A long-term care insurance policy which | ||
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(Source: P.A. 85-1440; 86-384.)
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(215 ILCS 5/351A-7) (from Ch. 73, par. 963A-7)
Sec. 351A-7.
Right to return.
(a) An individual long-term care
insurance policyholder shall have the right to return the policy within 30
days of its delivery and to have the premium refunded directly to him or
her if, after examination of the policy, the policyholder is not satisfied
for any reason. Long-term care insurance policies shall have a notice
prominently printed on the first page of the policy or attached thereto
stating in substance that the policyholder shall have the right to return
the policy within 30 days of its delivery and to have the premium refunded
if, after examination of the policy, the policyholder is not satisfied for
any reason.
(b) A person insured under a long-term care insurance policy or
certificate issued pursuant to a direct response solicitation shall have
the right to return the policy or certificate within 30 days of its
delivery and to have the premium refunded directly to him or her if, after
examination, the insured person is not satisfied for any reason. Long-term
care insurance policies or certificates issued pursuant to a direct
response solicitation shall have a notice prominently printed on the first
page of the policy or certificate attached thereto stating in substance
that the insured person shall have the right to return the policy or
certificate within 30 days of its delivery and to have the premium refunded
if, after examination of the policy or certificate, the insured person is
not satisfied for any reason. This subsection also applies to denials of
applications, and any refund must be made within 30 days of the return or
denial.
(Source: P.A. 92-148, eff. 7-24-01.)
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(215 ILCS 5/351A-8) (from Ch. 73, par. 963A-8)
Sec. 351A-8.
Outline of coverage.
(a) An outline of coverage shall be delivered to a prospective applicant
for long-term care insurance at the time of initial solicitation through
means which prominently direct the attention of the recipient to the
document and its purpose.
(1) The Director shall prescribe a standard format | ||
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(2) In the case of agent solicitations, an agent must | ||
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(3) In the case of direct response solicitations, the | ||
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(b) The outline of coverage shall include:
(1) A description of the principal benefits and | ||
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(2) A statement of the principal exclusions, | ||
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(3) A statement of the terms under which the policy | ||
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(4) A statement that the outline of coverage is a | ||
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(5) A description of the terms under which the policy | ||
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(6) A brief description of the relationship of cost | ||
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(7) A statement that discloses to the policyholder or | ||
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(Source: P.A. 92-148, eff. 7-24-01.)
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(215 ILCS 5/351A-9) (from Ch. 73, par. 963A-9)
Sec. 351A-9.
Disclosure in certificate.
A certificate issued pursuant
to a group long-term care insurance policy, which policy is delivered or
issued for delivery in this State, shall include each of the following:
(1) A description of the principal benefits and coverage provided in
the policy.
(2) A statement of the principal exclusions, reductions and limitations
contained in the policy.
(3) A statement that the group master policy determines governing
contractual provisions.
(Source: P.A. 85-1172; 85-1174; 85-1440.)
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(215 ILCS 5/351A-9.1) (from Ch. 73, par. 963A-9.1)
Sec. 351A-9.1.
Policy summary and benefit reports.
(a) At the time of policy delivery, a policy summary shall be delivered
for an individual life insurance policy which provides long-term care
benefits within the policy or by rider. In the case of direct response
solicitations, the insurer shall deliver the policy summary upon the
applicant's request, but regardless of request shall make such delivery no
later than at the time of policy delivery. In addition to complying with
all applicable requirements, the summary shall also include:
(1) an explanation of how the long-term care benefit | ||
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(2) an illustration of the amount of benefits, the | ||
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(3) any exclusions, reductions and limitations on | ||
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(4) if applicable to the policy type, the summary | ||
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(A) disclosure of the effects of exercising other | ||
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(B) disclosure of guarantees related to long-term | ||
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(C) current and projected maximum lifetime | ||
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(b) Any time a long-term care benefit, funded through a life insurance
vehicle by the acceleration of the death benefit, is in benefit payment
status, a monthly report shall be provided to the policyholder. Such
report shall include:
(1) any long-term care benefits paid during the month;
(2) an explanation of any changes in the policy, | ||
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(3) the amount of long-term care benefits existing or | ||
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(Source: P.A. 86-384.)
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(215 ILCS 5/351A-9.2)
Sec. 351A-9.2.
Delivery of policy.
If an applicant for a long-term care
insurance contract or certificate is approved, the issuer shall deliver the
contract or certificate of insurance to the applicant no later than 30 days
after the date of approval.
(Source: P.A. 92-148, eff. 7-24-01.)
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(215 ILCS 5/351A-9.3)
Sec. 351A-9.3.
Claim denial; explanation.
If a claim under a long-term
care insurance contract is denied, the issuer, within 60 days after
receipt of a written request by a policyholder or certificate holder or a
policyholder's or certificate holder's representative shall:
(1) provide a written explanation of the reasons for | ||
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(2) make available all information directly related | ||
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(Source: P.A. 92-148, eff. 7-24-01.)
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(215 ILCS 5/351A-10) (from Ch. 73, par. 963A-10)
Sec. 351A-10.
Any policy or rider advertised, marketed or offered as
long-term care or nursing home insurance shall comply with the provisions
of this Article.
(Source: P.A. 85-1440; 86-384.)
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(215 ILCS 5/351A-11) (from Ch. 73, par. 963A-11)
Sec. 351A-11.
Rules and regulations.
The Director may adopt rules and
regulations establishing minimum standards for marketing practices and
reporting practices, penalties for violating those standards, and loss
ratio standards for long-term care insurance policies, provided that a
specific reference to long-term care insurance policies is contained in the
regulation. Rules adopted pursuant to this Article shall be in accordance
with the provisions of the Illinois Administrative Procedure Act.
(Source: P.A. 87-601.)
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(215 ILCS 5/Art. XIXB heading) ARTICLE XIXB
SMALL EMPLOYER GROUP HEALTH INSURANCE LAW
(Repealed by P.A. 98-692, eff. 7-1-14; 98-969, eff. 1-1-15)
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(215 ILCS 5/Art. XX heading) ARTICLE XX.
ACCIDENT AND HEALTH INSURANCE
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(215 ILCS 5/352) (from Ch. 73, par. 964)
Sec. 352. 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.
(b) (Blank).
(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
follows:
(1) The policy must be issued to and insure an | ||
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(2) Payments by the insurer must be made to the | ||
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(e) A policy issued or delivered in this State to the Department of Healthcare and Family Services (formerly
Illinois Department
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
Aid Code.
(f) An in-office membership care agreement provided under the In-Office Membership Care Act is not insurance for the purposes of this Code. (Source: P.A. 101-190, eff. 8-2-19.)
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(215 ILCS 5/352a) (from Ch. 73, par. 964a)
Sec. 352a.
Mandated Coverages.
No legislation enacted after the
effective date of this Amendatory Act of 1990 which mandates or requires
the offering of health care coverages or services shall apply to any
insurer unless the legislation applies equally to employee welfare benefit
plans described in 29 U.S.C. 1001 et seq.
(Source: P.A. 86-1365.)
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(215 ILCS 5/352b) Sec. 352b. Policy of individual or group accident and health insurance. Unless specified otherwise and when used in context of accident and health insurance policy benefits, coverage, terms, or conditions required to be provided under this Article, "policy of individual or group accident and health insurance", as used in this Article, does not include any coverage or policy that provides an excepted benefit, as that term is defined in Section 2791(c) of the federal Public Health Service Act (42 U.S.C. 300gg-91). Nothing in this amendatory Act of the 101st General Assembly applies to a policy of liability, workers' compensation, automobile medical payment, or limited scope dental or vision benefits insurance issued under this Code.
(Source: P.A. 101-456, eff. 8-23-19.) |
(215 ILCS 5/353) (from Ch. 73, par. 965)
Sec. 353.
Non-cancellable accident and health insurance reserves.
(1) The legal minimum standard for computing the active life reserve,
including the unearned premium reserve, of non-cancellable accident and
health policies issued on and after January 1 of the year following that
during which this Code becomes effective shall be based on Class III
Disability Experience with interest at not to exceed three and one-half per
centum per annum on the full preliminary term basis; and the minimum
standard for computing the active life reserve of such policies issued
prior to January 1 of the year following that during which this Code
becomes effective shall be such as to place an adequate value, as
determined by sound insurance practices, on the liabilities thereunder.
(2) For policies with a waiting period of less than three (3) months, or
providing benefits at ages beyond the limits of Class III Disability
Experience, such tables shall be extended to cover the provisions of such
policies on such basis as may be approved by the Director.
(3) The reserve for losses under non-cancellable accident and health
policies issued on and after January 1 of the year following that during
which this Code becomes effective shall be based on Class III Disability
Experience, except that for claims of less than twenty-seven months
duration the reserve may be taken as equivalent to the prospective claim
payments for three and one-half times the elapsed period of disability,
provided, that in no case shall the reserve be less than the equivalent of
seven weeks' claim payments; and the minimum standard for computing the
reserve for losses under such policies issued prior to January 1 of the
year following that during which the Code becomes effective shall be such
as to place an adequate value, as determined by sound insurance practices,
on such losses.
(4) The Director shall modify the application of the tables and
requirements prescribed in this section to policies or to claims arising
under policies in accordance with the waiting period contained in such
policies and in accordance with any limitation as to the time for which
indemnity is payable. The company shall give the notice required in section
234 on all non-cancellable accident and health policies.
This section shall apply only to accident and health policies issued
prior to the operative date under section 353a as defined therein.
(Source: Laws 1965, p. 740.)
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(215 ILCS 5/353a) (from Ch. 73, par. 965a)
Sec. 353a. Accident
and health reserves.
The reserves for all accident and health policies issued after the
operative date of this section shall be computed and maintained on a basis
which shall place an actuarially sound value on the liabilities under such
policies. To provide a basis for the determination of such actuarially
sound value, the Director from time to time shall adopt rules requiring the
use of appropriate tables of morbidity, mortality, interest rates and
valuation methods for such reserves for policies issued before January 1, 2017. For policies issued on or after January 1, 2017, Section 223 shall govern the basis for determining such actuarially sound value. In no event shall such reserves be
less than the pro rata gross unearned premium reserve for such policies.
The company shall give the notice required in section 234 on all
non-cancellable accident and health policies.
After this section becomes effective, any company may file with the
Director written notice of its election to comply with the provisions of
this section after a specified date before January 1, 1967. After the
filing of such notice, then upon such specified date (which shall be the
operative date of this section for such company), this section shall become
operative with respect to the accident and health policies thereafter
issued by such company. If a company makes no such election, the operative
date of this section for such company shall be January 1, 1967.
After this section becomes effective, any company may file with the
Director written notice of its election to establish and maintain reserves
upon its accident and health policies issued prior to the operative date of
this section in accordance with the standards for reserves established by
this section, and thereafter the reserve standards prescribed pursuant to
this section shall be effective with respect to said accident and health
policies issued prior to the operative date of this section.
(Source: P.A. 102-775, eff. 5-13-22.)
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(215 ILCS 5/354) (from Ch. 73, par. 966)
Sec. 354.
Accident
and health loss reserves.
The loss reserves of all accident and health policies other than
non-cancellable accident and health policies shall be computed and
maintained in accordance with the applicable provisions of Article XXII.
The unearned premium reserve of all accident and health policies other than
non-cancellable accident and health policies shall be computed and
maintained on the monthly pro rata basis.
This Section shall apply only to accident and health policies issued
prior to the operative date under section 353a as defined therein.
(Source: P.A. 83-584.)
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(215 ILCS 5/355) (from Ch. 73, par. 967)
Sec. 355. Accident
and health policies; provisions.
(a) As used in this Section: "Inadequate rate" means a rate: (1) that is insufficient to sustain projected losses | ||
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(2) the continued use of which endangers the solvency | ||
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"Large employer" has the meaning provided in the Illinois Health Insurance Portability and Accountability Act. "Plain language" has the meaning provided in the federal Plain Writing Act of 2010 and subsequent guidance documents, including the Federal Plain Language Guidelines. "Unreasonable rate increase" means a rate increase that the Director determines to be excessive, unjustified, or unfairly discriminatory in accordance with 45 CFR 154.205. (b) No policy of insurance against loss or damage from the sickness, or from
the bodily injury or death of the insured by accident shall be issued or
delivered to any person in this State until a copy of the form thereof and
of the classification of risks and the premium rates pertaining thereto
have been filed with the Director; nor shall it be so issued or delivered
until the Director shall have approved such policy pursuant to the provisions
of Section 143. If the Director
disapproves the policy form, he or she shall make a written decision stating the
respects in which such form does not comply with the requirements of law
and shall deliver a copy thereof to the company and it shall be unlawful
thereafter for any such company to issue any policy in such form. On and after January 1, 2025, any form filing submitted for large employer group accident and health insurance shall be automatically deemed approved within 90 days of the submission date unless the Director extends by not more than an additional 30 days the period within which the form shall be approved or disapproved by giving written notice to the insurer of such extension before the expiration of the 90 days. Any form in receipt of such an extension shall be automatically deemed approved within 120 days of the submission date. The Director may toll the filing due to a conflict in legal interpretation of federal or State law as long as the tolling is applied uniformly to all applicable forms, written notification is provided to the insurer prior to the tolling, the duration of the tolling is provided within the notice to the insurer, and justification for the tolling is posted to the Department's website. The Director may disapprove the filing if the insurer fails to respond to an objection or request for additional information within the timeframe identified for response. As used in this subsection, "large employer" has the meaning given in Section 5 of the federal Health Insurance Portability and Accountability Act. (c) For plan year 2026 and thereafter, premium rates for all individual and small group accident and health insurance policies must be filed with the Department for approval. Unreasonable rate increases or inadequate rates shall be modified or disapproved. For any plan year during which the Illinois Health Benefits Exchange operates as a full State-based exchange, the Department shall provide insurers at least 30 days' notice of the deadline to submit rate filings.
(d) For plan year 2025 and thereafter, the Department shall post all insurers' rate filings and summaries on the Department's website 5 business days after the rate filing deadline set by the Department in annual guidance. The rate filings and summaries posted to the Department's website shall exclude information that is proprietary or trade secret information protected under paragraph (g) of subsection (1) of Section 7 of the Freedom of Information Act or confidential or privileged under any applicable insurance law or rule. All summaries shall include a brief justification of any rate increase or decrease requested, including the number of individual members, the medical loss ratio, medical trend, administrative costs, and any other information required by rule. The plain writing summary shall include notification of the public comment period established in subsection (e). (e) The Department shall open a 30-day public comment period on the rate filings beginning on the date that all of the rate filings are posted on the Department's website. The Department shall post all of the comments received to the Department's website within 5 business days after the comment period ends. (f) After the close of the public comment period described in subsection (e), the Department, beginning for plan year 2026, shall issue a decision to approve, disapprove, or modify a rate filing within 60 days. Any rate filing or any rates within a filing on which the Director does not issue a decision within 60 days shall automatically be deemed approved. The Director's decision shall take into account the actuarial justifications and public comments. The Department shall notify the insurer of the decision, make the decision available to the public by posting it on the Department's website, and include an explanation of the findings, actuarial justifications, and rationale that are the basis for the decision. Any company whose rate has been modified or disapproved shall be allowed to request a hearing within 10 days after the action taken. The action of the Director in disapproving a rate shall be subject to judicial review under the Administrative Review Law. (g) If, following the issuance of a decision but before the effective date of the premium rates approved by the decision, an event occurs that materially affects the Director's decision to approve, deny, or modify the rates, the Director may consider supplemental facts or data reasonably related to the event. (h) The Department shall adopt rules implementing the procedures described in subsections (d) through (g) by March 31, 2024. (i) Subsection (a) and subsections (c) through (h) of this Section do not apply to grandfathered health plans as defined in 45 CFR 147.140; excepted benefits as defined in 42 U.S.C. 300gg-91; student health insurance coverage as defined in 45 CFR 147.145; the large group market as defined in Section 5 of the Illinois Health Insurance Portability and Accountability Act; or short-term, limited-duration health insurance coverage as defined in Section 5 of the Short-Term, Limited-Duration Health Insurance Coverage Act. For a filing of premium rates or classifications of risk for any of these types of coverage, the Director's initial review period shall not exceed 60 days to issue informal objections to the company that request additional clarification, explanation, substantiating documentation, or correction of concerns identified in the filing before the company implements the premium rates, classifications, or related rate-setting methodologies described in the filing, except that the Director may extend by not more than an additional 30 days the period of initial review by giving written notice to the company of such extension before the expiration of the initial 60-day period. Nothing in this subsection shall confer authority upon the Director to approve, modify, or disapprove rates where that authority is not provided by other law. Nothing in this subsection shall prohibit the Director from conducting any investigation, examination, hearing, or other formal administrative or enforcement proceeding with respect to a company's rate filing or implementation thereof under applicable law at any time, including after the period of initial review. (Source: P.A. 103-106, eff. 1-1-24.)
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(215 ILCS 5/355.1) (from Ch. 73, par. 967.1)
Sec. 355.1.
No claim for benefits for loss of time from the insured person's
occupation, under a group or individual accident and health insurance
policy delivered in this State more than 120 days after the effective date
of this Section, shall be reduced by reason of any cost-of-living increase,
designated as such under the Federal Social Security Act, if such
cost-of-living increase occurs while the policy's benefits are payable for
that claim.
(Source: P.A. 78-603.)
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(215 ILCS 5/355.2) (from Ch. 73, par. 967.2)
Sec. 355.2.
Dental coverage reimbursement rates.
(a) Every company that issues, delivers, amends, or renews any
individual or group policy of accident and health insurance on or after the
effective date of this amendatory Act of 1991 that provides
dental insurance and bases payment for those benefits upon a
usual and customary fee charged by licensed dentists
must disclose all of the following:
(1) The frequency of the determination of the usual | ||
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(2) A general description of the methodology used to | ||
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(3) The percentile that determines the maximum | ||
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(b) The disclosure must be provided upon request to all group and
individual policy holders and group certificate holders. All proposals for
dental insurance must notify the prospective policy holder that information
regarding usual and customary fee determinations is available from the
insurer. All employee benefit descriptions or supplemental documents must
notify the employee that information regarding reimbursement rates is
available from the employer.
(Source: P.A. 87-587.)
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(215 ILCS 5/355.3) Sec. 355.3. Noncovered dental services. (a) In this Section: "Covered services" means dental care services for which a reimbursement is available under an
enrollee's plan contract, or for which a reimbursement would be available but for the application of
contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or
lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation. "Dental insurance" means any policy of insurance that is issued by a company that provides coverage for dental services not covered by a medical plan. (b) No company that issues, delivers, amends, or renews an individual or group policy of accident and health insurance on or after the effective date of this amendatory Act of the 97th General Assembly that provides dental insurance shall issue a service provider contract that requires a dentist to provide services to the insurer's policyholders at a fee set by the insurer unless the services are covered services under the applicable policyholder agreement.
(Source: P.A. 97-805, eff. 1-1-13.) |
(215 ILCS 5/355.4) Sec. 355.4. Provider notification of network plan changes. (a) As used in this Section: "Contracting entity" means any person or company that enters into direct contracts with providers for the delivery of dental services in the ordinary course of business, including a third-party administrator and a dental carrier. "Dental carrier" means a dental insurance company, dental service corporation, dental plan organization authorized to provide dental benefits, or a health insurance plan that includes coverage for dental services. (b) No dental carrier may automatically enroll a provider in a leased network without allowing any provider that is part of the dental carrier's provider network to choose to not participate by opting out. (c) Any contract entered into or renewed on or after the effective date of this amendatory Act of the 103rd General Assembly that allows the rights and obligations of the contract to be assigned or leased to another insurer shall provide for notice that informs each provider in writing via certified mail 60 days before any scheduled assignment or lease of the network to which the provider is a contracted provider. To be in compliance with this Section, the notification must include all contract terms, a policy manual, a fee schedule, and a statement that the provider has the right to choose not to participate in third-party access. (d) A dental carrier that leases or assigns its network shall not cancel a network participating dentist's contractual relationship or otherwise penalize a network participating dentist in any way based on whether or not the dentist accepts the terms of the assignment or lease. Before accepting the terms of an assignment or lease agreement as described in this Section, any provider who receives notification of an impending assignment or lease must be given the option to contract directly with the entities proposing to gain access to the provider's network. (e) The provisions of this Section do not apply: (1) if access to a provider network contract is | ||
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(2) to a provider network contract for dental | ||
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(Source: P.A. 103-24, eff. 1-1-24.) |
(215 ILCS 5/355.5) Sec. 355.5. Dental coverage reimbursement; prohibitions. No insurer, dental service plan corporation, professional service corporation, insurance network leasing company, or any company that amends, delivers, issues, or renews an individual or group policy of accident and health insurance on or after the effective date of this amendatory Act of the 103rd General Assembly shall require a dental care provider to incur a fee to access and obtain payment or reimbursement for services provided. A dental plan carrier shall provide a dental care provider with 100% of the contracted amount of the payment or reimbursement. Fees incurred directly by a dental care provider from third parties related to transmitting an automated clearing house network claim, transaction management, data management, or portal services and other fees charged by third parties that are not in the control of the dental plan carrier shall not be prohibited by this Section.(Source: P.A. 103-24, eff. 1-1-24.) |
(215 ILCS 5/355a) (from Ch. 73, par. 967a)
Sec. 355a. Standardization of terms and coverage.
(1) The purposes of this Section shall be (a) to provide
reasonable standardization and simplification of terms and coverages of
individual accident and health insurance policies to facilitate public
understanding and comparisons; (b) to eliminate provisions contained in
individual accident and health insurance policies which may be
misleading or unreasonably confusing in connection either with the
purchase of such coverages or with the settlement of claims; and (c) to
provide for reasonable disclosure in the sale of accident and health
coverages.
(2) Definitions applicable to this Section are as follows:
(a) "Policy" means all or any part of the forms | ||
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(b) "Service corporations" means voluntary health and | ||
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(c) "Accident and health insurance" means insurance | ||
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(3) The Director shall issue such rules as he shall deem necessary
or desirable to establish specific standards, including standards of
full and fair disclosure that set forth the form and content and
required disclosure for sale, of individual policies of accident and
health insurance, which rules and regulations shall be in addition to
and in accordance with the applicable laws of this State, and which may
cover but shall not be limited to: (a) terms of renewability; (b)
initial and subsequent conditions of eligibility; (c) non-duplication of
coverage provisions; (d) coverage of dependents; (e) pre-existing
conditions; (f) termination of insurance; (g) probationary periods; (h)
limitation, exceptions, and reductions; (i) elimination periods; (j)
requirements regarding replacements; (k) recurrent conditions; and (l)
the definition of terms, including, but not limited to, the following:
hospital, accident, sickness, injury, physician, accidental means, total
disability, partial disability, nervous disorder, guaranteed renewable,
and non-cancellable.
The Director may issue rules that specify prohibited policy
provisions not otherwise specifically authorized by statute which in the
opinion of the Director are unjust, unfair or unfairly discriminatory to
the policyholder, any person insured under the policy, or beneficiary.
(4) The Director shall issue such rules as he shall deem necessary
or desirable to establish minimum standards for benefits under each
category of coverage in individual accident and health policies, other
than conversion policies issued pursuant to a contractual conversion
privilege under a group policy, including but not limited to the
following categories: (a) basic hospital expense coverage; (b) basic
medical-surgical expense coverage; (c) hospital confinement indemnity
coverage; (d) major medical expense coverage; (e) disability income
protection coverage; (f) accident only coverage; and (g) specified
disease or specified accident coverage.
Nothing in this subsection (4) shall preclude the issuance of any
policy which combines two or more of the categories of coverage
enumerated in subparagraphs (a) through (f) of this subsection.
No policy shall be delivered or issued for delivery in this State
which does not meet the prescribed minimum standards for the categories
of coverage listed in this subsection unless the Director finds that
such policy is necessary to meet specific needs of individuals or groups
and such individuals or groups will be adequately informed that such
policy does not meet the prescribed minimum standards, and such policy
meets the requirement that the benefits provided therein are reasonable
in relation to the premium charged. The standards and criteria to be
used by the Director in approving such policies shall be included in the
rules required under this Section with as much specificity as
practicable.
The Director shall prescribe by rule the method of identification of
policies based upon coverages provided.
(5) (a) In order to provide for full and fair disclosure in the
sale of individual accident and health insurance policies, no such
policy shall be delivered or issued for delivery in this State unless
the outline of coverage described in paragraph (b) of this subsection
either accompanies the policy, or is delivered to the applicant at the
time the application is made, and an acknowledgment signed by the
insured, of receipt of delivery of such outline, is provided to the
insurer. In the event the policy is issued on a basis other than that
applied for, the outline of coverage properly describing the policy must
accompany the policy when it is delivered and such outline shall clearly
state that the policy differs, and to what extent, from that for which
application was originally made. All policies, except single premium
nonrenewal policies, shall have a notice prominently printed on the
first page of the policy or attached thereto stating in substance, that
the policyholder shall have the right to return the policy within 10 days of its delivery and to have the premium refunded if after
examination of the policy the policyholder is not satisfied for any
reason.
(b) The Director shall issue such rules as he shall deem necessary
or desirable to prescribe the format and content of the outline of
coverage required by paragraph (a) of this subsection. "Format" means
style, arrangement, and overall appearance, including such items as the
size, color, and prominence of type and the arrangement of text and
captions. "Content" shall include without limitation thereto,
statements relating to the particular policy as to the applicable
category of coverage prescribed under subsection (4); principal benefits;
exceptions, reductions and limitations; and renewal provisions,
including any reservation by the insurer of a right to change premiums.
Such outline of coverage shall clearly state that it constitutes a
summary of the policy issued or applied for and that the policy should
be consulted to determine governing contractual provisions.
(c) (Blank). (d) (Blank). (e) (Blank). (f) (Blank). (6) Prior to the issuance of rules pursuant to this Section, the
Director shall afford the public, including the companies affected
thereby, reasonable opportunity for comment. Such rulemaking is subject
to the provisions of the Illinois Administrative Procedure Act.
(7) When a rule has been adopted, pursuant to this Section, all
policies of insurance or subscriber contracts which are not in
compliance with such rule shall, when so provided in such rule, be
deemed to be disapproved as of a date specified in such rule not less
than 120 days following its effective date, without any further or
additional notice other than the adoption of the rule.
(8) When a rule adopted pursuant to this Section so provides, a
policy of insurance or subscriber contract which does not comply with
the rule shall, not less than 120 days from the effective date of such
rule, be construed, and the insurer or service corporation shall be
liable, as if the policy or contract did comply with the rule.
(9) Violation of any rule adopted pursuant to this Section shall be
a violation of the insurance law for purposes of Sections 370 and 446 of this
Code.
(Source: P.A. 102-775, eff. 5-13-22.)
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(215 ILCS 5/355b) Sec. 355b. Claim-related information; alternative means of communication. (a) For the purposes of this Section, "claim-related information" means all claim or billing information relating specifically to an insured, subscriber, or person covered by an individual or group policy of accident and health insurance issued, delivered, amended, or renewed by a company doing business in this State. (b) A company that issues, delivers, amends, or renews an individual or group policy of accident and health insurance on or after the effective date of this amendatory Act of the 98th General Assembly shall accommodate a reasonable request by a person covered by a policy issued by the company to receive communications of claim-related information from the company by alternative means or at alternative locations if the person clearly states that disclosure of all or part of the information could endanger the person. (c) If a child is covered by a policy issued by a company, then the child's parent or guardian may make a request to the company pursuant to subsection (b) of this Section. (d) A company may require (1) a person making a request pursuant to subsection (b) of this Section to do so in writing, (2) the request to contain a statement that disclosure of all or part of the claim-related information to which the request pertains could endanger the person or child, and (3) the specification of an alternative address, telephone number, or other method of contact. (e) Except with the express consent of the person making a request pursuant to subsection (b) of this Section, a company may not disclose to the policyholder (1) the address, telephone number, or any other personally identifying information of the person who made the request or child for whose benefit a request was made, (2) the nature of the health care services provided, or (3) the name or address of the provider of the health care services. (f) A company that makes reasonable and good faith efforts to comply with this Section shall not be subject to civil or criminal liability on the grounds of noncompliance with this Section. (g) The Director shall adopt rules to guide companies in guarding against the disclosure of the information protected pursuant to this Section. (h) Nothing in this Section shall prevent, hinder, or otherwise affect the entry of an appropriate order made in the best interests of a child by a court of competent jurisdiction adjudicating disputed issues of child welfare or custody.
(Source: P.A. 98-189, eff. 1-1-14.) |
(215 ILCS 5/355c) Sec. 355c. Availability of information on qualified health plans. (a) Without limiting the generality of paragraph (b) of subsection (5) of Section 355a, no qualified health plans shall be offered for sale directly to consumers through the health insurance marketplace operating in this State in accordance with Sections 1311 and 1321 of the federal Patient Protection and Affordable Care Act of 2010 (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any amendments thereto, or regulations or guidance issued thereunder (collectively, "the Federal Act"), unless the following information is made available to the consumer at the time he or she is comparing policies and their premiums: (1) With respect to prescription drug benefits, | ||
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(2) The most recently published provider directory | ||
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(b) Each company that offers qualified health plans for sale directly to consumers through the health insurance marketplace operating in this State shall make the information in subsection (a), for each qualified health plan that it offers, available and accessible to the general public on the company's website and through other means for individuals without access to the Internet. (c) The Department shall ensure that State-operated websites, in addition to the website for the health insurance marketplace established in this State in accordance with the Federal Act, prominently provide links to Internet-based materials and tools to help consumers be informed purchasers of health insurance. (d) Nothing in this Section shall be interpreted or implemented in a manner not consistent with the Federal Act. This Section shall apply to all qualified health plans offered for sale directly to consumers through the health insurance marketplace operating in this State for any coverage year beginning on or after January 1, 2015.
(Source: P.A. 102-775, eff. 5-13-22.) |
(215 ILCS 5/356a) (from Ch. 73, par. 968a)
Sec. 356a.
Form of
policy.
(1) No policy of accident and health insurance shall be delivered or
issued for delivery to any person in this state unless:
(a) the entire money and other considerations therefor are expressed
therein; and
(b) the time at which the insurance takes effect and terminates is
expressed therein; and
(c) it purports to insure only one person, except that a policy may
insure, originally or by subsequent amendment, upon the application of an
adult member of a family who shall be deemed the policyholder, any two or
more eligible members of that family, including husband, wife, dependent
children or any children under a specified age which shall not exceed 19
years and any other person dependent upon the policyholder; and
(d) the style, arrangement and over-all appearance of the policy give no
undue prominence to any portion of the text, and unless every printed
portion of the text of the policy and of any endorsements or attached
papers is plainly printed in light-faced type of a style in general use,
the size of which shall be uniform and not less than ten-point with a
lower-case unspaced alphabet length not less than one hundred and
twenty-point (the "text" shall include all printed matter except the name
and address of the insurer, name or title of the policy, the brief
description if any, and captions and subcaptions); and
(e) the exceptions and reductions of indemnity are set forth in the
policy and, except those which are set forth in Sections 357.1 through
357.30 of this act, are printed, at the insurer's option, either included
with the benefit provision to which they apply, or under an appropriate
caption such as "EXCEPTIONS", or "EXCEPTIONS AND REDUCTIONS", provided that
if an exception or reduction specifically applies only to a particular
benefit of the policy, a statement of such exception or reduction shall be
included with the benefit provision to which it applies; and
(f) each such form, including riders and endorsements, shall be
identified by a form number in the lower left-hand corner of the first page
thereof; and
(g) it contains no provision purporting to make any portion of the
charter, rules, constitution, or by-laws of the insurer a part of the
policy unless such portion is set forth in full in the policy, except in
the case of the incorporation of, or reference to, a statement of rates or
classification of risks, or short-rate table filed with the Director.
(2) If any policy is issued by an insurer domiciled in this state for
delivery to a person residing in another state, and if the official having
responsibility for the administration of the insurance laws of such other
state shall have advised the Director that any such policy is not subject
to approval or disapproval by such official, the Director may by ruling
require that such policy meet the standards set forth in subsection (1) of
this section and in Sections 357.1 through 357.30.
(Source: P.A. 76-860.)
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(215 ILCS 5/356b) (from Ch. 73, par. 968b)
Sec. 356b. (a) This Section applies to the hospital and medical expense
provisions of an accident or health insurance policy.
(b) If a policy provides that coverage of a dependent person terminates
upon attainment of the limiting age for dependent persons specified in the
policy, the attainment of such limiting age
does not operate to terminate the hospital and medical coverage of a person
who, because of a disabling condition that occurred before
attainment of the limiting age, is incapable of self-sustaining employment and
is dependent on his or her parents or other care providers for lifetime
care and supervision.
(c) For purposes of subsection (b), "dependent on other care providers" is
defined as requiring a Community Integrated Living Arrangement, group home,
supervised apartment, or other residential services licensed or certified by
the Department of Human Services (as successor to the Department of Mental
Health and Developmental Disabilities), the Department of Public Health, or
the Department of Healthcare and Family Services (formerly Department of Public Aid).
(d) The insurer may inquire of the policyholder 2 months prior to
attainment by a dependent of the limiting age set forth in the policy, or at
any reasonable time thereafter, whether such dependent is in fact a person who has a disability and is dependent and, in the absence of proof submitted within 60 days of
such inquiry that such dependent is a person who has a disability and is dependent may
terminate coverage of such person at or after attainment of the limiting age.
In the absence of such inquiry, coverage of any person who has a disability and is dependent
shall continue through the term of such policy or any extension or renewal
thereof.
(e) This amendatory Act of 1969 is applicable to policies issued or
renewed
more than 60 days after the effective date of this amendatory Act of 1969.
(Source: P.A. 99-143, eff. 7-27-15.)
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(215 ILCS 5/356c) (from Ch. 73, par. 968c)
Sec. 356c.
(1) No policy of accident and health insurance providing
coverage of hospital expenses or medical expenses or
both on an expense incurred basis which in addition to covering the
insured, also covers members of the insured's immediate family, shall
contain any disclaimer, waiver or other limitation of coverage relative to
the hospital or medical
coverage or insurability of newborn infants from and after
the moment of birth.
(2) Each such policy of accident and health insurance shall contain
a provision stating that the accident and health insurance benefits
applicable for children shall be granted immediately with respect to a
newly born child from the moment of birth. The coverage for newly born
children shall include coverage of illness, injury, congenital defects (including the treatment of cleft lip and cleft palate),
birth abnormalities and premature birth.
(3) If payment of a specific premium is required to provide coverage
for a child, the policy may require that notification of birth of a
newly born child must be furnished to the insurer within 31 days after
the date of birth in order to have the coverage continue beyond such 31
day period and may require payment of the appropriate premium.
(4) In the event that no other members of the insured's immediate
family are covered, immediate coverage for the first newborn infant shall
be provided if the insured applies for dependent's coverage
within 31 days of the newborn's birth.
Such coverage shall be contingent upon payment of the additional premium.
(5) The requirements of this Section shall apply, on or after the
sixtieth day following the effective date of this Section, (a) to all
such non-group policies delivered or issued for delivery, and (b) to all
such group policies delivered, issued for delivery, renewed or amended.
The insurers of such non-group policies in effect on the sixtieth day
following the effective date of this Section shall extend to owners of
said policies, on or before the first policy anniversary following such
date, the opportunity to apply for the addition to their policies of a
provision as set forth in paragraph (2) above, with, at the option of
the insurer, payment of a premium appropriate thereto.
(Source: P.A. 102-768, eff. 1-1-24.)
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(215 ILCS 5/356d) (from Ch. 73, par. 968d)
Sec. 356d.
Conversion privileges for insured former spouses.
(1) No policy
of accident and health insurance providing coverage of
hospital and/or medical expense on either an expense incurred basis or
other than an expense incurred basis, which in addition to covering the
insured also provides coverage to the spouse of the insured shall
contain a provision for termination of coverage for a spouse covered
under the policy solely as a result of a break in the marital
relationship except by reason of an entry of a valid judgment of dissolution
of marriage between the parties.
(2) Every policy which contains a provision for termination of coverage
of the spouse upon dissolution of marriage shall contain a provision to the
effect that upon the entry of a valid judgment of dissolution of marriage
between the insured parties the spouse whose marriage was dissolved
shall be entitled to have issued to
him or her, without evidence of insurability, upon application made to
the company within 60 days following the entry of such judgment, and upon
the payment of the appropriate premium, an individual policy of accident
and health insurance. Such policy shall provide the coverage then being
issued by the insurer which is most nearly similar to, but not greater
than, such terminated coverages. Any and all probationary and/or
waiting periods set forth in such policy shall be considered as being
met to the extent coverage was in force under the prior policy.
(3) The requirements of this Section shall apply to all policies
delivered or issued for delivery on or after the 60th day following the
effective date of this Section.
(Source: P.A. 84-545.)
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(215 ILCS 5/356e) (from Ch. 73, par. 968e)
Sec. 356e. Victims of certain offenses.
(1) No policy of accident and health insurance, which provides
benefits for hospital or medical expenses based upon the actual expenses
incurred, delivered or issued for delivery to any person in this State
shall contain any specific exception to coverage which would preclude
the payment under that policy of actual expenses incurred in the
examination and testing of a victim of an offense defined in Sections
11-1.20 through 11-1.60 or 12-13 through 12-16 of the Criminal Code of 1961 or the Criminal Code of 2012,
or an attempt to commit such offense to
establish that sexual contact did occur or did not occur, and to
establish the presence or absence of sexually transmitted
disease or infection, and
examination and treatment of injuries and trauma sustained by a victim
of such offense arising
out of the offense.
Every policy of accident
and health insurance which specifically provides benefits for routine physical
examinations shall provide full coverage for expenses incurred in the
examination
and testing of a victim of an offense defined in Sections 11-1.20 through 11-1.60 or 12-13 through
12-16 of the Criminal Code of 1961 or the Criminal Code of 2012, or an attempt
to commit such offense
as set forth in this Section.
This Section shall not apply to a policy which covers hospital and
medical expenses for specified illnesses or injuries only.
(2) For purposes of enabling the recovery of State funds, any insurance
carrier subject to this Section shall upon reasonable demand by the Department
of Public Health disclose the names and identities of its insureds entitled
to benefits under this provision to the Department of Public Health whenever
the Department of Public Health has determined that it has paid, or is about
to pay, hospital or medical expenses for which an insurance carrier is liable
under this Section. All information received by the Department of Public
Health under this provision shall be held on a confidential basis and shall
not be subject to subpoena and shall not be made public by the Department
of Public Health or used for any purpose other than that authorized by this
Section.
(3) Whenever the Department of Public Health finds that it has paid all
or part of any hospital or medical expenses which an insurance carrier is
obligated to pay under this Section, the Department of Public Health shall
be entitled to receive reimbursement for its payments from such insurance
carrier provided that the Department of Public Health has notified the
insurance
carrier of its claims before the carrier has paid such benefits to its insureds
or in behalf of its insureds.
(Source: P.A. 96-1551, eff. 7-1-11; 97-1150, eff. 1-25-13.)
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(215 ILCS 5/356f) (from Ch. 73, par. 968f)
Sec. 356f.
No policy of accident or health insurance or any renewal thereof
shall be denied or cancelled by the insurer, nor shall any such policy contain
any exception or exclusion of benefits, solely because the mother of the
insured has taken diethylstilbestrol, commonly referred to as DES.
(Source: P.A. 81-656.)
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(215 ILCS 5/356g) (from Ch. 73, par. 968g)
Sec. 356g. Mammograms; mastectomies.
(a) Every insurer shall provide in each group or individual
policy, contract, or certificate of insurance issued or renewed for persons
who are residents of this State, coverage for screening by low-dose
mammography for all women 35 years of age or older for the presence of
occult breast cancer within the provisions of the policy, contract, or
certificate. The coverage shall be as follows:
(1) A baseline mammogram for women 35 to 39 years of | ||
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(2) An annual mammogram for women 40 years of age or | ||
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(3) A mammogram at the age and intervals considered | ||
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(4) For an individual or group policy of accident and | ||
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(5) A screening MRI when medically necessary, as | ||
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(6) For an individual or group policy of accident and | ||
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A policy subject to this subsection shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided; except that this sentence does not apply to coverage of diagnostic mammograms to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to Section 223 of the Internal Revenue Code (26 U.S.C. 223). For purposes of this Section: "Diagnostic
mammogram" means a mammogram obtained using diagnostic mammography. "Diagnostic
mammography" means a method of screening that is designed to
evaluate an abnormality in a breast, including an abnormality seen
or suspected on a screening mammogram or a subjective or objective
abnormality otherwise detected in the breast. "Low-dose mammography"
means the x-ray examination of the breast using equipment dedicated
specifically for mammography, including the x-ray tube, filter, compression
device, and image receptor, with radiation exposure delivery of less than
1 rad per breast for 2 views of an average size breast. The term also includes digital mammography and includes breast tomosynthesis. As used in this Section, the term "breast tomosynthesis" means a radiologic procedure that involves the acquisition of projection images over the stationary breast to produce cross-sectional digital three-dimensional images of the breast.
If, at any time, the Secretary of the United States Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the Federal Register or publishes a comment in the Federal Register or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Public Law 111-148), including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any successor provision, to defray the cost of any coverage for breast tomosynthesis outlined in this subsection, then the requirement that an insurer cover breast tomosynthesis is inoperative other than any such coverage authorized under Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and the State shall not assume any obligation for the cost of coverage for breast tomosynthesis set forth in this subsection. (a-5) Coverage as described by subsection (a) shall be provided at no cost to the insured and shall not be applied to an annual or lifetime maximum benefit. (a-10) When health care services are available through contracted providers and a person does not comply with plan provisions specific to the use of contracted providers, the requirements of subsection (a-5) are not applicable. When a person does not comply with plan provisions specific to the use of contracted providers, plan provisions specific to the use of non-contracted providers must be applied without distinction for coverage required by this Section and shall be at least as favorable as for other radiological examinations covered by the policy or contract. (b) No policy of accident or health insurance that provides for
the surgical procedure known as a mastectomy shall be issued, amended,
delivered, or renewed in this State unless
that coverage also provides for prosthetic devices
or reconstructive surgery
incident to the mastectomy.
Coverage for breast reconstruction in connection with a mastectomy shall
include:
(1) reconstruction of the breast upon which the | ||
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(2) surgery and reconstruction of the other breast to | ||
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(3) prostheses and treatment for physical | ||
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Care shall be determined in consultation with the attending physician and the
patient.
The offered coverage for prosthetic devices and
reconstructive surgery shall be subject to the deductible and coinsurance
conditions applied to the mastectomy, and all other terms and conditions
applicable to other benefits. When a mastectomy is performed and there is
no evidence of malignancy then the offered coverage may be limited to the
provision of prosthetic devices and reconstructive surgery to within 2
years after the date of the mastectomy. As used in this Section,
"mastectomy" means the removal of all or part of the breast for medically
necessary reasons, as determined by a licensed physician.
Written notice of the availability of coverage under this Section shall be
delivered to the insured upon enrollment and annually thereafter. An insurer
may not deny to an insured eligibility, or continued eligibility, to enroll or
to renew coverage under the terms of the plan solely for the purpose of
avoiding the requirements of this Section. An insurer may not penalize or
reduce or
limit the reimbursement of an attending provider or provide incentives
(monetary or otherwise) to an attending provider to induce the provider to
provide care to an insured in a manner inconsistent with this Section.
(c) 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. 100-395, eff. 1-1-18; 101-580, eff. 1-1-20.) |
(215 ILCS 5/356g.5) Sec. 356g.5. Clinical breast exam. (a) The General Assembly finds that clinical breast examinations are a critical tool in the early detection of breast cancer, while the disease is in its earlier and potentially more treatable stages. Insurer reimbursement of clinical breast examinations is essential to the effort to reduce breast cancer deaths in Illinois. (b) Every insurer shall provide, in each group or individual policy, contract, or certificate of accident or health insurance issued or renewed for persons who are residents of Illinois, coverage for complete and thorough clinical breast examinations as indicated by guidelines of practice, performed by a physician licensed to practice medicine in all its branches, a licensed advanced practice registered nurse, or a licensed physician assistant, to check for lumps and other changes for the purpose of early detection and prevention of breast cancer as follows: (1) at least every 3 years for women at least 20 | ||
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(2) annually for women 40 years of age or older. (c) Upon approval of a nationally recognized separate and distinct clinical breast exam code that is compliant with all State and federal laws, rules, and regulations, public and private insurance plans shall take action to cover clinical breast exams on a separate and distinct basis.
(Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18.) |
(215 ILCS 5/356g.5-1) Sec. 356g.5-1. Breast cancer pain medication and therapy. A group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 95th General Assembly must provide coverage for all medically necessary pain medication and pain therapy related to the treatment of breast cancer on the same terms and conditions that are generally applicable to coverage for other conditions. For purposes of this Section, "pain therapy" means pain therapy that is medically based and includes reasonably defined goals, including, but not limited to, stabilizing or reducing pain, with periodic evaluations of the efficacy of the pain therapy against these goals. The provisions of this Section do not apply to short-term travel, accident-only, limited, or specified-disease policies, or to policies or contracts designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare, or any other similar coverage under State or federal governmental plans. Rulemaking authority to implement this amendatory Act of the 95th General Assembly, 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. 95-1045, eff. 3-27-09.) |
(215 ILCS 5/356h) (from Ch. 73, par. 968h)
Sec. 356h.
No individual or group policy of accident and health
insurance which covers the insured's immediate family or children, as well
as covering the insured, shall exclude a child from coverage or limit
coverage for a child solely because the child is an adopted child, or
solely because the child does not reside with the insured. For purposes of
this Section, a child who is in the custody of the insured, pursuant to an
interim court order of adoption or, in the case of group insurance, placement
of adoption, whichever comes first, vesting temporary care of the child in
the
insured, is an adopted child, regardless of whether a final order granting
adoption is ultimately issued.
(Source: P.A. 91-549, eff. 8-14-99.)
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(215 ILCS 5/356i) (from Ch. 73, par. 968i)
Sec. 356i.
Medical assistance; coverage of child.
(a) In this Section, "Medicaid" means medical assistance authorized under
Section 1902 of the Social Security Act.
(b) An individual or group
policy of accident and health insurance that is delivered or issued for
delivery to any person in this State or renewed or amended may not contain
any provision which limits or excludes payments of hospital or
medical
benefits coverage to or on behalf of the insured because the insured or
any covered dependent is eligible for or receiving Medicaid benefits in this or any other state.
(c) To the extent that payment for covered expenses has been made under
Article V, VI, or VII of the Illinois Public Aid Code for health care services
provided to an individual, if a third party has a legal liability to make
payments for those health care services, the State is considered to have
acquired the rights of the individual to payment.
(d) If a child is covered under an accident and health insurance policy
issued to the child's noncustodial parent, the issuer of the policy shall do
all of the following:
(1) Provide necessary information to the child's | ||
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(2) Permit the child's custodial parent (or the | ||
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(3) Make payments on claims submitted in accordance | ||
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(e) An insurer may not deny enrollment of a child under the accident and
health insurance coverage of the child's parent on any of the following
grounds:
(1) The child was born out of wedlock.
(2) The child is not claimed as a dependent on the | ||
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(3) The child does not reside with the parent or in | ||
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(f) If a parent is required by a court or administrative order to provide
accident and health insurance coverage for a child and the parent is insured
under a plan that offers coverage
for eligible dependents, the insurer, upon receiving a copy of the order,
shall:
(1) Upon application, permit the parent to add to the | ||
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(2) Add the child to the parent's coverage upon | ||
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(g) An insurer may not impose, on a state agency that has been assigned the
rights of a covered individual who
receives Medicaid benefits, requirements that are different from requirements
applicable to an assignee of any other individual covered under the same
insurance policy.
(h) Nothing in subsections (e) and (f) prevents an
insurer from denying any such application if the child is not eligible for
coverage according to the insurer's medical underwriting standards.
(i) The insurer may not eliminate coverage of such a child unless the
insurer
is provided
satisfactory written evidence of either of the following:
(1) The court or administrative order is no longer in | ||
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(2) The child is or will be covered under a | ||
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(Source: P.A. 89-183, eff. 1-1-96.)
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(215 ILCS 5/356j) (from Ch. 73, par. 968j)
Sec. 356j.
(Repealed).
(Source: Repealed by P.A. 89-183, eff. 1-1-96.)
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(215 ILCS 5/356K) (from Ch. 73, par. 968K)
Sec. 356K.
Coverage for Organ Transplantation Procedures.
No accident
and health insurer providing coverage under this Act for hospital or
medical expenses shall deny reimbursement for an otherwise covered expense
incurred for any organ transplantation procedure solely on the basis that
such procedure is deemed experimental or investigational unless supported
by the determination of the Office of Health Care Technology Assessment
within the Agency for Health Care Policy and Research within the federal
Department of Health and Human Services that such procedure is either
experimental or investigational or that there is insufficient data or
experience to determine whether an organ transplantation procedure is
clinically acceptable. If an accident and health insurer has made written
request, or had one made on its behalf by a national organization, for
determination by the Office of Health Care Technology Assessment within the
Agency for Health Care Policy and Research within the federal Department of
Health and Human Services as to whether a specific organ transplantation
procedure is clinically acceptable and said organization fails to respond
to such a request within a period of 90 days, the failure to act may be
deemed a determination that the procedure is deemed to be experimental or
investigational.
(Source: P.A. 87-218.)
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(215 ILCS 5/356L) (from Ch. 73, par. 968L)
Sec. 356L.
No policy of accident or health insurance shall include any
provision which shall have the effect of denying coverage to or on behalf
of an insured under such policy on the basis of a failure by the insured to
file a notice of claim within the time period required by the policy,
provided such failure is caused solely by the physical inability or mental
incapacity of the
insured to file such notice of claim because of a period of emergency hospitalization.
(Source: P.A. 86-784.)
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(215 ILCS 5/356m) (from Ch. 73, par. 968m)
Sec. 356m. Infertility coverage.
(a) No group policy of accident and health insurance providing coverage
for more than 25 employees that provides pregnancy related benefits may be
issued, amended, delivered, or
renewed in this State after the effective date of this amendatory Act of the 99th General Assembly unless the policy contains coverage for the diagnosis and treatment of
infertility including, but not limited to, in vitro fertilization, uterine
embryo lavage, embryo transfer, artificial insemination, gamete
intrafallopian tube transfer, zygote intrafallopian tube transfer, and low
tubal ovum transfer.
(b) The coverage required under subsection (a) is subject to the following conditions:
(1) Coverage for procedures for in vitro | ||
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(A) the covered individual has been unable to | ||
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(B) the covered individual has not undergone 4 | ||
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(C) the procedures are performed at medical | ||
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(2) The procedures required to be covered under this | ||
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(c) As used in this Section, "infertility" means a disease, condition, or status characterized by:
(1) a failure to establish a pregnancy or to carry a | ||
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(2) a person's inability to reproduce either as a | ||
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(3) a licensed physician's findings based on a | ||
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(d) A policy, contract, or certificate may not impose any exclusions, limitations, or other restrictions on coverage of fertility medications that are different from those imposed on any other prescription medications, nor may it impose any exclusions, limitations, or other restrictions on coverage of any fertility services based on a covered individual's participation in fertility services provided by or to a third party, nor may it impose deductibles, copayments, coinsurance, benefit maximums, waiting periods, or any other limitations on coverage for the diagnosis of infertility, treatment for infertility, and standard fertility preservation services, except as provided in this Section, that are different from those imposed upon benefits for services not related to infertility. (Source: P.A. 102-170, eff. 1-1-22.)
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(215 ILCS 5/356n) (from Ch. 73, par. 968n)
Sec. 356n.
Fibrocystic condition; denial of coverage.
No
group or individual policy of accident or health insurance or
any renewal thereof shall be denied by the insurer, nor shall any policy
contain any exception or exclusion of benefits, solely because the insured
has been diagnosed as having a fibrocystic breast condition, unless the
condition is diagnosed by a breast biopsy that demonstrates an increased
disposition to the development of breast cancer or unless the insured's medical
history confirms a chronic, relapsing, symptomatic breast condition.
(Source: P.A. 87-519; 87-895; 87-1066.)
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(215 ILCS 5/356p) (from Ch. 73, par. 968p)
Sec. 356p.
Breast implant removal.
No individual or group policy of
accident and health insurance shall deny coverage for the removal of breast
implants when the removal of the implants is medically necessary treatment
for a sickness or injury. This Section does not apply to surgery performed
for removal of breast implants that were implanted solely for cosmetic
reasons. For the purpose of this Section, cosmetic reasons does not include
cosmetic surgery performed as reconstruction resulting from sickness or
injury.
(Source: P.A. 87-938.)
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(215 ILCS 5/356q)
Sec. 356q.
On or after the effective date of this Section, every insurer
which delivers or issues for delivery in this State a group accident and health
policy providing coverage for hospital, medical, or surgical treatment on an
expense-incurred basis shall offer, for an additional premium and subject to
the insurer's standard of insurability, optional coverage for the reasonable
and necessary medical treatment of temporomandibular joint disorder and
craniomandibular disorder. The group policyholder shall accept or reject the
coverage in writing on the application or an amendment thereto for the master
group policy. Benefits may be subject to the same pre-existing
conditions, limitations, deductibles, co-payments and co-insurance that
generally apply to any other sickness. The maximum lifetime benefits for
temporomandibular joint disorder and craniomandibular treatment shall be no
less than $2,500. Nothing herein shall prevent an insurer from including such
coverage for temporomandibular joint disorder and craniomandibular disorder as
part of a policy's basic coverage, in lieu of offering optional coverage.
(Source: P.A. 88-592, eff. 1-1-95.)
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(215 ILCS 5/356r)
Sec. 356r. Woman's principal health care provider.
(a) An individual or group policy of accident and health insurance or a
managed care plan amended, delivered, issued, or renewed in this State after
November 14, 1996 that
requires an insured or enrollee to designate an individual to coordinate care
or to control access to health care services shall also permit a female insured
or enrollee to designate a participating woman's principal health care
provider,
and the insurer or managed care plan shall provide the following written
notice to all female insureds or enrollees no later than 120 days after the
effective date of this amendatory Act of 1998; to all new enrollees at the
time of enrollment;
and thereafter to all existing enrollees at least annually, as a part of a
regular publication or informational mailing:
"NOTICE TO ALL FEMALE PLAN MEMBERS:
YOUR RIGHT TO SELECT A WOMAN'S PRINCIPAL
HEALTH CARE PROVIDER.
Illinois law allows you to select "a woman's | ||
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Your woman's principal health care provider must be a | ||
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If the insurer or managed care plan exercises the option set forth in
subsection
(a-5), the notice shall also state:
"Your plan requires that your primary care physician | ||
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No later than 120 days after the effective date of this amendatory Act of
1998, the insurer or managed
care plan shall provide each employer who has a policy of insurance or a
managed
care plan with the insurer or managed care plan with a list of physicians
licensed to practice medicine in all its branches specializing in obstetrics or
gynecology or specializing in family practice who have contracted with the
plan. At the time of enrollment and thereafter within 10 days after a request
by an insured or enrollee, the insurer or managed care plan also shall provide
this list directly to the insured or enrollee.
The list shall include each physician's address, telephone
number, and specialty. No insurer or plan formal or informal
policy may restrict a female insured's or enrollee's right to designate a
woman's
principal health care provider, except as set forth in subsection (a-5).
If the
female enrollee is an enrollee of a managed care plan under contract with the
Department of Healthcare and Family Services, the physician chosen by the enrollee as her woman's
principal health care provider must be a Medicaid-enrolled provider.
This requirement does not require a female insured or enrollee to make a
selection of a woman's principal health care provider.
The female insured or enrollee may designate a physician licensed to practice
medicine in
all its branches specializing in family practice as her woman's principal
health care provider.
(a-5) The insured or enrollee may be required by the insurer or managed care
plan to select a woman's principal health care provider who has a
referral
arrangement with the insured's or enrollee's individual who coordinates care or
controls access to health care services
if such referral arrangement exists
or to
select a new individual to coordinate care or to control access to health care
services who has a referral arrangement with the
woman's principal health care provider chosen by the insured or enrollee, if
such referral arrangement exists. If an
insurer or a managed care plan requires an insured or enrollee to select a new
physician under this subsection (a-5), the insurer or managed care plan must
provide the insured or enrollee with both options to select a new physician
provided in this subsection
(a-5).
Notwithstanding a plan's restrictions of the frequency or timing of making
designations of primary care providers, a female enrollee or insured who is
subject to the selection requirements of this subsection, may, at any time,
effect a change in primary care physicians in order to make a
selection of a woman's principal health care provider.
(a-6) If an insurer or managed care plan exercises the option in
subsection (a-5), the list to be provided under subsection (a) shall identify
the referral arrangements that exist between the individual who
coordinates
care or controls access to health care services and the woman's principal
health care provider in order to assist the female insured or enrollee to make
a selection within the insurer's or managed care plan's requirement.
(b) If a female insured or enrollee has designated a woman's principal
health care provider, then the insured or enrollee must be given direct access
to the woman's principal health care provider for services covered by the
policy or plan without the need
for a referral or prior approval. Nothing shall prohibit the insurer or
managed care plan from requiring prior authorization or approval from either a
primary care provider or the woman's principal health care provider for
referrals for additional care or services.
(c) For the purposes of this Section the following terms are defined:
(1) "Woman's principal health care provider" means a | ||
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(2) "Managed care entity" means any entity including | ||
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(3) "Managed care plan" means a plan operated by a | ||
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(A) organizational arrangements for ongoing | ||
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(B) financial incentives for persons enrolled in | ||
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(4) "Participating provider" means a physician who | ||
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(d) The original provisions of this Section became law on July 17,
1996 and took effect November 14, 1996, which is 120 days after
becoming law.
(Source: P.A. 95-331, eff. 8-21-07.)
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(215 ILCS 5/356s)
Sec. 356s.
Post-parturition care.
An individual or group
policy of accident and health insurance that provides maternity coverage and is
amended, delivered, issued, or renewed after the effective date of this
amendatory Act of 1996 shall provide coverage for the following:
(1) a minimum of 48 hours of inpatient care following | ||
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(2) a minimum of 96 hours of inpatient care following | ||
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A shorter length of hospital inpatient stay for services related to maternity
and newborn care may be provided if the attending physician licensed to
practice medicine in all of its branches determines, in accordance with the
protocols and guidelines developed by the American College of Obstetricians and
Gynecologists or the American Academy of Pediatrics, that the mother and the
newborn meet the appropriate guidelines for that length of stay based upon
evaluation of the mother and newborn and the coverage and availability of a
post-discharge physician office visit or in-home nurse visit to verify the
condition of the infant in the first 48 hours after discharge.
(Source: P.A. 89-513, eff. 9-15-96; 90-14, eff. 7-1-97.)
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(215 ILCS 5/356t)
Sec. 356t.
Post-mastectomy care.
An individual or group policy of accident
and health insurance or managed care plan that provides surgical coverage and
is amended, delivered, issued, or renewed after the effective date of this
amendatory Act of 1997 shall provide inpatient coverage following a mastectomy
for a length of time determined by the attending physician to be medically
necessary and in accordance with protocols and guidelines based on sound
scientific evidence and upon evaluation of the patient and the coverage for and
availability of a post-discharge physician office visit or in-home nurse visit
to verify the condition of the patient in the first 48 hours after discharge.
(Source: P.A. 90-7, eff. 6-10-97; 90-655, eff. 7-30-98.)
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(215 ILCS 5/356u)
(Text of Section before amendment by P.A. 103-30)
Sec. 356u. Pap tests and prostate cancer screenings.
(a) A group policy of accident and health insurance that provides coverage
for hospital or medical treatment or services for illness on an
expense-incurred basis and is amended, delivered, issued, or renewed after January 1, 2024 shall provide coverage, without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement, for all of
the
following:
(1) An annual cervical smear or Pap smear test for | ||
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(2) An annual prostate cancer screening for male | ||
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(A) asymptomatic men age 50 and over;
(B) African-American men age 40 and over; and
(C) men age 40 and over with a family history of | ||
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(3) Surveillance tests for ovarian cancer for female | ||
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(b) This Section shall not apply to agreements, contracts, or policies that
provide coverage for a specified disease or other limited benefit coverage.
(c) This Section does not apply to coverage of prostate cancer screenings to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to Section 223 of the Internal Revenue Code. (d) For the purposes of this Section: "At risk for ovarian cancer" means: (1) having a family history (i) with one or more | ||
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(2) testing positive for BRCA1 or BRCA2 mutations. "Prostate cancer screening" means medically viable methods for the detection and diagnosis of prostate cancer, including a digital rectal exam and the prostate-specific antigen test and associated laboratory work. "Prostate cancer screening" includes medically necessary subsequent follow-up testing as directed by a health care provider, including, but not limited to: (1) urinary analysis; (2) serum biomarkers; and (3) medical imaging, including, but not limited to, | ||
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"Surveillance tests for ovarian cancer" means annual screening using (i) CA-125 serum tumor marker testing, (ii) transvaginal ultrasound, (iii) pelvic examination.
(Source: P.A. 102-1073, eff. 1-1-23.)
(Text of Section after amendment by P.A. 103-30)
Sec. 356u. Pap tests and prostate cancer screenings.
(a) A group policy of accident and health insurance that provides coverage
for hospital or medical treatment or services for illness on an
expense-incurred basis and is amended, delivered, issued, or renewed after January 1, 2024 shall provide coverage, without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement, for all of
the
following:
(1) An annual cervical smear or Pap smear test for | ||
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(2) An annual prostate cancer screening for insureds | ||
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(A) asymptomatic individuals age 50 and over;
(B) African-American individuals age 40 and over; | ||
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(C) individuals age 40 and over with a family | ||
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(3) Surveillance tests for ovarian cancer for | ||
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(b) This Section shall not apply to agreements, contracts, or policies that
provide coverage for a specified disease or other limited benefit coverage.
(c) This Section does not apply to coverage of prostate cancer screenings to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to Section 223 of the Internal Revenue Code. (d) For the purposes of this Section: "At risk for ovarian cancer" means: (1) having a family history (i) with one or more | ||
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(2) testing positive for BRCA1 or BRCA2 mutations. "Prostate cancer screening" means medically viable methods for the detection and diagnosis of prostate cancer, including a digital rectal exam and the prostate-specific antigen test and associated laboratory work. "Prostate cancer screening" includes medically necessary subsequent follow-up testing as directed by a health care provider, including, but not limited to: (1) urinary analysis; (2) serum biomarkers; and (3) medical imaging, including, but not limited to, | ||
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"Surveillance tests for ovarian cancer" means annual screening using (i) CA-125 serum tumor marker testing, (ii) transvaginal ultrasound, (iii) pelvic examination.
(Source: P.A. 102-1073, eff. 1-1-23; 103-30, eff. 1-1-25.)
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(215 ILCS 5/356u.5) Sec. 356u.5. Coverage for genetic testing for breast and ovarian cancer susceptibility. A group or individual policy of accident and health insurance that is amended, delivered, issued, or renewed on or after January 1, 2024 shall provide coverage for the cost of the genetic testing of the BRCA1 and BRCA2 genes to detect an increased risk for breast and ovarian cancer if recommended by a health care provider in accordance with the United States Preventive Services Task Force's recommendations for testing.
(Source: P.A. 102-979, eff. 1-1-23.) |
(215 ILCS 5/356v)
Sec. 356v.
Use of information derived from genetic testing.
After the effective date of this amendatory Act of 1997, an insurer must comply
with the provisions of the Genetic Information Privacy Act in connection with
the amendment, delivery, issuance, or renewal of, or claims for or denial of
coverage under, an individual or group policy of accident and health insurance.
Additionally, genetic information shall not be treated as a condition
described in item (1) of subsection (A) of Section 20 of the Illinois Health
Insurance Portability and Accountability Act in the absence of a diagnosis of
the condition related to that genetic information.
(Source: P.A. 90-25, eff. 1-1-98; 90-655, eff. 7-30-98; 91-549, eff. 8-14-99.)
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(215 ILCS 5/356w)
Sec. 356w. Diabetes self-management training and education.
(a) A group policy of accident and health insurance that is amended,
delivered,
issued, or renewed after the
effective date of this amendatory Act of 1998 shall provide coverage for
outpatient self-management
training and education, equipment, and supplies, as set forth in this Section,
for the treatment of type 1 diabetes, type 2 diabetes, and gestational diabetes
mellitus.
(b) As used in this Section:
"Diabetes self-management training"
means instruction in an outpatient setting
which enables a diabetic patient to understand the diabetic management process
and daily management of
diabetic therapy as a means of avoiding frequent hospitalization and
complications. Diabetes self-management training shall include
the content areas listed in the National Standards for Diabetes Self-Management
Education Programs as published by the American Diabetes Association, including
medical nutrition therapy and education programs, as defined by the contract of insurance, that allow the patient to maintain an A1c level within the range identified in nationally recognized standards of care.
"Medical nutrition therapy" shall have the meaning
ascribed to that term in the Dietitian Nutritionist
Practice Act.
"Physician" means a
physician licensed to practice medicine in all of
its branches providing care to the individual.
"Qualified provider" for an
individual that is enrolled in:
(1) a health maintenance organization that uses a | ||
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(2) an insurance plan means (A) a physician licensed | ||
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(c) Coverage under this Section for diabetes self-management training,
including medical nutrition
education, shall be limited to the following:
(1) Up to 3 medically necessary visits to a qualified | ||
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(2) Up to 2 medically necessary visits to a qualified | ||
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Payment by the insurer or health maintenance organization for the coverage
required for diabetes self-management training pursuant to the provisions of
this Section is only required to be made for services provided.
No coverage is required for additional visits beyond those specified in items
(1) and (2) of this subsection.
Coverage under this subsection (c) for diabetes self-management training
shall
be subject to the same
deductible, co-payment, and co-insurance provisions that apply to coverage
under
the policy for other
services provided by the same type of provider.
(d) Coverage shall be provided for the following
equipment when medically necessary
and prescribed by a physician licensed to practice medicine in all
of its branches.
Coverage for the following items shall be subject to deductible, co-payment
and co-insurance provisions
provided for under the policy or a durable medical equipment rider to the
policy:
(1) blood glucose monitors;
(2) blood glucose monitors for the legally blind;
(3) cartridges for the legally blind; and
(4) lancets and lancing devices.
This subsection does not apply to a group policy of accident and health
insurance that does not provide a durable medical equipment benefit.
(e) Coverage shall be provided for the following pharmaceuticals and
supplies when
medically necessary and prescribed by a physician licensed to
practice medicine in all of its
branches.
Coverage for the following items shall be subject to the same coverage,
deductible,
co-payment, and co-insurance
provisions under the policy or a drug rider to the policy, except as otherwise provided for under Section 356z.41:
(1) insulin;
(2) syringes and needles;
(3) test strips for glucose monitors;
(4) FDA approved oral agents used to control blood | ||
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(5) glucagon emergency kits.
This subsection does not apply to a group policy of accident and health
insurance that does not provide a drug benefit.
(f) Coverage shall be provided for regular foot care exams by a
physician or by a
physician to whom a physician has referred the patient. Coverage
for regular foot care exams
shall be subject to the same deductible, co-payment, and co-insurance
provisions
that apply under the policy for
other services provided by the same type of provider.
(g) If authorized by a physician, diabetes self-management
training may be provided as a part of an office visit, group setting, or home
visit.
(h) This Section shall not apply to agreements, contracts, or policies that
provide coverage for a specified diagnosis or other limited benefit coverage.
(Source: P.A. 101-625, eff. 1-1-21.)
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(215 ILCS 5/356x)
Sec. 356x.
Coverage for colorectal cancer examination and screening.
(a) An individual or group policy of accident and health insurance or a
managed care plan that is amended, delivered, issued,
or
renewed on or after the effective date of this amendatory Act of the 93rd
General Assembly that provides coverage to a resident of this State must
provide benefits or coverage for all colorectal cancer examinations and
laboratory
tests for colorectal cancer
as prescribed by a physician, in
accordance with the
published American Cancer Society guidelines on colorectal cancer
screening or
other existing colorectal cancer screening guidelines issued by nationally
recognized professional medical
societies or federal government agencies, including the
National Cancer Institute, the Centers for Disease
Control and Prevention, and the
American College of Gastroenterology.
(b) Coverage required under this Section may not impose any deductible,
coinsurance, waiting
period, or other cost-sharing limitation that is greater than that
required for other coverage under the policy.
(Source: P.A. 93-568, eff. 1-1-04.)
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(215 ILCS 5/356y)
Sec. 356y.
(Repealed).
(Source: P.A. 91-406, eff. 1-1-00. Repealed internally, eff. 1-1-03.)
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(215 ILCS 5/356z.1)
Sec. 356z.1. Prenatal HIV testing. An individual or group policy of
accident and health insurance that provides maternity coverage and is amended,
delivered, issued, or renewed after the effective date of this amendatory Act
of the 92nd General Assembly must provide coverage for prenatal HIV testing
ordered by an attending physician licensed to practice medicine in all its
branches, or by a physician assistant or advanced practice registered nurse, including but not limited to orders consistent with
the recommendations of the American College of Obstetricians and Gynecologists
or the American Academy of Pediatrics.
(Source: P.A. 99-173, eff. 7-29-15.)
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(215 ILCS 5/356z.2)
Sec. 356z.2. Coverage for adjunctive services in dental care.
(a) An individual or group policy of accident and health insurance
amended, delivered, issued, or renewed after January 1, 2003 (the effective date of Public Act 92-764) shall cover
charges incurred, and anesthetics provided, in
conjunction with dental care that is provided to a covered individual in a
hospital or
an ambulatory surgical treatment center
if any of the
following
applies:
(1) the individual is a child age 6 or under;
(2) the individual has a medical condition that | ||
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(3) the individual is a person with a disability.
(a-5) An individual or group policy of accident and health insurance amended, delivered, issued, or renewed after January 1, 2016 (the effective date of Public Act 99-141) shall cover charges incurred, and anesthetics provided by a dentist with a permit provided under Section 8.1 of the Illinois Dental Practice Act, in conjunction with dental care that is provided to a covered individual in a dental office, oral surgeon's office, hospital, or ambulatory surgical treatment center if the individual is under age 26 and has been diagnosed with an autism spectrum disorder as defined in Section 10 of the Autism Spectrum Disorders Reporting Act or a developmental disability. A covered individual shall be required to make 2 visits to the dental care provider prior to accessing other coverage under this subsection. For purposes of this subsection, "developmental disability" means "developmental disability" as defined in Section 1-106 of the Mental Health and Developmental Disabilities Code. (b) For purposes of this Section, "ambulatory surgical treatment center"
has the meaning given to that term in Section 3 of the Ambulatory
Surgical Treatment Center Act.
For purposes of this Section, "person with a disability" means a person, regardless of age,
with a chronic
disability if the chronic disability meets all of the following conditions:
(1) It is attributable to a mental or physical | ||
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(2) It is likely to continue.
(3) It results in substantial functional limitations | ||
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(A) self-care;
(B) receptive and expressive language;
(C) learning;
(D) mobility;
(E) capacity for independent living; or
(F) economic self-sufficiency.
(c) The coverage required under this Section may be subject to any
limitations, exclusions, or cost-sharing provisions that apply generally under
the insurance policy.
(d) This Section does not apply to a policy that covers only dental care.
(e) Nothing in this Section requires that the dental services be
covered.
(f) The provisions of this Section do not apply to short-term travel,
accident-only, limited, or specified disease policies, nor to policies or
contracts designed for issuance to persons eligible for coverage under Title
XVIII of the Social Security Act, known as Medicare, or any other similar
coverage under State or federal governmental plans.
(Source: P.A. 101-525, eff. 1-1-20; 102-972, eff. 1-1-23.)
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(215 ILCS 5/356z.3) Sec. 356z.3. Disclosure of limited benefit. An insurer that
issues,
delivers,
amends, or
renews an individual or group policy of accident and health insurance in this
State after the
effective date of this amendatory Act of the 92nd General Assembly and
arranges, contracts
with, or administers contracts with a provider whereby beneficiaries are
provided an incentive to
use the services of such provider must include the following disclosure on its
contracts and
evidences of coverage: "WARNING, LIMITED BENEFITS WILL BE PAID WHEN
NON-PARTICIPATING PROVIDERS ARE USED. You should be aware that when you elect
to
utilize the services of a non-participating provider for a covered service in non-emergency
situations, benefit payments to such non-participating provider are not based upon the amount
billed. The basis of your benefit payment will be determined according to your policy's fee
schedule, usual and customary charge (which is determined by comparing charges for similar
services adjusted to the geographical area where the services are performed), or other method as
defined by the policy. YOU CAN EXPECT TO PAY MORE THAN THE COINSURANCE
AMOUNT DEFINED IN THE POLICY AFTER THE PLAN HAS PAID ITS REQUIRED
PORTION. Non-participating providers may bill members for any amount up to the
billed
charge after the plan has paid its portion of the bill, except as provided in Section 356z.3a of the Illinois Insurance Code for covered services received at a participating health care facility from a nonparticipating provider that are: (a) ancillary services, (b) items or services furnished as a result of unforeseen, urgent medical needs that arise at the time the item or service is furnished, or (c) items or services received when the facility or the non-participating provider fails to satisfy the notice and consent criteria specified under Section 356z.3a. Participating providers
have agreed to accept
discounted payments for services with no additional billing to the member other
than co-insurance and deductible amounts. You may obtain further information
about the
participating
status of professional providers and information on out-of-pocket expenses by
calling the toll
free telephone number on your identification card.".(Source: P.A. 102-901, eff. 1-1-23.) |
(215 ILCS 5/356z.3a) Sec. 356z.3a. Billing; emergency services; nonparticipating providers. (a) As used in this Section: "Ancillary services" means: (1) items and services related to emergency | ||
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(2) items and services provided by assistant | ||
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(3) diagnostic services, including radiology and | ||
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(4) items and services provided by other specialty | ||
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(5) items and services provided by a | ||
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(6) items and services provided by a | ||
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"Cost sharing" means the amount an insured, beneficiary, or enrollee is responsible for paying for a covered item or service under the terms of the policy or certificate. "Cost sharing" includes copayments, coinsurance, and amounts paid toward deductibles, but does not include amounts paid towards premiums, balance billing by out-of-network providers, or the cost of items or services that are not covered under the policy or certificate. "Emergency department of a hospital" means any hospital department that provides emergency services, including a hospital outpatient department. "Emergency medical condition" has the meaning ascribed to that term in Section 10 of the Managed Care Reform and Patient Rights Act. "Emergency medical screening examination" has the meaning ascribed to that term in Section 10 of the Managed Care Reform and Patient Rights Act. "Emergency services" means, with respect to an emergency medical condition: (1) in general, an emergency medical screening | ||
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(2) additional items and services for which | ||
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"Freestanding Emergency Center" means a facility licensed under Section 32.5 of the Emergency Medical Services (EMS) Systems Act. "Health care facility" means, in the context of non-emergency services, any of the following: (1) a hospital as defined in 42 U.S.C. 1395x(e); (2) a hospital outpatient department; (3) a critical access hospital certified under 42 | ||
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(4) an ambulatory surgical treatment center as | ||
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(5) any recipient of a license under the Hospital | ||
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"Health care provider" means a provider as defined in subsection (d) of Section 370g. "Health care provider" does not include a provider of air ambulance or ground ambulance services. "Health care services" has the meaning ascribed to that term in subsection (a) of Section 370g. "Health insurance issuer" has the meaning ascribed to that term in Section 5 of the Illinois Health Insurance Portability and Accountability Act. "Nonparticipating emergency facility" means, with respect to the furnishing of an item or service under a policy of group or individual health insurance coverage, any of the following facilities that does not have a contractual relationship directly or indirectly with a health insurance issuer in relation to the coverage: (1) an emergency department of a hospital; (2) a Freestanding Emergency Center; (3) an ambulatory surgical treatment center as | ||
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(4) with respect to emergency services described in | ||
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"Nonparticipating provider" means, with respect to the furnishing of an item or service under a policy of group or individual health insurance coverage, any health care provider who does not have a contractual relationship directly or indirectly with a health insurance issuer in relation to the coverage. "Participating emergency facility" means any of the following facilities that has a contractual relationship directly or indirectly with a health insurance issuer offering group or individual health insurance coverage setting forth the terms and conditions on which a relevant health care service is provided to an insured, beneficiary, or enrollee under the coverage: (1) an emergency department of a hospital; (2) a Freestanding Emergency Center; (3) an ambulatory surgical treatment center as | ||
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(4) with respect to emergency services described in | ||
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For purposes of this definition, a single case agreement between an emergency facility and an issuer that is used to address unique situations in which an insured, beneficiary, or enrollee requires services that typically occur out-of-network constitutes a contractual relationship and is limited to the parties to the agreement. "Participating health care facility" means any health care facility that has a contractual
relationship directly or indirectly with a health insurance issuer offering group or individual health insurance coverage setting forth the terms and conditions on which a relevant health care service is provided to an insured, beneficiary, or enrollee under the coverage. A single case agreement between an emergency facility and an issuer that is used to address unique situations in which an insured, beneficiary, or enrollee requires services that typically occur out-of-network constitutes a contractual relationship for purposes of this definition and is limited to the parties to the agreement. "Participating provider" means any health care provider that has a
contractual relationship directly or indirectly with a health insurance issuer offering group or individual health insurance coverage setting forth the terms and conditions on which a relevant health care service is provided to an insured, beneficiary, or enrollee under the coverage. "Qualifying payment amount" has the meaning given to that term in 42 U.S.C. 300gg-111(a)(3)(E) and the regulations promulgated thereunder. "Recognized amount" means the lesser of the amount initially billed by the provider or the qualifying payment amount. "Stabilize" means "stabilization" as defined in Section 10 of the Managed Care Reform and Patient Rights Act. "Treating provider" means a health care provider who has evaluated the individual. "Visit" means, with respect to health care services furnished to an individual at a health care facility, health care services furnished by a provider at the facility, as well as equipment, devices, telehealth services, imaging services, laboratory services, and preoperative and postoperative services regardless of whether the provider furnishing such services is at the facility. (b) Emergency services. When a beneficiary, insured, or enrollee receives emergency services from a nonparticipating provider or a nonparticipating emergency facility, the health insurance issuer shall ensure that the beneficiary, insured, or enrollee shall incur no greater out-of-pocket costs than the beneficiary, insured, or enrollee would have incurred with a participating provider or a participating emergency facility. Any cost-sharing requirements shall be applied as though the emergency services had been received from a participating provider or a participating facility. Cost sharing shall be calculated based on the recognized amount for the emergency services. If the cost sharing for the same item or service furnished by a participating provider would have been a flat-dollar copayment, that amount shall be the cost-sharing amount unless the provider has billed a lesser total amount. In no event shall the beneficiary, insured, enrollee, or any group policyholder or plan sponsor be liable to or billed by the health insurance issuer, the nonparticipating provider, or the nonparticipating emergency facility for any amount beyond the cost sharing calculated in accordance with this subsection with respect to the emergency services delivered. Administrative requirements or limitations shall be no greater than those applicable to emergency services received from a participating provider or a participating emergency facility. (b-5) Non-emergency services at participating health care facilities. (1) When a beneficiary, insured, or enrollee utilizes | ||
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(2) When a beneficiary, insured, or enrollee utilizes | ||
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(A) any cost-sharing requirements shall be | ||
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(B) cost sharing shall be calculated based on | ||
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(C) in no event shall the beneficiary, insured, | ||
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(c) Notwithstanding any other provision of this Code, except when the notice and consent criteria are satisfied for the situation in paragraph (2) of subsection (b-5), any benefits a beneficiary, insured, or enrollee receives for services under the situations in subsection (b) or (b-5) are assigned to the nonparticipating providers or the facility acting on their behalf. Upon receipt of the provider's bill or facility's bill, the health insurance issuer shall provide the nonparticipating provider or the facility with a written explanation of benefits that specifies the proposed reimbursement and the applicable deductible, copayment, or coinsurance amounts owed by the insured, beneficiary, or enrollee. The health insurance issuer shall pay any reimbursement subject to this Section directly to the nonparticipating provider or the facility. (d) For bills assigned under subsection (c), the nonparticipating provider or the facility may bill the health insurance issuer for the services rendered, and the health insurance issuer may pay the billed amount or attempt to negotiate reimbursement with the nonparticipating provider or the facility. Within 30 calendar days after the provider or facility transmits the bill to the health insurance issuer, the issuer shall send an initial payment or notice of denial of payment with the written explanation of benefits to the provider or facility. If attempts to negotiate reimbursement for services provided by a nonparticipating provider do not result in a resolution of the payment dispute within 30 days after receipt of written explanation of benefits by the health insurance issuer, then the health insurance issuer or nonparticipating provider or the facility may initiate binding arbitration to determine payment for services provided on a per-bill or batched-bill basis, in accordance with Section 300gg-111 of the Public Health Service Act and the regulations promulgated thereunder. The party requesting arbitration shall notify the other party arbitration has been initiated and state its final offer before arbitration. In response to this notice, the nonrequesting party shall inform the requesting party of its final offer before the arbitration occurs. Arbitration shall be initiated by filing a request with the Department of Insurance. (e) The Department of Insurance shall publish a list of approved arbitrators or entities that shall provide binding arbitration. These arbitrators shall be American Arbitration Association or American Health Lawyers Association trained arbitrators. Both parties must agree on an arbitrator from the Department of Insurance's or its approved entity's list of arbitrators. If no agreement can be reached, then a list of 5 arbitrators shall be provided by the Department of Insurance or the approved entity. From the list of 5 arbitrators, the health insurance issuer can veto 2 arbitrators and the provider or facility can veto 2 arbitrators. The remaining arbitrator shall be the chosen arbitrator. This arbitration shall consist of a review of the written submissions by both parties. The arbitrator shall not establish a rebuttable presumption that the qualifying payment amount should be the total amount owed to the provider or facility by the combination of the issuer and the insured, beneficiary, or enrollee. Binding arbitration shall provide for a written decision within 45 days after the request is filed with the Department of Insurance. Both parties shall be bound by the arbitrator's decision. The arbitrator's expenses and fees, together with other expenses, not including attorney's fees, incurred in the conduct of the arbitration, shall be paid as provided in the decision. (f) (Blank). (g) Section 368a of this Act shall not apply during the pendency of a decision under subsection (d). Upon the issuance of the arbitrator's decision, Section 368a applies with respect to the amount, if any, by which the arbitrator's determination exceeds the issuer's initial payment under subsection (c), or the entire amount of the arbitrator's determination if initial payment was denied. Any interest required to be paid to a provider under Section 368a shall not accrue until after 30 days of an arbitrator's decision as provided in subsection (d), but in no circumstances longer than 150 days from the date the nonparticipating facility-based provider billed for services rendered.
(h) Nothing in this Section shall be interpreted to change the prudent layperson provisions with respect to emergency services under the Managed Care Reform and Patient Rights Act. (i) Nothing in this Section shall preclude a health care provider from billing a beneficiary, insured, or enrollee for reasonable administrative fees, such as service fees for checks returned for nonsufficient funds and missed appointments. (j) Nothing in this Section shall preclude a beneficiary, insured, or enrollee from assigning benefits to a nonparticipating provider when the notice and consent criteria are satisfied under paragraph (2) of subsection (b-5) or in any other situation not described in subsection (b) or (b-5). (k) Except when the notice and consent criteria are satisfied under paragraph (2) of subsection (b-5), if an individual receives health care services under the situations described in subsection (b) or (b-5), no referral requirement or any other provision contained in the policy or certificate of coverage shall deny coverage, reduce benefits, or otherwise defeat the requirements of this Section for services that would have been covered with a participating provider. However, this subsection shall not be construed to preclude a provider contract with a health insurance issuer, or with an administrator or similar entity acting on the issuer's behalf, from imposing requirements on the participating provider, participating emergency facility, or participating health care facility relating to the referral of covered individuals to nonparticipating providers. (l) Except if the notice and consent criteria are satisfied under paragraph (2) of subsection (b-5), cost-sharing amounts calculated in conformity with this Section shall count toward any deductible or out-of-pocket maximum applicable to in-network coverage. (m) The Department has the authority to enforce the requirements of this Section in the situations described in subsections (b) and (b-5), and in any other situation for which 42 U.S.C. Chapter 6A, Subchapter XXV, Parts D or E and regulations promulgated thereunder would prohibit an individual from being billed or liable for emergency services furnished by a nonparticipating provider or nonparticipating emergency facility or for non-emergency health care services furnished by a nonparticipating provider at a participating health care facility. (n) This Section does not apply with respect to air ambulance or ground ambulance services. This Section does not apply to any policy of excepted benefits or to short-term, limited-duration health insurance coverage. (Source: P.A. 102-901, eff. 7-1-22; 102-1117, eff. 1-13-23; 103-440, eff. 1-1-24.) |
(215 ILCS 5/356z.4)
Sec. 356z.4. Coverage for contraceptives. (a)(1) The General Assembly hereby finds and declares all of the following: (A) Illinois has a long history of expanding | ||
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(B) The federal Patient Protection and Affordable | ||
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(C) The General Assembly intends to build on | ||
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(D) Medical management techniques such as denials, | ||
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(2) As used in this subsection (a): "Contraceptive services" includes consultations, examinations, procedures, and medical services related to the use of contraceptive methods (including natural family planning) to prevent an unintended pregnancy. "Medical necessity", for the purposes of this subsection (a), includes, but is not limited to, considerations such as severity of side effects, differences in permanence and reversibility of contraceptive, and ability to adhere to the appropriate use of the item or service, as determined by the attending provider. "Therapeutic equivalent version" means drugs, devices, or products that can be expected to have the same clinical effect and safety profile when administered to patients under the conditions specified in the labeling and satisfy the following general criteria: (i) they are approved as safe and effective; (ii) they are pharmaceutical equivalents in that they | ||
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(iii) they are bioequivalent in that (A) they do not | ||
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(iv) they are adequately labeled; and (v) they are manufactured in compliance with Current | ||
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(3) An individual or group policy of accident and health insurance amended,
delivered, issued, or renewed in this State after the effective date of this amendatory Act of the 99th General Assembly shall provide coverage for all of the following services and contraceptive methods: (A) All contraceptive drugs, devices, and other | ||
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(i) If the United States Food and Drug | ||
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(ii) If an individual's attending provider | ||
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(iii) If a drug, device, or product is not | ||
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(iv) This coverage must provide for the | ||
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(B) Voluntary sterilization procedures. (C) Contraceptive services, patient education, and | ||
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(D) Follow-up services related to the drugs, | ||
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(4) Except as otherwise provided in this subsection (a), a policy subject to this subsection (a) shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided. The provisions of this paragraph do not apply to coverage of voluntary male sterilization procedures to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to the federal Internal Revenue Code, 26 U.S.C. 223. (5) Except as otherwise authorized under this subsection (a), a policy shall not impose any restrictions or delays on the coverage required under this subsection (a). (6) If, at any time, the Secretary of the United States Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the Federal Register or publishes a comment in the Federal Register or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Public Law 111-148), including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any successor provision, to defray the cost of any coverage outlined in this subsection (a), then this subsection (a) is inoperative with respect to all coverage outlined in this subsection (a) other than that authorized under Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and the State shall not assume any obligation for the cost of the coverage set forth in this subsection (a). (b) This subsection (b) shall become operative if and only if subsection (a) becomes inoperative. An individual or group policy of accident and health insurance amended,
delivered, issued, or renewed in this State after the date this subsection (b) becomes operative that provides coverage for
outpatient services and outpatient prescription drugs or devices must provide
coverage for the insured and any
dependent of the
insured covered by the policy for all outpatient contraceptive services and
all outpatient contraceptive drugs and devices approved by the Food and
Drug Administration. Coverage required under this Section may not impose any
deductible, coinsurance, waiting period, or other cost-sharing or limitation
that is greater than that required for any outpatient service or outpatient
prescription drug or device otherwise covered by the policy.
Nothing in this subsection (b) shall be construed to require an insurance
company to cover services related to permanent sterilization that requires a
surgical procedure. As used in this subsection (b), "outpatient contraceptive service" means
consultations, examinations, procedures, and medical services, provided on an
outpatient basis and related to the use of contraceptive methods (including
natural family planning) to prevent an unintended pregnancy.
(c) (Blank).
(d) If a plan or issuer utilizes a network of providers, nothing in this Section shall be construed to require coverage or to prohibit the plan or issuer from imposing cost-sharing for items or services described in this Section that are provided or delivered by an out-of-network provider, unless the plan or issuer does not have in its network a provider who is able to or is willing to provide the applicable items or services.
(Source: P.A. 103-551, eff. 8-11-23.)
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(215 ILCS 5/356z.4a) Sec. 356z.4a. Coverage for abortion. (a) Except as otherwise provided in this Section, no individual or group policy of accident and health insurance that provides pregnancy-related benefits may be issued, amended, delivered, or renewed in this State after the effective date of this amendatory Act of the 101st General Assembly unless the policy provides a covered person with coverage for abortion care. Regardless of whether the policy otherwise provides prescription drug benefits, abortion care coverage must include medications that are obtained through a prescription and used to terminate a pregnancy, regardless of whether there is proof of a pregnancy. (b) Coverage for abortion care may not impose any deductible, coinsurance, waiting period, or other cost-sharing limitation that is greater than that required for other pregnancy-related benefits covered by the policy. (c) Except as otherwise authorized under this Section, a policy shall not impose any restrictions or delays on the coverage required under this Section. (d) This Section does not, pursuant to 42 U.S.C. 18054(a)(6), apply to a multistate plan that does not provide coverage for abortion. (e) If the Department concludes that enforcement of this Section may adversely affect the allocation of federal funds to this State, the Department may grant an exemption to the requirements, but only to the minimum extent necessary to ensure the continued receipt of federal funds.
(Source: P.A. 101-13, eff. 6-12-19; 102-1117, eff. 1-13-23.) |
(215 ILCS 5/356z.4b) Sec. 356z.4b. Billing for long-acting reversible contraceptives. (a) In this Section, "long-acting reversible contraceptive device" means any intrauterine device or contraceptive implant. (b) Any individual or group policy of accident and health insurance or qualified health plan that is offered through the health insurance marketplace that is amended, delivered, issued, or renewed on or after the effective date of this amendatory Act of the 102nd General Assembly shall allow hospitals separate reimbursement for a long-acting reversible contraceptive device provided immediately postpartum in the inpatient hospital setting before hospital discharge. The payment shall be made in addition to a bundled or Diagnostic Related Group reimbursement for labor and delivery.
(Source: P.A. 102-665, eff. 10-8-21.) |
(215 ILCS 5/356z.5)
Sec. 356z.5. Prescription inhalants. A group or individual
policy of
accident and health insurance or managed care plan amended, delivered, issued,
or renewed
after the effective date of this amendatory Act of the 93rd General Assembly
that provides
coverage for prescription drugs may not deny or limit coverage
for prescription inhalants to enable persons to breathe when suffering from
asthma or other life-threatening bronchial ailments based upon any restriction
on the number of days before an inhaler refill may be obtained if, contrary to
those restrictions, the inhalants have been ordered or prescribed by the
treating physician and are medically appropriate.
(Source: P.A. 95-331, eff. 8-21-07.)
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(215 ILCS 5/356z.6)
Sec. 356z.6. Bone mass measurement; osteoporosis. A group or individual
policy of
accident and health insurance amended, delivered, issued,
or renewed after the effective date of this amendatory Act of the 93rd General
Assembly must
provide coverage for
medically necessary bone mass measurement and for the diagnosis and treatment
of osteoporosis on
the
same terms and conditions that are generally
applicable
to coverage for other
medical conditions.
(Source: P.A. 93-853, eff. 1-1-05.) |
(215 ILCS 5/356z.7) (was 215 ILCS 5/370r)
Sec. 356z.7. Prescription drugs; cancer treatment. No group policy of
accident or health insurance that provides coverage for prescribed
drugs approved by the federal Food and Drug Administration for the
treatment of certain types of cancer shall exclude coverage of any drug on
the basis that the drug has been prescribed for the treatment of a type of
cancer for which the drug has not been approved by the federal Food and
Drug Administration. The drug, however, must be approved by the federal
Food and Drug Administration and must be recognized for the treatment of the
specific type of cancer for which the drug has been prescribed in any
one of the following established reference compendia:
(a) the American Hospital Formulary Service Drug | ||
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(b) National Comprehensive Cancer Network's Drugs & | ||
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(c) Thomson Micromedex's Drug Dex; (d) Elsevier Gold Standard's Clinical Pharmacology; or (e) other authoritative compendia as identified from | ||
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or if not in the compendia, recommended for that particular type of cancer
in formal clinical studies, the results of which have been published in at
least two peer reviewed professional medical journals published in the
United States or Great Britain.
Any coverage required by this Section shall also include those medically
necessary services associated with the administration of a drug.
Despite the provisions of this Section, coverage shall
not be required for any experimental or investigational drugs or any drug
that the federal Food and Drug Administration has determined to be
contraindicated for treatment of the specific type of cancer for which the
drug has been prescribed. This Section shall apply only to cancer drugs.
Nothing in this Section shall be construed, expressly or by implication, to
create, impair, alter, limit, notify, enlarge, abrogate or prohibit
reimbursement for drugs used in the treatment of any other disease or
condition.
(Source: P.A. 95-331, eff. 8-21-07; 96-457, eff. 8-14-09.)
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(215 ILCS 5/356z.8)
Sec. 356z.8. Multiple sclerosis preventative physical therapy. A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 94th General Assembly must provide coverage for medically necessary preventative physical therapy for insureds diagnosed with multiple sclerosis. For the purposes of this Section, "preventative physical therapy" means physical therapy that is prescribed by a physician licensed to practice medicine in all of its branches for the purpose of treating parts of the body affected by multiple sclerosis, but only where the physical therapy includes reasonably defined goals, including, but not limited to, sustaining the level of function the person has achieved, with periodic evaluation of the efficacy of the physical therapy against those goals. The coverage required under this Section shall be subject to the same deductible, coinsurance, waiting period, cost sharing limitation, treatment limitation, calendar year maximum, or other limitations as provided for
other physical or rehabilitative therapy benefits covered by the policy.
(Source: P.A. 94-1076, eff. 12-29-06.) |
(215 ILCS 5/356z.9)
Sec. 356z.9. Human papillomavirus vaccine. A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 95th General Assembly must provide coverage for a human papillomavirus vaccine (HPV) that is approved for marketing by the federal Food and Drug Administration.
(Source: P.A. 95-422, eff. 8-24-07; 95-876, eff. 8-21-08.) |
(215 ILCS 5/356z.10) Sec. 356z.10. Amino acid-based elemental formulas. A group or individual major medical accident and health insurance policy or managed care plan amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 95th General Assembly must provide coverage and reimbursement for amino acid-based elemental formulas, regardless of delivery method, for the diagnosis and treatment of (i) eosinophilic disorders and (ii) short bowel syndrome when the prescribing physician has issued a written order stating that the amino acid-based elemental formula is medically necessary.
(Source: P.A. 95-520, eff. 8-28-07; 95-876, eff. 8-21-08.) |
(215 ILCS 5/356z.11) Sec. 356z.11. Dependent students; medical leave of absence. A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 95th General Assembly must continue to provide coverage for a dependent college student who takes a medical leave of absence or reduces his or her course load to part-time status because of a catastrophic illness or injury. Continuation of coverage under this Section is subject to all of the policy's terms and
conditions applicable to those forms of insurance. Continuation of insurance under the policy shall terminate 12 months after notice of the illness or injury or until the coverage would have otherwise lapsed pursuant to the terms and conditions of the policy, whichever comes first, provided the need for part-time status or medical leave of absence is supported by a clinical certification of need from a physician licensed to practice medicine in all its branches. The provisions of this Section do not apply to short-term travel, accident-only, limited, or specified disease policies or to policies or contracts designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare, or any other similar coverage under State or federal governmental plans.
(Source: P.A. 95-958, eff. 6-1-09; 96-328, eff. 8-11-09.) |
(215 ILCS 5/356z.12) Sec. 356z.12. Dependent coverage. (a) A group or individual policy of accident and health insurance or managed care plan that provides coverage for dependents and that is amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 95th General Assembly shall not terminate coverage or deny the election of coverage for an unmarried dependent by reason of the dependent's age before the dependent's 26th birthday. (b) A policy or plan subject to this Section shall, upon amendment, delivery, issuance, or renewal, establish an initial enrollment period of not less than 90 days during which an insured may make a written election for coverage of an unmarried person as a dependent under this Section. After the initial enrollment period, enrollment by a dependent pursuant to this Section shall be consistent with the enrollment terms of the plan or policy. (c) A policy or plan subject to this Section shall allow for dependent coverage during the annual open enrollment date or the annual renewal date if the dependent, as of the date on which the insured elects dependent coverage under this subsection, has: (1) a period of continuous creditable coverage of 90 | ||
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(2) not been without creditable coverage for more | ||
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An insured may elect coverage for a dependent who does not meet the continuous creditable coverage requirements of this subsection (c) and that dependent shall not be denied coverage due to age. For purposes of this subsection (c), "creditable coverage" shall have the meaning provided under subsection (C)(1) of Section 20 of the Illinois Health Insurance Portability and Accountability Act. (d) Military personnel. A group or individual policy of accident and health insurance or managed care plan that provides coverage for dependents and that is amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 95th General Assembly shall not terminate coverage or deny the election of coverage for an unmarried dependent by reason of the dependent's age before the dependent's 30th birthday if the dependent (i) is an Illinois resident, (ii) served as a member of the active or reserve components of any of the branches of the Armed Forces of the United States, and (iii) has received a release or discharge other than a dishonorable discharge. To be eligible for coverage under this subsection (d), the eligible dependent shall submit to the insurer a form approved by the Illinois Department of Veterans' Affairs stating the date on which the dependent was released from service. (e) Calculation of the cost of coverage provided to an unmarried dependent under this Section shall be identical. (f) Nothing in this Section shall prohibit an employer from requiring an employee to pay all or part of the cost of coverage provided under this Section. (g) No exclusions or limitations may be applied to coverage elected pursuant to this Section that do not apply to all dependents covered under the policy. (h) A policy or plan subject to this Section shall not condition eligibility for dependent coverage provided pursuant to this Section on enrollment in any educational institution. (i) Notice regarding coverage for a dependent as provided pursuant to this Section shall be provided to an insured by the insurer: (1) upon application or enrollment; (2) in the certificate of coverage or equivalent | ||
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(3) (blank).
(Source: P.A. 98-226, eff. 1-1-14.) |
(215 ILCS 5/356z.13) Sec. 356z.13. Shingles vaccine. A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of the amendatory Act of this 95th General Assembly must provide coverage for a vaccine for shingles that is approved for marketing by the federal Food and Drug Administration if the vaccine is ordered by a physician licensed to practice medicine in all its branches and the enrollee is 60 years of age or older.
(Source: P.A. 95-978, eff. 1-1-09; 96-328, eff. 8-11-09.) |
(215 ILCS 5/356z.14) Sec. 356z.14. Autism spectrum disorders. (a) A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after December 12, 2008 (the effective date of Public Act 95-1005) must provide individuals under 21 years of age coverage for the diagnosis of autism spectrum disorders and for the treatment of autism spectrum disorders to the extent that the diagnosis and treatment of autism spectrum disorders are not already covered by the policy of accident and health insurance or managed care plan. (b) Coverage provided under this Section shall be subject to a maximum benefit of $36,000 per year, but shall not be subject to any limits on the number of visits to a service provider. After December 30, 2009, the Director of the Division of Insurance shall, on an annual basis, adjust the maximum benefit for inflation using the Medical Care Component of the United States Department of Labor Consumer Price Index for All Urban Consumers. Payments made by an insurer on behalf of a covered individual for any care, treatment, intervention, service, or item, the provision of which was for the treatment of a health condition not diagnosed as an autism spectrum disorder, shall not be applied toward any maximum benefit established under this subsection. (c) Coverage under this Section shall be subject to copayment, deductible, and coinsurance provisions of a policy of accident and health insurance or managed care plan to the extent that other medical services covered by the policy of accident and health insurance or managed care plan are subject to these provisions. (d) This Section shall not be construed as limiting benefits that are otherwise available to an individual under a policy of accident and health insurance or managed care plan and benefits provided under this Section may not be subject to dollar limits, deductibles, copayments, or coinsurance provisions that are less favorable to the insured than the dollar limits, deductibles, or coinsurance provisions that apply to physical illness generally. (e) An insurer may not deny or refuse to provide otherwise covered services, or refuse to renew, refuse to reissue, or otherwise terminate or restrict coverage under an individual contract to provide services to an individual because the individual or their dependent is diagnosed with an autism spectrum disorder or due to the individual utilizing benefits in this Section. (e-5) An insurer may not deny or refuse to provide otherwise covered services under a group or individual policy of accident and health insurance or a managed care plan solely because of the location wherein the clinically appropriate services are provided. (f) Upon request of the reimbursing insurer, a provider of treatment for autism spectrum disorders shall furnish medical records, clinical notes, or other necessary data that substantiate that initial or continued medical treatment is medically necessary and is resulting in improved clinical status. When treatment is anticipated to require continued services to achieve demonstrable progress, the insurer may request a treatment plan consisting of diagnosis, proposed treatment by type, frequency, anticipated duration of treatment, the anticipated outcomes stated as goals, and the frequency by which the treatment plan will be updated. (g) When making a determination of medical necessity for a treatment modality for autism spectrum disorders, an insurer must make the determination in a manner that is consistent with the manner used to make that determination with respect to other diseases or illnesses covered under the policy, including an appeals process. During the appeals process, any challenge to medical necessity must be viewed as reasonable only if the review includes a physician with expertise in the most current and effective treatment modalities for autism spectrum disorders. (h) Coverage for medically necessary early intervention services must be delivered by certified early intervention specialists, as defined in 89 Ill. Adm. Code 500 and any subsequent amendments thereto. (h-5) If an individual has been diagnosed as having an autism spectrum disorder, meeting the diagnostic criteria in place at the time of diagnosis, and treatment is determined medically necessary, then that individual shall remain eligible for coverage under this Section even if subsequent changes to the diagnostic criteria are adopted by the American Psychiatric Association. If no changes to the diagnostic criteria are adopted after April 1, 2012, and before December 31, 2014, then this subsection (h-5) shall be of no further force and effect. (h-10) An insurer may not deny or refuse to provide covered services, or refuse to renew, refuse to reissue, or otherwise terminate or restrict coverage under an individual contract, for a person diagnosed with an autism spectrum disorder on the basis that the individual declined an alternative medication or covered service when the individual's health care provider has determined that such medication or covered service may exacerbate clinical symptomatology and is medically contraindicated for the individual and the individual has requested and received a medical exception as provided for under Section 45.1 of the Managed Care Reform and Patient Rights Act. For the purposes of this subsection (h-10), "clinical symptomatology" means any indication of disorder or disease when experienced by an individual as a change from normal function, sensation, or appearance. (h-15) If, at any time, the Secretary of the United States Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the Federal Register or publishes a comment in the Federal Register or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Public Law 111-148), including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any successor provision, to defray the cost of any coverage outlined in subsection (h-10), then subsection (h-10) is inoperative with respect to all coverage outlined in subsection (h-10) other than that authorized under Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and the State shall not assume any obligation for the cost of the coverage set forth in subsection (h-10). (i) As used in this Section: "Autism spectrum disorders" means pervasive developmental disorders as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, including autism, Asperger's disorder, and pervasive developmental disorder not otherwise specified. "Diagnosis of autism spectrum disorders" means one or more tests, evaluations, or assessments to diagnose whether an individual has autism spectrum disorder that is prescribed, performed, or ordered by (A) a physician licensed to practice medicine in all its branches or (B) a licensed clinical psychologist with expertise in diagnosing autism spectrum disorders. "Medically necessary" means any care, treatment, intervention, service or item which will or is reasonably expected to do any of the following: (i) prevent the onset of an illness, condition, injury, disease, or disability; (ii) reduce or ameliorate the physical, mental or developmental effects of an illness, condition, injury, disease, or disability; or (iii) assist to achieve or maintain maximum functional activity in performing daily activities. "Treatment for autism spectrum disorders" shall include the following care prescribed, provided, or ordered for an individual diagnosed with an autism spectrum disorder by (A) a physician licensed to practice medicine in all its branches or (B) a certified, registered, or licensed health care professional with expertise in treating effects of autism spectrum disorders when the care is determined to be medically necessary and ordered by a physician licensed to practice medicine in all its branches: (1) Psychiatric care, meaning direct, consultative, | ||
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(2) Psychological care, meaning direct or | ||
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(3) Habilitative or rehabilitative care, meaning | ||
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(4) Therapeutic care, including behavioral, speech, | ||
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(j) Rulemaking authority to implement this amendatory Act of the 95th General Assembly, 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. 102-322, eff. 1-1-22; 103-154, eff. 6-30-23.) |
(215 ILCS 5/356z.15) Sec. 356z.15. Habilitative services for children. (a) As used in this Section, "habilitative services" means occupational therapy, physical therapy, speech therapy, and other services prescribed by the insured's treating physician pursuant to a treatment plan to enhance the ability of a child to function with a congenital, genetic, or early acquired disorder. A congenital or genetic disorder includes, but is not limited to, hereditary disorders. An early acquired disorder refers to a disorder resulting from illness, trauma, injury, or some other event or condition suffered by a child prior to that child developing functional life skills such as, but not limited to, walking, talking, or self-help skills. Congenital, genetic, and early acquired disorders may include, but are not limited to, autism or an autism spectrum disorder, cerebral palsy, and other disorders resulting from early childhood illness, trauma, or injury. (b) A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 95th General Assembly must provide coverage for habilitative services for children under 19 years of age with a congenital, genetic, or early acquired disorder so long as all of the following conditions are met: (1) A physician licensed to practice medicine in all | ||
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(2) The treatment is administered by a licensed | ||
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(3) The initial or continued treatment must be | ||
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(c) The coverage required by this Section shall be subject to other general exclusions and limitations of the policy, including coordination of benefits, participating provider requirements, restrictions on services provided by family or household members, utilization review of health care services, including review of medical necessity, case management, experimental, and investigational treatments, and other managed care provisions. (d) Coverage under this Section does not apply to those services that are solely educational in nature or otherwise paid under State or federal law for purely educational services. Nothing in this subsection (d) relieves an insurer or similar third party from an otherwise valid obligation to provide or to pay for services provided to a child with a disability. (e) Coverage under this Section for children under age 19 shall not apply to treatment of mental or emotional disorders or illnesses as covered under Section 370 of this Code as well as any other benefit based upon a specific diagnosis that may be otherwise required by law. (f) The provisions of this Section do not apply to short-term travel, accident-only, limited, or specific disease policies. (g) Any denial of care for habilitative services shall be subject to appeal and external independent review procedures as provided by Section 45 of the Managed Care Reform and Patient Rights Act. (h) Upon request of the reimbursing insurer, the provider under whose supervision the habilitative services are being provided shall furnish medical records, clinical notes, or other necessary data to allow the insurer to substantiate that initial or continued medical treatment is medically necessary and that the patient's condition is clinically improving. When the treating provider anticipates that continued treatment is or will be required to permit the patient to achieve demonstrable progress, the insurer may request that the provider furnish a treatment plan consisting of diagnosis, proposed treatment by type, frequency, anticipated duration of treatment, the anticipated goals of treatment, and how frequently the treatment plan will be updated. (i) Rulemaking authority to implement this amendatory Act of the 95th General Assembly, 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.
(j) An insurer may not deny or refuse to provide
otherwise covered services under a group or individual policy
of accident and health insurance or a managed care plan solely
because of the location wherein the clinically appropriate
services are provided. (Source: P.A. 102-322, eff. 1-1-22.) |
(215 ILCS 5/356z.16)
Sec. 356z.16. (Repealed).
(Source: P.A. 100-386, eff. 1-1-18. Repealed by P.A. 101-456, eff. 8-23-19.)
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(215 ILCS 5/356z.17) Sec. 356z.17. Wellness coverage. (a) A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after January 1, 2010 (the effective date of Public Act 96-639) that provides coverage for hospital or medical treatment on an expense incurred basis may offer a reasonably designed program for wellness coverage that allows for a reward, a contribution, a reduction in premiums or reduced medical, prescription drug, or equipment copayments, coinsurance, or deductibles, or a combination of these incentives, for participation in any health behavior wellness, maintenance, or improvement program approved or offered by the insurer or managed care plan. The insured or enrollee may be required to provide evidence of participation in a program. Individuals unable to participate in these incentives due to an adverse health factor shall not be penalized based upon an adverse health status. (b) For purposes of this Section, "wellness coverage" means health care coverage with the primary purpose to engage and motivate the insured or enrollee through: incentives; provision of health education, counseling, and self-management skills; identification of modifiable health risks; and other activities to influence health behavior changes. For the purposes of this Section, "reasonably designed program" means a program of wellness coverage that has a reasonable chance of improving health or preventing disease; is not overly burdensome; does not discriminate based upon factors of health; and is not otherwise contrary to law. (c) Incentives as outlined in this Section are specific and unique to the offering of wellness coverage and have no application to any other required or optional health care benefit. (d) Such wellness coverage must satisfy the requirements for an exception from the general prohibition against discrimination based on a health factor under the federal Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191; 110 Stat. 1936), including any federal regulations that are adopted pursuant to that Act. (e) A plan offering wellness coverage must do the following: (i) give participants the opportunity to qualify for | ||
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(ii) allow a reasonable alternative to any individual | ||
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(iii) not provide a total incentive that exceeds 30% | ||
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(f) A reward, contribution, or reduction established under this Section and included in the policy or certificate does not violate Section 151 of this Code.
(Source: P.A. 102-462, eff. 8-20-21.) |
(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 hospital or medical, hospital confinement 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 hospital or medical, hospital confinement 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 5/356z.19) Sec. 356z.19. Cardiovascular disease. Because cardiovascular disease is a leading cause of death and disability, an insurer providing group or individual policies of accident and health insurance or a managed care plan shall develop and implement a process to communicate with their adult enrollees on an annual basis regarding the importance and value of early detection and proactive management of cardiovascular disease. Nothing in this Section affects any change in the terms, conditions, or benefits of the policies and plans, nor the criteria, standards, and procedures related to the application for, enrollment in, or renewal of coverage or conditions of participation of enrollees in the health plans or policies subject to this Code.
(Source: P.A. 97-282, eff. 8-9-11; 97-813, eff. 7-13-12.) |
(215 ILCS 5/356z.20) Sec. 356z.20. Cancer drug parity. (a) As used in this Section: "Financial requirement" means deductibles, copayments,
coinsurance, out-of-pocket expenses, aggregate lifetime
limits, and annual limits. "Treatment limitation" means limits on the frequency of
treatment, days of coverage, or other similar limits on the
scope or duration of treatment. (b) On and after the effective date of this amendatory Act
of the 97th General Assembly, every insurer that amends,
delivers, issues, or renews an individual or group policy of
accident and health insurance amended, delivered, issued, or
renewed on or after the effective date of this amendatory Act
of the 97th General Assembly that provides coverage for
prescribed orally-administered cancer medications and
intravenously administered or injected cancer medications
shall ensure that: (1) the financial requirements applicable to such | ||
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(2) the treatment limitations applicable to such | ||
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(c) An insurer cannot achieve compliance with this Section
by increasing financial requirements or imposing more
restrictive treatment limitations on prescribed orally-administered cancer medications or intravenously
administered or injected cancer medications covered under the
policy on the effective date of this amendatory Act of the 97th
General Assembly.
(Source: P.A. 97-198, eff. 1-1-12; 97-813, eff. 7-13-12.) |
(215 ILCS 5/356z.21) Sec. 356z.21. Tobacco use cessation programs; coverage offer. (a) Tobacco use is the number one cause of preventable disease and death in Illinois, costing $4.1 billion annually in direct health care costs and an additional $4.35 billion in lost productivity. In Illinois, the smoking rates are highest among African Americans (25.8%). Smoking rates among lesbian, gay, and bisexual adults range from 25% to 44%. The U.S. Public Health Service Clinical Practice Guideline 2008 Update found that tobacco dependence treatments are both clinically effective and highly cost effective. A study in the Journal of Preventive Medicine concluded that comprehensive smoking cessation treatment is one of the 3 most important and cost effective preventive services that can be provided in medical practice. Greater efforts are needed to achieve more of this potential value by increasing current low
levels of performance. (b) In this Section, "tobacco use cessation program" means a program recommended by a physician that follows evidence-based treatment, such as is outlined in the United States Public Health Service guidelines for tobacco use cessation. "Tobacco use cessation program" includes education and medical treatment components designed to assist a person in ceasing the use of tobacco products. "Tobacco use cessation program" includes education and counseling by physicians or associated medical personnel and all FDA approved medications for the treatment of tobacco dependence irrespective of whether they are available only over the counter, only by prescription, or both over the counter and by prescription. (c) On or after the effective date of this amendatory Act of the 97th General Assembly, every
insurer that amends, delivers, issues, or renews group accident and health policies providing coverage for hospital or medical treatment or services on an expense-incurred basis shall offer, for an additional premium and subject to the insurer's standard of insurability, optional coverage or optional reimbursement of up to $500 annually for a tobacco use cessation program for a person enrolled in the plan who is 18 years of age or older. (d) The coverage required by this Section shall be subject
to other general exclusions and limitations of the policy,
including coordination of benefits, participating provider
requirements, restrictions on services provided by family or household members, utilization review of health care services, including review of medical necessity, case management, experimental and investigational treatments, and other managed care provisions. (e) For the coverage provided under this Section, an insurer may not penalize or reduce or limit the reimbursement of an attending provider or provide incentives, monetary or otherwise, to an attending provider to induce the provider to provide care to an insured in a manner inconsistent with the coverage under this Section.
(Source: P.A. 97-592, eff. 1-1-12; 97-813, eff. 7-13-12.) |
(215 ILCS 5/356z.22) Sec. 356z.22. Coverage for telehealth services. (a) For purposes of this Section: "Asynchronous store and forward system" has the meaning given to that term in Section 5 of the Telehealth Act. "Distant site" has the meaning given to that term in Section 5 of the Telehealth Act. "E-visits" has the meaning given to that term in Section 5 of the Telehealth Act. "Facility" means any hospital facility licensed under the Hospital Licensing Act or the University of Illinois Hospital Act, a federally qualified health center, a community mental health center, a behavioral health clinic, a substance use disorder treatment program licensed by the Division of Substance Use Prevention and Recovery of the Department of Human Services, or other building, place, or institution that is owned or operated by a person that is licensed or otherwise authorized to deliver health care services. "Health care professional" has the meaning given to that term in Section 5 of the Telehealth Act. "Interactive telecommunications system" has the meaning given to that term in Section 5 of the Telehealth Act. As used in this Section, "interactive telecommunications system" does not include virtual check-ins. "Originating site" has the meaning given to that term in Section 5 of the Telehealth Act. "Telehealth services" has the meaning given to that term in Section 5 of the Telehealth Act. As used in this Section, "telehealth services" do not include asynchronous store and forward systems, remote patient monitoring technologies, e-visits, or virtual check-ins. "Virtual check-in" has the meaning given to that term in Section 5 of the Telehealth Act. (b) An individual or group policy of accident or health insurance that is amended, delivered, issued, or renewed on or after the effective date of this amendatory Act of the 102nd General Assembly shall cover telehealth services, e-visits, and virtual check-ins rendered by a health care professional when clinically appropriate and medically necessary to insureds, enrollees, and members in the same manner as any other benefits covered under the policy. An individual or group policy of accident or health insurance may provide reimbursement to a facility that serves as the originating site at the time a telehealth service is rendered. (c) To ensure telehealth service, e-visit, and virtual check-in access is equitable for all patients in receipt of health care services under this Section and health care professionals and facilities are able to deliver medically necessary services that can be appropriately delivered via telehealth within the scope of their licensure or certification, coverage required under this Section shall comply with all of the following: (1) An individual or group policy of accident or | ||
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(A) require that in-person contact occur between | ||
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(B) require patients, health care professionals, | ||
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(C) require the use of telehealth services, | ||
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(D) require the use of telehealth services when | ||
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(E) require a health care professional to be | ||
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(F) create geographic or facility restrictions | ||
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(G) require health care professionals or | ||
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(H) require patients to use telehealth | ||
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(I) impose upon telehealth services, e-visits, | ||
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(2) Deductibles, copayments, coinsurance, or any | ||
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(3) An individual or group policy of accident or | ||
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(d) For purposes of reimbursement, an individual or group policy of accident or health insurance that is amended, delivered, issued, or renewed on or after the effective date of this amendatory Act of the 102nd General Assembly shall reimburse an in-network health care professional or facility, including a health care professional or facility in a tiered network, for telehealth services provided through an interactive telecommunications system on the same basis, in the same manner, and at the same reimbursement rate that would apply to the services if the services had been delivered via an in-person encounter by an in-network or tiered network health care professional or facility. This subsection applies only to those services provided by telehealth that may otherwise be billed as an in-person service. This subsection is inoperative on and after January 1, 2028, except that this subsection is operative after that date with respect to mental health and substance use disorder telehealth services. (e) The Department and the Department of Public Health shall commission a report to the General Assembly administered by an established medical college in this State wherein supervised clinical training takes place at an affiliated institution that uses telehealth services, subject to appropriation. The report shall study the telehealth coverage and reimbursement policies established in subsections (b) and (d) of this Section, to determine if the policies improve access to care, reduce health disparities, promote health equity, have an impact on utilization and cost-avoidance, including direct or indirect cost savings to the patient, and to provide any recommendations for telehealth access expansion in the future. An individual or group policy of accident or health insurance shall provide data necessary to carry out the requirements of this subsection upon request of the Department. The Department and the Department of Public Health shall submit the report by December 31, 2026. The established medical college may utilize subject matter expertise to complete any necessary actuarial analysis. (f) Nothing in this Section is intended to limit the ability of an individual or group policy of accident or health insurance and a health care professional or facility to voluntarily negotiate alternate reimbursement rates for telehealth services. Such voluntary negotiations shall take into consideration the ongoing investment necessary to ensure these telehealth platforms may be continuously maintained, seamlessly updated, and integrated with a patient's electronic medical records. (g) An individual or group policy of accident or health insurance that is amended, delivered, issued, or renewed on or after the effective date of this amendatory Act of the 102nd General Assembly shall provide coverage for telehealth services for licensed dietitian nutritionists and certified diabetes educators who counsel diabetes patients in the diabetes patients' homes to remove the hurdle of transportation for diabetes patients to receive treatment, in accordance with the Dietitian Nutritionist Practice Act. (h) Any policy, contract, or certificate of health insurance coverage that does not distinguish between in-network and out-of-network health care professionals and facilities shall be subject to this Section as though all health care professionals and facilities were in-network. (i) Health care professionals and facilities shall determine the appropriateness of specific sites, technology platforms, and technology vendors for a telehealth service, as long as delivered services adhere to all federal and State privacy, security, and confidentiality laws, rules, or regulations, including, but not limited to, the Health Insurance Portability and Accountability Act of 1996 and the Mental Health and Developmental Disabilities Confidentiality Act. (j) Nothing in this Section shall be deemed as precluding a health insurer from providing benefits for other telehealth services, including, but not limited to, services not required for coverage provided through an asynchronous store and forward system, remote patient monitoring services, other monitoring services, or oral communications otherwise covered under the policy.
(k) There shall be no restrictions on originating site requirements for telehealth coverage or reimbursement to the distant site under this Section other than requiring the telehealth services to be medically necessary and clinically appropriate. (l) The Department may adopt rules, including emergency rules subject to the provisions of Section 5-45 of the Illinois Administrative Procedure Act, to implement the provisions of this Section. (Source: P.A. 102-104, eff. 7-22-21.) |
(215 ILCS 5/356z.23) Sec. 356z.23. Coverage for opioid antagonists. (a) An individual or group policy of accident and health insurance amended, delivered, issued, or renewed in this State after the effective date of this amendatory Act of the 99th General Assembly that provides coverage for prescription drugs must provide coverage for at least one opioid antagonist, including the medication product, administration devices, and any pharmacy administration fees related to the dispensing of the opioid antagonist. This coverage must include refills for expired or utilized opioid antagonists. (a-5) Notwithstanding subsection (a), no individual or group policy of accident and health insurance amended, delivered, issued, or renewed after January 1, 2024 that provides coverage for naloxone hydrochloride shall impose a copayment on the coverage provided, except that this subsection does not apply to coverage of naloxone hydrochloride to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account under Section 223 of the Internal Revenue Code. (b) As used in this Section, "opioid antagonist" means a drug that binds to opioid receptors and blocks or inhibits the effect of opioids acting on those receptors, including, but not limited to, naloxone hydrochloride or any other similarly acting drug approved by the U.S. Food and Drug Administration.
(Source: P.A. 102-1038, eff. 1-1-23.) |
(215 ILCS 5/356z.24) Sec. 356z.24. Immune gamma globulin therapy. (a) A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 99th General Assembly may not allow for the delay, discontinuation, or interruption of immune gamma globulin therapy for persons who are diagnosed with a primary immunodeficiency when prescribed as medically necessary by a physician licensed to practice medicine in all of its branches and if provided as a covered benefit under the plan. Nothing in this Section shall prevent an insurer from applying appropriate utilization review standards to the ongoing coverage of immune gamma globulin therapy for persons diagnosed with a primary immunodeficiency by a physician licensed to practice medicine in all of its branches. (b) Upon diagnosis of primary immunodeficiency by the prescribing physician, determination of an initial authorization for immune gamma globulin therapy shall be no less than 3 months. Reauthorization for immune gamma globulin therapy for patients with a primary immunodeficiency diagnosis may occur every 6 months thereafter. For patients with a diagnosis of primary immunodeficiency who have been receiving immune gamma globulin therapy for at least 2 years with sustained beneficial response based on the treatment notes or clinical narrative detailing progress to date, reauthorization shall be no less than 12 months unless a more frequent duration has been indicated by the prescribing physician. (c) If, at any time, the Secretary of the United States Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the Federal Register or publishes a comment in the Federal Register or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Public Law 111-148), including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any successor provision, to defray the cost of any coverage outlined in subsections (a) and (b), then subsections (a) and (b) are inoperative with respect to all coverage outlined in subsections (a) and (b) other than that authorized under Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and the State shall not assume any obligation for the cost of the coverage set forth in subsections (a) and (b).
(Source: P.A. 99-788, eff. 8-12-16.) |
(215 ILCS 5/356z.25) Sec. 356z.25. Coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. A group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after July 18, 2017 (the effective date of Public Act 100-24) shall provide coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome, including, but not limited to, the use of intravenous immunoglobulin therapy. No group or individual policy of accident and health insurance or managed care plan shall deny or delay coverage for medically necessary treatment under this Section solely because the insured, enrollee, or beneficiary previously received any treatment, including the same or similar treatment, for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections or pediatric acute onset neuropsychiatric syndrome, or because the insured, enrollee, or beneficiary has been diagnosed with or receives treatment for an otherwise diagnosed condition. For the purposes of this Section, coverage of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall adhere to the treatment recommendations developed by a medical professional consortium convened for the purposes of researching, identifying, and publishing best practice standards for diagnosis and treatment of such disorders or syndrome that are accessible for medical professionals and are based on evidence of positive patient outcomes. Coverage for any form of medically necessary treatment shall not be limited over a lifetime of an insured, enrollee, or beneficiary, unless the patient is no longer benefiting from the treatment, or by policy period. Nothing in this Section prevents insurers from requesting treatment notes and anticipated duration of treatment and outcomes. For billing and diagnosis purposes, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome shall be coded as autoimmune encephalitis until the American Medical Association and the Centers for Medicare and Medicaid Services create and assign a specific code for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. Thereafter, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome may be coded as autoimmune encephalitis, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or pediatric acute onset neuropsychiatric syndrome. If, at any time, the Secretary of the United States Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the Federal Register or publishes a comment in the Federal Register or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Public Law 111-148), including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any successor provision, to defray the cost of any coverage for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome outlined in this Section, then the requirement that an insurer cover pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome is inoperative other than any such coverage authorized under Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and the State shall not assume any obligation for the cost of coverage for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome.
(Source: P.A. 103-59, eff. 6-9-23.) |
(215 ILCS 5/356z.26) Sec. 356z.26. Synchronization. (a) As used in this Section, "synchronization" means the coordination of medication refills for a patient taking 2 or more medications for one or more chronic conditions such that the patient's medications are refilled on the same schedule for a given time period. (b) Every policy of health and accident insurance amended, delivered, issued, or renewed after August 18, 2017 (the effective date of Public Act 100-138) that provides coverage for prescription drugs shall provide for synchronization of prescription drug refills on at least one occasion per insured per year, provided all of the following conditions are met: (1) the prescription drugs are covered by the | ||
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(2) the prescription drugs are maintenance | ||
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(3) the medications are not Schedule II, III, or IV | ||
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(4) the insured meets all utilization management | ||
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(5) the prescription drugs are of a formulation that | ||
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(6) the prescription drugs do not have special | ||
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(c) When necessary to permit synchronization, the policy shall apply a prorated daily cost-sharing rate to any medication dispensed by a network pharmacy pursuant to this Section. No dispensing fees shall be prorated, and all dispensing fees shall be based on the number of prescriptions filled or refilled.
(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18.) |
(215 ILCS 5/356z.27)
Sec. 356z.27. (Repealed).
(Source: P.A. 100-863, eff. 8-14-18. Repealed by P.A. 102-775, eff. 5-13-22.)
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(215 ILCS 5/356z.28) Sec. 356z.28. Dry needling by a physical therapist. A group or individual policy of accident and health insurance or a qualified health plan offered through the health insurance market place is not required to provide coverage for dry needling performed by a physical therapist as described in Section 1.5 of the Illinois Physical Therapy Act.
(Source: P.A. 100-418, eff. 8-25-17; 100-863, eff. 8-14-18.) |
(215 ILCS 5/356z.29) Sec. 356z.29. Stage 4 advanced, metastatic cancer. (a) As used in this Section, "stage 4 advanced, metastatic cancer" means cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph nodes, or other areas or parts of the body. (b) No individual or group policy of accident and health insurance amended, issued, delivered, or renewed in this State after January 1, 2019 (the effective date of Public Act 100-1057) that, as a provision of hospital, medical, or surgical services, directly or indirectly covers the treatment of stage 4 advanced, metastatic cancer shall limit or exclude coverage for a drug approved by the United States Food and Drug Administration by mandating that the insured shall first be required to fail to successfully respond to a different drug or prove a history of failure of the drug as long as the use of the drug is consistent with best practices for the treatment of stage 4 advanced, metastatic cancer and is supported by peer-reviewed medical literature. (c) If, at any time before or after January 1, 2019 (the effective date of Public Act 100-1057), the Secretary of the United States Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the Federal Register, publishes a comment in the Federal Register, or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Pub. L. 111–148), including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any successor provision, to defray the cost of the prohibition of coverage restrictions or exclusions contained in subsection (b) of this Section for the treatment of stage 4 advanced, metastatic cancer, then this Section is inoperative with respect to all such coverage other than that authorized under Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and the State shall not assume any obligation for the cost of the prohibition of coverage restrictions or exclusions contained in subsection (b) of this Section for the treatment of stage 4 advanced, metastatic cancer.
(Source: P.A. 100-1057, eff. 1-1-19; 101-81, eff. 7-12-19.) |
(215 ILCS 5/356z.30) (Text of Section before amendment by P.A. 103-530) Sec. 356z.30. Coverage for hearing aids for individuals under the age of 18. (a) As used in this Section: "Hearing care professional" means a person who is a
licensed hearing instrument dispenser, licensed audiologist, or licensed physician. "Hearing instrument" or "hearing aid" means any wearable
non-disposable, non-experimental instrument or device designed to aid or
compensate for impaired human hearing and any parts, attachments, or accessories for the instrument or device, including
an ear mold but excluding batteries and cords. (b) An individual or group policy of accident and health
insurance or managed care plan that is amended, delivered,
issued, or renewed after August 22, 2018 (the effective date of Public Act 100-1026) must provide coverage for
medically necessary hearing instruments and related services for all individuals under the age of 18
when a hearing care professional prescribes a hearing instrument to augment communication. (c) An insurer shall provide coverage, subject to all applicable co-payments, co-insurance, deductibles, and out-of-pocket limits, subject to the following restrictions: (1) one hearing instrument shall be covered for each | ||
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(2) related services, such as audiological exams and | ||
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(3) hearing instrument repairs may be covered when | ||
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(d) If, at any time before or after August 22, 2018 (the effective date of Public Act 100-1026), the Secretary of the United States Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the Federal Register, publishes a comment in the Federal Register, or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Pub. L. 111–148), including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any successor provision, to defray the cost of coverage for medically necessary hearing instruments and related services for individuals under the age of 18, then this Section is inoperative with respect to all such coverage other than that authorized under Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and the State shall not assume any obligation for the cost of coverage for medically necessary hearing instruments and related services for individuals under the age of 18.
(Source: P.A. 100-1026, eff. 8-22-18; 101-81, eff. 7-12-19.) (Text of Section after amendment by P.A. 103-530) Sec. 356z.30. Coverage for hearing aids. (a) As used in this Section: "Hearing care professional" means a person who is a
licensed hearing instrument dispenser, licensed audiologist, or licensed physician. "Hearing instrument" or "hearing aid" means any wearable
non-disposable, non-experimental instrument or device designed to aid or
compensate for impaired human hearing and any parts, attachments, or accessories for the instrument or device, including
an ear mold but excluding batteries and cords. (b) An individual or group policy of accident and health
insurance or managed care plan that is amended, delivered,
issued, or renewed after the effective date of this amendatory Act of the 103rd General Assembly must provide coverage for
medically necessary hearing instruments and related services for all individuals
when a hearing care professional prescribes a hearing instrument to augment communication. (c) An insurer shall provide coverage, subject to all applicable co-payments, co-insurance, deductibles, and out-of-pocket limits, subject to the following restrictions: (1) one hearing instrument shall be covered for each | ||
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(2) related services, such as audiological exams and | ||
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(3) hearing instrument repairs may be covered when | ||
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(d) If, at any time before or after the effective date of this amendatory Act of the 103rd General Assembly, the Secretary of the United States Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the Federal Register, publishes a comment in the Federal Register, or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Pub. L. 111–148), including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any successor provision, to defray the cost of coverage for medically necessary hearing instruments and related services for any individual, then this Section is inoperative with respect to all such coverage other than that authorized under Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and the State shall not assume any obligation for the cost of coverage for medically necessary hearing instruments and related services for any individual subject to federally defrayed cost of coverage.
(Source: P.A. 103-530, eff. 1-1-25.) |
(215 ILCS 5/356z.30a) Sec. 356z.30a. Coverage for hearing instruments. (a) As used in this Section: "Hearing care professional" means a person who is a licensed hearing instrument dispenser, licensed audiologist, or a licensed physician. "Hearing instrument" means any wearable non-disposable instrument or device designed to aid or compensate for impaired human hearing and any parts, attachments, or accessories for the instrument or device, including an ear mold but excluding batteries and cords. "Related services" means those services necessary to assess, select, and adjust or fit the hearing instrument to ensure optimal performance, including, but not limited to: audiological exams, replacement ear molds, and repairs to the hearing instrument. (b) An individual or group policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 101st General Assembly shall offer, for an additional premium and subject to the insurer's standard of insurability, optional coverage or optional reimbursement for hearing instruments and related services for all individuals when a hearing care professional prescribes a hearing instrument to augment communication. (c) This optional coverage shall be subject to all applicable copayments, coinsurance, deductibles, and out-of-pocket limits for the cost of a hearing instrument for each ear, as needed, as well as related services, with a
maximum for the hearing instrument and related services of no
more than $2,500 per hearing instrument every 24 months. (d) Nothing in this Section precludes an insured from selecting a hearing instrument that costs more than the amount covered by a plan of accident and health insurance or a managed care plan and paying the uncovered cost at his or her own expense. (e) Nothing in this Section shall be construed to require a group policy of accident and health insurance to provide coverage if the group is unable to meet mandatory minimum participation requirements set by the insurer.
(Source: P.A. 101-393, eff. 1-1-20.) |
(215 ILCS 5/356z.31) Sec. 356z.31. Recovery housing for persons with substance use
disorders. (a) Definitions. As used in this Section: "Substance use disorder" and "case management" have the meanings ascribed to those terms in Section 1-10 of the Substance Use Disorder Act. "Hospital" means a facility licensed by the Department of Public Health under the Hospital Licensing Act. "Federally qualified health center" means a facility as defined in Section 1905(l)(2)(B) of the federal Social Security Act. "Recovery housing" means a residential extended care treatment facility or a recovery home as defined and licensed in 77 Illinois Administrative Code, Part 2060, by the Illinois Department of Human Services, Division of Substance Use Prevention and Recovery. (b) A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after January 1, 2019 (the effective date of Public Act 100-1065) may provide coverage for residential extended care services and supports for persons recovery housing for persons with substance use disorders who are at risk of a relapse following discharge from a health care clinic, federally qualified health center, hospital withdrawal management program or any other licensed withdrawal management program, or hospital emergency department so long as all of the following conditions are met: (1) A health care clinic, federally qualified health | ||
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(2) The recovery housing is administered by a | ||
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(3) The recovery housing is administered by a | ||
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(c) Based on the individualized needs assessment, any coverage provided in accordance with this Section may include, but not be limited to, the following: (1) Substance use disorder treatment services that | ||
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(2) Transitional housing services, including food or | ||
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(3) Individualized case management and referral | ||
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(4)
Job training or placement services. (d) The insurer may rate each community-based agency that is licensed by or under contract with the Department of Human Services, Division of Substance Use Prevention and Recovery to provide recovery housing based on an evaluation of each agency's ability to: (1) reduce health care costs; (2) reduce recidivism rates for persons suffering | ||
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(3) improve outcomes; (4) track persons with substance use disorders; and (5) improve the quality of life of persons with | ||
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The insurer may publish the results of the ratings on its official website and shall, on an annual basis, update the posted results. (e) The Department of Insurance may adopt any rules necessary to implement the provisions of this Section in accordance with 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. 100-1065, eff. 1-1-19; 101-81, eff. 7-12-19.) |
(215 ILCS 5/356z.32) Sec. 356z.32. Coverage for fertility preservation services. (a) As used in this Section: "Iatrogenic infertility" means an impairment of | ||
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"May directly or indirectly cause" means the likely | ||
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"Standard fertility preservation services" means | ||
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(b) An individual or group policy of accident and health insurance amended, delivered, issued, or renewed in this State after January 1, 2019 (the effective date of Public Act 100-1102) must provide coverage for medically necessary expenses for standard fertility preservation services when a necessary medical treatment may directly or indirectly cause iatrogenic infertility to an enrollee. (c) In determining coverage pursuant to this Section, an insurer shall not discriminate based on an individual's expected length of life, present or predicted disability, degree of medical dependency, quality of life, or other health conditions, nor based on personal characteristics, including age, sex, sexual orientation, or marital status. (d) If, at any time before or after January 1, 2019 (the effective date of Public Act 100-1102), the Secretary of the United States Department of Health and Human Services, or its successor agency, promulgates rules or regulations to be published in the Federal Register, publishes a comment in the Federal Register, or issues an opinion, guidance, or other action that would require the State, pursuant to any provision of the Patient Protection and Affordable Care Act (Pub. L. 111–148), including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any successor provision, to defray the cost of coverage for fertility preservation services, then this Section is inoperative with respect to all such coverage other than that authorized under Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and the State shall not assume any obligation for the cost of coverage for fertility preservation services.
(Source: P.A. 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19.) |
(215 ILCS 5/356z.33) (Text of Section before amendment by P.A. 103-454) Sec. 356z.33. Coverage for epinephrine injectors. A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2020 (the effective date of Public Act 101-281) shall provide coverage for medically necessary epinephrine injectors for persons 18 years of age or under. As used in this Section, "epinephrine injector" has the meaning given to that term in Section 5 of the Epinephrine Injector Act.
(Source: P.A. 101-281, eff. 1-1-20; 102-558, eff. 8-20-21.) (Text of Section after amendment by P.A. 103-454) Sec. 356z.33. Coverage for epinephrine injectors. (a) A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2020 (the effective date of Public Act 101-281) shall provide coverage for medically necessary epinephrine injectors for persons 18 years of age or under. As used in this Section, "epinephrine injector" has the meaning given to that term in Section 5 of the Epinephrine Injector Act. (b) An insurer that provides coverage for medically necessary epinephrine injectors shall limit the total amount that an insured is required to pay for a twin-pack of medically necessary epinephrine injectors at an amount not to exceed $60, regardless of the type of epinephrine injector. (c) Nothing in this Section prevents an insurer from reducing an insured's cost sharing by an amount greater than the amount specified in subsection (b). (d) The Department may adopt rules as necessary to implement and administer this Section.
(Source: P.A. 102-558, eff. 8-20-21; 103-454, eff. 1-1-25.) |
(215 ILCS 5/356z.34) Sec. 356z.34. Coverage for cardiopulmonary monitors. A group or individual policy of accident and health insurance amended, delivered, issued, or renewed after January 1, 2020 (the effective date of Public Act 101-218) shall provide coverage for cardiopulmonary monitors determined to be medically necessary for a person 18 years old or younger who has had a cardiopulmonary event.
(Source: P.A. 101-218, eff. 1-1-20; 102-558, eff. 8-20-21.) |
(215 ILCS 5/356z.35) Sec. 356z.35. Long-term antibiotic therapy for tick-borne diseases. (a) As used in this Section: "Long-term antibiotic therapy" means the administration of oral, intramuscular, or intravenous antibiotics singly or in combination for periods of time in excess of 4 weeks. "Tick-borne disease" means a disease caused when an infected tick bites a person and the tick's saliva transmits an infectious agent (bacteria, viruses, or parasites) that can cause illness, including, but not limited to, the following: (1) a severe infection with borrelia burgdorferi; (2) a late stage, persistent, or chronic infection or | ||
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(3) an infection with other strains of borrelia or a | ||
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(4) the presence of signs or symptoms compatible with | ||
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(b) An individual or group policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2020 (the effective date of Public Act 101-371) shall provide coverage for long-term antibiotic therapy, including necessary office visits and ongoing testing, for a person with a tick-borne disease when determined to be medically necessary and ordered by a physician licensed to practice medicine in all its branches after making a thorough evaluation of the person's symptoms, diagnostic test results, or response to treatment. An experimental drug shall be covered as a long-term antibiotic therapy if it is approved for an indication by the United States Food and Drug Administration. A drug, including an experimental drug, shall be covered for an off-label use in the treatment of a tick-borne disease if the drug has been approved by the United States Food and Drug Administration.
(Source: P.A. 101-371, eff. 1-1-20; 102-558, eff. 8-20-21.) |
(215 ILCS 5/356z.36) Sec. 356z.36. Coverage of treatment models for early treatment of serious mental illnesses. (a) For purposes of early treatment of a serious mental illness in a child or young adult under age 26, a group or individual policy of accident and health insurance, or managed care plan, that is amended, delivered, issued, or renewed after December 31, 2020 shall provide coverage of the following bundled, evidence-based treatment: (1) Coordinated specialty care for first episode | ||
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(2) Assertive community treatment (ACT) and community | ||
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(b) Adherence to the clinical models. For purposes of ensuring adherence to the coordinated specialty care for first episode psychosis treatment model, only providers contracted with the Department of Human Services' Division of Mental Health to be FIRST.IL providers to deliver coordinated specialty care for first episode psychosis treatment shall be permitted to provide such treatment in accordance with this Section and such providers must adhere to the fidelity of the treatment model. For purposes of ensuring fidelity to ACT and CST, only providers certified to provide ACT and CST by the Department of Human Services' Division of Mental Health and approved to provide ACT and CST by the Department of Healthcare and Family Services, or its designee, in accordance with 89 Ill. Adm. Code 140, shall be permitted to provide such services under this Section and such providers shall be required to adhere to the fidelity of the models. (c) Development of medical necessity criteria for coverage. Within 6 months after January 1, 2020 (the effective date of Public Act 101-461), the Department of Insurance shall lead and convene a workgroup that includes the Department of Human Services' Division of Mental Health, the Department of Healthcare and Family Services, providers of the treatment models listed in this Section, and insurers operating in Illinois to develop medical necessity criteria for such treatment models for purposes of coverage under this Section. The workgroup shall use the medical necessity criteria the State and other states use as guidance for establishing medical necessity for insurance coverage. The Department of Insurance shall adopt a rule that defines medical necessity for each of the 3 treatment models listed in this Section by no later than June 30, 2020 based on the workgroup's recommendations. (d) For purposes of credentialing the mental health professionals and other medical professionals that are part of a coordinated specialty care for first episode psychosis treatment team, an ACT team, or a CST team, the credentialing of the psychiatrist or the licensed clinical leader of the treatment team shall qualify all members of the treatment team to be credentialed with the insurer. (e) Payment for the services performed under the treatment models listed in this Section shall be based on a bundled treatment model or payment, rather than payment for each separate service delivered by a treatment team member. By no later than 6 months after January 1, 2020 (the effective date of Public Act 101-461), the Department of Insurance shall convene a workgroup of Illinois insurance companies and Illinois mental health treatment providers that deliver the bundled treatment approaches listed in this Section to determine a coding solution that allows for these bundled treatment models to be coded and paid for as a bundle of services, similar to intensive outpatient treatment where multiple services are covered under one billing code or a bundled set of billing codes. The coding solution shall ensure that services delivered using coordinated specialty care for first episode psychosis treatment, ACT, or CST are provided and billed as a bundled service, rather than for each individual service provided by a treatment team member, which would deconstruct the evidence-based practice. The coding solution shall be reached prior to coverage, which shall begin for plans amended, delivered, issued, or renewed after December 31, 2020, to ensure coverage of the treatment team approaches as intended by this Section. (f) If, at any time, the Secretary of the United States Department of Health and Human Services, or its successor agency, adopts rules or regulations to be published in the Federal Register or publishes a comment in the Federal Register or issues an opinion, guidance, or other action that would require the State, under any provision of the Patient Protection and Affordable Care Act (P.L. 111-148), including, but not limited to, 42 U.S.C. 18031(d)(3)(b), or any successor provision, to defray the cost of any coverage for serious mental illnesses or serious emotional disturbances outlined in this Section, then the requirement that a group or individual policy of accident and health insurance or managed care plan cover the bundled treatment approaches listed in this Section is inoperative other than any such coverage authorized under Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and the State shall not assume any obligation for the cost of the coverage. (g) After 5 years following full implementation of this Section, if requested by an insurer, the Department of Insurance shall contract with an independent third party with expertise in analyzing health insurance premiums and costs to perform an independent analysis of the impact coverage of the team-based treatment models listed in this Section has had on insurance premiums in Illinois. If premiums increased by more than 1% annually solely due to coverage of these treatment models, coverage of these models shall no longer be required. (h) The Department of Insurance shall adopt any rules necessary to implement the provisions of this Section by no later than June 30, 2020.
(Source: P.A. 101-461, eff. 1-1-20; 102-558, eff. 8-20-21.) |
(215 ILCS 5/356z.37) Sec. 356z.37. Whole body skin examination. An individual or group policy of accident and health insurance shall cover, without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement upon the insured patient, one annual office visit, using appropriate routine evaluation and management Current Procedural Terminology codes or any successor codes, for a whole body skin examination for lesions suspicious for skin cancer. The whole body skin examination shall be indicated using an appropriate International Statistical Classification of Diseases and Related Health Problems code or any successor codes. The provisions of this Section do not apply to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to 26 U.S.C. 223.
(Source: P.A. 101-500, eff. 1-1-20; 102-558, eff. 8-20-21.) |
(215 ILCS 5/356z.38) Sec. 356z.38. Human breast milk coverage. (a) Notwithstanding any other provision of this Act, pasteurized donated human breast milk, which may include human milk fortifiers if indicated by a prescribing licensed medical practitioner, shall be covered under an individual or group health insurance for persons who are otherwise eligible for coverage under this Act if the covered person is an infant under the age of 6 months, a licensed medical practitioner prescribes the milk for the covered person, and all of the following conditions are met: (1) the milk is obtained from a human milk bank that | ||
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(2) the infant's mother is medically or physically | ||
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(3) the milk has been determined to be medically | ||
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(4) one or more of the following applies: (A) the infant's birth weight is below 1,500 | ||
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(B) the infant has a congenital or acquired | ||
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(C) the infant has infant hypoglycemia; (D) the infant has congenital heart disease; (E) the infant has had or will have an organ | ||
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(F) the infant has sepsis; or (G) the infant has any other serious congenital | ||
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(b) Notwithstanding any other provision of this Act, pasteurized donated human breast milk, which may include human milk fortifiers if indicated by a prescribing licensed medical practitioner, shall be covered under an individual or group health insurance for persons who are otherwise eligible for coverage under this Act if the covered person is a child 6 months through 12 months of age, a licensed medical practitioner prescribes the milk for the covered person, and all of the following conditions are met: (1) the milk is obtained from a human milk bank that | ||
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(2) the child's mother is medically or physically | ||
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(3) the milk has been determined to be medically | ||
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(4) one or more of the following applies: (A) the child has spinal muscular atrophy; (B) the child's birth weight was below 1,500 | ||
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(C) the child has had or will have an organ | ||
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(D) the child has a congenital or acquired | ||
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(Source: P.A. 101-511, eff. 1-1-20; 102-558, eff. 8-20-21.) |
(215 ILCS 5/356z.39) Sec. 356z.39. Coverage of the psychiatric Collaborative Care Model. (a) As used in this Section, "psychiatric Collaborative Care Model" means the evidence-based, integrated behavioral health service delivery method, which includes a formal collaborative arrangement among a primary care team consisting of a primary care provider, a care manager, and a psychiatric consultant, and includes, but is not limited to, the following elements: (1) care directed by the primary care team; (2) structured care management; (3) regular assessments of clinical status using | ||
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(4) modification of treatment as appropriate. (b) An individual or group policy of accident and health insurance amended, delivered, issued, or renewed on or after January 1, 2020 (the effective date of Public Act 101-574) or managed care organization that provides mental health benefits shall provide reimbursement for benefits that are delivered through the psychiatric Collaborative Care Model. The following American Medical Association 2018 current procedural terminology codes and Healthcare Common Procedure Coding System code shall be used to bill for benefits delivered through the psychiatric Collaborative Care Model: (1) 99492; (2) 99493; (3) 99494; and (4) G0512. (c) The Director of Insurance shall update the billing codes in subsection (b) if there are any alterations or additions to the billing codes for the psychiatric Collaborative Care Model. (d) An individual or group policy or managed care organization that provides benefits under this Section may deny reimbursement of any billing code listed in this Section on the grounds of medical necessity if such medical necessity determinations are in compliance with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and its implementing and related regulations and that such determinations are made in accordance with the utilization review requirements under Section 85 of the Managed Care Reform and Patient Rights Act.
(Source: P.A. 101-574, eff. 1-1-20; 102-558, eff. 8-20-21.) |
(215 ILCS 5/356z.40) Sec. 356z.40. Pregnancy and postpartum coverage. (a) An individual or group policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after the effective date of this amendatory Act of the 102nd General Assembly shall provide coverage for pregnancy and newborn care in accordance with 42 U.S.C. 18022(b) regarding essential health benefits. (b) Benefits under this Section shall be as follows: (1) An individual who has been identified as | ||
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(2) An individual shall have access to medically | ||
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(3) The benefits provided for inpatient and | ||
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(4) The benefits for the first 48 hours of initiation | ||
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(5) If an insurer determines that continued inpatient | ||
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(6) Except as otherwise stated in this subsection | ||
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(7) The benefits required by paragraphs (2) and (6) | ||
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(Source: P.A. 102-665, eff. 10-8-21.) |
(215 ILCS 5/356z.41) (Text of Section before amendment by P.A. 103-429) Sec. 356z.41. Cost sharing in prescription insulin drugs; limits; confidentiality of rebate information. (a) As used in this Section, "prescription insulin drug" means a prescription drug that contains insulin and is used to control blood glucose levels to treat diabetes but does not include an insulin drug that is
administered to a patient intravenously. (b) This Section applies to a group or individual policy of accident and health insurance amended, delivered, issued, or renewed on or after the effective date of this amendatory Act of the 101st General Assembly. (c) An insurer that provides coverage for prescription insulin drugs pursuant to the terms of a health coverage plan the insurer offers shall limit the total amount that an insured is required to pay for a 30-day supply of covered prescription insulin drugs at an amount not to exceed $100, regardless of the quantity or type of covered prescription insulin drug used to fill the insured's prescription. (d) Nothing in this Section prevents an insurer from reducing an insured's cost sharing by an amount greater than the amount specified in subsection (c). (e) The Director may use any of the Director's enforcement powers to obtain an insurer's compliance with this Section. (f) The Department may adopt rules as necessary to implement and administer this Section and to align it with federal requirements. (g) On January 1 of each year, the limit on the amount that an insured is required to pay for a 30-day supply of a covered prescription insulin drug shall increase by a percentage equal to the percentage change from the preceding year in the medical care component of the Consumer Price Index of the Bureau of Labor Statistics of the United States Department of Labor.
(Source: P.A. 101-625, eff. 1-1-21.) (Text of Section after amendment by P.A. 103-429) Sec. 356z.41. Cost sharing in prescription insulin drugs; limits; confidentiality of rebate information. (a) As used in this Section, "prescription insulin drug" means a prescription drug that contains insulin and is used to control blood glucose levels to treat diabetes but does not include an insulin drug that is
administered to a patient intravenously. (b) This Section applies to a group or individual policy of accident and health insurance amended, delivered, issued, or renewed on or after the effective date of this amendatory Act of the 101st General Assembly. (c) An insurer that provides coverage for prescription insulin drugs pursuant to the terms of a health coverage plan the insurer offers shall limit the total amount that an insured is required to pay for a 30-day supply of covered prescription insulin drugs at an amount not to exceed $35, regardless of the quantity or type of covered prescription insulin drug used to fill the insured's prescription. (d) Nothing in this Section prevents an insurer from reducing an insured's cost sharing by an amount greater than the amount specified in subsection (c). (e) The Director may use any of the Director's enforcement powers to obtain an insurer's compliance with this Section. (f) The Department may adopt rules as necessary to implement and administer this Section and to align it with federal requirements. (g) On January 1 of each year, the limit on the amount that an insured is required to pay for a 30-day supply of a covered prescription insulin drug shall increase by a percentage equal to the percentage change from the preceding year in the medical care component of the Consumer Price Index of the Bureau of Labor Statistics of the United States Department of Labor.
(Source: P.A. 103-429, eff. 7-1-25.) |
(215 ILCS 5/356z.42) Sec. 356z.42. (Repealed).
(Source: P.A. 101-625, eff. 1-24-20. Repealed internally, eff. 12-31-20.) |
(215 ILCS 5/356z.43) Sec. 356z.43. (Repealed).
(Source: P.A. 102-813, eff. 5-13-22. Repealed internally, eff. 1-1-22.) |
(215 ILCS 5/356z.44) Sec. 356z.44. Vitamin D testing. (a) As used in this Section, "vitamin D testing" means vitamin D blood testing that measures the level of vitamin D in an individual's blood. (b) A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after the effective date of this amendatory Act of the 102nd General Assembly shall provide coverage for vitamin D testing recommended by a health care provider in accordance with vitamin D deficiency risk factors identified by the United States Centers for Disease Control and Prevention. Risk factors for vitamin D deficiency include, but are not limited to: (1) having osteoporosis or other bone-health | ||
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(2) having conditions that affect fat absorption, | ||
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(3) routinely taking medications that interfere | ||
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(4) beneficiaries aged 55 and older; (5) having a darker skin color; (6) inadequate sunlight exposure; (7) being obese; (8) previous diagnosis of diabetes or kidney | ||
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(9) exhibiting poor muscle strength or constant | ||
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(Source: P.A. 102-530, eff. 1-1-22.) |
(215 ILCS 5/356z.45)
Sec. 356z.45. Coverage for patient care services provided by a pharmacist. A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2023 shall provide coverage for health care or patient care services provided by a pharmacist if: (1) the pharmacist meets the requirements and scope | ||
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(2) the health plan provides coverage for the same | ||
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(3) the pharmacist is included in the health | ||
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(4) a reimbursement has been successfully | ||
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(Source: P.A. 102-103, eff. 1-1-23; 102-813, eff. 5-13-22; 102-1051, eff. 1-1-23.)
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(215 ILCS 5/356z.46)
Sec. 356z.46. Biomarker testing. (a) As used in this Section: "Biomarker" means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention. "Biomarker" includes, but is not limited to, gene mutations or protein expression. "Biomarker testing" means the analysis of a patient's tissue, blood, or fluid biospecimen for the presence of a biomarker. "Biomarker testing" includes, but is not limited to, single-analyte tests, multi-plex panel tests, and partial or whole genome sequencing. (b) A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after January 1, 2022 shall include coverage for biomarker testing as defined in this Section pursuant to criteria established under subsection (d). (c) Biomarker testing shall be covered and conducted in an efficient manner to provide the most complete range of results to the patient's health care provider without requiring multiple biopsies, biospecimen samples, or other delays or disruptions in patient care. (d) Biomarker testing must be covered for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of an enrollee's disease or condition when the test is supported by medical and scientific evidence, including, but not limited to: (1) labeled indications for an FDA-approved test or | ||
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(2) federal Centers for Medicare and Medicaid | ||
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(3) nationally recognized clinical practice | ||
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(4) consensus statements; (5) professional society recommendations; (6) peer-reviewed literature, biomedical compendia, | ||
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(7) peer-reviewed scientific studies published in | ||
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(e) When coverage of biomarker testing for the purpose of diagnosis, treatment, or ongoing monitoring of any medical condition is restricted for use by a group or individual policy of accident and health insurance or managed care plan, the patient and prescribing practitioner shall have access to a clear, readily accessible, and convenient processes to request an exception. The process shall be made readily accessible on the insurer's website.
(Source: P.A. 102-203, eff. 1-1-22; 102-813, eff. 5-13-22.)
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(215 ILCS 5/356z.47)
Sec. 356z.47. Coverage for pancreatic cancer screening. A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2022 shall provide coverage for medically necessary pancreatic cancer screening.
(Source: P.A. 102-306, eff. 1-1-22; 102-813, eff. 5-13-22.)
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(215 ILCS 5/356z.48)
Sec. 356z.48. Colonoscopy coverage. (a) A group policy of accident and health insurance that is amended, delivered, issued, or renewed on or after January 1, 2022 shall provide coverage for a colonoscopy that is a follow-up exam based on an initial screen where the colonoscopy was determined to be medically necessary by a physician licensed to practice medicine in all its branches, an advanced practice registered nurse, or a physician assistant. (b) A policy subject to this Section shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided; except that this subsection does not apply to coverage of colonoscopies to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to Section 223 of the Internal Revenue Code.
(Source: P.A. 102-443, eff. 1-1-22; 102-813, eff. 5-13-22.)
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(215 ILCS 5/356z.49)
Sec. 356z.49. A1C testing. (a) As used in this Section, "A1C testing" means blood sugar level testing used to diagnose prediabetes, type 1 diabetes, and type 2 diabetes and to monitor management of blood sugar levels. (b) A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after January 1, 2022 (the effective date of Public Act 102-530) shall provide coverage for A1C testing recommended by a health care provider for prediabetes, type 1 diabetes, and type 2 diabetes in accordance with prediabetes and diabetes risk factors identified by the United States Centers for Disease Control and Prevention. (1) Risk factors for prediabetes may include, but | ||
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(2) Risk factors for type 1 diabetes may include, | ||
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(3) Risk factors for type 2 diabetes may include, | ||
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(Source: P.A. 102-530, eff. 1-1-22; 102-813, eff. 5-13-22.)
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(215 ILCS 5/356z.50)
Sec. 356z.50. Comprehensive cancer testing. (a) As used in this Section: "Comprehensive cancer testing" includes, but is not limited to, the following forms of testing: (1) Targeted cancer gene panels. (2) Whole-exome genome testing. (3) Whole-genome sequencing. (4) RNA sequencing. (5) Tumor mutation burden. "Testing of blood or constitutional tissue for cancer predisposition testing" includes, but is not limited to, the following forms of testing: (1) Targeted cancer gene panels. (2) Whole-exome genome testing. (3) Whole-genome sequencing. (b) An individual or group policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2022 (the effective date of Public Act 102-589) shall provide coverage for medically necessary comprehensive cancer testing and testing of blood or constitutional tissue for cancer predisposition testing as determined by a physician licensed to practice medicine in all of its branches.
(Source: P.A. 102-589, eff. 1-1-22; 102-813, eff. 5-13-22.)
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(215 ILCS 5/356z.51)
Sec. 356z.51. Coverage for port-wine stain treatment. (a) A group or individual policy of accident and health
insurance or managed care plan amended, delivered, issued, or
renewed on or after January 1, 2022 shall provide coverage for
treatment to eliminate or provide maximum
feasible treatment of nevus flammeus, also known as port-wine
stains, including, but not limited to, port-wine stains caused
by Sturge-Weber syndrome. For purposes of this Section, treatment or maximum feasible treatment shall include early intervention treatment, including topical, intralesional, or systemic medical therapy and surgery, and laser treatments approved by the U.S. Food and Drug Administration in children aged 18 years and younger that are intended to prevent functional impairment related to vision function, oral function, inflammation, bleeding, infection, and other medical complications associated with port-wine stains. (b) Coverage for treatment required under this Section shall not include treatment solely for cosmetic purposes.
(Source: P.A. 102-642, eff. 1-1-22; 102-813, eff. 5-13-22.)
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(215 ILCS 5/356z.53) Sec. 356z.53. Coverage for home health services. A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2024 shall provide coverage for access to home health services for the duration of medically necessary care.
(Source: P.A. 102-816, eff. 1-1-23; 103-154, eff. 6-30-23.) |
(215 ILCS 5/356z.54)
Sec. 356z.54. Coverage for breast reduction surgery. A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2024 shall provide coverage for medically necessary breast reduction surgery.
(Source: P.A. 102-731, eff. 1-1-23; 103-154, eff. 6-30-23.)
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(215 ILCS 5/356z.55) Sec. 356z.55. Coverage for cleft lip and cleft palate. (a) As used in this Section, "medically necessary care and treatment" to address congenital anomalies associated with a cleft lip or palate, or both, includes: (1) oral and facial surgery, including reconstructive | ||
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(2) prosthetic treatment such as obturators, speech | ||
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(3) orthodontic treatment and management; (4) prosthodontic treatment and management; and (5) otolaryngology treatment and management. "Medically necessary care and treatment" does not include cosmetic surgery performed to reshape normal structures of the lip, jaw, palate, or other facial structures to improve appearance. (b) An individual or group policy of accident and health insurance amended, delivered, issued, or renewed on or after January 1, 2024 (the effective date of Public Act 102-768) shall provide coverage for the medically necessary care and treatment of cleft lip and palate for children under the age of 19. Coverage for cleft lip and palate care and treatment may impose the same deductible, coinsurance, or other cost-sharing limitation that is imposed on other related surgical benefits under the policy. (c) This Section does not apply to a policy that covers only dental care.(Source: P.A. 102-768, eff. 1-1-24; 103-154, eff. 6-30-23.) |
(215 ILCS 5/356z.56)
Sec. 356z.56. Coverage for hormone therapy to treat menopause. A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2024 shall provide coverage for medically necessary hormone therapy treatment to treat menopause that has been induced by a hysterectomy.
(Source: P.A. 102-804, eff. 1-1-23; 103-154, eff. 6-30-23.)
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(215 ILCS 5/356z.57)
Sec. 356z.57. Pediatric palliative care. (a) A group or individual policy of accident and health insurance or a managed care plan amended, delivered, issued, or renewed on or after January 1, 2024 shall provide coverage for community-based pediatric palliative care and hospice care. This care shall be delivered to any qualifying child with a serious illness by a trained interdisciplinary team that allows a child to receive community-based pediatric palliative care and hospice care while continuing to pursue curative treatment and disease-directed therapies for the qualifying illness. (b) As used in this Section, "palliative care" and "serious illness" have the same meaning as set forth in the Pediatric Palliative Care Act.
(Source: P.A. 102-860, eff. 1-1-23; 103-154, eff. 6-30-23.)
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(215 ILCS 5/356z.58)
Sec. 356z.58. Prenatal vitamins coverage. A group or individual policy of accident and health insurance that is amended, delivered, issued, or renewed on or after January 1, 2024 that provides coverage for prescription drugs shall provide coverage for prenatal vitamins when prescribed by a physician licensed to practice medicine in all of its branches or an advanced practice registered nurse licensed under the Nurse Practice Act.
(Source: P.A. 102-930, eff. 1-1-23; 103-154, eff. 6-30-23.)
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(215 ILCS 5/356z.59)
Sec. 356z.59. Coverage for continuous glucose monitors. A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2024 shall provide coverage for medically necessary continuous glucose monitors for individuals who are diagnosed with type 1 or type 2 diabetes and require insulin for the management of their diabetes.
(Source: P.A. 102-1093, eff. 1-1-23; 103-154, eff. 6-30-23.)
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(215 ILCS 5/356z.60) Sec. 356z.60. Coverage for abortifacients, hormonal therapy, and human immunodeficiency virus pre-exposure prophylaxis and post-exposure prophylaxis. (a) As used in this Section: "Abortifacients" means any medication administered to terminate a pregnancy as prescribed or ordered by a health care professional. "Health care professional" means a physician licensed to practice medicine in all of its branches, licensed advanced practice registered nurse, or physician assistant. "Hormonal therapy medication" means hormonal treatment administered to treat gender dysphoria. "Therapeutic equivalent version" means drugs, devices, or products that can be expected to have the same clinical effect and safety profile when administered to patients under the conditions specified in the labeling and that satisfy the following general criteria: (1) it is approved as safe and effective; (2) it is a pharmaceutical equivalent in that it: (A) contains identical amounts of the same | ||
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(B) meets compendial or other applicable | ||
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(3) it is bioequivalent in that: (A) it does not present a known or potential | ||
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(B) if it does present such a known or | ||
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(4) it is adequately labeled; and (5) it is manufactured in compliance with Current | ||
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(b) An individual or group policy of accident and health insurance amended, delivered, issued, or renewed in this State on or after January 1, 2024 shall provide coverage for all abortifacients, hormonal therapy medication, human immunodeficiency virus pre-exposure prophylaxis, and post-exposure prophylaxis drugs approved by the United States Food and Drug Administration, and follow-up services related to that coverage, including, but not limited to, management of side effects, medication self-management or adherence counseling, risk reduction strategies, and mental health counseling. This coverage shall include drugs approved by the United States Food and Drug Administration that are prescribed or ordered for off-label use for the purposes described in this Section. (c) The coverage required under subsection (b) is subject to the following conditions: (1) If the United States Food and Drug | ||
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(2) If an individual's attending provider | ||
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(3) If a drug is not covered, plans and issuers | ||
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The conditions listed under this subsection (c) also apply to drugs prescribed for off-label use as abortifacients. (d) Except as otherwise provided in this Section, a policy subject to this Section shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided. The provisions of this subsection do not apply to coverage of procedures to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to the federal Internal Revenue Code, 26 U.S.C. 223. (e) Except as otherwise authorized under this Section, a policy shall not impose any restrictions or delays on the coverage required under this Section. (f) The coverage requirements in this Section for
abortifacients do not, pursuant to 42 U.S.C. 18054(a)(6),
apply to a multistate plan that does not provide coverage for
abortion. (g) If the Department concludes that enforcement of any
coverage requirement of this Section for abortifacients may
adversely affect the allocation of federal funds to this
State, the Department may grant an exemption to that
requirement, but only to the minimum extent necessary to ensure the continued receipt of federal funds.
(Source: P.A. 102-1117, eff. 1-13-23; 103-462, eff. 8-4-23.) |
(215 ILCS 5/356z.61) (Text of Section from P.A. 103-1) Sec. 356z.61. Coverage of pharmacy testing, screening, vaccinations, and treatment. A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 shall provide coverage for health care or patient care services provided by a pharmacist if: (1) the pharmacist meets the requirements and scope | ||
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(2) the health plan provides coverage for the same | ||
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(3) the pharmacist is included in the health benefit | ||
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(4) reimbursement has been successfully negotiated in | ||
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(Source: P.A. 103-1, eff. 4-27-23.) (Text of Section from P.A. 103-84) Sec. 356z.61. Coverage for liver disease screening. A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 shall provide coverage for preventative liver disease screenings for individuals 35 years of age or older and under the age of 65 at high risk for liver disease, including liver ultrasounds and alpha-fetoprotein blood tests every 6 months, without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided; except that this Section does not apply to coverage of liver disease screenings to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to Section 223 of the Internal Revenue Code.(Source: P.A. 103-84, eff. 1-1-24.) (Text of Section from P.A. 103-91) Sec. 356z.61. Coverage for compression sleeves. A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 shall provide coverage for compression sleeves that is medically necessary for the enrollee to prevent or mitigate lymphedema.(Source: P.A. 103-91, eff. 1-1-24.) (Text of Section from P.A. 103-123) Sec. 356z.61. Coverage for reconstructive services. (a) As used in this Section, "reconstructive services" means treatments performed on structures of the body damaged by trauma to restore physical appearance. (b) A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 may not deny coverage for medically necessary reconstructive services that are intended to restore physical appearance.(Source: P.A. 103-123, eff. 1-1-24.) (Text of Section from P.A. 103-325) Sec. 356z.61. Proton beam therapy. (a) As used in this Section: "Medically necessary" has the meaning given to that term in the Prior Authorization Reform Act. "Proton beam therapy" means a type of radiation therapy treatment that utilizes protons as the radiation delivery method for the treatment of tumors and cancerous cells. "Radiation therapy treatment" means the delivery of biological effective doses with proton therapy, intensity modulated radiation therapy, brachytherapy, stereotactic body radiation therapy, three-dimensional conformal radiation therapy, or other forms of therapy using radiation. (b) A group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 that provides coverage for the treatment of cancer shall not apply a higher standard of clinical evidence for the coverage of proton beam therapy than the insurer applies for the coverage of any other form of radiation therapy treatment. (c) A group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 that provides coverage or benefits to any resident of this State for radiation oncology shall include coverage or benefits for medically necessary proton beam therapy for the treatment of cancer. (Source: P.A. 103-325, eff. 1-1-24.) (Text of Section from P.A. 103-420) Sec. 356z.61. Coverage of prescription estrogen. (a) A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 and that provides coverage for prescription drugs shall include coverage for one or more therapeutic equivalent versions of vaginal estrogen in its formulary. (b) If a particular vaginal estrogen product or its therapeutic equivalent version approved by the United States Food and Drug Administration is determined to be medically necessary, the issuer must cover that service or item pursuant to the cost-sharing requirement contained in subsection (c). (c) A policy subject to this Section shall not impose a deductible, copayment, or any other cost sharing requirement that exceeds any deductible, coinsurance, copayment, or any other cost-sharing requirement imposed on any prescription drug authorized for the treatment of erectile dysfunction covered by the policy; except that this subsection does not apply to coverage of vaginal estrogen to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to Section 223 of the Internal Revenue Code. (d) As used in this Section, "therapeutic equivalent version" has the meaning given to that term in paragraph (2) of subsection (a) of Section 356z.4. (Source: P.A. 103-420, eff. 1-1-24.) (Text of Section from P.A. 103-445) Sec. 356z.61. Home saliva cancer screening. (a) As used in this Section, "home saliva cancer screening" means an outpatient test that utilizes an individual's saliva to detect biomarkers for early-stage cancer. (b) An individual or group policy of accident and health insurance that is amended, delivered, issued, or renewed on or after January 1, 2025 shall cover a medically necessary home saliva cancer screening every 24 months if the patient: (1) is asymptomatic and at high risk for the disease | ||
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(2) demonstrates symptoms of the disease being tested | ||
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(Source: P.A. 103-445, eff. 1-1-24.) (Text of Section from P.A. 103-458) Sec. 356z.61. Coverage for children with neuromuscular, neurological, or cognitive impairment. A group or individual policy of accident and health insurance amended, delivered, issued, or renewed on or after January 1, 2025 shall provide coverage for therapy, diagnostic testing, and equipment necessary to increase quality of life for children who have been clinically or genetically diagnosed with any disease, syndrome, or disorder that includes low tone neuromuscular impairment, neurological impairment, or cognitive impairment.(Source: P.A. 103-458, eff. 1-1-24.) (Text of Section from P.A. 103-535) Sec. 356z.61. Coverage of no-cost mental health prevention and wellness visits. (a) A group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2025 shall provide coverage for one annual mental health prevention and wellness visit for children and for adults. (b) Mental health prevention and wellness visits shall include any age-appropriate screening recommended by the United States Preventive Services Task Force or by the American Academy of Pediatrics' Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents for purposes of identifying a mental health issue, condition, or disorder; discussing mental health symptoms that might be present, including symptoms of a previously diagnosed mental health condition or disorder; performing an evaluation of adverse childhood experiences; and discussing mental health and wellness. (c) A mental health prevention and wellness visit shall be covered for up to 60 minutes and may be performed by a physician licensed to practice medicine in all of its branches, a licensed clinical psychologist, a licensed clinical social worker, a licensed clinical professional counselor, a licensed marriage and family therapist, a licensed social worker, or a licensed professional counselor. (d) A policy subject to this Section shall not impose a deductible, coinsurance, copayment, or other cost-sharing requirement for mental health prevention and wellness visits. The cost-sharing prohibition in this subsection (d) does not apply to coverage of mental health prevention and wellness visits to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to Section 223 of the Internal Revenue Code. (e) A mental health prevention and wellness visit shall be in addition to an annual physical examination and shall not replace a well-child visit or a general health or medical visit. (f) A mental health prevention and wellness visit shall be reimbursed through the following American Medical Association current procedural terminology codes and at the same rate that current procedural terminology codes are reimbursed for the provision of other medical care: 99381-99387 and 99391-99397. The Department shall update the current procedural terminology codes through adoption of rules if the codes listed in this subsection are altered, amended, changed, deleted, or supplemented. (g) Reimbursement of any of the current procedural terminology codes listed in this Section shall comply with the following: (1) reimbursement may be adjusted for payment of | ||
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(2) for a mental health prevention and wellness visit | ||
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(h) A mental health prevention and wellness visit may be incorporated into and reimbursed within any type of integrated primary care service delivery method, including, but not limited to, a psychiatric collaborative care model as provided for under this Code. (i) The Department shall adopt any rules necessary to implement this Section by no later than October 31, 2024.(Source: P.A. 103-535, eff. 8-11-23.) |
(215 ILCS 5/356z.62) Sec. 356z.62. Coverage of preventive health services. (a) A policy of group health insurance coverage or individual health insurance coverage as defined in Section 5 of the Illinois Health Insurance Portability and Accountability Act shall, at a minimum, provide coverage for and shall not impose any cost-sharing requirements, including a copayment, coinsurance, or deductible, for: (1) evidence-based items or services that have in | ||
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(2) immunizations that have in effect a | ||
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(3) with respect to infants, children, and | ||
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(4) with respect to women, such additional preventive | ||
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(b) For purposes of this Section, and for purposes of any other provision of State law, recommendations of the United States Preventive Services Task Force regarding breast cancer screening, mammography, and prevention issued in or around November 2009 are not considered to be current. (c) For office visits: (1) if an item or service described in subsection (a) | ||
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(2) if an item or service described in subsection (a) | ||
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(3) if an item or service described in subsection (a) | ||
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(d) A policy must provide coverage pursuant to subsection (a) for plan or policy years that begin on or after the date that is one year after the date the recommendation or guideline is issued. If a recommendation or guideline is in effect on the first day of the plan or policy year, the policy shall cover the items and services specified in the recommendation or guideline through the last day of the plan or policy year unless either: (1) a recommendation under paragraph (1) of | ||
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(2) the item or service is subject to a safety recall | ||
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(e) Network limitations. (1) Subject to paragraph (3) of this subsection, | ||
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(2) Subject to paragraph (3) of this subsection, | ||
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(3) If a policy does not have in its network a | ||
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(f) Nothing in this Section prevents a company from using reasonable medical management techniques to determine the frequency, method, treatment, or setting for an item or service described in subsection (a) to the extent not specified in the recommendation or guideline. (g) Nothing in this Section shall be construed to prohibit a policy from providing coverage for items or services in addition to those required under subsection (a) or from denying coverage for items or services that are not required under subsection (a). Unless prohibited by other law, a policy may impose cost-sharing requirements for a treatment not described in subsection (a) even if the treatment results from an item or service described in subsection (a). Nothing in this Section shall be construed to limit coverage requirements provided under other law. (h) The Director may develop guidelines to permit a company to utilize value-based insurance designs. In the absence of guidelines developed by the Director, any such guidelines developed by the Secretary of the U.S. Department of Health and Human Services that are in force under 42 U.S.C. 300gg-13 shall apply. (i) For student health insurance coverage as defined at 45 CFR 147.145, student administrative health fees are not considered cost-sharing requirements with respect to preventive services specified under subsection (a). As used in this subsection, "student administrative health fee" means a fee charged by an institution of higher education on a periodic basis to its students to offset the cost of providing health care through health clinics regardless of whether the students utilize the health clinics or enroll in student health insurance coverage. (j) For any recommendation or guideline specifically referring to women or men, a company shall not deny or limit the coverage required or a claim made under subsection (a) based solely on the individual's recorded sex or actual or perceived gender identity, or for the reason that the individual is gender nonconforming, intersex, transgender, or has undergone, or is in the process of undergoing, gender transition, if, notwithstanding the sex or gender assigned at birth, the covered individual meets the conditions for the recommendation or guideline at the time the item or service is furnished. (k) This Section does not apply to grandfathered health plans, excepted benefits, or short-term, limited-duration health insurance coverage.
(Source: P.A. 103-551, eff. 8-11-23.) |
(215 ILCS 5/357.1) (from Ch. 73, par. 969.1)
Sec. 357.1.
Accident and health policy provisions required.
Except as provided in section 357.26 of this article each accident
and health policy delivered or issued for delivery to any person in this
State shall contain the provisions set forth in sections 357.2 through
357.13 in the words in which the same appear in the specified sections;
provided, however, that the company may, at its option, substitute for
one or more of such provisions corresponding provisions of different
wording approved by the Director which are in each instance not less
favorable in any respect to the insured or the beneficiary. Such
provisions shall be preceded individually by the caption appearing at
the beginning of each such section or, at the option of the company, by
such appropriate individual or group captions or subcaptions as the
Director may approve.
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.2) (from Ch. 73, par. 969.2)
Sec. 357.2.
"ENTIRE CONTRACT; CHANGES:
This policy, including the
endorsements and the attached papers, if any, constitutes the entire
contract of insurance. No change in this policy shall be valid until
approved by an executive officer of the company and unless such approval
be endorsed hereon or attached hereto. No agent has authority to change
this policy or to waive any of its provisions."
(1) Premium Notice Required. No policy of accident and health
insurance, as enumerated in class 1(b) or 2(a) of Section 4, shall be
declared forfeited or lapsed within 6 months after default in payment of
any premium installment or interest or any portion thereof, nor shall
any such policy be forfeited or lapsed by reason of nonpayment when due
of any premium, installment or interest, or any portion thereof,
required by the terms of the policy to be paid, within 6 months from the
default in payment of such premium, installment or interest, unless a
written or printed notice stating the amount of such premium,
installment, interest or portion thereof due on such policy, the place
where it shall be paid and the person to whom the same is payable, shall
have been duly addressed and mailed with the required postage affixed,
to the person insured or to the premium payor if other than the insured
at the last known post office address of the insured or premium payor,
at least 15 days and not more than 45 days prior to the day when same is
due and payable before the beginning of the grace period.
Such notice shall also state that unless such premium or other sum
due shall be paid to the company or its agent the policy and all
payments thereon will become forfeited and void, except as to any right
to a surrender value or paid up policy as provided for by the policy.
The affidavit of any officer, clerk or agent of the company or of anyone
authorized to mail such notice that the notice required by this Section
bearing the required postage has been duly addressed and mailed shall be
presumptive evidence that such notice has been duly given.
If the notice is given in a manner other than mailing, then
physical proof of the receipt of such notice by the proper recipient
shall be maintained by the insurer.
(2) Paragraph (1) of this Section shall not apply
to cancellable policies which are renewable at the option of the company
nor shall it apply to group policies, industrial policies, or any
policies upon which premiums are payable monthly or at shorter intervals.
(Source: P.A. 91-357, eff. 7-29-99.)
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(215 ILCS 5/357.3) (from Ch. 73, par. 969.3)
Sec. 357.3. "TIME LIMIT ON CERTAIN DEFENSES: (1) After 2 years from the
date of issue of this policy no misstatements, except fraudulent
misstatements, made by the applicant in the application for such policy
shall be used to void the policy or to deny a claim for loss incurred or
disability (as defined in the policy) commencing after the expiration of
such 2 year period."
(The foregoing policy provision shall not be so construed as to affect
any legal requirement for avoidance of a policy or denial of a claim during
such initial 2 year period, nor to limit the application of section 357.15
through section 357.19 in the event of misstatement with respect to age
or occupation or other insurance.)
A policy which the insured has the right to continue in force subject to
its terms by the timely payment of premium (1) until at least age 50 or,
(2) in the case of a policy issued after age 44, for at least 5 years from
its date of issue, may contain in lieu of the foregoing the following
provisions (from which the clause in parentheses may be omitted at the
company's option) under the caption "INCONTESTABLE":
"After this policy has been in force for a period of 2 years during the
lifetime of the insured (excluding any period during which the insured is
a person with a disability), it shall become incontestable as to the statements contained in
the application."
(2) "No claim for loss incurred or disability (as defined in the policy)
commencing after 2 years from the date of issue of this policy shall be
reduced or denied on the ground that a disease or physical condition not
excluded from coverage by name or specific description effective on the
date of loss had existed prior to the effective date of coverage of this
policy."
(Source: P.A. 99-143, eff. 7-27-15.)
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(215 ILCS 5/357.4) (from Ch. 73, par. 969.4)
Sec. 357.4.
"GRACE PERIOD:
A grace period of ....(insert a number not less
than "7" for weekly premium policies, "10" for monthly premium policies and
"31" for all other policies) days will be granted for the payment of each
premium falling due after the first premium, during which grace period the
policy shall continue in force."
(A policy which contains a cancellation provision may add, at the end of
the above provision: "Subject to the right of the company to cancel in
accordance with the cancellation provision hereof."
A policy in which the company reserves the right to refuse any renewal
shall have, at the beginning of the above provision:
"Unless not less than 30 days prior to the premium due date the company
has delivered to the insured or has mailed to his last address as shown by
the records of the company written notice of its intention not to renew
this policy beyond the period for which the premium has been accepted.")
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.5) (from Ch. 73, par. 969.5)
Sec. 357.5.
"REINSTATEMENT:
If any renewal premium be not paid within
the time granted the insured for payment, a subsequent acceptance of
premium by the company or by any agent duly authorized by the company to
accept such premium, without requiring in connection therewith an
application for reinstatement, shall reinstate the policy; provided,
however, that if the company or such agent requires an application for
reinstatement and issues a conditional receipt for the premium tendered,
the policy will be reinstated upon approval of such application by the
company or, lacking such approval, upon the 45th day following the date
of such conditional receipt unless the company has previously notified
the insured in writing of its disapproval of such application. The
reinstated policy shall cover only loss resulting from such accidental
injury as may be sustained after the date of reinstatement and loss due
to such sickness as may begin more than 10 days after such date. In all
other respects the insured and company shall have the same rights
thereunder as they had under the policy immediately before the due date
of the defaulted premium, subject to any provisions endorsed hereon or
attached hereto in connection with the reinstatement. Any premium
accepted in connection with a reinstatement shall be applied to a period
for which premium has not been previously paid, but not to any period
more than 60 days prior to the date of reinstatement."
The last sentence of the above provision may be omitted from any
policy which the insured has the right to continue in force subject to
its terms by the timely payment of premiums (1) until at least age 50
or, (2) in the case of a policy issued after age 44, for at least 5
years from its date of issue.
For the purpose of this Section, the phrase "loss resulting from such
accidental injury as may be sustained after the date of reinstatement and
loss due to such sickness as may begin more than 10 days
after such date" shall mean that the reinstated policy shall not cover a
loss resulting from accidental injury sustained after the date of lapse
of the policy and prior to the date of reinstatement or a loss resulting
from sickness which is first manifested after the date of lapse of the policy
but not after a date more than 10 days after the date of
reinstatement. An accidental injury and a sickness as described in this
Section shall be subject to the requirements of Section 357.3 with the
exception that references to date of issue and application shall mean date
of reinstatement and reinstatement application. All other accidental
injuries and sicknesses will be subject to the requirements of 357.3.
Provisions endorsed or attached to the policy in connection with the
reinstatement shall relate to a disease or physical condition of an insured
under the policy.
(Source: P.A. 84-1308.)
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(215 ILCS 5/357.6) (from Ch. 73, par. 969.6)
Sec. 357.6.
"NOTICE OF CLAIM:
Written notice of claim must be given to the
company within 20 days after the occurrence or commencement of any loss
covered by the policy, or as soon thereafter as is reasonably possible.
Notice given by or on behalf of the insured or the beneficiary to the
company at ....(insert the location of such office as the company may
designate for the purpose), or to any authorized agent of the company, with
information sufficient to identify the insured, shall be deemed notice to
the company."
In a policy providing a loss-of-time benefit which may be payable for at
least 2 years, a company may at its option insert the following between the
first and second sentences of the above provision:
"Subject to the qualifications set forth below, if the insured suffers
loss of time on account of disability for which indemnity may be payable
for at least 2 years, he shall, at least once in every 6 months after
having given notice of claim, give to the company notice of continuance of
said disability, except in the event of legal incapacity. The period of 6
months following any filing of proof by the insured or any payment by the
company on account of such claim or any denial of liability in whole or in
part by the company shall be excluded in applying this provision. Delay in
the giving of such notice shall not impair the insured's right to any
indemnity which would otherwise have accrued during the period of 6 months
preceding the date on which such notice is actually given."
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.7) (from Ch. 73, par. 969.7)
Sec. 357.7.
"CLAIM FORMS:
The company, upon receipt of a notice of claim,
will furnish to the claimant such forms as are usually furnished by it for
filing proofs of loss. If such forms are not furnished within 15 days after
the giving of such notice the claimant shall be deemed to have complied
with the requirements of this policy as to proof of loss upon submitting,
within the time fixed in the policy for filing proofs of loss, written
proof covering the occurrence, the character and the extent of the loss for
which claim is made."
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.8) (from Ch. 73, par. 969.8)
Sec. 357.8.
"PROOFS OF LOSS:
Written proof of loss must be furnished to the
company at its said office in case of claim for loss for which this policy
provides any periodic payment contingent upon continuing loss within 90
days after the termination of the period for which the company is liable
and in case of claim for any other loss within 90 days after the date of
such loss. Failure to furnish such proof within the time required shall not
invalidate nor reduce any claim if it was not reasonably possible to give
proof within such time, provided such proof is furnished as soon as
reasonably possible and in no event, except in the absence of legal
capacity, later than one year from the time proof is otherwise required."
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.9) (from Ch. 73, par. 969.9)
Sec. 357.9.
"TIME OF PAYMENT OF CLAIMS:
Indemnities
payable under
this policy for any loss other than loss for which this policy provides
any periodic payment will be paid immediately upon receipt of due
written proof of such loss.
Subject
to due written proof of loss, all
accrued indemnities for loss for which this policy provides periodic
payment will be paid ....
(insert period for payment which must not be
less frequently than monthly) and any balance remaining unpaid upon the
termination of liability, will be paid immediately upon receipt of due
written proof."
All claims and indemnities payable under the terms of
a policy of accident and health insurance shall be paid within 30 days
following receipt by the insurer of due proof of loss.
Failure to pay
within such period shall entitle the insured
to interest at the rate of 9
per cent per annum 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.
An insured or an insured's assignee shall be
notified by the insurer, health maintenance organization, managed care plan,
health care plan, preferred provider organization, or third party administrator
of any known failure to provide sufficient documentation for a
due proof of
loss within 30 days after receipt of the claim.
Any
required interest payments shall be made within 30 days after the payment.
The requirements of this Section shall apply to any policy of accident
and health insurance delivered, issued for delivery, renewed or amended on
or after 180 days following the effective date of this amendatory Act of 1985.
The requirements of this Section also shall specifically apply to
any group policy of dental insurance only, delivered, issued for
delivery, renewed or amended on or after 180 days following the effective
date of this amendatory Act of 1987.
(Source: P.A. 91-605, eff. 12-14-99.)
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(215 ILCS 5/357.9a) (from Ch. 73, par. 969.9a)
Sec. 357.9a.
Delay in payment of claims.
Periodic payments
of accrued indemnities for loss-of-time coverage under accident
and health policies shall commence not later than 30 days after
the receipt by the company of the required written proofs of loss.
An insurer which violates this Section if liable under said policy, shall
pay to the insured, in addition to any other penalty provided for in this Code,
interest at the rate of 9% per annum from the 30th day after
receipt of such proofs of loss to the date of late payment of the
accrued indemnities, provided that interest amounting to less than
one dollar need not be paid.
(Source: P.A. 92-139, eff. 7-24-01.)
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(215 ILCS 5/357.10) (from Ch. 73, par. 969.10)
Sec. 357.10.
"PAYMENT OF CLAIMS:
Indemnity for loss of life will be payable
in accordance with the beneficiary designation and the provisions
respecting such payment which may be prescribed herein and effective at the
time of payment. If no such designation or provision is then effective,
such indemnity shall be payable to the estate of the insured. Any other
accrued indemnities unpaid at the insured's death may, at the option of the
company, be paid either to such beneficiary or to such estate. All other
indemnities will be payable to the insured."
The following provisions, or either of them, may be included with the
foregoing provision at the option of the company:
"If any indemnity of this policy shall be payable to the estate of the
insured, or to an insured or beneficiary who is a minor or otherwise not
competent to give a valid release, the company may pay such indemnity, up
to an amount not exceeding $....(insert an amount which shall not exceed
$1000), to any relative by blood or connection by marriage of the insured
or beneficiary who is deemed by the company to be equitably entitled
thereto. Any payment made by the company in good faith pursuant to this
provision shall fully discharge the company to the extent of such payment.
"Subject to any written direction of the insured in the application or
otherwise all or a portion of any indemnities provided by this policy on
account of hospital, nursing, medical, or surgical services may, at the
company's option and unless the insured requests otherwise in writing not
later than the time of filing proofs of such loss, be paid directly to the
hospital or person rendering such services; but it is not required that the
service be rendered by a particular hospital or person. Nothing in this
provision shall prohibit an insurer from providing incentives for insureds
to utilize the services of a particular hospital or person."
(Source: P.A. 84-618.)
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(215 ILCS 5/357.11) (from Ch. 73, par. 969.11)
Sec. 357.11.
"PHYSICAL EXAMINATIONS AND AUTOPSY:
The company at its own
expense shall have the right and opportunity to examine the person of the
insured when and as often as it may reasonably require during the pendency
of a claim hereunder and to make an autopsy in case of death where it is
not forbidden by law."
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.12) (from Ch. 73, par. 969.12)
Sec. 357.12.
"LEGAL ACTIONS:
No civil action shall be brought
to recover on this policy prior to the expiration of 60 days after written
proof of loss has been furnished in accordance with the requirements of
this policy. No such action shall be brought after the expiration of 3
years after the time written proof of loss is required to be furnished."
(Source: P.A. 79-1362.)
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(215 ILCS 5/357.13) (from Ch. 73, par. 969.13)
Sec. 357.13.
"CHANGE OF BENEFICIARY:
Unless the insured makes an
irrevocable designation of beneficiary, the right to change of beneficiary
is reserved to the insured and the consent of the beneficiary or
beneficiaries shall not be requisite to surrender or assignment of this
policy or to any change of beneficiary or beneficiaries, or to any other
changes in this policy."
(The first clause of this provision, relating to the irrevocable
designation of beneficiary, may be omitted at the company's option.)
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.14) (from Ch. 73, par. 969.14)
Sec. 357.14. Except as provided in section 357.26, no such policy delivered
or issued for delivery to any person in this State shall contain provisions
respecting the matters set forth in sections 357.15 through 357.24 unless
such provisions are in the words in which the same appear in this article;
provided, however, that the company may, at its option, use in lieu of any
such provision a corresponding provision of different wording approved by
the Director which is not less favorable in any respect to the insured or
the beneficiary. Any such provision contained in the policy shall be
preceded individually by the appropriate caption appearing in the following
sections or, at the option of the company, by such appropriate individual
or group captions or subcaptions as the Director may approve.
(Source: P.A. 95-230, eff. 1-1-08.)
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(215 ILCS 5/357.15) (from Ch. 73, par. 969.15)
Sec. 357.15.
"CHANGE OF OCCUPATION:
If the insured be injured or contract
sickness after having changed his occupation to one classified by the
company as more hazardous than that stated in this policy or while doing
for compensation anything pertaining to an occupation so classified, the
company will pay only such portion of the indemnities provided in this
policy as the premium paid would have purchased at the rates and within the
limits fixed by the company for such more hazardous occupation. If the
insured changes his occupation to one classified by the company as less
hazardous than that stated in this policy, the company, upon receipt of
proof of such change of occupation, will reduce the premium rate
accordingly, and will return the excess pro-rata unearned premium from the
date of change of occupation or from the policy anniversary date
immediately preceding receipt of such proof, whichever is the more recent.
In applying this provision, the classification of occupational risk and the
premium rates shall be such as have been last filed by the company prior to
the occurrence of the loss for which the company is liable or prior to date
of proof of change in occupation with the state official having supervision
of insurance in the state where the insured resided at the time this policy
was issued; but if such filing was not required, then the classification of
occupational risk and the premium rates shall be those last made effective
by the company in such state prior to the occurrence of the loss or prior
to the date of proof of change in occupation."
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.16) (from Ch. 73, par. 969.16)
Sec. 357.16.
"MISSTATEMENT OF AGE:
If the age of the insured has been
misstated, all amounts payable under this policy shall be such as the
premium paid would have purchased at the correct age."
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.17) (from Ch. 73, par. 969.17)
Sec. 357.17.
"OTHER INSURANCE IN THIS COMPANY:
If an accident or health or
accident and health policy or policies previously issued by the company to
the insured be in force concurrently herewith, making the aggregate
indemnity for ....(insert type of coverage or coverages) in excess of
$....(insert maximum limit of indemnity or indemnities) the excess
insurance shall be void and all premiums paid for such excess shall be
returned to the insured or to his estate."
or, in lieu thereof:
"Insurance effective at any one time on the insured under a like policy
or policies in this company is limited to the one such policy elected by
the insured, his beneficiary or his estate, as the case may be, and the
company will return all premiums paid for all other such policies."
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.18) (from Ch. 73, par. 969.18)
Sec. 357.18.
"INSURANCE WITH OTHER COMPANIES:
If there be other valid
coverage, not with this company, providing benefits for the same loss on
a provision of service basis or on an expense incurred basis and of
which this company has not been given written notice prior to the
occurrence or commencement of loss, the only liability under any expense
incurred coverage of this policy shall be for such proportion of the
loss as the amount which would otherwise have been payable hereunder
plus the total of the like amounts under all such other valid coverages
for the same loss of which this company had notice bears to the total
like amounts under all valid coverages for such loss, and for the return
of such portion of the premiums paid as shall exceed the pro-rata
portion for the amount so determined. For the purpose of applying this
provision when other coverage is on a provision of service basis, the
"like amount" of such other coverage shall be taken as the amount which
the services rendered would have cost in the absence of such coverage."
(If the foregoing policy provision is included in a policy which also
contains the next following policy provision there shall be added to the
caption of the foregoing provision the phrase "--EXPENSE INCURRED
BENEFITS". The company may, at its option, include in this provision a
definition of "other valid coverage", approved as to form by the
Director, which definition shall be limited in subject matter to
coverage provided by organizations subject to regulation by insurance
law or by insurance authorities of this or any other state of the United
States or any province of Canada, and by hospital or medical service
organizations, and to any other coverage the inclusion of which may be
approved by the Director. In the absence of such definition such term
does not include group insurance, automobile medical payments insurance,
or coverage provided by hospital or medical service organizations or by
union welfare plans or employer or employee benefit organizations. For
the purpose of applying the foregoing policy provision with respect to
any insured, any amount of benefit provided for such insured pursuant to
any compulsory benefit statute (including any workers' compensation or
employer's liability statute) whether provided by a governmental agency
or otherwise is "other valid coverage" of which the company has had
notice. In applying the foregoing policy provision no third party
liability coverage shall be included as "other valid coverage".)
(Source: P.A. 91-357, eff. 7-29-99.)
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(215 ILCS 5/357.19) (from Ch. 73, par. 969.19)
Sec. 357.19.
"INSURANCE WITH OTHER COMPANIES:
If there be other valid
coverage, not with this company, providing benefits for the same loss on
other than an expense incurred basis and of which this company has not
been given written notice prior to the occurrence or commencement of
loss, the only liability for such benefits under this policy shall be
for such proportion of the indemnities otherwise provided hereunder for
such loss as the like indemnities of which the company had notice
(including the indemnities under this policy) bear to the total amount
of all like indemnities for such loss, and for the return of such
portion of the premium paid as shall exceed the pro-rata portion for the
indemnities thus determined."
(If the foregoing policy provision is included in a policy which also
contains the next preceding policy provision there shall be added to the
caption of the foregoing provision the phrase "--OTHER BENEFITS". The
company may, at its option, include in this provision a definition of
"other valid coverage", approved as to form by the Director, which
definition shall be limited in subject matter to coverage provided by
organizations subject to regulation by insurance law or by insurance
authorities of this or any other state of the United States or any
province of Canada, and to any other coverage the inclusion of which may
be approved by the Director. In the absence of such definition such term
does not include group insurance, or benefits provided by union welfare
plans or by employer or employee benefit organizations. For the purpose
of applying the foregoing policy provision with respect to any insured,
any amount of benefit provided for such insured pursuant to any
compulsory benefit statute (including any workers' compensation or
employer's liability statute) whether provided by a governmental agency
or otherwise is "other valid coverage" of which the company has had
notice. In applying the foregoing policy provision no third party liability
coverage shall be included as "other valid coverage".)
(Source: P.A. 91-357, eff. 7-29-99.)
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(215 ILCS 5/357.20) (from Ch. 73, par. 969.20)
Sec. 357.20.
"RELATION OF EARNINGS TO INSURANCE:
If the total monthly
amount of loss of time benefits promised for the same loss under all
valid loss of time coverage upon the insured, whether payable on a
weekly or monthly basis, shall exceed the monthly earnings of the
insured at the time disability commenced or his average monthly earnings
for the period of 2 years immediately preceding a disability for which
claim is made, whichever is the greater, the company will be liable only
for such proportionate amount of such benefits under this policy as the
amount of such monthly earnings or such average monthly earnings of the
insured bears to the total amount of monthly benefits for the same loss
under all such coverage upon the insured at the time such disability
commences and for the return of such part of the premiums paid during
such 2 years as shall exceed the pro-rata amount of the premiums for the
benefits actually paid hereunder; but this shall not operate to reduce
the total monthly amount of benefits payable under all such coverage
upon the insured below the sum of $200.00 or the sum of the monthly
benefits specified in such coverages, whichever is the lesser, nor shall
it operate to reduce benefits other than those payable for loss of
time."
(The foregoing policy provision may be inserted only in a policy
which the insured has the right to continue in force subject to its
terms by the timely payment of premiums (1) until at least age 50 or,
(2) in the case of a policy issued after age 44, for at least 5 years
from its date of issue. The company may, at its option, include in this
provision a definition of "valid loss of time coverage", approved as to
form by the Director, which definition shall be limited in subject
matter to coverage provided by governmental agencies or by organizations
subject to regulation by insurance law or by insurance authorities of
this or any other state of the United States or any province of Canada,
or to any other coverage the inclusion of which may be approved by the
Director or any combination of such coverages. In the absence of such
definition such term does not include any coverage provided for such
insured pursuant to any compulsory benefit statute (including any
workers' compensation or employer's liability statute), or benefits
provided by union welfare plans or by employer or employee benefit
organizations.)
(Source: P.A. 91-357, eff. 7-29-99.)
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(215 ILCS 5/357.21) (from Ch. 73, par. 969.21)
Sec. 357.21.
"UNPAID PREMIUM:
Upon the payment of a claim under this
policy, any premium then due and unpaid or covered by any note or written
order may be deducted therefrom."
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.22) (from Ch. 73, par. 969.22)
Sec. 357.22.
"CANCELLATION:
The company may cancel this policy at any time
by written notice delivered to the insured, or mailed to his last address
as shown by the records of the company, stating when, not less than 30 days
thereafter, such cancellation shall be effective; and after the policy has
been continued beyond its original term the insured may cancel this policy
at any time by written notice delivered or mailed to the company, effective
upon receipt or on such later date as may be specified in such notice. In
the event of cancellation, the company will return promptly the unearned
portion of any premium paid. If the insured cancels, the earned premium
shall be computed by the use of the short-rate table last filed with the
state official having supervision of insurance in the state where the
insured resided when the policy was issued. If the company cancels, the
earned premium shall be computed pro-rata. Cancellation shall be without
prejudice to any claim originating prior to the effective date of
cancellation." (Notice to the policy holder of the cancellable nature of
his policy shall be set forth on the face of the policy.)
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.23) (from Ch. 73, par. 969.23)
Sec. 357.23.
"CONFORMITY WITH STATE STATUTES:
Any provision of this policy
which, on its effective date, is in conflict with the statutes of the state
in which the insured resides on such date is hereby amended to conform to
the minimum requirements of such statutes."
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.24) (from Ch. 73, par. 969.24)
Sec. 357.24.
"ILLEGAL OCCUPATION:
The company shall not be liable for any
loss to which a contributing cause was the insured's commission of or
attempt to commit a felony or to which a contributing cause was the
insured's being engaged in an illegal occupation."
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.25)
Sec. 357.25. (Repealed).
(Source: Laws 1967, p. 1735. Repealed by P.A. 95-230, eff. 1-1-08.)
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(215 ILCS 5/357.26) (from Ch. 73, par. 969.26)
Sec. 357.26.
If any provision of the preceding sections is in whole
or in part inapplicable to or inconsistent with the coverage provided by
a particular form of policy the company, with the approval of the
Director, shall omit from such policy any inapplicable provision or part
of a provision, and shall modify any inconsistent provision or part of
the provision in such manner as to make the provision as contained in the
policy consistent with the coverage provided by the policy.
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.27) (from Ch. 73, par. 969.27)
Sec. 357.27.
The provisions which are the subject of Sections 357.2 through
357.25, or any corresponding provisions which are used in lieu thereof in
accordance with such sections, shall be printed in the consecutive order of
the provisions in such sections or, at the option of the company, any such
provision may appear as a unit in any part of the policy, with other
provisions to which it may be logically related, provided the resulting
policy shall not be in whole or in part unintelligible, uncertain,
ambiguous, abstruse, or likely to mislead a person to whom the policy is
offered, delivered or issued.
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.28) (from Ch. 73, par. 969.28)
Sec. 357.28.
The word "insured", as used in this article, shall not be
construed as preventing a person other than the insured with a proper
insurable interest from making application for and owning a policy covering
the insured or from being entitled under such a policy to any indemnities,
benefits and rights provided therein.
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.29) (from Ch. 73, par. 969.29)
Sec. 357.29.
Any policy of a foreign or alien company, when delivered or
issued for delivery to any person in this State, may contain any provision
which is not less favorable to the insured or the beneficiary than the
provisions of this article and which is prescribed or required by the law
of the state under which the company is organized.
Any policy of a domestic company may, when issued for delivery in any
other state or country, contain any provision permitted or required by the
laws of such other state or country.
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.30) (from Ch. 73, par. 969.30)
Sec. 357.30.
The Director may make such reasonable rules and regulations
concerning the procedure for the filing or submission of policies subject
to this article as are necessary, proper or advisable to the administration
of this article. This provision shall not abridge any other authority
granted the Director by law. The effective date of the new provisions added
by this amendatory Act shall be January 1, 1968.
(Source: Laws 1967, p. 1735.)
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(215 ILCS 5/357.31) (from Ch. 73, par. 969.31)
Sec. 357.31.
In the event of the death of a policyholder of an
individual accident and health insurance policy, the insurance company,
upon receipt of notice of the policyholder's death and a request for a
pro-rata refund, supported by a valid death certificate supplied by a party
entitled to claim such refund, shall refund the unearned premium pro-rated
to the month of the policyholder's death. In no event shall such refund of
premium be computed by the use of a short-rate table. Refund of the
premium and termination of the coverage shall be without prejudice to any
claim originating prior to the date of the policyholder's
death. Coverage of persons insured under the same policy other than the
policyholder shall not be affected by the premium refund provided for in
this Section nor shall the obligation of such other insureds to pay
required premiums be diminished pursuant to this Section.
(Source: P.A. 86-665.)
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(215 ILCS 5/358a) (from Ch. 73, par. 970a)
Sec. 358a.
Conforming to statute.
(1) Other Policy Provisions
No policy provision which is not subject to section 357a of this act
shall make a policy, or any portion thereof, less favorable in any respect
to the insured or the beneficiary than the provisions thereof which are
subject to this act.
(2) Policy Conflicting with this Article
A policy delivered or issued for delivery to any person in this state in
violation of this article shall be held valid but shall be construed as
provided in this article. When any provision in a policy subject to this
article is in conflict with any provision of this article, the rights,
duties and obligations of the insurer, the insured and the beneficiary
shall be governed by the provisions of this article.
(3) Operating under Old Provisions
Subsection (3) of Section 356a of this Act is hereby incorporated into
and made a part of this section by express reference.
(Source: Laws 1951, p. 611.)
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(215 ILCS 5/359a) (from Ch. 73, par. 971a)
Sec. 359a.
Application.
(1) No policy of insurance except an Industrial Accident and Health
Policy provided for by this article shall be issued, except upon the
signed application of the person or persons sought to be insured. Any
information or statement of the applicant shall plainly appear upon such
application in the form of interrogatories by the insurer and answers by
the applicant. The insured shall not be bound by any statement made in an
application for any policy, including an Industrial Accident and Health
Policy, unless a copy of such application is attached to or endorsed on the
policy when issued as a part thereof. If any such policy delivered or
issued for delivery to any person in this state shall be reinstated or
renewed, and the insured or the beneficiary or assignee of such policy
shall make written request to the insurer for a copy of the application, if
any, for such reinstatement or renewal, the insurer shall within fifteen
days after the receipt of such request at its home office or any branch
office of the insurer, deliver or mail to the person making such request, a
copy of such application. If such copy shall not be so delivered or mailed,
the insurer shall be precluded from introducing such application as
evidence in any action or proceeding based upon or involving such policy or
its reinstatement or renewal.
(2) No alteration of any written application for any such policy shall
be made by any person other than the applicant without his written consent,
except that insertions may be made by the insurer, for administrative
purposes only, in such manner as to indicate clearly that such insertions
are not to be ascribed to the applicant.
(3) The falsity of any statement in the application for any policy
covered by this act may not bar the right to recovery thereunder unless
such false statement materially affected either the acceptance of the risk
or the hazard assumed by the insurer.
(Source: Laws 1951, p. 611.)
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(215 ILCS 5/359b)
Sec. 359b. (Repealed).
(Source: P.A. 96-857, eff. 1-5-10. Repealed by P.A. 98-969, eff. 1-1-15.) |
(215 ILCS 5/359c)
Sec. 359c. (Repealed).
(Source: P.A. 97-524, eff. 1-1-12. Repealed by P.A. 98-969, eff. 1-1-15.) |
(215 ILCS 5/360a) (from Ch. 73, par. 972a)
Sec. 360a.
Notice,
waiver.
The acknowledgement by any insurer of the receipt of notice given under
any policy covered by this article, or the furnishing of forms for filing
proofs of loss, or the acceptance of such proofs, or the investigation of
any claim thereunder shall not operate as a waiver of any of the rights of
the insurer in defense of any claim arising under such policy.
(Source: Laws 1951, p. 611.)
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(215 ILCS 5/361a) (from Ch. 73, par. 973a)
Sec. 361a.
Age
limit.
If any such policy contains a provision establishing, as an age limit or
otherwise, a date after which the coverage provided by the policy will not
be effective, and if such date falls within a period for which premium is
accepted by the insurer or if the insurer accepts a premium after such
date, the coverage provided by the policy will continue in force subject to
any right of cancellation until the end of the period for which premium has
been accepted. In the event the age of the insured has been misstated and
if, according to the correct age of the insured, the coverage provided by
the policy would not have become effective, or would have ceased prior to
the acceptance of such premium or premiums, then the liability of the
insurer shall be limited to the refund, upon request, of all premiums paid
for the period not covered by the policy.
(Source: Laws 1951, p. 611.)
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(215 ILCS 5/362a) (from Ch. 73, par. 974a)
Sec. 362a. Non-application to certain policies. The provisions of sections 356a to 359a, both inclusive, shall not
apply to or affect (1) any policy of workers' compensation insurance or
any policy of liability insurance with or without supplementary expense
coverage therein; or (2) any policy or contract of reinsurance; or (3)
any group policy of insurance (unless otherwise specifically provided);
or (4) life insurance, endowment or annuity contracts, or contracts
supplemental thereto which contain only such provisions relating to
accident and sickness insurance as (a) provide additional benefits in
case of death or dismemberment or loss of sight by accident, or as (b)
operate to safeguard such contracts against lapse, or to give a special
surrender value or special benefit or an annuity in the event that the
insured or annuitant shall become a person with a total and permanent disability, as
defined by the contract or supplemental contract.
(Source: P.A. 99-143, eff. 7-27-15.)
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(215 ILCS 5/363) (from Ch. 73, par. 975)
Sec. 363. Medicare supplement policies; minimum standards.
(1) Except as otherwise specifically provided therein, this
Section and Section 363a of this Code shall apply to:
(a) all Medicare supplement policies and subscriber | ||
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(b) all certificates issued under group Medicare | ||
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This Section shall not apply to "Accident Only" or "Specified Disease"
types of policies. The provisions of this Section are not intended to prohibit
or apply to policies or health care benefit plans, including group
conversion policies, provided to Medicare eligible persons, which policies
or plans are not marketed or purported or held to be Medicare supplement
policies or benefit plans.
(2) For the purposes of this Section and Section 363a, the following
terms have the following meanings:
(a) "Applicant" means:
(i) in the case of individual Medicare supplement | ||
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(ii) in the case of a group Medicare policy or | ||
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(b) "Certificate" means any certificate delivered or | ||
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(c) "Medicare supplement policy" means an individual | ||
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(d) "Issuer" includes insurance companies, fraternal | ||
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(e) "Medicare" means the Health Insurance for the | ||
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(3) No Medicare supplement insurance policy, contract, or
certificate,
that provides benefits that duplicate benefits provided by Medicare, shall
be issued or issued for delivery in this State after December 31, 1988. No
such policy, contract, or certificate shall provide lesser benefits than
those required under this Section or the existing Medicare Supplement
Minimum Standards Regulation, except where duplication of Medicare benefits
would result.
(4) Medicare supplement policies or certificates shall have a
notice
prominently printed on the first page of the policy or attached thereto
stating in substance that the policyholder or certificate holder shall have
the right to return the policy or certificate within 30 days of its
delivery and to have the premium refunded directly to him or her in a
timely manner if, after examination of the policy or certificate, the
insured person is not satisfied for any reason.
(5) A Medicare supplement policy or certificate may not deny a
claim
for losses incurred more than 6 months from the effective date of coverage
for a preexisting condition. The policy may not define a preexisting
condition more restrictively than a condition for which medical advice was
given or treatment was recommended by or received from a physician within 6
months before the effective date of coverage.
(6) An issuer of a Medicare supplement policy shall:
(a) not deny coverage to an applicant under 65 years | ||
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(i) becomes eligible for Medicare by reason of | ||
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(ii) has Medicare and an employer group health | ||
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(iii) is insured by a Medicare Advantage plan | ||
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(iv) is insured by a Medicare supplement policy | ||
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(b) make available to persons eligible for Medicare | ||
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(c) not charge individuals who become eligible for | ||
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(d) provide the rights granted by items (a) through | ||
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(7) The Director shall issue reasonable rules and regulations
for the
following purposes:
(a) To establish specific standards for policy | ||
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(A) Terms of renewability.
(B) Initial and subsequent terms of eligibility.
(C) Non-duplication of coverage.
(D) Probationary and elimination periods.
(E) Benefit limitations, exceptions and | ||
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(F) Requirements for replacement.
(G) Recurrent conditions.
(H) Definition of terms.
(I) Requirements for issuing rebates or credits | ||
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(J) Uniform methodology for the calculating and | ||
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(K) Assuring public access to loss ratio | ||
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(L) Establishing a process for approving or | ||
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(M) Establishing a policy for holding public | ||
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(N) Establishing standards for Medicare Select | ||
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(O) Prohibited policy provisions not otherwise | ||
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(b) To establish minimum standards for benefits and | ||
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(c) To implement transitional requirements of | ||
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(8) If an individual is at least 65 years of age but no more than 75 years of age and has an existing Medicare supplement policy, the individual is entitled to an annual open enrollment period lasting 45 days, commencing with the individual's birthday, and the individual may purchase any Medicare supplement policy with the same issuer that offers benefits equal to or lesser than those provided by the previous coverage. During this open enrollment period, an issuer of a Medicare supplement policy shall not deny or condition the issuance or effectiveness of Medicare supplemental coverage, nor discriminate in the pricing of coverage, because of health status, claims experience, receipt of health care, or a medical condition of the individual. An issuer shall provide notice of this annual open enrollment period for eligible Medicare supplement policyholders at the time that the application is made for a Medicare supplement policy or certificate. The notice shall be in a form that may be prescribed by the Department. (9) Without limiting an individual's eligibility under Department rules implementing 42 U.S.C. 1395ss(s)(2)(A), for at least 63 days after the later of the applicant's loss of benefits or the notice of termination of benefits, including a notice of claim denial due to termination of benefits, under the State's medical assistance program under Article V of the Illinois Public Aid Code, an issuer shall not deny or condition the issuance or effectiveness of any Medicare supplement policy or certificate that is offered and is available for issuance to new enrollees by the issuer; shall not discriminate in the pricing of such a Medicare supplement policy because of health status, claims experience, receipt of health care, or medical condition; and shall not include a policy provision that imposes an exclusion of benefits based on a preexisting condition under such a Medicare supplement policy if the individual: (a) is enrolled for Medicare Part B; (b) was enrolled in the State's medical assistance | ||
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(c) was terminated or disenrolled from the State's | ||
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(A) the individual's Medicare supplement open | ||
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(B) the 6-month period described in Section | ||
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(d) submits evidence of the date of termination of | ||
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(10) Each Medicare supplement policy and certificate available from an insurer on and after the effective date of this amendatory Act of the 103rd General Assembly shall be made available to all applicants who qualify under subparagraph (i) of paragraph (a) of subsection (6) or Department rules implementing 42 U.S.C. 1395ss(s)(2)(A) without regard to age or applicability of a Medicare Part B late enrollment penalty.(Source: P.A. 102-142, eff. 1-1-22; 103-102, eff. 6-16-23.)
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(215 ILCS 5/363a) (from Ch. 73, par. 975a)
Sec. 363a.
Medicare supplement policies; disclosure, advertising, loss
ratio standards.
(1) Scope. This Section pertains to disclosure requirements of
companies and agents and mandatory and prohibited practices of agents
when selling a policy to supplement the Medicare program or any other
health insurance policy sold to individuals eligible for Medicare. No policy
shall be referred to or labeled as a Medicare
supplement policy if it does not comply with the minimum standards
required by regulation pursuant to Section 363 of this Code. Except as
otherwise specifically provided in paragraph (d) of subsection (6), this
Section shall not apply to accident only or specified disease type of
policies or hospital confinement indemnity or other type policies clearly
unrelated to Medicare.
(2) Advertising. An advertisement that describes or offers to provide
information concerning the federal Medicare program shall comply with all
of the following:
(a) It may not include any reference to that program | ||||||||
| ||||||||
(b) It must include a prominent statement to the | ||||||||
| ||||||||
(c) It must prominently disclose that it is an | ||||||||
| ||||||||
(d) It must prominently identify and set forth the | ||||||||
| ||||||||
(e) It must prominently state that any material or | ||||||||
| ||||||||
The Director may issue reasonable rules and regulations for the
purpose of establishing criteria and guidelines for the advertising of
Medicare supplement insurance.
(3) Mandatory agent practices. For the purpose of this Act, "home
solicitation sale by an agent" means a sale or attempted sale of an
insurance policy at the purchaser's residence, agent's transient quarters,
or away from the agent's home office when the initial contact is personally
solicited by the agent or insurer. Any agent involved in any home
solicitation sale of a Medicare supplement policy or other policy of
accident and health insurance, subject to subsection (1) of this Section,
sold to individuals eligible for Medicare shall promptly do the following:
(a) Identify himself as an insurance agent.
(b) Identify the insurer or insurers for which he is | ||||||||
| ||||||||
(c) Provide the purchaser with a clearly printed or | ||||||||
| ||||||||
(d) Determine what, if any, policy is appropriate, | ||||||||
| ||||||||
(e) Fully and completely disclose the purchaser's | ||||||||
| ||||||||
(f) Complete a Policy Check List in duplicate as | ||||||||
| ||||||||
POLICY CHECK LIST
Applicant's Name: Policy Number: Name of Existing Insurer: Expiration Date of Existing Insurance:
| ||||||||
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Service Hospital Skilled Nursing Home Care Prescription Drugs
This policy does/does not (circle one) comply with | ||||||||
| ||||||||
Signature of ApplicantSignature of Agent
This Policy Check List is to be completed in the | ||||||||
| ||||||||
(g) Except in the case of refunds of premium made | ||||||||
| ||||||||
(h) Deliver to the purchaser, along with every policy | ||||||||
| ||||||||
(4) Prohibited agent practices.
(a) No insurance agent engaged in a home solicitation | ||||||||
| ||||||||
(i) Is offering insurance that is approved or | ||||||||
| ||||||||
(ii) Is in any way representing, working for, or | ||||||||
| ||||||||
(iii) Is engaged in an advisory business in which | ||||||||
| ||||||||
(iv) Will provide a continuing service to the | ||||||||
| ||||||||
(b) No agent engaged in a home solicitation sale of a | ||||||||
| ||||||||
(i) The identity of the insurance company or | ||||||||
| ||||||||
(ii) That the assistance programs of the State or | ||||||||
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(iii) That an insurance company in which the | ||||||||
| ||||||||
(iv) The coverage of the policy being sold.
(v) The effective date of coverage under the | ||||||||
| ||||||||
(vi) That any pre-existing health condition of | ||||||||
| ||||||||
(vii) The right of the purchaser to cancel the | ||||||||
| ||||||||
(5) Mandatory company practices. Any company involved in the sale of
Medicare supplement policies or any policies of accident and health insurance
(subject to subsection (1) of this Section) sold to individuals eligible
for Medicare shall do the following:
(a) Be able to readily determine the number of | ||||||||
| ||||||||
(b) Make certain that policies of Medicare supplement | ||||||||
| ||||||||
(c) Maintain copies of the Policy Check List as | ||||||||
| ||||||||
(6) Disclosures. In order to provide for full and fair disclosure in
the sale of Medicare supplement policies, there must be compliance with the following:
(a) No Medicare supplement policy or certificate | ||||||||
| ||||||||
(b) Outline of coverage requirements for Medicare | ||||||||
| ||||||||
(i) Insurers issuing Medicare supplement policies | ||||||||
| ||||||||
(ii) If an outline of coverage is provided at the | ||||||||
| ||||||||
"NOTICE: Read this outline of coverage carefully. | ||||||||
| ||||||||
(iii) The outline of coverage provided to | ||||||||
| ||||||||
(c) Insurers issuing policies that provide hospital | ||||||||
| ||||||||
(d) Outlines of coverage delivered in connection with | ||||||||
| ||||||||
"This policy, certificate or subscriber contract IS | ||||||||
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(e) In the case wherein a policy, as defined in | ||||||||
| ||||||||
(7) Loss ratio standards.
(a) Every issuer of Medicare supplement policies or | ||||||||
| ||||||||
(b) Medicare supplement policies shall, for the | ||||||||
| ||||||||
(i) In the case of group policies, at least 75% | ||||||||
| ||||||||
(ii) In the case of individual policies, at least | ||||||||
| ||||||||
(iii) In the case of sponsored group policies in | ||||||||
| ||||||||
(c) For the purposes of this Section, the insurer | ||||||||
| ||||||||
(8) Applicability. This Section shall apply to those companies
writing
the kind or kinds of business enumerated in Classes 1(b) and 2(a) of
Section 4 of this Code and to those entities organized and operating under
the Voluntary Health Services
Plans Act and the Health Maintenance Organization Act.
(9) Penalties.
(a) Any company or agent who is found to have | ||||||||
| ||||||||
(b) In addition to any other applicable penalties for | ||||||||
| ||||||||
(c) After June 30, 1991, no person may advertise, | ||||||||
| ||||||||
(10) Replacement. Application forms shall include a question
designed
to elicit information as to whether a Medicare supplement policy or
certificate is intended to replace any similar accident and sickness policy
or certificate presently in force. A supplementary application or other
form to be signed by the applicant containing the question may be used.
Upon determining that a sale of Medicare supplement coverage will involve
replacement, an insurer, other than a direct response insurer, or its
agent, shall furnish the applicant, prior to issuance or delivery of the
Medicare supplement policy or certificate, a notice regarding replacement
of Medicare supplement coverage. One copy of the notice shall be provided
to the applicant, and an additional copy signed by the applicant shall be
retained by the insurer. A direct response insurer shall deliver to the
applicant at the time of the issuance of the policy the notice regarding
replacement of Medicare supplement coverage.
(Source: P.A. 93-32, eff. 7-1-03.)
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(215 ILCS 5/364) (from Ch. 73, par. 976)
Sec. 364. Discrimination prohibited. Discrimination between
individuals of the same class of risk in the issuance of its policies
or in the amount of premiums or rates charged
for any insurance covered by this article, or in the benefits
payable thereon, or in any of the terms or conditions of such policy, or
in any other manner whatsoever is prohibited. Nothing in this provision
shall prohibit an insurer from providing incentives for insureds to utilize
the services of a particular hospital or person. It is hereby expressly
provided that whenever the terms "physician" or "doctor" appear or are
used in any way in any policy of accident or health insurance issued in
this state, said terms shall include within their meaning persons
licensed to practice dentistry under the Illinois Dental Practice Act with
regard to benefits payable for services performed by a person so
licensed, which such services are within the coverage provided by the
particular policy or contract of insurance and are within the
professional services authorized to be performed by such person under
and in accordance with the said Act.
No company, in any policy of accident or health insurance issued in this
State, shall make or permit any distinction or discrimination against
individuals solely because of the individuals' disabilities in the amount of
payment of premiums or rates charged for policies of insurance, in the
amount of any dividends or other benefits payable thereon, or in any other
terms and conditions of the contract it makes, except where the distinction
or discrimination is based on sound actuarial principles or is related to
actual or reasonably anticipated experience.
No company shall refuse to insure, or refuse to continue to insure,
or limit the amount or extent or kind of coverage available to an
individual, or charge an individual a different rate for the same coverage
solely because of blindness or partial blindness. With respect to all
other conditions, including the underlying cause of the blindness or
partial blindness, persons who are blind or partially blind shall be
subject to the same standards of sound actuarial principles or actual or
reasonably anticipated experience as are sighted persons. Refusal to
insure includes denial by an insurer of disability insurance coverage on
the grounds that the policy defines "disability" as being presumed in the
event that the insured loses his or her eyesight.
(Source: P.A. 99-143, eff. 7-27-15.)
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(215 ILCS 5/364.01) Sec. 364.01. Qualified clinical cancer trials. (a) No individual or group policy of accident and health insurance issued or renewed in this State may be cancelled or non-renewed for any individual based on that individual's participation in a qualified clinical cancer trial. (b) Qualified clinical cancer trials must meet the following criteria: (1) the effectiveness of the treatment has not been | ||
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(2) the trial is under clinical investigation as part | ||
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(3) the trial is: (A) approved by the Food and Drug Administration; | ||
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(B) approved and funded by the National | ||
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(4) the patient's primary care physician, if any, is | ||
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(c) No group policy of accident and health insurance shall exclude coverage for any routine patient care administered to an insured who is a qualified individual participating in a qualified clinical cancer trial, if the policy covers that same routine patient care of insureds not enrolled in a qualified clinical cancer trial. (d) The coverage that may not be excluded under subsection (c) of this Section is subject to all terms, conditions, restrictions, exclusions, and limitations that apply to the same routine patient care received by an insured not enrolled in a qualified clinical cancer trial, including the application of any authorization requirement, utilization review, or medical management practices. The insured or enrollee shall incur no greater out-of-pocket liability than had the insured or enrollee not enrolled in a qualified clinical cancer trial. (e) If the group policy of accident and health insurance uses a preferred provider program and a preferred provider provides routine patient care in connection with a qualified clinical cancer trial, then the insurer may require the insured to use the preferred provider if the preferred provider agrees to provide to the insured that routine patient care. (f) A qualified clinical cancer trial may not pay or refuse to pay for routine patient care of an individual participating in the trial, based in whole or in part on the person's having or not having coverage for routine patient care under a group policy of accident and health insurance. (g) Nothing in this Section shall be construed to limit an insurer's coverage with respect to clinical trials. (h) Nothing in this Section shall require coverage for out-of-network services where the underlying health benefit plan does not provide coverage for out-of-network services. (i) As used in this Section, "routine patient care" means all health care services provided in the qualified clinical cancer trial that are otherwise generally covered under the policy if those items or services were not provided in connection with a qualified clinical cancer trial consistent with the standard of care for the treatment of cancer, including the type and frequency of any diagnostic modality, that a provider typically provides to a cancer patient who is not enrolled in a qualified clinical cancer trial. "Routine patient care" does not include, and a group policy of accident and health insurance may exclude, coverage for: (1) a health care service, item, or drug that is the | ||
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(2) a health care service, item, or drug provided | ||
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(3) an investigational drug or device that has not | ||
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(4) transportation, lodging, food, or other expenses | ||
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(5) a health care service, item, or drug customarily | ||
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(6) a health care service or item, which except for | ||
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(A) costs of extra treatments, services, | ||
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(B) costs of nonhealth care services that the | ||
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(7) costs for services, items, or drugs that are | ||
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(8) costs associated with approved cancer clinical | ||
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(9) a health care service or item that is eligible | ||
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The definitions of the terms "health care services", "Non-Preferred Provider", "Preferred Provider", and "Preferred Provider Program", stated in 50 Ill. Adm. Code Part 2051 Preferred Provider Programs apply to these terms in this Section. (j) The external review procedures established under the Health Carrier External Review Act shall apply to the provisions under this Section.(Source: P.A. 103-154, eff. 6-30-23.) |
(215 ILCS 5/364.1) (from Ch. 73, par. 976.1)
Sec. 364.1.
Every policy of accident and health insurance
delivered or issued for delivery to any person in this State after the
effective date of this amendatory Act of 1979 which provides coverage
for services coming within the practice of
optometry as defined in the Illinois Optometric Practice Act of
1987, as now or hereafter amended shall, upon
issuance or delivery, be accompanied by a written notice to the
policyholder that such policyholder may elect for optometric services
received to be reimbursed to either a physician licensed to practice
medicine in all its branches or to an optometrist licensed in this State.
(Source: P.A. 85-1209.)
|
(215 ILCS 5/364.2) Sec. 364.2. Purchase of ophthalmic goods or services. An insurer may not require a provider, as a condition of participation by the provider, to purchase ophthalmic goods or services, including but not limited to eyeglass frames, in a quantity or dollar amount in excess of the quantity or dollar amount an enrollee purchases under the terms of the policy.
(Source: P.A. 93-1077, eff. 1-18-05.) |
(215 ILCS 5/364.3) Sec. 364.3. Insurer uniform electronic prior authorization form; prescription benefits. (a) As used in this Section, "prescribing provider" includes a provider authorized to write a prescription, as described in subsection (e) of Section 3 of the Pharmacy Practice Act, to treat a medical condition of an insured. (b) Notwithstanding any other provision of law to the contrary, on and after July 1, 2021, an insurer that provides prescription drug benefits shall utilize and accept the uniform electronic prior authorization form developed pursuant to subsection (c) when requiring prior authorization for prescription drug benefits. (c) On or before July 1, 2020, the Department shall develop a uniform electronic prior authorization form that shall be used by commercial insurers. Notwithstanding any other provision of law to the contrary, on and after July 1, 2021, every prescribing provider must use the uniform electronic prior authorization form to request prior authorization for coverage of prescription drug benefits and every insurer shall accept the uniform electronic prior authorization form as sufficient to request prior authorization for prescription drug benefits. (d) The Department shall develop the uniform electronic prior authorization form with input from interested parties, including, but not limited to, the following individuals appointed by the Director: 2 psychiatrists recommended by a State organization that represents psychiatrists, 2 pharmacists recommended by a State organization that represents pharmacists, 2 physicians recommended by a State organization that represents physicians, 2 family physicians recommended by a State organization that represents family physicians, 2 pediatricians recommended by a State organization that represents pediatricians, and 2 representatives of the association that represents commercial insurers, from at least one public meeting. (e) The Department, in development of the uniform electronic prior authorization form, shall take into consideration the following: (1) existing prior authorization forms established by | ||
| ||
(2) national standards pertaining to electronic prior | ||
| ||
(f) If, upon receipt of a completed and accurate electronic prior authorization request from a prescribing provider pursuant to the submission of a uniform electronic prior authorization form, an insurer fails to use or accept the uniform electronic prior authorization form or fails to respond within 24 hours (if the patient has urgent medication needs) or within 72 hours (if the patient has regular medication needs), then the prior authorization request shall be deemed to have been granted.
(Source: P.A. 101-463, eff. 1-1-20.) |
(215 ILCS 5/367) (from Ch. 73, par. 979)
Sec. 367. Group accident and health insurance.
(1) Group accident and health insurance is hereby declared to be that
form of accident and health insurance covering not less than 2
employees,
members, or employees of members, written under a
master policy issued to any governmental corporation, unit, agency or
department thereof, or to any corporation, copartnership, individual
employer, or to any association upon application of an executive officer or
trustee of such association having a constitution or bylaws and formed in
good faith for purposes other than that of obtaining insurance, where
officers, members, employees, employees of members or classes or department
thereof, may be insured for their individual benefit. In addition a group
accident and health policy may be written to insure any group which may be
insured under a group life insurance policy. The term "employees" shall
include the officers, managers and employees of subsidiary or affiliated
corporations, and the individual proprietors, partners and employees of
affiliated individuals and firms, when the business of such subsidiary or
affiliated corporations, firms or individuals, is controlled by a common
employer through stock ownership, contract or otherwise.
(2) Any insurance company authorized to write accident and health
insurance in this State shall have power to issue group accident and
health policies. No policy of group accident and health insurance may
be issued or delivered in this State unless a copy of the form thereof
shall have been filed with the department and approved by it in
accordance with Section 355, and it contains in substance those
provisions contained in Sections 357.1 through 357.30 as may be applicable
to group accident and health insurance and the following provisions:
(a) A provision that the policy, the application of | ||
| ||
(b) A provision that the insurer will issue to the | ||
| ||
(c) A provision that to the group or class thereof | ||
| ||
(3) Anything in this code to the contrary notwithstanding, any group
accident and health 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. Nothing in this
subsection (3) shall prohibit an insurer from providing incentives for
insureds to utilize the services of a particular hospital or person.
(4) Special group policies may be issued to school districts
providing medical or hospital service, or both, for pupils of the
district injured while participating in any athletic activity under the
jurisdiction of or sponsored or controlled by the district or the
authorities of any school thereof. The provisions of this Section
governing the issuance of group accident and health insurance shall,
insofar as applicable, control the issuance of such policies issued to
schools.
(5) No policy of group accident and health insurance may be issued
or delivered in this State unless it provides that upon the death of the
insured employee or group member the dependents' coverage, if any,
continues for a period of at least 90 days subject to any other policy
provisions relating to termination of dependents' coverage.
(6) No group hospital policy covering miscellaneous hospital
expenses issued or delivered in this State shall contain any exception
or exclusion from coverage which would preclude the payment of expenses
incurred for the processing and administration of blood and its
components.
(7) No policy of group accident and health insurance, delivered in
this State more than 120 days after the effective day of the Section,
which provides inpatient hospital coverage for sicknesses shall exclude
from such coverage the treatment of alcoholism. This subsection shall
not apply to a policy which covers only specified sicknesses.
(8) No policy of group accident and health insurance, which
provides benefits for hospital or medical expenses based upon the actual
expenses incurred, issued or delivered in this State shall contain any
specific exception to coverage which would preclude the payment of
actual expenses incurred in the examination and testing of a victim of
an offense defined in Sections 11-1.20 through 11-1.60 or 12-13 through 12-16 of the Criminal Code
of 1961 or the Criminal Code of 2012, or an attempt to commit such offense,
to establish that sexual contact did occur or did not occur, and to
establish the presence or absence of sexually transmitted
disease or infection, and
examination and treatment of injuries and trauma sustained by the victim of
such offense, arising out of the offense. Every group policy of accident
and health insurance which specifically provides benefits for routine
physical examinations shall provide full coverage for expenses incurred in
the examination and testing of a victim of an offense defined in Sections
11-1.20 through 11-1.60 or 12-13 through 12-16 of the Criminal Code of 1961 or the Criminal Code of 2012, or an attempt to commit such
offense, as set forth in this
Section. This subsection shall not apply to a policy which covers hospital
and medical expenses for specified illnesses and injuries only.
(9) For purposes of enabling the recovery of State funds, any insurance
carrier subject to this Section shall upon reasonable demand by the Department
of Public Health disclose the names and identities of its insureds entitled
to benefits under this provision to the Department of Public Health whenever
the Department of Public Health has determined that it has paid, or is about
to pay, hospital or medical expenses for which an insurance carrier is liable
under this Section. All information received by the Department of Public
Health under this provision shall be held on a confidential basis and shall
not be subject to subpoena and shall not be made public by the Department
of Public Health or used for any purpose other than that authorized by this
Section.
(10) Whenever the Department of Public Health finds that it has paid all
or part of any hospital or medical expenses which an insurance carrier is
obligated to pay under this Section, the Department of Public Health shall
be entitled to receive reimbursement for its payments from such insurance
carrier provided that the Department of Public Health has notified the
insurance carrier of its claim before the carrier has paid the benefits to
its insureds or the insureds' assignees.
(11) (a) No group hospital, medical or surgical expense | ||
| ||
(b) When dependents of insureds are covered under 2 | ||
| ||
(12) Every group policy under this Section shall be subject to the
provisions of Sections 356g and 356n of this Code.
(13) No accident and health insurer providing coverage for hospital
or medical expenses on an expense incurred basis shall deny
reimbursement for an otherwise covered expense incurred for any organ
transplantation procedure solely on the basis that such procedure is deemed
experimental or investigational unless supported by the determination of
the Office of Health Care Technology Assessment within the Agency for
Health Care Policy and Research within the federal Department of Health and
Human Services that such procedure is either experimental or investigational or
that there is insufficient data or experience to determine whether an organ
transplantation procedure is clinically acceptable. If an accident and
health insurer has made written request, or had one made on its behalf by a
national organization, for determination by the Office of Health Care
Technology Assessment within the Agency for Health Care Policy and Research
within the federal Department of Health and Human Services as to whether a
specific organ transplantation procedure is clinically acceptable and said
organization fails to respond to such a request within a period of 90 days,
the failure to act may be deemed a determination that the procedure is
deemed to be experimental or investigational.
(14) Whenever a claim for benefits by an insured under a dental
prepayment program is denied or reduced, based on the review of x-ray
films, such review must be performed by a dentist.
(Source: P.A. 96-1551, eff. 7-1-11; 97-1150, eff. 1-25-13.)
|
(215 ILCS 5/367.2) (from Ch. 73, par. 979.2)
Sec. 367.2.
Spousal continuation privilege; group contracts.
A. No policy of group accident or health insurance, nor any
certificate thereunder shall be delivered or issued for delivery in this
State after December 1, 1985, unless the policy provides for a continuation
of the existing insurance benefits for an employee's spouse and dependent
children who are insured under the provisions of that group policy or
certificate thereunder, notwithstanding that the marriage is dissolved by
judgment or terminated by the death of the employee or, after the
effective date of this amendatory Act of the 93rd General Assembly, notwithstanding the
retirement of the employee provided that
the employee's
spouse is at
least 55 years of age, in each case without any other eligibility
requirements. The provisions of this amendatory Act of the 93rd General
Assembly apply to every
group policy of accident or health insurance and every certificate issued
thereunder delivered or issued for delivery after the effective date of
this amendatory Act of the 93rd General Assembly.
B. Within 30 days of the entry of judgment or the death or
retirement of the employee, the spouse of an employee insured under
the policy who seeks a continuation of coverage thereunder shall give the
employer or the insurer written notice of the dissolution of the
marriage
or the death or retirement of the employee. The employer, within 15
days of receipt of the notice
shall give written notice
of the dissolution of the employee's marriage or the death or retirement of
the employee and that former spouse's or retired employee's spouse's
residence
to the insurance
company issuing the policy.
The employer shall immediately send a copy of the notice to the former
spouse of the employee or the spouse of the retired employee at the retired
employee's spouse's residence or at the former spouse's residence. For
purposes of this Act, the term "former spouse" includes "widow" or "widower".
C. Within 30 days after the date of receipt of a notice from the
employer, retired employee's spouse or former spouse or of the initiation
of a new group policy, the insurance company, by certified mail, return
receipt requested, shall notify the retired employee's spouse or former
spouse at his or her residence that the policy may be continued for that
retired employee's spouse or former spouse and covered dependents, and the
notice shall include:
(i) a form for election to continue the insurance | ||
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(ii) the amount of periodic premiums to be charged | ||
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(iii) instructions for returning the election form | ||
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Failure of the retired employee's spouse or former spouse to exercise the
election to continue insurance coverage by notifying the insurance company
in writing within such 30
day period
shall terminate the continuation of benefits and the right to continuation.
If the insurance company fails to notify the retired employee's spouse
or former spouse as provided for in subsection C hereof, all premiums shall
be waived from the date the notice was required until notice is sent, and
the benefits shall continue under the terms and provisions of the policy,
from the date the notice was required until the notice is sent,
notwithstanding any other provision hereof, except where the benefits in
existence at the time the company's notice was to be sent pursuant to
subsection C are terminated as to all employees.
D. With respect to a former spouse who has not attained the age of 55
at the time continuation coverage begins, the monthly premium
for
continuation shall be computed as follows:
(i) an amount, if any, that would be charged an | ||
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(ii) an amount, if any, that the employer would | ||
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Failure to pay the initial monthly premium within 30 days after the date of
receipt of notice required in subsection C of this Section terminates
the continuation benefits and the right to continuation benefits.
The continuation coverage for former
spouses who have not attained the
age of 55 at the time coverage begins shall terminate upon the
earliest to happen of the following:
(i) The failure to pay premiums when due, including | ||
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(ii) When coverage would terminate under the terms of | ||
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(iii) the date on which the former spouse first | ||
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(iv) the date on which the former spouse remarries; or
(v) the expiration of 2 years from the date | ||
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Upon the termination of continuation coverage, the former
spouse shall be
entitled to convert the coverage to an individual policy.
The continuation rights granted to former spouses who have not attained age
55
shall also
include eligible dependents insured prior to the dissolution of marriage or the
death of the
employee.
E. With respect to a retired employee's spouse or former spouse who
has attained the age of 55 at the time continuation coverage begins, the
monthly premium for the continuation shall be computed as follows:
(i) an amount, if any, that would be charged an | ||
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(ii) an amount, if any, that the employer would | ||
| ||
Beginning 2 years after coverage begins under this paragraph, the
monthly premium shall be computed as follows:
(i) an amount, if any, that would be charged an | ||
| ||
(ii) an amount, if any, that the employer would | ||
| ||
(iii) an additional amount, not to exceed 20% of (i) | ||
| ||
Failure to pay the initial monthly premium within 30 days after the date
of receipt of the notice required in subsection C of this Section
terminates the continuation benefits and the right to continuation benefits.
The continuation coverage for retired employees'
spouses and former spouses
who have attained the age of 55 at the time coverage begins shall
terminate upon the earliest to happen of the following:
(i) The failure to pay premiums when due, including | ||
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(ii) When coverage would terminate, except due to the | ||
| ||
(iii) the date on which the retired employee's spouse | ||
| ||
(iv) the date on which the former spouse remarries; or
(v) the date that person reaches the qualifying age | ||
| ||
Upon the termination of continuation coverage, the former
spouse shall be
entitled to convert the coverage to an individual policy.
The continuation rights granted to former spouses who have attained age 55
shall also
include eligible dependents insured prior to the dissolution of marriage, the
death of the
employee, or the retirement of the employee.
F. The renewal, amendment, or extension of any group policy affected by
this Section shall be deemed to be delivery or issuance for delivery of a
new policy or contract of insurance in this State.
G. If (i) the policy is canceled, and (ii) another
insurance company
contracts to provide group health and accident insurance to the employer,
and (iii) continuation coverage is in effect for the retired employee's
spouse or former spouse at the time of cancellation and (iv) the employee
is or would have been included under the new group policy, then the new
insurer must also offer continuation coverage to the retired employee's
spouse and to an employee's former spouse under the same terms and
conditions as contained in this Section.
H. This Section shall not limit the right of the retired employee's spouse
or any former spouse to exercise
the privilege to convert to an individual policy as contained in this Code.
I. No person who obtains coverage under this Section shall be required
to pay a rate greater than that applicable to any employee or member
covered under that group except as provided in clause (iii) of the
second paragraph of subsection E.
(Source: P.A. 93-477, eff. 1-1-04.)
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(215 ILCS 5/367.2-5)
Sec. 367.2-5.
Dependent child continuation privilege; group contracts.
(a) No policy of group accident or health insurance, nor any certificate
thereunder
shall be amended, renewed, delivered, or issued for delivery in this State
after
July 1,
2004, unless the policy provides for a continuation of the existing insurance
benefits for
an employee's dependent child who is insured under the provisions of that group
policy
or certificate in the event of the death of the employee and the child is not
eligible for
coverage as a dependent under the provisions of Section 367.2 or the dependent
child has
attained the limiting age under the policy.
(b) In the event of the death of the employee, if continuation coverage is
desired,
the dependent child or a responsible adult acting on behalf of the dependent
child shall
give the employer or the insurer written notice of the death of employee within
30 days of
the date the coverage terminates. The employer, within 15 days of receipt of
the notice,
shall give written notice to the insurance company issuing the policy of the
death of the
employee and the dependent child's residence. The employer shall immediately
send a
copy of the notice to the dependent child or responsible adult at the dependent
child's
residence.
(c) In the event of the dependent child attaining the limiting age under the
policy,
if continuation coverage is desired, the dependent child shall give the
employer or the
insurer written notice of the attainment of the limiting age within 30 days of
the date the
coverage terminates. The employer, within 15 days of receipt of the notice,
shall give
written notice to the insurance company issuing the policy of the attainment
of the
limiting age by the dependent child and of the dependent child's residence.
(d) Within 30 days after the date of receipt of a notice from the employer,
dependent child, or responsible adult acting on behalf of the dependent child,
or of the
initiation of a new group policy, the insurance company, by certified mail,
return receipt
requested, shall notify the dependent child or responsible adult at the
dependent child's
residence that the policy may be continued for the dependent child. The
notice shall
include:
(1) a form for election to continue the insurance | ||
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(2) the amount of periodic premiums to be charged for | ||
| ||
(3) instructions for returning the election form | ||
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Failure of the dependent child or the responsible adult acting on behalf of
the dependent
child to exercise the election to continue insurance coverage by notifying the
insurance
company in writing within such 30 day period shall terminate the continuation
of benefits
and the right to continuation.
If the insurance company fails to notify the dependent child or responsible
adult acting on
behalf of the dependent child as provided for in this subsection (d), all
premiums shall
be waived from the date the notice was required until notice was sent, and the
benefits shall
continue under the terms and provisions of the policy, from the date the notice
was
required until the notice was sent, notwithstanding any other provision hereof,
except where
the benefits in existence at the time the company's notice was to be sent
pursuant to
this subsection (d) are terminated as to all employees.
(e) The monthly premium for continuation shall be computed as follows:
(1) an amount, if any, that would be charged an | ||
| ||
(2) an amount, if any, that the employer would | ||
| ||
Failure to pay the initial monthly premium within 30 days after the date of
receipt of
notice required in subsection (d) of this Section terminates the continuation
benefits and
the right to continuation benefits.
Continuation coverage provided under this Act shall terminate upon the
earliest to happen
of the following:
(1) the failure to pay premiums when due, including | ||
| ||
(2) when coverage would terminate under the terms of | ||
| ||
(3) the date on which the dependent child first | ||
| ||
(4) the expiration of 2 years from the date | ||
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Upon the termination of continuation coverage, the dependent child shall be
entitled to
convert the coverage to an individual policy.
(f) The renewal, amendment, or extension of any group policy affected by
this
Section shall be deemed to be delivery or issuance for delivery of a new policy
or
contract of insurance in this State.
(g) If (1) the policy is cancelled, and (2) another insurance company
contracts to
provide group health and accident insurance to the employer, and (3)
continuation
coverage is in effect for the dependent child at the time of cancellation, and
(4) the
employee is or would have been included under the new group policy, then the
new
insurer must also offer continuation coverage to the dependent child under the
same
terms and conditions as contained in this Section.
(h) This Section shall not limit the right of any dependent child to
exercise the
privilege to convert to an individual policy as contained in this Code.
(i) No person who obtains coverage under this Section shall be required to
pay a
rate greater than that applicable to any employee or member covered under that
group.
(Source: P.A. 93-477, eff. 1-1-04.)
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(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 | ||
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(2) the issuance of the policy will result in | ||
| ||
(3) the benefits under the policy are reasonable in | ||
| ||
(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 | ||
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(3) evidence of approval by the state of situs of the | ||
| ||
(4) copies of all supportive material furnished to | ||
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(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) Group accident and health insurance subject to the provisions of
this Section is also subject to the provisions of Section 367i of this Code.
(Source: P.A. 90-655, eff. 7-30-98.)
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(215 ILCS 5/367a) (from Ch. 73, par. 979a)
Sec. 367a.
Blanket
accident and health insurance.
(1) Blanket accident and health insurance is that form of accident and
health insurance 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.
(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.)
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(215 ILCS 5/367b) (from Ch. 73, par. 979b)
Sec. 367b. (a) This Section applies to the hospital and medical expense
provisions of a group accident or health insurance policy.
(b) If a policy
provides that coverage of a dependent of an employee or other member of the
covered group terminates upon attainment of the limiting age for dependent
persons specified in the policy, the
attainment of such limiting age does not operate to terminate the hospital
and medical coverage of a person who, because of a disabling
condition that occurred before attainment of the limiting age, is incapable of
self-sustaining employment and is dependent on his or her parents or other
care providers for lifetime care and supervision.
(c) For purposes of subsection (b), "dependent on other care providers" is
defined as requiring a Community Integrated Living Arrangement, group home,
supervised apartment, or other residential services licensed or certified by
the Department of Human Services (as successor to the Department of Mental
Health and Developmental Disabilities), the Department
of Public Health, or the Department of Healthcare and Family Services (formerly Department of Public Aid).
(d) The insurer may inquire of the person insured 2 months prior to
attainment by a dependent of the limiting age set forth in the policy, or
at any reasonable time thereafter, whether such dependent is in fact a
person who has a disability and is dependent and, in the absence of proof submitted within
31 days of such inquiry that such dependent is a person who has a disability and is dependent may terminate coverage of such person at or after attainment of the
limiting age. In the absence of such inquiry, coverage of any person who has a disability and is dependent shall continue through the term of such policy or any
extension or renewal.
(e) This amendatory Act of 1969 is applicable to policies issued or
renewed
more than 60 days after the effective date of this amendatory Act of 1969.
(Source: P.A. 99-143, eff. 7-27-15.)
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(215 ILCS 5/367c) (from Ch. 73, par. 979c)
Sec. 367c.
No claim shall be denied, under any group accident and health policy
delivered or renewed in this State after the effective date of this
Amendatory Act, for treatment or services for mental illness rendered in a
hospital solely because such hospital lacks surgical facilities.
(Source: P.A. 78-708.)
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(215 ILCS 5/367d) (from Ch. 73, par. 979d)
Sec. 367d.
No claim shall be denied, under any group accident and health
policy delivered or renewed in this State after the effective date of this
amendatory Act, for treatment or services for rehabilitation following either a
physical or mental illness, rendered in a hospital solely because such hospital
lacks surgical facilities.
(Source: P.A. 79-303.)
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(215 ILCS 5/367d.1) (from Ch. 73, par. 979d.1)
Sec. 367d.1.
After the effective date of this amendatory Act of 1992,
no group policy of accident and health insurance that provides coverage for
the treatment of alcoholism or other drug abuse or dependency on both an
inpatient and outpatient basis may be issued, delivered or amended in this
State if it excludes from coverage services provided by persons or entities
licensed by the Department of Human Services to provide
substance use disorder treatment, provided however that (a)
the charges are otherwise eligible for reimbursement under the policy and
(b) the services provided are medically necessary and within the scope of
the licensure of the provider. This Section shall not apply to
arrangements, agreements or policies authorized under the Health Care
Reimbursement Reform Act of 1985; the Limited
Health Service Organization Act; or the
Health Maintenance Organization Act.
(Source: P.A. 100-759, eff. 1-1-19.)
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(215 ILCS 5/367e) (from Ch. 73, par. 979e)
Sec. 367e. Continuation of Group Hospital, Surgical and Major Medical
Coverage After Termination of Employment or Membership.
A group policy delivered, issued for delivery, renewed or amended in this
state which insures employees or members
for hospital, surgical or major medical insurance on an expense incurred
or service basis, other than for specific diseases or for accidental injuries
only, shall provide that employees or members whose insurance under the
group policy would otherwise terminate because of termination of employment
or membership or because of a reduction in hours below the minimum required
by the group plan shall be entitled to continue their hospital, surgical and
major medical insurance under that group policy, for themselves and their
eligible dependents, subject to all of the group policy's terms and conditions
applicable to those forms of insurance and to the following conditions:
1. Continuation shall only be available to an | ||
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2. Continuation shall not be available for any person | ||
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3. Continuation need not include dental, vision care, | ||
| ||
4. Within 10 days after the employee's or member's | ||
| ||
The insurer shall not deny coverage to the employee | ||
| ||
4a. Unless contrary to the provisions of, or any | ||
| ||
4b. Unless contrary to the provisions of, or any | ||
| ||
5. An employee or member electing continuation must | ||
| ||
6. Continuation of insurance under the group policy | ||
| ||
(a) The date 12 months after the date the | ||
| ||
(b) If the employee or member fails to make | ||
| ||
(c) The date on which the group policy is | ||
| ||
(i) The employee or member shall have the | ||
| ||
(ii) The prior group policy shall continue to | ||
| ||
7. A notification of the continuation privilege shall | ||
| ||
8. Continuation shall not be available for any | ||
| ||
9. An employee or member without an election of | ||
| ||
Unless contrary to the provisions of, or any rules | ||
| ||
An employee or member electing continuation of | ||
| ||
Continuation of coverage elected pursuant to this | ||
| ||
With respect to an employee or member who elects | ||
| ||
The requirements of this amendatory Act of 1983 shall apply to any group
policy as defined in this Section, delivered or issued for delivery on or after
180 days following the effective date of this amendatory Act of 1983.
The requirements of this amendatory Act of 1985 shall apply to any
group policy as defined in this Section, delivered, issued for delivery,
renewed or amended on or after 180 days following the effective date of
this amendatory Act of 1985.
(Source: P.A. 96-13, eff. 6-18-09; 96-894, eff. 5-17-10.)
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(215 ILCS 5/367e.1)
Sec. 367e.1.
Group Accident and Health Insurance Conversion Privilege.
(A) A group policy which provides hospital, medical, or major
medical expense insurance, or any combination of these coverages, on an
expense-incurred basis, but not including a policy which provides
benefits for specific diseases or for accidental injuries only, shall
provide that an employee or member (i) whose insurance under the group
policy has been terminated for any reason other than discontinuance of
the group policy in its entirety where there is a succeeding carrier, or
failure of the employee or member to pay any required contribution; and
(ii) who has been continuously insured under the group policy (and under
any group policy providing similar benefits which it replaces) for at
least three months immediately prior to termination, shall be entitled
to have issued to him by the insurer a policy of health insurance
(hereafter referred to as the converted policy), subject to the
following conditions:
(1) Written application for the converted policy | ||
| ||
Written notice presented to the employee or member by | ||
| ||
(2) The converted policy shall be issued without | ||
| ||
(3) The initial premium for the converted policy | ||
| ||
(4) The effective date of the converted policy shall | ||
| ||
(5) The converted policy shall cover the employee or | ||
| ||
(6) The insurer shall not be required to issue a | ||
| ||
(7) In the event that coverage would be continued | ||
| ||
(8) Subject to the conditions set forth above, the | ||
| ||
(9) A notification of the conversion privilege shall | ||
| ||
(10) The insurer may elect to provide group insurance | ||
| ||
(B) A converted policy issued upon the exercise of the conversion
privilege required by subsection (A) of this Section shall conform to
the following minimum standards:
(1) If the group policy provided hospital, surgical, | ||
| ||
(a) Hospital room and board benefits in an amount | ||
| ||
(b) Miscellaneous hospital benefits for any one | ||
| ||
(c) Surgical benefits according to a surgical | ||
| ||
(d) Non-surgical medical attendance benefits for | ||
| ||
(2) If the group policy provided major medical | ||
| ||
(a) A maximum benefit at least equal to (i) or | ||
| ||
(i) A maximum payment of twenty-five thousand | ||
| ||
(ii) A maximum payment of twenty-five | ||
| ||
(b) Payment of benefits for covered medical | ||
| ||
(c) A deductible for each benefit period which, | ||
| ||
(d) The term "covered medical expenses," as used | ||
| ||
(3) The converted policy may contain any exclusion, | ||
| ||
(4) The insurer may, at its option, also offer | ||
| ||
(5) The converted policy may only exclude a | ||
| ||
(6) The converted policy may provide for the | ||
| ||
(7) The converted policy may provide that the insurer | ||
| ||
(8) The converted policy shall not contain any | ||
| ||
(9) The converted policy may contain any provisions | ||
| ||
(10) In the conversion of group health insurance in | ||
| ||
(11) With respect to any person who was covered by | ||
| ||
(12) If the insurer elects to provide group insurance | ||
| ||
(C) The requirements of this Section shall apply to any group policy
of accident and health insurance delivered, issued for delivery, renewed
or amended on or after 180 days following the effective date of this
Section.
(Source: P.A. 93-477, eff. 1-1-04.)
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(215 ILCS 5/367f) (from Ch. 73, par. 979f)
Sec. 367f. Firefighters' continuance privilege. As used in this Section:
1. The terms "municipality", "deferred pensioner" and "creditable service"
shall have the meaning ascribed to such terms by Sections 4-103, 4-105a and
4-108, respectively, of the Illinois Pension Code, as now or hereafter amended.
2. "Firefighter" means a person who is a "firefighter" as defined in Section 4-106 of the Illinois Pension Code, a paramedic who is employed by a unit of local government, or an emergency medical technician, emergency medical technician-basic, emergency medical technician-intermediate, or advanced emergency medical technician who is employed by a unit of local government.
3. The "retirement or disability period" of a firefighter means the period:
a. which begins on the day the firefighter is | ||
| ||
b. which ends on the first to occur of any of the | ||
| ||
No policy of group accident and health insurance under which firefighters
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 firefighter 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 firefighter 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 firefighter throughout the retirement or disability period of
the firefighter and, unless the firefighter 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 firefighter who are
insured under the group policy on the day immediately preceding the day on
which the retirement or disability period of the firefighter begins; provided,
however, that when such continued group insurance coverage is in effect
with respect to a firefighter on the date
of the firefighter's death but the retirement or disability period of the firefighter
does not end with such firefighter's death, then the deceased firefighter'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
firefighters 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 firefighters 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 a person electing continued coverage under this Section becomes
eligible for medicare coverage, benefits under the group policy may
continue as a supplement to the medicare coverage upon payment of any
required premiums to maintain the benefits of the group policy as
supplemental coverage.
Within 15 days of the beginning of the retirement or disability period
of any firefighter entitled to elect continued group insurance coverage under any
group policy affected by this Section, the municipality last employing such
firefighter 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 firefighter's name and last known place of residence and the
beginning date of the firefighter'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 firefighter at the firefighter's last known place of
residence that coverage under the group policy may be continued for the
retirement or disability period of the firefighter as provided in this Section.
Such notice shall set forth: (i) a statement of election to be filed by
the firefighter if the firefighter 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
firefighter 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 firefighter elects to continue coverage, it shall be the obligation
of the firefighter 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 firefighter 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 Firefighter's Pension
Fund from any monthly pension payment otherwise payable
to or on behalf of the firefighter pursuant to Article 4 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 firefighter'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 firefighters 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 firefighters or both, such firefighters 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 firefighters of
the municipality and qualifying surviving spouses not later than July 1, 1985.
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.
Pursuant to paragraphs (h) and (i) of Section 6 of Article VII of the
Illinois Constitution, this Section specifically denies and limits the
exercise by a home rule unit of any power which is inconsistent with this
Section and all existing laws and ordinances which are inconsistent with
this Section are hereby superseded. This Section does not preempt the
concurrent exercise by home rule units of powers consistent herewith. The Division of Insurance of the Department of Financial and Professional Regulation shall enforce the provisions of this Section, including provisions relating to municipality self-insured benefit plans.
(Source: P.A. 103-52, eff. 1-1-24.)
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(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.)
|
(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 | ||
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b. which ends on the first to occur of any of the | ||
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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) (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.)
|
(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 | ||
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(2) The term "municipality" means any municipality, | ||
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(3) The term "employee" shall mean an employee as | ||
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(4) The "retirement or disability period" of an | ||
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(A) which begins on the day the employee is | ||
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(B) which ends on the first to occur of any of | ||
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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) 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) 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 | ||
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(2) The use of private health insurance to pay for | ||
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(3) The use of private health insurance to pay for | ||
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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.) |
(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)
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 | ||
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(2) When a payor requires selection of a health care | ||
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(3) A payor shall provide the health care | ||
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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.)
|
(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)
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)
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 | ||
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(2) an insurer is acting as a plan administrator for | ||
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(3) the provider has already been paid in full by any | ||
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(4) an insurer contracted with the Department of | ||
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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)
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) 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 | ||
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(2) by mailing written notice to policyholders whose | ||
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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.) |
(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) (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) (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) (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) (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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(215 ILCS 5/370b.1) Sec. 370b.1. Surgical assistant payments. Payment for services rendered by a registered surgical assistant, as defined in the Registered Surgical Assistant and Registered Surgical Technologist Title Protection Act, who is neither an employee of an ambulatory surgical treatment center, as defined in the Ambulatory Surgical Treatment Center Act, nor an employee of a hospital shall be paid at the appropriate non-physician modifier rate if the payor would have made payment had the same services been provided by a physician.
(Source: P.A. 99-100, eff. 1-1-16.) |
(215 ILCS 5/370c) (from Ch. 73, par. 982c)
Sec. 370c. Mental and emotional disorders.
(a)(1) On and after January 1, 2022 (the effective date of Public Act 102-579),
every insurer that amends, delivers, issues, or renews
group accident and health policies providing coverage for hospital or medical treatment or
services for illness on an expense-incurred basis shall provide coverage for the medically necessary treatment of mental, emotional, nervous, or substance use disorders or conditions consistent with the parity requirements of Section 370c.1 of this Code.
(2) Each insured that is covered for mental, emotional, nervous, or substance use
disorders or conditions shall be free to select the physician licensed to
practice medicine in all its branches, licensed clinical psychologist,
licensed clinical social worker, licensed clinical professional counselor, licensed marriage and family therapist, licensed speech-language pathologist, or other licensed or certified professional at a program licensed pursuant to the Substance Use Disorder Act of
his or her choice to treat such disorders, and
the insurer shall pay the covered charges of such physician licensed to
practice medicine in all its branches, licensed clinical psychologist,
licensed clinical social worker, licensed clinical professional counselor, licensed marriage and family therapist, licensed speech-language pathologist, or other licensed or certified professional at a program licensed pursuant to the Substance Use Disorder Act up
to the limits of coverage, provided (i)
the disorder or condition treated is covered by the policy, and (ii) the
physician, licensed psychologist, licensed clinical social worker, licensed
clinical professional counselor, licensed marriage and family therapist, licensed speech-language pathologist, or other licensed or certified professional at a program licensed pursuant to the Substance Use Disorder Act is
authorized to provide said services under the statutes of this State and in
accordance with accepted principles of his or her profession.
(3) Insofar as this Section applies solely to licensed clinical social
workers, licensed clinical professional counselors, licensed marriage and family therapists, licensed speech-language pathologists, and other licensed or certified professionals at programs licensed pursuant to the Substance Use Disorder Act, those persons who may
provide services to individuals shall do so
after the licensed clinical social worker, licensed clinical professional
counselor, licensed marriage and family therapist, licensed speech-language pathologist, or other licensed or certified professional at a program licensed pursuant to the Substance Use Disorder Act has informed the patient of the
desirability of the patient conferring with the patient's primary care
physician.
(4) "Mental, emotional, nervous, or substance use disorder or condition" means a condition or disorder that involves a mental health condition or substance use disorder that falls under any of the diagnostic categories listed in the mental and behavioral disorders chapter of the current edition of the World Health Organization's International Classification of Disease or that is listed in the most recent version of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. "Mental, emotional, nervous, or substance use disorder or condition" includes any mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression. (5) Medically necessary treatment and medical necessity determinations shall be interpreted and made in a manner that is consistent with and pursuant to subsections (h) through (t). (b)(1) (Blank).
(2) (Blank).
(2.5) (Blank). (3) Unless otherwise prohibited by federal law and consistent with the parity requirements of Section 370c.1 of this Code, the reimbursing insurer that amends, delivers, issues, or renews a group or individual policy of accident and health insurance, a qualified health plan offered through the health insurance marketplace, or a provider of treatment of mental, emotional, nervous,
or substance use disorders or conditions shall furnish medical records or other necessary data
that substantiate that initial or continued treatment is at all times medically
necessary. An insurer shall provide a mechanism for the timely review by a
provider holding the same license and practicing in the same specialty as the
patient's provider, who is unaffiliated with the insurer, jointly selected by
the patient (or the patient's next of kin or legal representative if the
patient is unable to act for himself or herself), the patient's provider, and
the insurer in the event of a dispute between the insurer and patient's
provider regarding the medical necessity of a treatment proposed by a patient's
provider. If the reviewing provider determines the treatment to be medically
necessary, the insurer shall provide reimbursement for the treatment. Future
contractual or employment actions by the insurer regarding the patient's
provider may not be based on the provider's participation in this procedure.
Nothing prevents
the insured from agreeing in writing to continue treatment at his or her
expense. When making a determination of the medical necessity for a treatment
modality for mental, emotional, nervous, or substance use disorders or conditions, an insurer must make the determination in a
manner that is consistent with the manner used to make that determination with
respect to other diseases or illnesses covered under the policy, including an
appeals process. Medical necessity determinations for substance use disorders shall be made in accordance with appropriate patient placement criteria established by the American Society of Addiction Medicine. No additional criteria may be used to make medical necessity determinations for substance use disorders.
(4) A group health benefit plan amended, delivered, issued, or renewed on or after January 1, 2019 (the effective date of Public Act 100-1024) or an individual policy of accident and health insurance or a qualified health plan offered through the health insurance marketplace amended, delivered, issued, or renewed on or after January 1, 2019 (the effective date of Public Act 100-1024):
(A) shall provide coverage based upon medical | ||
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(i) 45 days of inpatient treatment; and
(ii) beginning on June 26, 2006 (the effective | ||
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(iii) for plans or policies delivered, issued for | ||
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(B) may not include a lifetime limit on the number of | ||
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(C) (Blank).
(5) An issuer of a group health benefit plan or an individual policy of accident and health insurance or a qualified health plan offered through the health insurance marketplace may not count toward the number
of outpatient visits required to be covered under this Section an outpatient
visit for the purpose of medication management and shall cover the outpatient
visits under the same terms and conditions as it covers outpatient visits for
the treatment of physical illness.
(5.5) An individual or group health benefit plan amended, delivered, issued, or renewed on or after September 9, 2015 (the effective date of Public Act 99-480) shall offer coverage for medically necessary acute treatment services and medically necessary clinical stabilization services. The treating provider shall base all treatment recommendations and the health benefit plan shall base all medical necessity determinations for substance use disorders in accordance with the most current edition of the Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions established by the American Society of Addiction Medicine. The treating provider shall base all treatment recommendations and the health benefit plan shall base all medical necessity determinations for medication-assisted treatment in accordance with the most current Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions established by the American Society of Addiction Medicine. As used in this subsection: "Acute treatment services" means 24-hour medically supervised addiction treatment that provides evaluation and withdrawal management and may include biopsychosocial assessment, individual and group counseling, psychoeducational groups, and discharge planning. "Clinical stabilization services" means 24-hour treatment, usually following acute treatment services for substance abuse, which may include intensive education and counseling regarding the nature of addiction and its consequences, relapse prevention, outreach to families and significant others, and aftercare planning for individuals beginning to engage in recovery from addiction. (6) An issuer of a group health benefit
plan may provide or offer coverage required under this Section through a
managed care plan.
(6.5) An individual or group health benefit plan amended, delivered, issued, or renewed on or after January 1, 2019 (the effective date of Public Act 100-1024): (A) shall not impose prior authorization | ||
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(B) shall not impose any step therapy requirements, | ||
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(C) shall place all prescription medications approved | ||
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(D) shall not exclude coverage for a prescription | ||
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(7) (Blank).
(8)
(Blank).
(9) With respect to all mental, emotional, nervous, or substance use disorders or conditions, coverage for inpatient treatment shall include coverage for treatment in a residential treatment center certified or licensed by the Department of Public Health or the Department of Human Services. (c) This Section shall not be interpreted to require coverage for speech therapy or other habilitative services for those individuals covered under Section 356z.15
of this Code. (d) With respect to a group or individual policy of accident and health insurance or a qualified health plan offered through the health insurance marketplace, the Department and, with respect to medical assistance, the Department of Healthcare and Family Services shall each enforce the requirements of this Section and Sections 356z.23 and 370c.1 of this Code, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, 42 U.S.C. 18031(j), and any amendments to, and federal guidance or regulations issued under, those Acts, including, but not limited to, final regulations issued under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and final regulations applying the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 to Medicaid managed care organizations, the Children's Health Insurance Program, and alternative benefit plans. Specifically, the Department and the Department of Healthcare and Family Services shall take action: (1) proactively ensuring compliance by individual and | ||
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(2) evaluating all consumer or provider complaints | ||
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(3) performing parity compliance market conduct | ||
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(A) nonquantitative treatment limitations, | ||
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(B) denials of authorization, payment, and | ||
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(C) other specific criteria as may be determined | ||
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The findings and the conclusions of the parity compliance market conduct examinations and audits shall be made public. The Director may adopt rules to effectuate any provisions of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 that relate to the business of insurance. (e) Availability of plan information. (1) The criteria for medical necessity determinations | ||
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(2) The reason for any denial under a group health | ||
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(f) As used in this Section, "group policy of accident and health insurance" and "group health benefit plan" includes (1) State-regulated employer-sponsored group health insurance plans written in Illinois or which purport to provide coverage for a resident of this State; and (2) State employee health plans. (g) (1) As used in this subsection: "Benefits", with respect to insurers, means
the benefits provided for treatment services for inpatient and outpatient treatment of substance use disorders or conditions at American Society of Addiction Medicine levels of treatment 2.1 (Intensive Outpatient), 2.5 (Partial Hospitalization), 3.1 (Clinically Managed Low-Intensity Residential), 3.3 (Clinically Managed Population-Specific High-Intensity Residential), 3.5 (Clinically Managed High-Intensity Residential), and 3.7 (Medically Monitored Intensive Inpatient) and OMT (Opioid Maintenance Therapy) services. "Benefits", with respect to managed care organizations, means the benefits provided for treatment services for inpatient and outpatient treatment of substance use disorders or conditions at American Society of Addiction Medicine levels of treatment 2.1 (Intensive Outpatient), 2.5 (Partial Hospitalization), 3.5 (Clinically Managed High-Intensity Residential), and 3.7 (Medically Monitored Intensive Inpatient) and OMT (Opioid Maintenance Therapy) services. "Substance use disorder treatment provider or facility" means a licensed physician, licensed psychologist, licensed psychiatrist, licensed advanced practice registered nurse, or licensed, certified, or otherwise State-approved facility or provider of substance use disorder treatment. (2) A group health insurance policy, an individual health benefit plan, or qualified health plan that is offered through the health insurance marketplace, small employer group health plan, and large employer group health plan that is amended, delivered, issued, executed, or renewed in this State, or approved for issuance or renewal in this State, on or after January 1, 2019 (the effective date of Public Act 100-1023) shall comply with the requirements of this Section and Section 370c.1. The services for the treatment and the ongoing assessment of the patient's progress in treatment shall follow the requirements of 77 Ill. Adm. Code 2060. (3) Prior authorization shall not be utilized for the benefits under this subsection. The substance use disorder treatment provider or facility shall notify the insurer of the initiation of treatment. For an insurer that is not a managed care organization, the substance use disorder treatment provider or facility notification shall occur for the initiation of treatment of the covered person within 2 business days. For managed care organizations, the substance use disorder treatment provider or facility notification shall occur in accordance with the protocol set forth in the provider agreement for initiation of treatment within 24 hours. If the managed care organization is not capable of accepting the notification in accordance with the contractual protocol during the 24-hour period following admission, the substance use disorder treatment provider or facility shall have one additional business day to provide the notification to the appropriate managed care organization. Treatment plans shall be developed in accordance with the requirements and timeframes established in 77 Ill. Adm. Code 2060. If the substance use disorder treatment provider or facility fails to notify the insurer of the initiation of treatment in accordance with these provisions, the insurer may follow its normal prior authorization processes. (4) For an insurer that is not a managed care organization, if an insurer determines that benefits are no longer medically necessary, the insurer shall notify the covered person, the covered person's authorized representative, if any, and the covered person's health care provider in writing of the covered person's right to request an external review pursuant to the Health Carrier External Review Act. The notification shall occur within 24 hours following the adverse determination. Pursuant to the requirements of the Health Carrier External Review Act, the covered person or the covered person's authorized representative may request an expedited external review.
An expedited external review may not occur if the substance use disorder treatment provider or facility determines that continued treatment is no longer medically necessary. If an expedited external review request meets the criteria of the Health Carrier External Review Act, an independent review organization shall make a final determination of medical necessity within 72 hours. If an independent review organization upholds an adverse determination, an insurer shall remain responsible to provide coverage of benefits through the day following the determination of the independent review organization. A decision to reverse an adverse determination shall comply with the Health Carrier External Review Act. (5) The substance use disorder treatment provider or facility shall provide the insurer with 7 business days' advance notice of the planned discharge of the patient from the substance use disorder treatment provider or facility and notice on the day that the patient is discharged from the substance use disorder treatment provider or facility. (6) The benefits required by this subsection shall be provided to all covered persons with a diagnosis of substance use disorder or conditions. The presence of additional related or unrelated diagnoses shall not be a basis to reduce or deny the benefits required by this subsection. (7) Nothing in this subsection shall be construed to require an insurer to provide coverage for any of the benefits in this subsection. (h) As used in this Section: "Generally accepted standards of mental, emotional, nervous, or substance use disorder or condition care" means standards of care and clinical practice that are generally recognized by health care providers practicing in relevant clinical specialties such as psychiatry, psychology, clinical sociology, social work, addiction medicine and counseling, and behavioral health treatment. Valid, evidence-based sources reflecting generally accepted standards of mental, emotional, nervous, or substance use disorder or condition care include peer-reviewed scientific studies and medical literature, recommendations of nonprofit health care provider professional associations and specialty societies, including, but not limited to, patient placement criteria and clinical practice guidelines, recommendations of federal government agencies, and drug labeling approved by the United States Food and Drug Administration. "Medically necessary treatment of mental, emotional, nervous, or substance use disorders or conditions" means a service or product addressing the specific needs of that patient, for the purpose of screening, preventing, diagnosing, managing, or treating an illness, injury, or condition or its symptoms and comorbidities, including minimizing the progression of an illness, injury, or condition or its symptoms and comorbidities in a manner that is all of the following: (1) in accordance with the generally accepted | ||
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(2) clinically appropriate in terms of type, | ||
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(3) not primarily for the economic benefit of the | ||
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"Utilization review" means either of the following: (1) prospectively, retrospectively, or concurrently | ||
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(2) evaluating the medical necessity, | ||
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"Utilization review criteria" means patient placement criteria or any criteria, standards, protocols, or guidelines used by an insurer to conduct utilization review. (i)(1) Every insurer that amends, delivers, issues, or renews a group or individual policy of accident and health insurance or a qualified health plan offered through the health insurance marketplace in this State and Medicaid managed care organizations providing coverage for hospital or medical treatment on or after January 1, 2023 shall, pursuant to subsections (h) through (s), provide coverage for medically necessary treatment of mental, emotional, nervous, or substance use disorders or conditions. (2) An insurer shall not set a specific limit on the duration of benefits or coverage of medically necessary treatment of mental, emotional, nervous, or substance use disorders or conditions or limit coverage only to alleviation of the insured's current symptoms. (3) All medical necessity determinations made by the insurer concerning service intensity, level of care placement, continued stay, and transfer or discharge of insureds diagnosed with mental, emotional, nervous, or substance use disorders or conditions shall be conducted in accordance with the requirements of subsections (k) through (u). (4) An insurer that authorizes a specific type of treatment by a provider pursuant to this Section shall not rescind or modify the authorization after that provider renders the health care service in good faith and pursuant to this authorization for any reason, including, but not limited to, the insurer's subsequent cancellation or modification of the insured's or policyholder's contract, or the insured's or policyholder's eligibility. Nothing in this Section shall require the insurer to cover a treatment when the authorization was granted based on a material misrepresentation by the insured, the policyholder, or the provider. Nothing in this Section shall require Medicaid managed care organizations to pay for services if the individual was not eligible for Medicaid at the time the service was rendered. Nothing in this Section shall require an insurer to pay for services if the individual was not the insurer's enrollee at the time services were rendered. As used in this paragraph, "material" means a fact or situation that is not merely technical in nature and results in or could result in a substantial change in the situation. (j) An insurer shall not limit benefits or coverage for medically necessary services on the basis that those services should be or could be covered by a public entitlement program, including, but not limited to, special education or an individualized education program, Medicaid, Medicare, Supplemental Security Income, or Social Security Disability Insurance, and shall not include or enforce a contract term that excludes otherwise covered benefits on the basis that those services should be or could be covered by a public entitlement program. Nothing in this subsection shall be construed to require an insurer to cover benefits that have been authorized and provided for a covered person by a public entitlement program. Medicaid managed care organizations are not subject to this subsection. (k) An insurer shall base any medical necessity determination or the utilization review criteria that the insurer, and any entity acting on the insurer's behalf, applies to determine the medical necessity of health care services and benefits for the diagnosis, prevention, and treatment of mental, emotional, nervous, or substance use disorders or conditions on current generally accepted standards of mental, emotional, nervous, or substance use disorder or condition care. All denials and appeals shall be reviewed by a professional with experience or expertise comparable to the provider requesting the authorization. (l) For medical necessity determinations relating to level of care placement, continued stay, and transfer or discharge of insureds diagnosed with mental, emotional, and nervous disorders or conditions, an insurer shall apply the patient placement criteria set forth in the most recent version of the treatment criteria developed by an unaffiliated nonprofit professional association for the relevant clinical specialty or, for Medicaid managed care organizations, patient placement criteria determined by the Department of Healthcare and Family Services that are consistent with generally accepted standards of mental, emotional, nervous or substance use disorder or condition care. Pursuant to subsection (b), in conducting utilization review of all covered services and benefits for the diagnosis, prevention, and treatment of substance use disorders an insurer shall use the most recent edition of the patient placement criteria established by the American Society of Addiction Medicine. (m) For medical necessity determinations relating to level of care placement, continued stay, and transfer or discharge that are within the scope of the sources specified in subsection (l), an insurer shall not apply different, additional, conflicting, or more restrictive utilization review criteria than the criteria set forth in those sources. For all level of care placement decisions, the insurer shall authorize placement at the level of care consistent with the assessment of the insured using the relevant patient placement criteria as specified in subsection (l). If that level of placement is not available, the insurer shall authorize the next higher level of care. In the event of disagreement, the insurer shall provide full detail of its assessment using the relevant criteria as specified in subsection (l) to the provider of the service and the patient. Nothing in this subsection or subsection (l) prohibits an insurer from applying utilization review criteria that were developed in accordance with subsection (k) to health care services and benefits for mental, emotional, and nervous disorders or conditions that are not related to medical necessity determinations for level of care placement, continued stay, and transfer or discharge. If an insurer purchases or licenses utilization review criteria pursuant to this subsection, the insurer shall verify and document before use that the criteria were developed in accordance with subsection (k). (n) In conducting utilization review that is outside the scope of the criteria as specified in subsection (l) or relates to the advancements in technology or in the types or levels of care that are not addressed in the most recent versions of the sources specified in subsection (l), an insurer shall conduct utilization review in accordance with subsection (k). (o) This Section does not in any way limit the rights of a patient under the Medical Patient Rights Act. (p) This Section does not in any way limit early and periodic screening, diagnostic, and treatment benefits as defined under 42 U.S.C. 1396d(r). (q) To ensure the proper use of the criteria described in subsection (l), every insurer shall do all of the following: (1) Educate the insurer's staff, including any | ||
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(2) Make the educational program available to other | ||
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(3) Provide, at no cost, the utilization review | ||
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(4) Track, identify, and analyze how the | ||
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(5) Conduct interrater reliability testing to | ||
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(6) Run interrater reliability reports about how | ||
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(7) Achieve interrater reliability pass rates of at | ||
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(8) Maintain documentation of interrater | ||
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(r) This Section applies to all health care services and benefits for the diagnosis, prevention, and treatment of mental, emotional, nervous, or substance use disorders or conditions covered by an insurance policy, including prescription drugs. (s) This Section applies to an insurer that amends, delivers, issues, or renews a group or individual policy of accident and health insurance or a qualified health plan offered through the health insurance marketplace in this State providing coverage for hospital or medical treatment and conducts utilization review as defined in this Section, including Medicaid managed care organizations, and any entity or contracting provider that performs utilization review or utilization management functions on an insurer's behalf. (t) If the Director determines that an insurer has violated this Section, the Director may, after appropriate notice and opportunity for hearing, by order, assess a civil penalty between $1,000 and $5,000 for each violation. Moneys collected from penalties shall be deposited into the Parity Advancement Fund established in subsection (i) of Section 370c.1. (u) An insurer shall not adopt, impose, or enforce terms in its policies or provider agreements, in writing or in operation, that undermine, alter, or conflict with the requirements of this Section. (v) The provisions of this Section are severable. If any provision of this Section or its application is held invalid, that invalidity shall not affect other provisions or applications that can be given effect without the invalid provision or application. (Source: P.A. 102-558, eff. 8-20-21; 102-579, eff. 1-1-22; 102-813, eff. 5-13-22; 103-426, eff. 8-4-23.) |
(215 ILCS 5/370c.1) (Text of Section from P.A. 103-94) Sec. 370c.1. Mental, emotional, nervous, or substance use disorder or condition parity. (a) On and after July 23, 2021 (the effective date of Public Act 102-135), every insurer that amends, delivers, issues, or renews a group or individual policy of accident and health insurance or a qualified health plan offered through the Health Insurance Marketplace in this State providing coverage for hospital or medical treatment and for the treatment of mental, emotional, nervous, or substance use disorders or conditions shall ensure prior to policy issuance that: (1) the financial requirements applicable to such | ||
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(2) the treatment limitations applicable to such | ||
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(b) The following provisions shall apply concerning aggregate lifetime limits: (1) In the case of a group or individual policy of | ||
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(A) if the policy does not include an aggregate | ||
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(B) if the policy includes an aggregate lifetime | ||
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(i) apply the applicable lifetime limit both | ||
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(ii) not include any aggregate lifetime limit | ||
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(2) In the case of a policy that is not described in | ||
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(c) The following provisions shall apply concerning annual limits: (1) In the case of a group or individual policy of | ||
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(A) if the policy does not include an annual | ||
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(B) if the policy includes an annual limit on | ||
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(i) apply the applicable annual limit both to | ||
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(ii) not include any annual limit on mental, | ||
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(2) In the case of a policy that is not described in | ||
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(d) With respect to mental, emotional, nervous, or substance use disorders or conditions, an insurer shall use policies and procedures for the election and placement of mental, emotional, nervous, or substance use disorder or condition treatment drugs on their formulary that are no less favorable to the insured as those policies and procedures the insurer uses for the selection and placement of drugs for medical or surgical conditions and shall follow the expedited coverage determination requirements for substance abuse treatment drugs set forth in Section 45.2 of the Managed Care Reform and Patient Rights Act. (e) This Section shall be interpreted in a manner consistent with all applicable federal parity regulations including, but not limited to, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, final regulations issued under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and final regulations applying the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 to Medicaid managed care organizations, the Children's Health Insurance Program, and alternative benefit plans. (f) The provisions of subsections (b) and (c) of this Section shall not be interpreted to allow the use of lifetime or annual limits otherwise prohibited by State or federal law. (g) As used in this Section: "Financial requirement" includes deductibles, copayments, coinsurance, and out-of-pocket maximums, but does not include an aggregate lifetime limit or an annual limit subject to subsections (b) and (c). "Mental, emotional, nervous, or substance use disorder or condition" means a condition or disorder that involves a mental health condition or substance use disorder that falls under any of the diagnostic categories listed in the mental and behavioral disorders chapter of the current edition of the International Classification of Disease or that is listed in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders. "Treatment limitation" includes limits on benefits based on the frequency of treatment, number of visits, days of coverage, days in a waiting period, or other similar limits on the scope or duration of treatment. "Treatment limitation" includes both quantitative treatment limitations, which are expressed numerically (such as 50 outpatient visits per year), and nonquantitative treatment limitations, which otherwise limit the scope or duration of treatment. A permanent exclusion of all benefits for a particular condition or disorder shall not be considered a treatment limitation. "Nonquantitative treatment" means those limitations as described under federal regulations (26 CFR 54.9812-1). "Nonquantitative treatment limitations" include, but are not limited to, those limitations described under federal regulations 26 CFR 54.9812-1, 29 CFR 2590.712, and 45 CFR 146.136.
(h) The Department of Insurance shall implement the following education initiatives: (1) By January 1, 2016, the Department shall develop | ||
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(2) The Department, in coordination with the | ||
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(3) Not later than January 1 of each year, the | ||
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(A) Cover the methodology the Departments use to | ||
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(B) Cover the methodology the Departments use to | ||
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(C) Identify market conduct examinations or, in | ||
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(i) the number of market conduct examinations | ||
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(ii) the benefit classifications examined by | ||
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(iii) the subject matter of each market | ||
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(iv) a summary of the basis for the final | ||
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Individually identifiable information shall be | ||
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(D) Detail any educational or corrective actions | ||
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(E) The report must be written in non-technical, | ||
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(i) The Parity Advancement Fund is created as a special fund in the State treasury. Moneys from fines and penalties collected from insurers for violations of this Section shall be deposited into the Fund. Moneys deposited into the Fund for appropriation by the General Assembly to the Department shall be used for the purpose of providing financial support of the Consumer Education Campaign, parity compliance advocacy, and other initiatives that support parity implementation and enforcement on behalf of consumers. (j) The Department of Insurance and the Department of Healthcare and Family Services shall convene and provide technical support to a workgroup of 11 members that shall be comprised of 3 mental health parity experts recommended by an organization advocating on behalf of mental health parity appointed by the President of the Senate; 3 behavioral health providers recommended by an organization that represents behavioral health providers appointed by the Speaker of the House of Representatives; 2 representing Medicaid managed care organizations recommended by an organization that represents Medicaid managed care plans appointed by the Minority Leader of the House of Representatives; 2 representing commercial insurers recommended by an organization that represents insurers appointed by the Minority Leader of the Senate; and a representative of an organization that represents Medicaid managed care plans appointed by the Governor. The workgroup shall provide recommendations to the General Assembly on health plan data reporting requirements that separately break out data on mental, emotional, nervous, or substance use disorder or condition benefits and data on other medical benefits, including physical health and related health services no later than December 31, 2019. The recommendations to the General Assembly shall be filed with the Clerk of the House of Representatives and the Secretary of the Senate in electronic form only, in the manner that the Clerk and the Secretary shall direct. This workgroup shall take into account federal requirements and recommendations on mental health parity reporting for the Medicaid program. This workgroup shall also develop the format and provide any needed definitions for reporting requirements in subsection (k). The research and evaluation of the working group shall include, but not be limited to: (1) claims denials due to benefit limits, if | ||
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(2) administrative denials for no prior authorization; (3) denials due to not meeting medical necessity; (4) denials that went to external review and whether | ||
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(5) out-of-network claims; (6) emergency care claims; (7) network directory providers in the outpatient | ||
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(8) the impact of existing and pertinent limitations | ||
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(9) when reporting and publishing should begin. Representatives from the Department of Healthcare and Family Services, representatives from the Division of Mental Health, and representatives from the Division of Substance Use Prevention and Recovery shall provide technical advice to the workgroup. (j-5) The Department of Insurance shall collect the following information: (1) The number of employment disability insurance | ||
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(A) individual short-term policies; (B) individual long-term policies; (C) group short-term policies; and (D) group long-term policies. (2) The number of policies referenced in paragraph | ||
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(3) The average defined benefit period for the | ||
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(4) Whether the policies referenced in paragraph | ||
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(5) The identities of the individuals, entities, or | ||
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(6) The average defined benefit period for plans | ||
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(A) individual short-term policies; (B) individual long-term policies; (C) group short-term policies; and (D) group long-term policies. (7) The average premiums for disability income | ||
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(A) individual short-term policies that limit | ||
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(B) individual long-term policies that limit | ||
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(C) group short-term policies that limit mental | ||
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(D) group long-term policies that limit mental | ||
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(E) individual short-term policies that include | ||
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(F) individual long-term policies that include | ||
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(G) group short-term policies that include | ||
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(H) group long-term policies that include | ||
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The Department shall present its findings regarding information collected under this subsection (j-5) to the General Assembly no later than April 30, 2024. Information regarding a specific insurance provider's contributions to the Department's report shall be exempt from disclosure under paragraph (t) of subsection (1) of Section 7 of the Freedom of Information Act. The aggregated information gathered by the Department shall not be exempt from disclosure under paragraph (t) of subsection (1) of Section 7 of the Freedom of Information Act. (k) An insurer that amends, delivers, issues, or renews a group or individual policy of accident and health insurance or a qualified health plan offered through the health insurance marketplace in this State providing coverage for hospital or medical treatment and for the treatment of mental, emotional, nervous, or substance use disorders or conditions shall submit an annual report, the format and definitions for which will be developed by the workgroup in subsection (j), to the Department, or, with respect to medical assistance, the Department of Healthcare and Family Services starting on or before July 1, 2020 that contains the following information separately for inpatient in-network benefits, inpatient out-of-network benefits, outpatient in-network benefits, outpatient out-of-network benefits, emergency care benefits, and prescription drug benefits in the case of accident and health insurance or qualified health plans, or inpatient, outpatient, emergency care, and prescription drug benefits in the case of medical assistance: (1) A summary of the plan's pharmacy management | ||
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(2) A summary of the internal processes of review for | ||
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(3) A summary of how the plan's policies and | ||
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(4) A description of the process used to develop or | ||
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(5) Identification of all nonquantitative treatment | ||
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(6) The results of an analysis that demonstrates that | ||
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(A) identify the factors used to determine that a | ||
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(B) identify and define the specific evidentiary | ||
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(C) provide the comparative analyses, including | ||
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(D) provide the comparative analyses, including | ||
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(E) disclose the specific findings and | ||
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(7) Any other information necessary to clarify data | ||
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(l) An insurer that amends, delivers, issues, or renews a group or individual policy of accident and health insurance or a qualified health plan offered through the health insurance marketplace in this State providing coverage for hospital or medical treatment and for the treatment of mental, emotional, nervous, or substance use disorders or conditions on or after January 1, 2019 (the effective date of Public Act 100-1024) shall, in advance of the plan year, make available to the Department or, with respect to medical assistance, the Department of Healthcare and Family Services and to all plan participants and beneficiaries the information required in subparagraphs (C) through (E) of paragraph (6) of subsection (k). For plan participants and medical assistance beneficiaries, the information required in subparagraphs (C) through (E) of paragraph (6) of subsection (k) shall be made available on a publicly-available website whose web address is prominently displayed in plan and managed care organization informational and marketing materials. (m) In conjunction with its compliance examination program conducted in accordance with the Illinois State Auditing Act, the Auditor General shall undertake a review of
compliance by the Department and the Department of Healthcare and Family Services with Section 370c and this Section. Any
findings resulting from the review conducted under this Section shall be included in the applicable State agency's compliance examination report. Each compliance examination report shall be issued in accordance with Section 3-14 of the Illinois State
Auditing Act. A copy of each report shall also be delivered to
the head of the applicable State agency and posted on the Auditor General's website. (Source: P.A. 102-135, eff. 7-23-21; 102-579, eff. 8-25-21; 102-813, eff. 5-13-22; 103-94, eff. 1-1-24.) (Text of Section from P.A. 103-105) Sec. 370c.1. Mental, emotional, nervous, or substance use disorder or condition parity. (a) On and after July 23, 2021 (the effective date of Public Act 102-135), every insurer that amends, delivers, issues, or renews a group or individual policy of accident and health insurance or a qualified health plan offered through the Health Insurance Marketplace in this State providing coverage for hospital or medical treatment and for the treatment of mental, emotional, nervous, or substance use disorders or conditions shall ensure prior to policy issuance that: (1) the financial requirements applicable to such | ||
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(2) the treatment limitations applicable to such | ||
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(b) The following provisions shall apply concerning aggregate lifetime limits: (1) In the case of a group or individual policy of | ||
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(A) if the policy does not include an aggregate | ||
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(B) if the policy includes an aggregate lifetime | ||
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(i) apply the applicable lifetime limit both | ||
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(ii) not include any aggregate lifetime limit | ||
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(2) In the case of a policy that is not described in | ||
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(c) The following provisions shall apply concerning annual limits: (1) In the case of a group or individual policy of | ||
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(A) if the policy does not include an annual | ||
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(B) if the policy includes an annual limit on | ||
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(i) apply the applicable annual limit both to | ||
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(ii) not include any annual limit on mental, | ||
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(2) In the case of a policy that is not described in | ||
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(d) With respect to mental, emotional, nervous, or substance use disorders or conditions, an insurer shall use policies and procedures for the election and placement of mental, emotional, nervous, or substance use disorder or condition treatment drugs on their formulary that are no less favorable to the insured as those policies and procedures the insurer uses for the selection and placement of drugs for medical or surgical conditions and shall follow the expedited coverage determination requirements for substance abuse treatment drugs set forth in Section 45.2 of the Managed Care Reform and Patient Rights Act. (e) This Section shall be interpreted in a manner consistent with all applicable federal parity regulations including, but not limited to, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, final regulations issued under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and final regulations applying the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 to Medicaid managed care organizations, the Children's Health Insurance Program, and alternative benefit plans. (f) The provisions of subsections (b) and (c) of this Section shall not be interpreted to allow the use of lifetime or annual limits otherwise prohibited by State or federal law. (g) As used in this Section: "Financial requirement" includes deductibles, copayments, coinsurance, and out-of-pocket maximums, but does not include an aggregate lifetime limit or an annual limit subject to subsections (b) and (c). "Mental, emotional, nervous, or substance use disorder or condition" means a condition or disorder that involves a mental health condition or substance use disorder that falls under any of the diagnostic categories listed in the mental and behavioral disorders chapter of the current edition of the International Classification of Disease or that is listed in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders. "Treatment limitation" includes limits on benefits based on the frequency of treatment, number of visits, days of coverage, days in a waiting period, or other similar limits on the scope or duration of treatment. "Treatment limitation" includes both quantitative treatment limitations, which are expressed numerically (such as 50 outpatient visits per year), and nonquantitative treatment limitations, which otherwise limit the scope or duration of treatment. A permanent exclusion of all benefits for a particular condition or disorder shall not be considered a treatment limitation. "Nonquantitative treatment" means those limitations as described under federal regulations (26 CFR 54.9812-1). "Nonquantitative treatment limitations" include, but are not limited to, those limitations described under federal regulations 26 CFR 54.9812-1, 29 CFR 2590.712, and 45 CFR 146.136.
(h) The Department of Insurance shall implement the following education initiatives: (1) By January 1, 2016, the Department shall develop | ||
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(2) The Department, in coordination with the | ||
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(3) Not later than January 1 of each year, the | ||
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(A) Cover the methodology the Departments use to | ||
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(B) Cover the methodology the Departments use to | ||
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(C) Identify market conduct examinations or, in | ||
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(i) the number of market conduct examinations | ||
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(ii) the benefit classifications examined by | ||
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(iii) the subject matter of each market | ||
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(iv) a summary of the basis for the final | ||
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Individually identifiable information shall be | ||
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(D) Detail any educational or corrective actions | ||
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(E) The report must be written in non-technical, | ||
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(i) The Parity Advancement Fund is created as a special fund in the State treasury. Moneys from fines and penalties collected from insurers for violations of this Section shall be deposited into the Fund. Moneys deposited into the Fund for appropriation by the General Assembly to the Department shall be used for the purpose of providing financial support of the Consumer Education Campaign, parity compliance advocacy, and other initiatives that support parity implementation and enforcement on behalf of consumers. (j) (Blank). (k) An insurer that amends, delivers, issues, or renews a group or individual policy of accident and health insurance or a qualified health plan offered through the health insurance marketplace in this State providing coverage for hospital or medical treatment and for the treatment of mental, emotional, nervous, or substance use disorders or conditions shall submit an annual report, the format and definitions for which will be determined by the Department and the Department of Healthcare and Family Services and posted on their respective websites, starting on September 1, 2023 and annually thereafter, that contains the following information separately for inpatient in-network benefits, inpatient out-of-network benefits, outpatient in-network benefits, outpatient out-of-network benefits, emergency care benefits, and prescription drug benefits in the case of accident and health insurance or qualified health plans, or inpatient, outpatient, emergency care, and prescription drug benefits in the case of medical assistance: (1) A summary of the plan's pharmacy management | ||
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(2) A summary of the internal processes of review for | ||
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(3) A summary of how the plan's policies and | ||
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(4) A description of the process used to develop or | ||
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(5) Identification of all nonquantitative treatment | ||
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(6) The results of an analysis that demonstrates that | ||
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(A) identify the factors used to determine that a | ||
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(B) identify and define the specific evidentiary | ||
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(C) provide the comparative analyses, including | ||
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(D) provide the comparative analyses, including | ||
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(E) disclose the specific findings and | ||
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(7) Any other information necessary to clarify data | ||
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(l) An insurer that amends, delivers, issues, or renews a group or individual policy of accident and health insurance or a qualified health plan offered through the health insurance marketplace in this State providing coverage for hospital or medical treatment and for the treatment of mental, emotional, nervous, or substance use disorders or conditions on or after January 1, 2019 (the effective date of Public Act 100-1024) shall, in advance of the plan year, make available to the Department or, with respect to medical assistance, the Department of Healthcare and Family Services and to all plan participants and beneficiaries the information required in subparagraphs (C) through (E) of paragraph (6) of subsection (k). For plan participants and medical assistance beneficiaries, the information required in subparagraphs (C) through (E) of paragraph (6) of subsection (k) shall be made available on a publicly-available website whose web address is prominently displayed in plan and managed care organization informational and marketing materials. (m) In conjunction with its compliance examination program conducted in accordance with the Illinois State Auditing Act, the Auditor General shall undertake a review of
compliance by the Department and the Department of Healthcare and Family Services with Section 370c and this Section. Any
findings resulting from the review conducted under this Section shall be included in the applicable State agency's compliance examination report. Each compliance examination report shall be issued in accordance with Section 3-14 of the Illinois State
Auditing Act. A copy of each report shall also be delivered to
the head of the applicable State agency and posted on the Auditor General's website. (Source: P.A. 102-135, eff. 7-23-21; 102-579, eff. 8-25-21; 102-813, eff. 5-13-22; 103-105, eff. 6-27-23.) |
(215 ILCS 5/370c.2) Sec. 370c.2. (Repealed).
(Source: P.A. 102-304, eff. 8-6-21. Repealed internally, eff. 1-1-23.) |
(215 ILCS 5/370d) (from Ch. 73, par. 982d)
Sec. 370d.
Companies which issue insurance policies under this Article
containing business overhead expense coverage shall make available to persons
whose occupation is that of homemaker and who are not otherwise gainfully
employed, coverage which provides for reimbursement of certain specified
expenses ordinarily incurred by members of the household due to the incapacity
of the homemaker during periods of his or her total disability resulting
from injury or sickness, provided that such companies shall be required
to offer coverage which is at least 80% of total eligible expenses or $300
per month, whichever provides the lesser coverage.
(Source: P.A. 81-916.)
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(215 ILCS 5/370d.1) Sec. 370d.1. Group policies; chambers of commerce. Companies that issue group policies of accident and health insurance under this Article must offer such policies to local chambers of commerce.
(Source: P.A. 102-611, eff. 1-1-22.) |
(215 ILCS 5/370e) (from Ch. 73, par. 982e)
Sec. 370e.
Companies which issue group accident and health policies
or blanket accident and health plans to employer groups in this State shall
provide the employer with notice of termination of a group or blanket accident
and health plan because of the employer's failure to pay the premium when
due. The insurance company shall send a copy of such notice to the Department.
(Source: P.A. 83-1006.)
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(215 ILCS 5/Art. XX.5 heading) ARTICLE XX-1/2
HEALTH CARE REIMBURSEMENT
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(215 ILCS 5/370f) (from Ch. 73, par. 982f)
Sec. 370f.
Short Title.
This Article may be cited as the "Health Care
Reimbursement Reform Act of 1985".
(Source: P.A. 84-618.)
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(215 ILCS 5/370g) (from Ch. 73, par. 982g)
Sec. 370g. Definitions. As used in this Article, the following definitions
apply:
(a) "Health care services" means health care services or products
rendered or sold by a provider within the scope of the provider's license
or legal authorization. The term includes, but is not limited to, hospital,
medical, surgical, dental, vision and pharmaceutical services or products.
(b) "Insurer" means an insurance company or a health service corporation
authorized in this State to issue policies or subscriber contracts which
reimburse for expenses of health care services.
(c) "Insured" means an individual entitled to reimbursement for expenses
of health care services under a policy or subscriber contract issued or
administered by an insurer.
(d) "Provider" means an individual or entity duly licensed or legally
authorized to provide health care services.
(e) "Noninstitutional provider" means any person licensed under the Medical
Practice Act of 1987, as now or hereafter amended.
(f) "Beneficiary" means an individual entitled to reimbursement for
expenses of or the discount of provider fees for health care services under
a program where the beneficiary has an incentive to utilize the services of a
provider which has entered into an agreement or arrangement with an
administrator.
(g) "Administrator" means any person, partnership or corporation, other
than an insurer or health maintenance organization holding a certificate of
authority under the "Health Maintenance Organization Act", as now or hereafter
amended, that arranges, contracts with, or administers contracts with a
provider whereby beneficiaries are provided an incentive to use the services of
such provider.
(h) "Emergency medical condition" has the meaning given to that term in Section 10 of the Managed Care Reform and Patient Rights Act.
(Source: P.A. 102-409, eff. 1-1-22.)
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(215 ILCS 5/370h) (from Ch. 73, par. 982h)
Sec. 370h.
Noninstitutional providers.
Before entering into any agreement
under this Article an insurer or administrator shall establish terms and
conditions that must be met by noninstitutional providers wishing to enter into
an agreement with the insurer or administrator. These terms and conditions may
not discriminate unreasonably against or among noninstitutional providers.
Neither difference in prices among noninstitutional providers produced by
a process of individual negotiation nor price differences among other
noninstitutional providers in different geographical areas or different
specialties constitutes unreasonable discrimination.
An insurer or administrator shall not refuse to contract with any
noninstitutional provider who meets the terms and conditions
established by the insurer or administrator.
(Source: P.A. 90-655, eff. 7-30-98.)
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(215 ILCS 5/370i) (from Ch. 73, par. 982i)
Sec. 370i.
Policies, agreements or arrangements with incentives or
limits on reimbursement authorized.
(a) Policies, agreements or arrangements issued under this Article may
not contain terms or conditions that would operate unreasonably to restrict
the access and availability of health care services for the insured.
(b) An insurer or administrator may:
(1) enter into agreements with certain providers of | ||
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(2) issue or administer programs, policies or | ||
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(c) After the effective date of this amendatory Act of the 92nd General
Assembly, any insurer
that arranges, contracts with, or administers contracts with a provider whereby
beneficiaries are
provided an incentive to use the services of such provider must include the
following disclosure
on its contracts and evidences of coverage: "WARNING, LIMITED BENEFITS WILL
BE
PAID WHEN NON-PARTICIPATING PROVIDERS ARE USED. You should be aware that
when you elect to utilize the services of a non-participating provider for a
covered service in
non-emergency situations, benefit payments to such non-participating provider
are not based
upon the amount billed. The basis of your benefit payment will be determined
according to your
policy's fee schedule, usual and customary charge (which is determined by
comparing charges
for similar services adjusted to the geographical area where the services are
performed), or other
method as defined by the policy. YOU CAN EXPECT TO PAY MORE THAN THE
COINSURANCE AMOUNT DEFINED IN THE POLICY AFTER THE PLAN HAS PAID ITS
REQUIRED PORTION. Non-participating providers may bill members for any amount
up to
the billed charge after the plan has paid its portion of the bill.
Participating providers have
agreed to accept discounted payments for services with no additional billing to
the member other
than co-insurance and deductible amounts. You may obtain further information
about the
participating status of professional providers and information on out-of-pocket
expenses by
calling the toll free telephone number on your identification card.".
(Source: P.A. 92-579, eff. 1-1-03.)
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(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) (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) (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) (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) (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) (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) (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) (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) (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)
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.)
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(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 heading) ARTICLE XXII.
CASUALTY INSURANCE, FIDELITY BONDS AND SURETY CONTRACTS
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(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) (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) (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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(215 ILCS 5/388-1) (from Ch. 73, par. 1000-1)
Sec. 388-1.
No company selling insurance defined in clause (b) of class 2 of
Section 4 may require a policyholder to take a physical examination as a
condition for renewal of such policy if the policyholder has been
insured by the company for 5 years or longer, unless the company pays
the cost of such physical examination, and the physical examination is
given by a physician chosen by the policyholder.
(Source: P.A. 78-703.)
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(215 ILCS 5/388a) (from Ch. 73, par. 1000a)
Sec. 388a.
Group
vehicle insurance defined.
(a) Group vehicle insurance is declared to be that form of vehicle
insurance
covering not less than 10 employees, members, or employees of members,
written under a master policy issued to any governmental corporation, unit,
agency or department thereof, or to any corporation, co-partnership,
individual employer, or to any association upon application of an executive
officer or trustee of such association having a constitution or by-laws and
formed in good faith for purposes other than that of obtaining insurance,
where officers, members, employees, employees of members or classes or
department thereof, may be insured for their individual benefit. In
addition a group vehicle policy may be written to insure any group which
may be insured under a group life insurance policy. The term "employees"
shall include the officers, managers and employees of subsidiary or
affiliated corporations, and the individual proprietors, partners and
employees of affiliated individuals and firms, when the business of such
subsidiary or affiliated corporations, firms or individuals, is controlled
by a common employer through stock ownership, contract or otherwise.
(b) A group vehicle insurance policy may provide physical damage coverage,
liability coverage, or a combination of physical damage and
liability
coverage. A group
physical damage policy and a certificate incidental to that policy, issued
in accordance with this Section, does not meet the mandatory insurance
requirements under the Illinois Vehicle Code and must contain a warning to the
consumer
that the policy does not comply with those requirements.
(Source: P.A. 88-313.)
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(215 ILCS 5/388b) (from Ch. 73, par. 1000b)
Sec. 388b.
Group
vehicle insurance authorized.
Any insurance company authorized to write vehicle insurance in this
State, as authorized by clause (b) of Class 2 and clause (e) of Class 3 of
Section 4, shall have
power to issue group vehicle policies. Group vehicle insurance policies
shall be subject to the filing requirements of Section 143 and shall include
the provisions required by Sections 388c through 388f of this Code. A group
vehicle insurance policy that provides liability coverage shall comply with the
requirements of Section 7-317 of the Illinois Vehicle Code.
(Source: P.A. 88-313.)
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(215 ILCS 5/388c) (from Ch. 73, par. 1000c)
Sec. 388c.
"Entire
contract" specified.
Each group vehicle insurance policy shall provide that the policy, the
application of the employer, or executive officer or trustee of any
association, and the individual applications, if any, of the employees,
members or employees of members insured shall constitute the entire
contract between the parties, and that all statements made by the employer,
or the executive officer or trustee, or by the individual employees,
members or employees of members shall, in the absence of fraud, be deemed
representations and not warranties, and that no such statement shall be
used in defense to a claim under the policy, unless it is contained in a
written application.
(Source: P.A. 77-1576.)
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(215 ILCS 5/388d) (from Ch. 73, par. 1000d)
Sec. 388d.
Certificates required.
Each group vehicle insurance policy shall provide that the insurer will
issue to the employer, or to the executive officer or trustee of the
association, for delivery to the employee, member or employee of a member,
who is insured under such policy, an individual certificate setting forth a
statement as to the insurance protection to which he is entitled and to
whom payable and, at the request of any participating member or employee
that has liability insurance coverage, will issue a certificate of his
vehicle
insurance to the Secretary of State
as proof of the insured's financial
responsibility in compliance with the Illinois Vehicle Code.
(Source: P.A. 88-313.)
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(215 ILCS 5/388e) (from Ch. 73, par. 1000e)
Sec. 388e.
New
members of group.
Each group vehicle insurance policy shall provide that to the group or
class thereof originally insured shall be added from time to time all new
employees of the employer, members of the association or employees of
members eligible to and applying for insurance in such group or class but
participation in the group plan shall not be required as a condition of
employment, nor shall any member not participating in the plan be coerced
or discriminated against.
(Source: P.A. 77-1576.)
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(215 ILCS 5/388f) (from Ch. 73, par. 1000f)
Sec. 388f.
Conversion rights.
Each group vehicle insurance policy shall provide that any member of the
group shall have the right to convert his group policy to an individual
standard policy of insurance in the same company as offered by the insurer
to the non-group insureds upon termination of his connection with the group
extending to him the same limits of coverage.
(Source: P.A. 77-1576.)
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(215 ILCS 5/388g) (from Ch. 73, par. 1000g)
Sec. 388g.
Cancellation restricted.
An insurer may not cancel the insurance of an individual member of a
group covered by a group vehicle insurance policy except for the
non-payment of premium by such member or unless the insurance for the
entire group is cancelled. In such cases notice of cancellation as provided
in like non-group policies shall be given to each member and, when
appropriate, to the Secretary of State.
(Source: P.A. 77-1576.)
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(215 ILCS 5/388h) (This Section may contain text from a Public Act with a delayed effective date) Sec. 388h. Opioid antagonists; Liquor Control Act of 1934. An insurer that is licensed and authorized to do business in this State shall consider an applicant's or insured's compliance with Section 6-39 of the Liquor Control Act of 1934 when providing commercial liability insurance to a music venue as defined in subsection (a) of Section 6-39 of the Liquor Control Act of 1934.
(Source: P.A. 103-20, eff. 6-1-24.) |
(215 ILCS 5/389) (from Ch. 73, par. 1001)
Sec. 389.
Definition.
Fidelity and surety business specified in paragraph (g) of Class 2 of
section 4 shall be known as surety business, and the obligations
connected therewith as suretyship obligations notwithstanding any other
designation or classification contained in this Code to the contrary.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/390) (from Ch. 73, par. 1002)
Sec. 390.
Corporate bonds satisfy legal requirement.
Whenever a bond, undertaking, recognizance, guaranty or other
obligation is required, permitted, authorized or allowed; or whenever
the performance of any act, duty or obligation, or forbearance, is
required, permitted, authorized or allowed to be secured or guaranteed,
such bond, undertaking, recognizance or other obligation, or such
security or guaranty, may be executed by a company authorized in this
State to do the kinds of business described in clause (g) of Class 2 of
section 4; and such companies are authorized and empowered to execute all
such instruments; and in case two or more of such companies execute any
such instrument each of such companies is hereby authorized and
empowered to limit its liability therein to an amount less than the
aggregate penalty of such instrument and also to limit its liability to
a pro rata part of any and all losses under such instrument; and the
execution by any such company of such bond, undertaking, recognizance,
guaranty or other obligation by an officer, attorney-in-fact or other
authorized representative shall be sufficient and be accepted as and be
a full compliance with every law or other requirement now in force or
that may hereafter be enacted or made that such bond, undertaking,
recognizance, guaranty or like obligation be required or permitted or be
executed by a surety or sureties, or that such surety or sureties be
residents, householders or owners or life tenants of real estate,
or possess any other qualifications.
(Source: P.A. 84-551.)
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(215 ILCS 5/391) (from Ch. 73, par. 1003)
Sec. 391.
Trustee may have corporate surety.
A party of whom a bond or
other undertaking is required or permitted or by law allowed may agree with
his sureties for the deposit or safekeeping of any or all moneys, assets
and other property for which he, she or it is or may be held responsible,
with a bank, savings bank, safe deposit, savings and loan association or
trust company authorized by law to do business as such, and in such manner
as to prevent the withdrawal
or alienation thereof without the written consent of such sureties or an
order of the court having jurisdiction of such fiduciary made on such notice
to such sureties as such court may direct. It shall be lawful for such sureties
to enter into contracts for their indemnity or security with any person, partnership,
association or corporation, provided that such contracts are not prohibited
by law or against public policy.
(Source: P.A. 83-1362.)
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(215 ILCS 5/392) (from Ch. 73, par. 1004)
Sec. 392.
Estoppel.
Any company which shall execute any bond, recognizance, obligation,
stipulation or undertaking as surety shall be estopped, in any proceeding
to enforce the liability which it shall have assumed to incur, to deny its
power to execute the same or assume such liability.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/392.1) (from Ch. 73, par. 1004.1)
Sec. 392.1.
Casualty and surety companies exempted from filing appeal bonds upon proof of liability - Taxable costs.
Whenever an appeal is taken from any judgment in any case wherein it
appears to the court that all of the particular liability of the
appellant thereunder is insured against in and by a liability insurance
policy or surety bond issued by any insurance company authorized to do
business in the State of Illinois, and the court is satisfied of the
applicable coverage of such policy or bond, it shall not be required of the
appellant to provide any appeal bond or bond to stay enforcement pending such
appeal, but such insurance company may be required by the court, and is
hereby given authority, to execute its written recognizance of the adverse
party or parties for the payment of the taxable costs of such appeal.
Such company shall deposit with the court a copy of the
insurance policy or bond and shall admit its liability thereunder, and
agree to pay such judgment against its insured, if any, as shall be
affirmed by the appellate court; and in such case the court having
jurisdiction thereof, on its own motion, may enter judgment against the
insurance company to such extent without further proceedings.
(Source: P.A. 84-546.)
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(215 ILCS 5/Art. XXIII heading) ARTICLE XXIII.
FIRE AND MARINE INSURANCE
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(215 ILCS 5/393) (from Ch. 73, par. 1005)
Sec. 393.
Scope of
article.
This article shall apply to all companies authorized to transact the
kind or kinds of business enumerated in Class 3 of Section 4.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/393.1) (from Ch. 73, par. 1005.1)
Sec. 393.1.
Unearned premium reserve.
(1) Every insurance company authorized in this State to transact any of
the kinds of business described in Class 3 of Section 4 shall maintain an
unearned premium reserve on all policies in force which reserve shall be
charged as a liability. The portions of the gross premiums in force, after
deducting bona fide reinsurance in authorized companies, which shall be
held as a premium reserve, shall never be less in the aggregate than the
company's actual liability to all its insureds for the return of gross
unearned premiums. In the calculation of the company's actual liability to
all its insureds, the reserve shall be computed pursuant to the method
commonly referred to as the monthly pro rata method; provided, however,
that the Director may require that such reserve shall be equal to the
unearned portions of the gross premiums in force, after deducting
reinsurance in authorized companies, in which case the reserve shall be
computed on each respective risk from the date of the issuance of the
policy.
(2) Before any reinsurance may qualify as a deduction from a company's
unearned premium reserve, the accepting company shall assume full liability
for the amount of coverage which the ceding company guaranteed for the
portions of premiums which it ceded to the accepting company.
(Source: Laws 1967, p. 1745.)
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(215 ILCS 5/393a) (from Ch. 73, par. 1005a)
Sec. 393a.
Group professional liability insurance defined.) Group
professional liability insurance is declared to be that form of liability
insurance covering not less than 10 employees of any public school
district, nonprofit organization or other organization operating an
elementary or secondary school, including, but not limited to, nursery and
kindergarten programs, or of any public, nonprofit or other institution of
higher education for all sums for which such employees may become liable
for rendering, failing to render, or as a consequence of rendering or
failing to render professional services in such employment.
However, such coverage shall not include intentional acts or omissions
in violation of any law or court order.
Such coverage shall
be written under a master policy issued to
any governmental corporation, unit, agency or department thereof, or to
any corporation, copartnership,
individual employer, or to any association upon application of an executive
officer or trustee of such
association having a constitution or by-laws and formed in good faith for
purposes other than that of
obtaining insurance, where officers, members, employees of members or classes
or departments thereof,
may be insured for their individual benefit.
(Source: P.A. 79-685.)
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(215 ILCS 5/393b) (from Ch. 73, par. 1005b)
Sec. 393b.
Group
professional liability insurance authorized.)
Any insurance company authorized to write group professional liability insurance in this
State shall have power to issue group professional liability policies.
No policy of group
professional liability insurance may be issued or delivered in this State unless
a copy of the form thereof shall have been filed with the Director of
Insurance and approved by it
and it contains in substance
the provisions required by Sections 393c through 393f of this
Article.
(Source: P.A. 79-685.)
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(215 ILCS 5/393c) (from Ch. 73, par. 1005c)
Sec. 393c.
"Entire contract" specified.)
Each group professional liability insurance policy shall provide that the policy, the
application of the employer, or executive officer or trustee of any
association, and the individual applications, if any, of the employees,
members or employees of members insured shall constitute the entire
contract between the parties, and that all statements made by the employer,
or the executive officer or trustee, or by the individual employees,
members or employees of members shall, in the absence of fraud, be deemed
representations and not warranties, and that no such statement shall be
used in defense to a claim under the policy, unless it is contained in a
written application.
(Source: P.A. 79-685.)
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(215 ILCS 5/393d) (from Ch. 73, par. 1005d)
Sec. 393d.
Certificates required.)
Each group professional liability insurance policy shall provide that the insurer will
issue to the employer, or to the executive officer or trustee of the
association, for delivery to the employee, member or employee of a member,
who is insured under such policy, an individual certificate setting forth a
statement as to the insurance protection to which he is entitled and to
whom payable.
(Source: P.A. 79-685.)
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(215 ILCS 5/393e) (from Ch. 73, par. 1005e)
Sec. 393e.
New
members of group.)
Each group professional liability insurance policy shall provide that to the group or
class thereof originally insured shall be added from time to time all new
employees of the employer, members of the association or employees of
members eligible to and applying for insurance in such group or class but
participation in the group plan shall not be required as a condition of
employment, nor shall any member not participating in the plan be coerced
or discriminated against.
(Source: P.A. 79-685.)
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(215 ILCS 5/393f) (from Ch. 73, par. 1005f)
Sec. 393f.
Conversion rights.)
Each group professional liability insurance policy shall provide that any member of the
group shall have the right to convert his group policy to an individual
standard policy of insurance in the same company as offered by the insurer
to the non-group insureds upon termination of his connection with the group
extending to him the same limits of coverage.
(Source: P.A. 79-685.)
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(215 ILCS 5/393g) (from Ch. 73, par. 1005g)
Sec. 393g.
Cancellation restricted.)
An insurer may not cancel the insurance of an individual member of a
group covered by a group professional liability insurance policy except for the
non-payment of premium by such member or unless the insurance for the
entire group is cancelled. In such cases notice of cancellation as provided
in like non-group policies shall be given to each member.
(Source: P.A. 79-685.)
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(215 ILCS 5/395) (from Ch. 73, par. 1007)
Sec. 395.
Reserves for marine and inland marine.
In the case of policies
of marine or inland navigation or transportation insurance the unearned
premium reserve, to be charged as a liability, shall be fifty per centum of
the amount of the premiums upon risks covering not more than one passage
not terminated and shall be upon a pro rata basis for all other policies.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/396) (from Ch. 73, par. 1008)
Sec. 396.
Loss and
loss expense reserves.
(1) Every company authorized to transact in this State any of the kinds
of business described in Class 3 of Section 4 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. For the
purpose of such reserves, the company shall keep a complete and itemized
record showing all losses and claims on which it has received notice,
including all notices received by it of the occurrence of any event which
may result in a loss. Such record shall be opened in chronological receipt
order, with each notice of loss or claim identified by appropriate number
or coding.
(2) Whenever the loss and loss expense experience of such company shows
the reserves, calculated in accordance with the foregoing provisions, to be
inadequate, the Director may require such company to maintain additional
reserves.
(Source: Laws 1967, p. 1819.)
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(215 ILCS 5/397) (from Ch. 73, par. 1009)
Sec. 397.
Standard fire policy.) The Director of Insurance shall
promulgate such rules and regulations as may be necessary to effect
uniformity in all basic policies of fire and lightning insurance issued
in this State, to the end that there be concurrency of contract where
two or more companies insure the same risk.
(Source: P.A. 80-1441.)
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(215 ILCS 5/397.05) (from Ch. 73, par. 1009.05)
Sec. 397.05.
Standard fire policy; appraisal.
When an insured
requests an appraisal under a policy of fire and extended coverage
insurance, as defined in subsection (b) of Section 143.13, and the
insured's full amount of appraised loss is upheld by agreement of the
appraisers or the umpire, then the insured's appraisal fee and umpire's
appraisal fee shall be paid by the insurer.
(Source: P.A. 87-681.)
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(215 ILCS 5/397.1) (from Ch. 73, par. 1009.1)
Sec. 397.1.
Certificate regarding payment of taxes and expenses on
property sustaining loss.
(a) It shall be unlawful for any company transacting insurance business
in this State to pay a claim of an insured property owner for loss by fire
or explosion to a structure located in this State where the amount
recoverable for loss to the structure under a policy exceeds $25,000, until
the insurance company receives the certificate required by this Section. A
notice, to the State's Attorney of the county where the structure is
located, of the insurers intent to pay a claim shall include the name of
the property owner, the address of the property, its legal description, the
permanent real estate index number that identifies the property for
purposes of taxation, and the amount of the claim to be paid.
(b) For purposes of this Section, the following definitions are
applicable:
(1) "Insured property owner" is a person named as an | ||
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(2) "Amount recoverable" is the dollar amount payable | ||
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(3) "Proceeds" is the dollar amount payable for loss | ||
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(4) "Delinquent property taxes" are those property | ||
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In determining delinquent property taxes under this | ||
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(5) "Incurred demolition expense" is: a. the cost of | ||
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Incurred demolition expense shall be determined under | ||
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(6) "Property" is the lot on which the structure is | ||
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(7) "Structure" is a building.
(8) "Claim" is the demand by an insured for payment | ||
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(9) "Proof of Loss" is the document on which an | ||
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(10) "Certificate" is the executed form prescribed by | ||
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(11) "Executed" means signed by the appropriate | ||
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(c) For any claim to which this Section is applicable, an insured
property owner must submit one of the following to the insurance
company:
(1) a certificate that with respect to the property | ||
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a. no delinquent property taxes, and
b. no unpaid incurred demolition expenses;
(2) a certificate setting forth with respect to the | ||
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a. the amount of unpaid delinquent property taxes,
b. the amount of unpaid incurred demolition | ||
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c. a direction by an insured property owner to | ||
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(d) (1) Except as provided in paragraph (2) of this | ||
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Any proceeds remaining shall be paid to the insured | ||
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(2) In the event incurred demolition expense is | ||
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In determining the amount of proceeds remaining under | ||
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(e) If, under this Section, the proceeds payable are less than the
amount of the unpaid delinquent property taxes and unpaid incurred
demolition expense, unpaid property taxes shall be paid first.
(f) If incurred demolition expense withheld pursuant to
subparagraphs b. or c. of paragraph 5 of subsection (b) of this Section
exceeds the ultimate cost of demolition, the excess shall first be
applied to unpaid delinquent property taxes. Any amount of proceeds
remaining shall be paid to the insured property owner.
(g) Nothing in this Section shall be construed as:
(1) making an insurance company liable for any amount | ||
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(2) making a unit of local government or tax | ||
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(3) creating an obligation for an insurance company | ||
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(h) An insurance company making a payment of proceeds under this
Section for unpaid delinquent taxes or unpaid incurred demolition
expense shall be entitled to the full benefit of such payment, including
subrogation rights and other rights of assignment.
(i) Unpaid property taxes and unpaid incurred demolition expense for
a claim for loss to a structure occurring after the issuance of a tax
deed pursuant to Section 22-40 of the Property Tax Code shall not include any
unpaid property tax or unpaid demolition expense arising before the issuance of
the tax deed.
(j) The county collector shall be designated as the local
official who shall execute the certificate required by this Section regarding
delinquent property taxes. The village clerk or city clerk in incorporated
areas and the official in charge of the county building department in
unincorporated areas shall be designated as
the local official who shall execute the certificate required by this Section
regarding demolition expenses.
(k) A fee not to exceed $5 may be charged by a unit of local
government for execution of the certificate required by this Section.
(l) This Section shall retroactively apply to any policy issued or renewed
on or after January 1, 1978 for which a claim subject to this Section remains
unpaid as of the effective date of this amendatory Act of 1978.
(Source: P.A. 87-507; 88-667, eff. 9-16-94; 88-670, eff. 12-2-94.)
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(215 ILCS 5/399) (from Ch. 73, par. 1011)
Sec. 399.
Combination policies.
Two or more companies authorized to transact business in this State
may issue a combination or group form of policy, using a distinctive
title therefor, which title shall appear at the head of such policy
followed by the titles of the companies obligated thereupon, and which
policy shall be executed by the officers of each such companies;
provided, that before such companies shall issue such combination or
group policy, the title of such proposed policy and the terms of the
additional provisions thereof, hereby authorized, shall have been filed
with the Director, which terms, in addition to the provisions of the
standard policy and not inconsistent therewith, shall provide
substantially under a separate title therein, as follows:
(a) that each company executing such policy shall be liable for the
full amount of any loss or damage, according to the terms of the policy,
or a specific percentage thereof;
(b) that service of process, or of any notice or proof of loss
required by the said policy, upon any of the companies executing the
same shall be deemed to be service upon all; and provided further that
the unearned premium liability on each policy so issued shall be
maintained by each of such companies on the basis of the liability of
each to the insured thereunder.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/400) (from Ch. 73, par. 1012)
Sec. 400.
Supplemental or comprehensive contracts.
Forms for supplemental contracts or comprehensive contracts whereby
the property described may be insured against one or more risks
specified in Class 2 or Class 3 of Section 4, in addition to the risk of
direct loss or damage by fire, and forms of fire policies on farm
property may be approved by the Director and their use in connection
with or in lieu of a standard fire insurance policy may be authorized by
the Director.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/400.1) (from Ch. 73, par. 1012.1)
Sec. 400.1. Group or master policy-certificate inland marine
insurance authorized. (1) Any insurance company authorized to write inland
marine insurance in this State may issue group or master policy-certificate inland
marine policies which may include coverages incidental or supplemental to the
inland marine policy, if the insurer is authorized to write the class of coverage
which is incidental or supplemental. No policy, certificate of insurance, memorandum
of insurance, application for insurance, endorsement or rider, may be issued
for delivery
in this State unless a copy of the form thereof shall have been filed with the Director
of Insurance and approved, or unless exempted from filing by such
rules and regulations as may be promulgated by the Director.
(2) The Director shall within 90 days after the filing of such forms disapprove
any such
form if the benefits provided therein are not reasonable in relation to
the premium charged, or
if it contains provisions that are unjust, unfair, inequitable, misleading,
deceptive, or
encourage misrepresentation of the coverage, or are contrary to any provision
of this
Code, or any rule or regulation promulgated thereunder. The Director may,
upon written notice
within such waiting period to the company which made the filing, extend
such waiting period for
an additional 30 days. A filing shall be deemed to meet the requirements
of this Section unless
disapproved by the Director within the waiting period or the extension thereof.
(3) If the Director notifies the insurer that the form is disapproved,
the insurer shall not
issue or use such form. In such notice the Director shall specify the reason
for his disapproval.
The company may request a hearing on such disapproval within 30 days after
receipt of such
disapproval. The Director shall grant a hearing subsequent to the receipt
of such request.
(4) The Director may, at any time after a hearing held not less than 20
days after written
notice to the insurer, withdraw his approval of any such form on any ground set forth in
subsection (2) above. The written notice of such hearing shall state the
reason for the proposed
withdrawal.
(5) It is not lawful for the insurer to issue such forms or use them after
the effective
date of such withdrawal.
(6) The Director may at any time require the filing of the schedules of premium rates
used or to be used in connection with the specific policy filings required.
(7) The Director shall promulgate such rules and regulations as he may
deem necessary to
provide for the filing and review of premium rates schedules, and for the
disapproval of those
he may deem to be inadequate, excessive or unfairly discriminatory.
(8) Any order or final determination of the Director under the provisions
of this Section
shall be subject to judicial review.
(Source: P.A. 100-863, eff. 8-14-18.)
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(215 ILCS 5/Art. XXIV heading) ARTICLE XXIV.
DIRECTOR OF INSURANCE, HEARINGS AND REVIEW
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(215 ILCS 5/401) (from Ch. 73, par. 1013)
Sec. 401. General powers of the director. The Director is charged with the rights, powers and duties appertaining
to the enforcement and execution of all the insurance laws of this State.
He shall have the power
(a) to make reasonable rules and regulations as may | ||
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(b) to conduct such investigations as may be | ||
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(c) to conduct such examinations, investigations and | ||
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(d) to institute such actions or other lawful | ||
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Whenever the Director is authorized or
required by law to consider some aspect of criminal history record
information for the purpose of carrying out his statutory powers and
responsibilities, then, upon request and payment of fees in conformance
with the requirements of Section 2605-400 of the Illinois State Police Law, the Illinois State Police is
authorized to furnish, pursuant to positive identification, such
information contained in State files as is necessary to meet the
requirements of such authorization or statutes.
(Source: P.A. 102-538, eff. 8-20-21.)
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(215 ILCS 5/401.1) (from Ch. 73, par. 1013.1)
Sec. 401.1.
(1) This Section applies to all companies and persons subject to
examination by the Director, or purporting to do insurance business in
this State, or in the process of organization with intent to do such
business therein, or for whom a Certificate of Authority is required for
the transaction of business, or whose Certificate of Authority is
revoked or suspended.
(2) Whenever it appears to the Director that any person or company
subject to this Code is conducting its business and affairs in such a
manner as to threaten to render it insolvent, or that it is in a
hazardous condition, or is conducting its business and affairs in a
manner which is hazardous to its policyholders, creditors or the public,
or that it has committed or engaged in, or is committing or engaging in,
any unlawful act, or any act, practice or transaction which under any
provision of this Code would constitute ground rendering the person
subject to conservation, liquidation or rehabilitation proceedings and
that irreparable loss and injury to the property and business of a
person or company has occurred or may occur unless the Director acts
immediately, the Director may, without notice, and before hearing, issue
and cause to be served upon such person or company an order requiring
such person or company to forthwith cease and desist from engaging
further in the acts, practices or transactions which are causing such
conduct, condition or ground to exist.
(3) At the same time an order is served pursuant to paragraph (2) of
this Section, the Director must issue and also serve upon the person or
company a notice of hearing to be held at a time and place fixed therein
which may not be less than 20 or more than 30 days after the service
thereof. The notice must contain a statement of the conduct, condition
or ground which the Director deems violative of the provisions of this
Section.
(4) If, after hearing as provided by paragraph (3) of this Section,
any of the statements as to conduct, conditions or grounds in the notice
are found to be true, the Director may make such order or orders as may
be reasonably necessary to correct, eliminate or remedy such conduct,
conditions or grounds.
(5) Any person or company subject to an order pursuant
to this Article is entitled to judicial review of the order in accordance
with the provisions of the Administrative Review Law.
(6) If any person or company violates or fails to comply with any
order of the Director or any part thereof which as to such person has
become final and is still in effect, the Director may, after a hearing
and notice at which it is determined that a violation of such order has
been committed, further order that:
(a) Such person shall forfeit and pay to the State of Illinois a sum
not to exceed $100 per day for each and every day that such violation or
failure to comply shall continue, but in no event to exceed a maximum
amount of $5,000. Such liability shall be enforced in an action brought
in any court of competent jurisdiction by the Director in the name of
the people of the State of Illinois; and
(b) Proceedings be commenced to revoke or suspend any license or
Certificate of Authority held by such person under this Code, in
accordance with the procedures provided therefor.
(7) The powers vested in the Director by this Section are additional
to any and all other powers and remedies vested in the Director by law,
and nothing herein shall be construed as requiring that the Director
shall employ the powers conferred herein instead of or as a condition
precedent to the exercise of any other power or remedy vested in the
Director.
(8) Any order or notice of the Director hereunder may be served on
any person, in the same manner and with the same effect as provided for
in civil actions in a Circuit Court of this State.
(Source: P.A. 82-783.)
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(215 ILCS 5/401.3) Sec. 401.3. Advisory council; powers and duties. There is created within the Department an advisory council to review and make recommendations to the Department regarding rules to be adopted with respect to continuing education courses for which the approval of the Department is required under the provisions of this Code. In addition, the advisory council shall make recommendations to the Department regarding rules with respect to course materials, curriculum, and credentials of instructors. The advisory council shall be comprised of 7 members appointed by the Director. One member shall be an educational instructor who has regularly provided educational offerings for more than 5 out of the last 10 years to individuals licensed under this Code. Three members shall be recommended by the leadership of 3 statewide trade organizations whose memberships are primarily composed of individuals licensed under this Code, none of which may come from the same organization. Three members shall represent a domestic company. The members' terms shall be 3 years or until their successors are appointed, and the expiration of their terms shall be staggered. No individual may serve more than 3 consecutive terms. The Director shall appoint an employee of the Department to serve as the chairperson of the advisory council, ex officio, without a vote. Four voting advisory council members shall constitute a quorum. A quorum is necessary for all advisory council decisions and recommendations.
(Source: P.A. 100-876, eff. 8-14-18.) |
(215 ILCS 5/401.5)
Sec. 401.5.
Investigation of insurance law violations.
(a) If the Director of Insurance has cause to
believe that a person has engaged in, or is engaging in, an act,
activity, or practice that constitutes a business offense,
misdemeanor, or felony violation of the Illinois Insurance Code or related
insurance laws, he or she shall designate appropriate investigators or
agents to investigate the violations. For purposes of carrying
out investigations under this Section, the Department of Insurance is deemed a
criminal justice agency under all federal and State laws
and regulations, and as such shall have access to any information that concerns
or relates to a violation of the Illinois Insurance Code or
related insurance laws and that is available to criminal justice
agencies.
(b) The Director of Insurance may
transmit or receive written or oral information relating to possible violations
of the insurance laws of this State received by or from any other criminal
justice agencies, whether federal, State, or local, if, in the opinion of
the Director, the transmittal is appropriate and may further the
effective prevention of criminal activities.
(c) The Department of Insurance's papers, documents, reports,
or evidence relevant to the subject of an investigation under this Section
is not subject to public inspection for so long as the
Department deems reasonably necessary to complete the investigation, to protect
the person investigated
from unwarranted injury, or to be in the public interest. Further, the papers,
documents, reports, or evidence relevant to the subject of an
investigation under this Section is not subject to
subpoena until opened for public inspection by the Department, unless the
Department consents, or until, after notice to the Department and a hearing,
the court determines the Department would not be unnecessarily hindered by
the subpoena. No officer, agent, or employee of the
Department is subject to subpoena in civil actions by a court of this State to
testify concerning a matter of which
they have knowledge under a pending insurance fraud
investigation by the Department.
(d) No insurer, or employees or agents of an
insurer, are subject
to civil liability for libel or otherwise by virtue of furnishing information
required by the insurance laws of this State or required by the Department
of Insurance as a result of its investigation. No cause of action exists and
no liability may be imposed, either civil or criminal,
against the State, the Director, any officer, agent, or employee of the
Department of Insurance, or individuals employed or retained by the Director,
for an act or omission by them in the performance of a
power or duty authorized by this Section, unless the act or
omission
was performed in bad faith and with intent to injure a particular person.
(e) The powers vested in the Director by this Section are
additional to other powers and remedies vested in the Director
by law, and nothing in this Section shall be construed as
requiring that the Director shall employ the powers conferred in this
Section instead of or as a condition precedent to the exercise of
any other power or remedy vested in the Director. The Director may establish
systems and procedures for carrying out investigations under this Section as
are necessary to avoid the impairment or compromise of his or her authority
under this Section or any other law relating to the regulation of insurance.
(Source: P.A. 89-234, eff. 1-1-96.)
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(215 ILCS 5/402) (from Ch. 73, par. 1014)
Sec. 402.
Examinations, investigations and hearings.
(1) All examinations, investigations and hearings provided for by this
Code may be conducted either by the Director personally, or by one or more
of the actuaries, technical advisors, deputies, supervisors or examiners
employed or retained by the Department and designated by the Director for
such purpose. When necessary to supplement its examination procedures, the
Department may retain independent actuaries deemed competent by the
Director, independent certified public accountants, or qualified
examiners of insurance companies deemed competent by the Director, or any
combination of the foregoing, the cost of which shall be borne by the
company or person being examined. The Director may compensate independent
actuaries, certified public accountants and qualified examiners retained
for supplementing examination procedures in amounts not to exceed the
reasonable and customary charges for such services. The Director
may also accept as a part of the Department's examination of any company or
person (a) a report by an independent actuary deemed competent by the
Director or (b) a report of an audit made by an independent certified
public accountant. Neither those persons so designated nor any members of
their immediate families shall be officers of, connected with, or
financially interested in any company other than as policyholders, nor
shall they be financially interested in any other corporation or person
affected by the examination, investigation or hearing.
(2) All hearings provided for in this Code shall, unless otherwise
specially provided, be held at such time and place as shall be designated
in a notice which shall be given by the Director in writing to the person
or company whose interests are affected, at least 10 days before the date
designated therein. The notice shall state the subject of inquiry and the
specific charges, if any. The hearings shall be held in the City of
Springfield, the City of Chicago, or in the county where the principal
business address of the person or company affected is located.
(Source: P.A. 87-757.)
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(215 ILCS 5/403) (from Ch. 73, par. 1015)
Sec. 403.
Power to subpoena and examine witnesses.
(1) In the conduct of any examination, investigation or hearing provided
for by this Code, the Director or other officer designated by him or her to
conduct the same, shall have power to compel the attendance of any person
by subpoena, to administer oaths and to examine any person under oath
concerning the business, conduct or affairs of any company or person
subject to the provisions of this Code, and in connection therewith to
require the production of any books, records or papers relevant to the
inquiry.
(2) If a person subpoenaed to attend such inquiry fails to obey the
command of the subpoena without reasonable excuse, or if a person in
attendance upon such inquiry shall, without reasonable cause, refuse to be
sworn or to be examined or to answer a question or to produce a book or
paper when ordered to do so by any officer conducting such inquiry, or if
any person fails to perform any act required hereunder to be performed,
he or she shall be required to pay a penalty of not more than $2,000
to be recovered in the name of the People of the State of Illinois by the
State's Attorney
of the county in which the violation occurs, and the penalty so recovered
shall be paid into the county treasury.
(3) When any person neglects or refuses without reasonable cause to obey
a subpoena issued by the Director, or refuses without reasonable cause to
testify, to be sworn or to produce any book or paper described in the
subpoena, the Director may file a petition against such person in the
circuit court of the county in which the testimony is desired to be or has
been taken or has been attempted to be taken, briefly setting forth the
fact of such refusal or neglect and attaching a copy of the subpoena and
the return of service thereon and applying for an order requiring such
person to attend, testify or produce the books or papers before the
Director or his or her actuary, supervisor, deputy or examiner, at such
time or place as may be specified in such order. Any circuit court of this
State, upon the filing of such petition, either before or after
notice to such person, may, in the judicial discretion of such court, order
the attendance of such person, the production of books
and papers and the giving of testimony before the Director or any of his
or her actuaries, supervisors, deputies or examiners. If such person shall fail or
refuse to obey the order of the court and it shall appear to the court that
the failure or refusal of such person to obey its order is wilful, and
without lawful excuse, the court shall punish such person by fine or
imprisonment in the county jail, or both, as the nature of the case may
require, as is now, or as may hereafter be lawful for the court to do in
cases of contempt of court.
(4) The fees of witnesses for attendance and travel shall be the same as
the fees of witnesses before the circuit courts of this State. When a
witness is subpoenaed by or testifies at the instance of the Director or
other officer designated by him or her, such fees shall be paid in the
same manner as other expenses of the Department. When a witness is subpoenaed
or
testifies at the instance of any other party to any such proceeding, the
cost of the subpoena or subpoenas duces tecum and the fee of the witness
shall be borne by the party at whose instance a witness is summoned. In
such case, the Department in its discretion, may require a deposit to cover
the cost of such service and witness fees.
(Source: P.A. 93-32, eff. 7-1-03.)
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(215 ILCS 5/403A) (from Ch. 73, par. 1015A)
Sec. 403A.
Violations; Notice of Apparent Liability; Limitation
of Forfeiture Liability.
(1) Any company or person, agent or broker,
officer or director and any other person subject to this Code and as may
be defined in Section 2 of this Code, who willfully or repeatedly fails
to observe or who otherwise violates any of the provisions of this Code
or any rule or regulation promulgated by the Director under authority
of this Code or any final order of the Director entered under the authority
of this Code shall by civil penalty forfeit to the State of Illinois a sum
not to exceed $2,000. Each day during which a violation occurs
constitutes
a separate offense. The civil penalty provided for in this Section shall
apply only to those Sections of this Code or administrative regulations
thereunder that do not otherwise provide for a monetary civil penalty.
(2) No forfeiture liability under paragraph (1) of this Section
may attach unless a written notice of apparent liability has been issued
by the Director and received by the respondent, or the Director sends written
notice of apparent liability by registered or certified mail, return receipt
requested, to the last known address of the respondent. Any respondent so
notified must be granted an opportunity to request a
hearing within 10 days from receipt of notice, or to show in writing,
why he should not be held liable. A notice issued under this Section must
set forth the date, facts and nature of the act or omission with which the
respondent is charged and must specifically identify the particular
provision of the Code, rule, regulation or order of which a violation is
charged.
(3) No forfeiture liability under paragraph (1) of this Section
may attach for any violation occurring more than 2 years prior to the date
of issuance of the notice of apparent liability and in no event may the total
civil penalty forfeiture imposed for the acts or omissions set forth in any
one notice of apparent liability exceed $500,000.
(4) The civil penalty forfeitures provided for in this Section
are payable to the General Revenue Fund of the State of Illinois, and
may be recovered in a civil suit in the name of the State of Illinois brought
in the Circuit Court in Sangamon County, or in the Circuit Court of the
county where the respondent is domiciled or has its principal operating
office.
(5) In any case where the Director issues a notice of apparent
liability looking toward the imposition of a civil penalty forfeiture
under this Section, that fact may not be used in any other proceeding before
the Director to the prejudice of the respondent to whom the notice was issued,
unless (a) the civil penalty forfeiture has been paid, or (b) a court has
ordered payment of the civil penalty
forfeiture and that order has become final.
(Source: P.A. 93-32, eff. 7-1-03.)
|
(215 ILCS 5/404) (from Ch. 73, par. 1016)
Sec. 404. Office of Director; a public office; destruction or
disposal of records, papers, documents, and memoranda.
(1)(a) The office of the Director shall be a public office and the
records,
books, and papers thereof on file
therein, except those records
or documents containing or disclosing any analysis, opinion, calculation,
ratio, recommendation, advice, viewpoint, or estimation by any Department staff
regarding the financial or market condition of an insurer not otherwise made
part of the public record by the Director,
shall be accessible to the
inspection of the public, except as the Director, for good reason, may
decide otherwise, or except as may be otherwise provided in this Code or as otherwise provided in Section 7 of the Freedom of Information Act.
(b) Except where another provision of this Code expressly prohibits a
disclosure of confidential information to the specific officials or
organizations described in this subsection, the Director may disclose or share
any confidential records or information in his custody and control with any
insurance regulatory officials of any state or country, with the law
enforcement officials of this State, any other state, or the federal
government, or with the National Association of Insurance Commissioners, upon
the written agreement of the official or organization receiving the information
to hold the information or records confidential and in a manner consistent with
this Code.
(c) The Director shall maintain as confidential any records or
information received from the National Association of Insurance Commissioners
or insurance regulatory officials of other states which is confidential in that
other jurisdiction.
(2) Upon the filing of the examination to which they relate, the Director
is authorized to destroy or otherwise dispose of all working papers relative
to any company which has been examined at any time prior to that last
examination by the Department, so that in such circumstances only current
working papers of that last examination may be retained by the Department.
(3) Five years after the conclusion of the transactions to
which they relate, the Director is authorized to destroy or otherwise
dispose of all books, records, papers, memoranda and correspondence
directly related to consumer complaints or inquiries.
(4) Two years after the conclusion of the transactions to which they
relate, the Director is authorized to destroy or otherwise dispose of all
books, records, papers, memoranda, and correspondence directly related to
all void, obsolete, or superseded rate filings and schedules required to be
filed by statute; and all individual company rating experience data and all
records, papers, documents and memoranda in the possession of the Director
relating thereto.
(5) Five years after the conclusion of the transactions to which
they relate, the Director is authorized to destroy or otherwise dispose
of all examination reports of companies made by the insurance supervisory
officials of states other than Illinois; applications, requisitions, and
requests for licenses; all records of hearings; and all similar records,
papers, documents, and memoranda in the possession of the Director.
(6) Ten years after the conclusion of the transactions to which they
relate, the Director is authorized to destroy or otherwise dispose of all
official correspondence of foreign and alien companies, all foreign
companies' and alien companies' annual statements, valuation reports, tax
reports, and all similar records, papers, documents and memoranda in the
possession of the Director.
(7) Whenever any records, papers, documents or memoranda are
destroyed or otherwise disposed of pursuant to the provisions of this
section, the Director shall execute and file in a separate, permanent
office file a certificate listing and setting forth by summary
description the records, papers, documents or memoranda so destroyed or
otherwise disposed of, and the Director may, in his discretion, preserve
copies of any such records, papers, documents or memoranda by means of
microfilming or photographing the same.
(8) This Section shall apply to records, papers, documents, and
memoranda presently in the possession of the Director as well as to
records, papers, documents, and memoranda hereafter coming into his
possession.
(Source: P.A. 97-1004, eff. 8-17-12.)
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(215 ILCS 5/404.1) (from Ch. 73, par. 1016.1)
Sec. 404.1.
Safekeeping of deposits.
The Director may maintain with
a corporation qualified to administer trusts in this State under the
Corporate Fiduciary Act for the securities deposited with the
Director, a limited agency, custodial, or depository account, or other type
of account for the safekeeping of those securities, and for collecting the
income from those securities and providing supportive accounting services
relating to such safekeeping and collection. Such a corporation, in
safekeeping
such securities, shall have all the powers, rights, duties and responsibilities
that it has for holding securities in its fiduciary accounts under the
Securities in Fiduciary Accounts Act.
The Director shall arrange with any depository institution that has been
authorized to accept and execute trusts to provide for
collateralization of any cash accounts resulting from the failure of any
depositing company to give instruction regarding the investment of any such
cash amounts as provided for by Section 6 of the Public Funds Investment Act.
(Source: P.A. 93-477, eff. 1-1-04.)
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(215 ILCS 5/405) (from Ch. 73, par. 1017)
Sec. 405.
Certificates and certified copies as evidence.
All certificates issued by the Director in accordance with the
provisions of the insurance laws and all copies of documents filed in his
office in accordance with the provisions of this Code when certified by
him, shall be taken and received in all courts, public offices, and
official bodies as prima facie evidence of the facts therein stated. A
certificate by the Director under the seal of the Department, as to the
existence or non-existence of the facts relating to companies which would
not appear from a certified copy of any of the foregoing documents or
certificates shall be taken and received in all courts, public offices, and
official bodies as prima facie evidence of the existence or non-existence
of the facts therein stated.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/406) (from Ch. 73, par. 1018)
Sec. 406.
Annual
report.
The Director shall report annually, or oftener at the request of the
Governor, to the Governor his official transactions, and shall include in
such report abstracts of the annual statements of the several companies and
an exhibit of the financial condition and business transactions of the said
companies as disclosed by official examinations of the same or by their
annual statements. He shall also include therein a statement of the
receipts and expenditures of the Department for the preceding year and such
other information and recommendations relative to insurance and the
insurance laws of the State as he shall deem proper.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/407) (from Ch. 73, par. 1019)
Sec. 407.
Court review of orders and decisions.
Except as to those
orders or decisions of the Director to make good an impairment of capital
or surplus or a deficiency in the amount of admitted assets, the provisions
of the Administrative Review Law, and all amendments and modifications
thereof, and the rules adopted pursuant thereto, shall apply to and govern
all proceedings for the judicial review of final administrative decisions
of the Department. The term "administrative decision" is defined as in
Section 3-101 of the Code of Civil Procedure.
The Department shall not be required to certify any record to the court
or file any answer in court or otherwise appear in any court in a judicial
review proceeding, unless there is filed in the court with the complaint
a receipt from the Department acknowledging payment of the costs of furnishing
and certifying the record, which costs shall be computed at the rate of $1
per page of such record. Failure on the part of the plaintiff to file such
receipt in Court shall be grounds for dismissal of the action.
(Source: P.A. 84-989.)
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(215 ILCS 5/407.1) (from Ch. 73, par. 1019.1)
Sec. 407.1.
The provisions of "The Illinois Administrative
Procedure Act", as now or hereafter amended, are hereby
expressly adopted and incorporated herein as though a part
of this Act, and shall apply to all administrative rules
and procedures of the Department of Insurance under this Act.
(Source: P.A. 80-960.)
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(215 ILCS 5/407.2) (from Ch. 73, par. 1019.2)
Sec. 407.2.
(1) When any person or company has a license or certificate of authority
under this Code and knowingly fails or refuses to comply with a lawful
Order of the Director, entered after notice and hearing, within the period
of time specified in the Order, the Director may, in addition to any other
penalty or authority provided, refuse to renew or revoke the license or
certificate of authority of such person or company, or may suspend the
license or certificate of authority of such person or company until
compliance with such order has been obtained.
(2) When any person or company has a license or certificate of authority
under this Code and knowingly fails or refuses to comply with any provision
of this Code, the Director may, after notice and hearing, in addition to
any other penalty provided, refuse to renew or revoke the license or
certificate of authority of such person or company, or may suspend the
license or certificate of authority of such person or company, until
compliance with such provision of the Code has been obtained.
(3) No suspension or revocation under this Section may become effective
until 5 days from the date that the Notice of suspension or revocation has
been personally delivered or delivered by registered or certified mail to
the company or person. A suspension or revocation under this Section is
stayed upon the filing, by the company or person, of a petition for
judicial review under the Administrative Review Law.
(Source: P.A. 82-783.)
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(215 ILCS 5/Art. XXV heading) ARTICLE XXV.
FEES, CHARGES AND TAXES
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(215 ILCS 5/408) (from Ch. 73, par. 1020)
(Text of Section before amendment by P.A. 103-75)
Sec. 408. Fees and charges.
(1) The Director shall charge, collect and
give proper acquittances for the payment of the following fees and charges:
(a) For filing all documents submitted for the | ||
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(b) For filing all documents submitted for the | ||
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(c) For filing amendments to articles of | ||
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(d) For filing amendments to articles of | ||
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(e) For filing amendments to articles of | ||
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(f) For filing bylaws or amendments thereto, $50.
(g) For filing agreement of merger or consolidation:
(i) for a domestic company, except for a | ||
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(ii) for a foreign or alien company, except for a | ||
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(iii) for a fraternal benefit society, a mutual | ||
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(h) For filing agreements of reinsurance by a | ||
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(i) For filing all documents submitted by a foreign | ||
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(j) For filing all documents submitted by a foreign | ||
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(k) For filing declaration of withdrawal of a foreign | ||
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(l) For filing annual statement by a domestic | ||
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(m) For filing annual statement by a domestic | ||
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(n) For filing annual statement by a farm mutual, a | ||
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(o) For issuing a certificate of authority or renewal | ||
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(p) For issuing a certificate of authority or renewal | ||
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(q) For issuing an amended certificate of authority, | ||
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(r) For each certified copy of certificate of | ||
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(s) For each certificate of deposit, or valuation, or | ||
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(t) For copies of papers or records per page, $1.
(u) For each certification to copies of papers or | ||
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(v) For multiple copies of documents or certificates | ||
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(w) For issuing a permit to sell shares or increase | ||
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(i) in connection with a public stock offering, | ||
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(ii) in any other case, $100.
(x) For issuing any other certificate required or | ||
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(y) For filing a plan of exchange of the stock of a | ||
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(z) For filing a statement of acquisition of a | ||
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(aa) For filing an agreement to purchase the business | ||
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(bb) For filing a statement of acquisition of a | ||
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(cc) For filing a registration statement as required | ||
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(dd) For filing an application for licensing of:
(i) a religious or charitable risk pooling trust | ||
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(ii) a workers' compensation service company, | ||
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(iii) a self-insured automobile fleet, $200; or
(iv) a renewal of or amendment of any license | ||
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(ee) For filing articles of incorporation for a | ||
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(ff) For filing amended articles of incorporation for | ||
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(gg) For filing articles of incorporation for a | ||
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(hh) For filing amended articles of incorporation for | ||
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(ii) For a permit to solicit subscriptions to a | ||
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(jj) For the filing of each form as required in | ||
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(i) For the purposes of the form filing fee, | ||
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(ii) Only one fee shall be charged for a form, | ||
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(iii) Fees charged for a policy filed as it will | ||
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(iv) The Director may by rule exempt forms from | ||
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(kk) For filing an application for licensing of a | ||
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(ll) For filing an application for renewal of a | ||
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(mm) For filing a plan of division of a domestic | ||
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(nn) For filing all documents submitted by a | ||
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(oo) For filing a renewal by a foreign or alien | ||
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(pp) For filing all documents submitted by a | ||
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(qq) For filing a renewal by a reinsurer domiciled | ||
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(rr) For registering a captive management company | ||
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(2) When printed copies or numerous copies of the same paper or records
are furnished or certified, the Director may reduce such fees for copies
if he finds them excessive. He may, when he considers it in the public
interest, furnish without charge to state insurance departments and persons
other than companies, copies or certified copies of reports of examinations
and of other papers and records.
(3) The expenses incurred in any performance
examination authorized by law shall be paid by the company or person being
examined. The charge shall be reasonably related to the cost of the
examination including but not limited to compensation of examiners,
electronic data processing costs, supervision and preparation of an
examination report and lodging and travel expenses.
All lodging and travel expenses shall be in accord
with the applicable travel regulations as published by the Department of
Central Management Services and approved by the Governor's Travel Control
Board, except that out-of-state lodging and travel expenses related to
examinations authorized under Section 132 shall be in accordance with
travel rates prescribed under paragraph 301-7.2 of the Federal Travel
Regulations, 41 C.F.R. 301-7.2, for reimbursement of subsistence expenses
incurred during official travel. All lodging and travel expenses may be reimbursed directly upon authorization of the
Director. With the exception of the
direct reimbursements authorized by the
Director, all performance examination charges collected by the
Department shall be paid
to the Insurance Producer Administration Fund,
however, the electronic data processing costs
incurred by the Department in the performance of any examination shall be
billed directly to the company being examined for payment to the Technology Management
Revolving Fund.
(4) At the time of any service of process on the Director
as attorney for such service, the Director shall charge and collect the
sum of $40, which may be recovered as taxable costs by
the party to the suit or action causing such service to be made if he prevails
in such suit or action.
(5) (a) The costs incurred by the Department of Insurance
in conducting any hearing authorized by law shall be assessed against the
parties to the hearing in such proportion as the Director of Insurance may
determine upon consideration of all relevant circumstances including: (1)
the nature of the hearing; (2) whether the hearing was instigated by, or
for the benefit of a particular party or parties; (3) whether there is a
successful party on the merits of the proceeding; and (4) the relative levels
of participation by the parties.
(b) For purposes of this subsection (5) costs incurred shall
mean the hearing officer fees, court reporter fees, and travel expenses
of Department of Insurance officers and employees; provided however, that
costs incurred shall not include hearing officer fees or court reporter
fees unless the Department has retained the services of independent
contractors or outside experts to perform such functions.
(c) The Director shall make the assessment of costs incurred as part of
the final order or decision arising out of the proceeding; provided, however,
that such order or decision shall include findings and conclusions in support
of the assessment of costs. This subsection (5) shall not be construed as
permitting the payment of travel expenses unless calculated in accordance
with the applicable travel regulations of the Department
of Central Management Services, as approved by the Governor's Travel Control
Board. The Director as part of such order or decision shall require all
assessments for hearing officer fees and court reporter fees, if any, to
be paid directly to the hearing officer or court reporter by the party(s)
assessed for such costs. The assessments for travel expenses of Department
officers and employees shall be reimbursable to the
Director of Insurance for
deposit to the fund out of which those expenses had been paid.
(d) The provisions of this subsection (5) shall apply in the case of any
hearing conducted by the Director of Insurance not otherwise specifically
provided for by law.
(6) The Director shall charge and collect an annual financial
regulation fee from every domestic company for examination and analysis of
its financial condition and to fund the internal costs and expenses of the
Interstate Insurance Receivership Commission as may be allocated to the State
of Illinois and companies doing an insurance business in this State pursuant to
Article X of the Interstate Insurance Receivership Compact. The fee shall be
the greater fixed amount based upon
the combination of nationwide direct premium income and
nationwide reinsurance
assumed premium
income or upon admitted assets calculated under this subsection as follows:
(a) Combination of nationwide direct premium income | ||
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(i) $150, if the premium is less than $500,000 | ||
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(ii) $750, if the premium is $500,000 or more, | ||
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(iii) $3,750, if the premium is less than | ||
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(iv) $7,500, if the premium is $5,000,000 or | ||
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(v) $18,000, if the premium is $10,000,000 or | ||
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(vi) $22,500, if the premium is $25,000,000 or | ||
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(vii) $30,000, if the premium is $50,000,000 or | ||
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(viii) $37,500, if the premium is $100,000,000 or | ||
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(b) Admitted assets.
(i) $150, if admitted assets are less than | ||
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(ii) $750, if admitted assets are $1,000,000 or | ||
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(iii) $3,750, if admitted assets are $5,000,000 | ||
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(iv) $7,500, if admitted assets are $25,000,000 | ||
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(v) $18,000, if admitted assets are $50,000,000 | ||
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(vi) $22,500, if admitted assets are $100,000,000 | ||
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(vii) $30,000, if admitted assets are | ||
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(viii) $37,500, if admitted assets are | ||
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(c) The sum of financial regulation fees charged to | ||
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(7) The Director shall charge and collect an annual financial regulation
fee from every foreign or alien company, except fraternal benefit
societies, for the
examination and analysis of its financial condition and to fund the internal
costs and expenses of the Interstate Insurance Receivership Commission as may
be allocated to the State of Illinois and companies doing an insurance business
in this State pursuant to Article X of the Interstate Insurance Receivership
Compact.
The fee shall be a fixed amount based upon Illinois direct premium income
and nationwide reinsurance assumed premium income in accordance with the
following schedule:
(a) $150, if the premium is less than $500,000 and | ||
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(b) $750, if the premium is $500,000 or more, but | ||
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(c) $3,750, if the premium is less than $5,000,000 | ||
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(d) $7,500, if the premium is $5,000,000 or more, but | ||
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(e) $18,000, if the premium is $10,000,000 or more, | ||
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(f) $22,500, if the premium is $25,000,000 or more, | ||
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(g) $30,000, if the premium is $50,000,000 or more, | ||
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(h) $37,500, if the premium is $100,000,000 or more.
The sum of financial regulation fees under this subsection (7)
charged to the foreign or alien companies within the same affiliated group
shall not exceed $250,000 in the aggregate in any single year
and shall be
billed by the Director to the member company designated by the group.
(8) Beginning January 1, 1992, the financial regulation fees imposed
under subsections (6) and (7)
of this Section shall be paid by each company or domestic affiliated group
annually. After January
1, 1994, the fee shall be billed by Department invoice
based upon the company's
premium income or admitted assets as shown in its annual statement for the
preceding calendar year. The invoice is due upon
receipt and must be paid no later than June 30 of each calendar year. All
financial
regulation fees collected by the Department shall be paid to the Insurance
Financial Regulation Fund. The Department may not collect financial
examiner per diem charges from companies subject to subsections (6) and (7)
of this Section undergoing financial examination
after June 30, 1992.
(9) In addition to the financial regulation fee required by this
Section, a company undergoing any financial examination authorized by law
shall pay the following costs and expenses incurred by the Department:
electronic data processing costs, the expenses authorized under Section 131.21
and
subsection (d) of Section 132.4 of this Code, and lodging and travel expenses.
Electronic data processing costs incurred by the Department in the
performance of any examination shall be billed directly to the company
undergoing examination for payment to the Technology Management Revolving
Fund. Except for direct reimbursements authorized by the Director or
direct payments made under Section 131.21 or subsection (d) of Section
132.4 of this Code, all financial regulation fees and all financial
examination charges collected by the Department shall be paid to the
Insurance Financial Regulation Fund.
All lodging and travel expenses shall be in accordance with applicable
travel regulations published by the Department of Central Management
Services and approved by the Governor's Travel Control Board, except that
out-of-state lodging and travel expenses related to examinations authorized
under Sections 132.1 through 132.7 shall be in accordance
with travel rates prescribed
under paragraph 301-7.2 of the Federal Travel Regulations, 41 C.F.R. 301-7.2,
for reimbursement of subsistence expenses incurred during official travel.
All lodging and travel expenses may be
reimbursed directly upon the authorization of the Director.
In the case of an organization or person not subject to the financial
regulation fee, the expenses incurred in any financial examination authorized
by law shall be paid by the organization or person being examined. The charge
shall be reasonably related to the cost of the examination including, but not
limited to, compensation of examiners and other costs described in this
subsection.
(10) Any company, person, or entity failing to make any payment of $150
or more as required under this Section shall be subject to the penalty and
interest provisions provided for in subsections (4) and (7)
of Section 412.
(11) Unless otherwise specified, all of the fees collected under this
Section shall be paid into the Insurance Financial Regulation Fund.
(12) For purposes of this Section:
(a) "Domestic company" means a company as defined in | ||
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(b) "Foreign company" means a company as defined in | ||
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(c) "Alien company" means a company as defined in | ||
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(d) "Fraternal benefit society" means a corporation, | ||
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(e) "Mutual benefit association" means a company, | ||
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(f) "Burial society" means a person, firm, | ||
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(g) "Farm mutual" means a district, county and | ||
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(Source: P.A. 102-775, eff. 5-13-22.)
(Text of Section after amendment by P.A. 103-75)
Sec. 408. Fees and charges.
(1) The Director shall charge, collect and
give proper acquittances for the payment of the following fees and charges:
(a) For filing all documents submitted for the | ||
| ||
(b) For filing all documents submitted for the | ||
| ||
(c) For filing amendments to articles of | ||
| ||
(d) For filing amendments to articles of | ||
| ||
(e) For filing amendments to articles of | ||
| ||
(f) For filing bylaws or amendments thereto, $50.
(g) For filing agreement of merger or consolidation:
(i) for a domestic company, except for a | ||
| ||
(ii) for a foreign or alien company, except for a | ||
| ||
(iii) for a fraternal benefit society, a mutual | ||
| ||
(h) For filing agreements of reinsurance by a | ||
| ||
(i) For filing all documents submitted by a foreign | ||
| ||
(j) For filing all documents submitted by a foreign | ||
| ||
(k) For filing declaration of withdrawal of a foreign | ||
| ||
(l) For filing annual statement by a domestic | ||
| ||
(m) For filing annual statement by a domestic | ||
| ||
(n) For filing annual statement by a farm mutual, a | ||
| ||
(o) For issuing a certificate of authority or renewal | ||
| ||
(p) For issuing a certificate of authority or renewal | ||
| ||
(q) For issuing an amended certificate of authority, | ||
| ||
(r) For each certified copy of certificate of | ||
| ||
(s) For each certificate of deposit, or valuation, or | ||
| ||
(t) For copies of papers or records per page, $1.
(u) For each certification to copies of papers or | ||
| ||
(v) For multiple copies of documents or certificates | ||
| ||
(w) For issuing a permit to sell shares or increase | ||
| ||
(i) in connection with a public stock offering, | ||
| ||
(ii) in any other case, $100.
(x) For issuing any other certificate required or | ||
| ||
(y) For filing a plan of exchange of the stock of a | ||
| ||
(z) For filing a statement of acquisition of a | ||
| ||
(aa) For filing an agreement to purchase the business | ||
| ||
(bb) For filing a statement of acquisition of a | ||
| ||
(cc) For filing a registration statement as required | ||
| ||
(dd) For filing an application for licensing of:
(i) a religious or charitable risk pooling trust | ||
| ||
(ii) a workers' compensation service company, | ||
| ||
(iii) a self-insured automobile fleet, $200; or
(iv) a renewal of or amendment of any license | ||
| ||
(ee) For filing articles of incorporation for a | ||
| ||
(ff) For filing amended articles of incorporation for | ||
| ||
(gg) For filing articles of incorporation for a | ||
| ||
(hh) For filing amended articles of incorporation for | ||
| ||
(ii) For a permit to solicit subscriptions to a | ||
| ||
(jj) For the filing of each form as required in | ||
| ||
(i) For the purposes of the form filing fee, | ||
| ||
(ii) Only one fee shall be charged for a form, | ||
| ||
(iii) Fees charged for a policy filed as it will | ||
| ||
(iv) The Director may by rule exempt forms from | ||
| ||
(kk) For filing an application for licensing of a | ||
| ||
(ll) For filing an application for renewal of a | ||
| ||
(mm) For filing a plan of division of a domestic | ||
| ||
(nn) For filing all documents submitted by a | ||
| ||
(oo) For filing a renewal by a foreign or alien | ||
| ||
(pp) For filing all documents submitted by a | ||
| ||
(qq) For filing a renewal by a reinsurer domiciled | ||
| ||
(rr) For registering a captive management company | ||
| ||
(ss) For filing an insurance business transfer plan | ||
| ||
(2) When printed copies or numerous copies of the same paper or records
are furnished or certified, the Director may reduce such fees for copies
if he finds them excessive. He may, when he considers it in the public
interest, furnish without charge to state insurance departments and persons
other than companies, copies or certified copies of reports of examinations
and of other papers and records.
(3) The expenses incurred in any performance
examination authorized by law shall be paid by the company or person being
examined. The charge shall be reasonably related to the cost of the
examination including but not limited to compensation of examiners,
electronic data processing costs, supervision and preparation of an
examination report and lodging and travel expenses.
All lodging and travel expenses shall be in accord
with the applicable travel regulations as published by the Department of
Central Management Services and approved by the Governor's Travel Control
Board, except that out-of-state lodging and travel expenses related to
examinations authorized under Section 132 shall be in accordance with
travel rates prescribed under paragraph 301-7.2 of the Federal Travel
Regulations, 41 C.F.R. 301-7.2, for reimbursement of subsistence expenses
incurred during official travel. All lodging and travel expenses may be reimbursed directly upon authorization of the
Director. With the exception of the
direct reimbursements authorized by the
Director, all performance examination charges collected by the
Department shall be paid
to the Insurance Producer Administration Fund,
however, the electronic data processing costs
incurred by the Department in the performance of any examination shall be
billed directly to the company being examined for payment to the Technology Management
Revolving Fund.
(4) At the time of any service of process on the Director
as attorney for such service, the Director shall charge and collect the
sum of $40, which may be recovered as taxable costs by
the party to the suit or action causing such service to be made if he prevails
in such suit or action.
(5) (a) The costs incurred by the Department of Insurance
in conducting any hearing authorized by law shall be assessed against the
parties to the hearing in such proportion as the Director of Insurance may
determine upon consideration of all relevant circumstances including: (1)
the nature of the hearing; (2) whether the hearing was instigated by, or
for the benefit of a particular party or parties; (3) whether there is a
successful party on the merits of the proceeding; and (4) the relative levels
of participation by the parties.
(b) For purposes of this subsection (5) costs incurred shall
mean the hearing officer fees, court reporter fees, and travel expenses
of Department of Insurance officers and employees; provided however, that
costs incurred shall not include hearing officer fees or court reporter
fees unless the Department has retained the services of independent
contractors or outside experts to perform such functions.
(c) The Director shall make the assessment of costs incurred as part of
the final order or decision arising out of the proceeding; provided, however,
that such order or decision shall include findings and conclusions in support
of the assessment of costs. This subsection (5) shall not be construed as
permitting the payment of travel expenses unless calculated in accordance
with the applicable travel regulations of the Department
of Central Management Services, as approved by the Governor's Travel Control
Board. The Director as part of such order or decision shall require all
assessments for hearing officer fees and court reporter fees, if any, to
be paid directly to the hearing officer or court reporter by the party(s)
assessed for such costs. The assessments for travel expenses of Department
officers and employees shall be reimbursable to the
Director of Insurance for
deposit to the fund out of which those expenses had been paid.
(d) The provisions of this subsection (5) shall apply in the case of any
hearing conducted by the Director of Insurance not otherwise specifically
provided for by law.
(6) The Director shall charge and collect an annual financial
regulation fee from every domestic company for examination and analysis of
its financial condition and to fund the internal costs and expenses of the
Interstate Insurance Receivership Commission as may be allocated to the State
of Illinois and companies doing an insurance business in this State pursuant to
Article X of the Interstate Insurance Receivership Compact. The fee shall be
the greater fixed amount based upon
the combination of nationwide direct premium income and
nationwide reinsurance
assumed premium
income or upon admitted assets calculated under this subsection as follows:
(a) Combination of nationwide direct premium income | ||
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(i) $150, if the premium is less than $500,000 | ||
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(ii) $750, if the premium is $500,000 or more, | ||
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(iii) $3,750, if the premium is less than | ||
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(iv) $7,500, if the premium is $5,000,000 or | ||
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(v) $18,000, if the premium is $10,000,000 or | ||
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(vi) $22,500, if the premium is $25,000,000 or | ||
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(vii) $30,000, if the premium is $50,000,000 or | ||
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(viii) $37,500, if the premium is $100,000,000 or | ||
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(b) Admitted assets.
(i) $150, if admitted assets are less than | ||
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(ii) $750, if admitted assets are $1,000,000 or | ||
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(iii) $3,750, if admitted assets are $5,000,000 | ||
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(iv) $7,500, if admitted assets are $25,000,000 | ||
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(v) $18,000, if admitted assets are $50,000,000 | ||
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(vi) $22,500, if admitted assets are $100,000,000 | ||
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(vii) $30,000, if admitted assets are | ||
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(viii) $37,500, if admitted assets are | ||
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(c) The sum of financial regulation fees charged to | ||
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(7) The Director shall charge and collect an annual financial regulation
fee from every foreign or alien company, except fraternal benefit
societies, for the
examination and analysis of its financial condition and to fund the internal
costs and expenses of the Interstate Insurance Receivership Commission as may
be allocated to the State of Illinois and companies doing an insurance business
in this State pursuant to Article X of the Interstate Insurance Receivership
Compact.
The fee shall be a fixed amount based upon Illinois direct premium income
and nationwide reinsurance assumed premium income in accordance with the
following schedule:
(a) $150, if the premium is less than $500,000 and | ||
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(b) $750, if the premium is $500,000 or more, but | ||
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(c) $3,750, if the premium is less than $5,000,000 | ||
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(d) $7,500, if the premium is $5,000,000 or more, but | ||
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(e) $18,000, if the premium is $10,000,000 or more, | ||
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(f) $22,500, if the premium is $25,000,000 or more, | ||
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(g) $30,000, if the premium is $50,000,000 or more, | ||
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(h) $37,500, if the premium is $100,000,000 or more.
The sum of financial regulation fees under this subsection (7)
charged to the foreign or alien companies within the same affiliated group
shall not exceed $250,000 in the aggregate in any single year
and shall be
billed by the Director to the member company designated by the group.
(8) Beginning January 1, 1992, the financial regulation fees imposed
under subsections (6) and (7)
of this Section shall be paid by each company or domestic affiliated group
annually. After January
1, 1994, the fee shall be billed by Department invoice
based upon the company's
premium income or admitted assets as shown in its annual statement for the
preceding calendar year. The invoice is due upon
receipt and must be paid no later than June 30 of each calendar year. All
financial
regulation fees collected by the Department shall be paid to the Insurance
Financial Regulation Fund. The Department may not collect financial
examiner per diem charges from companies subject to subsections (6) and (7)
of this Section undergoing financial examination
after June 30, 1992.
(9) In addition to the financial regulation fee required by this
Section, a company undergoing any financial examination authorized by law
shall pay the following costs and expenses incurred by the Department:
electronic data processing costs, the expenses authorized under Section 131.21
and
subsection (d) of Section 132.4 of this Code, and lodging and travel expenses.
Electronic data processing costs incurred by the Department in the
performance of any examination shall be billed directly to the company
undergoing examination for payment to the Technology Management Revolving
Fund. Except for direct reimbursements authorized by the Director or
direct payments made under Section 131.21 or subsection (d) of Section
132.4 of this Code, all financial regulation fees and all financial
examination charges collected by the Department shall be paid to the
Insurance Financial Regulation Fund.
All lodging and travel expenses shall be in accordance with applicable
travel regulations published by the Department of Central Management
Services and approved by the Governor's Travel Control Board, except that
out-of-state lodging and travel expenses related to examinations authorized
under Sections 132.1 through 132.7 shall be in accordance
with travel rates prescribed
under paragraph 301-7.2 of the Federal Travel Regulations, 41 C.F.R. 301-7.2,
for reimbursement of subsistence expenses incurred during official travel.
All lodging and travel expenses may be
reimbursed directly upon the authorization of the Director.
In the case of an organization or person not subject to the financial
regulation fee, the expenses incurred in any financial examination authorized
by law shall be paid by the organization or person being examined. The charge
shall be reasonably related to the cost of the examination including, but not
limited to, compensation of examiners and other costs described in this
subsection.
(10) Any company, person, or entity failing to make any payment of $150
or more as required under this Section shall be subject to the penalty and
interest provisions provided for in subsections (4) and (7)
of Section 412.
(11) Unless otherwise specified, all of the fees collected under this
Section shall be paid into the Insurance Financial Regulation Fund.
(12) For purposes of this Section:
(a) "Domestic company" means a company as defined in | ||
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(b) "Foreign company" means a company as defined in | ||
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(c) "Alien company" means a company as defined in | ||
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(d) "Fraternal benefit society" means a corporation, | ||
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(e) "Mutual benefit association" means a company, | ||
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(f) "Burial society" means a person, firm, | ||
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(g) "Farm mutual" means a district, county and | ||
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(Source: P.A. 102-775, eff. 5-13-22; 103-75, eff. 1-1-25.)
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(215 ILCS 5/408.1) (from Ch. 73, par. 1020.1)
Sec. 408.1.
Fee for valuation of life insurance policies.
Upon the effective date of this amendatory Act of 1998, all actions to
collect life insurance policy valuation fees or to transfer such fees to the
General Revenue Fund from any protest account established under the State
Officers and Employees Money Disposition Act shall cease and any such protested
life insurance policy valuation fee payments shall be returned to the taxpayer
who initiated the protest.
(Source: P.A. 90-583, eff. 5-29-98.)
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(215 ILCS 5/408.2) (from Ch. 73, par. 1020.2)
Sec. 408.2. Statistical services. Any public record, or any data obtained
by the Department of Insurance, which is subject to public inspection or
copying and which is maintained on a computer processible medium, may be
furnished in a computer processed or computer processible medium upon the
written request of any applicant and the payment of a reasonable fee
established by the Director sufficient to cover the total cost of the
Department for processing, maintaining and generating such computer
processible records or data, except to the extent of any salaries or
compensation of Department officers or employees.
The Director of Insurance is specifically authorized to contract with
members of the public at large, enter waiver agreements, or otherwise enter
written agreements for the purpose of assuring public access to the
Department's computer processible records or data, or for the purpose of
restricting, controlling or limiting such access where necessary to protect
the confidentiality of individuals, companies or other entities identified
by such documents.
All fees collected by the Director under this Section 408.2 shall be
deposited in the Technology Management Revolving Fund and credited to the
account of the Department of Insurance. Any surplus funds remaining in
such account at the close of any fiscal year shall be delivered to the
State Treasurer for deposit in the Insurance Financial Regulation Fund.
(Source: P.A. 100-23, eff. 7-6-17.)
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(215 ILCS 5/408.3) (from Ch. 73, par. 1020.3)
Sec. 408.3. Insurance Financial Regulation Fund; uses. The monies
deposited into the Insurance Financial
Regulation Fund shall be used only for (i) payment of the expenses of the
Department, including related administrative expenses, incurred in
analyzing, investigating and examining the financial condition or control
of insurance companies and other entities licensed or seeking to be
licensed by the Department, including the collection, analysis and
distribution of information on insurance premiums, other income, costs and
expenses, and (ii) to pay internal costs and expenses of the Interstate
Insurance Receivership Commission allocated to this State and authorized and
admitted companies doing an insurance business in this State under Article X of
the Interstate Receivership Compact. All distributions and payments from the
Insurance Financial Regulation Fund shall be subject to appropriation as
otherwise provided by law for
payment of such expenses.
Sums appropriated under clause (ii) of the preceding paragraph shall be
deemed to satisfy, pro tanto, the obligations of insurers doing business in
this
State under Article X of the Interstate Insurance Receivership Compact.
Nothing in this Code shall prohibit the General Assembly from
appropriating funds from the General Revenue Fund to the Department for the
purpose of administering this Code.
No fees collected pursuant to Section 408 of this Code shall be used
for the regulation of pension funds or activities by the Department in the
performance of its duties under Article 22 of the Illinois Pension Code.
If at the end of a fiscal year the balance in the Insurance Financial
Regulation Fund which remains unexpended or unobligated exceeds the amount
of funds that the Director may certify is needed for the purposes
enumerated in this Section, then the General Assembly may appropriate that
excess amount for purposes other than those enumerated in this Section.
(Source: P.A. 98-609, eff. 1-1-14.)
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(215 ILCS 5/408.4)
Sec. 408.4.
Receipt and use grants.
(a) The Department is authorized to accept, receive, and use, for and in
behalf of the State, any grant of money given to further the purposes of the
insurance laws of this State by the federal government as may be offered
unconditionally or under conditions, agreements, covenants, or terms that, in
the judgment of the Department, are proper and consistent with the provisions
of subsection (b). All moneys so received shall be deposited into the
Insurance Producer Administration Fund.
(b) The moneys deposited into the Insurance Producer Administration Fund
under
this Section shall be accounted for separately and shall be expended, pursuant
to appropriation, only in accordance with the conditions, agreements,
covenants, or terms, if any, under which they were accepted and must be used to
disseminate and provide insurance related information or assistance to senior
citizens.
(Source: P.A. 88-313.)
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(215 ILCS 5/409) (from Ch. 73, par. 1021)
Sec. 409. Annual privilege tax payable by
companies. (1) As of January 1, 1999 for all health maintenance organization premiums
written; as of July 1, 1998 for all premiums written as accident and health
business, voluntary health service plan business, dental service plan business,
or limited health service organization business; and as of January 1, 1998
for all other types of insurance premiums written, every company doing any form
of insurance business in this
State, including, but not limited to, every risk retention group, and excluding
all fraternal benefit societies, all farm mutual companies, all religious
charitable risk pooling trusts, and excluding all statutory residual market and
special purpose entities in which companies are statutorily required to
participate, whether incorporated or otherwise, shall pay, for the privilege of
doing business in this State, to the Director for the State treasury a State
tax equal to 0.5% of the net taxable premium written, together with any amounts
due under Section 444 of this Code, except that the tax to be paid on any
premium derived from any accident and health insurance or on any insurance
business written by any company operating as a health maintenance organization,
voluntary health service plan, dental service plan, or limited health service
organization shall be equal to 0.4% of such net taxable premium written,
together with any amounts due under Section 444. Upon the failure of any
company to pay any such tax due, the Director may, by order, revoke or
suspend the company's certificate of authority after giving 20 days written
notice to the company, or commence proceedings for the suspension of business
in this State under the procedures set forth by Section 401.1 of this Code.
The gross taxable premium written shall be the gross amount of premiums
received on direct business during the calendar year on contracts covering
risks in this State, except premiums on annuities, premiums on which State
premium taxes are prohibited by federal law, premiums paid by the State for
health care coverage for Medicaid eligible insureds as described in Section
5-2 of the Illinois Public Aid Code, premiums paid for health care services
included as an element of tuition charges at any university or college owned
and operated by the State of Illinois, premiums on group insurance contracts
under the State Employees Group Insurance Act of 1971, and except premiums for
deferred compensation plans for employees of the State, units of local
government, or school districts. The net taxable premium shall be the gross
taxable premium written reduced only by the following:
(a) the amount of premiums returned thereon which | ||
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(b) dividends on such direct business that have been | ||
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(2) The annual privilege tax payment due from a company under subsection (4)
of
this Section may be reduced by: (a) the excess amount, if any, by which the
aggregate income taxes paid by the company, on a cash basis, for the preceding
calendar year under Sections 601 and 803 of the Illinois
Income Tax Act exceed 1.5% of the company's net taxable premium written for
that prior calendar year, as determined under subsection (1) of this Section;
and (b) the amount of any fire department taxes paid by the company during the
preceding calendar year under Section 11-10-1 of the Illinois Municipal Code.
Any deductible amount or offset allowed under items (a) and (b) of this
subsection for any calendar year will not be allowed as a deduction or offset
against the company's privilege tax liability for any other taxing period or
calendar year.
(3) If a company survives or was formed by a merger, consolidation,
reorganization, or reincorporation, the premiums received and amounts returned
or paid by all companies party to the merger, consolidation, reorganization,
or reincorporation shall, for purposes of determining the amount of the tax
imposed by this Section, be regarded as received, returned, or paid by the
surviving
or new company.
(4)(a) All companies subject to the provisions of this Section shall make an
annual return for the preceding calendar year on or before March 15 setting
forth such information on such forms as the Director may reasonably require.
Payments of quarterly installments of the taxpayer's total estimated tax for
the current calendar year shall be due on or before April 15, June 15,
September 15, and December 15 of such year, except that all companies
transacting insurance in this State whose annual tax for the immediately
preceding calendar year was less than $5,000 shall make only an annual return.
Failure of a company to make the annual payment, or to make the quarterly
payments, if required, of at least 25% of either (i) the total tax paid during
the
previous calendar year or (ii) 80% of the actual tax for the current calendar
year shall subject it to the penalty provisions set forth in Section 412 of
this Code.
(b) Notwithstanding the foregoing provisions, no annual return shall be
required or made on March 15, 1998, under this subsection. For the calendar
year 1998:
(i) each health maintenance organization shall have | ||
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(ii) all companies subject to the tax as of July 1, | ||
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(iii) all other companies shall have estimated tax | ||
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In the year 1999 and thereafter all companies shall make annual and
quarterly installments of their estimated tax as provided by paragraph (a) of
this subsection.
(5) In addition to the authority specifically granted under Article XXV of
this Code, the Director shall have such authority to adopt rules and establish
forms as may be reasonably necessary
for purposes of determining the allocation of Illinois corporate income taxes
paid under subsections (a) through (d) of Section 201 of the Illinois Income
Tax Act amongst members of a business group that files an Illinois corporate
income tax return on a unitary basis, for purposes of regulating the amendment
of tax returns, for purposes of defining terms, and for purposes of enforcing
the provisions of
Article XXV of
this Code. The Director shall also have authority to defer, waive, or abate
the tax
imposed by this Section if in his opinion the company's solvency and ability to
meet its insured obligations would be immediately threatened by payment of the
tax due.
(6) This Section is subject to the provisions of Section 10 of the New Markets Development Program Act. (Source: P.A. 97-813, eff. 7-13-12; 98-1169, eff. 1-9-15.)
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(215 ILCS 5/410) (from Ch. 73, par. 1022)
Sec. 410.
Reports
and statements for purpose of auditing retaliatory and privilege tax returns.
(1) For the purpose of enabling the Director to audit the retaliatory and
privilege tax
calculation of a company liable for such tax under the provisions of
Sections 409, 444 and 444.1, every such company, in addition to all other
statements and
reports required by law, shall file a report in writing with the Director
not later than March 1 of each year, in the form prescribed by the
Director, signed and sworn to by its president, vice president, secretary,
treasurer or manager.
(2) In every such return the reporting of premiums for tax purposes
shall be on a written basis or on a paid for basis, consistent with the
basis required by the annual statement of the insurer filed with the
Director pursuant to Section 136.
(3) The Director may require at any time verified supplemental
statements with reference to any matter pertinent to the proper calculation
of the tax.
(Source: P.A. 82-767.)
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(215 ILCS 5/412) (from Ch. 73, par. 1024)
Sec. 412. Refunds; penalties; collection.
(1)(a) Whenever it appears to
the satisfaction of the Director that because of some mistake of fact,
error in calculation, or erroneous interpretation of a statute of this
or any other state, any authorized company, surplus line producer, or industrial insured has paid to him, pursuant to
any provision of law, taxes, fees, or other charges
in excess of the
amount legally chargeable against it, during the 6 year period
immediately preceding the discovery of such overpayment, he shall have
power to refund to such company, surplus line producer, or industrial insured the amount of the excess or excesses by
applying the amount or amounts thereof toward
the payment of taxes, fees, or other charges already due, or which may
thereafter become due from that company until such excess or excesses have been
fully
refunded, or upon a written request from the authorized company, surplus line producer, or industrial insured, the
Director shall provide a cash refund within
120 days after receipt of the written request if all necessary information has
been filed with the Department in order for it to perform an audit of the
tax report for the transaction or period or annual return for the year in which the overpayment occurred or within 120 days
after the date the Department receives all the necessary information to perform
such audit. The Director shall not provide a cash refund if there are
insufficient funds in the Insurance Premium Tax Refund Fund to provide a cash
refund, if the amount of the overpayment is less than $100, or if the amount of
the overpayment can be fully offset against the taxpayer's estimated liability
for the year following the year of the cash refund request. Any cash refund
shall be paid from the Insurance Premium Tax Refund Fund, a special fund hereby
created in the
State treasury.
(b) As determined by the Director pursuant to paragraph (a) of this subsection, the Department shall deposit an amount of cash refunds approved by the Director for payment as a result of overpayment of tax liability
collected under Sections 121-2.08, 409, 444, 444.1, and 445 of
this
Code into the Insurance Premium Tax Refund Fund.
(c) Beginning July 1, 1999, moneys in the Insurance Premium Tax Refund
Fund
shall be expended exclusively for the purpose of paying cash refunds resulting
from overpayment of tax liability under Sections 121-2.08, 409, 444, 444.1, and 445 of this
Code
as
determined by the Director pursuant to subsection 1(a) of this Section. Cash
refunds made in accordance with this Section may be made from the Insurance
Premium Tax Refund Fund only to the extent that amounts have been deposited and
retained in the Insurance Premium Tax Refund Fund.
(d) This Section shall constitute an irrevocable and continuing
appropriation from the Insurance Premium Tax Refund Fund for the purpose of
paying cash refunds pursuant to the provisions of this Section.
(2)(a) When any insurance company fails to
file any tax return required under Sections 408.1, 409, 444, and 444.1 of
this Code or Section 12 of the Fire Investigation Act on the date
prescribed, including any extensions, there shall be added as a penalty
$400 or 10% of the amount of such tax, whichever is
greater, for each month
or part of a month of failure to file, the entire penalty not to exceed
$2,000 or 50% of the tax due, whichever is greater.
(b) When any industrial insured or surplus line producer fails to file any tax return or report required under Sections 121-2.08 and 445 of this Code or Section 12 of the Fire Investigation Act on the date prescribed, including any extensions, there shall be added: (i) as a late fee, if the return or report is | ||
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(ii) as a late fee, if the return or report is | ||
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(iii) as a penalty, if the return or report is | ||
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A tax return or report shall be deemed received as of the date mailed as evidenced by a postmark, proof of mailing on a recognized United States Postal Service form or a form acceptable to the United States Postal Service or other commercial mail delivery service, or other evidence acceptable to the Director.
(3)(a) When any insurance company
fails to pay the full amount due under the provisions of this Section,
Sections 408.1, 409, 444, or 444.1 of this Code, or Section 12 of the
Fire Investigation Act, there shall be added to the amount due as a penalty
an amount equal to 10% of the deficiency.
(a-5) When any industrial insured or surplus line producer fails to pay the full amount due under the provisions of this Section, Sections 121-2.08 or 445 of this Code, or Section 12 of the Fire Investigation Act on the date prescribed, there shall be added: (i) as a late fee, if the payment is received at | ||
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(ii) as a late fee, if the payment is received at | ||
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(iii) as a late fee, if the payment is received at | ||
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(iv) as a penalty, if the return or report is | ||
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A tax payment shall be deemed received as of the date mailed as evidenced by a postmark, proof of mailing on a recognized United States Postal Service form or a form acceptable to the United States Postal Service or other commercial mail delivery service, or other evidence acceptable to the Director.
(b) If such failure to pay is determined by the Director to be wilful,
after a hearing under Sections 402 and 403, there shall be added to the tax
as a penalty an amount equal to the greater of 50% of the
deficiency or 10%
of the amount due and unpaid for each month or part of a month that the
deficiency remains unpaid commencing with the date that the amount becomes
due. Such amount shall be in lieu of any determined under paragraph (a) or (a-5).
(4) Any insurance company, industrial insured, or surplus line producer that
fails to pay the full amount due under this Section or Sections 121-2.08, 408.1, 409,
444, 444.1, or 445 of this Code, or Section 12 of the Fire Investigation
Act is liable, in addition to the tax and any late fees and penalties, for interest
on such deficiency at the rate of 12% per annum, or at such higher adjusted
rates as are or may be established under subsection (b) of Section 6621
of the Internal Revenue Code, from the date that payment of any such tax
was due, determined without regard to any extensions, to the date of payment
of such amount.
(5) The Director, through the Attorney
General, may institute an action in the name of the People of the State
of Illinois, in any court of competent jurisdiction, for the recovery of
the amount of such taxes, fees, and penalties due, and prosecute the same to
final judgment, and take such steps as are necessary to collect the same.
(6) In the event that the certificate of authority of a foreign or
alien company is revoked for any cause or the company withdraws from
this State prior to the renewal date of the certificate of authority as
provided in Section 114, the company may recover the amount of any such
tax paid in advance. Except as provided in this subsection, no
revocation or withdrawal excuses payment of or constitutes grounds for
the recovery of any taxes or penalties imposed by this Code.
(7) When an insurance company or domestic affiliated group fails to pay
the full amount of any fee of $200 or more due under
Section 408 of this Code, there shall be added to the amount due as
a penalty the greater of $100 or an amount equal to 10%
of the deficiency for
each month or part of
a month that the deficiency remains unpaid.
(8) The Department shall have a lien for the taxes, fees, charges, fines, penalties, interest, other charges, or any portion thereof, imposed or assessed pursuant to this Code, upon all the real and personal property of any company or person to whom the assessment or final order has been issued or whenever a tax return is filed without payment of the tax or penalty shown therein to be due, including all such property of the company or person acquired after receipt of the assessment, issuance of the order, or filing of the return. The company or person is liable for the filing fee incurred by the Department for filing the lien and the filing fee incurred by the Department to file the release of that lien. The filing fees shall be paid to the Department in addition to payment of the tax, fee, charge, fine, penalty, interest, other charges, or any portion thereof, included in the amount of the lien. However, where the lien arises because of the issuance of a final order of the Director or tax assessment by the Department, the lien shall not attach and the notice referred to in this Section shall not be filed until all administrative proceedings or proceedings in court for review of the final order or assessment have terminated or the time for the taking thereof has expired without such proceedings being instituted. Upon the granting of Department review after a lien has attached, the lien shall remain in full force except to the extent to which the final assessment may be reduced by a revised final assessment following the rehearing or review. The lien created by the issuance of a final assessment shall terminate, unless a notice of lien is filed, within 3 years after the date all proceedings in court for the review of the final assessment have terminated or the time for the taking thereof has expired without such proceedings being instituted, or (in the case of a revised final assessment issued pursuant to a rehearing or review by the Department) within 3 years after the date all proceedings in court for the review of such revised final assessment have terminated or the time for the taking thereof has expired without such proceedings being instituted. Where the lien results from the filing of a tax return without payment of the tax or penalty shown therein to be due, the lien shall terminate, unless a notice of lien is filed, within 3 years after the date when the return is filed with the Department. The time limitation period on the Department's right to file a notice of lien shall not run during any period of time in which the order of any court has the effect of enjoining or restraining the Department from filing such notice of lien. If the Department finds that a company or person is about to depart from the State, to conceal himself or his property, or to do any other act tending to prejudice or to render wholly or partly ineffectual proceedings to collect the amount due and owing to the Department unless such proceedings are brought without delay, or if the Department finds that the collection of the amount due from any company or person will be jeopardized by delay, the Department shall give the company or person notice of such findings and shall make demand for immediate return and payment of the amount, whereupon the amount shall become immediately due and payable. If the company or person, within 5 days after the notice (or within such extension of time as the Department may grant), does not comply with the notice or show to the Department that the findings in the notice are erroneous, the Department may file a notice of jeopardy assessment lien in the office of the recorder of the county in which any property of the company or person may be located and shall notify the company or person of the filing. The jeopardy assessment lien shall have the same scope and effect as the statutory lien provided for in this Section. If the company or person believes that the company or person does not owe some or all of the tax for which the jeopardy assessment lien against the company or person has been filed, or that no jeopardy to the revenue in fact exists, the company or person may protest within 20 days after being notified by the Department of the filing of the jeopardy assessment lien and request a hearing, whereupon the Department shall hold a hearing in conformity with the provisions of this Code and, pursuant thereto, shall notify the company or person of its findings as to whether or not the jeopardy assessment lien will be released. If not, and if the company or person is aggrieved by this decision, the company or person may file an action for judicial review of the final determination of the Department in accordance with the Administrative Review Law. If, pursuant to such hearing (or after an independent determination of the facts by the Department without a hearing), the Department determines that some or all of the amount due covered by the jeopardy assessment lien is not owed by the company or person, or that no jeopardy to the revenue exists, or if on judicial review the final judgment of the court is that the company or person does not owe some or all of the amount due covered by the jeopardy assessment lien against them, or that no jeopardy to the revenue exists, the Department shall release its jeopardy assessment lien to the extent of such finding of nonliability for the amount, or to the extent of such finding of no jeopardy to the revenue. The Department shall also release its jeopardy assessment lien against the company or person whenever the amount due and owing covered by the lien, plus any interest which may be due, are paid and the company or person has paid the Department in cash or by guaranteed remittance an amount representing the filing fee for the lien and the filing fee for the release of that lien. The Department shall file that release of lien with the recorder of the county where that lien was filed. Nothing in this Section shall be construed to give the Department a preference over the rights of any bona fide purchaser, holder of a security interest, mechanics lienholder, mortgagee, or judgment lien creditor arising prior to the filing of a regular notice of lien or a notice of jeopardy assessment lien in the office of the recorder in the county in which the property subject to the lien is located. For purposes of this Section, "bona fide" shall not include any mortgage of real or personal property or any other credit transaction that results in the mortgagee or the holder of the security acting as trustee for unsecured creditors of the company or person mentioned in the notice of lien who executed such chattel or real property mortgage or the document evidencing such credit transaction. The lien shall be inferior to the lien of general taxes, special assessments, and special taxes levied by any political subdivision of this State. In case title to land to be affected by the notice of lien or notice of jeopardy assessment lien is registered under the provisions of the Registered Titles (Torrens) Act, such notice shall be filed in the office of the Registrar of Titles of the county within which the property subject to the lien is situated and shall be entered upon the register of titles as a memorial or charge upon each folium of the register of titles affected by such notice, and the Department shall not have a preference over the rights of any bona fide purchaser, mortgagee, judgment creditor, or other lienholder arising prior to the registration of such notice. The regular lien or jeopardy assessment lien shall not be effective against any purchaser with respect to any item in a retailer's stock in trade purchased from the retailer in the usual course of the retailer's business.(Source: P.A. 102-775, eff. 5-13-22; 103-426, eff. 8-4-23.)
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(215 ILCS 5/413) (from Ch. 73, par. 1025)
Sec. 413.
Privilege
Tax Payable on Admission of Foreign or Alien Company.
(1) Every foreign or alien company applying for a certificate of
authority to transact business in this State shall pay to the Director a
tax for the privilege of transacting business in this State in accordance
with Section 409.
(2) If during all or any part of the 3 year period next preceding the
date of application for a certificate of authority the company had a
certificate of authority to transact business in this State, or if it
survives or was formed by a merger, consolidation, reorganization or
reincorporation, and one or more of the parties thereto was a foreign or
alien company authorized to transact business in this State during all or
any part of such 3 year period, then the tax shall be determined in
accordance with Section 409 on the basis of the last entire calendar year
during which the company or any one of the foreign or alien companies
parties to the merger, consolidation, reorganization or reincorporation was
authorized to transact business in this State, or if none was authorized
during any entire calendar year, then on the basis of the last partial
calendar year during which any of such companies were authorized to
transact business in this State.
(Source: P.A. 77-2087.)
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(215 ILCS 5/414a) (from Ch. 73, par. 1026a)
Sec. 414a.
Notwithstanding the provisions of this or any other Act, the
tax authorized by Section 414 of this Act shall not be imposed after January
1, 1979; provided that this Section shall not prohibit the collection after
January 1, 1979 of any taxes levied under Section 414 prior to January
1, 1979, on property subject to assessment and taxation under Section 414
of this Act prior to January 1, 1979. For the purpose of replacing the revenue
lost by taxing districts, as defined in Section 1-150 of the Property Tax
Code, as a result of the abolition of ad
valorem taxes on personal property after January 1, 1979, there shall be
imposed the taxes described in Section 201(c) and (d) of the Illinois
Income Tax Act, Section 2a.1 of the Messages Tax Act,
Section 2a.1 of the Gas Revenue Tax Act, Section 2a.1 of
the Public Utilities Revenue Act, and Section 1 of the Water Company Invested
Capital Tax Act. Such replacement taxes owed
within one year of the effective date of the taxes established by
this amendatory Act of 1979 shall replace the personal property tax levies of
1979. The replacement taxes owed in each succeeding year shall replace the
personal property tax that could have been levied in each succeeding year.
(Source: P.A. 88-670, eff. 12-2-94.)
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(215 ILCS 5/415) (from Ch. 73, par. 1027)
Sec. 415.
No taxes to be imposed by political subdivisions.
The fees, charges and taxes provided for by this Article
shall be in lieu of all license fees or privilege or occupation taxes or
other fees levied or assessed by any municipality, county or other political
subdivision of this State, and no municipality, county or other political
subdivision of this State shall impose any license fee or privilege or
occupation tax or fee upon any domestic, foreign or alien company, or upon any
of its agents, for the privilege of doing an insurance business therein, except
the tax authorized by Division 10 of Article 11 of the Illinois Municipal Code,
as heretofore and hereafter amended. This Section shall not be construed to
prohibit the levy and collection of:
(a) State, county or municipal taxes upon the real | ||
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(b) taxes for the purpose of maintaining the Office | ||
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(Source: P.A. 91-357, eff. 7-29-99.)
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(215 ILCS 5/416)
Sec. 416. Illinois Workers' Compensation
Commission Operations Fund Surcharge.
(a) As of July 30, 2004 (the effective date of Public Act 93-840), every company licensed or
authorized by the Illinois Department of Insurance and insuring employers'
liabilities arising under the Workers' Compensation Act or the Workers'
Occupational Diseases Act shall remit to the Director a surcharge based upon
the annual direct written premium, as reported under Section 136 of this Act,
of the company in the manner provided in this
Section. Such
proceeds shall
be deposited into the Illinois Workers' Compensation
Commission Operations Fund as
established in
the Workers' Compensation Act. If a company
survives or
was formed by a merger, consolidation, reorganization, or reincorporation, the
direct
written premiums of all companies party to the merger, consolidation,
reorganization, or
reincorporation shall, for purposes of determining the amount of the fee
imposed by this
Section, be regarded as those of the surviving or new company.
(b)(1) Except as provided in subsection (b)(2) of this Section, beginning on
July 30, 2004 (the effective date of Public Act 93-840) and on July 1 of each year thereafter,
the
Director shall
charge an annual Illinois Workers' Compensation Commission Operations Fund Surcharge from every
company subject to subsection (a) of this Section equal to 1.01% of its direct
written
premium for insuring employers' liabilities arising under the Workers'
Compensation Act or Workers' Occupational Diseases Act as reported in each
company's
annual
statement filed for the previous year as required by Section 136. The
Illinois Workers' Compensation Commission Operations Fund Surcharge shall be collected by companies
subject to subsection (a) of this Section as a separately stated surcharge on
insured employers at the rate of 1.01% of direct written premium. The
Illinois Workers' Compensation Commission Operations Fund Surcharge shall not be collected by companies
subject to subsection (a) of this Section from any employer that self-insures its liabilities arising under the Workers' Compensation Act or Workers' Occupational Diseases Act, provided that the employer has paid the Illinois Workers' Compensation Commission Operations Fund Fee pursuant to Section 4d of the Workers' Compensation Act. All sums
collected by
the Department of Insurance under the provisions of this Section shall be paid
promptly
after the receipt of the same, accompanied by a detailed statement thereof,
into the
Illinois Workers' Compensation Commission Operations Fund in the State treasury.
(b)(2) The surcharge due pursuant to Public Act 93-840 shall be collected instead of the surcharge due on July 1, 2004 under Public Act 93-32. Payment of the surcharge due under Public Act 93-840 shall discharge the employer's obligations due on July 1, 2004.
(c) In addition to the authority specifically granted under Article XXV of
this
Code, the Director shall have such authority to adopt rules or establish forms
as may be
reasonably necessary for purposes of enforcing this Section. The Director shall
also have
authority to defer, waive, or abate the surcharge or any penalties imposed by
this
Section if in
the Director's opinion the company's solvency and ability to meet its insured
obligations
would be immediately threatened by payment of the surcharge due.
(d) When a company fails to pay the full amount of any annual
Illinois Workers' Compensation
Commission Operations Fund Surcharge of $100 or more due under this Section,
there
shall be
added to the amount due as a penalty an amount equal
to 10% of
the deficiency for each month or part of a month that the deficiency remains
unpaid.
(e) The Department of Insurance may enforce the collection of any delinquent
payment, penalty, or portion thereof by legal action or in any other manner by
which the
collection of debts due the State of Illinois may be enforced under the laws of
this State.
(f) Whenever it appears to the satisfaction of the Director that a company
has
paid
pursuant to this Act an Illinois Workers' Compensation Commission Operations Fund Surcharge in
an amount
in excess of the amount legally collectable from the company, the Director
shall issue a
credit memorandum for an amount equal to the amount of such overpayment. A
credit
memorandum may be applied for the 2-year period from the date of issuance,
against the
payment of any amount due during that period under the surcharge imposed by
this
Section or,
subject to reasonable rule of the Department of Insurance including requirement
of
notification, may be assigned to any other company subject to regulation under
this Act.
Any application of credit memoranda after the period provided for in this
Section is void.
(g) Annually, the Governor may direct a transfer of up to 2% of all moneys
collected under this Section to the Insurance Financial Regulation Fund.
(Source: P.A. 102-775, eff. 5-13-22.)
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(215 ILCS 5/Art. XXVI heading) ARTICLE XXVI.
UNFAIR METHODS OF COMPETITION AND UNFAIR AND DECEPTIVE ACTS
AND PRACTICES
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(215 ILCS 5/421) (from Ch. 73, par. 1028)
Sec. 421.
Declaration of purpose.
The purpose of this article is to regulate trade practices in the
business of insurance in accordance with the intent of Congress as
expressed in the Act of Congress of March 9, 1945 (Public Law 15, 79th
Congress), by defining, or providing for the determination of, all such
practices in this State which constitute unfair methods of competition or
unfair or deceptive acts or practices and by prohibiting the trade
practices so defined or determined.
(Source: Laws 1959, p. 734.)
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(215 ILCS 5/422) (from Ch. 73, par. 1029)
Sec. 422.
Definitions.
When used in this Article, "Person" shall mean any individual,
partnership, association, corporation, society, order, firm, company,
aggregation of individuals, reciprocal exchange, inter-insurer, Lloyds
insurer, fraternal benefit society, and any other legal entity to which any
article of this Code is applicable, or which is subject to examination,
visitation or supervision by the Director under any provision of this Code
or under any law of this State, or which is engaged or engaging in or
proposing or attempting to engage in or is representing that it is doing an
insurance or surety business in this State, or which is in process of
organization for the purpose of doing such business, including agents,
brokers, adjusters and solicitors.
(Source: Laws 1959, p. 734.)
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(215 ILCS 5/423) (from Ch. 73, par. 1030)
Sec. 423.
Unfair
methods of competition or unfair and deceptive acts or practices
prohibited.
(1) No person shall engage in this State in any trade practice which is
defined in this Article as, or determined pursuant to this Article to be an
unfair method of competition or an unfair or deceptive act or practice in
the business of insurance.
(2) No person domiciled in or resident of this State shall engage in any
other State, Territory, Province, Possession, Country or District in which
he is not licensed or otherwise authorized to transact business in any
trade practice which is defined in this Article as, or determined pursuant
to this Article to be an unfair method of competition or an unfair or
deceptive act or practice in the business of insurance.
(Source: Laws 1967, p. 990.)
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(215 ILCS 5/424) (from Ch. 73, par. 1031)
Sec. 424. Unfair methods of competition and unfair or deceptive acts or
practices defined. The following are hereby defined as unfair methods of
competition and unfair and deceptive acts or practices in the business of
insurance:
(1) The commission by any person of any one or more | ||
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(2) Entering into any agreement to commit, or by any | ||
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(3) Making or permitting, in the case of insurance of | ||
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(4) Engaging in any of the acts or practices defined | ||
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(5) Making or charging any rate for insurance against | ||
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(6) Failing to meet any requirement of the Unclaimed | ||
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(Source: P.A. 102-778, eff. 7-1-22.)
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(215 ILCS 5/425) (from Ch. 73, par. 1032)
Sec. 425.
Power of
Director.
The Director shall have power to examine and investigate into the
affairs of every person engaged in the business of insurance in this State
and to examine and investigate into the affairs of any person domiciled in
or resident of this State engaged in the business of insurance in any other
State, Territory, Province, Possession, Country or District in which he is
not licensed or otherwise authorized to transact business in order to
determine whether such person has been or is engaged in any unfair method
of competition or in any unfair or deceptive act or practice prohibited by
Section 424.
(Source: Laws 1967, p. 990.)
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(215 ILCS 5/426) (from Ch. 73, par. 1033)
Sec. 426.
Hearings.
(1) Whenever the Director shall have reason to believe that any such
person has been engaged or is engaging in this State in any unfair method
of competition or any unfair or deceptive act or practice defined in
Section 424, or that any person domiciled in or resident of this State
has been engaged or is engaging in any other State, Territory, Province,
Possession, Country or District in which he is not licensed or otherwise
authorized to transact business in any unfair method of competition or any
unfair or deceptive act or practice defined in Section 424, and that a
proceeding by him in respect thereto would be to the interest of the
public, he shall issue and serve upon such person or persons domiciled in
or resident of this State a statement of the charges in that respect and a
notice of a hearing thereon to be held at a time and place fixed in the
notice, which shall not be less than 10 days after the date of the service
thereof.
(2) At the time and place fixed for such hearing, such person shall have
an opportunity to be heard in person or by counsel and to show cause why an
order should not be made by the Director requiring such persons to cease
and desist from the acts, methods or practices so complained of. Upon good
cause shown, before the commencement of such hearing, the Director shall
permit any person to intervene, appear and be heard at such hearing by
counsel or in person.
(3) The Director, upon such hearing, may, and upon the request of any
party shall, cause to be made a stenographic record of all the evidence and
all the proceedings had at such hearing. If no stenographic record is made
and if a judicial review is sought, the Director shall prepare a statement
of the evidence and proceeding for use on review.
(Source: Laws 1967, p. 990.)
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(215 ILCS 5/427) (from Ch. 73, par. 1034)
Sec. 427.
Cease and
desist orders and modifications thereof.
(1) If, after such hearing, the Director shall determine that the method
of competition or the act or practice in question is defined in Section
424 and that the person complained of has engaged in such method of
competition, act or practice in violation of this article, he shall reduce
his findings to writing and shall issue and cause to be served upon the
person charged with the violation an order requiring such person to cease
and desist from engaging in such method of competition, act or practice.
(2) Until the expiration of the time allowed under Section 407 of this
Code for filing a complaint for review if no such complaint has been duly
filed within such time or, if a complaint for review has been filed within
such time, then until the answer in the proceeding has been filed in the
court, as provided in said section, the Director may at any time, upon such
notice and in such manner as he shall deem proper, modify or set aside in
whole or in part any order issued by him under this section.
(3) After the expiration of the time allowed for filing such a complaint
for review if no such complaint has been duly filed within such time, the
Director may at any time, after notice and opportunity for hearing, reopen
and alter, modify or set aside, in whole or in part, any order issued by
him under this section, whenever in his opinion conditions of fact or of
law have so changed as to require such action or if the public interest
shall so require.
(Source: Laws 1959, p. 734.)
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(215 ILCS 5/428) (from Ch. 73, par. 1035)
Sec. 428.
Procedure
on review.
(1) To the extent that the order of the Director is affirmed, the court
shall thereupon enter its own order commanding obedience to the terms of
the order of the Director. If either party applies to the court for
leave to adduce additional evidence, and shows to the satisfaction of
the court that such additional evidence is material and that there were
reasonable grounds for the failure to adduce such evidence in the
proceeding before the Director, the court may order such additional
evidence to be taken before the Director and to be adduced upon the hearing
in such manner and upon such terms and conditions as to the court may seem
proper. The Director, may modify his or her findings of fact, or make new findings
by reason of the additional evidence so taken, and he or she shall file such
modified or new findings as well as any modification of the original order
reached as a result of hearing such additional evidence.
(2) A cease and desist order issued by the Director under Section 427
shall become final.
(a) Upon the expiration of the time allowed for filing a complaint for
review if no such complaint has been duly filed within such time; but
the Director may thereafter modify or set aside his or her order to the
extent provided in Section 427 (2); or
(b) Upon the entry of a final decision, order or judgment of the
court.
(3) No order of the Director under this Article or order of a court to
enforce the same shall in any way relieve or absolve any person affected by
such order from any liability under any other laws of this State.
(Source: P.A. 84-1308.)
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(215 ILCS 5/429) (from Ch. 73, par. 1036)
Sec. 429. Procedure
as to unfair methods of competition and unfair or deceptive acts or
practices which are not defined. (1) Whenever the Director shall have reason to believe (a) that any
person engaged in the business of insurance is engaging in this State in
any method of competition or in any act or practice in the conduct of such
business which is not defined in Section 424, as an unfair method of
competition or an unfair or deceptive act or practice or that any person
domiciled in or resident of this State engaged in the business of insurance
is engaging in any other state, territory, province, possession, country,
or district in which he or she is not licensed or otherwise authorized to transact
business in any method of competition or in any act or practice in the
conduct of such business which is not defined in Section 424, as an unfair
method of competition or an unfair or deceptive act or practice, and (b)
that such method of competition is unfair or that such act or practice is
unfair or deceptive, or (c) that such unfair method of competition or such
unfair or deceptive act or practice violates any of the provisions of this Code or any other law of this State, or (d) that a proceeding
by him or her in respect thereto would be to the interest of the public,
he or she may
issue and serve upon such person a statement of the charges in that respect
and a notice of a hearing thereon to be held at a time and place fixed in
the notice, which shall not be less than 10 days after the date of the
service thereof. Each such hearing shall be conducted in the same manner as
the hearings provided for in Section 426. The Director shall, after such
hearing, make a report in writing in which he or she shall state his
or her findings as
to the facts, and he or she shall serve a copy thereof upon such person.
(2) If such report charges a violation of this Article and if such
method of competition, act, or practice has not been discontinued, the
Director may, through the Attorney General of this State, at any time after
the service of such report cause a complaint to be filed in the Circuit
Court of Sangamon County or in the Circuit Court of this State within the
county wherein the person resides or has his principal place of business,
to enjoin and restrain such person from engaging in such method, act, or
practice. The court shall have jurisdiction of the proceeding and shall
have power to make and enter appropriate orders in connection therewith and
to enter such orders as are ancillary to its jurisdiction
or are necessary
in its judgment to prevent injury to the public pendente lite.
(3) A transcript of the proceedings before the Director including all
evidence taken and the report and findings shall be filed with such
complaint. If either party shall apply to the court for leave to adduce
additional evidence and shall show, to the satisfaction of the court, that
such additional evidence is material and there were reasonable grounds for
the failure to adduce such evidence in the proceedings before the Director
the court may order such additional evidence to be taken before the
Director and to be adduced upon the hearing in such manner and upon such
terms and conditions as to the court may seem proper. The Director may
modify his or her findings of fact or make new findings by reason of the
additional evidence so taken, and he or she shall file such modified or new
findings with the return of such additional evidence.
(4) If the court finds (a) that the method of competition complained of
is unfair or that the act or practice complained of is unfair or deceptive,
or (b) that such unfair method of competition or such unfair or deceptive
act or practice is in violation of this Code or any other law of
this State and (c) that the proceeding by the Director with respect thereto
is to the interest of public and (d) that the findings of the Director are
supported by the evidence, it shall enter an order enjoining and
restraining the continuance of such method of competition, act, or practice.
(Source: P.A. 100-863, eff. 8-14-18.)
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(215 ILCS 5/430) (from Ch. 73, par. 1037)
Sec. 430.
Judicial review by intervenor.
If the report of the Director
does not charge a violation of this
Article, then any party in interest who was an intervenor in the
proceedings before the Director may within 35 days after the service of
such report, cause a complaint to be filed in the Circuit Court of Sangamon
County for a review of such report. Upon such review, the court shall have
authority to issue appropriate orders and judgment in connection therewith,
including, if the court finds that it is to the interest of the public,
orders enjoining and restraining the continuance of any method of
competition, act or practice which it finds, notwithstanding such report of
the Director, constitutes a violation of this Article.
(Source: P.A. 79-1362.)
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(215 ILCS 5/431) (from Ch. 73, par. 1038)
Sec. 431.
Penalty.
Any person who violates a cease and desist order of the Director under
Section 427, after it has become final, and while such order is in
effect, or who violates an order of the Circuit Court under Section 429,
shall, upon proof thereof to the satisfaction of the court, forfeit and pay
to the State of Illinois, a sum not to exceed $1,000, which may be
recovered
in a civil action, for each violation.
(Source: P.A. 93-32, eff. 7-1-03.)
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(215 ILCS 5/432) (from Ch. 73, par. 1039)
Sec. 432.
Provisions additional to existing law.
The powers vested in the Director by this Article shall be additional to
any other powers to enforce any penalties, fines or forfeitures authorized
by law with respect to the methods, acts and practices hereby declared to
be unfair or deceptive.
(Source: Laws 1959, p. 734.)
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(215 ILCS 5/433) (from Ch. 73, par. 1040)
Sec. 433.
Immunity
from prosecution.
If any person shall ask to be excused from attending and testifying or
from producing any books, papers, records, correspondence or other
documents at any hearing on the ground that the testimony or evidence
required of him may tend to incriminate him or subject him to a penalty or
forfeiture, and shall notwithstanding be directed to give such testimony or
produce such evidence, he must none the less comply with such direction,
but he shall not thereafter be prosecuted or subjected to any penalty or
forfeiture for or on account of any transaction, matter or thing concerning
which he may testify or produce evidence pursuant thereto, and no testimony
so given or evidence produced shall be received against him upon any
criminal action, investigation or proceeding, provided, however, that no
such individual so testifying shall be exempt from prosecution or
punishment for any perjury committed by him while so testifying and the
testimony or evidence so given or produced shall be admissible against him
upon any criminal action, investigation or proceeding concerning such
perjury, nor shall he be exempt from the refusal, revocation or suspension
of any license, permission or authority conferred, or to be conferred,
pursuant to the insurance laws of this State. Any such individual may
execute, acknowledge and file in the office of the Director a statement
expressly waiving such immunity or privilege in respect to any transaction,
matter or thing specified in such statement and thereupon the testimony of
such person or such evidence into such transaction, matter or thing may be
received or produced before any judge or justice, court, tribunal, grand
jury or otherwise, and if so received or produced such individual shall not
be entitled to any immunity or privilege on account of any testimony he may
so give or evidence so produced.
(Source: Laws 1959, p. 734.)
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(215 ILCS 5/434) (from Ch. 73, par. 1041)
Sec. 434.
Separability provision.
If any provision of this Article, or the application of such provision
to any person or circumstances, shall be held invalid, the remainder of the
Article, and the application of such provision to persons or circumstances
other than those as to which it is held invalid, shall not be affected
thereby.
(Source: Laws 1959, p. 734.)
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(215 ILCS 5/Art. XXVIII heading) ARTICLE XXVIII.
FINAL PROVISIONS
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(215 ILCS 5/441) (from Ch. 73, par. 1053)
Sec. 441.
General
corporate powers.
(1) In order to carry out the purpose for which it is organized, each
company under the laws of the State and subject to the provisions of this
Code shall have
(a) perpetual succession by its corporate name unless a limited period
of duration is stated in its articles of incorporation;
(b) power in its corporate name to sue and be sued, to contract and be
contracted with, to own, hold, sell, convey, mortgage, pledge, lease and
otherwise dispose of real and personal property;
(c) power to adopt by-laws not in conflict with the provisions of this
Code, and to adopt and use a seal and to alter the same at pleasure;
(d) power to make donations in reasonable amounts for the public welfare
or for charitable, scientific, religious or educational purposes;
(e) such other powers as shall be needful to accomplish the purposes of
its organization.
(2) Such power shall be exercised subject to the provisions and
restrictions of this Code and other laws of this State.
(3) No conveyance or transfer by or to any company of property, real or
personal, of any kind or description, shall be invalid or fail because in
making such conveyance or transfer or in acquiring such property, real or
personal, the company, its board of directors, trustees or other governing
body, or any of its officers, acting within the scope of the actual or
apparent authority given to them by its board of directors, trustees or
other governing body, have in so doing exceeded any of the purposes or
powers of the company.
(Source: Laws 1959, p. 151.)
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(215 ILCS 5/442) (from Ch. 73, par. 1054)
Sec. 442.
Validation of illegally issued policies.
Any contract or policy of insurance or any application, endorsement or
rider form used in connection therewith issued in violation of any section
of this Code requiring certain provisions to be inserted therein or the
inclusion of provisions prohibited, or issued without submitting same for
approval by the Director in accordance with section 143, shall
nevertheless be held valid but shall be construed in accordance with the
requirements of the section that the said policy, application, endorsement
or rider violates, and when any provision in such contract, application,
endorsement or rider is in conflict with any provision of this Code, the
rights, and obligations of the company thereunder shall not be less
favorable to the holder of the contract and the beneficiary or annuitant
thereunder than is required by the provisions of this Code applicable
thereto.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/443) (from Ch. 73, par. 1055)
Sec. 443.
Reciprocity.
The policies of a company, not organized under the laws of this State,
may contain any provision which the law of the state or country under which
the company is organized prescribes shall be in such policies when issued
in this State, and the policies of such insurance company organized under
the laws of this State may, when issued or delivered in any other state or
country, contain any provisions required by the laws of the state or
country in which the same are issued, anything in this Code to the contrary
notwithstanding.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/444) (from Ch. 73, par. 1056)
Sec. 444. Retaliation.
(1) Whenever the existing or future laws of any other state or country
shall
require of companies incorporated or organized under the laws of this State
as a condition precedent to their doing business in such other state or
country, compliance with laws, rules, regulations, and prohibitions more
onerous or burdensome than the rules and regulations imposed by this State
on foreign or alien companies, or shall require any deposit of securities
or other obligations in such state or country, for the protection of
policyholders or otherwise or require of such companies or agents thereof
or brokers the payment of penalties, fees, charges, or taxes greater than
the penalties, fees, charges, or taxes required in the aggregate for like
purposes by this Code or any other law of this State, of foreign or alien
companies, agents thereof or brokers, then such laws, rules, regulations,
and prohibitions of said other state or country shall apply to companies
incorporated or organized under the laws of such state or country doing
business in this State, and all such companies, agents thereof, or brokers
doing business in this State, shall be required to make deposits, pay
penalties, fees, charges, and taxes, in amounts equal to those required in
the aggregate for like purposes of Illinois companies doing business in
such state or country, agents thereof or brokers. Whenever any other state
or country shall refuse to permit any insurance company incorporated or
organized under the laws of this State to transact business according to
its usual plan in such other state or country, the director may, if
satisfied that such company of this State is solvent, properly managed, and
can operate legally under the laws of such other state or country,
forthwith suspend or cancel the license of every insurance company doing
business in this State which is incorporated or organized under the laws of
such other state or country to the extent that it insures in this State
against any of the risks or hazards which are sought to be insured against
by the company of this State in such other state or country.
(2) The provisions of this Section shall not apply to residual market
or special purpose assessments or guaranty fund or guaranty association
assessments, both under the laws of this State and under the laws of any other
state
or country, and any tax offset or credit for any such assessment shall, for
purposes of this Section, be treated as a tax paid both under the laws of this
State and under the laws of any other state or country.
(3) The terms "penalties", "fees", "charges", and "taxes" in subsection
(1) of this
Section
shall include: the penalties, fees, charges, and taxes collected on a cash basis under State
law
and
referenced within Article XXV exclusive of any items referenced by
subsection
(2) of this Section, but including any tax offset allowed under Section 531.13
of this Code; the aggregate Illinois corporate income taxes paid under Sections 601 and 803
of the Illinois Income Tax Act during the calendar year for which the retaliatory tax calculation is being made, less the recapture of any Illinois corporate income tax cash refunds to the extent that the amount of tax refunded was reported as part of the Illinois basis in the calculation of the retaliatory tax for a prior tax year, provided that such recaptured refund shall not exceed the amount necessary for equivalence of the Illinois basis with the state of incorporation basis in such tax year, and after
any tax offset allowed under Section 531.13 of this Code;
income or personal property taxes imposed by other states or countries;
penalties, fees, charges, and taxes of other states
or countries imposed for purposes like those of the penalties, fees, charges,
and taxes
specified in Article XXV of this Code exclusive of any item referenced in
subsection (2) of this Section; and any penalties, fees, charges, and taxes
required as
a
franchise, privilege, or licensing tax for
conducting the business of insurance whether calculated as a percentage of
income, gross receipts, premium, or otherwise.
(4) Nothing contained in this Section or Section 409 or Section 444.1 is
intended to authorize or expand any power of local governmental units or
municipalities to impose taxes, fees, or charges.
(5) This Section is subject to the provisions of Section 10 of the New Markets Development Program Act. (Source: P.A. 98-1169, eff. 1-9-15.)
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(215 ILCS 5/444.1) (from Ch. 73, par. 1056.1)
Sec. 444.1. Payment of retaliatory taxes.
(1) Every foreign or alien
company doing insurance business in this State shall pay the Director the
retaliatory tax determined in accordance with Section 444.
(2) (a) All companies subject to the provisions of this Section shall
make an
annual return for the preceding calendar year on or before March 15 setting
forth such information on such forms as the Director may reasonably require.
Payments of quarterly installments of the taxpayer's total estimated
retaliatory tax for the current calendar year shall be due on or before April
15, June 15, September 15, and December 15 of such year, except that all
companies
transacting insurance business in this State whose annual tax for the
immediately
preceding calendar year was less than $5,000 shall make only an annual
return. Failure of a company to make the annual payment, or to make the
quarterly payments, if required, of at least one-fourth of either (i) the total
tax paid during the previous calendar year or (ii) 80% of the actual tax for
the current calendar year shall subject it to the penalty provisions set forth
in Section 412 of this Code.
(b) Notwithstanding the foregoing provisions of paragraph (a) of this
subsection, the retaliatory tax liability of companies under Section 444 of
this Code for the calendar year ended December 31, 1997 shall be
determined in accordance with this amendatory Act of 1998 and shall include in
the aggregate comparative tax burden for the State of Illinois, any tax offset
allowed under Section 531.13 of this Code and any income
taxes paid for the year 1997 under subsections (a) through (d) of Section 201
of the Illinois Income Tax Act after any tax offset allowed under Section
531.13 of this Code.
(i) Any annual retaliatory tax returns and payments | ||
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(ii) Any overpayment resulting from such amended | ||
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(iii) In the year 1999 and thereafter all companies | ||
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(3) Any tax payment made under this Section and any tax returns prepared
in compliance with Section 410 shall give full consideration to the impact
of any future reduction in or elimination of a taxpayer's liability under
Section 409, whether such reduction or elimination is due to an operation
of law or an Act of the General Assembly.
(4) Any foreign or alien taxpayer who makes, under protest, a tax payment
required by Section 409 shall, at the time of payment, file a retaliatory
tax return sufficient to disclose the full amount of retaliatory taxes which
would be due and owing for the tax period in question if the protest were
upheld. Notwithstanding the provisions of the State Officers and Employees
Money Disposition Act or any other laws of this State, the protested
payment, to the extent of the retaliatory tax so disclosed, shall be deposited
directly in the General Revenue Fund; and the balance of the payment, if
any, shall be deposited in a protest account pursuant to the provisions
of the aforesaid Act, as now or hereafter amended.
(5) The failure of a company to make the annual payment or to make the
quarterly payments, if required,
of at least one-fourth of either (i) the total tax paid
during the preceding
calendar year or (ii) 80% of the actual tax for the current calendar
year shall subject it to the penalty provisions set forth in Section
412 of this Code.
(6) This Section is subject to the provisions of Section 10 of the New Markets Development Program Act. (Source: P.A. 95-1024, eff. 12-31-08.)
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(215 ILCS 5/445) (from Ch. 73, par. 1057)
Sec. 445. Surplus line.
(1) Definitions. For the purposes of this Section:
"Affiliate" means, with respect to an insured, any entity that controls, is controlled by, or is under common control with the insured. For the purpose of this definition, an entity has control over another entity if: (A) the entity directly or indirectly or acting | ||
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(B) the entity controls in any manner the election of | ||
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"Affiliated group" means any group of entities that are all affiliated. "Authorized insurer" means an insurer that holds a certificate of
authority
issued by the Director but, for the purposes of this Section, does not
include a
domestic surplus line insurer as defined in Section 445a or any
residual market
mechanism. "Exempt commercial purchaser" means any person purchasing commercial insurance that, at the time of placement, meets the following requirements: (A) The person employs or retains a qualified risk | ||
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(B) The person has paid aggregate nationwide | ||
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(C) The person meets at least one of the following | ||
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(I) The person possesses a net worth in excess of | ||
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(II) The person generates annual revenues in | ||
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(III) The person employs more than 500 full-time | ||
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(IV) The person is a not-for-profit organization | ||
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(V) The person is a municipality with a | ||
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Effective on January 1, 2015 and each fifth January 1 occurring thereafter, the amounts in subitems (I), (II), and (IV) of item (C) of this definition shall be adjusted to reflect the percentage change for such 5-year period in the Consumer Price Index for All Urban Consumers published by the Bureau of Labor Statistics of the Department of Labor. "Home state" means the following: (A) With respect to an insured, except as provided | ||
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(I) the state in which an insured maintains its | ||
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(II) if 100% of the insured risk is located out | ||
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(B) If more than one insured from an affiliated group | ||
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If more than one insured from a group that is not | ||
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(I) if individual group members pay 100% of the | ||
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(II) otherwise, "home state" means the home | ||
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Nothing in this definition shall be construed to alter the terms of the surplus line insurance contract. "Master policy" means a surplus line insurance contract with a single set of general contractual terms that are designed to apply on a group basis to multiple insureds who may or may not be affiliated and who may be added to or removed from the contract throughout the course of the contract period. A master policy may include certain provisions that vary for each insured depending on the insured's characteristics and the coverage sought. "Multi-State risk" means a risk with insured exposures in more than one State. "NAIC" means the National Association of Insurance Commissioners or any successor entity. "Personal lines insurance" means insurance as defined in subsection (a), (b), or (c) of Section 143.13 of this Code. "Premium" means any amount designated as premium on the declarations page or elsewhere in a policy and on any endorsement, but does not include taxes, the Surplus Line Association of Illinois recording fee, or any other fee. "Program business" means a clearly defined group of insurance contracts procured by a licensed surplus line producer from an unauthorized insurer, under a single agreement between the producer and insurer, for insureds with the same or similar characteristics and containing the same or similar contract terms. "Qualified risk manager" means, with respect to a policyholder of commercial insurance, a person who meets all of the following requirements: (A) The person is an employee of, or third-party | ||
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(B) The person provides skilled services in loss | ||
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(C) With regard to the person: (I) the person has: (a) a bachelor's degree or higher from an | ||
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(b) the following: (i) three years of experience in risk | ||
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(ii) alternatively has: (AA) a designation as a Chartered | ||
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(BB) a designation as an Associate in | ||
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(CC) a designation as Certified Risk | ||
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(DD) a designation as a RIMS Fellow | ||
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(EE) any other designation, | ||
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(II) the person has: (a) at least 7 years of experience in risk | ||
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(b) has any one of the designations specified | ||
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(III) the person has at least 10 years of | ||
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(IV) the person has a graduate degree from an | ||
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"Residual market mechanism" means an association, organization, or other
entity described in Article XXXIII of this Code or Section 7-501 of the
Illinois Vehicle Code or any similar association, organization, or other
entity. "State" means any state of the United States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the Northern Mariana Islands, the Virgin Islands, and American Samoa. "Surplus line insurance" means insurance on a risk: (A) of the kinds specified in Classes 2 and 3 of | ||
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(B) that is procured from an unauthorized insurer | ||
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(C) where Illinois is the home state of the insured, | ||
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(D) that is located in Illinois, for policies | ||
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"Taxable premium" means a premium for any risk that is located in or attributed to any state. "Unauthorized insurer" means an insurer that does not hold a valid
certificate of authority issued by the Director but, for the purposes of this
Section, shall also include a domestic surplus line insurer as defined in
Section 445a.
(1.5) Procuring surplus line insurance; surplus line insurer requirements. (a) License required. Insurance producers may procure | ||
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(b) Domestic and foreign insurer eligibility. | ||
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(i) is permitted in its domiciliary jurisdiction | ||
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(ii) has, based upon information available to the | ||
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(iii) has standards of solvency and management | ||
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Where an unauthorized insurer does not meet the | ||
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(c) Alien insurer eligibility. Licensed surplus line | ||
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(d) Prohibited transactions. Insurance producers | ||
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(i) that is designed to satisfy the proof of | ||
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(ii) that covers the risk of accidental injury to | ||
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(iii) that insures any Illinois personal lines | ||
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Where there is an insurance policy issued by an | ||
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(e) Exempt commercial purchaser diligent effort. | ||
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(i) the producer has disclosed to the exempt | ||
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(ii) the exempt commercial purchaser has | ||
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(f) Commercial wholesale transaction diligent | ||
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(g) Master policy diligent effort. For a master | ||
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(h) Program business diligent effort. For program | ||
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(2) Surplus line producer; license. Any licensed producer who is a
resident of this State, or any nonresident who qualifies under Section
500-40, may be licensed as a surplus line producer upon payment of an annual license fee of $400.
A surplus line producer so licensed shall keep a separate
account of
the business transacted thereunder for 7 years from the policy effective date which shall be open at all times to the
inspection of the Director or his representative.
No later than July 21, 2012, the State of Illinois shall participate in the national insurance producer database of the NAIC, or any other equivalent uniform national database, for the licensure of surplus line producers and the renewal of such licenses.
(3) Taxes and reports.
(a) Surplus line tax and penalty for late payment. | ||
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(i) 3% for policies or contracts with an | ||
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(ii) 3.5% for policies or contracts with an | ||
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A surplus line producer shall file with the Director | ||
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Any surplus line producer who fails to pay the full | ||
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(b) Fire Marshal Tax. Each surplus line producer | ||
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(c) Taxes and fees charged to insured. The taxes | ||
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(4) (Blank).
(5) Submission of documents to Surplus Line Association of Illinois.
A surplus line producer shall submit every insurance contract and premium-bearing endorsement
issued
under his or her license to the Surplus Line Association of Illinois for
recording. The submission and recording may be
effected through electronic means. The submission shall set
forth:
(a) the name of the insured;
(b) the description and location of the insured | ||
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(c) (blank);
(d) the gross premiums charged or returned;
(e) the name of the unauthorized insurer from whom | ||
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(f) the kind or kinds of insurance procured; and
(g) amount of premium subject to tax required by | ||
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Proposals, endorsements, and other documents which are
incidental to the insurance but which do not affect the premium
charged
are exempted from the submission and recording requirements.
The submission of insuring contracts
to the Surplus Line Association of
Illinois constitutes a certification by the surplus line producer or by the insurance producer who presented the risk to the surplus line producer for
placement as a surplus line risk that
after diligent effort, where required, the required insurance could not be procured from
authorized insurers and that
such procurement was otherwise in accordance with the surplus line law.
(6) Evidence of recording required. It shall be unlawful for an insurance
producer to deliver any unauthorized insurer
contract or premium-bearing endorsement unless it contains evidence of recording by the Surplus Line Association of
Illinois.
(7) Inspection of records. A surplus line producer shall
maintain
separate records of the business transacted under his or her license for 7 years from the policy effective date,
including complete copies of surplus line insurance contracts maintained on
paper or by electronic means, which
records shall be open at all times for inspection by the Director and by
the Surplus Line Association of Illinois.
(8) Violations and penalties. The Director may suspend or revoke or
refuse to renew a surplus line producer license for any violation of this Code.
In addition to or in lieu of suspension or revocation, the Director may
subject a surplus line producer
to a civil penalty of up to $2,000 for each cause for suspension
or
revocation. Such penalty is enforceable under subsection (5) of Section
403A of this Code.
Whenever it appears to the satisfaction of the Director that a surplus line producer has made a documented good faith determination of the home state for a surplus line insurance contract and has paid the surplus line taxes to a state other than Illinois, and the Director determines that the producer's good faith determination was incorrect and the home state is Illinois, the surplus line producer may, at the discretion of the Director, be required to submit the contract to the Surplus Line Association of Illinois and pay applicable taxes and recording fees, but there shall be no penalty, interest, or late fee assessed. (9) Director may declare insurer ineligible. If the
Director determines
that the further assumption of risks might be hazardous to the
policyholders of an unauthorized insurer, the Director may
order the
Surplus Line Association of
Illinois not to accept and record insurance contracts evidencing insurance in
such insurer and order surplus line producers to cease
procuring insurance
from such insurer.
(10) Service of process upon Director. Insurance contracts
delivered under this Section from unauthorized insurers, other than domestic
surplus line insurers as defined in Section 445a,
shall contain a
provision designating the
Director and his successors in office the true and lawful attorney of the
insurer upon whom may be served all lawful process in any
action, suit or
proceeding arising out of such insurance.
Service of process made upon the Director to be valid hereunder must state
the name of the insured, the name of the unauthorized insurer
and identify
the contract of insurance. The Director at his option is authorized to
forward a copy of the process to the Surplus Line Association of Illinois
for delivery to the unauthorized insurer or the Director may deliver the process to the
unauthorized insurer by other means which he considers to be
reasonably
prompt and certain.
(10.5) Required notice to policyholder. Insurance contracts delivered under this Section from unauthorized insurers, other than domestic surplus line insurers as defined in Section 445a, shall have stamped or imprinted on the first page thereof in not less than 12-pt. bold face type the following legend: "Notice to Policyholder: This contract is issued, pursuant to Section 445 of the Illinois Insurance Code, by a company not authorized and licensed to transact business in Illinois and as such is not covered by the Illinois Insurance Guaranty Fund." Insurance contracts delivered under this Section from domestic surplus line insurers as defined in Section 445a shall have stamped or imprinted on the first page thereof in not less than 12-pt. bold face type the following legend: "Notice to Policyholder: This contract is issued by a domestic surplus line insurer, as defined in Section 445a of the Illinois Insurance Code, pursuant to Section 445, and as such is not covered by the Illinois Insurance Guaranty Fund."
(11) Marine, aviation, and transportation. The Illinois Surplus Line law does not apply to insurance of
property and operations of railroads or aircraft engaged in interstate or
foreign commerce, insurance of vessels, crafts or hulls, cargoes, marine
builder's risks, marine protection and indemnity, or other risks including
strikes and war risks insured under ocean or wet marine forms of policies.
(12) Applicability of Illinois Insurance Code. Surplus line insurance procured under this Section, including
insurance procured from a domestic surplus line insurer, is not subject
to the provisions of the Illinois Insurance Code other than Sections 123,
123.1, 401, 401.1, 402, 403, 403A, 408, 412, 445, 445a, 445.1, 445.2, 445.3,
445.4, and all of the provisions of Article XXXI to the extent that the
provisions of Article XXXI are not inconsistent with the terms of this Act.
(Source: P.A. 102-224, eff. 1-1-22.)
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(215 ILCS 5/445a)
Sec. 445a. Domestic surplus line insurer.
(a) A domestic insurer possessing
policyholder surplus of at least $15,000,000 may pursuant to a resolution by
its board of directors, and with the written approval of the Director, be
designated as a "domestic surplus line insurer".
(b) A domestic surplus line insurer may insure in this State an
Illinois risk only if procured from a surplus line producer pursuant to Section 445 of
this Code.
(c) A domestic surplus line insurer must agree not to issue a policy
designed to satisfy the financial responsibility requirements of the Illinois
Vehicle Code, the Workers' Compensation Act, or the Workers' Occupational
Diseases Act. A domestic surplus line insurer is not subject to the provisions
of Articles XXXIII, XXXIII 1/2, XXXIV, XXXVIIIA, Section 468, or Section
478.1 of this Code.
(d) For the purposes of the federal Nonadmitted and Reinsurance Reform Act of 2010 (15 USC 8201 et seq.), a domestic surplus line insurer shall be considered a nonadmitted insurer, as the term is defined in the Act, with respect to risks insured in this State. (Source: P.A. 97-955, eff. 8-14-12.)
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(215 ILCS 5/445.1) (from Ch. 73, par. 1057.1)
Sec. 445.1. Surplus Line Association of Illinois. There is hereby created a
non-profit association to be known as the Surplus Line Association of
Illinois. All surplus line producers shall be and must remain individual
members of the Association as a condition of their holding a license as a
surplus line producer in this State. The Association must perform its
functions under the plan of operation established and approved under
Section 445.3 and must exercise its powers through a board of directors
established under Section 445.2 of this Code. The Association shall be
supervised by the Director and is subject to the applicable provisions of
the Illinois Insurance Code. The Association shall be authorized and have the
duty to:
(1) receive and record all surplus line insurance | ||
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(2) prepare monthly reports for the Director on | ||
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(3) prepare and deliver to the Director and, at the | ||
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(4) assess its members for costs of operations in | ||
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(5) employ and retain such persons as are necessary | ||
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(6) borrow money as necessary to effect the purposes | ||
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(7) enter contracts as necessary to effect the | ||
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(8) perform such other acts as will facilitate and | ||
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(9) provide such other services to its members as are | ||
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Nothing in this Act shall be
construed as giving the Association any discretionary authority to enforce
this Act or to withhold or decline acceptance and recording of insurance contracts that meet
the requirements of subsection (5) of Section 445.
(Source: P.A. 102-224, eff. 1-1-22.)
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(215 ILCS 5/445.2) (from Ch. 73, par. 1057.2)
Sec. 445.2.
Board of Directors.
The Association shall function through
a Board of Directors elected by the Association members, and officers who
shall be elected by the Board of Directors.
The Board of Directors of the Association shall consist of not less than
5 nor more than 9 persons serving terms as established in the plan of
operation. The plan of operation shall provide for the election of a Board
of Directors by the members of the Association from its membership. The
plan of operation shall fix the manner of voting and may weigh each
member's vote to reflect the annual surplus line insurance premium written
by the member. Members employed by the same or affiliated employers may
consolidate their premiums written and delegate an individual officer or
partner to represent the member in the exercise of Association affairs,
including service on the Association Board of Directors.
The Director shall appoint an interim Board of Directors for the sole purpose
of conducting an election of Directors. If no Board of Directors is elected
within 90 days after the effective date of this amendatory Act of 1984,
the Director shall appoint the initial members of the Board of Directors.
The Board of Directors shall elect such officers as may be provided in
the plan of operation.
(Source: P.A. 83-1300.)
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(215 ILCS 5/445.3) (from Ch. 73, par. 1057.3)
Sec. 445.3.
Plan of Operation.
(1) The Association shall submit to
the Director a plan of operation and any amendments thereto to provide
operating procedures for the
administration of the Association. The plan of operation and any amendments
thereto shall become effective upon approval in writing by the Director.
(2) If the Association fails to submit a suitable plan of operation within
180 days following the effective date of this amendatory Act of 1984, or
if at any time thereafter the Association fails to submit required amendments
to the plan of operation, the Director shall, after notice and hearing pursuant
to Sections 401, 402 and 403 of this Code, adopt and promulgate such rules
as are necessary or advisable to effectuate the provisions of this Act.
Such rules shall
continue in force until modified by the Director or superseded by a plan
of operation submitted by the Association and approved by the Director.
(3) All Association members must comply with the plan of operation.
(Source: P.A. 83-1300.)
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(215 ILCS 5/445.4) (from Ch. 73, par. 1057.4)
Sec. 445.4. Examination. The Director shall, at such times as he deems
necessary, make or cause to be made an examination of the Association.
The reasonable cost of any such examination shall be paid by the Association
upon presentation to it by the Director of a detailed account of such cost.
During the course of such examination, the directors, officers, members, agents and
employees of the Association may be examined under oath regarding the operation
of the Association and shall make available all books, records, accounts,
documents and agreements pertaining thereto. The Director shall furnish
a copy of the examination report to the Association. Within 20 days after
receipt of the report, the Association may request a hearing on the report
or any facts or recommendations therein. If the Director finds the Association
or any of its members to be in violation of this Act, he may issue an order
requiring discontinuance of such violation. The Association shall annually provide for an independent financial audit of the books and records of the Association by a certified public accountant and shall provide a copy of the audit report to the Director.
(Source: P.A. 98-978, eff. 1-1-15.)
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(215 ILCS 5/445.5) (from Ch. 73, par. 1057.5)
Sec. 445.5.
Immunity.
There shall be no liability on the part of and
no causes of action of any nature shall arise against the Association, its
directors, officers, agents or employees, or the Director of Insurance or
his representatives for any action taken or omitted by them in the performance
of their powers and duties under this Act.
(Source: P.A. 83-1300.)
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(215 ILCS 5/446) (from Ch. 73, par. 1058)
Sec. 446.
Penalties.
Any person who violates any of the provisions of this Code, or fails to
comply with any duty imposed upon him or it by any provision of this law,
for which violation or failure no penalty is elsewhere provided by the laws
of this State, shall be guilty of a petty offense.
(Source: P.A. 77-2699.)
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(215 ILCS 5/447) (from Ch. 73, par. 1059)
Sec. 447.
Domestic
company's adoption of code.
Any company, other than a stock company, heretofore organized or
incorporated under the laws of this State may, without reincorporation,
avail itself of all the provisions of this Code by filing with the
Director, a certified copy of a resolution adopted by its board of
directors, trustees, or other governing body, and in the case of a stock
company such certified copy and a certified copy of a resolution adopted by
at least two-thirds of its shareholders, accepting the provisions of this
Code.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/448) (from Ch. 73, par. 1060)
Sec. 448.
Certain
powers reserved to General Assembly.
The General Assembly shall at all times have power to prescribe such
regulations, provisions, and limitations as it may deem advisable, which
regulations, provisions, and limitations shall be binding upon any and all
companies, domestic, foreign or alien, subject to the provisions of this
Code, and the General Assembly shall have power to amend, repeal, or modify
this Code at pleasure.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/449) (from Ch. 73, par. 1061)
Sec. 449.
Effect of
repeal of prior law.
The repeal of a law by this Code shall not affect any right accrued or
established, or any liability or penalty incurred, under the provisions of
such law, prior to the repeal thereof.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/450) (from Ch. 73, par. 1062)
Sec. 450.
Effect of
invalidity of part of code.
If any provision of this Code, or the application of such provision to
any person or circumstances, shall be held invalid, the remainder of the
Code, and the application of such provision to persons or circumstances
other than those as to which it is held invalid, shall not be affected
thereby.
(Source: Laws 1937, p. 696.)
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(215 ILCS 5/451) (from Ch. 73, par. 1063)
Sec. 451. Companies
not subject to Code. This Code shall not apply to companies now or hereafter organized or
transacting business under the Title Insurance Act, or Act amendatory thereof,
supplementary thereto, or in replacement thereof; nor to corporations now or hereafter organized and
transacting business under "An Act to provide for the incorporation and
regulation of nonprofit hospital service corporations" approved July 6,
1935, or Act amendatory thereof or supplementary thereto; nor shall any
part of this Code other than Articles X, XI, XIII, and XXIV apply to
companies now or hereafter organized or transacting business under an Act
entitled, "An Act relating to local mutual district, county and township
insurance companies," approved March 13, 1936, or Act amendatory thereof
or supplementary thereto. No domestic company shall be organized under this
Code, nor shall any foreign or alien company receive a certificate of
authority under this Code, to transact the business of title insurance. The changes made to this Section by Public Act 96-334 are a statement and clarification of existing law.
(Source: P.A. 96-334, eff. 1-1-10; 96-1000, eff. 7-2-10.)
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(215 ILCS 5/452) (from Ch. 73, par. 1064)
Sec. 452. Civil
Administrative Code of Illinois. Nothing in this Code contained shall be held or construed to alter,
modify, or repeal any of the provisions of the Civil Administrative Code of Illinois.
(Source: P.A. 101-81, eff. 7-12-19.)
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(215 ILCS 5/Art. XXIX heading) ARTICLE XXIX.
WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY RATES.
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(215 ILCS 5/454) (from Ch. 73, par. 1065.1)
Sec. 454.
Purpose of Article.
The purpose of this Article is to promote the public welfare by
regulating workers' compensation and employer's liability insurance
rates to the end that they shall not be excessive, inadequate or
unfairly discriminatory, or erroneously applied and to authorize and
regulate co-operative
action among companies in rate making and in other matters within the
scope of this Article. Nothing in this Article is intended (1) to
prohibit or discourage reasonable competition, or (2) to prohibit, or
encourage except to the extent necessary to accomplish the
aforementioned purpose, uniformity in insurance rates, rating systems,
rating plans or practices. This Article shall be liberally interpreted
to carry into effect the provisions of this Section. Section 462b of
this Article is a codification of existing law and practice.
(Source: P.A. 83-1002.)
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(215 ILCS 5/455) (from Ch. 73, par. 1065.2)
Sec. 455.
Scope of article.
This Article applies to workers' compensation and employers'
liability insurance incidental thereto and written in connection
therewith but shall not apply to reinsurance thereon.
(Source: P.A. 81-992.)
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(215 ILCS 5/456) (from Ch. 73, par. 1065.3)
Sec. 456. Making of rates. (1) All rates shall be made in accordance with the following provisions:
(a) Due consideration shall be given to past and | ||
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(b) The systems of expense provisions included in the | ||
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(c) Risks may be grouped by classifications for the | ||
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(d) Rates shall not be excessive, inadequate or | ||
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A rate is excessive if it is likely to produce a | ||
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A rate is not inadequate unless such rate is clearly | ||
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Unfair discrimination exists if, after allowing for | ||
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(e) The rating plan shall contain a mandatory offer | ||
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(f) Any rating plan or program shall include a rule | ||
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(2) Except to the extent necessary to meet the provisions of
subdivision (d) of subsection (1) of this Section, uniformity among
companies in any matters within the scope of this Section is neither
required nor prohibited.
(Source: P.A. 100-1118, eff. 2-1-19.)
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(215 ILCS 5/457) (from Ch. 73, par. 1065.4)
Sec. 457. Rate filings. (1) Every company
shall prefile with the Director every manual of classifications, every manual
of rules and rates, every rating plan and every modification of the foregoing
which it intends to use. Such filings shall be made at least 30 days before
they become effective.
A company may satisfy its obligation to make such filings by adopting the
filing of a licensed rating organization of which it is a member or subscriber,
filed pursuant to subsection (2) of this Section, in total or, with the approval of the Director, deviate from such filing. If a company intends to deviate from the filing of a licensed rating organization of which it is a member, the company shall provide the Director with supporting information that specifies the basis for the requested deviation and provides justification for the deviation. Any
company adopting a pure premium filed by a rating organization pursuant to subsection
(2) must file with the Director the modification factor it is using for
expenses and profit so that the final rates in use by such company can be determined.
(2) Each licensed rating organization must prefile
with the Director every manual of classification, every manual of rules
and advisory rates, every pure premium which has been fully adjusted and
fully developed, every rating plan and every modification of any of the
foregoing which it intends to recommend for use to its members and subscribers,
at least 30 days before such manual, premium, plan or modification
thereof takes effect. Every licensed rating organization shall also file
with the Director the rate classification system, all rating rules, rating
plans, policy forms, underwriting rules or similar materials, and each modification
of any of the foregoing which it requires its members and subscribers to
adhere to not later than 30 days before such filings or modifications thereof
are to take effect. Every such filing shall state the proposed effective
date thereof and shall indicate the character and extent of the coverage contemplated.
(3) A filing and any supporting information made pursuant to this Section
shall be open to public inspection as soon as filed.
(4) A filing shall not be effective nor used until approved by the Director. A filing shall be deemed approved and legally effective if the Director fails to disapprove within 30 days after the filing. (Source: P.A. 100-1118, eff. 2-1-19.)
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(215 ILCS 5/458) (from Ch. 73, par. 1065.5)
Sec. 458. Disapproval of filings. (1) If within 30 days of any filing the Director
finds that such filing does not meet the requirements of this Article, he
shall send to the company or rating organization which made such filing a
written notice of disapproval of such filing, specifying therein in what
respects he finds that such filing fails to meet the requirements of this
Article. A company or rating organization whose filing has been disapproved shall be given a hearing upon a written request made within 30 days after the disapproval order.
(2) If at any time subsequent to the applicable review period provided
for in subsection (1) of this Section, the Director finds that a
filing does not meet the requirements of this Article, he shall, after a
hearing held upon not less than ten days written notice, specifying the
matters to be considered at such hearing, to every company and rating
organization which made such filing, issue an order specifying in what
respects he finds that such filing fails to meet the requirements of this
Article, and stating when, within a reasonable period thereafter, such
filings shall be deemed no longer effective. Copies of said order shall be
sent to every such company and rating organization. Said order shall not
affect any contract or policy made or issued prior to the expiration of the
period set forth in said order.
(3) Any person or organization aggrieved with respect to any filing
which is in effect may make written application to the Director for a
hearing thereon, provided, however, that the company or rating organization
that made the filing shall not be authorized to proceed under this
subsection. Such application shall specify the grounds to be relied upon by
the applicant. If the Director shall find that the application is made in
good faith, that the applicant would be so aggrieved if his grounds are
established, and that such grounds otherwise justify holding such a
hearing, he shall, within thirty days after receipt of such application,
hold a hearing upon not less than ten days written notice to the applicant
and to every company and rating organization which made such filing.
If, after such hearing, the Director finds that the filing does not meet
the requirements of this Article, he shall issue an order specifying in
what respects he finds that such filing fails to meet the requirements of
this Article, and stating when, within a reasonable period thereafter, such
filing shall be deemed no longer effective. Copies of said order shall be
sent to the applicant and to every such company and rating organization.
Said order shall not affect any contract or policy made or issued prior to
the expiration of the period set forth in said order.
(4) Whenever an insurer has no legally effective rates as a result of the Director's disapproval of rates or other act, the Director shall on request of the insurer specify interim rates for the insurer that are high enough to protect the interests of all parties and may order that a specified portion of the premiums be placed in an escrow account approved by him or her. When new rates become legally effective, the Director shall order the escrowed funds or any overcharge in the interim rates to be distributed appropriately, except that refunds to policyholders that are de minimis shall not be required.(Source: P.A. 100-1118, eff. 2-1-19.)
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(215 ILCS 5/459) (from Ch. 73, par. 1065.6)
Sec. 459.
Rating organizations.
(1) A corporation, an unincorporated association, a partnership or an
individual, whether located within or outside this state, may make
application to the Director for license as a rating organization for such
kinds of insurance or subdivisions thereof as are specified in its
application and shall file therewith (a) a copy of its constitution, its
articles of agreement or association or its certificate of incorporation,
and of its bylaws, rules and regulations governing the conduct of its
business, (b) a list of its members and subscribers, (c) the name and
address of a resident of this state upon whom notices or orders of the
Director or process affecting such rating organization may be served and
(d) a statement of its qualifications as a rating organization. If the
Director finds that the applicant is competent, trustworthy and otherwise
qualified to act as a rating organization and that its constitution,
articles of agreement or association or certificate of incorporation, and
its bylaws, rules and regulations governing the conduct of its business
conform to the requirements of law, he shall issue a license specifying the
kinds of insurance or subdivisions thereof for which the applicant is
authorized to act as a rating organization. Every such application shall be
granted or denied in whole or in part by the Director within sixty days of
the date of its filing with him. Licenses issued pursuant to this Section
shall remain in effect for three years unless sooner suspended or revoked
by the Director. The fee for said license shall be twenty-five dollars.
Licenses issued pursuant to this Section may be suspended or revoked by the
Director, after hearing upon notice, in the event the rating organization
ceases to meet the requirements of this subsection. Every rating
organization shall notify the Director promptly of every change in (a) its
constitution, its articles of agreement or association or its certificate
of incorporation, and its bylaws, rules and regulations governing the
conduct of its business, (b) its list of members and subscribers and (c)
the name and address of the resident of this state designated by it upon
whom notices or orders of the Director or process affecting such rating
organization may be served.
(2) Subject to rules and regulations which have been approved by the
Director as reasonable, each rating organization shall permit any company,
not a member, to be a subscriber to its rating services for any kind of
insurance or subdivision thereof for which it is authorized to act as a
rating organization. Notice of proposed changes in such rules and
regulations shall be given to subscribers. Each rating organization shall
furnish its rating services without discrimination to its members and
subscribers. The reasonableness of any rule or regulation in its
application to subscribers, or the refusal of any rating organization to
admit a company as a subscriber, shall, at the request of any subscriber or
any such company, be reviewed by the Director at a hearing held upon at
least ten days' written notice to such rating organization and to such
subscriber or company. If the Director finds that such rule or regulation
is unreasonable in its application to subscribers, he shall order that such
rule or regulation shall not be applicable to subscribers. If the rating
organization fails to grant or reject a company's application for
subscribership within thirty days after it was made, the company may
request a review by the Director as if the application had been rejected.
If the Director finds that the company has been refused admittance to the
rating organization as a subscriber without justification, he shall order
the rating organization to admit the company as a subscriber. If he finds
that the action of the rating organization was justified, he shall make an
order affirming its action.
(3) No rating organization shall adopt any rule the effect of which
would be to prohibit or regulate the payment of dividends, savings or
unabsorbed premium deposits allowed or returned by companies to their
policyholders, members or subscribers.
(4) Cooperation among rating organizations or among rating organizations
and companies in matters within the scope of this
Article is hereby authorized, provided the filings resulting from such
cooperation are subject to all the provisions of this Article which are
applicable to filings generally. The Director may review such cooperative
activities and practices and if, after a hearing, he finds that any such
activity or practice is unfair or unreasonable or otherwise inconsistent
with the provisions of this Article, he may issue a written order
specifying in what respects such activity or practice is unfair or
unreasonable or otherwise inconsistent with the provisions of this Article,
and requiring the discontinuance of such activity or practice.
(5) A rating organization may require members and subscribers to adhere
to a rate classification system, rating rules, rating plans, policy forms,
and underwriting rules or similar materials; however, no insurer may agree
with any other insurer or with a rating organization to adhere to or use
any rate or schedule rating plan. For the purposes of this Article, "rate"
means the charge for insurance per unit of exposure, prior to any application
of individual risk variations based on loss or expense considerations, or
a consideration of both, and does not include minimum premiums.
(6) Two or more insurers having a common ownership or operating in this
State under common management or control may act in concert between or among
themselves with respect to those activities authorized in this Article as
if they were a single insurer.
(7) The fact that 2 or more insurers consistently or intermittently
use the same rates is not sufficient in itself to support a finding that
an illegal agreement exists, and may be used only for the purpose of supplementing
or explaining other direct evidence of the existence of any such agreement.
(Source: P.A. 82-939.)
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(215 ILCS 5/460) (from Ch. 73, par. 1065.7)
Sec. 460. (Repealed).
(Source: P.A. 99-642, eff. 7-28-16. Repealed by P.A. 100-1118, eff. 2-1-19.)
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(215 ILCS 5/461) (from Ch. 73, par. 1065.8)
Sec. 461.
Appeal
by minority.
Any member of or subscriber to a rating organization may appeal to the
Director from the action or decision of such rating organization in
approving or rejecting any proposed change in or addition to the filings of
such rating organization and the Director shall, after a hearing held upon
not less than ten days' written notice to the appellant and to such rating
organization, issue an order approving the action or decision of such
rating organization or directing it to give further consideration to such
proposal, or, if such appeal is from the action or decision of the rating
organization in rejecting a proposed addition to its filings, he may, in
the event he finds that such action or decision was unreasonable, issue an
order directing the rating organization to make an addition to its filings,
on behalf of its members and subscribers, in a manner consistent with his
findings, within a reasonable time after the issuance of such order.
If such appeal is based upon the failure of the rating organization to
make a filing on behalf of such member or subscriber which is based on a
system of expense provisions which differs, in accordance with the right
granted in subdivision (b) of subsection (1) of Section 456, from the
system of expense provisions included in a filing made by the rating
organization, the Director shall, if he grants the appeal, order the rating
organization to make the requested filing for use by the appellant. In
deciding such appeal the Director shall apply the standards set forth in
Section 456.
(Source: Laws 1947, p. 1098.)
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(215 ILCS 5/462) (from Ch. 73, par. 1065.9)
Sec. 462.
Information to be furnished insureds - Hearings and appeals of
insureds. Every rating organization, and every company which does
not adopt the rates of a rating organization,
shall, within a reasonable time after receiving written request therefor, furnish to
any insured affected by a rate made by it, or to the authorized
representative of such insured, in readily understandable language,
all pertinent information as to such rate as specified in rules adopted
by the Department.
Every rating organization, and every company which does not adopt
the rates of a rating organization,
shall provide within this state reasonable means whereby any person
aggrieved by the application of its rating system may be heard, in
person or by his authorized representative, on his written request to
review the manner in which such rating system has been applied in
connection with the insurance afforded him. If the rating organization
or company fails to grant or reject such request within thirty days
after it is made, the applicant may proceed in the same manner as if his
application had been rejected. Any party affected by the action of such
rating organization or such company on such request may, within thirty
days after written notice of such action, appeal to the Director, who,
after a hearing held upon not less than ten days' written notice to the
appellant and to such rating organization or company, may affirm or
reverse such action.
(Source: P.A. 82-939.)
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(215 ILCS 5/462a) Sec. 462a. Premium increase notice. A policy of workers' compensation insurance issued, delivered, amended, or renewed on or after January 1, 2019 shall remain in full force and effect subject to the same terms and conditions, loss cost multipliers, and classification of the employer with regard to the payment of dividends, unless written notice is mailed or delivered by the insurer to the employer, at the address shown on the policy, and to the employer's authorized agent or broker, indicating the insurer's intention to condition renewal upon issuance of a policy that supersedes the policy previously issued and that will result in a premium in excess of 5% above the rate recommendation filed with the Department, exclusive of any premium increase generated as a result of increased loss costs or increased exposure units or as a result of experience rating, contractor credit adjustment program, large deductible, retrospective rating, or audit. The notice shall be delivered at least 30 days in advance of the expiration date of the policy, and shall set forth: (1) the amount of the premium increase or, if the amount cannot reasonably be determined as of the time the notice is provided, a reasonable estimate of the premium increase based upon the information available to the insurer at that time; and (2) the reason for the increased premium in excess of the rate recommendation filed with the Department. Nothing in this Section requires the insurer to provide notice when the employer, an agent or broker authorized by the employer, or another insurer of the employer has delivered written notice that the policy has been replaced or is no longer desired.
(Source: P.A. 100-1118, eff. 11-27-18.) |
(215 ILCS 5/462b) (from Ch. 73, par. 1065.9b)
Sec. 462b.
Insurance companies shall apply correct classifications,
payrolls and other factors of a rating system to compute premiums. If the
application of incorrect classifications, payrolls or any other factors
of a rating system results in the payment by an insured of premiums in excess
of the premiums that would have been paid utilizing the correct applications
of classifications, payrolls or other factors of a rating system, the insurer
shall refund to the insured the excessive premium paid for the period during
which the incorrect application of classifications, payrolls or other factors
of a rating system were applied. This Section is intended to codify existing
law and practice.
(Source: P.A. 83-1002.)
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(215 ILCS 5/463) (from Ch. 73, par. 1065.10)
Sec. 463.
Advisory organizations.
(1) Every group, association or other organization of companies whether
located within or outside this state, which assists companies which make
their own filings or rating organizations in rate making, by the collection
and furnishing of loss or expense statistics, or by the submission of
recommendations, but which does not make filings under this Article, shall
be known as an advisory organization.
(2) Every advisory organization shall file with the Director (a) a copy
of its constitution, its articles of agreement or association or its
certificate of incorporation and of its by-laws, rules and regulations
governing its activities, (b) a list of its members, (c) the name and
address of a resident of this state upon whom notices or orders of the
Director or process issued at his direction may be served, and (d) an
agreement that the Director may examine such advisory organization in
accordance with the provisions of Section 465 of this Article.
(3) If, after a hearing, the Director finds that the furnishing of such
information or assistance involves any act or practice which is unfair or
unreasonable or otherwise inconsistent with the provisions of this Article,
he may issue a written order specifying in what respects such act or
practice is unfair or unreasonable or otherwise inconsistent with the
provisions of this Article, and requiring the discontinuance of such act or
practice.
(4) No company which makes its own filings nor any rating organization
shall support its filings by statistics or adopt rate making
recommendations, furnished to it by an advisory organization which has not
complied with this Section or with an order of the Director involving such
statistics or recommendations issued under subsection (3) of this Section.
If the Director finds such company or rating organization to be in
violation of this subsection he may issue an order requiring the
discontinuance of such violation.
(Source: Laws 1947, p. 1098.)
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(215 ILCS 5/464) (from Ch. 73, par. 1065.11)
Sec. 464.
Joint underwriting or joint reinsurance.
(1) Every group,
association or other organization of companies which
engages in joint underwriting or joint reinsurance, shall be subject to
regulation with respect thereto as herein provided, subject, however, with
respect to joint underwriting, to all provisions of this Article, and with
respect to joint reinsurance, to Sections 465, 467, 469, 470 and 471 of
this Article.
(2) If, after a hearing, the Director finds that any activity or
practice of any such group, association or other organization is unfair or
unreasonable or otherwise inconsistent with the provisions of this Article,
he may issue a written order specifying in what respects such activity or
practice is unfair or unreasonable or otherwise inconsistent with the
provisions of this Article, and requiring the discontinuance of such
activity or practice.
(Source: Laws 1947, p. 1098.)
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(215 ILCS 5/464a) (from Ch. 73, par. 1065.11a)
Sec. 464a.
(Repealed).
(Source: P.A. 81-1482. Repealed by P.A. 91-757, eff. 1-1-01.)
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(215 ILCS 5/465) (from Ch. 73, par. 1065.12)
Sec. 465.
Examinations.
The Director shall, at least once in five years, make or cause to be
made an examination of each rating organization licensed in this state as
provided in Section 459 and he may, as often as he may deem it expedient,
make or cause to be made an examination of each advisory organization
referred to in Section 463 and of each group, association or other
organization referred to in Section 464. The reasonable costs of any such
examination shall be paid by the rating organization, advisory
organization, or group, association or other organization examined upon
presentation to it of a detailed account of such costs. The officers,
manager, agents and employees of such rating organization, advisory
organization or group, association or other organization may be examined at
any time under oath and shall exhibit all books, records, accounts,
documents, or agreements governing its method of operation. In lieu of any
such examination the Director may accept the report of an examination made
by the insurance supervisory official of another state, pursuant to the
laws of such state. The provisions of Sections 132 through 132.7, 402,
and 403 shall be
applicable to the examinations hereunder.
(Source: P.A. 89-97, eff. 7-7-95.)
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(215 ILCS 5/466) (from Ch. 73, par. 1065.13)
Sec. 466.
Rate administration.
(1) Recording and Reporting of Loss and Expense Experience.
The Director shall promulgate reasonable rules and shall approve statistical
plans, reasonably adapted to each of the rating systems on file with him, which
may be modified from time to time and which shall be used thereafter by
each company in the recording and reporting of its loss and countrywide
expense experience, in order that the experience of all companies may be
made available at least annually in such form and detail as may be
necessary to aid him in determining whether rating systems comply with the
standards set forth in Section 456. An approved statistical plan need not
be adopted as a rule, but shall be made available for public inspection at
the Department's principal office and a copy of the plan shall be filed
with the Secretary of State. Such rules and plans may also provide
for the recording and reporting of expense experience items which are
specially applicable to this state and are not susceptible of determination
by a prorating of countrywide expense experience. In promulgating such rules
and approving plans, the Director shall give due consideration to the rating
systems on file with him and in order that such rules and plans may be as
uniform as is practicable among the several states, to the rules and to the
form of the plans used for such rating systems in other states. No company
shall be required to record or report any experience on an experience
classification which it does not use in the making of its rates or to
record or report its experience on any basis or statistical plan that
differs from that which is regularly employed and used in the usual course
of such company's business, nor shall any company be required to record or
report its loss experience on a classification basis that is inconsistent
with the rating system filed by it, nor shall it be required to report such
experience to any rating organization of which it is not a member or
subscriber, or to an agency operated by or subject to the control of such a
rating organization, nor shall the Department's rules state that the
insurer must record or report its experience in accordance with a uniform
statistical plan which differs from that which is regularly employed and
used in the usual course of such company's business. Any
company not reporting such experience to a rating
organization or other agency designated by the Director, shall report such
experience to the Director. The Director may designate one or more rating
organizations or other agencies to assist him in gathering all such
experience and in making compilations thereof. The experience of any
company filed with the Director shall be deemed confidential and shall not
be revealed by the Director to any other company or other person, provided,
however, that the Director may make compilations of all experience,
including the experience of any such company, or of such experience and the
compilation made by the designated rating organization or other agency. All
such compilations, whether made by the Director or by any designated rating
organization or other agency, shall be made available, subject to
reasonable rules promulgated by the Director, to companies and rating
organizations.
(2) Interchange of Rating Plan Data
Reasonable rules and plans may be promulgated by the Director for the
interchange of data necessary for the application of rating plans.
(3) Consultation with Other States
In order to further uniform administration of rate regulatory laws, the
Director and every company and rating organization may exchange information
and experience data with insurance supervisory officials, companies and
rating organizations in other states and may consult with them with respect
to rate making and the application of rating systems.
(4) Rules and Regulations
The Director may make reasonable rules and regulations necessary to
effect the purpose of this Article.
(Source: P.A. 84-427.)
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(215 ILCS 5/467) (from Ch. 73, par. 1065.14)
Sec. 467.
False or misleading information.
No person, company or
organization shall wilfully withhold information
from, or knowingly give false or misleading information to the Director,
any statistical agency designated by the Director, any rating organization,
or, any company which will affect the rates or premiums chargeable under
this Article. A violation of this Section shall subject the one guilty of
such violation to the penalties provided in Section 470 of this Article.
(Source: Laws 1947, p. 1098.)
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(215 ILCS 5/468) (from Ch. 73, par. 1065.15)
Sec. 468.
Residual Market Mechanism.
All companies licensed to write
workers' compensation and employers' liability insurance in this State shall
participate in a plan providing for the equitable apportionment among them
of insurance which may be afforded applicants who are in good faith entitled
to but who are unable to procure such insurance through ordinary methods.
Companies must submit such a plan for the Director's approval within 60
days of the effective date of this amendatory Act of 1982. The rates to be used
in such a plan and any future modification thereof must be submitted to
the Director for approval at least 30 days prior to their effective date.
Such rates shall reflect residual market experience to the extent it is
actuarially appropriate. The Director shall disapprove any filing that
does not meet the requirements
of subparagraph (d) of paragraph (1) of Section 456 of this Article. A
filing shall be deemed to meet such requirements unless disapproved by the
Director within 30 days after the filing is made. In disapproving a filing
made under this Section, the Director shall have the same authority and
shall follow the same procedure as in disapproving a filing under Section
458. Notwithstanding any other provisions of this Article, rating organizations
may make and file rates under this Section.
(Source: P.A. 82-939.)
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(215 ILCS 5/469) (from Ch. 73, par. 1065.16)
Sec. 469. Rebates prohibited. No broker or agent shall knowingly charge, demand, or receive a premium
for any policy of insurance except in accordance with the provisions of
this Article. No company or employee thereof, and no broker or agent shall
pay, allow, or give, or offer to pay, allow, or give, directly or indirectly,
as an inducement to insurance, or after insurance has been effected, any
rebates, discount, abatement, credit, or reduction of the premium named in a
policy of insurance, or any special favor or advantage in the dividends or
other benefits to accrue thereon, or any valuable consideration or
inducement whatever, not specified in the policy of insurance, except to
the extent provided for in an applicable filing. No insured named in a
policy of insurance, nor any employee of such insured shall knowingly
receive or accept, directly or indirectly, any such rebate, discount,
abatement, credit, or reduction of premium, or any such special favor or
advantage or valuable consideration or inducement. Nothing in this Section
shall be construed as prohibiting the payment of commissions or other
compensation to duly licensed agents and brokers, nor as prohibiting any
company from allowing or returning to its participating policyholders,
members, or subscribers, dividends, savings, or unabsorbed premium deposits.
Sections 151 and 152 of this Code shall not apply to any kind
of insurance subject to this Article.
(Source: P.A. 100-863, eff. 8-14-18.)
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(215 ILCS 5/470) (from Ch. 73, par. 1065.17)
Sec. 470.
Penalties.
Any person, company or organization violating any provision of this
Article shall be guilty of a petty offense for each such violation,
provided that a series of acts or events based upon the same alleged
violation shall be treated and considered as a single violation.
The Director may suspend the license of any rating organization or
company which fails to comply with an order of the Director within the time
limited by such order, or any extension thereof which the Director may
grant. The Director shall not suspend the license of any rating
organization or company for failure to comply with an order until the time
prescribed for filing a petition for review thereof as provided in Section
471 has expired or if such petition for review has been filed until such
order has been affirmed. The Director may determine when a suspension of
license shall become effective and it shall remain in effect for the period
fixed by him, unless he modifies or rescinds such suspension, or until the
order upon which such suspension is based is modified, rescinded or
reversed.
No license shall be suspended or revoked except upon a written order of
the Director, stating his findings, made after a hearing held upon not less
than ten days' written notice to such person or organization specifying the
alleged violation.
(Source: P.A. 77-2699.)
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(215 ILCS 5/471) (from Ch. 73, par. 1065.18)
Sec. 471.
Hearing procedure and judicial review.
(1) Any company or rating
organization aggrieved by any order or
decision of the Director made without a hearing, may, within 30 days
after notice of the order to the company or organization, make written
request to the Director for a hearing thereon. The Director shall hear
such party or parties within 20 days after receipt of such request
and shall give not less than 10 days' written notice of the time and
place of the hearing. Within 15 days after such hearing the
Director shall affirm, reverse or modify his previous action, specifying
his reasons therefor. Pending such hearing and decision thereon the
Director may suspend or postpone the effective date of his previous
action.
(2) Nothing contained in this Article shall require the observance
at any hearing of formal rules of pleading or evidence.
(3) The Administrative Review Law shall apply to and govern all
proceedings for the judicial review of orders and decisions of the
Director under this Article. Provided, however, that, in the review of
any order or decision of the Director under this Article, such order or
decision shall not be deemed prima facie to be correct and proper, and
provided further that a rating organization aggrieved by an order or
decision under this Article may initiate such proceedings for its
review.
(Source: P.A. 82-783.)
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(215 ILCS 5/Art. XXX.5 heading) ARTICLE XXX 1/2.
PROPERTY AND
CASUALTY RATES OTHER THAN WORKERS'
(Repealed by P.A. 90-372, eff. 7-1-98)
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(215 ILCS 5/Art. XXXI heading) ARTICLE XXXI.
INSURANCE PRODUCERS, LIMITED
INSURANCE REPRESENTATIVES AND REGISTERED FIRMS
(Article scheduled to be repealed on January 1, 2027)
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(215 ILCS 5/490.1) (from Ch. 73, par. 1065.37-1)
Sec. 490.1.
(Repealed).
(Source: P.A. 83-801. Repealed by P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/491.1) (from Ch. 73, par. 1065.38-1)
Sec. 491.1.
(Repealed).
(Source: P.A. 91-234, eff. 1-1-00. Repealed by P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/492.2) (from Ch. 73, par. 1065.39-2)
Sec. 492.2.
(Repealed).
(Source: P.A. 91-234, eff. 1-1-00. Repealed by P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/493.1) (from Ch. 73, par. 1065.40-1)
Sec. 493.1.
(Repealed).
(Source: P.A. 83-749. Repealed by P.A. 90-499, eff. 8-19-97.)
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(215 ILCS 5/493.2) (from Ch. 73, par. 1065.40-2)
Sec. 493.2.
(Repealed).
(Source: P.A. 85-334. Repealed by P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/494.1) (from Ch. 73, par. 1065.41-1)
Sec. 494.1.
(Repealed).
(Source: P.A. 91-234, eff. 1-1-00. Repealed by P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/494.2) (from Ch. 73, par. 1065.41-2)
Sec. 494.2.
(Repealed).
(Source: P.A. 87-1216. Repealed by P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/495.1) (from Ch. 73, par. 1065.42-1)
Sec. 495.1.
(Repealed).
(Source: P.A. 86-600. Repealed by P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/495.2)
Sec. 495.2.
(Repealed).
(Source: P.A. 91-234, eff. 1-1-00. Repealed by P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/496.2) (from Ch. 73, par. 1065.43-2)
Sec. 496.2.
(Repealed).
(Source: P.A. 91-234, eff. 1-1-00. Repealed by P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/497.1) (from Ch. 73, par. 1065.44-1)
Sec. 497.1.
(Repealed).
(Source: P.A. 91-234, eff. 1-1-00. Repealed by P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/497.2) (from Ch. 73, par. 1065.44-2)
Sec. 497.2.
(Repealed).
(Source: P.A. 87-601. Repealed by P.A. 89-265, eff. 1-1-96.)
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(215 ILCS 5/498.1) (from Ch. 73, par. 1065.45-1)
Sec. 498.1.
(Repealed).
(Source: P.A. 88-313. Repealed by P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/499.1) (from Ch. 73, par. 1065.46-1)
Sec. 499.1.
(Repealed).
(Source: P.A. 91-234, eff. 1-1-00. Repealed by P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/500-5)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-5.
Scope of Article.
This Article applies to all persons and
insurance companies as
defined in this Code. This Article does not apply to surplus lines producers
licensed pursuant to
Section 445 except as provided in Section 500-40 and subsection (b) of Section
500-90 of this
Article.
(Source: P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/500-10)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-10. Definitions. In addition to the definitions in Section 2 of
the
Code, the following
definitions apply to this Article:
"Business entity" means a corporation, association, partnership, limited
liability
company, limited liability partnership, or other legal entity.
"Car rental limited line licensee" means a person authorized under the
provisions of
Section 500-105 to sell certain coverages relating to the rental of vehicles.
"Home state" means the District of Columbia and any state or territory of the
United
States in which an insurance producer maintains his or her principal place of
residence or
principal place of business and is licensed to act as an insurance producer.
"Insurance" means any of the lines of authority in Section 500-35, any health
care plan
under the Health Maintenance Organization Act, or any limited health care plan
under the
Limited Health Service Organization Act.
"Insurance producer" means a person required to be licensed under the laws of
this State
to sell, solicit, or negotiate insurance.
"Insurer" means a company as defined in subsection (e) of Section 2 of this
Code, a
health maintenance organization as defined in the Health Maintenance
Organization Act, or a
limited health service organization as defined in the Limited Health
Service Organization Act.
"License" means a document issued by the Director authorizing an individual
to act as an
insurance producer for the lines of authority specified in the document or
authorizing a business
entity to act as an insurance producer. The license itself does not create any
authority, actual,
apparent, or inherent, in the holder to represent or commit
an insurance carrier.
"Limited lines insurance" means those lines of insurance defined in Section
500-100 or
any other line of insurance that the Director may deem it necessary to
recognize for the purposes
of complying with subsection (e) of Section 500-40.
"Limited lines producer" means a person authorized by the Director to sell,
solicit, or
negotiate limited lines insurance.
"Negotiate" means the act of conferring directly with or offering advice
directly to a
purchaser or prospective purchaser of a particular contract of insurance
concerning any
of the substantive benefits, terms, or conditions of the contract, provided
that the person
engaged in that act either sells insurance or obtains insurance from
insurers for purchasers.
"Person" means an individual or a business entity.
"Rental agreement" means a written agreement setting forth the terms and
conditions
governing the use of a vehicle provided by a rental company for
rental or lease.
"Rental company" means a person, or a franchisee of the person, in the
business of
providing primarily private passenger vehicles to the public under a
rental agreement for a period
not to exceed 30 days.
"Rental period" means the term of the rental agreement.
"Renter" means a person obtaining the use of a vehicle from a
rental company under the
terms of a rental agreement for a period not to exceed 30 days.
"Self-service storage facility limited line licensee" means a person
authorized under the provisions of Section 500-107 to sell certain coverages
relating to the rental of self-service storage facilities.
"Sell" means to exchange a contract of insurance by any means, for
money or its equivalent, on
behalf of an insurance company.
"Solicit" means attempting to
sell insurance or asking or urging a person to apply for a
particular kind of insurance from a particular company.
"Terminate" means the cancellation of the relationship between an insurance
producer and the
insurer or the termination of a producer's authority to transact insurance.
"Travel insurance" has the meaning provided in Section 1630. "Uniform Business Entity Application" means the current version of the
National Association of Insurance Commissioners' Uniform
Business Entity Application for nonresident business entities.
"Uniform Application" means the current version of the National Association
of Insurance Commissioners' Uniform
Application for
nonresident producer licensing.
"Vehicle" or "rental vehicle" means a motor vehicle of (1) the private
passenger
type, including passenger vans, mini vans, and sport utility vehicles or (2)
the cargo type,
including cargo vans, pickup trucks, and trucks with a gross vehicle
weight of less than
26,000 pounds the operation of which does not require the operator to possess a
commercial
driver's license.
"Webinar" means an online educational presentation during which a live and participating instructor and participating viewers, whose attendance is periodically verified throughout the presentation, actively engage in discussion and in the submission and answering of questions. (Source: P.A. 102-212, eff. 10-28-21.)
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(215 ILCS 5/500-15)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-15.
License required.
(a) A person may not sell, solicit, or negotiate insurance in this State for
any class or
classes of insurance unless the person is licensed for that line of authority
in accordance with this
Article.
(b) A person may not, for a fee, engage in the business of offering any
advice, counsel, opinion, or service with respect to the benefits, advantages,
or disadvantages under any policy of insurance that could be issued in
Illinois, unless that person is:
(1) engaged or employed as an attorney licensed to | ||
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(2) a licensed insurance producer, limited insurance | ||
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(3) a trust officer of a bank performing duties | ||
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(4) an actuary or a certified public accountant | ||
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(5) a licensed public adjuster acting within the | ||
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(c) In addition to any other penalty set forth in this Article, an
individual
who
knowingly violates subsection (a) is guilty of a Class A misdemeanor.
(d) In addition to any other penalty set forth in this Article, any
individual violating subsection (a) or (b) and misappropriating or converting
any moneys collected in conjunction with the violation is guilty of a Class 4
felony.
(Source: P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/500-20)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-20.
Exceptions to licensing.
(a) Nothing in this Article shall be construed to require an insurer to
obtain
an
insurance producer license. In this Section, the term "insurer" does not
include an insurer's
officers, directors, employees, subsidiaries, or affiliates.
(b) A license as an insurance producer shall not be required of the
following:
(1) an officer, director, or employee of an insurer | ||
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(A) the officer's, director's, or employee's | ||
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(B) the officer's, director's, or employee's | ||
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(C) the officer, director, or employee is acting | ||
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(2) a person who secures and furnishes information | ||
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(3) an employer or association or its officers, | ||
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(4) employees of insurers or organizations employed | ||
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(5) a person whose activities in this State are | ||
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(6) a person who is not a resident of this State who | ||
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(7) a salaried, full-time employee who counsels or | ||
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(Source: P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/500-25)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-25.
Application for examination.
(a) A resident individual applying for an insurance producer license must
pass a written
examination unless exempt pursuant to Section 500-45. Both part one and part 2
of the
examination must be passed within 90 days of each other. The examination shall
test the
knowledge of the individual concerning the lines of authority for which
application is made, the
duties and responsibilities of an insurance producer, and the insurance laws
and rules of this
State. Examinations required by this Section must be developed and conducted
under rules
prescribed by the Director.
(b) The Director may make arrangements,
including contracting with an outside testing
service, for administering
examinations and collecting the nonrefundable fee set forth in Section
500-135.
(c) An individual applying for an examination must remit a nonrefundable fee
as
prescribed by the Director as set forth in Section 500-135, plus a separate
remittance payable to
the designated testing service for the total fees the testing service charges
for each of the various
services being requested by the applicant.
(d) An individual who fails to appear for the examination as scheduled or
fails
to pass the
examination, must reapply for an examination and remit all required fees and
forms before being
rescheduled for another examination.
(Source: P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/500-30)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-30. Application for license.
(a) An individual applying for a resident insurance producer license must
make
application on a form specified by the Director and declare under penalty of
refusal, suspension,
or revocation of the license that the statements made in the application are
true, correct, and
complete to the best of the individual's knowledge and belief. Before
approving the application,
the Director must find that the individual:
(1) is at least 18 years of age;
(2) is sufficiently rehabilitated in cases in which | ||||||||||||||||
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(3) has completed, if required by the Director, a | ||||||||||||||||
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(4) has paid the fees set forth in Section 500-135; | ||||||||||||||||
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(5) has successfully passed the examinations for the | ||||||||||||||||
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(b) A pre-licensing course of study for each class of insurance for which
an insurance
producer license is requested must be established in accordance with rules
prescribed by the
Director and must consist of the following minimum hours:
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7.5 hours of each pre-licensing course must be completed in a classroom or webinar setting, except Motor Vehicle, which would require 5 hours in a classroom or webinar setting. (c) A business entity acting as an insurance producer must obtain an
insurance
producer license. Application must be made using the Uniform Business Entity
Application.
Before approving the application, the Director must find that:
(1) the business entity has paid the fees set forth | ||||||||||||||||
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(2) the business entity has designated a licensed | ||||||||||||||||
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(d) The Director may require any documents reasonably necessary to verify
the
information contained in an application.
(Source: P.A. 102-135, eff. 7-23-21.)
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(215 ILCS 5/500-35)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-35. License.
(a) Unless denied a license pursuant to Section 500-70, persons who have met
the
requirements of Sections 500-25 and 500-30 shall be issued a 2-year insurance
producer license.
An insurance producer may receive qualification for a license in one or more of
the following
lines of authority:
(1) Life: insurance coverage on human lives including | ||
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(2) Variable life and variable annuity products: | ||
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(3) Accident and health or sickness: insurance | ||
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(4) Property: insurance coverage for the direct or | ||
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(5) Casualty: insurance coverage against legal | ||
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(6) Personal lines: property and casualty insurance | ||
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(7) Any other line of insurance permitted under State | ||
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(b) An insurance producer license shall remain in effect unless revoked or
suspended
as long as the fee set forth in Section 500-135 is paid and education
requirements for resident
individual producers are met by the due date.
(1) Before each license renewal, an insurance | ||
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(2) An insurance producer license automatically | ||
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(3) An insurance producer's active participation in | ||
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(A) service on a board of directors of a State | ||
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(B) service on a formal committee of a State or | ||
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(C) service on a formal subcommittee or task | ||
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(c) A provider of a pre-licensing or continuing education course required
by Section
500-30 and this Section must pay a registration fee and a course certification
fee for each course
being certified as provided by Section 500-135.
(d) An individual insurance producer who allows his or her license to lapse
may,
within 12 months after the due date of the renewal fee, be issued a license
without the necessity
of passing a written examination. However, a penalty in the amount of double
the unpaid renewal
fee shall be required after the due date.
(e) A licensed insurance producer who is unable to comply with license
renewal
procedures due to military service may request a waiver of those procedures.
(f) The license must contain the licensee's name, address, and personal
identification
number, the date of issuance, the lines of authority, the expiration date, and
any other
information the Director deems necessary.
(g) Licensees must inform the Director by any means acceptable to the
Director of a
change of address within 30 days after the change.
(h) In order to assist in the performance of the Director's duties, the
Director may
contract with a non-governmental entity including the National Association of
Insurance
Commissioners (NAIC), or any affiliates or subsidiaries that the NAIC oversees,
to perform any
ministerial functions, including collection of fees, related to producer
licensing that the Director
and the non-governmental entity may deem appropriate.
(Source: P.A. 102-766, eff. 1-1-23.)
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(215 ILCS 5/500-40)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-40.
Nonresident licensing.
(a) Unless denied a license pursuant to Section 500-70, a nonresident person
shall
receive a nonresident producer license if:
(1) the person is currently licensed as a resident | ||
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(2) the person has submitted the proper request for a | ||
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(3) the person has submitted or transmitted to the | ||
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(4) the person's home state awards nonresident | ||
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(b) The Director may verify the producer's licensing status through the
Producer
Database maintained by the National Association of Insurance Commissioners or
its
affiliates or
subsidiaries or by obtaining certification from the public official having
supervision of insurance in the
applicant's state of
residence that the applicant has passed the written examination for the class
of insurance applied for.
(c) A nonresident producer who moves from one state to another state or a
resident
producer who moves from this State to another state must file a change of
address and provide
certification from the new resident state within 30 days after the change of
legal residence. No
fee or license application is required.
(d) Notwithstanding any other provision of this Article, a person licensed
as
a surplus
lines producer in his or her home state shall receive a nonresident surplus
lines producer license
pursuant to subsection (a) of this Section. Except as provided in subsection
(a),
nothing in this Section
supersedes any provision of Section 445 of this Code.
(e) Notwithstanding any other provision of this Article, a person licensed
as
a limited
lines producer in his or her home state shall receive a nonresident limited
lines producer license,
pursuant to subsection (a) of this Section, granting the same scope of
authority as granted under
the license issued by the producer's home state. For the purposes of this
subsection, limited line
insurance is any authority granted by the home state that restricts the
authority of the license to
less than the total authority prescribed in the associated major lines pursuant
to items (1) through
(5) of subsection (a) of Section 500-35.
(Source: P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/500-45)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-45.
Exemption from examination.
(a) An individual who applies for an insurance producer license in this
State who was
previously licensed for the same lines of authority in another state shall not
be required to
complete any pre-licensing education or examination. This exemption is only
available if the
person is currently licensed in that state or if the application is received
within 90 days after the
cancellation of the applicant's previous license and if the prior state issues
a certification that, at
the time of cancellation, the applicant was in good standing in that state or
the state's Producer
Database records, maintained by the National Association of Insurance
Commissioners, its
affiliates, or subsidiaries indicate that the producer is or was licensed in
good standing for the
line of authority requested.
(b) A person licensed as an insurance producer in another state who moves to
this
State must make application within 90 days after establishing legal residence
to become a
resident licensee pursuant to Section 500-30. A pre-licensing education or
examination is
not required of that person to obtain any line of authority previously held in
the
prior state except
when the Director determines otherwise by rule.
(Source: P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/500-50)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-50. Insurance producers; examination statistics.
(a) The use of examinations for the purpose of determining qualifications of
persons
to be licensed as insurance producers has a direct and far-reaching effect on
persons seeking
those licenses, on insurance companies, and on the public. It is in the public
interest and it will
further the public welfare to insure that examinations for licensing do not
have the effect of
unlawfully discriminating against applicants for licensing as insurance
producers on the basis of
race, color, national origin, or sex.
(b) As used in this Section, the following words have the meanings given in
this
subsection.
Examination. "Examination" means the examination in each line of insurance
administered pursuant to Section 500-30.
Examinee. "Examinee" means a person who takes an examination.
Part. "Part" means a portion of an examination for which a score is
calculated.
Operational item. "Operational item" means a test question considered in
determining an
examinee's score.
Test form. "Test form" means the test booklet or instrument used for a part
of
an
examination.
Pretest item. "Pretest item" means a prospective test question that is
included
in a test
form in order to assess its performance, but is not considered in determining
an examinee's score.
Minority group or examinees. "Minority group" or "minority examinees" means
examinees who are American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, or Native Hawaiian or Other Pacific Islander.
Correct-answer rate. "Correct-answer rate" for an item means the number of
examinees
who provided the correct answer on an item divided by the number of examinees
who answered
the item.
Correlation. "Correlation" means a statistical measure of the relationship
between
performance on an item and performance on a part of the examination.
(c) The Director shall ask each examinee to self-report on a voluntary basis
on the
answer sheet, application form, or by other appropriate means, the following
information:
(1) race or ethnicity (American Indian or Alaska | ||
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(2) education (8th grade or less; less than 12th | ||
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(3) gender (male or female).
The Director must advise all examinees that they are not required to provide
this
information, that they will not be penalized for not doing so, and that the
Director will use the
information provided exclusively for research and statistical purposes and to
improve the quality
and fairness of the examinations.
(d) No later than May 1 of each year, the Director must prepare, publicly
announce,
and publish an Examination Report of summary statistical information relating
to each
examination administered during the preceding calendar year. Each Examination
Report shall
show with respect to each examination:
(1) For all examinees combined and separately by race | ||
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(A) number of examinees;
(B) percentage and number of examinees who passed | ||
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(C) percentage and number of examinees who passed | ||
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(D) mean scaled scores on each part; and
(E) standard deviation of scaled scores on each | ||
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(2) For male examinees, female examinees, Black or | ||
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No later than May 1 of each year, the Director must prepare and make
available on
request an Item Report of summary statistical information relating to each
operational item on
each test form administered during the preceding calendar year. The Item Report
shall show, for
each operational item, for all examinees combined and separately for Black or African
American
examinees, white examinees, American Indian or Alaska Native examinees, Asian examinees,
Hispanic or Latino examinees, and Native Hawaiian or Other Pacific Islander, the correct-answer rates and correlations.
The Director is not required to report separate statistical information
for any group or
subgroup comprising fewer than 50 examinees.
(e) The Director must obtain a regular analysis of the data collected under
this
Section, and any other relevant information, for purposes of the development of
new test forms.
The analysis shall continue the implementation of the item selection
methodology as
recommended in the Final Report of the Illinois Insurance Producer's Licensing
Examination
Advisory Committee dated November 19, 1991, and filed with the Department
unless some other
methodology is determined by the Director to be as effective in minimizing
differences between
white and minority examinee pass-fail rates.
(f) The Director has the discretion to set cutoff scores for the
examinations, provided
that scaled scores on test forms administered after July 1, 1993, shall be made
comparable to
scaled scores on test forms administered in 1991 by use of professionally
acceptable methods so
as to minimize changes in passing rates related to the presence or absence of
or changes in
equating or scaling equations or methods or content outlines. Each calendar
year, the scaled
cutoff score for each part of each examination shall fluctuate by no more than
the standard error
of measurement from the scaled cutoff score employed during the preceding year.
(g) No later than May 1, 2003 and no later than May 1 of every fourth year
thereafter,
the Director must release to the public and make generally available one
representative test form
and set of answer keys for each part of each examination.
(h) The Director must maintain, for a period of 3 years after they are
prepared or
used, all registration forms, test forms, answer sheets, operational items and
pretest items, item
analyses, and other statistical analyses relating to the examinations. All
personal identifying
information regarding examinees and the content of test items must be
maintained confidentially
as necessary for purposes of protecting the personal privacy of examinees and
the maintenance of
test security.
(i) In administering the examinations, the Director must make such
accommodations
for examinees with disabilities as are reasonably warranted by the particular disability
involved,
including the provision of additional time if necessary to complete an
examination or special
assistance in taking an examination. (j) For the purposes of this Section:
(1) "American Indian or Alaska Native" means a person | ||
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(2) "Asian" means a person having origins in any of | ||
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(3) "Black or African American" means a person having | ||
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(4) "Hispanic or Latino" means a person of Cuban, | ||
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(5) "Native Hawaiian or Other Pacific Islander" means | ||
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(6) "White" means a person having origins in any of | ||
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(Source: P.A. 102-465, eff. 1-1-22; 102-1100, eff. 1-1-23.)
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(215 ILCS 5/500-55)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-55.
Assumed names.
An insurance producer doing business under
any
name other than
the producer's legal name must notify the Director before using the assumed
name.
(Source: P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/500-60)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-60. Temporary licensing.
(a) The Director may issue a temporary insurance producer license for a
period not to
exceed 180 days and, at the discretion of the Director, may renew the temporary
producer license
for an additional 180 days without requiring an examination if the Director
deems that the
temporary license is necessary for the servicing of an insurance business in
the following cases:
(1) to the surviving spouse or court-appointed | ||
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(2) to a member or employee of a business entity | ||
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(3) to the designee of a licensed insurance producer | ||
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(b) The Director may by order limit the authority of any temporary licensee
in any
way deemed necessary to protect insureds and the public. The Director may
require the
temporary licensee to have a suitable sponsor who is a licensed producer or
insurer and who
assumes responsibility for all acts of the temporary licensee and may impose
other similar
requirements designed to protect insureds and the public. The Director may by
order revoke a
temporary license if the interest of insureds or the public are endangered. A
temporary license
may not continue after the owner or the personal representative disposes of the
business.
(c) Before any temporary insurance producer license is issued, there must be
filed
with the Director a written application by the person desiring the license in
the form, with the
supplements, and containing the information that the Director requires.
License fees, as
provided for in Section 500-135, must be paid upon the issuance of the original
temporary
insurance producer license, but not for any renewal thereof.
(Source: P.A. 99-143, eff. 7-27-15.)
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(215 ILCS 5/500-65)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-65.
Temporary insurance producer license for an applicant.
(a) The Director may grant a temporary insurance producer license to an
applicant for
an insurance producer license, without requiring an examination, for a period
of 90 days, when
the applicant otherwise meets the requirements of this Article. During that
90-day period, the
applicant must be enrolled in a training course or training program conducted
by or on behalf of
the appointing insurance company and be in the process of fulfilling the
pre-licensing
requirements of Sections 500-25 and 500-30.
(b) An individual applicant may not hold more than one temporary insurance
producer license during his or her lifetime.
(c) The Director may refuse to grant temporary insurance producer licenses
to
applicants from an insurance company when during a 6-month period more than 50%
of that
company's temporary insurance producer license holders have failed to obtain
insurance producer
licenses prior to the expiration of their temporary insurance producer
licenses.
(d) Before the Director approves any temporary insurance producer license,
the
insurance company requesting the license must file with the Director an
application and the fee
required by Section 500-135. The application must be made on the form and in
the manner the
Director requires.
(Source: P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/500-70)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-70. License denial, nonrenewal, or revocation.
(a) The Director may place on probation, suspend, revoke, or refuse to issue
or renew
an insurance producer's license or may levy a civil penalty in accordance with
this Section or
take any combination of actions, for any one or more of the following causes:
(1) providing incorrect, misleading, incomplete, or | ||
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(2) violating any insurance laws, or violating any | ||
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(3) obtaining or attempting to obtain a license | ||
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(4) improperly withholding, misappropriating or | ||
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(5) intentionally misrepresenting the terms of an | ||
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(6) having been convicted of a felony, unless the | ||
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(7) having admitted or been found to have committed | ||
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(8) using fraudulent, coercive, or dishonest | ||
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(9) having an insurance producer license, or its | ||
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(10) forging a name to an application for insurance | ||
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(11) improperly using notes or any other reference | ||
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(12) knowingly accepting insurance business from an | ||
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(13) failing to comply with an administrative or | ||
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(14) failing to pay state income tax or penalty or | ||
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(15) (blank); or
(16) failing to comply with any provision of the | ||
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(b) If the action by the Director is to nonrenew, suspend, or revoke a
license or to
deny an application for a license, the Director shall notify the applicant or
licensee and advise, in
writing, the applicant or licensee of the reason for the suspension,
revocation, denial or
nonrenewal of the applicant's or licensee's license. The applicant or licensee
may make written
demand upon the Director within 30 days after the date of mailing for a hearing
before the
Director to determine the reasonableness of the Director's action. The hearing
must be held
within not fewer than 20 days nor more than 30 days after the mailing of the
notice of hearing
and shall be held pursuant to 50 Ill. Adm. Code 2402.
(c) The license of a business entity may be suspended, revoked, or refused
if the
Director finds, after hearing, that an individual licensee's violation was
known or should have
been known by one or more of the partners, officers, or managers acting on
behalf of the
partnership, corporation, limited liability company, or limited liability
partnership and the
violation was neither reported to the Director nor corrective action taken.
(d) In addition to or instead of any applicable denial, suspension, or
revocation of a
license, a person may, after hearing, be subject to a civil penalty of up to
$10,000 for each cause for
denial, suspension, or revocation, however, the civil penalty may total no more
than $100,000.
(e) The Director has the authority to enforce the provisions of and impose
any penalty
or remedy authorized by this Article against any person who is under
investigation for or charged
with a violation of this Code or rules even if the person's license or
registration has been
surrendered or has lapsed by operation of law.
(f) Upon the suspension, denial, or revocation of a license, the licensee or
other
person having possession or custody of the license shall promptly deliver it to
the Director in
person or by mail. The Director shall publish all suspensions, denials, or
revocations after the
suspensions, denials, or revocations become final in a manner designed to
notify interested
insurance companies and other persons.
(g) A person whose license is revoked or whose application is denied
pursuant to this
Section is ineligible to apply for any license for 3 years after the revocation
or denial. A person
whose license as an insurance producer has been revoked, suspended, or denied
may not be
employed, contracted, or engaged in any insurance related capacity during the
time the
revocation, suspension, or denial is in effect.
(Source: P.A. 100-286, eff. 1-1-18; 100-872, eff. 8-14-18.)
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(215 ILCS 5/500-75)
Sec. 500-75. (Repealed).
(Source: P.A. 92-386, eff. 1-1-02. Repealed by P.A. 96-1332, eff. 1-1-11.)
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(215 ILCS 5/500-76) (Section scheduled to be repealed on January 1, 2027) Sec. 500-76. Applicant convictions. (a) The Director and the Department shall not require applicants to report the following information and shall not collect and consider the following criminal history records in connection with an insurance producer license application: (1) Juvenile adjudications of delinquent minors as | ||
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(2) Law enforcement records, court records, and | ||
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(3) Records of arrest not followed by a charge or | ||
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(4) Records of arrest where charges were dismissed | ||
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(5) Convictions overturned by a higher court. (6) Convictions or arrests that have been sealed or | ||
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(b) The Director, upon a finding that an applicant for a license under this Act was previously convicted of a felony, shall consider any mitigating factors and evidence of rehabilitation contained in the applicant's record, including any of the following factors and evidence, to determine if a license may be denied because the prior conviction will impair the ability of the applicant to engage in the position for which a license is sought: (1) the bearing, if any, of the offense for which | ||
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(2) whether the conviction suggests a future | ||
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(3) whether 5 years since a felony conviction or 3 | ||
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(4) if the applicant was previously licensed or | ||
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(5) the age of the person at the time of the criminal | ||
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(6) successful completion of sentence and, for | ||
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(7) evidence of the applicant's present fitness and | ||
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(8) evidence of rehabilitation or rehabilitative | ||
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(9) any other mitigating factors that contribute to | ||
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(c) If a nonresident licensee meets the standards set forth in items (1) through (4) of subsection (a) of Section 500-40 and has received consent pursuant to 18 U.S.C. 1033(e)(2) from his or her home state, the Director shall grant the nonresident licensee a license. (d) If the Director refuses to issue a license to an applicant based upon a conviction or convictions in whole or in part, then the Director shall notify the applicant of the denial in writing with the following included in the notice of denial: (1) a statement about the decision to refuse to issue | ||
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(2) a list of convictions that the Director | ||
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(3) a list of the convictions that were the sole or | ||
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(4) a summary of the appeal process or the earliest | ||
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(Source: P.A. 100-286, eff. 1-1-18.) |
(215 ILCS 5/500-77)
(Section scheduled to be repealed on January 1, 2027) Sec. 500-77. Policyholder information and exclusive ownership
of expirations.
(a) As used in this Section, "expirations" means all information relative to
an insurance policy including, but not limited to, the name and address of the
insured, the location and description of the property insured, the value of the
insurance policy, the inception date, the renewal date, and the expiration date
of the insurance policy, the premiums, the limits and a description of the
terms and coverage of the insurance policy, and any other personal and
privileged information, as defined by Section 1003 of this Code, compiled by a
business entity or furnished by the insured to the
insurer or any agent,
contractor, or representative of the insurer.
For purposes of this Section only, a business entity
also includes a sole
proprietorship that transacts the business of insurance as an insurance agency.
(b) All "expirations" as defined in subsection (a) of this Section shall be
mutually and exclusively owned by the insured and the business entity. The
limitations on the use of expirations as provided in subsections (c) and (d)
of this Section shall be for mutual benefit of the insured and the business
entity.
(c) Except as otherwise provided in this Section, for
purposes of soliciting, selling, or negotiating the renewal or
sale of insurance coverage, insurance products, or insurance
services or for any other marketing purpose, a business entity shall own
and have the exclusive
use of expirations, records, and other written or electronically
stored information directly related to an insurance application
submitted by, or an insurance policy written through, the
business entity. No insurance company, managing
general agent, surplus
lines insurance broker, wholesale broker, group self-insurance
fund, third-party administrator, or any other entity, other than a financial
institution as defined in Section 1402 of this Code, shall use such
expirations, records, or other written or electronically stored information
to solicit, sell, or negotiate the renewal or sale of insurance coverage,
insurance products, or insurance services to the insured or for
any other marketing purposes, either directly or by providing such
information to others,
without, separate from the general agency
contract, the written consent of the business entity.
However, such
expirations,
records, or other written or electronically stored information may be used
for any purpose necessary for placing such business through the
insurance producer including reviewing an application and issuing
or renewing a policy and for loss control services.
(d) With respect to a business entity, this Section
shall not apply:
(1) when the insured requests either orally or in | ||
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(2) to policies in the Illinois Fair Plan, the | ||
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(3) when the insurance producer is employed by or has | ||
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(4) to policies providing life and accident and | ||
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(5) when the business entity is in default for | ||
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(6) to any insurance company's obligations under | ||
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(7) to any insurer that, separate from a producer or | ||
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For purposes of this Section, an insurance producer shall be deemed to
have
agreed to act primarily for one company or a group of affiliated insurance
companies if the producer (i) receives 75% or more of his or her insurance
related commissions from one company or a group of affiliated companies or (ii)
places 75% or more of his or her policies with one company or a group of
affiliated companies.
Nothing in this Section prohibits an insurance company, with respect to any
items herein, from conveying to the insured or the business entity any
additional benefits or ownership rights including, but not limited to, the
ownership of expirations on any policy issued or the imposition of further
restrictions on the insurance company's use of the insured's personal
information.
(e) Nothing in this Section prevents a financial institution, as defined
in Section 1402 of this Code, from obtaining from the insured, the insurer, or
the business entity the expiration dates of an
insurance policy placed on
collateral or otherwise used as security in connection with a loan made or
serviced by the
financial institution when the financial institution requires the expiration
dates for evidence of insurance.
(f) For purposes of this Section, "financial institution" does not include
an insurance company, business entity, managing general
agent, surplus lines
broker, wholesale broker, group self-funded insurance fund, or third-party
administrator.
(g) The Director may adopt rules in accordance with Section
401 of this Code for the enforcement of this Section.
(h) This Section applies to the expirations relative to all policies of
insurance bound, applied for, sold, renewed, or otherwise taking effect on or
after
June 1, 2001.
(Source: P.A. 94-248, eff. 7-19-05.)
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(215 ILCS 5/500-80)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-80.
Commissions.
(a) An insurer or insurance producer may not pay a commission, service fee,
brokerage, or other valuable consideration to a person for selling, soliciting,
or negotiating
insurance in this State if that person is required to be licensed under this
Article and is not so
licensed at the time of selling, soliciting, or negotiating the insurance.
(b) A person may not accept a commission, service fee, brokerage, or other
valuable
consideration for selling, soliciting, or negotiating insurance in this State
if that person is
required to be licensed under this Article and is not so licensed.
(c) Renewal or other deferred commissions may be paid to a person for
selling,
soliciting, or negotiating
insurance in this State if the person was required to be licensed under
this Article at the time of
the sale, solicitation, or negotiation and was so licensed at that time.
(d) An insurer or insurance producer may pay or assign commissions, service
fees,
brokerages, or other valuable consideration to an insurance agency or to
persons who do not sell,
solicit, or negotiate insurance in this State, unless the payment would violate
Section 151 of this
Code.
(e) When an insurance producer or business entity charges any fee or
compensation separate from commissions deductible from, or directly
attributable to, premiums on insurance
policies or contracts, it must comply with all of the following:
(1) It must provide written disclosure to the | ||
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(2) If the combined compensation or fee exceeds 10% | ||
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(3) If an insurance policy or contract is cancelled | ||
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(4) If the policy file contains documentation that | ||
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(Source: P.A. 92-386, eff. 1-1-02; 92-587, eff. 6-26-02.)
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(215 ILCS 5/500-85)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-85.
Notification of termination; immunity; confidentiality.
(a) An insurer or authorized representative of an insurer that terminates
the appointment,
employment, contract, or other insurance business relationship with a producer
must notify the
Director within 30 days following the effective date of the termination, using
a format prescribed
by the Director, if the reason for termination is one of the reasons set forth
in Section 500-70 or
the insurer has knowledge the producer was found by a court, government body,
or self-regulatory organization authorized by law to have engaged in any of the
activities in Section 500-70. Upon written request by the Director, the insurer
must provide additional information,
documents, records, or other data pertaining to the termination or activity of
the producer.
(b) The insurer or the authorized representative of the insurer must
promptly notify the
Director in a format acceptable to the Director if, upon further review or
investigation, the insurer
discovers additional
information that would have been reportable to the Director in accordance
with subsection (a) had the insurer then known of its existence.
(c) Within 15 days after making the notification required by subsections (a)
and (b), the
insurer must mail a copy
of the notification to the producer at his or her last known address. If
the producer is terminated for cause for any of the reasons listed in Section
500-70, the insurer
must provide a copy of the notification to the producer at his or her last
known address by
certified mail, return receipt requested, postage prepaid or by overnight
delivery using a
nationally recognized carrier.
Within 30 days after the
producer has received the original or additional notification, the
producer may file written comments concerning the substance of the notification
with the
Director. The producer
must, by the same means, simultaneously send a copy of the comments to
the reporting insurer, and the comments shall become a part of the Director's
file and accompany
every copy of a report distributed or disclosed for any reason about the
producer as permitted
under this Code.
(d) There shall be no liability on the part of, nor shall a cause of
action of any nature arise against, an insurer, the authorized representative
of the insurer, a producer, the Director, or an organization of which the
Director is a member for any information, documents, records, or statements
provided pursuant to this Section.
(e) An insurer, the authorized representative of the insurer, or a
producer that fails to report as required under the provisions of this Section
or that is found to have reported with malicious intent by a court of competent
jurisdiction may, after notice and hearing, have its license or certificate of
authority suspended or revoked and may be subjected to a civil penalty.
(Source: P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/500-90)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-90.
Reciprocity.
(a) The Director shall waive any requirements for a nonresident license
applicant
with a valid license from his or her home state, except the requirements
imposed by Section 500-40 of this Article, if the applicant's home state awards
nonresident licenses to residents of this
State on the same basis.
(b) A nonresident producer's satisfaction of his or her home state's
continuing
education
requirements for licensed insurance producers shall constitute satisfaction of
this
State's continuing
education requirements if the non-resident producer's home state recognizes
the satisfaction of
its continuing education requirements imposed upon producers from this State
on the same basis.
(Source: P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/500-95)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-95.
Reporting of actions.
An individual who, while licensed as an
insurance producer,
is convicted of a felony, must report the conviction to the Director within 30
days after the entry
date of the judgment. Within that 30-day period, the individual must also
provide the Director
with a copy of the judgment, the probation or commitment order, and any other
relevant
documents.
(Source: P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/500-100)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-100. Limited lines producer license.
(a) An individual who is at least 18 years of age and whom the Director
considers to
be competent, trustworthy, and of good business reputation may obtain a limited
lines producer
license for one or more of the following classes:
(1) travel insurance, as defined in Section 500-10 of | ||
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(2) industrial life insurance, as defined in Section | ||
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(3) industrial accident and health insurance, as | ||
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(4) insurance issued by a company organized under the | ||
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(5) legal expense insurance;
(6) enrollment of recipients of public aid or | ||
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(7) a limited health care plan issued by an | ||
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(8) credit life and credit accident and health | ||
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(b) The application for a limited lines producer license must be submitted
on a form
prescribed by the Director by a designee of the insurance company, health
maintenance
organization, or limited health service organization appointing the limited
insurance
representative. The insurance company, health maintenance organization, or
limited health
service organization must pay the fee required by Section 500-135.
(c) A limited lines producer may represent more than one insurance company,
health
maintenance organization, or limited health service organization.
(d) An applicant who has met the requirements of this Section shall be
issued a
perpetual limited lines producer license.
(e) A limited lines producer license shall remain in effect as long as the
appointing
insurance company pays the respective fee required by Section 500-135 prior to
January 1 of
each year, unless the license is revoked or suspended pursuant to
Section 500-70. Failure of the
insurance company to pay the license fee or to submit the required documents
shall cause
immediate termination of the limited line insurance producer license with
respect to which the
failure occurs.
(f) A limited lines producer license may be terminated by the insurance
company or
the licensee.
(g) A person whom the Director considers to be competent, trustworthy, and
of
good
business reputation may be issued a car rental limited line license. A car
rental limited line
license for a rental company shall remain in effect as long as the car rental
limited line licensee
pays the respective fee required by Section 500-135 prior to the next fee date
unless the car rental
license is revoked or suspended pursuant to Section 500-70. Failure of the car
rental limited line
licensee to pay the license fee or to submit the required documents shall cause
immediate
suspension of the car rental limited line license. A car rental limited line
license for rental
companies may be voluntarily
terminated by the car rental limited line licensee. The license fee
shall not be refunded upon termination of the car rental limited line license
by the car rental
limited line licensee.
(g-5) A business entity may be issued a limited lines producer license for credit life and credit accident and health insurance and other credit insurance policies approved or permitted by the Director, provided that: (1) application for the limited lines producer | ||
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(2) the appointing insurance company has paid the | ||
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(3) the business entity has designated an individual | ||
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Except as specifically authorized by paragraph (8) of subsection (a) of this Section or this subsection (g-5), a business entity holding a limited lines license under this subsection (g-5) may not advertise, represent, or otherwise hold itself or any of its employees out as licensed insurers, insurance producers, insurance agents, or insurance brokers. (h) A limited lines producer issued a license pursuant to this Section is
not
subject to
the requirements of Section 500-30.
(i) A limited lines producer license must contain the name, address and
personal
identification number of the licensee, the date the license was issued,
general conditions relative
to the license's expiration or termination, and any other information the
Director considers
proper. A limited line producer license, if applicable, must also contain the
name and address of
the appointing insurance company.
(Source: P.A. 98-159, eff. 8-2-13; 98-756, eff. 7-16-14; 98-1165, eff. 6-1-15; 99-161, eff. 1-1-16.)
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(215 ILCS 5/500-105)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-105.
Car rental limited line license for rental companies.
(a) A rental company must obtain a producer license or obtain a car rental
limited line
license before offering or selling insurance in connection with and incidental
to the rental of
vehicles. The sale of the insurance may occur at the rental office or by
preselection of coverage
in a master, corporate, group rental, or individual agreement. The following
general categories
of coverage may be offered or sold:
(1) personal accident insurance covering the risks of | ||
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(2) liability insurance, including uninsured and | ||
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(3) personal effects insurance that provides | ||
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(4) roadside assistance and emergency sickness | ||
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(5) any other travel or auto-related coverage that a | ||
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(b) Insurance may not be offered by a car rental limited line producer
pursuant to this
Section unless:
(1) the rental company has applied for and obtained a | ||
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(2) the rental period of the rental agreement does | ||
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(3) at every rental location where rental agreements | ||
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(A) summarize clearly and correctly, the material | ||
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(B) disclose that the coverage offered by the | ||
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(C) state that the purchase by the renter of the | ||
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(D) describe the process for filing a claim in | ||
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(4) evidence of coverage in the rental agreement is | ||
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(c) Car rental company franchisees must apply for a car rental limited line
license
independent of the franchisor if insurance provided pursuant to this Section is
offered by the
franchisee.
(d) A car rental limited line license issued under this Section shall also
authorize any
employee of the car rental
limited line licensee to act individually on behalf and
under the
supervision of the car rental limited line licensee with respect to the kinds
of coverage specified
in this Section.
(e) A rental company licensed pursuant to this Section must conduct a
training
program in which employees being trained shall receive basic instruction about
the kinds of
coverage specified in this Section and offered for purchase by prospective
renters of rental
vehicles.
(f) Notwithstanding any other provision of this Section or any rule adopted
by the
Director, a car rental limited line producer pursuant to this Section is not
required to treat moneys
collected from renters purchasing insurance when renting vehicles as funds
received in a
fiduciary capacity, provided that the charges for coverage shall be itemized
and be ancillary to a
rental transaction.
(g) The sale of insurance not in conjunction with a rental transaction shall
not be
permitted.
(h) A car rental limited line producer under this Section may not advertise,
represent,
or otherwise hold itself or any of its employees out as licensed insurers,
insurance producers,
insurance agents, or insurance brokers.
(i) Direct commissions may not be paid to rental car company employees by
the
insurer or the customer purchasing insurance products. The rental car company
may include
insurance products in an overall employee performance compensation incentive
program.
(j) An application for a car rental limited line license must be made on a
form
specified by the Director.
(Source: P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/500-107)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-107.
Self-service storage facility limited line license for
self-storage
facilities.
(a) Except as permitted by
subsection (j) of this Section, a
self-service storage facility must obtain a producer license or obtain
a
self-service storage facility limited line license before offering or selling
insurance in
connection with and incidental to the rental of storage space provided by a
self-service
storage facility. The sale of insurance may occur at the rental office or by
preselection of
coverage in a master, corporate, group rental, or individual agreement. The
following
general categories of coverage may be offered or sold:
(1) insurance that provides hazard insurance coverage | ||
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(2) any other coverage the Director may approve as | ||
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(b) Insurance may not be offered by a self-service storage limited line
producer
pursuant to this Section unless:
(1) the self-service storage facility has applied for | ||
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(2) at every rental location where rental agreements | ||
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(A) summarize clearly and correctly the material | ||
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(B) disclose that the coverage offered by the | ||
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(C) state that the purchase by the renter of the | ||
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(D) describe the process for filing a claim in | ||
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(3) evidence of coverage is provided to each renter | ||
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(c) A self-service storage facility limited line license issued under this
Section
shall also authorize any employee of the self-service storage facility limited
line licensee
to act individually on behalf and under the supervision of the self-service
storage facility
limited line licensee with respect to the kinds of coverage specified in this
Section.
(d) A self-service storage facility licensed pursuant to this Section must
conduct a
training program in which employees being trained shall receive basic
instruction about
the kinds of coverage specified in this Section and offered for purchase by
prospective
renters of storage space.
(e) Notwithstanding any other provision of this Section or any rule adopted
by the
Director, a self-service storage facility limited line producer pursuant to
this Section is
not required to treat moneys collected from renters purchasing insurance when
renting
storage space as funds received in a fiduciary capacity, provided that the
charges for
coverage shall be itemized and ancillary to a rental transaction.
(f) The sale of insurance not in conjunction with a rental transaction shall
not be
permitted.
(g) A self-service storage facility limited line producer under this Section
may not
advertise, represent, or otherwise hold itself or any of its employees out as
licensed
insurers, insurance producers, insurance agents, or insurance brokers.
(h) Direct commissions may not be paid to self-service storage facility
employees
by the insurer or the customer purchasing insurance products. The self-service
storage
facility may include insurance products in an overall employee performance
compensation incentive program.
(i) An application for a self-service storage facility limited line license
must be
made on a form specified by the Director.
(j) Nothing contained in this Section
shall prohibit an unlicensed person from enrolling, issuing, or otherwise
distributing certificates
of insurance under a group master policy lawfully issued in this or another
state when:
(1) the enrollment or distribution is by an employee | ||
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(2) no commission is paid for such enrollment or | ||
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(3) the distribution is incidental and ancillary to | ||
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(4) the group master policy is sold to the group | ||
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(k) Nothing in this Section applies to or affects common carriers regulated
by
the Illinois Commerce Commission.
(Source: P.A. 93-288, eff. 1-1-04.)
|
(215 ILCS 5/500-108) Sec. 500-108. (Repealed).
(Source: P.A. 98-1165, eff. 6-1-15. Repealed by P.A. 102-212, eff. 10-28-21.) |
(215 ILCS 5/500-110)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-110.
Regulatory examinations.
(a) The Director may examine any applicant for or holder of an insurance
producer
license, limited line producer license or
temporary insurance producer license or any business
entity.
(b) All persons being examined, as well
as their officers, directors, insurance
producers, limited lines producers, and temporary
insurance producers must provide to the
Director convenient and free access, at all reasonable
hours at their offices, to all books, records,
documents, and other papers relating to the persons' insurance business
affairs. The officers,
directors, insurance producers, limited
lines producers, temporary insurance producers, and
employees must facilitate and aid
the Director in the examinations as much as it is in their power
to do so.
(c) The Director may designate an examiner or examiners to conduct any
examination under this Section. The Director or his or her designee may
administer oaths and
examine under oath any individual relative to the business of the person being
examined.
(d) The examiners designated by the Director under this Section may make
reports to
the Director. A report alleging substantive violations of this Article or any
rules prescribed by
the Director must be in writing and be based upon facts
ascertained from the books, records,
documents, papers, and other evidence obtained by the
examiners or from sworn or affirmed
testimony of or written affidavits from the person's
officers, directors, insurance producers,
limited lines producer, temporary insurance producers,
or employees or other individuals, as
given to the examiners. The report of an examination
must be verified by the examiners.
(e) If a report is made, the Director must either
deliver a duplicate of the report to the
person being examined or send the duplicate by
certified or registered mail to the person's
address of record. The Director shall afford
the person an opportunity to demand a hearing with
reference to the facts and other evidence contained
in the report. The person may request a
hearing within 14 calendar days after he or she receives
the duplicate of the examination report
by giving the Director written notice of that request,
together with a written statement of the
person's objections to the report. The Director must,
if requested to do so, conduct a hearing in
accordance with Sections 402 and 403 of this Code. The
Director must issue a written order
based upon the examination report and upon the hearing, if
a hearing is held, within 90 days after
the report is filed, or within 90 days after the hearing if
a hearing is held. If the report is refused
or otherwise undeliverable, or a hearing is not requested in
a timely fashion, the right to a hearing
is waived. After the hearing or the expiration of the time
period in which a person may request a
hearing, if the examination reveals that the person is operating
in violation of any law, rule, or
prior order, the Director in the written
order may require the person to take any action the
Director considers necessary or appropriate
in accordance with the report or examination hearing.
The order is subject to review under the
Administrative Review Law.
(f) The Director may adopt reasonable rules
to further the purposes of this Section.
(g) A person who violates or aids and abets
any violation of a written order
issued
under this Section shall be guilty of a business
offense and his or her license
may be revoked or
suspended pursuant to Section 500-70 of this
Article and he or she may be subjected to a civil penalty of
not more than
$20,000.
(Source: P.A. 92-386, eff. 1-1-02; 93-32, eff. 7-1-03.)
|
(215 ILCS 5/500-115)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-115.
Financial responsibilities.
(a) Any money that an insurance producer, limited line producer, temporary
insurance producer, business entity, or surplus line producer receives for
soliciting, negotiating,
effecting, procuring, renewing,
continuing, or binding policies of insurance shall be held in a
fiduciary capacity and shall not
be misappropriated, converted, or improperly withheld. An
insurance company that delivers to
any insurance producer in this State a policy or contract for
insurance pursuant to the application
or request of an insurance producer, authorizes the producer
to collect or receive on its behalf payment
of any premium that is due on the policy or contract for
insurance at the time of its issuance or delivery and any premium that becomes
due on the policy
or contract not more than 90 days thereafter.
(b) An insurer that issues a policy of insurance shall be deemed to have
received
payment of the premium
if the insured paid any insurance producer requesting the coverage. The
insurer shall be responsible
to the insured for any return premium.
(c) In the case of open
accounts receivable with the balance payable to an insurance
producer within a specified
period of 90 days or less, where the balance is not fully paid within
that period, a late charge
not exceeding 1.5% per month may be added by the insurance producer
to the unpaid balance to induce
payment of the premium.
(d) If an insurance producer or surplus line producer knowingly
misappropriates or converts to his or her own use or illegally withholds
fiduciary moneys in the amount of $150 or less, he or she is guilty of a Class
A misdemeanor for a first offense and a Class 4 felony for subsequent
conversions, misappropriations, and withholdings of that nature. If an
insurance producer or surplus line producer knowingly misappropriates or
converts to his or her own use or illegally withholds premiums in excess of
$150, he or she is guilty of a Class 3 felony.
(Source: P.A. 92-386, eff. 1-1-02.)
|
(215 ILCS 5/500-120)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-120.
Conflicts of interest; inactive status.
(a) A person, partnership, association, or
corporation licensed by the
Department
who, due to employment with any unit of government
that would cause a conflict
of interest with
the holding of that license, notifies the Director
in writing on forms
prescribed by the Department
and, subject to rules of the Department, makes payment
of applicable licensing
renewal fees, may
elect to place the license on an inactive status.
(b) A licensee whose license is on inactive status
may have the license
restored by
making application to the Department on such form as may
be prescribed by the
Department.
The application must be accompanied with a fee of $100 plus
the current
applicable license fee.
(c) A license may be placed on inactive status for a 2-year period, and upon
request,
the inactive status may be extended for a successive 2-year period not to
exceed a cumulative 4-year inactive period. After a license has been on
inactive status for 4 years or more, the licensee
must meet all of the standards required of a new applicant before the license
may be restored to
active status.
(d) If requests for inactive
status are not renewed as set forth in subsection
(c), the
license will be taken off the inactive status and the license will lapse
immediately.
(Source: P.A. 92-386, eff. 1-1-02; 93-32, eff. 7-1-03.)
|
(215 ILCS 5/500-125)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-125.
Controlled business.
(a) An insurance producer license may not be granted or extended to any
person if the
Director has reasonable cause to believe:
(1) that during either of the 2 calendar years | ||
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(2) that during the 12-month period immediately | ||
| ||
(b) Controlled business means insurance procured or to be procured by or
through the
person upon:
(1) his own life, person, property or risks, or those | ||
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(2) the life, person, property, or risks of his | ||
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(Source: P.A. 92-386, eff. 1-1-02.)
|
(215 ILCS 5/500-130)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-130. Bond required of insurance producers.
(a) An insurance producer who places insurance either directly or indirectly
with an
insurer with which the insurance producer does not have an agency contract must
maintain in force
while licensed a bond in favor of the people of the
State of Illinois executed by an authorized
surety company and payable to any party injured under
the terms of the bond. The bond shall be
continuous in form and in the amount of $2,500 or 5% of
the premiums brokered in the previous
calendar year, whichever is greater, but not to exceed
$50,000 total aggregate liability. The bond
shall be conditioned upon full accounting and due payment
to the person or company entitled
thereto, of funds coming into the insurance producer's
possession as an incident to insurance
transactions under the license or surplus line insurance
transactions under the license as a surplus
line producer.
(b) Authorized insurance producers of a business entity may
meet the requirements of this
Section with a bond in the name of the business entity,
continuous in form, and in the amounts
set forth in subsection (a) of this Section. Insurance
producers may meet the requirements of this
Section with a bond in the name of an association. An
individual producer remains responsible
for assuring that a producer bond is in effect and is for
the correct amount. The association must
have been in existence for 5 years, have common membership,
and been formed for a purpose
other than obtaining a bond.
(c) The surety may cancel the bond and be released from further
liability thereunder upon
30 days' written notice in advance to the principal. The
cancellation does not affect any liability
incurred or accrued under the bond before the termination
of the 30-day period.
(d) The producer's license may be revoked if the producer acts without a
bond that is
required under this Section.
(e) If a party injured under the terms of the bond requests the producer to
provide the
name of the surety and the bond number, the producer must provide the
information within 3
working days after receiving the request.
(f) An association may meet the requirements of this Section for all of its
members with a
bond in the name of the association that is continuous in form and in the
amounts set forth in
subsection (a) of this Section.
(Source: P.A. 102-135, eff. 7-23-21.)
|
(215 ILCS 5/500-135)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-135. Fees.
(a) The fees required by this Article are as follows:
(1) a fee of $215 for a person who is a resident of | ||
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(2) a fee of $50 for the issuance of a temporary | ||
| ||
(3) a fee of $150 payable once every 2 years for a | ||
| ||
(4) an annual $50 fee for a limited line producer | ||
| ||
(5) a $50 application fee for the processing of a | ||
| ||
(6) an annual registration fee of $1,000 for | ||
| ||
(7) a certification fee of $50 for each certified | ||
| ||
(8) a fee of $215 for a person who is a resident of | ||
| ||
(9) a fee of $200 payable once every 2 years for a | ||
| ||
(10) a fee of $50 payable once every 2 years for a | ||
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(a-5) Beginning on July 1, 2021, an amount equal to the additional amount of revenue collected under paragraphs (1) and (8) of subsection (a) as a result of the increase in the fees under this amendatory Act of the 102nd General Assembly shall be transferred annually, with 10% of that amount paid into the State Police Training and Academy Fund and 90% of that amount paid into the Law Enforcement Training Fund. (b) Except as otherwise provided, all
fees paid to and collected by the Director under
this Section shall be paid promptly after receipt thereof, together with a
detailed statement of
such fees, into a special fund in the State Treasury to be known as the
Insurance Producer
Administration Fund. The moneys deposited into the Insurance Producer
Administration Fund
may be used only for payment of the expenses of the Department in the
execution,
administration, and enforcement of the insurance laws of this State, and shall
be appropriated as
otherwise provided by law for the payment of those expenses with first priority
being any
expenses incident to or associated with the administration and enforcement of
this Article.
(Source: P.A. 102-16, eff. 6-17-21.)
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(215 ILCS 5/500-140)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-140. Injunctive relief. A person required to be licensed under
this Article but failing to
obtain a valid and current license under this Article constitutes a public
nuisance. The Director
may report the failure to obtain a license to the Attorney General, whose duty
it is to apply
forthwith by complaint on relation of the Director in the name of the people of
the State of
Illinois, for injunctive relief in the circuit court of the county where the
failure to obtain a license
occurred to enjoin that person from acting in any capacity that requires such a license. Upon the
filing of a verified
petition in the court, the court, if satisfied by affidavit or otherwise that
the person is required to
have a license and does not
have a valid and current license, may enter a temporary restraining
order without notice or bond,
enjoining the defendant from acting in any capacity that requires such
license. A copy of the verified
complaint shall be served upon the defendant, and the
proceedings shall thereafter be
conducted as in other civil cases. If it is established that the
defendant has been, or is engaged
in any unlawful practice, the court may enter an order or
judgment perpetually enjoining the
defendant from further engaging in such practice. In all
proceedings brought under this Section,
the court, in its discretion, may apportion the costs
among the parties, including the cost of
filing the complaint, service of process, witness fees and
expenses, court reporter charges, and
reasonable attorney fees. In case of the violation of any
injunctive order entered under the provisions of this Section,
the court may summarily try and
punish the offender for contempt of court. The injunctive relief
available
under this Section is in
addition to and not in lieu of all other penalties and remedies provided in
this Code.
(Source: P.A. 103-426, eff. 8-4-23.)
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(215 ILCS 5/500-145)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-145.
Rules.
The Director may, in accordance with Section 401 of
this
Code, promulgate
reasonable rules as are necessary or proper to carry out the purposes of this
Article.
(Source: P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/500-150)
(Section scheduled to be repealed on January 1, 2027)
Sec. 500-150.
Severability.
The provisions of this Article are severable
under Section 1.31 of
the Statute on Statutes.
(Source: P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/500-155) (Section scheduled to be repealed on January 1, 2027) Sec. 500-155. Disclosure. A policy the solicitation of which involves an
insurance producer,
limited insurance representative, or temporary insurance producer must identify
the name of the
producer, representative, or firm. An individual life or accident and health
application and a
master policy application for life or accident and health group coverages must
bear the name and
signature of the licensee who solicited and wrote the application.
(Source: P.A. 97-207, eff. 7-28-11.) |
(215 ILCS 5/500.1) (from Ch. 73, par. 1065.47-1)
Sec. 500.1.
(Repealed).
(Source: P.A. 85-334. Repealed by P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/501.2) (from Ch. 73, par. 1065.48-2)
Sec. 501.2.
(Repealed).
(Source: P.A. 83-801. Repealed by P.A. 92-386, eff. 1-1-02.)
|
(215 ILCS 5/502.2) (from Ch. 73, par. 1065.49-2)
Sec. 502.2.
(Repealed).
(Source: P.A. 83-801. Repealed by P.A. 92-386, eff. 1-1-02.)
|
(215 ILCS 5/503.1) (from Ch. 73, par. 1065.50-1)
Sec. 503.1.
(Repealed).
(Source: P.A. 83-801. Repealed by P.A. 92-386, eff. 1-1-02.)
|
(215 ILCS 5/504) (from Ch. 73, par. 1065.51)
Sec. 504.
(Repealed).
(Source: P.A. 83-1007. Repealed by P.A. 92-386, eff. 1-1-02.)
|
(215 ILCS 5/504.1) (from Ch. 73, par. 1065.51-1)
Sec. 504.1.
(Repealed).
(Source: P.A. 83-1299. Repealed by P.A. 92-386, eff. 1-1-02.)
|
(215 ILCS 5/505.1) (from Ch. 73, par. 1065.52-1)
Sec. 505.1.
(Repealed).
(Source: P.A. 91-234, eff. 1-1-00. Repealed by P.A. 92-386, eff. 1-1-02.)
|
(215 ILCS 5/505.2) (from Ch. 73, par. 1065.52-2)
Sec. 505.2.
(Repealed).
(Source: P.A. 86-905. Repealed by P.A. 92-386, eff. 1-1-02.)
|
(215 ILCS 5/506.1) (from Ch. 73, par. 1065.53-1)
Sec. 506.1.
(Repealed).
(Source: P.A. 83-1299. Repealed by P.A. 92-386, eff. 1-1-02.)
|
(215 ILCS 5/507.1) (from Ch. 73, par. 1065.54-1)
Sec. 507.1.
(Repealed).
(Source: P.A. 88-313. Repealed by P.A. 92-386, eff. 1-1-02.)
|
(215 ILCS 5/507.2)
(Section scheduled to be repealed on January 1, 2027)
Sec. 507.2.
Policyholder information and exclusive ownership
of expirations.
(a) As used in this Section, "expirations" means all
information relative to an insurance policy including, but not
limited to, the name and address of the insured, the location and
description of the property insured, the value of the insurance
policy, the inception date, the renewal date, and the expiration date of the
insurance policy, the premiums, the limits and a description of
the
terms and coverage
of
the insurance policy, and any other personal and privileged information, as
defined by Section 1003 of this Code,
compiled by a registered firm or furnished by the insured to
the insurer or any agent, contractor, or representative of the insurer.
For purposes of this Section only, a registered firm also includes a sole
proprietorship that transacts the
business of insurance as an insurance agency.
(b) All "expirations" as defined in subsection (a) of this Section shall be
mutually and exclusively owned by the insured and the registered firm. The
limitations on the use of expirations as provided in subsections (c) and (d) of
this Section shall be for mutual benefit of the insured and the registered
firm.
(c) Except as otherwise provided in this Section, for
purposes of soliciting, selling, or negotiating the renewal or
sale of insurance coverage, insurance products, or insurance
services or for any other marketing purpose, a registered firm shall own
and have the exclusive
use of expirations, records, and other written or electronically
stored information directly related to an insurance application
submitted by, or an insurance policy written through, the
registered firm. No insurance company, managing general agent, surplus
lines insurance broker, wholesale broker, group self-insurance
fund, third-party administrator, or any other entity, other than a financial
institution as defined in Section 1402 of this Code, shall use
such expirations,
records, or other written or electronically stored information to solicit,
sell, or negotiate the renewal or sale of insurance coverage,
insurance products, or insurance services to the insured or for
any other marketing purposes, either directly or by providing such
information to others,
without, separate from the general agency
contract, the written consent of the registered firm. However, such
expirations,
records, or other written or electronically stored information may be used
for any purpose necessary for placing such business through the
insurance producer including reviewing an application and issuing
or renewing a policy and for loss control services.
(d) With respect to a registered firm, this Section shall not apply:
(1) when the insured requests either orally or in | ||
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(2) to policies in the Illinois Fair Plan, the | ||
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(3) when the insurance producer is employed by or has | ||
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(4) to policies providing life and accident and | ||
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(5) when the registered firm is in default for | ||
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(6) to any insurance company's obligations under | ||
| ||
(7) to any insurer that, separate from a producer or | ||
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For purposes of this Section, an insurance producer shall be deemed to
have
agreed to act primarily for one company or a group of affiliated insurance
companies if the producer (i) receives 75% or more of his or her insurance
related commissions from one company or a group of affiliated companies or (ii)
places 75% or more of his or her policies with one company or a group of
affiliated companies.
Nothing in this Section prohibits an insurance company, with respect to any
items herein, from conveying to the insured or the registered firm any
additional benefits or ownership rights including, but not limited to, the
ownership of expirations on any policy issued or the imposition of further
restrictions on the insurance company's use of the insured's personal
information.
(e) Nothing in this Section prevents a financial institution, as defined
in Section 1402 of this Code, from obtaining from the insured, the insurer, or
the registered firm the expiration dates of an insurance policy placed on
collateral or otherwise used as security in connection with a loan made or
serviced by the
financial institution when the financial institution requires the expiration
dates for evidence of insurance.
(f) For purposes of this Section, "financial institution" does not include
an insurance company, registered firm, managing general agent, surplus lines
broker, wholesale broker, group self-funded insurance fund, or third-party
administrator.
(g) The Director may adopt rules in accordance with Section
401 of this Code for the enforcement of this Section.
(h) This Section applies to the expirations relative to all policies of
insurance bound, applied for, sold, renewed, or otherwise taking effect on or
after
the effective date of this amendatory Act of the 92nd General Assembly.
(Source: P.A. 92-5, eff. 6-1-01.)
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(215 ILCS 5/508.1) (from Ch. 73, par. 1065.55-1)
Sec. 508.1.
(Repealed).
(Source: P.A. 85-334. Repealed by P.A. 92-386, eff. 1-1-02.)
|
(215 ILCS 5/508.2) (from Ch. 73, par. 1065.55-2)
Sec. 508.2.
(Repealed).
(Source: P.A. 91-234, eff. 1-1-00. Repealed by P.A. 92-386, eff. 1-1-02.)
|
(215 ILCS 5/509.1) (from Ch. 73, par. 1065.56-1)
Sec. 509.1.
(Repealed).
(Source: P.A. 91-234, eff. 1-1-00. Repealed by P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/510.2) (from Ch. 73, par. 1065.57-2)
Sec. 510.2.
(Repealed).
(Source: P.A. 91-234, eff. 1-1-00. Repealed by P.A. 92-386, eff. 1-1-02.)
|
(215 ILCS 5/511.1) (from Ch. 73, par. 1065.58-1)
Sec. 511.1.
(Repealed).
(Source: P.A. 84-548. Repealed by P.A. 92-386, eff. 1-1-02.)
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(215 ILCS 5/Art. XXXI.25 heading) ARTICLE XXXI 1/4.
THIRD PARTY ADMINISTRATORS
(Article scheduled to be repealed on January 1, 2027)
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(215 ILCS 5/511.100) (from Ch. 73, par. 1065.58-100)
(Section scheduled to be repealed on January 1, 2027)
Sec. 511.100.
Purpose.
The purpose of this Article is to recognize and
provide reasonable public supervision and licensing of persons who provide
administrative services in connection with insurance or alternatives to
insurance.
(Source: P.A. 84-887.)
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(215 ILCS 5/511.101) (from Ch. 73, par. 1065.58-101)
(Section scheduled to be repealed on January 1, 2027)
Sec. 511.101. Definitions. For the purpose of this Article:
(a) "Administrator" means any person who on behalf of a plan sponsor or
insurer receives or collects charges, contributions or premiums for, or
adjusts or settles claims on residents of this State in connection with
any type of life or accident or health benefit provided through or as an
alternative to insurance within the scope of Class 1(a), 1(b) or 2(a) of
Section 4 of this Code, other than any of the following:
(1) A corporation, association, trust or partnership | ||
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(2) A union administering a plan for its members;
(3) A plan sponsor administering its own plan;
(4) An insurer or dental service plan to the extent | ||
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(5) A producer licensed in this State whose insurance | ||
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(6) A trust and its trustees and employees acting | ||
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(7) A person who adjusts or settles claims in the | ||
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(8) A person who administers only self-insured | ||
| ||
(9) A credit card issuing company which advances for | ||
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(10) A creditor on behalf of its debtors with respect | ||
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(b) "Covered Individual" means any individual eligible for life or accident
or health benefits under a plan.
(c) "Contributions" means any money charged a covered individual, plan
sponsor or other entity to fund the self-insured portion of any plan in
accordance with written provisions of the plan or contracts of insurance.
Contributions shall include administrative fees charged to a covered
individual. Administrative fee means any compensation paid by a covered
individual for services performed by the administrator.
(d) "Premiums" means any money charged a covered individual, plan sponsor
or other entity to provide life or accident or health insurance under a
plan. The term premium shall include amounts paid by or charged to a covered
individual plan sponsor or other entity for stop loss or excess insurance.
(e) "Charges" means any compensation paid by a plan sponsor or insurer
for services performed by the administrator.
(f) "Administrator Trust Fund", hereinafter referred to as "ATF", means
a special fiduciary account established and maintained by an administrator
pursuant to Section 511.112 in which contributions and premiums are deposited.
(g) "Claims Administration Services Account", hereinafter referred to
as "CASA", means a special fiduciary account established and maintained
by an administrator pursuant to Section 511.112 of this Code from which
claims and claims adjustment expenses are disbursed.
(h) "Plan Sponsor" means any person other than an insurer, who establishes
or maintains a plan covering residents of this State, including but not
limited to plans established or maintained by 2 or more employers or
jointly by one or more employers and one or more employee organizations,
the association, committee, joint board of trustees, or other similar group
of representatives of the parties who establish or maintain the plan.
Provided, however, that "Plan Sponsor" shall not include:
(1) The employer in the case of a plan established or | ||
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(2) The employee organization in the case of a plan | ||
| ||
No plan sponsor covered in whole by provisions of the Employee Retirement
Income Security Act of 1974 (ERISA) shall be covered by any of the
provisions of this Act to the extent that such provisions are inconsistent
with or in conflict with any provisions of ERISA as now or hereafter amended.
(i) "Financial Institution" means any federal or state chartered bank
or savings and loan institution which is insured by the Federal Deposit
Insurance Corporation (FDIC) or the Federal Savings and Loan Insurance
Corporation (FSLIC).
(j) "Plan" means any plan, fund or program established or maintained by
a plan sponsor or insurer to the extent that such plan, fund or program
was established or is maintained to provide through insurance or alternatives
to insurance any type of life or accident or health benefit within the scope
of Class 1(a), 1(b) or 2(a) of Section 4 of the Illinois Insurance Code.
(k) "Insurer" means any person who transacts insurance or health care
service business authorized under the laws of this State.
(l) "Quasi-resident" means a nonresident licensee who produces 50% or
more of his contributions and premium volume during a calendar year from
residents of this State.
(Source: P.A. 101-108, eff. 1-1-20.)
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(215 ILCS 5/511.102) (from Ch. 73, par. 1065.58-102)
(Section scheduled to be repealed on January 1, 2027)
Sec. 511.102.
License required.
(a) No person may act as or hold
himself out to be an administrator after July 1, 1986 unless duly licensed
in accordance with this Article. An administrator doing business in this
State on July 1, 1986 shall apply for a license within 90 days thereafter.
(b) In addition to any other penalty set forth in this Article, any person
violating subsection (a) above is guilty of a Class A misdemeanor.
(Source: P.A. 84-887.)
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(215 ILCS 5/511.103) (from Ch. 73, par. 1065.58-103)
(Section scheduled to be repealed on January 1, 2027)
Sec. 511.103.
Application.
The applicant for a license shall file
with the Director an application upon a form prescribed by the Director,
which shall include or have attached the following:
(1) The names, addresses and official positions of | ||
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(2) A non-refundable filing fee of $200 which shall | ||
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(Source: P.A. 93-32, eff. 7-1-03.)
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(215 ILCS 5/511.104) (from Ch. 73, par. 1065.58-104)
(Section scheduled to be repealed on January 1, 2027)
Sec. 511.104.
Bond requirements for administrators.
(a) Every applicant
for an administrator's license shall file with the application and shall
thereafter maintain in force while so licensed, a fidelity bond in favor
of the people of the State of Illinois executed by a surety company and
payable to any party injured under the terms of the bond. The bond shall
be continuous in form and in one of the following amounts:
(1) For an administrator which maintains an ATF but | ||
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(2) For an administrator which maintains a CASA but | ||
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(3) For an administrator which maintains both an ATF | ||
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Such bond is required of an administrator who maintains or should maintain
funds in a fiduciary capacity as set forth in Section 511.112 of this Code
unless the administrator is contracted with the insurer as an
administrator and if the plan is fully insured by the insurer on whose
behalf the funds are held.
(b) Such bond shall remain in force and effect until the surety is
released from liability by the Director or until the bond is cancelled by
the surety. The surety may cancel the bond and be released from further
liability thereunder upon 30 days' written notice in advance to the
Director. Such cancellation shall not affect any liability incurred or
accrued thereunder before the termination of the 30-day period. Upon
receipt of any notice of cancellation, the Director shall immediately notify
the licensee.
(c) The license required by Section 511.102 shall automatically
terminate if the bond required by this Section is not in force. Within 30
days thereafter, the administrator shall return the license to the Director
for cancellation.
(Source: P.A. 84-1431.)
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(215 ILCS 5/511.105) (from Ch. 73, par. 1065.58-105)
(Section scheduled to be repealed on January 1, 2027)
Sec. 511.105.
License.
(a) The Director shall cause a license to be
issued to each applicant that has demonstrated to the Director's satisfaction
compliance with the requirements of this Article.
(b) Each administrator license shall remain in effect as long as the holder
of the license maintains in force and effect the bond required by Section
511.104 and pays the annual fee of $200 prior to the anniversary
date of
the license, unless the license is revoked or suspended pursuant to Section
511.107.
(c) Each license shall contain the name, business address and
identification number of the licensee, the date the license was issued and
any other information the Director considers proper.
(Source: P.A. 93-32, eff. 7-1-03.)
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(215 ILCS 5/511.106) (from Ch. 73, par. 1065.58-106)
(Section scheduled to be repealed on January 1, 2027)
Sec. 511.106.
Administrator requirements.
(a) Each administrator shall
identify to the Director any ownership interest or affiliation of any kind
with any plan sponsor or insurer responsible directly or through reinsurance
for providing benefits to any plan for which it provides services as an administrator.
(b) An administrator shall provide services as an administrator pursuant
to a written agreement. The written agreement shall be between the administrator
and the plan sponsor or insurer and shall be retained as part of the official
records of the administrator for the duration of said agreement and for
5 years thereafter.
(c) An administrator shall maintain in its principal office for the duration
of the written agreement with any plan sponsor or insurer and for 5 years
thereafter adequate books and records of all transactions involving a plan
sponsor or insurer and covered individuals or beneficiaries. Such books and
records shall be maintained in accordance with generally accepted standards
of business recordkeeping. An administrator is not required to maintain
copies of books and records if such originals are returned to the plan sponsor
or insurer prior to the end of such 5 year period. The administrator shall
maintain evidence of the return of the originals for the balance of the 5 year period.
(d) The administrator shall file with the Director the names and addresses
of the insurers and plan sponsors with whom the administrator has written
agreements. If an insurer or plan sponsor does not assume or bear the risk,
the administrator must disclose the name and address of the ultimate risk
bearer. This filing requirement shall apply to the initial application
for an administrator's license and the renewal of such license.
(e) An administrator shall use only advertising pertaining to the plan which
has been approved in advance by the plan sponsor or insurer.
(f) Upon receipt of instructions from the plan sponsor or insurer, an
administrator shall deliver promptly to covered individuals or beneficiaries
all policies, certificate booklets, termination notices or other written communications.
(g) An administrator shall not receive compensation from a plan sponsor
or insurer which is contingent upon the loss ratio of the plan. This subsection
shall not, however, prevent the administrator from engaging in cost containment
activities with a plan sponsor or insurer.
(h) An administrator shall not receive from any plan sponsor, insurer,
covered individual or beneficiary under a plan any compensation or other
payments except as expressly set forth in the written agreement between
the administrator and the plan sponsor or insurer.
(i) Upon request of the Director, an administrator shall make available
for examination, either in the City of Springfield or at the licensee's
principal place of business, all basic organizational documents including
but not limited to articles of incorporation, articles of association, partnership
agreement, trade name certificate, trust agreement, shareholder agreement
and other applicable documents and all amendments thereto, bylaws, rules
and regulations or similar documents regulating the conduct of its internal affairs.
(Source: P.A. 84-887.)
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(215 ILCS 5/511.107) (from Ch. 73, par. 1065.58-107)
(Section scheduled to be repealed on January 1, 2027)
Sec. 511.107.
License suspension, revocation or denial.
(a) Any license
issued under this Article may be suspended or revoked, after notice to the
licensee and an opportunity for hearing, and any application for a license
may be denied, after notice and an opportunity for hearing, if the Director
finds that the licensee or applicant:
(1) has wilfully violated any applicable provisions | ||
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(2) has intentionally made a material misstatement in | ||
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(3) has obtained or attempted to obtain a license | ||
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(4) has misappropriated or converted to its own use, | ||
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(5) has, in the transaction of business under its | ||
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(6) has been, within the past 3 years, convicted of a | ||
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(7) has failed to appear without reasonable cause or | ||
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(8) is using such methods or practices in the conduct | ||
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(9) is affiliated with and is under the same general | ||
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(10) has had its license suspended or revoked or its | ||
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(11) has failed to report under Section 511.108 a | ||
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(b) Denial of an application or suspension or revocation of a license,
pursuant to this Section shall be by written order sent to the applicant
or licensee by certified or registered mail at the address specified in
the records of the Department. The written order shall state the grounds,
charges or conduct on which denial, suspension or revocation is based.
The applicant or licensee may in writing request a hearing within 30 days
from the date of mailing. Upon receipt of a written request, the Director
shall issue an order setting (i) a specific time for the hearing, which
may not be less than 20 nor more than 30 days after receipt of the request
and (ii) a specific place for the hearing, which may be in either the City
of Springfield or in the county in Illinois where the applicant's or licensee's
principal place of business is located. If no written request is received
by the Director, such order shall be final upon the expiration of said 30 days.
(c) Upon revocation of a license, the licensee or other person having
possession or custody of such license shall deliver it to the Director
in person or by mail within 30 days of such revocation.
(d) Any administrator whose license is revoked or whose application is
denied pursuant to this Section shall be ineligible to reapply for any license
for 2 years. A suspension pursuant to this Section may be for a period
of up to 2 years.
(Source: P.A. 84-887.)
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(215 ILCS 5/511.108) (from Ch. 73, par. 1065.58-108)
(Section scheduled to be repealed on January 1, 2027)
Sec. 511.108. Felony convictions. Any administrator and any individual
listed on the application as required by Section 511.103, who is convicted
of a felony shall report such conviction to the Director within 30 days
of the entry date of the judgment. Within that 30-day
period, the administrator
shall also provide the Director with a copy of the judgment, the probation
or commitment order and any other relevant documents.
(Source: P.A. 96-328, eff. 8-11-09.)
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(215 ILCS 5/511.109) (from Ch. 73, par. 1065.58-109)
(Section scheduled to be repealed on January 1, 2027)
Sec. 511.109.
Examination.
(a) The Director or his designee may examine
any applicant for or holder of an administrator's license.
(b) Any administrator being examined shall provide to the Director or
his designee convenient and free access, at all reasonable hours at their
offices, to all books, records, documents and other papers relating to such
administrator's business affairs.
(c) The Director or his designee may administer oaths and thereafter examine
any individual about the business of the administrator.
(d) The examiners designated by the Director pursuant to this Section
may make reports to the Director. Any report alleging substantive violations
of this Article, any applicable provisions of the Illinois Insurance Code,
or any applicable Part of Title 50 of the Illinois Administrative Code shall
be in writing and be based upon facts obtained by the examiners. The report
shall be verified by the examiners.
(e) If a report is made, the Director shall either deliver a duplicate
thereof to the administrator being examined or send such duplicate by certified
or registered mail to the administrator's address specified in the records
of the Department. The Director shall afford the administrator an opportunity
to request a hearing to object to the report. The administrator may request
a hearing within 30 days after receipt of the duplicate of the examination
report by giving the Director written notice of such request together with
written objections to the report. Any hearing shall be conducted in accordance
with Sections 402 and 403 of this Code. The right to hearing is waived
if the delivery of the report is refused or the report is otherwise
undeliverable or the administrator does not timely request a hearing.
After the hearing or upon expiration of the time period during which an
administrator may request a hearing, if the examination reveals that the
administrator is operating in violation of any applicable provision of the
Illinois Insurance Code, any applicable Part of Title 50 of the Illinois
Administrative Code or prior order, the Director, in the written order, may
require the administrator to take any action the Director considers
necessary or appropriate in accordance with the report or examination
hearing. If the Director issues an order, it shall be issued within 90
days after the report is filed, or if there is a hearing, within 90 days
after the conclusion of the hearing. The order is subject to review under
the Administrative Review Law.
(Source: P.A. 84-887.)
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(215 ILCS 5/511.110) (from Ch. 73, par. 1065.58-110)
(Section scheduled to be repealed on January 1, 2027)
Sec. 511.110.
Administrative fine.
(a) If the Director finds that one
or more grounds exist for the revocation or suspension of a license issued
under this Article, the Director may, in lieu of or in addition to such
suspension or revocation, impose a fine upon the administrator.
(b) With respect to any knowing and wilful violation of a lawful order
of the Director, any applicable portion of the Illinois Insurance Code or
Part of Title 50 of the Illinois Administrative Code, or a provision of
this Article, the Director may impose a fine upon the administrator in an
amount not to exceed $10,000 for each such violation. In no
event shall
such fine exceed an aggregate amount of $50,000 for all knowing
and wilful
violations arising out of the same action.
(Source: P.A. 93-32, eff. 7-1-03.)
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(215 ILCS 5/511.111) (from Ch. 73, par. 1065.58-111)
(Section scheduled to be repealed on January 1, 2027)
Sec. 511.111. Insurance Producer Administration Fund. All fees and fines
paid to and collected by the Director under this Article shall be paid promptly
after receipt thereof, together with a detailed statement of such fees,
into a special fund in the State Treasury to be known as the Insurance Producer
Administration Fund. The monies deposited into the Insurance Producer
Administration Fund shall be used only for payment of the expenses of the
Department and shall be appropriated as otherwise provided by law for the
payment of such expenses. Moneys in the Insurance Producer Administration Fund may be transferred to the Professions Indirect Cost Fund, as authorized under Section 2105-300 of the Department of Professional Regulation Law of the Civil Administrative Code of Illinois.
(Source: P.A. 98-463, eff. 8-16-13.)
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(215 ILCS 5/511.112) (from Ch. 73, par. 1065.58-112)
(Section scheduled to be repealed on January 1, 2027)
Sec. 511.112.
Fiduciary accounts and duties.
(a) Administrators shall
hold in a fiduciary capacity all contributions and premiums received or
collected on behalf of a plan sponsor or insurer. Such funds shall not be
used as general operating funds of the administrator. All contributions
and premiums received or collected by the administrator from residents of
this State, which the Administrator holds more than 15 days or deposits
into an account which is not under the control of the plan sponsor or insurer,
shall be placed in a special fiduciary account, which account shall
be designated an "Administrator
Trust Fund Account" ("ATF"). All resident and quasi-resident licensees
required to maintain an ATF pursuant to this Section shall maintain such
ATF with one or more financial institutions located within the State of
Illinois and subject to jurisdiction of the Illinois courts. Funds
belonging to 2 or more plans may be
held in the same ATF, provided the administrator's records clearly indicate
the funds belonging to each plan. Checks drawn on the ATF shall indicate
on their face that they are drawn on the ATF of the administrator.
(b) The administrator may make the following disbursements from the ATF:
(1) contributions and premiums due insurers or other | ||
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(2) return contributions and premiums to a plan or | ||
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(3) commissions or administrative fees due to the | ||
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(4) transfers into the CASA of the administrator.
(c) For each plan where an ATF is required, the balance in the ATF shall
at all times be the amount deposited plus accrued interest, if any, less
authorized disbursements. If the balance at the financial institution with
respect to the ATF is less than the amount deposited plus accrued interest,
if any, less authorized disbursements, the administrator shall be deemed
to have misappropriated fiduciary funds and to have acted in a financially
irresponsible manner.
(d) If the ATF is interest bearing or income producing, the full nature
of the account must first be disclosed to the plan sponsors or insurers
on whose behalf the funds are or will be held. The administrator
must secure written consent and authorization from the plan sponsors or
insurers for the investment of the money and disposition of the interest
or earnings. No investment shall be made which assumes any risk other than
the risk that the obligor shall not pay the principal when due.
The use of specialized techniques or strategies which incur additional
risks to generate higher returns or to extend maturities is not permitted.
Such techniques would include, but not be limited to, the following: Use
of financial futures or options, buying on margins and pledging of ATF balances.
(e) Administrators may place ATF funds in interest bearing or income
producing investments and retain the interest or income thereon, providing
the administrator obtains the prior written authorization of the plan
sponsors or insurers on whose behalf the funds are to be held. In addition
to savings and checking accounts, an administrator may invest in the following:
(1) direct obligations of the United States of | ||
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(2) certificates of deposit, with a maturity of not | ||
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(3) repurchase agreements with financial institutions | ||
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(A) the value of the repurchase agreement is | ||
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(B) the collateral has a market value at the time | ||
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(C) the repurchase agreement does not exceed 30 | ||
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(4) commercial paper, provided the commercial paper | ||
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(5) money market funds, provided the money market | ||
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(6) each investment transaction must be made in the | ||
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(f) The administrator shall hold in a fiduciary capacity all moneys which
the administrator receives to pay claims and claim adjustment expenses.
All resident and quasi-resident licensees shall
place all such money for claims and claim adjustment
expenses for residents of this State, whether received from a plan sponsor
or insurer or from the ATF of the administrator, in a special fiduciary
account in a financial institution located in this State. The account shall
be designated a "Claims Administration Service Account" ("CASA"). Funds
belonging to 2 or more plans may be held in the same CASA, provided the
administrator's records clearly indicate the funds belonging to each plan.
Checks drawn on the CASA shall indicate on their face that they are drawn
on the CASA of the administrator.
(g) No deposit shall be made into a CASA and no disbursement shall be
made from a CASA except for claims and claims adjustment expenses. For
each plan where a CASA is required, the balance in the CASA shall at all
times be the amount deposited less claims and claims adjustment expenses paid.
If the CASA balance is less than such amount, the administrator shall be
deemed to have misappropriated fiduciary funds and to have acted in a
financially irresponsible manner.
(h)(1) Administrators shall maintain detailed books and records which
reflect all transactions involving the receipt and disbursement of:
(i) contributions and premiums received on behalf of | ||
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(ii) claims and claim adjustment expenses received | ||
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(2) The detailed preparation, journalizing and posting of such books and
records must be maintained on a timely basis and all journal entries for
receipts and disbursements shall be supported by evidential matter, which
must be referenced in the journal entry so that it may be traced for
verification. Administrators shall prepare and maintain monthly financial
institution account reconciliations of any ATF and CASA established by the
administrator. The minimum detail required shall be as follows:
(i) The sources, amounts and dates of any moneys | ||
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(ii) The date and person to whom a disbursement is | ||
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(iii) A description of the disbursement in such | ||
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(i) Failure to maintain accurately and timely the books and records required
above shall be deemed untrustworthy, hazardous or injurious to participants
in the plan or the public and financially irresponsible.
(j) This Section shall not apply to nonresident administrators who are
subject to substantially similar requirements in their state of domicile.
(Source: P.A. 84-1431.)
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(215 ILCS 5/511.113) (from Ch. 73, par. 1065.58-113)
(Section scheduled to be repealed on January 1, 2027)
Sec. 511.113.
Unauthorized Activities.
Nothing in this Article shall
be construed to permit any person or entity to receive, or collect charges,
contributions or premiums for, or adjust or settle claims in connection with
any type of life or accident or health benefit unless such person or entity
is authorized through the insurance laws of a state or the ERISA of 1974, 29
USC par. 1001 et seq. as amended, to provide such benefits.
(Source: P.A. 84-887.)
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(215 ILCS 5/511.114)
(Section scheduled to be repealed on January 1, 2027)
Sec. 511.114.
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 5/511.118)
(Section scheduled to be repealed on January 1, 2027)
Sec. 511.118.
Managed Care Reform and Patient Rights Act.
All
administrators are
subject to the provisions of Sections 55 and 85 of the Managed Care
Reform and Patient Rights Act.
(Source: P.A. 91-617, eff. 1-1-00.)
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(215 ILCS 5/Art. XXXI.5 heading) ARTICLE XXXI 1/2.
THIRD PARTY PRESCRIPTION PROGRAMS
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(215 ILCS 5/512-1) (from Ch. 73, par. 1065.59-1)
Sec. 512-1.
Short Title.
This Article shall be known and may be cited
as the "Third Party Prescription Program Act".
(Source: P.A. 82-1005.)
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(215 ILCS 5/512-2) (from Ch. 73, par. 1065.59-2)
Sec. 512-2.
Purpose.
It is hereby determined and declared that the
purpose of this Article is to regulate certain practices engaged in by third-party
prescription
program administrators.
(Source: P.A. 82-1005.)
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(215 ILCS 5/512-3) (from Ch. 73, par. 1065.59-3)
Sec. 512-3. Definitions. For the purposes of this Article, unless the
context otherwise requires, the terms defined in this Article have the meanings
ascribed
to them herein:
(a) "Third party prescription program" or "program" means any system of
providing for the reimbursement of pharmaceutical services and prescription
drug products offered or operated in this State under a contractual arrangement
or agreement between a provider of such services and another party who is
not the consumer of those services and products. Such programs may include, but need not be limited to, employee benefit
plans whereby a consumer receives prescription drugs or other pharmaceutical
services and those services are paid for by
an agent of the employer or others.
(b) "Third party program administrator" or "administrator" means any person,
partnership or corporation who issues or causes to be issued any payment
or reimbursement to a provider for services rendered pursuant to a third
party prescription program, but does not include the Director of Healthcare and Family Services or any agent authorized by
the Director to reimburse a provider of services rendered pursuant to a
program of which the Department of Healthcare and Family Services is the third party.
(Source: P.A. 95-331, eff. 8-21-07.)
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(215 ILCS 5/512-4) (from Ch. 73, par. 1065.59-4)
Sec. 512-4.
Registration.
All third party prescription programs and
administrators doing business in the State shall register with the Director
of Insurance. The Director shall promulgate regulations establishing criteria
for registration in accordance with the terms of this Article. The Director
may by rule establish an annual registration fee for each third party administrator.
(Source: P.A. 82-1005.)
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(215 ILCS 5/512-5) (from Ch. 73, par. 1065.59-5)
Sec. 512-5.
Fiduciary and Bonding Requirements.
A third party prescription program administrator 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 of
providers of services under the program, 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 the program.
The establishment of such fiduciary accounts and bonds shall be consistent
with applicable State law.
If a bond of indemnity is posted, it shall be held by the Director of Insurance
for the benefit and indemnification of the providers of services under the
third party prescription program.
An administrator who operates more than one third party prescription 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.
The requirements of this Section do not apply to any third party prescription
program administered by or on behalf of any insurance company, Health Care
Service Plan Corporation or Pharmaceutical Service Plan Corporation authorized
to do business in the State of Illinois.
(Source: P.A. 82-1005.)
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(215 ILCS 5/512-6) (from Ch. 73, par. 1065.59-6)
Sec. 512-6.
Notice.
Notice of any change in the terms of a third party prescription program,
including but not limited to drugs covered, reimbursement rates, co-payments,
and dosage quantity, shall be given to each enrolled pharmacy at least 30
days prior to the time it becomes effective.
(Source: P.A. 82-1005.)
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(215 ILCS 5/512-7) (from Ch. 73, par. 1065.59-7)
Sec. 512-7. Contractual provisions.
(a) Any agreement or contract entered into in this State between the
administrator of a program and a pharmacy shall include a statement of the
method and amount of reimbursement to the pharmacy for services rendered to
persons enrolled in the program, the frequency of payment by the program
administrator to the pharmacy for those services, and a method for the
adjudication of complaints and the settlement of disputes between the
contracting parties.
(b)(1) A program shall provide an annual period of at | ||
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(2) If compliance with the requirements of this | ||
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(3) This subsection (b) does not apply if:
(A) the program administrator is a licensed | ||
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(B) the program administrator is a licensed | ||
| ||
(4) This subsection (b) shall be inoperative | ||
| ||
(c) The program administrator shall cause to be issued an identification
card to each person enrolled in the program. The identification card
shall include:
(1) the name of the individual enrolled in the | ||
| ||
(2) an expiration date if required under the | ||
| ||
(Source: P.A. 95-689, eff. 10-29-07.)
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(215 ILCS 5/512-8) (from Ch. 73, par. 1065.59-8)
Sec. 512-8.
Cancellation procedures.
(a) The administrator of a program
shall notify all pharmacies enrolled in the program of any cancellation
of the coverage of benefits of any group enrolled in the program at least
30 days prior to the effective date of such cancellation.
However, if the administrator of a program is not notified at least 45
days prior to the effective date of such cancellation, the administrator
shall notify all pharmacies enrolled in the program of the cancellation
as soon as practicable after having received notice.
(b) When a program is terminated, all persons enrolled therein shall be
so notified, and the employer shall make every reasonable effort to gain
possession of any plan identification cards in such persons' possession.
(c) Any person who intentionally uses a program identification card to
obtain services from a pharmacy after having received notice of the cancellation
of his benefits shall be guilty of a Class C misdemeanor. Persons shall
be liable to the program administrator for all monies paid by the program
administrator for any services received pursuant to any improper use of
the identification card.
(Source: P.A. 82-1005.)
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(215 ILCS 5/512-9) (from Ch. 73, par. 1065.59-9)
Sec. 512-9.
Denial of Payment.
(a) No administrator shall deny payment
to any pharmacy for covered pharmaceutical services or prescription drug
products rendered as a result of the misuse, fraudulent or illegal use of
an identification card unless such identification card had expired, been
noticeably altered, or the pharmacy was notified of the cancellation of
such card. In lieu of notifying pharmacies which have a common ownership,
the administrator may notify a party designated by the pharmacy to receive
such notice, in which case, notification shall not become effective until
5 calendar days after the designee receives notification.
(b) No program administrator may withhold any payment to any pharmacy
for covered pharmaceutical services or prescription drug products beyond
the time period specified in the payment schedule provisions of the agreement,
except for individual claims for payment which have been returned to the pharmacy
as incomplete or illegible. Such returned claims shall be paid if resubmitted
by the pharmacy to the program administrator with the appropriate corrections made.
(Source: P.A. 82-1005.)
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(215 ILCS 5/512-10) (from Ch. 73, par. 1065.59-10)
Sec. 512-10.
Failure to Register.
Any third party prescription program
or administrator which operates without a certificate of registration or
fails to register with the Director and pay the fee prescribed by this Article
shall be construed to be an unauthorized insurer as defined in Article VII
of this Code and shall be subject to all penalties contained therein.
The provisions of the Article shall apply to all new programs established
on or after January 1, 1983. Existing programs shall comply with the provisions
of this Article on the anniversary date of the programs that occurs on or
after January 1, 1983.
(Source: P.A. 82-1005.)
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(215 ILCS 5/Art. XXXI.75 heading) ARTICLE XXXI 3/4
PUBLIC INSURANCE ADJUSTERS
AND REGISTERED FIRMS
(Repealed)(Source: Repealed by P.A. 102-135, eff. 7-23-21.)
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(215 ILCS 5/Art. XXXIIA heading) ARTICLE XXXIIA.
PREMIUM FINANCE REGULATION
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(215 ILCS 5/513a1) (from Ch. 73, par. 1065.60a1)
Sec. 513a1.
Scope of Article.
(a) Except as provided in subsection (b), this Article applies to all
persons engaged in the business of financing insurance premiums, entering
into premium finance agreements, or otherwise acquiring premium finance
agreements, and insurance companies and insurance producers as defined in
this Code, except in connection with premiums on the kinds of business
described as Class 1(a) or Class 1(b) of Section 4.
(b) Except for the provisions of Section 513a11 that apply to all
premium financing agreements in which the right to cancel one or more
policies of insurance on behalf of the named has been assigned to the
lender, this Article does not apply to the following entities:
(1) Credit unions, as defined in the Illinois Credit | ||
| ||
(2) Banks, as defined in the Illinois Banking Act.
(3) Savings and loan associations, as defined in the | ||
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(4) Persons operating under the provisions of Section | ||
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(5) Persons operating under the Consumer Installment | ||
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(6) Persons that acquire premium finance agreements | ||
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(Source: P.A. 87-811.)
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(215 ILCS 5/513a2) (from Ch. 73, par. 1065.60a2)
Sec. 513a2.
Definitions.
(a) "Accepted agreement" means a premium finance
agreement deemed to be accepted by a premium finance company when a binder
number or policy number is provided for each policy premium listed on the
premium finance agreement and premium payment book or when the first
premium payment notice has been sent to the named insured.
(b) "Financing insurance premiums" means
to be engaged in the practice of:
(1) advancing monies directly or indirectly to an | ||
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(2) allowing 10% or more of a producer's or | ||
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(c) "Premium finance agreement" means a
promissory note, loan contract, or agreement by which an insured or
prospective insured promises to pay to another person an amount advanced or
to be advanced thereunder to an insurer in payment of premiums on an
insurance contract together with a service charge and which contains an
assignment of or is otherwise secured by the unearned premium payable by
the insurer upon cancellation of the insurance contract; provided, however,
that a premium finance agreement shall not include an installment sale
contract, lease agreement, security agreement, or mortgage covering
personal or real property that includes a charge for insurance or pursuant
to which the vendor, lessor, lienholder, or mortgagee is authorized to pay
or advance the premium for insurance with respect to that property.
(d) "Premium finance company" means any person
engaged in the business of financing insurance premiums, of entering into
premium finance agreements with insureds, or of acquiring premium finance
agreements.
(Source: P.A. 90-655, eff. 7-30-98.)
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(215 ILCS 5/513a3) (from Ch. 73, par. 1065.60a3)
Sec. 513a3.
License required.
(a) No person may act as a premium finance company or hold himself out
to be engaged in the business of financing insurance premiums, either
directly or indirectly, without first having obtained a license as a
premium finance company from the Director.
(b) An insurance producer shall be deemed to be engaged in the
business of financing insurance premiums if 10% or more of the producer's total
premium accounts receivable are more than 90 days past due.
(c) In addition to any other penalty set forth in this Article, any
person violating subsection (a) of this Section may, after hearing as set
forth in Article XXIV of this Code, be required to pay a civil penalty of
not more than $2,000 for each offense.
(d) In addition to any other penalty set forth in this Article, any
person violating subsection (a) of this Section is guilty of a Class A
misdemeanor. Any individual violating subsection (a) of this Section, and
misappropriating or converting any monies collected in conjunction with the
violation, is guilty of a Class 4 felony.
(Source: P.A. 93-32, eff. 7-1-03.)
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(215 ILCS 5/513a4) (from Ch. 73, par. 1065.60a4)
Sec. 513a4.
Application and license.
(a) Each application for a premium finance license shall be made on a
form specified by the Director and shall be signed by the applicant
declaring under penalty of refusal, suspension, or revocation of the
license that the statements made in the application are true, correct, and
complete to the best of the applicant's knowledge and belief. The Director
shall cause to be issued a license to each applicant that has demonstrated
to the Director that the applicant:
(1) is competent and trustworthy and of a good | ||
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(2) has a minimum net worth of $50,000; and
(3) has paid the fees required by this Article.
(b) Each applicant at the time of request for a license or renewal of
a license shall:
(1) certify that no charge for financing premiums | ||
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(2) certify that the premium finance agreement or | ||
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(3) certify that he or she has a minimum net worth of | ||
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(4) attach with the application a non-refundable | ||
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(c) An applicant who has met the requirements of subsection (a) and
subsection (b) shall be issued a premium finance license.
(d) Each premium finance license shall remain in effect as long as the
holder of the license annually continues to meet the requirements of
subsections (a) and (b) by the due date unless the license is revoked or
suspended by the Director.
(e) The individual holder of a premium finance license shall inform the
Director in writing of a change in residence address within 30 days of the
change, and a corporation, partnership, or association holder of a premium
finance license shall inform the Director in writing of a change in
business address within 30 days of the change.
(f) Every partnership or corporation holding a license as a premium
finance company shall appoint one or more partners or officers to be
responsible for the firm's compliance with the Illinois Insurance Code and
applicable rules and regulations. Any change in the appointed person or
persons shall be reported to the Director in writing within 30 days of the
change.
(Source: P.A. 93-32, eff. 7-1-03.)
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(215 ILCS 5/513a5) (from Ch. 73, par. 1065.60a5)
Sec. 513a5. Insurance Producer Administration Fund. All fees and
penalties paid to and collected by the Director under this Article shall be
paid promptly after receipt, together with a detailed statement of the
fees, into the Insurance Producer Administration Fund.
(Source: P.A. 98-463, eff. 8-16-13.)
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(215 ILCS 5/513a6) (from Ch. 73, par. 1065.60a6)
Sec. 513a6.
Felony convictions.
Any person or authorized member of a
partnership or corporation who, while licensed as a premium finance
company, is convicted of a felony shall report the conviction to the
Director within 30 days of the entry date of the judgement. Within that 30
day period, the person shall also provide the Director with a copy of the
judgement, the probation or commitment order, and any other relevant document.
(Source: P.A. 87-811.)
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(215 ILCS 5/513a7) (from Ch. 73, par. 1065.60a7)
Sec. 513a7.
License suspension; revocation or denial.
(a) Any license issued under this Article may be suspended, revoked, or
denied if the Director finds that the licensee or applicant:
(1) has wilfully violated any provisions of this Code | ||
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(2) has intentionally made a material misstatement in | ||
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(3) has obtained or attempted to obtain a license | ||
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(4) has misappropriated or converted to his own use | ||
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(5) has used fraudulent, coercive, or dishonest | ||
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(6) has been, within the past 3 years, convicted of a | ||
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(7) has failed to appear without reasonable cause or | ||
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(8) has had a license suspended, revoked, or denied | ||
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(9) has failed to report a felony conviction as | ||
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(b) Suspension, revocation, or denial of a license under this Section
shall be by written order sent to the licensee or applicant by certified or
registered mail at the address specified in the records of the Department.
The licensee or applicant may in writing request a hearing within 30 days
from the date of mailing. If no written request is made the order shall be
final upon the expiration of that 30 day period.
(c) If the licensee or applicant requests a hearing under this Section,
the Director shall issue a written notice of hearing sent to the licensee
or applicant by certified or registered mail at his address, as specified
in the records of the Department, and stating:
(1) the grounds, charges, or conduct that justifies | ||
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(2) the specific time for the hearing, which may not | ||
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(3) a specific place for the hearing, which may be | ||
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(d) Upon the suspension or revocation of a license, the licensee or
other person having possession or custody of the license shall promptly
deliver it to the Director in person or by mail. The Director shall
publish all suspensions and revocations after they become final in a manner
designed to notify interested insurance companies and other persons.
(e) Any person whose license is revoked or denied under this Section
shall be ineligible to apply for any license for 2 years. A suspension
under this Section may be for a period of up to 2 years.
(f) In addition to or instead of a denial, suspension, or revocation of
a license under this Section, the licensee may be subjected to a civil
penalty of up to $2,000 for each cause for denial, suspension,
or
revocation. The penalty is enforceable under subsection (5) of Section
403A of this Code.
(Source: P.A. 93-32, eff. 7-1-03.)
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(215 ILCS 5/513a8) (from Ch. 73, par. 1065.60a8)
Sec. 513a8.
Examinations.
(a) The Director may examine any applicant for or holder of a premium
finance license.
(b) All persons being examined, as well as their officers and directors,
shall provide to the Director convenient and free access, at all reasonable
hours at their offices, to all books, records, documents, and other papers
relating to the person's insurance and premium financing business affairs.
The licensee or its officers, directors, and employees shall facilitate and
aid the Director in the examinations as much as it is in their power to do so.
(c) The Director may designate an examiner or examiners to conduct any
examination under this Section. The Director or his designee may administer
oaths and examine under oath any individual relative to the business of the
person being examined.
(d) The examiners designated by the Director under this Section may make
reports to the Director. Any report alleging substantive violations of this
Code or the rules and regulations thereunder shall be in writing and be
based upon facts obtained by the examiners. The report of examination shall
be verified by the examiners.
(e) If a report is made, the Director shall either deliver a duplicate
thereof to the licensee being examined or send the duplicate by certified
or registered mail to the licensee's address of record. The Director shall
afford the licensee an opportunity to request a hearing with reference to
the facts and other evidence contained in the report. The licensee may
request a hearing within 14 calendar days after he receives the duplicate
of the examination report by giving the Director written notice of that
request, together with written statement of the licensee's objection to the
report. The Director shall, if requested to do so, conduct a hearing in
accordance with Sections 402 and 403. The Director shall issue a written
order based upon the examination report within 90 days after the report is
filed or within 90 days after the hearing, if a hearing is held. If the
report is refused or otherwise undeliverable or a hearing is not requested
in a timely fashion, the right to a hearing is waived. After the hearing or
the expiration of the time period in which a licensee may request a
hearing, if the examination reveals that the licensee is operating in
violation of any law, this Code or rules and regulations promulgated
thereunder, or prior order, the Director in the written order may require
the licensee to take any action the Director considers necessary or
appropriate in accordance with the report or examination hearing. The
order is subject to review under the Administrative Review Law.
(f) Any licensee who violates or aids and abets any violation of a
written order issued under this Section shall be guilty of a business
offense, and his license may be revoked or suspended under Section 513a7,
and he may be fined not less than $501 nor more than $5,000.
(Source: P.A. 87-811.)
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(215 ILCS 5/513a9) (from Ch. 73, par. 1065.60a9)
Sec. 513a9.
Premium finance agreement.
(a) A premium finance
agreement must be dated and signed by or on behalf of the named
insured, and the printed
portion shall be in at least 8-point type. The following items must be set
forth on the first page of the accepted finance agreement:
(1) the total amount of the premiums;
(2) the amount of the down payment;
(3) the principal balance (the difference between | ||
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(4) the amount of the finance charges expressed in | ||
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(5) the balance payable by the insured (sum of items | ||
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(6) the number of installments, the due dates | ||
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(7) the policy numbers or binder numbers.
(b) The premium finance company is required to
furnish full and complete
disclosure of the terms and conditions of the premium finance
agreement including, but not limited to, the specific insurance coverages
financed to the named insured no later than the date that the first
premium payment notice is sent to the insured.
(c) As to policies written primarily for personal, family, or household
use, the premium finance company must:
(1) deliver or mail the premium check or checks in | ||
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(2) issue the premium check or checks payable to the | ||
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(3) properly identify the premium check or checks by | ||
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(d) As to all other policies the premium finance company may:
(1) deliver or mail the premium check or checks in | ||
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(2) issue the premium check or checks payable to the | ||
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(e) A premium finance company that pays the financed premium to the
producer pursuant to subsection (d) establishes the producer as the agent of
the premium finance company for payment of the premium and for receipt of any
return premium.
(Source: P.A. 89-265, eff. 1-1-96; 90-381, eff. 8-14-97.)
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(215 ILCS 5/513a10) (from Ch. 73, par. 1065.60a10)
Sec. 513a10.
Maximum service charge.
(a) No service charge shall be made for financing premiums other than as
permitted by this Article.
(b) The service charge is to be computed on the principal balance from
the effective date of the insurance coverage for which the premiums are
being advanced to and including the date when the final installment of the
premium finance agreement is payable.
(c) The service charge shall be a maximum of $10 per $100 per year plus
an allowable charge as follows:
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(d) The service charge or any other charge made by the licensee does not
have to be refunded upon cancellation or prepayment. The allowable charge
is considered to be part of the service charge.
(e) A premium finance agreement may provide for a delinquency charge of
not less than $1 nor more than 5% of any installment in default for more
than 5 days.
(f) Any other charges shall be disclosed in the premium finance agreement.
(Source: P.A. 87-811.)
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(215 ILCS 5/513a11) (from Ch. 73, par. 1065.60a11)
Sec. 513a11. Cancellation requirements upon default.
(a) When a premium finance agreement contains a power of attorney
enabling the premium finance company to cancel any insurance contract or
contracts listed in the premium finance agreement, the insurance contract
or contracts shall not be cancelled by the premium finance company unless
the request for cancellation is effectuated under this Section.
(b) Not less than 10 days written notice shall be mailed to the named
insured of the intent of the premium finance company to cancel the
insurance contract unless the default is cured within the 10 day period.
(c) After expiration of the 10 day period, the premium finance company
may request, in the name of the named insured, cancellation of the insurance
contract or contracts by mailing or hand delivering to the insurer a
request for cancellation, and the insurance contract shall be cancelled as
if the request for cancellation had been submitted by the named insured,
but without requiring the return of the insurance contract or contracts.
The premium finance company shall also mail a copy of the request for
cancellation to the named insured at his last known address.
(d) All statutory, regulatory, and contractual restrictions providing
that the insurance contract may not be cancelled unless notice is given to
a governmental agency, mortgagee, or other third party shall apply where
cancellation is effected under provisions of this Section. The insurer
shall give the notice to any governmental agency, mortgagee, or other
third party on or before the fifth business day after it receives the
notice of cancellation from the premium finance company. For purposes of this Section, any governmental agency, mortgagee, or other third party may opt to receive notices electronically.
(e) In the event that the collection of return premiums for the account of
the named insured results in a surplus over the amount due from the named
insured, the premium finance company shall refund the excess to the named
insured; however, no refund is required if it amounts to less than $5.
(f) All cancellation provisions required of the premium finance company
and insurer are applicable to any policy to which Section 143.11 applies.
(Source: P.A. 93-713, eff. 1-1-05.)
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(215 ILCS 5/513a12) (from Ch. 73, par. 1065.60a12)
Sec. 513a12.
Books and records.
(a) Until payment in full and 3 years thereafter every licensee shall
maintain each premium finance agreement or duplicate originals thereof and
all original documents relating thereto (except those papers returned to
the insured) so as to be readily available for examination by the Director.
(b) Every licensee shall maintain a register, ledger, or combination of
records for each premium finance agreement that can readily show:
(1) the date of acquisition;
(2) the name of the insured;
(3) the identifying number;
(4) the principal balance;
(5) the amount of all charges assessed;
(6) the balance; and
(7) a distribution of proceeds showing the dates, | ||
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(Source: P.A. 87-811.)
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(215 ILCS 5/513a13) Sec. 513a13. Electronic delivery of notices and documents. (a) As used in this Section: "Delivered by electronic means" includes: (1) delivery to an electronic mail address at which a | ||
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(2) posting on an electronic network or site | ||
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"Party" means any recipient of any notice or document required as part of a premium finance agreement including, but not limited to, an applicant or contracting party. For the purposes of this Section, "party" includes the producer of record. (b) Subject to the requirements of this Section, any notice to a party or any other document required under applicable law in a premium finance agreement or that is to serve as evidence of a premium finance agreement may be delivered, stored, and presented by electronic means so long as it meets the requirements of the Uniform Electronic Transactions Act. (c) Delivery of a notice or document in accordance with this Section shall be considered equivalent to delivery by first class mail or first class mail, postage prepaid. (d) A notice or document may be delivered by electronic means by a premium finance company to a party under this Section if: (1) the party has affirmatively consented to that | ||
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(2) the party, before giving consent, is provided | ||
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(A) the right of the party to withdraw consent to | ||
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(B) the types of notices and documents to which | ||
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(C) the right of a party to have a notice or | ||
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(D) the procedures a party must follow to | ||
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(3) the party: (A) before giving consent, is provided with a | ||
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(B) consents electronically, or confirms consent | ||
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(4) after consent of the party is given, the premium | ||
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(A) provides the party with a statement that | ||
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(i) the revised hardware and software | ||
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(ii) the right of the party to withdraw | ||
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(B) complies with paragraph (2) of this | ||
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(e) Delivery of a notice or document in accordance with this Section does not affect requirements related to content or timing of any notice or document required under applicable law. (f) The legal effectiveness, validity, or enforceability of any premium finance agreement executed by a party may not be denied solely because of the failure to obtain electronic consent or confirmation of consent of the party in accordance with subparagraph (B) of paragraph (3) of subsection (d) of this Section. (g) A withdrawal of consent by a party does not affect the legal effectiveness, validity, or enforceability of a notice or document delivered by electronic means to the party before the withdrawal of consent is effective. A withdrawal of consent by a party is effective within a reasonable period of time after receipt of the withdrawal by the premium finance company. Failure by a premium finance company to comply with paragraph (4) of subsection (d) of this Section and subsection (j) of this Section may be treated, at the election of the party, as a withdrawal of consent for purposes of this Section. (h) This Section does not apply to a notice or document delivered by a premium finance company in an electronic form before the effective date of this amendatory Act of the 100th General Assembly to a party who, before that date, has consented to receive notice or document in an electronic form otherwise allowed by law. (i) If the consent of a party to receive certain notices or documents in an electronic form is on file with a premium finance company before the effective date of this amendatory Act of the 100th General Assembly and, pursuant to this Section, a premium finance company intends to deliver additional notices or documents to the party in an electronic form, then prior to delivering such additional notices or documents electronically, the premium finance company shall: (1) provide the party with a statement that | ||
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(A) the notices or documents that shall be | ||
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(B) the party's right to withdraw consent to | ||
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(2) comply with paragraph (2) of subsection (d) | ||
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(j) A premium finance company shall deliver a notice or document by any other delivery method permitted by law other than electronic means if: (1) the premium finance company attempts to deliver | ||
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(2) the premium finance company becomes aware that | ||
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(k) The producer of record shall not be subject to civil liability for any harm or injury that occurs as a result of a party's election to receive any notice or document by electronic means or by a premium finance company's failure to deliver a notice or document by electronic means unless the harm or injury is caused by the willful and wanton misconduct of the producer of record. (l) This Section shall not be construed to modify, limit, or supersede the provisions of the federal Electronic Signatures in Global and National Commerce Act, as amended.
(Source: P.A. 102-38, eff. 6-25-21.) |
(215 ILCS 5/Art. XXXIIB heading) ARTICLE XXXIIB. PHARMACY BENEFIT MANAGERS
(Source: P.A. 101-452, eff. 1-1-20.) |
(215 ILCS 5/513b1) Sec. 513b1. Pharmacy benefit manager contracts. (a) As used in this Section: "340B drug discount program" means the program established
under Section 340B of the federal Public Health Service Act, 42 U.S.C. 256b. "340B entity" means a covered entity as defined in 42 U.S.C. 256b(a)(4) authorized to participate in the 340B drug discount program. "340B pharmacy" means any pharmacy used to dispense 340B drugs for a covered entity, whether entity-owned or external. "Biological product" has the meaning ascribed to that term in Section 19.5 of the Pharmacy Practice Act. "Maximum allowable cost" means the maximum amount that a pharmacy benefit manager will reimburse a pharmacy for the cost of a drug. "Maximum allowable cost list" means a list of drugs for which a maximum allowable cost has been established by a pharmacy benefit manager. "Pharmacy benefit manager" means a person, business, or entity, including a wholly or partially owned or controlled subsidiary of a pharmacy benefit manager, that provides claims processing services or other prescription drug or device services, or both, for health benefit plans. "Retail price" means the price an individual without prescription drug coverage would pay at a retail pharmacy, not including a pharmacist dispensing fee. "Third-party payer" means any entity that pays for prescription drugs on behalf of a patient other than a health care provider or sponsor of a plan subject to regulation under Medicare Part D, 42 U.S.C. 1395w-101 et seq. (b) A contract between a health insurer and a pharmacy benefit manager must require that the pharmacy benefit manager: (1) Update maximum allowable cost pricing information | ||
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(2) Maintain a process that will, in a timely manner, | ||
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(3) Provide access to its maximum allowable cost list | ||
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(4) Provide a process by which a contracted pharmacy | ||
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(A) A requirement that a contracted pharmacy has | ||
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(B) A requirement that a pharmacy benefit manager | ||
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(C) A telephone number and e-mail address or | ||
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(D) A requirement that, if an appeal is denied, | ||
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(E) A requirement that, if an appeal is | ||
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(5) Allow a plan sponsor contracting with a pharmacy | ||
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(6) Allow a plan sponsor contracting with a pharmacy | ||
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(7) Provide notice to the party contracting with the | ||
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(c) In order to place a particular prescription drug on a maximum allowable cost list, the pharmacy benefit manager must, at a minimum, ensure that: (1) if the drug is a generically equivalent drug, it | ||
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(2) the drug is available for purchase by each | ||
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(3) the drug is not obsolete. (d) A pharmacy benefit manager is prohibited from limiting a pharmacist's ability to disclose whether the cost-sharing obligation exceeds the retail price for a covered prescription drug, and the availability of a more affordable alternative drug, if one is available in accordance with Section 42 of the Pharmacy Practice Act. (e) A health insurer or pharmacy benefit manager shall not require an insured to make a payment for a prescription drug at the point of sale in an amount that exceeds the lesser of: (1) the applicable cost-sharing amount; or (2) the retail price of the drug in the absence of | ||
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(f) Unless required by law, a contract between a pharmacy benefit manager or third-party payer and a 340B entity or 340B pharmacy shall not contain any provision that: (1) distinguishes between drugs purchased through the | ||
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(2) imposes any fee, chargeback, or rate adjustment | ||
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(3) imposes any fee, chargeback, or rate adjustment | ||
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(4) prevents or interferes with an individual's | ||
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(5) excludes a 340B entity or 340B pharmacy from a | ||
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(6) prevents a 340B entity or 340B pharmacy from | ||
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(7) any other provision that discriminates against a | ||
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As used in this subsection, "pharmacy benefit manager" and "third-party payer" do not include pharmacy benefit managers and third-party payers acting on behalf of a Medicaid program. (g) A violation of this Section by a pharmacy benefit manager constitutes an unfair or deceptive act or practice in the business of insurance under Section 424. (h) A provision that violates subsection (f) in a contract between a pharmacy benefit manager or a third-party payer and a 340B entity that is entered into, amended, or renewed after July 1, 2022 shall be void and unenforceable. (i)(1) A pharmacy benefit manager may not retaliate against a pharmacist or pharmacy for disclosing information in a court, in an administrative hearing, before a legislative commission or committee, or in any other proceeding, if the pharmacist or pharmacy has reasonable cause to believe that the disclosed information is evidence of a violation of a State or federal law, rule, or regulation. (2) A pharmacy benefit manager may not retaliate against a pharmacist or pharmacy for disclosing information to a government or law enforcement agency, if the pharmacist or pharmacy has reasonable cause to believe that the disclosed information is evidence of a violation of a State or federal law, rule, or regulation. (3) A pharmacist or pharmacy shall make commercially reasonable efforts to limit the disclosure of confidential and proprietary information. (4) Retaliatory actions against a pharmacy or pharmacist include cancellation of, restriction of, or refusal to renew or offer a contract to a pharmacy solely because the pharmacy or pharmacist has: (A) made disclosures of information that the | ||
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(B) filed complaints with the plan or pharmacy | ||
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(C) filed complaints against the plan or pharmacy | ||
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(j) This Section applies to contracts entered into or renewed on or after July 1, 2022. (k) This Section applies to any group or individual policy of accident and health insurance or managed care plan that provides coverage for prescription drugs and that is amended, delivered, issued, or renewed on or after July 1, 2020.
(Source: P.A. 102-778, eff. 7-1-22; 103-154, eff. 6-30-23; 103-453, eff. 8-4-23.) |
(215 ILCS 5/513b2) Sec. 513b2. Licensure requirements. (a) Beginning on July 1, 2020, to conduct business in this State, a pharmacy benefit manager must register with the Director. To initially register or renew a registration, a pharmacy benefit manager shall submit: (1) A nonrefundable fee not to exceed $500. (2) A copy of the registrant's corporate charter, | ||
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(3) A completed registration form adopted by the | ||
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(A) The name and address of the registrant. (B) The name, address, and official position of | ||
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(b) The registrant shall report any change in information required under this Section to the Director in writing within 60 days after the change occurs. (c) Upon receipt of a completed registration form, the required documents, and the registration fee, the Director shall issue a registration certificate. The certificate may be in paper or electronic form, and shall clearly indicate the expiration date of the registration. Registration certificates are nontransferable. (d) A registration certificate is valid for 2 years after its date of issue. The Director shall adopt by rule an initial registration fee not to exceed $500 and a registration renewal fee not to exceed $500, both of which shall be nonrefundable. Total fees may not exceed the cost of administering this Section. (e) The Department shall adopt any rules necessary to implement this Section.
(Source: P.A. 101-452, eff. 1-1-20.) |
(215 ILCS 5/513b3) Sec. 513b3. Examination. (a) The Director, or his or her designee, may examine a registered pharmacy benefit manager. (b) Any pharmacy benefit manager being examined shall provide to the Director, or his or her designee, convenient and free access to all books, records, documents, and other papers relating to such pharmacy benefit manager's business affairs at all reasonable hours at its offices. (c) The Director, or his or her designee, may administer oaths and thereafter examine the pharmacy benefit manager's designee, representative, or any officer or senior manager as listed on the license or registration certificate about the business of the pharmacy benefit manager. (d) The examiners designated by the Director under this Section may make reports to the Director. Any report alleging substantive violations of this Article, any applicable provisions of this Code, or any applicable Part of Title 50 of the Illinois Administrative Code shall be in writing and be based upon facts obtained by the examiners. The report shall be verified by the examiners. (e) If a report is made, the Director shall either deliver a duplicate report to the pharmacy benefit manager being examined or send such duplicate by certified or registered mail to the pharmacy benefit manager's address specified in the records of the Department. The Director shall afford the pharmacy benefit manager an opportunity to request a hearing to object to the report. The pharmacy benefit manager may request a hearing within 30 days after receipt of the duplicate report by giving the Director written notice of such request together with written objections to the report. Any hearing shall be conducted in accordance with Sections 402 and 403 of this Code. The right to a hearing is waived if the delivery of the report is refused or the report is otherwise undeliverable or the pharmacy benefit manager does not timely request a hearing. After the hearing or upon expiration of the time period during which a pharmacy benefit manager may request a hearing, if the examination reveals that the pharmacy benefit manager is operating in violation of any applicable provision of this Code, any applicable Part of Title 50 of the Illinois Administrative Code, a provision of this Article, or prior order, the Director, in the written order, may require the pharmacy benefit manager to take any action the Director considers necessary or appropriate in accordance with the report or examination hearing. If the Director issues an order, it shall be issued within 90 days after the report is filed, or if there is a hearing, within 90 days after the conclusion of the hearing. The order is subject to review under the Administrative Review Law.
(Source: P.A. 101-452, eff. 1-1-20.) |
(215 ILCS 5/513b4) Sec. 513b4. Denial, revocation, or suspension of registration; administrative fines. (a) Denial of an application or suspension or revocation of a registration in accordance with this Section shall be by written order sent to the applicant or registrant by certified or registered mail at the address specified in the records of the Department. The written order shall state the grounds, charges, or conduct on which denial, suspension, or revocation is based. The applicant or registrant may in writing request a hearing within 30 days from the date of mailing. Upon receipt of a written request, the Director shall issue an order setting: (i) a specific time for the hearing, which may not be less than 20 nor more than 30 days after receipt of the request; and (ii) a specific place for the hearing, which may be in either the city of Springfield or in the county in Illinois where the applicant's or registrant's principal place of business is located. If no written request is received by the Director, such order shall be final upon the expiration of said 30 days. (b) If the Director finds that one or more grounds exist for the revocation or suspension of a registration issued under this Article, the Director may, in lieu of or in addition to such suspension or revocation, impose a fine upon the pharmacy benefit manager as provided under subsection (c). (c) With respect to any knowing and willful violation of a lawful order of the Director, any applicable portion of this Code, Part of Title 50 of the Illinois Administrative Code, or provision of this Article, the Director may impose a fine upon the pharmacy benefit manager in an amount not to exceed $50,000 for each violation.
(Source: P.A. 101-452, eff. 1-1-20.) |
(215 ILCS 5/513b5) Sec. 513b5. Failure to register. Any pharmacy benefit manager that operates without a registration or fails to register with the Director and pay the fee prescribed by this Article is an unauthorized insurer as defined in Article VII of this Code and shall be subject to all penalties provided for therein.
(Source: P.A. 101-452, eff. 1-1-20.) |
(215 ILCS 5/513b6) Sec. 513b6. Insurance Producer Administration Fund. All fees and fines paid to and collected by the Director under this Article shall be paid promptly after receipt thereof, together with a detailed statement of such fees, into the Insurance Producer Administration Fund. The moneys deposited into the Insurance Producer Administration Fund may be transferred to the Professions Indirect Cost Fund, as authorized under Section 2105-300 of the Department of Professional Regulation Law of the Civil Administrative Code of Illinois.
(Source: P.A. 101-452, eff. 1-1-20.) |
(215 ILCS 5/Art. XXXIII heading) ARTICLE XXXIII.
URBAN
PROPERTY INSURANCE
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(215 ILCS 5/513b7) Sec. 513b7. Pharmacy audits. (a) As used in this Section: "Audit" means any physical on-site, remote electronic, or concurrent review of a pharmacist or pharmacy service submitted to the pharmacy benefit manager or pharmacy benefit manager affiliate by a pharmacist or pharmacy for payment. "Auditing entity" means a person or company that performs a pharmacy audit. "Extrapolation" means the practice of inferring a frequency of dollar amount of overpayments, underpayments, nonvalid claims, or other errors on any portion of claims submitted, based on the frequency of dollar amount of overpayments, underpayments, nonvalid claims, or other errors actually measured in a sample of claims. "Misfill" means a prescription that was not dispensed; a prescription that was dispensed but was an incorrect dose, amount, or type of medication; a prescription that was dispensed to the wrong person; a prescription in which the prescriber denied the authorization request; or a prescription in which an additional dispensing fee was charged. "Pharmacy audit" means an audit conducted of any records of a pharmacy for prescriptions dispensed or nonproprietary drugs or pharmacist services provided by a pharmacy or pharmacist to a covered person. "Pharmacy record" means any record stored electronically or as a hard copy by a pharmacy that relates to the provision of a prescription or pharmacy services or other component of pharmacist care that is included in the practice of pharmacy. (b) Notwithstanding any other law, when conducting a pharmacy audit, an auditing entity shall: (1) not conduct an on-site audit of a pharmacy at any | ||
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(2) notify the pharmacy or its contracting agent no | ||
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(A) by mail or common carrier, return receipt | ||
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(B) electronically, not including facsimile, with | ||
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(3) limit the audit period to 24 months after the | ||
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(4) provide in writing the list of specific | ||
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(5) use the written and verifiable records of a | ||
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(6) limit the number of prescriptions audited to no | ||
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(7) provide the pharmacy or its contracting agent | ||
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(8) be allowed to conduct a follow-up audit on site | ||
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(9) accept invoice audits as validation invoices from | ||
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(10) provide the pharmacy or its contracting agent | ||
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(11) be required to provide the pharmacy or its | ||
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(12) conduct the audit in consultation with a | ||
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(13) not chargeback, recoup, or collect penalties | ||
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(14) not compensate the employee or contractor | ||
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(15) not use extrapolation to calculate penalties or | ||
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(16) not include dispensing fees in the calculation | ||
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(17) conduct a pharmacy audit under the same | ||
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(c) Except as otherwise provided by State or federal law, an auditing entity conducting a pharmacy audit may have access to a pharmacy's previous audit report only if the report was prepared by that auditing entity. (d) Information collected during a pharmacy audit shall be confidential by law, except that the auditing entity conducting the pharmacy audit may share the information with the health benefit plan for which a pharmacy audit is being conducted and with any regulatory agencies and law enforcement agencies as required by law. (e) A pharmacy may not be subject to a chargeback or recoupment for a clerical or recordkeeping error in a required document or record, including a typographical error or computer error, unless the pharmacy benefit manager can provide proof of intent to commit fraud or such error results in actual financial harm to the pharmacy benefit manager, a health plan managed by the pharmacy benefit manager, or a consumer. (f) A pharmacy shall have the right to file a written appeal of a preliminary and final pharmacy audit report in accordance with the procedures established by the entity conducting the pharmacy audit. (g) No interest shall accrue for any party during the audit period, beginning with the notice of the pharmacy audit and ending with the conclusion of the appeals process. (h) An auditing entity must provide a copy to the plan sponsor of its claims that were included in the audit, and any recouped money shall be returned to the plan sponsor, unless otherwise contractually agreed upon by the plan sponsor and the pharmacy benefit manager. (i) The parameters of an audit must comply with manufacturer listings or recommendations, unless otherwise prescribed by the treating provider, and must be covered under the individual's health plan, for the following: (1) the day supply for eye drops must be calculated | ||
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(2) the day supply for insulin must be calculated so | ||
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(3) the day supply for topical product must be | ||
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(j) This Section shall not apply to: (1) audits in which suspected fraud or knowing and | ||
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(2) audits of claims paid for by federally funded | ||
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(3) concurrent reviews or desk audits that occur | ||
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(Source: P.A. 103-102, eff. 1-1-24.) |
(215 ILCS 5/522) (from Ch. 73, par. 1065.69)
Sec. 522.
Purpose.
This article is to make basic property insurance increasingly available
to the citizens of this State, and to deter the insurance industry from
geographically redlining urban areas of this State by requiring the restructuring
of the Industry Placement Facility and administering the FAIR Plan (Fair
Access to Insurance Requirements) to deliver residential property insurance
to all citizens of this State on a reasonable access and marketing basis
by offering homeowners insurance, by requiring immediate binding of eligible
risks, by making use of premium installment payment plans, and by further
establishing reasonable service standards in its plan of operation subject
to the approval and review of the Director; and, to establish a central
operation facility for the equitable distribution of losses and expenses
in the writing of the basic property insurance and homeowners insurance in this State.
(Source: P.A. 80-1365.)
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(215 ILCS 5/523) (from Ch. 73, par. 1065.70)
Sec. 523.
Definitions.) (1) "Basic Property Insurance" means the
coverage against direct loss to real or tangible personal property at a
fixed location provided in the Standard Fire Policy and Extended
Coverage Endorsement and such vandalism and malicious mischief or such
other classes of insurance as may be added with respect to the property
by the Industry Placement Facility with the approval of the Director, except
insurance on automobile, farm and manufacturing
risks and it shall include homeowners insurance.
(2) "Homeowners Insurance" means the personal multi-peril property
coverages commonly known as Homeowners Insurance.
(3) "Inspection Bureau(s)" means the organization or organizations
designated by the Industry Placement Facility with the approval of the
Director to make inspections to determine the condition of the
properties for which basic property insurance is sought and to perform
such other duties as may be authorized by the Industry Placement
Facility;
(4) "Industry Placement Facility" or "Facility" means the
organization formed by insurers licensed to write and engaged in writing
basic property insurance (including multi-peril policies)
within the State of Illinois to assist applicants in urban areas in
securing basic property insurance and to formulate and administer a
program for the equitable apportionment among such insurers of such
basic property insurance.
(5) "Urban Area" means any community having a blighted, deteriorated
or deteriorating area which the Facility has designated with the
approval of the Director, or which the Secretary of the U.S. Department
of Housing and Urban Development has approved for an urban renewal
project after a local public agency has been formed in the community to
avail itself of a U.S. Housing and Urban Renewal Program, or which the
Director of Insurance has designated.
(6) "Premiums Written" means the gross direct premiums charged with
respect to property in this State on all policies of basic property
insurance and the basic property insurance premium components of all
multi-peril policies less return premiums, dividends paid or credited to
policyholders, or the unused or unabsorbed portions of premium deposits.
(Source: P.A. 80-1365.)
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(215 ILCS 5/524) (from Ch. 73, par. 1065.71)
Sec. 524.
FAIR Plan Procedure.
(1) Any person having an insurable
interest in real or tangible personal property at a fixed location in an
urban area who, after diligent effort has been unable to obtain basic
property insurance, as evidenced by 3 attempts to procure such insurance,
is entitled upon application to the Facility to an
inspection and evaluation of the property by representatives of the
Inspection Bureau.
(2) Any person who is an owner-resident of a one to four family
dwelling unit at a fixed location in an urban area and whose residential
real property insurance coverage has been nonrenewed through the
voluntary insurance market shall be entitled to submit a binding
application of coverage to the Facility for such period of time as is
required by the Facility to conduct a reasonable inspection of the
residential real property.
(3) The manner and scope of the inspection and evaluation report
for nonresidential property shall be prescribed by the Facility with
the approval of the Director. The
inspection must include, but need not be limited to, pertinent
structural and occupancy features as well as the general condition of
the building and surrounding structures. A representative photograph of
the property may be taken as part of the inspection.
(4) Promptly after the request for inspection is received an
inspection must be made and an inspection report filed with the company
or companies designated by the Facility. A copy of the completed
inspection and evaluation report must be sent to the Facility and made
available to the
applicant and to insurers in the voluntary insurance market upon request.
(5) If the Inspection Bureau finds that the residential property meets
the reasonable underwriting standards established under Section 525, the
applicant shall be so informed in writing. If the residential property does
not meet the criteria, the applicant shall be informed, in writing, of the
reasons for the failure of the residential property to meet the criteria.
(6) If, at any time, the applicant makes improvements in the residential
property or its condition which he or she believes are sufficient to make
the residential property meet the criteria, a representative of the Inspection
Bureau shall reinspect the residential property upon request. In any case,
the applicant for residential property insurance shall be eligible for one
reinspection any time
beginning 60 days after his or
her initial Fair plan inspection. If upon reinspection the residential property
meets the reasonable underwriting standards established under Section 525,
the applicant shall be so informed in writing.
(Source: P.A. 81-1430.)
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(215 ILCS 5/525) (from Ch. 73, par. 1065.72)
Sec. 525.
Industry Placement Program.)
(1) Within 30 days after the
effective date of this Article, all insurers engaged in writing in this
State, on a direct basis, basic property insurance or any property
insurance component in multi-peril policies, other than local district,
county and township mutual companies, must establish an Industry
Placement Facility to formulate and administer a Program for the
equitable apportionment among such insurers of basic property insurance
which may be afforded applicants in urban areas whose property is
insurable in accordance with reasonable underwriting standards, but
who, after diligent efforts, are unable to procure such insurance through
normal channels, as evidenced by 3 attempts to procure such insurance.
The Program may also provide, with the approval of the
Director, for the use of deductibles, percentage participation clauses
and other underwriting devices and for assessment of all members in
amounts sufficient to operate the Facility, and may establish maximum
limits of liability to be placed through the Program,
commissions to be paid to the license producer designated by the
applicant and for relieving any company from accepting referrals under
the FAIR Plan, in whole or in part, for reasonable cause. The Program
may also provide that the Facility issue policies in its own name. The
Program shall establish reasonable underwriting standards for determining
insurability of a risk, subject to the approval of the Director.
(2) The Industry Placement Program, through its plan of operation,
shall provide reasonable access and marketing procedures for (a)
immediate binding of eligible risks; (b) premium installment payment
plans; and, (c) establishing adequate marketing and service facilities
in all designated urban areas of this State.
(3) Homeowners insurance coverage shall become part of the Industry
Placement Program of basic property insurance. The Facility shall
develop, with the consultation of the Director, a homeowners insurance
contract(s) for urban areas. Such Program of homeowners insurance will
be implemented through a plan of operation specifically entitling owner
residents who have been nonrenewed through normal insurance channels of
immediate binding coverage pending a reasonable period of time for the
Facility to conduct an inspection of the premises to determine whether
the premises comply with underwriting requirements set out in the Program.
(4) Each insurer, as a condition of its authority to transact such
kinds of insurance in this State, must participate in the Industry
Placement Program in accordance with this Article and such a plan of
operation as may be established by a Governing Committee of 6 insurers
elected annually in a manner provided in a membership agreement to be
executed by each participating insurer, 4 members who are not
employees of or otherwise affiliated with the
insurance industry appointed by the Director to represent the
interest of insurance consumers, and one member who is an Illinois licensed
insurance producer appointed by the Director, who shall serve
for terms consistent with the terms served by
their counterparts from the insurance industry.
(Source: P.A. 88-667, eff. 9-16-94.)
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(215 ILCS 5/525.1) (from Ch. 73, par. 1065.72-1)
Sec. 525.1.
Centralized Operations Authorized.) (1) The Industry
Placement Facility is authorized, for FAIR Plan purposes only, to issue
policies of insurance and endorsements thereto in its own name or a
trade name duly adopted for that purpose, and to act on behalf of all
participating insurers in connection with said policies and otherwise in
any manner necessary to accomplish the purposes of this Article,
including but not limited to collection of premiums, issuance of
cancellations, and payment of commissions, losses, judgments and
expenses.
(2) The participating insurers shall be liable to the Facility as
provided in this Article, the Program and any related Articles of
Agreement for the expenses and liabilities so incurred by the Facility,
and the Governing Committee shall make assessments against the
participating insurers as required to meet such expenses and
liabilities. In connection with any policy issued by the Facility: (a)
the name and percentage participation of each participating insurer
shall be made available to the insured upon request to the Facility;
(b) service of any notice, proof of loss, legal process or other
communication with respect to the policy may and shall be made upon the
Facility; and (c) any action by the insured constituting a claim under
the policy shall be brought only against the Facility, and the Facility
shall be the proper party for all purposes in any action brought under
or in connection with any such policy. The foregoing requirements shall
be set forth in any policy issued by the Facility and the form and
content of any such policy shall be subject to the approval of the
Director of Insurance.
(3) The Facility is authorized to assume and cede reinsurance in
conformity with the Program.
(4) (a) Each insurer must participate in the writings, expenses,
profits and losses of the Facility in the proportion that its premiums written,
with respect to each fund, bear to the aggregate premiums written by all
insurers, with respect to each said fund, excluding that portion of the
premiums written attributable to the operation of the Facility except
as otherwise provided in this Section.
(b) The Director of Insurance shall by rule establish procedures for
determining the net level of participation required of each insurer, which
shall include the following elements:
(i) The designation of one or more contiguous ZIP CODE areas within
this State wherein the insurers writing new policies upon risks which they
do not insure prior to the effective date of this amendatory Act may receive
credit against
their obligation for FAIR Plan risks;
(ii) The minimum level of participation required of all insurers regardless of
the amount of credit allowed but which in no case shall be less than 50%
of that level of participation that would be required as defined in paragraph
(a) above;
(iii) A designation of the type of risks for which credit may be allowed,
provided that credit shall not apply to commercial risks where the annual
premium for the policy exceeds $2,000 for each fixed location;
(iv) The maximum level of participation required of all insurers regardless
of the amount of credit allowed.
(c) The procedures for determining levels of participation and all designations,
formulas, minima and maxima required by this Section shall be reasonably
designed to effect the intent of this Article without exempting any insurer
from the participation requirement.
(5) Voting on administrative questions of the Facility shall be
weighted in accordance with each insurers' premium written during the
second preceding calendar year as disclosed in the reports filed by the
insurer with the Director.
(6) The Facility may on its own initiative or at the request of the
Director, amend its rules or Program, subject to approval by the
Director.
(Source: P.A. 81-1426.)
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(215 ILCS 5/525.2) (from Ch. 73, par. 1065.72-2)
Sec. 525.2.
Premium financing.
In the event the Industry Placement Facility accepts premium payments
from licensed premium financing companies and whenever a financed FAIR Plan
insurance contract is cancelled in accordance with Section 521 of the
Illinois Insurance Code, the insurer or Industry Placement Facility shall
return whatever gross unearned premium is due under the insurance contract
to the premium finance company effecting the cancellation for the account
of the insured or insureds less the proportionate amount of the commissions
paid by it to the producers of such FAIR Plan risk, prorated as to the
unearned portion of the premium, which amount such producers shall return
to the premium finance company. In the event of cancellation as set forth
above the Industry Placement Facility may deduct and retain from the return
premium a reasonable amount as a service charge.
(Source: P.A. 77-1561.)
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(215 ILCS 5/525.3) (from Ch. 73, par. 1065.72-3)
Sec. 525.3.
Approval of Rates.
In the event that the Industry Placement
Facility proposes to issue policies of insurance or endorsements thereto
pursuant to subsection (1) of Section 525.1, the Facility shall file for
approval with the Director the proposed rates and supplemental rate information
to be used in connection with the issuance of such policies or endorsements.
Within 60 days of the filing of the proposed rates, the Director shall enter
an order either approving or disapproving, in whole or in part, the rate
plan filed. The Director may, upon notice to the Industry Placement Facility,
extend the period for entering an order under this Section an additional
30 days. No such policies or endorsements shall be issued until such time
as the Director approves the rates to be applied to the policy or endorsement.
An order disapproving a rate shall state the grounds for the disapproval
and the findings in support thereof.
(Source: P.A. 81-1426.)
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(215 ILCS 5/525.4) (from Ch. 73, par. 1965.72-4)
Sec. 525.4.
Application for Coverage of Risks by the Facility.
(1) In the
event that the Industry Placement Facility proposes to issue policies of
insurance or endorsements thereto pursuant to subsection (1) of Section
525.1, the Facility shall require a written application for such
policies or endorsements. All applications shall be incorporated into the
policy or endorsement for which application was made.
(2) Applications for coverage of risks on property which is held in a
land trust, except applications for policies described in subsection (b)
of Section 143.13, shall disclose all beneficial interests in the property
in accordance with "An Act to require disclosure, under certification of
perjury, of all beneficial interests in real property held in a land trust,
in certain cases", approved September 21, 1973, as amended. Changes, which
result in an aggregate of 25%, in beneficial interest in the property subsequent
to the verification made in the application shall be reported by the
applicant or policy holder to the Facility no later than 10 days after the
change in beneficial interest occurs.
This shall not apply to transfer of beneficial interest to members of the
immediate family including spouse, children and grandchildren and their
spouses, parents, sisters and brothers. Changes in beneficial interest
which result in an aggregate of less than 25% shall be reported at the time
of renewal of the policy. Disclosure of the beneficial interests in such
property is deemed material
to the application for new coverage or the continuation of existing coverage
and failure to disclose all beneficial interests, including any changes
therein, renders the contract of insurance voidable at the option of the
Facility. Upon being notified of any change in beneficial interest, the
Facility shall reevaluate its risk of loss as if the risk were a new application
for coverage. When a policy subject to this Section is issued or applied
for, the Facility shall give written notice as to the requirements of this Section
to the named insured or applicant and all beneficiaries disclosed in the application.
(3) Applications for policies or endorsements covering real property,
except applications for policies described in subsection (b) of Section
143.13, shall include the following information:
(a) name and address of the applicant;
(b) name and address of all parties with any financial interest in the
property to be insured and the nature and extent of such interest, including mortgages;
(c) all purchases and sales of the property to be insured during the last
five years, including all parties involved in such transactions, with their
names and addresses;
(d) the value the insured claims for the insurable interest and the method
utilized to derive that value;
(e) all income from the property to be insured during the current year
and the last calendar and tax years, if known;
(f) occupancy and use during the preceding two years, including percentage
of occupancy if a nonowner occupied dwelling, if known;
(g) prior loss history of the applicant and the property to be insured;
(h) all tax liens and other legal encumbrances affecting the property
to be insured; and
(i) all violations of building construction and maintenance ordinances
concerning the property to be insured which have been cited in a legal notice
from an ordinance enforcement authority and which violations have not been
certified as remedied by the enforcement authority, and for which an enforcement
action is pending.
(4) Within 60 days of receipt of an application submitted pursuant to
subsection (3), the Facility shall conduct an on-site inspection of the
property to be insured so as to determine the nature of the risk presented
and the availability of coverage by the Facility. Any policy or endorsement
issued on an application submitted pursuant to subsection (3) may be cancelled
by the Facility within 60 days of the issuance thereof.
(Source: P.A. 81-1426.)
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(215 ILCS 5/527) (from Ch. 73, par. 1065.74)
Sec. 527.
Right
to appeal.
(1) Any applicant or affected insurer has the right of appeal to the
Governing Committee. A decision of the Committee may be appealed to the
Director within 30 days after such decision.
(2) All orders or decisions of the Director made pursuant to this
Article are subject to judicial review
in accordance with the
Administrative Review Law.
(Source: P.A. 82-783.)
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(215 ILCS 5/528) (from Ch. 73, par. 1065.75)
Sec. 528.
Inspection reports.
There is no liability on the part of, and no cause of action against
insurers, the Inspection Bureau, the Facility, the Association, the
Governing Committee, their agents or employees, or the Director or his
authorized representatives, with respect to any inspections required to be
undertaken by this Article or for any acts or omissions in connection
therewith, or for any statements made in any report and communication
concerning the insurability of the property, or in the findings required by
the provisions of this Article, or at the hearings conducted in connection
with such inspections. The reports and communications of the Inspection
Bureau, the Facility, the Association, and the records of the Governing
Committee are not considered public documents.
(Source: Laws 1968, p. 15.)
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(215 ILCS 5/529) (from Ch. 73, par. 1065.76)
Sec. 529.
Illinois Insurance Development Fund.
(a) A trust fund is created to be known as the "Illinois Insurance
Development Fund" to be administered by the State Treasurer as a special
trust fund. The purpose is to provide financial back-up for the Facility
and the Association in order to enable companies to qualify for riot and
civil disorder reinsurance under the National Insurance Development
Corporation Act of 1968 or any other act of the United States which will
similarly provide reinsurance or financial back-up to accomplish the
purpose of this Article.
(b) The Fund shall consist of all payments made to the Fund by companies
in accordance with the provisions of this Article, any securities acquired
by and through use of monies belonging to the Fund, any monies appropriated
to the Fund, and any interest and accretions earned on assets of the Fund.
The State Treasurer shall have the same power to enforce the collection of
the assessments provided hereunder as any other obligation due the State.
(Source: P.A. 76-714.)
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(215 ILCS 5/529.1) (from Ch. 73, par. 1065.76-1)
Sec. 529.1.
Reimbursement of the Secretary.
The Fund shall reimburse the Secretary of the Department of Housing and
Urban Development (hereinafter referred to as "the Secretary") under the
provisions of Section 1223(a) (1) of the Urban Property Protection and
Reinsurance Act of 1968 (hereinafter referred to as "the Act") for losses
reinsured by the Secretary and occurring in this State on or after August
1, 1968, provided that the total amount of reimbursement in any one year
shall not, in the aggregate, exceed 5% of the aggregate property insurance
premiums earned in this State during the preceding calendar year on those
lines of insurance reinsured by the Secretary in this State during the
calendar year.
(Source: P.A. 76-714.)
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(215 ILCS 5/529.2) (from Ch. 73, par. 1065.76-2)
Sec. 529.2.
Making of assessments.
Whenever the Secretary shall, in accordance with the Act, present to the
State a request for reimbursement under the Act, the Fund shall immediately
assess all companies which, during the calendar year with respect to which
reimbursement is requested by the Secretary, are engaged in writing
property insurance in this State. The amount of each such company's
assessment shall be calculated by multiplying the amount of the
reimbursement requested by the Secretary by a fraction the numerator of
which is the company's direct property insurance premiums earned in this
State and the denominator of which is the aggregate of such premiums for
all companies. Within 30 days following the end of each full calendar
quarter, each company shall pay to the Fund an amount equal to one-twelfth
of the company's assessment.
(Source: P.A. 76-714.)
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(215 ILCS 5/529.3) (from Ch. 73, par. 1065.76-3)
Sec. 529.3.
Insolvency.
In the event any company fails, by reason of insolvency, to pay any
assessment, the Fund shall cause the reimbursement ratios, computed
under Section 529.2, to be immediately recalculated, excluding therefrom the
amount of the insolvent company's assessment determined by the Director
of Insurance to be uncollectible, so that such uncollectible amount is,
in effect, assumed and redistributed among the remaining companies.
(Source: P.A. 81-1509.)
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(215 ILCS 5/529.4) (from Ch. 73, par. 1065.76-4)
Sec. 529.4.
Whenever the fund shall assess insurers in accordance with this Section,
each insurer may charge an additional premium on every property insurance
policy issued by it insuring property in this state, the effective date of
which policy is within the 3 year period commencing 90 days after the date
of assessment by the Fund. The amount of the additional premium shall be
calculated on the basis of a uniform percentage of the premium on such
policies equal to 1/3 of the ratio of the amount of an insurer's assessment
to the amount of its direct earned premiums for the calendar year
immediately preceding the year in which the assessment is made, such that
over the period of 3 years the aggregate of all such additional premium
charges by an insurer shall be equal to the amount of the assessment of
such insurer. The minimum additional premium charged on a policy may be
$1.00 and any other additional premium charged may be rounded to the
nearest dollar.
(Source: P.A. 76-714.)
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(215 ILCS 5/529.5) (from Ch. 73, par. 1065.76-5)
Sec. 529.5.
The Industry Placement Facility shall compile an annual
operating report, and publish such report in at least 2 newspapers having
widespread circulation in the State, which report shall include:
(1) a description of the origin and purpose of the Illinois Fair Plan
and its relationship to the property and casualty insurance industry in
Illinois;
(2) a financial statement specifying the amount of profit or loss incurred
by the Facility for its financial year; and
(3) a disclosure as to the amount of subsidization per type of policy
written by the Facility, which is provided by the property and casualty
insurance companies operating in Illinois, if any.
This annual report shall be a matter of public record to be made available
to any person requesting a copy from the Facility at a fee not to exceed
$10 per copy. A copy shall be available for inspection at the
Department of Insurance.
(Source: P.A. 93-32, eff. 7-1-03.)
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(215 ILCS 5/530) (from Ch. 73, par. 1065.77)
Sec. 530.
Powers of the Director.) In addition to any powers
conferred upon him by this or any other law, the Director is charged
with the authority to supervise the Inspection Bureau, the Facility and
the Association. In addition the Director or any person designated by
him has the power:
(1) to examine the operation of the Facility and Association through
free access to all the books, records, files, papers and documents
relating to their operation and may summon, qualify and examine as
witnesses all persons having knowledge of such operations including
officers, agents or employees thereof;
(2) to do all things necessary to enable the State of Illinois and
any insurer participating in any Program approved by the Director to
fully participate in any federal program of reinsurance which may be
enacted for purposes similar to the purposes of this Article;
(3) to require such reports from insurers concerning risks insured
under any Program approved pursuant to this Article as he may deem
necessary;
(4) to approve a homeowners policy form(s) for the Industry Placement Program.
(5) To require the Insurance Placement Program to develop marketing programs
which will deter urban redlining and other unfairly discriminatory geographic
underwriting programs by making readily available basic property insurance.
(6) to permit modification of the Standard Fire Policy issued by the
facility for non owner-occupied residences exceeding four units, after the
director has conducted a public hearing which establishes that such modifications:
1) will provide for equitable settlements of loss;
2) will discourage arson for profit; and
3) will encourage neighborhood revitalization, while maintaining the interests
of the insured and the facility. The Director shall confer with the facility
to establish criteria by which it can be determined whether such modification
of the Standard Fire Policy is accomplishing its objectives. The Director
shall conduct, within two years of any modification of the Standard Fire
Policy, a public hearing to determine whether such modification has accomplished
the three preceding objectives. In the event that such public hearing does
not establish that such objectives are being accomplished, then the Director
shall rescind the modification of the Standard Fire Policy, or further modify
such policy to accomplish the objectives.
(Source: P.A. 82-499.)
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(215 ILCS 5/530a) (from Ch. 73, par. 1065.77a)
Sec. 530a.
The Director of Insurance shall form a task force to review
the policy forms and endorsements issued by the Industry Placement Facility
on residential property of 5 or more dwelling units. The task force shall
consider the coverage, perils and settlement provisions and make their recommendations
to the Director by January 15, 1981, on proposed policy forms and endorsements
which will provide for equitable settlement of loss, discourage arson for
profit and encourage neighborhood revitalization. Any recommendation of
the task force shall consider the impact on the continuous goal of depopulation
of the Facility.
The Task force shall be comprised of members of the insurance industry,
general public and 4 members of the General Assembly, 2 to be appointed
by the President of the Senate and 2 by the Speaker of the House with equal
representation from the majority and minority parties.
The Director shall hold public hearings on the task force recommendations
and promulgate a rule to adopt such policy forms and endorsements as minimum
standards for the Industry Placement Facility.
(Source: P.A. 81-1432.)
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(215 ILCS 5/Art. XXXIII.5 heading) ARTICLE XXXIII 1/2.
LIFE AND HEALTH
INSURANCE GUARANTY ASSOCIATION
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(215 ILCS 5/531.01) (from Ch. 73, par. 1065.80-1)
Sec. 531.01.
Title.) This Article is known and may be
cited as the Illinois Life and Health Insurance Guaranty Association
Law.
(Source: P.A. 81-899.)
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(215 ILCS 5/531.01a) (from Ch. 73, par. 1065.80-1a)
Sec. 531.01a.
Existing Liability.
Any liabilities of the
Association for any member company
which was an insolvent insurer as defined by this Article prior to January
1, 1986 shall be
determined under the law which was in effect at the time the member company
became an insolvent insurer
as if there had been no amendment to that law. Any liabilities of the
Association for a member company which became an insolvent insurer on or after
January 1, 1986, shall be
determined under the law in effect at the time when the member became an
insolvent insurer, notwithstanding any prior law.
On or after January 1, 1986, any assessments made against other member
companies to meet Association liabilities shall be made based on
the law which was in effect when the member company was an impaired or
insolvent insurer as defined by this Article. If different assessment
methods are used in any one year, those assessments shall be aggregated for
purposes of calculating the
aggregate assessment under Sections 531.09 and 531.13.
(Source: P.A. 84-1035.)
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(215 ILCS 5/531.02) (from Ch. 73, par. 1065.80-2)
Sec. 531.02. Purpose. The purpose of this Article is to protect,
subject to certain limitations, the persons specified in paragraph (1) of
Section 531.03 against failure
in the performance of contractual obligations, under life, health, and annuity policies, plans, or contracts and health or medical care service
contracts specified in paragraph (2) of Section 531.03, due to the
impairment or insolvency of the
member insurer issuing such policies, plans, or contracts. To provide this protection,
(1) an association of member insurers is created to enable the guaranty of payment
of benefits and of continuation of coverages, (2) members of the Association
are subject to assessment to provide funds to carry out the purpose of this
Article, and (3) the Association is authorized to assist the Director, in
the prescribed manner, in the detection and prevention of member insurer impairments
or insolvencies.
(Source: P.A. 100-687, eff. 8-3-18.)
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(215 ILCS 5/531.03) (from Ch. 73, par. 1065.80-3)
Sec. 531.03. Coverage and limitations.
(1) This Article shall provide
coverage for the policies and contracts specified in subsection (2) of this
Section:
(a) to persons who, regardless of where they reside | ||
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(b) to persons who are owners of or certificate | ||
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(i) are residents; or (ii) are not residents, but only under all of the | ||
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(A) the member insurer that issued the | ||
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(B) the states in which the persons reside | ||
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(C) the persons are not eligible for coverage | ||
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(c) For unallocated annuity contracts specified in | ||
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(i) persons who are the owners of the unallocated | ||
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(ii) persons who are owners of unallocated | ||
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(d) For structured settlement annuities specified in | ||
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(i) is a resident, regardless of where the | ||
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(ii) is not a resident, but only under both of | ||
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(A) with regard to residency: (I) the contract owner of the structured | ||
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(II) the contract owner of the structured | ||
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(B) neither the payee or beneficiary nor | ||
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(e) This Article shall not provide coverage to: (i) a person who is a payee or beneficiary of a | ||
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(ii) a person covered under paragraph (c) of this | ||
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(f) This Article is intended to provide coverage to | ||
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(2)(a) This Article shall provide coverage to the persons
specified in subsection (1) of this Section for policies or contracts of direct, (i)
nongroup life insurance, health insurance (that, for the purposes of this Article, includes health maintenance organization subscriber contracts and certificates), annuities and
supplemental contracts to any of these, (ii) for
certificates under direct group policies or contracts, (iii) for unallocated
annuity contracts and (iv) for contracts to furnish
health care services and subscription certificates for medical or health
care services issued by persons licensed to transact insurance business
in this State under this Code.
Annuity contracts and certificates under group annuity contracts include
but are not limited to guaranteed investment contracts, deposit
administration contracts, unallocated funding agreements, allocated funding
agreements, structured settlement agreements, lottery contracts
and any immediate or deferred annuity contracts.
(b) Except as otherwise provided in paragraph (c) of this subsection, this Article shall not provide coverage for:
(i) that portion of a policy or contract not | ||
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(ii) any such policy or contract or part thereof | ||
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(iii) any portion of a policy or contract to the | ||
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(A) averaged over the period of 4 years prior to | ||
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(B) on and after the date on which the member | ||
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(iv) any unallocated annuity contract issued to or in | ||
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(v) any portion of any unallocated annuity contract | ||
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(vi) an obligation that does not arise under the | ||
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(A) a claim based on marketing materials; (B) a claim based on side letters, riders, or | ||
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(C) a misrepresentation of or regarding policy | ||
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(D) an extra-contractual claim; or (E) a claim for penalties or consequential or | ||
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(vii) any stop-loss insurance, as defined in clause | ||
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(viii) any policy or contract providing any hospital, | ||
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(ix) any portion of a policy or contract to the | ||
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(x) any portion of a policy or contract issued to a | ||
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(A) a multiple employer welfare arrangement as | ||
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(B) a minimum premium group insurance plan; (C) a stop-loss group insurance plan; or (D) an administrative services only contract; (xi) any portion of a policy or contract to the | ||
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(A) dividends or experience rating credits; (B) voting rights; or (C) payment of any fees or allowances to any | ||
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(xii) any policy or contract issued in this State by | ||
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(xiii) any contractual agreement that establishes the | ||
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(xiv) any portion of a policy or contract to the | ||
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(xv) that portion or part of a variable life | ||
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(c) The exclusion from coverage referenced in subdivision (iii) of paragraph (b) of this subsection shall not apply to any portion of a policy or contract, including a rider, that provides long-term care or other health insurance benefits. (3) The benefits for which the Association may become liable shall in
no event exceed the lesser of:
(a) the contractual obligations for which the member | ||
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(b)(i) with respect to any one life, regardless of | ||
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(A) $300,000 in life insurance death benefits, | ||
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(B) for health insurance benefits: (I) $100,000 for coverages not defined as | ||
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(II) $300,000 for disability income | ||
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(III) $500,000 for health benefit plans;
(C) $250,000 in the present value of annuity | ||
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(ii) with respect to each individual participating in | ||
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(iii) with respect to each payee of a structured | ||
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(iv) with respect to either (1) one contract owner | ||
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In no event shall the Association be obligated to cover more than (1) an aggregate of $300,000 in benefits with respect to any one life under subparagraphs (i), (ii), and (iii) of this paragraph (b) except with respect to benefits for health benefit plans under item (B) of subparagraph (i) of this paragraph (b), in which case the aggregate liability of the Association shall not exceed $500,000 with respect to any one individual or (2) with respect to one owner of multiple nongroup policies of life insurance, whether the policy or contract owner is an individual, firm, corporation, or other person and whether the persons insured are officers, managers, employees, or other persons, $5,000,000 in benefits, regardless of the number of policies and contracts held by the owner. The limitations set forth in this subsection are limitations on the benefits for which the Association is obligated before taking into account either its subrogation and assignment rights or the extent to which those benefits could be provided out of the assets of the impaired or insolvent insurer attributable to covered policies. The costs of the Association's obligations under this Article may be met by the use of assets attributable to covered policies or reimbursed to the Association pursuant to its subrogation and assignment rights.
For purposes of this Article, benefits provided by a long-term care rider to a life insurance policy or annuity contract shall be considered the same type of benefits as the base life insurance policy or annuity contract to which it relates. (4) In performing its obligations to provide coverage under Section 531.08 of this Code, the Association shall not be required to guarantee, assume, reinsure, reissue, or perform or cause to be guaranteed, assumed, reinsured, reissued, or performed the contractual obligations of the insolvent or impaired insurer under a covered policy or contract that do not materially affect the economic values or economic benefits of the covered policy or contract. (Source: P.A. 100-687, eff. 8-3-18; 100-863, eff. 8-14-18.)
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(215 ILCS 5/531.04) (from Ch. 73, par. 1065.80-4)
Sec. 531.04. Construction. This Article shall be construed to
effect the purpose under Section 531.02.
(Source: P.A. 96-1450, eff. 8-20-10.)
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(215 ILCS 5/531.05) (from Ch. 73, par. 1065.80-5)
Sec. 531.05. Definitions. As used in this Act:
"Account" means either of the 2 accounts created under Section
531.06.
"Association" means the Illinois Life and Health Insurance
Guaranty Association created under Section 531.06.
"Authorized assessment" or the term "authorized" when used in the context of assessments means a resolution by the Board of Directors has been passed whereby an assessment shall be called immediately or in the future from member insurers for a specified amount. An assessment is authorized when the resolution is passed. "Benefit plan" means a specific employee, union, or association of natural persons benefit plan. "Called assessment" or the term "called" when used in the context of assessments means that a notice has been issued by the Association to member insurers requiring that an authorized assessment be paid within the time frame set forth within the notice. An authorized assessment becomes a called assessment when notice is mailed by the Association to member insurers. "Director" means the Director of Insurance of this State.
"Contractual obligation" means any obligation under a policy or
contract or certificate under a group policy or contract, or portion
thereof for which coverage is provided under Section 531.03.
"Covered person" means any person who is entitled to the
protection of the Association as described in Section 531.02.
"Covered contract" or "covered policy" means any policy or contract within the scope
of this Article under Section 531.03.
"Extra-contractual claims" shall include, but are not limited to, claims relating to bad faith in the payment of claims, punitive or exemplary damages, or attorneys' fees and costs. "Health benefit plan" means any hospital or medical expense policy or certificate or
health maintenance organization subscriber contract or any other similar health
contract. "Health benefit plan" does not include: (1) accident only insurance; (2) credit insurance; (3) dental only insurance; (4) vision only insurance; (5) Medicare supplement insurance; (6) benefits for long-term care, home health care, | ||
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(7) disability income insurance; (8) coverage for on-site medical clinics; or (9) specified disease, hospital confinement | ||
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"Impaired insurer" means (A) a member insurer which, after the effective date of this amendatory Act of the 96th General Assembly, is not an insolvent insurer, and is placed under an order of rehabilitation or conservation by a court of competent jurisdiction or (B) a member insurer deemed by the Director after the effective date of this amendatory Act of the 96th General Assembly to be potentially unable to fulfill its contractual obligations and not an insolvent insurer.
"Insolvent insurer" means a member insurer that, after the effective date of this amendatory Act of the 96th General Assembly, is placed under a final order of liquidation by a court of competent jurisdiction with a finding of insolvency.
"Member insurer" means an insurer or health maintenance organization licensed or holding a certificate of authority to transact in this State any kind of insurance or health maintenance organization business for which coverage is provided under Section 531.03 of this Code and includes an insurer or health maintenance organization whose license or certificate of authority in this State may have been suspended, revoked, not renewed, or voluntarily withdrawn or whose certificate of authority may have been suspended pursuant to Section 119 of this Code, but does not include: (1) a hospital or medical service organization, | ||
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(2) (blank); (3) any burial society organized under Article | ||
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(4) a mandatory State pooling plan; (5) a mutual assessment company or other person that | ||
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(6) an insurance exchange; (7) an organization that is permitted to issue | ||
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(8) any health services plan corporation | ||
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(9) any dental service plan corporation | ||
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(10) an entity similar to any of the above.
"Moody's Corporate Bond Yield Average" means the Monthly Average
Corporates as published by Moody's Investors Service, Inc., or any successor
thereto. "Owner" of a policy or contract and "policyholder", "policy owner", and "contract owner" mean the person who is identified as the legal owner under the terms of the policy or contract or who is otherwise vested with legal title to the policy or contract through a valid assignment completed in accordance with the terms of the policy or contract and properly recorded as the owner on the books of the member insurer. The terms owner, contract owner, policyholder, and policy owner do not include persons with a mere beneficial interest in a policy or contract. "Person" means an individual, corporation, limited liability company, partnership, association, governmental body or entity, or voluntary organization. "Plan sponsor" means: (1) the employer in the case of a benefit plan | ||
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(2) the employee organization in the case of a | ||
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(3) in a case of a benefit plan established or | ||
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"Premiums" mean amounts or considerations, by whatever name called, received on covered policies or contracts less returned premiums, considerations, and deposits and less dividends and experience credits. "Premiums" does not include: (A) amounts or considerations received for policies | ||
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(B) premiums in excess of $5,000,000 on an | ||
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(C) with respect to multiple nongroup policies of | ||
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"Principal place of business" of a plan sponsor or a person other than a natural person means the single state in which the natural persons who establish policy for the direction, control, and coordination of the operations of the entity as a whole primarily exercise that function, determined by the Association in its reasonable judgment by considering the following factors: (A) the state in which the primary executive and | ||
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(B) the state in which the principal office of the | ||
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(C) the state in which the board of directors (or | ||
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(D) the state in which the executive or management | ||
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(E) the state from which the management of the | ||
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(F) in the case of a benefit plan sponsored by | ||
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The principal place of business of a plan sponsor of a benefit plan described in paragraph (3) of the definition of "plan sponsor" shall be deemed to be the principal place of business of the association, committee, joint board of trustees, or other similar group of representatives of the parties who establish or maintain the benefit plan that, in lieu of a specific or clear designation of a principal place of business, shall be deemed to be the principal place of business of the employer or employee organization that has the largest investment in the benefit plan in question. "Receivership court" means the court in the insolvent or impaired insurer's state having jurisdiction over the conservation, rehabilitation, or liquidation of the member insurer. "Resident" means a person to whom a contractual obligation is owed and who resides in this State on the date of entry of a court order that determines a member insurer to be an impaired insurer or a court order that determines a member insurer to be an insolvent insurer. A person may be a resident of only one state, which in the case of a person other than a natural person shall be its principal place of business. Citizens of the United States that are either (i) residents of foreign countries or (ii) residents of United States possessions, territories, or protectorates that do not have an association similar to the Association created by this Article, shall be deemed residents of the state of domicile of the member insurer that issued the policies or contracts.
"Structured settlement annuity" means an annuity purchased in order to fund periodic payments for a plaintiff or other claimant in payment for or with respect to personal injury suffered by the plaintiff or other claimant. "State" means a state, the District of Columbia, Puerto Rico, and a United States possession, territory, or protectorate. "Supplemental contract" means a written agreement entered into for the distribution of proceeds under a life, health, or annuity policy or a life, health, or annuity contract.
"Unallocated annuity contract" means any annuity contract or group
annuity certificate which is not issued to and owned by an individual,
except to the extent of any annuity benefits guaranteed to an individual by
an insurer under such contract or certificate.
(Source: P.A. 100-687, eff. 8-3-18.)
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(215 ILCS 5/531.06) (from Ch. 73, par. 1065.80-6)
Sec. 531.06. Creation of the Association. There is created a
non-profit legal entity to be known as the Illinois Life and Health
Insurance Guaranty Association. All member insurers are and must remain
members of the Association as a condition of their authority to transact
insurance or a health maintenance organization business in this State. The Association must perform its functions under
the plan of operation established and approved under Section 531.10 and must
exercise its powers through a board of directors established under
Section 531.07. For purposes of administration and assessment, the Association
must maintain 2 accounts:
(1) The life insurance and annuity account, which | ||
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(a) Life Insurance Account;
(b) Annuity account, which shall include annuity | ||
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(c) Unallocated annuity account, which shall | ||
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(2) The health account.
The Association shall be supervised by the Director
and is subject to the applicable provisions of the Illinois Insurance
Code. Meetings or records of the Association may be opened to the public upon majority vote of the board of directors of the Association.
(Source: P.A. 100-687, eff. 8-3-18.)
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(215 ILCS 5/531.07) (from Ch. 73, par. 1065.80-7)
Sec. 531.07. Board of Directors.) The board of directors of the
Association consists of not less than 7 nor more than 11 members serving
terms as established in the plan of operation. The insurer members of the board
are to be selected by member insurers subject to the approval of the
Director. In addition, 2 persons who must be public representatives may be appointed by the Director to the board of directors. A public representative may not be an officer, director, or employee of an insurance company or a health maintenance organization or any person engaged in the business of insurance. Vacancies on the board must be filled for the remaining period
of the term in the manner described in the plan of operation.
In approving selections or in appointing members to the board, the
Director must consider, whether all member insurers are
fairly represented.
Members of the board may be reimbursed from the assets of the Association
for expenses incurred by them as members of the board of directors but
members of the board may not otherwise be compensated by the Association for
their services.
(Source: P.A. 100-687, eff. 8-3-18.)
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(215 ILCS 5/531.08) (from Ch. 73, par. 1065.80-8)
Sec. 531.08. Powers and duties of the Association. (a) In addition to
the powers and duties enumerated in other Sections of this Article:
(1) If a member insurer is an impaired insurer, then | ||
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(A) guarantee, assume, reissue, or reinsure or | ||
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(B) provide such money, pledges, loans, notes, | ||
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(2) If a member insurer is an insolvent insurer, | ||
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(A) guaranty, assume, reissue, or reinsure or | ||
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(B) provide benefits and coverages in accordance | ||
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(i) with respect to policies and contracts, | ||
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(a) with respect to group policies and | ||
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(b) with respect to nongroup policies, | ||
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(ii) make diligent efforts to provide all | ||
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(iii) with respect to nongroup policies and | ||
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(b) In providing the substitute coverage required under subparagraph (iii) of paragraph (B) of item (2) of subsection (a)
of this Section, the Association may offer either to reissue the
terminated coverage or to issue an alternative policy or contract at actuarially justified rates, subject to the prior approval of the Director.
Alternative or reissued policies or contracts shall be offered without requiring
evidence of insurability, and shall not provide for any waiting period or
exclusion that would not have applied under the terminated policy or contract.
The Association may reinsure any alternative or reissued policy or contract.
Alternative policies or contracts adopted by the Association shall be subject
to the approval of the Director. The Association may adopt alternative
policies or contracts of various types for future issuance without regard to any
particular impairment or insolvency.
Alternative policies or contracts shall contain at least the minimum statutory
provisions required in this State and provide benefits that shall not be
unreasonable in relation to the premium charged. The
Association shall set the premium in accordance with a table of rates which
it shall adopt. The premium shall reflect the amount of insurance to be
provided and the age and class of risk of each insured, but shall not
reflect any changes in the health of the insured after the original policy or contract
was last underwritten.
Any alternative policy or contract issued by the Association shall provide
coverage of a type similar to that of the policy or contract issued by the impaired or
insolvent insurer, as determined by the Association.
(c) If the Association elects to reissue terminated coverage at a
premium rate different from that charged under the terminated policy or contract, the
premium shall be actuarially justified and set by the Association in accordance with the amount of
insurance or coverage provided and the age and class of risk, subject to approval of
the Director.
(d) The Association's obligations with respect to coverage under any
policy or contract of the impaired or insolvent insurer or under any reissued or
alternative policy or contract shall cease on the date such coverage or policy or contract is
replaced by another similar policy or contract by the policyholder, the insured, the enrollee, or the
Association.
(e) When proceeding under this Section with
respect to any policy or contract carrying guaranteed minimum interest
rates, the Association shall assure the payment or crediting of a rate of
interest consistent with subparagraph (2)(b)(iii)(B) of Section 531.03.
(f) Nonpayment of premiums thirty-one days after the date required under
the terms of any guaranteed, assumed, alternative or reissued policy or
contract or substitute coverage shall terminate the Association's
obligations under such policy, contract, or coverage under this Act with respect to
such policy, contract, or coverage, except with respect to any claims incurred or any
net cash surrender value which may be due in accordance with the provisions of
this Act.
(g) Premiums due for coverage after entry of an order of liquidation of
an insolvent insurer shall belong to and be payable at the direction of the
Association,
and the Association shall be liable for unearned premiums due to policy or
contract owners arising after the entry of such order.
(h) In carrying out its duties under paragraph (2) of subsection (a) of this Section, the Association may: (1) subject to approval by a court in this State, | ||
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(2) subject to approval by a court in this State, | ||
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(i) There shall be no liability on the part of and no cause of action
shall arise against the Association or against any transferee from the
Association in connection with the transfer by reinsurance or otherwise of
all or any part of an impaired or insolvent insurer's business by reason of
any action taken or any failure to take any action by the impaired or
insolvent insurer at any time.
(j) If the Association fails to act within a reasonable period of
time as provided in subsection (2) of this Section with respect to an
insolvent insurer, the
Director shall have the powers and duties of the Association under this
Act with regard to such insolvent insurers.
(k) The Association or its designated representatives
may render assistance and advice to the
Director, upon his request, concerning rehabilitation, payment of
claims, continuations of coverage, or the performance of other
contractual obligations of any impaired or insolvent insurer.
(l) The Association shall have standing to appear or intervene before a court or agency in this State with jurisdiction over an impaired or insolvent insurer concerning which the Association is or may become obligated under this Article or with jurisdiction over any person or property against which the Association may have rights through subrogation or otherwise. Standing shall extend to all matters germane to the powers and duties of the Association, including, but not limited to, proposals for reinsuring, reissuing, modifying, or guaranteeing the policies or contracts of the impaired or insolvent insurer and the determination of the policies or contracts and contractual obligations. The Association shall also have the right to appear or intervene before a court or agency in another state with jurisdiction over an impaired or insolvent insurer for which the Association is or may become obligated or with jurisdiction over any person or property against whom the Association may have rights through subrogation or otherwise.
(m)(1) A person receiving benefits under this Article shall be deemed to have assigned the rights under and any causes of action against any person for losses arising under, resulting from, or otherwise relating to the covered policy or contract to the Association to the extent of the benefits received because of this Article, whether the benefits are payments of or on account of contractual obligations, continuation of coverage, or provision of substitute or alternative policies, contracts, or coverages. The Association may require an assignment to it of such rights and cause of action by any enrollee, payee, policy, or contract owner, beneficiary, insured, or annuitant as a condition precedent to the receipt of any right or benefits conferred by this Article upon the person.
(2) The subrogation rights of the Association under this subsection
have the same priority against the assets of the impaired or insolvent insurer as
that possessed by the person entitled to receive benefits under this
Article. (3) In addition to paragraphs (1) and (2), the Association shall have all common law rights of subrogation and any other equitable or legal remedy that would have been available to the impaired or insolvent insurer or owner, beneficiary, enrollee, or payee of a policy or contract with respect to the policy or contracts, including without limitation, in the case of a structured settlement annuity, any rights of the owner, beneficiary, enrollee, or payee of the annuity to the extent of benefits received pursuant to this Article, against a person originally or by succession responsible for the losses arising from the personal injury relating to the annuity or payment therefor, excepting any such person responsible solely by reason of serving as an assignee in respect of a qualified assignment under Internal Revenue Code Section 130. (4) If the preceding provisions of this subsection (m) are invalid or ineffective with respect to any person or claim for any reason, then the amount payable by the Association with respect to the related covered obligations shall be reduced by the amount realized by any other person with respect to the person or claim that is attributable to the policies or contracts, or portion thereof, covered by the Association. (5) If the Association has provided benefits with respect to a covered obligation and a person recovers amounts as to which the Association has rights as described in the preceding paragraphs of this subsection (10), then the person shall pay to the Association the portion of the recovery attributable to the policies or contracts, or portion thereof, covered by the Association.
(n) The Association may:
(1) Enter into such contracts as are necessary or | ||
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(2) Sue or be sued, including taking any legal | ||
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(3) Borrow money to effect the purposes of this | ||
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(4) Employ or retain such persons as are necessary to | ||
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(5) Negotiate and contract with any liquidator, | ||
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(6) Take such legal action as may be necessary to | ||
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(7) Exercise, for the purposes of this Article and to | ||
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(8) Exercise all the rights of the Director under | ||
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(9) Request information from a person seeking | ||
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(9.5) Unless prohibited by law, in accordance with | ||
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(10) Take other necessary or appropriate action to | ||
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(o) With respect to covered policies for which the Association becomes
obligated after an entry of an order of liquidation or rehabilitation,
the Association may
elect to succeed to the rights of the insolvent insurer arising after the
date of the order of liquidation or rehabilitation under any contract
of reinsurance to which
the insolvent insurer was a party, to the extent that such contract
provides coverage for losses occurring after the date of the order of
liquidation or rehabilitation. As a condition to making this election,
the Association must pay all unpaid premiums due under the contract for
coverage relating to periods before and after the date of the order of
liquidation or rehabilitation.
(p) A deposit in this State, held pursuant to law or required by the Director for the benefit of creditors, including policy owners or contract owners, not turned over to the domiciliary liquidator upon the entry of a final order of liquidation or order approving a rehabilitation plan of a member insurer domiciled in this State or in a reciprocal state, pursuant to Article XIII 1/2 of this Code, shall be promptly paid to the Association. The Association shall be entitled to retain a portion of any amount so paid to it equal to the percentage determined by dividing the aggregate amount of policy owners' or contract owners' claims related to that insolvency for which the Association has provided statutory benefits by the aggregate amount of all policy owners' or contract owners' claims in this State related to that insolvency and shall remit to the domiciliary receiver the amount so paid to the Association less the amount retained pursuant to this subsection (p). Any amount so paid to the Association and retained by it shall be treated as a distribution of estate assets pursuant to applicable State receivership law dealing with early access disbursements. (q) The Board of Directors of the Association shall have discretion and may exercise reasonable business judgment to determine the means by which the Association is to provide the benefits of this Article in an economical and efficient manner. (r) Where the Association has arranged or offered to provide the benefits of this Article to a covered person under a plan or arrangement that fulfills the Association's obligations under this Article, the person shall not be entitled to benefits from the Association in addition to or other than those provided under the plan or arrangement. (s) Venue in a suit against the Association arising under the Article shall be in Cook County. The Association shall not be required to give any appeal bond in an appeal that relates to a cause of action arising under this Article. (t) The Association may join an organization of one or more other State associations of similar purposes to further the purposes and administer the powers and duties of the Association. (u) In carrying out its duties in connection with guaranteeing, assuming, reissuing, or reinsuring policies or contracts under subsections (1) or (2), the Association may issue substitute coverage for a policy or contract that provides an interest rate, crediting rate, or similar factor determined by use of an index or other external reference stated in the policy or contract employed in calculating returns or changes in value by issuing an alternative policy or contract in accordance with the following provisions: (1) in lieu of the index or other external reference | ||
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(2) there is no requirement for evidence of | ||
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(3) the alternative policy or contract is | ||
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(Source: P.A. 100-687, eff. 8-3-18.)
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(215 ILCS 5/531.09) (from Ch. 73, par. 1065.80-9)
Sec. 531.09. Assessments. (1) For the purpose of providing the funds
necessary to carry out the powers and duties of the Association, the board
of directors shall assess the member insurers, separately for each account, at such
times and for such amounts as the board finds necessary. Assessments shall
be due not less than 30 days after written notice to the member insurers
and shall accrue interest from the due date at such adjusted rate as is
established under Section 6621 of Chapter 26 of the United States Code and
such interest shall be compounded daily.
(2) There shall be 2 classes of assessments, as follows:
(a) Class A assessments shall be made for the purpose | ||
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(b) Class B assessments shall be made to the extent | ||
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(3)(a) The amount of any Class A assessment shall be determined at the discretion of the board of directors and such assessments shall be authorized and called on a non-pro rata basis. The amount of any Class B
assessment, except for assessments related to long-term care insurance, shall be allocated for assessment
purposes among the accounts
and subaccounts pursuant to an allocation formula which may be based on
the premiums or reserves of the impaired or insolvent insurer or any other
standard deemed by the board in its sole discretion as being fair and
reasonable under the circumstances.
(b) Class B assessments against member insurers for each account and
subaccount shall
be in the proportion that the premiums received on business in this State
by each assessed member insurer on policies or contracts covered by
each account or subaccount for the three most recent calendar years
for which information is available preceding the year in which the member insurer
became impaired or insolvent, as the case may be, bears to such premiums
received on business in this State for such calendar years by all assessed
member insurers.
(b-5) The amount of the Class B assessment for long-term care insurance written by the impaired or insolvent insurer shall be allocated according to a methodology included in the plan of operation and approved by the Director. The methodology shall provide for 50% of the assessment to be allocated to accident and health member insurers and 50% to be allocated to life and annuity member insurers. (c) Assessments for funds to meet the requirements of the Association
with respect to an impaired or insolvent insurer shall not be made until
necessary to implement the purposes of this Article. Classification
of assessments
under subsection (2) and computations of assessments under this subsection
shall be made with a reasonable degree of accuracy, recognizing that exact
determinations may not always be possible.
(4) The Association may abate or defer, in whole or in part, the assessment of a member insurer if, in the opinion of the board, payment of the assessment would endanger the ability of the member insurer to fulfill its contractual obligations. In the event an assessment against a member insurer is abated or deferred in whole or in part the amount by which the assessment is abated or deferred may be assessed against the other member insurers in a manner consistent with the basis for assessments set forth in this Section. Once the conditions that caused a deferral have been removed or rectified, the member insurer shall pay all assessments that were deferred pursuant to a repayment plan approved by the Association. (5) (a) Subject to the provisions of this paragraph, the total of all assessments authorized by the Association with respect to a member insurer for each subaccount of the life insurance and annuity account and for the health account shall not in one calendar year exceed 2% of that member insurer's average annual premiums received in this State on the policies and contracts covered by the subaccount or account during the 3 calendar years preceding the year in which the member insurer became an impaired or insolvent insurer. If 2 or more assessments are authorized in one calendar year with respect to member insurers that become impaired or insolvent in different calendar years, the average annual premiums for purposes of the aggregate assessment percentage limitation referenced in subparagraph (a) of this paragraph shall be equal and limited to the higher of the 3-year average annual premiums for the applicable subaccount or account as calculated pursuant to this Section. If the maximum assessment, together with the other assets of the Association in an account, does not provide in one year in either account an amount sufficient to carry out the responsibilities of the Association, the necessary additional funds shall be assessed as soon thereafter as permitted by this Article. (b) The board may provide in the plan of operation a method of allocating funds among claims, whether relating to one or more impaired or insolvent insurers, when the maximum assessment will be insufficient to cover anticipated claims. (c) If the maximum assessment for a subaccount of the life insurance and annuity account in one year does not provide an amount sufficient to carry out the responsibilities of the Association, then pursuant to paragraph (b) of subsection (3), the board shall assess the other subaccounts of the life insurance and annuity account for the necessary additional amount, subject to the maximum stated in paragraph (a) of this subsection.
(6) The board may, by an equitable method as established in the
plan of operation, refund to member insurers, in proportion to the contribution
of each member insurer to that account, the amount by which the assets of the account
exceed the amount the board finds is necessary to carry out during the coming
year the obligations of the Association with regard to that account, including
assets accruing from net realized gains and income from investments. A
reasonable amount may be retained in any account to provide funds for the
continuing expenses of the Association and for future losses.
(7) An assessment is deemed to occur on the date upon which the board
votes such assessment. The board may defer calling the payment of the
assessment or may call for payment in one or more installments.
(8) It is proper for any member insurer, in determining its premium
rates and policy owner dividends as to any kind of insurance or health maintenance organization business within the scope of
this Article, to consider the amount reasonably necessary to meet its assessment
obligations under this Article.
(9) The Association must issue to each member insurer paying a
Class B assessment
under this Article a certificate of contribution,
in a form acceptable to the
Director, for the amount of the assessment so paid. All outstanding certificates
are of equal
dignity and priority without reference to amounts or dates of issue. A certificate
of contribution may be shown by the member insurer in its financial statement as an asset
in such form and for such amount, if any, and period of time as the Director
may approve, provided the member insurer shall in any event at its option have
the right to show a certificate of contribution as an admitted asset at
percentages of the original face amount for calendar years as follows:
100% for the calendar year after the year of issuance;
80% for the second calendar year after the year of issuance;
60% for the third calendar year after the year of issuance;
40% for the fourth calendar year after the year of issuance;
20% for the fifth calendar year after the year of issuance.
(10) The Association may request information of member insurers in order to aid in the exercise of its power under this Section and member insurers shall promptly comply with a request. (Source: P.A. 100-687, eff. 8-3-18.)
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(215 ILCS 5/531.10) (from Ch. 73, par. 1065.80-10)
Sec. 531.10. Plan of operation. (1)(a) The Association must
submit to the Director a plan of operation and any amendments thereto necessary
or suitable to assure the fair, reasonable, and equitable administration of the
Association. The plan of operation and any amendments thereto become effective
upon approval in writing by the Director.
(b) If the Association fails to submit a suitable plan of operation
within 180 days following the effective date of this Article or if at any time
thereafter the Association fails to submit suitable amendments to the plan, the
Director may, after notice and hearing, adopt and promulgate such reasonable
rules as are necessary or advisable to effectuate the provisions of this Article.
Such rules are in force until modified by the Director or superseded by a plan
submitted by the Association and approved by the Director.
(2) All member insurers must comply with the plan of operation.
(3) The plan of operation must, in addition to requirements enumerated
elsewhere in this Article:
(a) Establish procedures for handling the assets of | ||
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(b) Establish the amount and method of reimbursing | ||
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(c) Establish regular places and times for meetings | ||
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(d) Establish procedures for records to be kept of | ||
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(e) Establish the procedures whereby selections for | ||
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(f) Establish any additional procedures for | ||
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(g) Contain additional provisions necessary or proper | ||
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(4) The plan of operation shall establish a procedure for protest by
any member insurer of assessments made by the Association pursuant to
Section 531.09. Such procedures shall require that:
(a) a member insurer that wishes to protest all or | ||
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(b) within 30 days following the payment of an | ||
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(c) in the event the Association determines that the | ||
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(d) the decision of the Association with respect to a | ||
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(e) in the alternative to rendering a decision with | ||
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(f) interest on any refund due a protesting member | ||
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(5) The plan of operation may provide that any or all powers and duties
of the Association, except those under paragraph (3) of subsection (n)
of Section 531.08 and Section 531.09 are delegated to a corporation,
association or other organization which performs or will perform functions
similar to those of this Association, or its equivalent, in 2 or more states.
Such a corporation, association or organization shall be reimbursed for any
payments made on behalf of the Association and shall be paid for its
performance of any function of the Association. A delegation under this
subsection shall take effect only with the approval of both the Board of
Directors and the Director, and may be made only to a corporation, association
or organization which extends protection not substantially less favorable and
effective than that provided by this Act.
(Source: P.A. 100-687, eff. 8-3-18.)
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(215 ILCS 5/531.11) (from Ch. 73, par. 1065.80-11)
Sec. 531.11. Duties and powers of the Director. In addition to
the duties and powers enumerated elsewhere in this Article:
(1) The Director must do all of the following:
(a) Upon request of the board of directors, | ||
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(b) Notify the board of directors of the | ||
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(c) Give notice to an impaired insurer as | ||
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(d) In any liquidation or rehabilitation | ||
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(2) The Director may suspend or revoke, after notice | ||
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(3) Any action of the board of directors or the | ||
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(4) The liquidator, rehabilitator, or conservator of | ||
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(Source: P.A. 100-687, eff. 8-3-18.)
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(215 ILCS 5/531.12) (from Ch. 73, par. 1065.80-12)
Sec. 531.12. Prevention of Insolvencies. To aid in the detection and
prevention of member insurer insolvencies or impairments:
(1) It shall be the duty of the Director:
(a) To notify the Commissioners of all other | ||
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(i) revocation of license;
(ii) suspension of license;
(iii) makes any formal order except for an | ||
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Such notice shall be transmitted to all | ||
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(b) To report to the board of directors when he | ||
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(c) To report to the board of directors when the | ||
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(d) To furnish to the board of directors the | ||
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(2) The Director may seek the advice and | ||
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(3) The board of directors may, upon majority vote, | ||
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(4) The board of directors may, upon majority vote, | ||
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(5) The board of directors shall, at the conclusion | ||
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(Source: P.A. 100-687, eff. 8-3-18.)
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(215 ILCS 5/531.13) (from Ch. 73, par. 1065.80-13)
Sec. 531.13. Tax offset. In the event the aggregate Class A, B and C
assessments for all member insurers do not exceed $3,000,000 in any one
calendar year, no member insurer shall receive a tax offset. However, for
any one calendar year before 1998 in which the
total of such assessments exceeds $3,000,000,
the amount in excess of $3,000,000 shall be subject to a tax offset to the
extent of 20% of the amount of such assessment for each of the 5
calendar
years following the year in which such assessment was paid, and ending prior
to January 1, 2003, and each member
insurer may offset the proportionate amount of such excess paid by the member insurer
against its liabilities for the tax imposed by subsections (a) and (b)
of Section 201 of the Illinois
Income Tax Act. The provisions of this Section shall expire and be given no
effect for any tax period commencing on and after January 1, 2003.
(Source: P.A. 100-687, eff. 8-3-18.)
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(215 ILCS 5/531.14) (from Ch. 73, par. 1065.80-14)
Sec. 531.14. Miscellaneous provisions. (1) Nothing in this
Article may be construed to reduce the liability for unpaid assessments of the insured
of an impaired or insolvent insurer operating under a plan with assessment liability.
(2) Records must be kept of all negotiations and meetings in which
the Association or its representatives are involved to discuss the activities of the
Association in carrying out its powers and duties under Section 531.08. Records of such
negotiations or meetings may be made public only upon the termination of a
liquidation, rehabilitation, or conservation proceeding involving the impaired
or insolvent insurer, upon the termination of the impairment or insolvency
of the insurer, or upon the order
of a court of competent jurisdiction. Nothing in this paragraph (2) limits the
duty of the Association to render a report of its activities under Section
531.15.
(3) For the purpose of carrying out its obligations under this Article,
the Association is deemed to be a creditor of the impaired or insolvent
insurer to the extent of assets attributable to covered policies or contracts reduced by any
amounts to which the Association is entitled as subrogee (under subsection (m)
of Section 531.08). All assets of the impaired or insolvent insurer
attributable to covered policies or contracts must be used to continue all covered policies
and pay all contractual obligations of the impaired insurer as required by this
Article. "Assets attributable to covered policies or contracts", as used in this paragraph
(3), is that proportion of the
assets which the reserves that should have been established
for such policies or contracts bear to the reserve that should have been
established for all policies of
insurance or health benefit plans written by the impaired or insolvent insurer.
(4) (a) Prior to the termination of any liquidation, rehabilitation,
or conservation proceeding, the court may take into consideration the contributions
of the respective parties, including the Association, the shareholders, contract owners, certificate holders, enrollees, and policy owners
of the impaired or insolvent insurer, and any other party with
a bona fide interest,
in making an equitable distribution of the ownership rights of such impaired
or insolvent
insurer. In such a determination, consideration must be given to the welfare of the
policy owners, contract owners, certificate holders, and enrollees of the continuing or successor insurer.
(b) No distribution to stockholders, if any, of an impaired or insolvent insurer
may be made until and unless the total
amount of valid claims of the Association for funds expended with interest in carrying
out its powers and duties under Section 531.08, with respect to such member insurer
have been fully recovered by the Association.
(5) (a) If an order for liquidation or rehabilitation of
a member insurer
domiciled in this State has been entered, the receiver appointed under such
order has a right to recover on behalf of the member insurer, from any affiliate that
controlled it, the amount of distributions, other than stock dividends paid by
the member insurer on its capital stock, made at any time during the 5 years preceding
the petition for liquidation or rehabilitation subject to the limitations of
paragraphs (b) to (d).
(b) No such dividend is recoverable if the member insurer shows that when
paid the distribution was lawful and reasonable, and that the member insurer did not
know and could not reasonably have known that the distribution might adversely affect
the ability of the member insurer to fulfill its contractual obligations.
(c) Any person who as an affiliate that controlled the member insurer at
the time the distributions were paid is liable up to the amount of distributions
he received. Any person who was an affiliate that controlled the member insurer at the
time the distributions were declared, is liable up to the amount of distributions
he would have received if they had been paid immediately. If 2 persons are
liable with respect to the same distributions, they are jointly and severally liable.
(d) The maximum amount recoverable under subsection (5) of this Section is
the amount needed in excess of all other available assets of the insolvent insurer
to pay the contractual obligations of the insolvent insurer.
(e) If any person liable under paragraph (c) of subsection (5) of this
Section is insolvent, all its
affiliates that controlled it at the time the dividend was paid are jointly and
severally liable for any resulting deficiency in the amount recovered from
the insolvent affiliate.
(6) As a creditor of the impaired or insolvent insurer as established in subsection (3) of this Section and consistent with subsection (2) of Section 205 of this Code, the Association and other similar associations shall be entitled to receive a disbursement of assets out of the marshaled assets, from time to time as the assets become available to reimburse it, as a credit against contractual obligations under this Article. If the liquidator has not, within 120 days after a final determination of insolvency of a member insurer by the receivership court, made an application to the court for the approval of a proposal to disburse assets out of marshaled assets to guaranty associations having obligations because of the insolvency, then the Association shall be entitled to make application to the receivership court for approval of its own proposal to disburse these assets. (Source: P.A. 100-687, eff. 8-3-18.)
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(215 ILCS 5/531.15) (from Ch. 73, par. 1065.80-15)
Sec. 531.15.
Examination of the Association - Annual Report.
The
Association shall be subject to examination and regulation by the Director.
The board of directors must submit to the Director, not later than the
first day of the fifth month following the end of the Association's fiscal
year, a financial report for such fiscal year in a
form acceptable to the Director and a report of its
activities during such fiscal year.
(Source: P.A. 86-753.)
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(215 ILCS 5/531.16) (from Ch. 73, par. 1065.80-16)
Sec. 531.16.
Tax Exemptions.) The Association is exempt from payment of
all fees and all taxes levied by this State or any of its subdivisions, except taxes
levied on real property.
(Source: P.A. 81-899.)
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(215 ILCS 5/531.17) (from Ch. 73, par. 1065.80-17)
Sec. 531.17.
Immunity.) There is no liability on the part of and
no cause of action of any nature may arise against any member insurer or its agents
or employees, the Association or its agents or employees, members of the board of
directors, or the Director or his representatives, for any action taken by them
in the performance of their powers and duties under this Article.
(Source: P.A. 81-899.)
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(215 ILCS 5/531.18) (from Ch. 73, par. 1065.80-18)
Sec. 531.18. Stay of Proceedings - Reopening Default Judgments.)
All proceedings in which the insolvent insurer is a party in any court in this
State shall be stayed 180 days from the date an order of liquidation,
rehabilitation, or conservation is final to permit proper legal action by the
Association on any matters germane to its powers or duties. As to a judgment under
any decision, order, verdict, or finding based on default the Association may apply
to have such judgment set aside by the same court that made such judgment and must
be permitted to defend against such suit on the merits.
(Source: P.A. 96-1450, eff. 8-20-10.)
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(215 ILCS 5/531.19) (from Ch. 73, par. 1065.80-19)
Sec. 531.19. Prohibited advertisement of action of the Insurance Guaranty
Association in sale of insurance.
(a) No person, including a member insurer,
agent
or affiliate of a member insurer shall make, publish, disseminate, circulate,
or place before the public, or cause directly or indirectly, to be made,
published, disseminated, circulated or placed before the public, in any
newspaper, magazine or other publication, or in the form of a notice, circular,
pamphlet, letter or poster, or over any radio station or television station,
or in any other way, any advertisement, announcement or statement, written or
oral, which
uses the existence of the Insurance Guaranty Association of this State for
the purpose of sales, solicitation or inducement to purchase any form of
insurance or other coverage covered by this Article; provided, however, that this Section
shall not apply to the Illinois Life and Health Guaranty Association or
any other entity which does not sell or solicit insurance or coverage by a health maintenance organization.
(b) Within 180 days of August 16,
1993, the Association shall prepare a summary document describing the general
purposes and current limitations of this Article and complying with subsection
(c). This document shall be submitted to the Director for approval. Sixty
days after receiving approval, no member insurer may deliver a policy or contract
described in subparagraph (a) of paragraph (2) of Section 531.03 and not
excluded under subparagraph (b) of that Section to a policy owner,
contract owner, certificate holder, or enrollee unless the document is delivered to the policy owner, contract owner, certificate
holder, or enrollee prior to or at the time of delivery of the policy or contract. The document should also be available upon request
by
a policy owner, contract owner, certificate holder, or enrollee. The distribution, delivery, or contents or interpretation of
this document shall not mean that either the policy or the contract or the policy owner, contract owner, certificate
holder, or enrollee thereof would be covered in the event of the impairment or insolvency of
a member insurer. The description document shall be revised by the Association
as amendments to this Article may require. Failure to receive this document
does not give the policy owner, contract owner, certificate holder, enrollee, or insured
any greater rights than those stated in this Article.
(c) The document prepared under subsection (b) shall contain a clear and
conspicuous disclaimer on its face. The Director shall promulgate a rule
establishing the form and content of the disclaimer. The disclaimer shall:
(1) State the name and address of the Life and Health | ||
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(2) Prominently warn the policy owner, contract | ||
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(3) State that the member insurer and its agents are | ||
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(4) Emphasize that the policy owner, contract owner, | ||
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(5) Provide other information as directed by the | ||
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(d) (Blank).
(Source: P.A. 100-687, eff. 8-3-18.)
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(215 ILCS 5/531.20) Sec. 531.20. Merger of Illinois Health Maintenance Organization Guaranty Association with and into the Illinois Life and Health Insurance Guaranty Association. In order to provide for the merger of the Illinois Health Maintenance Organization Guaranty Association with and into the Illinois Life and Health Insurance Guaranty Association, the following shall apply: (1) The Illinois Health Maintenance Organization | ||
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(2) All premerger rights, powers, privileges, | ||
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(3) Subject to paragraph (2), the Illinois Life and | ||
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(4) All rights of creditors and all liens upon the | ||
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(5) Any action or proceeding pending by or against | ||
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(6) Notwithstanding any other provision to the | ||
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(A) It is the intent of this Section to preserve | ||
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(B) Accordingly, no contract owner, certificate | ||
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(Source: P.A. 100-687, eff. 8-3-18.) |
(215 ILCS 5/Art. XXXIV heading) ARTICLE XXXIV.
ILLINOIS INSURANCE GUARANTY FUND
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(215 ILCS 5/532) (from Ch. 73, par. 1065.82)
Sec. 532. Purpose. (a) The purpose of this Article is to provide a mechanism
for the payment of covered claims under certain insurance policies, to
avoid excessive delay in payment of covered claims, to avoid financial loss to claimants or policyholders
because of the entry of an Order of Liquidation against an insolvent
company, including through services offered to the Director in her or his capacity as receiver under Article XIII of this Code that relate to covered claims, to provide a Fund to assess among member companies the costs of such protection and maintain the continuity and self-sufficient operation of the Fund, and to offset the costs associated with maintaining the Fund's continuity and self-sufficient operations when practical by providing assistance and services to the Director in her or his capacity as receiver under Article XIII of this Code as described in this Section.
(b) The purpose of this Article is also to provide a mechanism for the Fund to participate in and facilitate the process by which the assets of an insolvent company are marshaled and distributed pursuant to Article XIII of this Code beyond reimbursing the cost of covered claims. This subsection (b) is inoperative 5 years after the effective date of this amendatory Act of the 102nd General Assembly. (Source: P.A. 102-396, eff. 8-16-21.)
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(215 ILCS 5/533) (from Ch. 73, par. 1065.83)
Sec. 533. Scope. This Article applies to all of the kinds of insurance
written on a direct basis which are included in Class 2 and
Class 3 of Section 4 of this Code, except that
it shall not apply to:
(a) accident and health insurance written under clause (a) of Class 2, or
(b) mortgage guaranty or other financial guaranty written as
suretyship obligations or insurance under clause (g), clause (h)
or clause (i) of Class 2 or otherwise, or
(c) fidelity or surety bonds, or any other bonding obligations other
than employee fidelity bonds, or
(d) marine insurance other than inland marine insurance, written under
clause (d) of Class 3, or
(e) insurance of warranties or service contracts, including insurance that
provides for the
repair, replacement, or service of goods or property or indemnification for
repair, replacement, or service for the operational or structural failure of
the goods or property due to a defect in materials, workmanship, or normal wear
and tear or provides reimbursement for the liability incurred by the issuer of
agreements or service contracts that provide these benefits, or
(f) any claim servicing agreement or insurance policy which contains a
retrospective rating or other premium adjustment agreement under which
premiums are substantially equal to the losses and loss expenses covered
under the policy or any policy providing retroactive insurance of known loss, or
(g) any insurance which is provided, guaranteed or reinsured pursuant to
the Federal Crop Insurance Program or the National Flood Insurance Program,
including flood insurance written by National Flood Insurance Program
Write Your Own Companies.
(Source: P.A. 103-113, eff. 6-30-23.)
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(215 ILCS 5/534) (from Ch. 73, par. 1065.84)
Sec. 534. Definitions. For the purposes of this Article, unless the
context requires otherwise, the words and phrases defined in Sections 534.1
through 534.9 have the meanings set forth in those Sections.
(Source: P.A. 103-113, eff. 6-30-23.)
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(215 ILCS 5/534.1) (from Ch. 73, par. 1065.84-1)
Sec. 534.1.
"Fund" means the Illinois Insurance Guaranty Fund created by this
Article.
(Source: P.A. 77-305.)
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(215 ILCS 5/534.2) (from Ch. 73, par. 1065.84-2)
Sec. 534.2.
"Director" means the Director of Insurance of the State of Illinois.
(Source: P.A. 77-305.)
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(215 ILCS 5/534.3) (from Ch. 73, par. 1065.84-3)
Sec. 534.3. Covered claim; unearned premium defined.
(a) "Covered claim" means an unpaid claim for a loss
arising out of and within the
coverage of an insurance policy to which this Article applies and which
is in force at the time of the occurrence giving rise to the unpaid
claim, including claims presented during any extended discovery period
which was purchased from the company before the entry of a liquidation
order or which is purchased or obtained from the liquidator after the entry
of a liquidation order, made by a person insured under such policy or by a
person
suffering injury or damage for which a person insured under such policy
is legally liable, and for unearned premium, if:
(i) The company issuing, assuming, or being allocated | ||
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(ii) The claimant or insured is a resident of this | ||
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(b) "Covered claim" does not include:
(i) any amount in excess of the applicable limits of | ||
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(ii) any claim for punitive or exemplary damages or | ||
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(iii) any first party claim by an insured who is an | ||
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(iv) any first party or third party claim by or | ||
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(v) any claim for any amount due any reinsurer, | ||
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(c) "Unearned Premium" means the premium for the unexpired period of a
policy which has been terminated prior to the expiration of the period for
which premium has been paid and does not mean premium which is returnable
to the insured for any other reason.
(Source: P.A. 101-60, eff. 7-12-19; 102-558, eff. 8-20-21.)
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(215 ILCS 5/534.4) (from Ch. 73, par. 1065.84-4)
Sec. 534.4.
"Insolvent company" means a company
organized as a stock company, mutual company, reciprocal or Lloyds (a)
which holds a certificate of authority to transact insurance
in this State either at the time the policy was issued or when
the insured event occurred, or any company which has assumed or has been allocated
such policy obligation through merger, division, insurance business transfer, consolidation, or
reinsurance, whether or not such assuming company held a
certificate of authority to transact insurance in this State
at the time such policy was issued or when the insured event occurred; and (b)
against which a final Order of Liquidation with a finding of
insolvency to which there is no further right of appeal has been entered by
a court of competent jurisdiction in the company's State of domicile after the
effective date of this Article.
(Source: P.A. 103-75, eff. 6-9-23.)
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(215 ILCS 5/534.5) (from Ch. 73, par. 1065.84-5)
Sec. 534.5.
Member company.
"Member Company" means any insurance
company organized as a
stock company, mutual company, reciprocal or Lloyds, which holds a certificate
of authority to transact
any kind of insurance in this State to
which this Article applies, and which is either:
(a) a domestic insurance company formed before or after the
effective date of this Article; or
(b) a foreign or alien insurance company.
An insurance company shall cease to be a member company effective on the
day following the termination or expiration of its license to transact the
kinds of insurance to which this Article applies; provided, however, that the
insurance company shall remain liable as a member company for any and all
obligations, including obligations for assessments levied before the
termination or expiration of the insurance company's license and assessments
levied after the termination or expiration, based on any insolvency as to which
the determination of insolvency by a court of competent jurisdiction occurs
before the termination or expiration of the insurance company's license.
(Source: P.A. 89-97, eff. 7-7-95.)
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(215 ILCS 5/534.6) (from Ch. 73, par. 1065.84-6)
Sec. 534.6.
"Net direct written premiums" means direct gross premiums
written in this State on insurance policies to which this Article applies, less return
premiums thereon and dividends paid or credited to policyholders on such
direct business. "Net direct written premiums" does not include premiums on
contracts of reinsurance or other contracts between insurers or reinsurers.
(Source: P.A. 85-576.)
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(215 ILCS 5/534.7) (from Ch. 73, par. 1065.84-7)
Sec. 534.7.
Affiliate.
An "affiliate" of a specified person means a
person who directly, or indirectly
through one or more intermediaries, controls, is controlled by, or is under
common control with the specified person on
December 31 of the year next
preceding the date the insolvent company became an
insolvent company.
(Source: P.A. 89-97, eff. 7-7-95.)
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(215 ILCS 5/534.8) (from Ch. 73, par. 1065.84-8)
Sec. 534.8.
"Control" means the possession, direct or indirect, of the
power to direct or cause the direction of the management and policies of a
person, whether through the ownership of voting securities, the holding of
proxies, by contract other than a commercial contract for goods or
nonmanagement services, or otherwise, unless the power is solely the result
of an official position with or corporate office held by the person.
Control shall be presumed to exist if any person, directly or indirectly,
owns, controls, holds with the power to vote, or holds proxies
representing, 10% or more of the voting securities or voting power of any
other person. This presumption may be rebutted by a showing that control
does not exist in fact.
(Source: P.A. 85-576.)
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(215 ILCS 5/534.9) Sec. 534.9. Cybersecurity insurance. "Cybersecurity insurance" means a type of insurance under Class 2 of Section 4 of this Code that involves first-party and third-party coverage, in a policy or endorsement, written on a direct, admitted basis to cover losses and loss mitigation arising out of or relating to data privacy breaches, unauthorized information network security intrusions, computer viruses, ransomware, cyber extortion, identity theft, and similar exposures.
(Source: P.A. 103-113, eff. 6-30-23.) |
(215 ILCS 5/535) (from Ch. 73, par. 1065.85)
Sec. 535.
Creation of the Fund.
There is created a nonprofit
unincorporated legal entity to be known as the Illinois Insurance
Guaranty Fund. All member companies as defined in Section 534.5 shall be and
remain members of the Fund as a condition of their authority to transact
business in this State. The Fund shall perform its functions under a
plan of operation established and approved under Section 539 and shall
exercise its powers through a board of directors established under
Section 536. For purposes of administration and assessment, the Fund
shall be divided into 2 separate accounts: (a) the automobile insurance
account; and (b) the account for all other insurance to which this
Article applies, including Workers' Compensation.
(Source: P.A. 85-576.)
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(215 ILCS 5/536) (from Ch. 73, par. 1065.86)
Sec. 536. Board of Directors. (a) The board of directors of the Fund shall consist of not less than 5
nor more than 10 persons, with one public member appointed by the Director, serving terms as established in the plan of
operation. The public member shall be a resident of this State, and he or she shall either (1) be a licensed and certified public accountant under the laws of this State or (2) have earned, and maintain in good standing, the Chartered Property and Casualty Underwriter (CPCU) designation from the American Institute for Chartered Property Casualty Underwriters. The plan of operation shall provide that the board of directors
be elected on the basis of one vote for each member company of the Fund. If
more than one company of a group of wholly owned or controlled companies is a
member company of the Fund only one vote will be allowed for the entire
group. The members of the board of directors shall be elected by member companies
subject to the approval of the Director. Vacancies on the board of
directors shall be filled for the remaining period of the term by the board
of directors, subject to the approval of the
Director.
(b) In approving elections to the board of directors, the Director shall consider
among other things whether all member companies are fairly represented.
(c) Members of the board of directors shall receive no compensation, but may be
reimbursed from the assets of the Fund for expenses incurred by them as
members of the board of directors.
(Source: P.A. 98-202, eff. 1-1-14.)
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(215 ILCS 5/537) (from Ch. 73, par. 1065.87)
Sec. 537.
Duties
and obligations of the Fund.
The Fund shall have the duties and obligations enumerated in Sections
537.1 through 537.9.
(Source: P.A. 82-210.)
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(215 ILCS 5/537.1) (from Ch. 73, par. 1065.87-1)
Sec. 537.1.
The Fund may provide for an equal annual fee of all member
companies on a non-pro rata basis to provide for contingent expenses of the
Fund. This fee may not exceed $500 per member company for any one calendar year.
(Source: P.A. 85-576.)
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(215 ILCS 5/537.2) (from Ch. 73, par. 1065.87-2)
Sec. 537.2. Obligation of Fund. The Fund shall be obligated to the
extent of the covered
claims existing prior to the entry of an Order of Liquidation against
an insolvent company and arising within
30 days after the entry of such
Order, or before the policy expiration date if less than 30 days after
the entry of such Order, or before the insured replaces the policy or on
request effects cancellation, if he does so within 30 days after the entry
of such Order. If the entry of an Order of Liquidation occurs on or after
October 1, 1975 and before October 1, 1977, such obligations shall not:
(i) exceed $100,000, or (ii)
include any obligation to refund the first $100 of any unearned premium
claim; and if the entry of an Order of Liquidation occurs on or after October
1, 1977 and before January 1, 1988, such obligations shall
not: (i) exceed
$150,000, except that this limitation shall not apply to any workers compensation
claims, or (ii)
include any obligation to refund the first
$100 of any unearned premium claim; and if the entry of an Order of
Liquidation occurs on or after January 1, 1988 and before January 1, 2011, such obligations shall not:
(i) exceed $300,000, except that this limitation shall not apply to any
workers compensation claims, or (ii) include any obligation to refund the
first $100 of any unearned premium claim or to refund any unearned premium
over $10,000 under any one policy. If the entry of an Order of Liquidation occurs on or after January 1, 2011, then such obligations shall not: (i) exceed $500,000, except that this limitation shall not apply to any workers compensation claims or (ii) include any obligation to refund the first $100 of any unearned premium claim or refund any unearned premium over $10,000 under any one policy. If the entry of an Order of Liquidation occurs on or after January 1, 2023, then such obligations shall not: (i) exceed $500,000, except that this limitation shall not apply to any workers compensation claims, or (ii) exceed without any deduction $50,000 for any unearned premium claim or refund under any one policy. In no event shall the Fund be
obligated to a policyholder or claimant in an amount in excess
of the face amount of the policy from which the claim arises, including, but not limited to, any applicable specific or aggregate limits. For purposes of this Article, obligations arising under an insurance policy written to indemnify a permissibly self-insured employer under subsection (a) of Section 4 of the Workers' Compensation Act for its liability to pay workers' compensation benefits in excess of a specific or aggregate retention shall be subject to the applicable per-claim limits set forth in this Section. In no event shall the Fund be obligated to pay an amount in excess of $500,000 in the aggregate for all first-party and third-party claims under a policy or endorsement providing cybersecurity insurance as defined in Section 534.9 and arising out of or related to a single insured event, regardless of the number of claims made or number of claimants.
In no event
shall the Fund be liable for any interest on
any
judgment entered against the insured or the insolvent company, or for any
other
interest claim against the insured or the insolvent company, regardless of
whether the insolvent company would have been obligated to pay such interest
under the terms of its policy. The Fund shall be liable for interest at the
statutory rate on money judgments entered against the Fund until the judgment
is satisfied.
Any obligation of the Fund to defend an insured shall cease upon the
Fund's payment or tender of an amount equal to the lesser of the Fund's
covered claim obligation limit or the applicable policy limit.
(Source: P.A. 103-113, eff. 6-30-23.)
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(215 ILCS 5/537.3) (from Ch. 73, par. 1065.87-3)
Sec. 537.3.
Access to insolvent company records.
The liquidator of an insolvent company shall
permit access by the Fund or its authorized
representatives, and by any similar organization in another state or its
authorized representatives, to such of the
insolvent company's records which are necessary for the
Fund or such similar organization in carrying
out its functions under this Article or similar laws in other states
with regard to covered claims. In
addition, the liquidator shall provide the Fund or its representative, or
such similar organization, with
copies of such records upon the request
and at the expense of
the Fund or such similar organization.
(Source: P.A. 85-576.)
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(215 ILCS 5/537.4) (from Ch. 73, par. 1065.87-4)
Sec. 537.4. Fund assumes obligations of insolvent companies. The Fund
shall be deemed the insolvent company to the extent
of the Fund's obligation for covered claims and to such extent
shall have all
rights, duties, and obligations of the insolvent company, subject to the
limitations provided in this Article, as if the company had not become
insolvent, with the
exception that the liquidator shall retain the sole right
to recover any reinsurance proceeds.
The Fund's rights under this Section include, but are not limited to, the
right to pursue and retain salvage and subrogation recoveries on paid covered
claim obligations to the extent paid by the Fund. The extent of the Fund's subrogation rights and any other rights of reimbursement with respect to its covered claims payments shall not be limited as if the Fund were the insolvent company, but shall be determined independently by taking into account the Fund's rights under Section 546 of this Article.
(Source: P.A. 99-387, eff. 8-17-15.)
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(215 ILCS 5/537.6) (from Ch. 73, par. 1065.87-6)
Sec. 537.6. Allocation of claims; assessments. The Fund shall allocate
covered claims paid and expenses
incurred between the accounts established by Section 535 separately, and
assess member companies separately for each
account amounts necessary to pay the obligations of the Fund under
Section 537.2 subsequent to the entry of an Order of Liquidation against
an insolvent company, the expenses of handling
covered claims subsequent to such Order of Liquidation and other expenses
authorized by this
Article. The assessments of each member company shall be in the proportion that
the net direct written premiums of the member company for the calendar
year immediately preceding the year in which the assessment is levied on
the kinds of insurance in the account bears to the net direct written
premiums of all member companies for such preceding calendar year on the
kinds of insurance in the account. Each member company shall be notified
of the assessment not later than 30 days before it is due. Before January 1,
2002, no member
company may be assessed in any year on any account an amount greater
than 1% of that member company's net direct written premiums
on the kinds of insurance in the account for the calendar
year preceding the assessment. Beginning January 1, 2002, the amount a
member company may be assessed in any year on any account shall be a maximum of
2% of that member company's net direct written premium on the kinds of
insurance in the account for the calendar year preceding the assessment. This
2% maximum shall apply regardless of the date of any insolvency that gives rise
to the need for the assessment. If the
maximum assessment, together with the other assets of the Fund in any
account, does not provide, in any one year, in any account, an amount
sufficient to make all necessary payments from that account, the funds
available shall be paid in the manner determined by the Fund and
approved by the Director and the unpaid portion shall be paid as
soon thereafter as funds become available. If requested by a member
company, the Director may exempt or defer the assessment of any member
company, if the assessment would cause the member company's financial
impairment.
In addition to the other assessment authority provided in this Section, the board of directors shall also have the assessment authority to pay off a loan as provided in Section 538.3. If a loan is projected to be outstanding for 3 years or more, then the board of directors shall have the authority to increase the assessment to 3% of the net direct written premiums for the previous year until the loan has been paid in full. (Source: P.A. 101-60, eff. 7-12-19.)
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(215 ILCS 5/537.7) (from Ch. 73, par. 1065.87-7)
Sec. 537.7. Investigation of claims; disposition.
(a) The Fund shall investigate claims brought against the
Fund and adjust, compromise, settle, and pay covered claims to the extent of
the Fund's
obligation and deny all other claims.
(b) The Fund shall not be bound by a settlement, release, compromise,
waiver, or final judgment executed or entered within 12 months prior to an
order of liquidation and shall have the right to assert all defenses available
to the Fund including, but not limited to, defenses applicable to determining
and enforcing its statutory rights and obligations to any claim. The Fund
shall be bound by a settlement, release, compromise, waiver, or final judgment
executed or entered more than 12 months prior to an order of liquidation,
but only
if the
claim is a covered claim and the settlement, release, compromise, waiver, or final judgment was not a result of
fraud, collusion, default, or failure to defend. In addition, with respect to
covered
claims arising from a judgment under a decision, verdict, or finding based on
the default of the insolvent insurer or its failure to defend, upon application
by the Fund, either on its own behalf or on behalf of an insured, the court
shall set aside the judgment, order, decision, verdict,
or finding, and the Fund shall be permitted to defend against the claim on the
merits. The same criteria determining whether the Fund will be bound, as specified in this subsection (b), shall apply to any settlement, release, compromise, waiver, or final judgment entered into by a high net worth insured before the date on which claims by or against that insured became non-exempt for reasons specified in paragraph (iv) of subsection (b) of Section 534.3.
(c) The Fund shall have the right to appoint or
approve and to direct legal counsel
retained under liability insurance policies for the defense
of covered claims as well as the right to appoint or approve and to direct legal counsel and other service providers under any other insurance policies subject to this Article, regardless of any limitations in the policy.
(Source: P.A. 103-113, eff. 6-30-23.)
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(215 ILCS 5/537.9) (from Ch. 73, par. 1065.87-9)
Sec. 537.9.
The Fund shall handle claims through its employees or
through one or more companies or other persons employed as servicing facilities.
(Source: P.A. 85-576.)
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(215 ILCS 5/538) (from Ch. 73, par. 1065.88)
Sec. 538. Powers
of the Fund. The Fund shall have the powers enumerated in the Sections following this Section and preceding Section 539.
(Source: P.A. 102-396, eff. 8-16-21.)
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(215 ILCS 5/538.1) (from Ch. 73, par. 1065.88-1)
Sec. 538.1.
The Fund may appear in, defend and appeal any action on a claim brought
against it on a covered claim.
(Source: P.A. 77-305.)
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(215 ILCS 5/538.2) (from Ch. 73, par. 1065.88-2)
Sec. 538.2.
The Fund may employ or retain such persons as are necessary to handle
claims, provide policy benefits and services, and perform other duties of the Fund.
(Source: P.A. 103-113, eff. 6-30-23.)
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(215 ILCS 5/538.3) (from Ch. 73, par. 1065.88-3)
Sec. 538.3.
The Fund may borrow an amount of money necessary to effect the purposes
of this Article in accord with the plan of operation. The board of directors shall have the authority to pledge all or an appropriate portion of future assessments as necessary to secure a loan that may be needed to pay covered claims. Until all loans secured by assessments are fully satisfied, the board of directors shall assess the maximum allowable under Section 537.6.
(Source: P.A. 101-60, eff. 7-12-19.)
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(215 ILCS 5/538.4) (from Ch. 73, par. 1065.88-4)
Sec. 538.4. Legal actions by Fund. The Fund may sue or be sued, including, but not limited to, taking any legal actions necessary
or proper for recovery of: (i) any unpaid assessments under Section 537.1 or 537.6; (ii) any amounts due to the Fund for salvage and subrogation under Section 537.4 or from insurers described in subsection (a) of Section 546; or (iii) any amounts due from an insured pursuant to subsections (a) and (d) of Section 545.
The Fund's power to sue includes, but is not limited to, the
power and right to
intervene as a party before any court that has jurisdiction over an insolvent
insurer when the Fund is a creditor or potential creditor of the insolvent
insurer.
(Source: P.A. 101-60, eff. 7-12-19.)
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(215 ILCS 5/538.5) (from Ch. 73, par. 1065.88-5)
Sec. 538.5.
The Fund may negotiate and become a party to such contracts as are
necessary to carry out the purposes of this Article.
(Source: P.A. 82-210.)
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(215 ILCS 5/538.7) (from Ch. 73, par. 1065.88-7)
Sec. 538.7.
(a) The Fund may perform such other acts as are necessary or proper to
effectuate the purposes of this Article.
(b) The Fund may contract with the Office of Special Deputy Receiver or any other person or organizations authorized by law to carry out the duties of the Director in her or his capacity as a receiver under Article XIII of this Code. The power of the Fund to contract with these persons or entities includes, but is not limited to, providing consulting services and claims administration services that assist with these persons or entities in the performance of their respective statutory and legal functions provided by law. The Fund may only exercise the authority to contract pursuant to this subsection upon the board of director's written determination that the provisioning of such services will advance the purposes set forth in Section 532. Any contract the Fund may enter into to provide services pursuant to this subsection shall be subordinate and subject to the Fund's statutory obligations to timely pay covered claims and avoid financial loss to claimants or policyholders described in this Article. This subsection (b) is inoperative 5 years after the effective date of this amendatory Act of the 102nd General Assembly. (Source: P.A. 102-396, eff. 8-16-21.)
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(215 ILCS 5/538.8) (from Ch. 73, par. 1065.88-8)
Sec. 538.8.
(a) If, at any time, the board of directors finds
that the assets of the Fund in any account exceed the liabilities and
expected costs and expenses of that account, the Fund may refund that amount of assets
of the account which exceed such liabilities, expenses and costs to the
member companies in such a manner as is determined by the board of
directors.
(b) If, at any time, the Fund receives monies as reimbursement from
the estate of an insolvent company, the Fund shall distribute those monies
in accordance with the procedures established in the plan of operation.
(Source: P.A. 85-576.)
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(215 ILCS 5/538.9) Sec. 538.9. Action regarding insolvent company records. (a) In this Section, "claims information" includes files, records, and electronic data. (b) The Fund may bring an action against any third-party administrator, agent, attorney, or other representative of the insolvent insurer to obtain custody and control of all claims information related to an insolvent company that are appropriate or necessary for the Fund or a similar association in other states to carry out its duties under this Article. In such an action, the Fund shall have the absolute right through emergency equitable relief to obtain custody and control of such claims information in possession of such third-party administrator, agent, attorney or other representative of the insolvent insurer, regardless of where that claims information may be physically located. In bringing an action under this Section, the Fund shall not be subject to any defense, lien (possessory or otherwise), or other legal or equitable ground whatsoever for refusal to surrender such claims information that might be asserted against the liquidator of the insolvent insurers. To the extent that litigation is required for the Fund to obtain custody and control of the claims information requested and it results in the relinquishment of claims information to the Fund after refusal to provide that information in response to a written demand, the court shall award the Fund its costs, expenses, and reasonable attorney's fees incurred in bringing the action. This Section shall have the same effect on the rights and remedies that the custodian of such claims information may have against the insolvent insurers, so long as these rights and remedies do not conflict with the rights of the Fund to custody and control of the claims information under this Article.
(Source: P.A. 101-60, eff. 7-12-19.) |
(215 ILCS 5/539) (from Ch. 73, par. 1065.89)
Sec. 539.
Plan of operation.
(a) The Fund shall submit to the Director
a plan of operation and any
amendments thereto necessary or suitable to assure the fair, reasonable,
and equitable administration of the Fund. The plan of operation and any
amendments thereto shall become effective upon approval in writing by the
Director.
(b) If the Fund fails to submit a suitable plan of operation within 90
days following the effective date of this Article or if at any time
thereafter the Fund fails to submit suitable amendments to the plan of operation, the
Director shall, after notice and hearing pursuant to Sections 401, 402 and
403 of this Code, adopt and promulgate
such reasonable
rules as are necessary or advisable to effectuate the provisions of this
Article. Such rules shall continue in force until modified by the Director
or superseded by a plan of operation submitted by the Fund and approved
by the Director.
(c) All member companies must comply with the plan of operation.
(Source: P.A. 82-210.)
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(215 ILCS 5/540) (from Ch. 73, par. 1065.90)
Sec. 540.
The plan of operation shall do the following as enumerated in Sections
540.1 through 540.9.
(Source: P.A. 77-305.)
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(215 ILCS 5/540.1) (from Ch. 73, par. 1065.90-1)
Sec. 540.1.
The plan of operation shall establish the procedures whereby all the
powers and duties of the Fund under Sections 537.1 through 537.9 will be
performed.
(Source: P.A. 82-210.)
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(215 ILCS 5/540.2) (from Ch. 73, par. 1065.90-2)
Sec. 540.2.
The plan of operation shall establish procedures for handling
assets of the Fund.
(Source: P.A. 77-305.)
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(215 ILCS 5/540.3) (from Ch. 73, par. 1065.90-3)
Sec. 540.3.
The plan of operation shall establish the amount and method of
reimbursing members of the board of directors under subsection (c) of Section 536.
(Source: P.A. 82-210.)
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(215 ILCS 5/540.5) (from Ch. 73, par. 1065.90-5)
Sec. 540.5.
(a) A covered claim, for other than unearned premium, is a claim
which appears on the books and records of the insolvent company as of the
date of the Order of Liquidation or a claim for which notice is given
in writing to the liquidator of the insolvent company's domiciliary state
or to an ancillary receiver in this State, if any, or to the Fund or its
agents prior to the earlier of the last date fixed for the timely
filing of proofs of claim
in the domiciliary liquidation proceedings or 18 months after the entry
of the order of liquidation. The liquidator or ancillary
receiver in this State, if any, shall periodically submit a list of claims
to the Fund or similar organization in another state.
(b) The Fund shall establish procedures by which
unearned premium claims are to be determined and paid as covered claims.
(Source: P.A. 85-576.)
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(215 ILCS 5/540.6) (from Ch. 73, par. 1065.90-6)
Sec. 540.6.
The plan of operation shall provide that any member company aggrieved by
any final action or decision of the Fund may appeal to the Director within
30 days after the action or decision.
(Source: P.A. 77-305.)
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(215 ILCS 5/540.7) (from Ch. 73, par. 1065.90-7)
Sec. 540.7.
The plan of operation shall establish the procedures whereby selections
for the board of directors will be submitted to the Director.
(Source: P.A. 77-305.)
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(215 ILCS 5/540.8) (from Ch. 73, par. 1065.90-8)
Sec. 540.8.
The plan of operation shall establish the procedures for
disposition of monies reimbursed from the estate of the insolvent company.
(Source: P.A. 85-576.)
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(215 ILCS 5/540.9) (from Ch. 73, par. 1065.90-9)
Sec. 540.9.
The plan of operation may contain additional provisions necessary or
proper for the execution of the powers, duties and obligations of the Fund.
(Source: P.A. 77-305.)
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(215 ILCS 5/541) (from Ch. 73, par. 1065.91)
Sec. 541.
The plan of operation may provide that any or all powers and duties
of the Fund, except those under Sections 537.6 and 538.3 may be
delegated to a corporation, association, or other organization which
performs or will perform functions similar to those of this Fund, or its
equivalent, in 2 or more states.
A delegation under this Section shall take effect only with
the approval of both the board of directors and the Director, and may be
made only to a corporation, association, or organization which extends
protection not substantially less favorable and effective than that
provided by this Article.
(Source: P.A. 80-827.)
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(215 ILCS 5/543) (from Ch. 73, par. 1065.93)
Sec. 543.
Duties
and obligations of the Director.
The Director shall have the duties and obligations enumerated in
Sections 543.1 through 543.3.
(Source: P.A. 77-305.)
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(215 ILCS 5/543.1) (from Ch. 73, par. 1065.93-1)
Sec. 543.1.
The Director shall serve a copy of the complaint seeking an
Order of Liquidation with a finding of insolvency against a domestic member
company on the Fund at the same time that such complaint is filed with the circuit court
or shall forward to the Fund notice of the filing of such a complaint
against a foreign or alien member company promptly upon receipt thereof.
The Director also shall serve on the Fund a copy of an Order of
Liquidation with a finding of insolvency against a domestic member company
immediately after it is entered by the circuit court or shall forward to
the Fund a copy of such order against a foreign or alien member company
promptly upon receipt thereof.
(Source: P.A. 85-576.)
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(215 ILCS 5/543.2) (from Ch. 73, par. 1065.93-2)
Sec. 543.2.
The Director shall, upon request of the board of directors, provide the
Fund with a statement of the net direct written premiums of each member
company for the preceding calendar year for which annual statements have
been filed with the Director.
(Source: P.A. 77-305.)
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(215 ILCS 5/543.3) (from Ch. 73, par. 1065.93-3)
Sec. 543.3.
The liquidator of an insolvent company shall notify the
policyholders of the insolvent company who are residents
of this State of the entry of an Order of Liquidation against the company
and of their rights under this
Article. Such notification shall be mailed to the last known
address of such policyholders,
where available, but if sufficient information for notification by mail is
not available, notice by publication in a newspaper of general circulation
shall be sufficient. If the insolvent company is domiciled in another
state and the liquidator fails to give notice which satisfies the purposes
of this Section, such notice shall be given by the Director as ancillary
receiver or if the insolvent company is domiciled in another state and there
is no ancillary receiver in this State, the Fund shall give such notice
provided the necessary information is made available to the Fund by the liquidator.
The form of the notice given by the Director as either liquidator or ancillary
receiver shall be submitted to the Fund for its approval prior to mailing
or publication.
(Source: P.A. 85-576.)
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(215 ILCS 5/544) (from Ch. 73, par. 1065.94)
Sec. 544.
Powers of the Director.
The Director shall either (a) suspend or revoke, after notice
and hearing pursuant to Sections 401, 402 and 403 of this Code, the
certificate of authority to do business in this State of any member company
which fails to pay an assessment when due or fails to comply with the plan
of operation, or (b) levy a fine on any member
company which fails to pay an assessment when due. Such fine shall not
exceed 5% per month of the unpaid assessment, except that no fine shall be
less than $200 per month.
(Source: P.A. 93-32, eff. 7-1-03.)
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(215 ILCS 5/545) (from Ch. 73, par. 1065.95)
Sec. 545. Effect of paid claims.
(a) Every insured or claimant seeking the
protection of this Article shall cooperate with the Fund to the same
extent as such person would have been required to cooperate with the
insolvent company. The Fund shall have all the rights, duties and
obligations under the policy to the extent of the covered claim payment,
provided the Fund shall have no cause of action against the
insured of the insolvent company for any sums it has paid out except
such causes of action as the insolvent company would have had if such
sums had been paid by the insolvent company and except as provided in
subsection (d) of this Section. Any person recovering under this Article and any insured whose liabilities are satisfied under this Article shall be deemed to have assigned the person's or insured's rights under the policy to the Fund to the extent of his or her recovery or satisfaction obtained from the Fund's payments.
(b) The Fund and any similar organization in another state shall be
recognized as claimants in the liquidation of an insolvent company for any
amounts paid by them on covered claims obligations as determined under this
Article or similar laws in other states and shall receive dividends at the
priority set forth in paragraph (d) of subsection (1) of Section
205 of this
Code; provided that if, at the time that the liquidator issues a cut-off notice to the Fund in anticipation of closing the estate, a reserve has been established by the Fund, or any similar organization in another state, for the amount of their future administrative expenses and loss development associated with unpaid reported pending claims, these reserves will be deemed to have been paid as of the date of the notice and payment shall be made accordingly.
The liquidator of an insolvent company shall be bound by
determinations of covered claim eligibility under the Act and by settlements
of claims made by
the Fund or a similar organization in
another state on the receipt of certification of such payments, to the extent
those
determinations or settlements satisfy obligations of the Fund, but the receiver
shall not be bound in any way by those determinations or settlements to the
extent that there remains a claim in the estate for amounts in excess of the
payments by the Fund.
In submitting their claim for covered claim payments the Fund and any
similar organization in another state shall not be subject to the
requirements of Sections 208 and 209 of this Code and shall not be affected
by the failure of the person receiving a covered claim payment to file a proof
of claim.
(c) The expenses of the Fund and of any similar
organization in any other state, other than expenses incurred in the
performance of
duties under Section 547 or similar duties under the
statute governing a similar organization in another state, shall
be accorded priority over all claims
against the estate, except as provided for in paragraph (a) of subsection (1) of
Section 205 of this Code. The liquidator shall make prompt reimbursement
to the Fund and any similar organization for such expense payments.
(d) The Fund has the right to recover from the following persons the amount
of any covered claims (as determined without regard to the exemption in paragraph (iv) of subsection (b) of Section 534.3) and allocated claims expenses which the Fund paid or
incurred on behalf of such person in satisfaction, in whole or in part, of
liability obligations of such person to any other person:
(i) any insured whose net worth on December 31 of the | ||
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(ii) any insured who is an affiliate of the insolvent | ||
| ||
The Fund may also, at its sole discretion and without assumption of any ongoing duty to do so, pay any workers compensation claims or any other third-party claims or any cybersecurity insurance obligations covered by a policy of an insolvent company on behalf of a high net worth insured as defined in paragraph (iv) of subsection (b) of Section 534.3. In that case, the Fund shall recover from the high net worth insured under this Section for all amounts paid on its behalf, all allocated claim adjusted expenses related to such claims, the Fund's attorney's fees, and all court costs in any action necessary to collect the full amount to the Fund's reimbursement under this Section. (Source: P.A. 103-113, eff. 6-30-23.)
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(215 ILCS 5/546) (from Ch. 73, par. 1065.96)
Sec. 546. Other insurance.
(a) An insured or claimant shall be required first to exhaust all
coverage provided by any other insurance policy, regardless of whether or not
such other insurance policy was written by a member company, if the claim under
such other policy arises from the same facts, injury, or loss that gave rise to
the covered claim against the Fund. The Fund's obligation under Section 537.2
shall be reduced by the amount recovered or recoverable, whichever is greater,
under such other insurance policy. Where such other insurance policy provides
uninsured
or underinsured motorist coverage, the amount recoverable shall be deemed to be
the full applicable limits of such coverage. To the extent that the Fund's
obligation under Section 537.2 is reduced by application of this Section, the
liability of the person insured by the insolvent insurer's policy for the claim
shall be reduced in the same amount. If the Fund pays a covered claim without the exhaustion of all other coverage that could have been exhausted under this Section, the Fund shall have an independent right of recovery against each insurer whose coverage was not exhausted in the amount the Fund would not have had to pay if that insurer's coverage had been exhausted first.
(b) Any insured or claimant having a claim which may be recovered under more
than one insurance guaranty fund or its equivalent shall seek recovery
first from the Fund of the place of residence of the insured except that
if it is a first party claim for damage to property with a permanent
location, he shall first seek recovery from the Fund of the location of
the property; if it is a workers' compensation claim, he shall first
seek recovery from the Fund of the residence of the claimant. Any
recovery under this Article shall be reduced by the amount of the
recovery from any other insurance guaranty fund or its equivalent.
(Source: P.A. 99-387, eff. 8-17-15.)
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(215 ILCS 5/547) (from Ch. 73, par. 1065.97)
Sec. 547. Prevention of insolvencies. To aid in the detection and prevention of company insolvencies:
(a) The board of directors may, upon majority vote, | ||
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(b) The board of directors may prepare a report on | ||
| ||
(c) The Director may disclose to the Fund the | ||
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(Source: P.A. 102-929, eff. 5-27-22.)
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(215 ILCS 5/548) (from Ch. 73, par. 1065.98)
Sec. 548. Examination of the Fund. The Fund shall be subject to examination and regulation by the Director.
The board of directors shall, not later than April 30 of each year, submit
a financial report for the preceding calendar year in a form approved by
the Director.
(Source: P.A. 99-388, eff. 1-1-16.)
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(215 ILCS 5/549) (from Ch. 73, par. 1065.99)
Sec. 549.
Tax
exemption.
The Fund shall be exempt from payment of all fees and all taxes levied
by this State or any of its subdivisions.
(Source: P.A. 77-305.)
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(215 ILCS 5/550) (from Ch. 73, par. 1065.100)
Sec. 550.
Immunity.
There shall be no liability on the part of and no cause of action of any
nature shall arise against any member company, the Fund or their agents or
employees, the board of directors, or the Director or his representatives
for any action taken or omitted by them in the performance of their powers
and duties under this Article.
(Source: P.A. 77-305.)
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(215 ILCS 5/551) (from Ch. 73, par. 1065.101)
Sec. 551.
Stay of proceedings.
All proceedings arising out of a claim under a policy of insurance written by
an insolvent company shall be stayed for 120 days from the date of the entry of
the Order of Liquidation to permit proper defense by the Fund of all such
pending causes of action.
(Source: P.A. 92-77, eff. 7-12-01.)
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(215 ILCS 5/552) (from Ch. 73, par. 1065.102)
Sec. 552.
All provisions of this Article shall be interpreted in
accordance with and pursuant to those Sections of Article XIII of this Code
which may be applicable.
(Source: P.A. 85-576.)
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(215 ILCS 5/553) (from Ch. 73, par. 1065.103)
Sec. 553.
Severability.
If any provision of this Article or the application thereof to any
claimant, company or circumstance is held invalid, such invalidity does not
affect other provisions or applications of this Article which can be given
effect without the invalid application or provision, and to this end the
provisions of this Article are declared to be severable.
(Source: P.A. 77-305.)
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(215 ILCS 5/Art. XXXVIII heading) ARTICLE XXXVIII.
(Repealed by P.A. 88-379)
|
(215 ILCS 5/801) (from Ch. 73, par. 1065.401)
Sec. 801.
(Repealed).
(Source: Repealed by P.A. 88-379.)
|
(215 ILCS 5/802) (from Ch. 73, par. 1065.402)
Sec. 802.
(Repealed).
(Source: Repealed by P.A. 88-379.)
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(215 ILCS 5/803) (from Ch. 73, par. 1065.403)
Sec. 803.
(Repealed).
(Source: Repealed by P.A. 88-379.)
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(215 ILCS 5/803a) (from Ch. 73, par. 1065.403a)
Sec. 803a.
(Repealed).
(Source: Repealed by P.A. 88-379.)
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(215 ILCS 5/804) (from Ch. 73, par. 1065.404)
Sec. 804.
(Repealed).
(Source: Repealed by P.A. 88-379.)
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(215 ILCS 5/805) (from Ch. 73, par. 1065.405)
Sec. 805.
(Repealed).
(Source: Repealed by P.A. 88-379.)
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(215 ILCS 5/806) (from Ch. 73, par. 1065.406)
Sec. 806.
(Repealed).
(Source: Repealed by P.A. 88-379.)
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(215 ILCS 5/806A) (from Ch. 73, par. 1065.406A)
Sec. 806A.
(Repealed).
(Source: Repealed by P.A. 88-379.)
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(215 ILCS 5/807) (from Ch. 73, par. 1065.407)
Sec. 807.
(Repealed).
(Source: Repealed by P.A. 88-379.)
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(215 ILCS 5/808) (from Ch. 73, par. 1065.408)
Sec. 808.
(Repealed).
(Source: Repealed by P.A. 88-379.)
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(215 ILCS 5/809) (from Ch. 73, par. 1065.409)
Sec. 809.
(Repealed).
(Source: Repealed by P.A. 88-379.)
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(215 ILCS 5/810) (from Ch. 73, par. 1065.410)
Sec. 810.
(Repealed).
(Source: Repealed by P.A. 88-379.)
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(215 ILCS 5/811) (from Ch. 73, par. 1065.411)
Sec. 811.
(Repealed).
(Source: Repealed by P.A. 88-379.)
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(215 ILCS 5/812) (from Ch. 73, par. 1065.412)
Sec. 812.
(Repealed).
(Source: Repealed by P.A. 88-379.)
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(215 ILCS 5/813) (from Ch. 73, par. 1065.413)
Sec. 813.
(Repealed).
(Source: Repealed by P.A. 88-379.)
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(215 ILCS 5/Art. XXXVIIIA heading) Article XXXVIIIA
MINE SUBSIDENCE INSURANCE
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(215 ILCS 5/801.1)
Sec. 801.1.
Purpose.
The purpose of this Article is to require insurers to
make mine subsidence insurance coverage available for residences, living units
and commercial buildings located in Illinois; to establish the Illinois Mine
Subsidence Insurance Fund; to divide the Fund into separate residential and
commercial sub-funds; and to make the Fund the reinsurer for the mine
subsidence insurance made available under this Article.
(Source: P.A. 88-379.)
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(215 ILCS 5/802.1)
Sec. 802.1.
Definitions.
As used in this Article:
(a) "Commercial Building" means any building, other than a residence,
permanently affixed to realty located in Illinois, including basements,
footings, foundations, septic systems and underground pipes directly servicing
the building, but does not include sidewalks, driveways, parking lots, living
units, land, trees, plants, crops or agricultural field drainage tile.
(b) "Commercial Coverage" means mine subsidence insurance for a commercial
building.
(c) "Insurer" or "Insurers" means insurance companies and reciprocals
licensed and authorized to write Class 3 policies of insurance, as defined in
this Code, within Illinois.
(d) "Living Unit" shall mean that physical portion designated for separate
ownership or occupancy for residential purposes, of a building or group of
buildings, permanently affixed to realty located in Illinois, having elements
which are owned or used in common, including a condominium unit, a cooperative
unit or any other similar unit.
(e) "Living Unit Coverage" means mine subsidence insurance for a living unit
covering the losses described in Section 805.1(d).
(f) "Mine Subsidence" means lateral or vertical ground movement caused by a
failure initiated at the mine level, of man-made underground mines, including,
but not limited to coal mines, clay mines, limestone mines, and fluorspar mines
that directly damages residences or commercial buildings. "Mine Subsidence"
does not include lateral or vertical ground movement caused by earthquake,
landslide, volcanic eruption, soil conditions, soil erosion, soil freezing and
thawing, improperly compacted soil, construction defects, roots of trees and
shrubs or collapse of storm and sewer drains and rapid transit tunnels.
(g) "Mine Subsidence Insurance Fund" or "Fund" means the fund established by
this Article.
(h) "Policy" or "policies" means any contract or contracts of insurance
providing the coverage of the Standard Fire Policy and Extended Coverage
Endorsement on any residence, living unit or commercial building. It does not
include those
insurance contracts that are referred to as marine or inland marine policies.
(i) "Premium" or "premiums" means the gross amount charged to policyholders
for the mine subsidence insurance made available under this Article.
(j) "Rates" or "rate schedules" means the rates by which premiums shall be
computed for the mine subsidence insurance made available under this Article.
(k) "Residence" means a building used principally for residential purposes
up
to and including a four family dwelling, permanently affixed to realty located
in Illinois, including appurtenant structures, driveways, sidewalks, basements,
footings, foundations, septic systems and underground pipes directly servicing
the dwelling or building, but does not include living units, land, trees,
plants, crops or agricultural field drainage tile.
(l) "Residential Coverage" means mine subsidence insurance for a
residence.
(m) "Intergovernmental cooperative" means an intergovernmental
cooperative organized pursuant to Article VII, Section 10 of the Illinois
Constitution and Section 6 of the Intergovernmental Cooperation Act.
(Source: P.A. 90-499, eff. 8-19-97.)
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(215 ILCS 5/803.1)
Sec. 803.1. Establishment of Fund.
(a) There is established a fund to be known as the "Illinois Mine Subsidence
Insurance Fund". The Fund shall operate pursuant to this Article. The Fund is
authorized to transact business, provide services, enter into contracts and sue
or be sued in its own name.
(b) The Fund shall provide reinsurance for mine subsidence losses to all
insurers writing mine subsidence insurance pursuant to this Article.
(c) The monies in the Fund shall be derived from premiums for mine
subsidence
insurance collected on behalf of the Fund pursuant to this Article, from
investment income and from receipt of Federal or State funds. No insurer shall
have any liability to the Fund or to any creditor of the Fund, except as may be
set forth in this Article, in the Articles of Governance which may be adopted
by the Fund, in a reinsurance agreement executed pursuant to Section 810.1,
in
the Plan of Operation established by the Fund, or in the rules and procedures
adopted by the Fund as authorized by the reinsurance agreement.
(d) The Fund shall establish its rates, rating schedules, deductibles and
retentions, minimum premiums,
classifications, and the maximum amount of reinsurance available per residence, commercial building, and living unit
for mine subsidence insurance which the Fund shall file
with the Director. The Director shall have 30 days from the
date of
receipt to approve or disapprove a rate filing. If no action is taken by the
Director within 30 days, the rate is deemed to be approved. The
Director
may, in writing, extend the period for an additional 30 days if
the
Director
determines that additional time is needed.
(e) The Fund shall establish its rates, rating schedules, deductibles and
retentions, minimum premiums,
classifications, and the maximum amount of reinsurance available per residence, commercial building, and living unit in such a manner as to satisfy all reasonably foreseeable
claims and expenses the Fund is likely to incur. The Fund shall give due
consideration to loss experience and relevant trends, premium and other income
and reasonable reserves established for contingencies in establishing the mine
subsidence rates.
(f) The Fund shall compile and publish an annual operating report.
(g) The Fund shall develop at least 2 consumer information publications to
aid the public in understanding mine subsidence and mine subsidence insurance
and shall establish a schedule for the distribution of the publications
pursuant
to the reinsurance agreement. Topics that shall be addressed shall include but
are not limited to:
(1) Descriptive information about mine subsidence, | ||
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(2) Information that will be useful to a policyholder | ||
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(h) The Fund shall be empowered to conduct research programs in an effort to
improve the administration of the mine subsidence insurance program and help
reduce and mitigate mine subsidence losses consistent with the public
interest.
(i) The Fund may enter into reinsurance agreements with any
intergovernmental cooperative that provides joint self-insurance for mine
subsidence losses of its members. These reinsurance agreements shall be
substantially similar to reinsurance agreements described in Section 810.1.
(Source: P.A. 95-92, eff. 1-1-08; 95-334, eff. 1-1-08.)
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(215 ILCS 5/804.1)
Sec. 804.1.
Management of the Fund.
(a) The Fund shall be managed by an 11 member Board of Directors, 6 of whom
shall be insurance industry directors, 4 of whom shall be public
directors, and one of whom shall be an Illinois licensed
insurance producer. The industry
directors shall be elected annually in the manner provided in Articles of
Governance adopted by the Fund. The public directors shall be appointed by the
Director, and shall not be employees of or otherwise affiliated with the
insurance industry. The Illinois licensed insurance producer shall be
appointed by the Director.
(b) The members of the Governing Committee of the Illinois Mine Subsidence
Insurance Fund established by Article XXXVIII who are members of the Governing
Committee as of December 31, 1993 shall become the members of the Board of
Directors of the Fund established by this Article on the effective date of this
Act, and shall continue to hold office until the next annual meeting of the
Fund.
(c) No later than the date of the next annual meeting of the Fund following
the effective date of this Act, the Director shall appoint 4 public directors,
one for a one-year term, one for a two-year term and 2 for three-year
terms.
No later than the date of the next annual meeting of the Fund following the
effective date of this amendatory Act of 1994, the Director shall appoint the
Illinois licensed insurance producer for a 2-year term. Thereafter, all public
directors and the licensed insurance producer shall be appointed for 3 year terms.
(d) As soon as practical after the effective date of this Act, the Fund
shall adopt Articles of Governance, which shall be submitted to the Director
for his review and approval.
(Source: P.A. 88-379; 88-667, eff. 9-16-94; 89-206, eff. 7-21-95.)
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(215 ILCS 5/805.1)
Sec. 805.1. Mine Subsidence Coverage.
(a) Beginning January 1, 1994, every policy issued or renewed insuring a
residence on a direct basis shall include, at a separately stated premium,
residential coverage unless waived in writing by the insured. Beginning
January 1, 1994, every policy issued or renewed insuring a commercial building
on a direct basis shall include at a separately stated premium, commercial
coverage unless waived in writing by the insured. Beginning January 1, 1994,
every policy issued or renewed insuring a living unit on a direct basis shall
include, at a separately stated premium, living unit coverage unless waived in
writing by the insured.
(b) If the insured has previously waived mine subsidence coverage in
writing,
the insurer or agent need not offer mine subsidence coverage in any renewal or
supplementary policy in connection with a policy previously issued to such
insured by the same insurer, unless the insured subsequently makes a written
request for mine subsidence coverage.
(c) The premium charged for residential, commercial or living unit coverage
shall be the
premium level set by the Fund. The loss covered shall be the loss in excess of
the deductible or retention established by the Fund and contained in a
mine subsidence endorsement to the policy. For all policies issued or renewed on or after January 1, 2008, the reinsured loss per residence, per commercial building, and per living unit shall be the amounts established by the Fund and approved by the Director.
For all policies issued or renewed on or after January 1, 1996, the amount of
reinsurance available from the Fund shall not be less than $200,000 per
residence, $200,000 per commercial building, or $15,000 per living unit. The
Fund may, from time to time, adjust the amount of reinsurance available as long
as the minimum set by this Section is met.
(d) The residential coverage provided pursuant to this Article may also
cover
the additional living expenses reasonably and necessarily incurred by the owner
of a residence who has been temporarily displaced as the direct result of
damage to the residence caused by mine subsidence if the underlying policy also
covers this type of loss, provided however, that the loss covered under living
unit coverage shall be limited to losses to improvements
and betterments, and reimbursement of additional living expenses and
assessments made against the insured on account of mine subsidence loss.
(e) The total amount of the loss reimbursable to an insurer shall be limited
to the amount of
insurance reinsured by the Fund in force at the time when the damage first
becomes reasonably observable. All damage caused by a single mine subsidence
event or several subsidence events which are continuous shall constitute one
occurrence. As set forth in subsections (a) and (c) of this Section, a policy issued or renewed must provide coverage, unless waived in writing by the insured, and the insurer must continue to charge the premium level set for that coverage by the Fund. If mine subsidence coverage is in force when the mine subsidence damage first becomes reasonably observable, then the insurer shall notify the insured making the mine subsidence claim that continuation of that coverage thereafter may not be necessary and is optional, but that continued coverage on the damaged residence or commercial building shall terminate only upon written waiver by the insured. The notification shall be made within 60 days after the insurer receives written confirmation from the Fund that the cause of loss is active mine subsidence. The notification shall be in the form of a separate mailing to the insured from the insurer via the United States Postal Service and shall include notification to the insured that mine subsidence premiums paid for coverage on a damaged residence or commercial building subsequent to the established date of loss shall be refunded to the insured within 60 days after the insured provides a signed waiver of mine subsidence coverage to the insurer. The notification shall be accompanied by a waiver of coverage form for the insured to sign and return to the insurer.
(f) No insurer shall be required to offer mine subsidence coverage in
excess of the reinsured limits.
(Source: P.A. 98-1007, eff. 1-1-15.)
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(215 ILCS 5/806.1)
Sec. 806.1.
Division of Fund Into Separate Residential and
Commercial Sub-funds.
(a) Effective January 1, 1994, the Fund shall establish 2
separate
sub-funds, a Residential Fund to provide reinsurance for mine subsidence losses
arising from residential and living unit coverage and a Commercial Fund to
provide reinsurance for mine subsidence losses arising from commercial
coverage. The assets and liabilities of the Fund shall be allocated to the two
sub-funds in such manner as determined by the Board of Directors, with the
approval of the Director. The two sub-funds shall continue to be managed by
the Board of Directors. Beginning January 1, 1994, all premiums received by
the Fund for residential coverage or living unit coverage shall be credited to
the Residential Fund, all losses and expenses for residential coverage or
living unit coverage shall be charged to the Residential Fund. All premiums
received by the Fund for commercial coverage shall be credited to the
Commercial Fund, and all losses and expenses for commercial coverage shall be
charged to the Commercial Fund. The Fund's overhead expenses shall be
allocated between the Residential Fund and the Commercial Fund on the basis of
annual written premium credited to each sub-fund. The assets and liabilities
of
the Residential and Commercial Funds shall be accounted for
separately. The assets of the Residential Fund shall not be used to reimburse
insurers for losses
for Commercial Coverage and the assets of the Commercial Fund shall not be used
to reimburse insurers for losses for residential coverage or living unit
coverage.
(b) No insurer shall be required to pay any claim for any loss reinsured
under
this Article except to the extent that the amount available in the Residential
Fund or the Commercial Fund, as the case may be, is sufficient to reimburse the
insurer for such payment.
(Source: P.A. 88-379; 89-206, eff. 7-21-95.)
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(215 ILCS 5/807.1)
Sec. 807.1.
Exemption of Certain Counties by the
Director.
The Director shall exempt every policy insuring residences, living units or
commercial buildings located in any county of 1,000,000 or more inhabitants or
any county contiguous to any such county, and, upon request of the Fund,
may exempt every policy insuring residences, living units or commercial
buildings located in any other specified county of this
State, from the provisions of Section 805.1 of this Article.
(Source: P.A. 91-357, eff. 7-29-99.)
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(215 ILCS 5/808.1)
Sec. 808.1.
Right of Insurers to Refuse to Provide Mine
Subsidence Coverage.
An insurer may refuse to provide mine subsidence coverage on a residence or
commercial building evidencing unrepaired mine subsidence damage until such
damage has been repaired.
(Source: P.A. 88-379.)
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(215 ILCS 5/809.1)
Sec. 809.1.
Arbitration.
In the event of a dispute between a policyholder and an insurer as to whether
a residence or commercial building covered by mine subsidence insurance has
been damaged by mine subsidence, a policyholder shall have the right to submit
that dispute to arbitration in accordance with this Section. No policyholder
shall have the right under this Section to submit to arbitration any issue
regarding the amount of loss or damage caused to a residence or commercial
building by mine subsidence.
Arbitration may be initiated only after the insurer has made a decision that
the residence or commercial building covered by mine subsidence insurance was
not damaged by mine subsidence and so notified the policyholder in writing,
accompanied by a notice informing the policyholder of the policyholder's right
to arbitration and containing specific reference to this Section. Within 60
days after receipt by the policyholder of the notification, the policyholder
may initiate arbitration in accordance with the Commercial Arbitration Rules of
the American Arbitration Association, as then in effect. All costs of the
arbitration shall be borne by the losing party. Appeals from the decision of
the arbitrators shall be in accordance with the Uniform Arbitration Act as in
effect in Illinois.
(Source: P.A. 88-379.)
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(215 ILCS 5/810.1)
Sec. 810.1.
Reinsurance Agreements.
All insurers shall enter into a
reinsurance agreement with the Fund. The reinsurance agreement shall be filed
with and approved by the
Director. The agreement shall provide that each
insurer shall cede 100% of any subsidence insurance written up to the limits
contained in Section 805.1(c) to the Fund and, in
consideration of the ceding
commission retained by the insurer, agrees to distribute informational
publications provided by the Fund on a schedule set by the Fund, undertake
adjustment of losses, payment of taxes, and all other expenses of the insurer
necessary for sale of policies and administration of the mine subsidence
insurance coverage. The Fund shall agree to reimburse the insurer for all
amounts reasonably and properly paid policyholders from claims resulting from
mine subsidence and for expenses specified in the reinsurance agreement. In
addition, the reinsurance agreement may contain, and may authorize the Fund to
establish and promulgate deductibles. The reinsurance agreement may also
contain reasonable rules and procedures covering
insurer documentation of losses; insurer reporting of claims, reports of
litigation, premiums and loss payments; loss payment review by the Fund;
remitting of premiums to the Fund; underwriting; and cause and origin
investigations; and procedures for
resolving disputes between the insurers and the Fund.
(Source: P.A. 90-655, eff. 7-30-98; 91-357, eff. 7-29-99.)
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(215 ILCS 5/811.1)
Sec. 811.1.
Distribution of Premiums.
The Fund is authorized to establish the proportion of total mine subsidence
insurance premiums collected by each insurer which shall be retained by the
insurer as a ceding commission, subject to review of the Director. The
remainder of such premiums shall be remitted by the insurer to the Fund at
times to be determined by the Fund. The ceding commission shall be uniform in
all reinsurance agreements entered into pursuant to Section 810.1 of this
Article
and shall be based on reasonable administrative costs to the insurers,
including agents' commissions.
(Source: P.A. 88-379.)
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(215 ILCS 5/812.1)
Sec. 812.1.
Claim Payments.
The Residential or the Commercial Fund, as the case may be, shall reimburse
insurers for all amounts due within 90 days after receiving adequate
documentation, as set forth in the reinsurance agreement, the Plan of Operation
or in the operating rules and procedures adopted by the Fund, that the insurer
has properly paid the claim and is entitled to reimbursement by the Fund,
subject to the limitations imposed by Section 806.1.
(Source: P.A. 88-379.)
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(215 ILCS 5/813.1)
Sec. 813.1.
Reporting Requirements.
Every insurer must report, at times designated by the Fund, such information
as is reasonably required by the Fund to conduct its affairs, establish claim
reserves, and reimburse insurers for losses paid to insureds.
(Source: P.A. 88-379.)
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(215 ILCS 5/814.1)
Sec. 814.1.
Right of Recourse.
(a) The Fund shall have no right of recourse against the insurer, once the
Fund has reimbursed the insurer for any particular loss, unless the insurer has
failed to settle that loss in its customary manner, or in case of fraud by the
insurer.
(b) The Fund may seek recovery against the policyholder for unjust
enrichment
if, in the Fund's judgment, the policyholder was not entitled to the amounts
paid because of fraud, or a material violation of the policy conditions. The
insurer shall provide cooperation to the Fund.
(Source: P.A. 88-379.)
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(215 ILCS 5/815.1)
Sec. 815.1.
Subrogation.
(a) All insurers issuing mine subsidence policies shall retain the right of
subrogation.
(b) The Fund, on its own behalf, may exercise the right of subrogation.
(c) Every insurer shall include in its reports an itemized list of all
losses
in subrogation and shall remit to the Fund all monies, less expenses, recovered
as the result of subrogation actions.
(Source: P.A. 88-379.)
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(215 ILCS 5/817.1)
Sec. 817.1.
Powers of Director.
In addition to any powers conferred upon
him by this or any other law, the Director shall have the authority to
supervise the operations of the Fund and shall review the Fund's rates once
every three years. In addition the Director or any person designated by him
has the power:
(a) to examine the operation of the Fund through free | ||
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(b) to do all things necessary to enable the State of | ||
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(c) to require such reports as the Director may deem | ||
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(Source: P.A. 90-655, eff. 7-30-98.)
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(215 ILCS 5/Art. XXXVIII.5 heading) ARTICLE XXXVIII 1/2.
GROUP SELF-INSURANCE PROGRAMS
(Repealed by P.A. 89-97, eff. 7-7-95)
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(215 ILCS 5/850) (from Ch. 73, par. 1065.501)
Sec. 850.
(Repealed).
(Source: Repealed by P.A. 89-97, eff. 7-7-95.)
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(215 ILCS 5/Art. XXXIX heading) ARTICLE XXXIX.
GROUP LEGAL EXPENSE INSURANCE
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(215 ILCS 5/900) (from Ch. 73, par. 1065.600)
Sec. 900.
Group legal expense defined.
Group legal expense insurance
means that form of legal expense insurance covering not less than 10 employees,
members, or employees of members, written under a master policy issued to
any governmental corporation, unit, agency or department thereof, or to
any corporation, copartnership, individual employer, or to any association
upon application of an executive officer or trustee of such association
having a constitution or bylaws and formed in good faith for purposes other
than that of obtaining insurance, where officers, members, employees, employees
of members or classes or departments thereof may be insured for their individual
benefit. In addition, a group legal expense policy may be written to insure
any group which may be insured under a group life insurance policy. The
term "employees" includes the officers, managers and employees or subsidiary
or affiliated corporations, and the individual proprietors, partners, and
employees of affiliated individuals and firms, when the business of such
subsidiary or affiliated corporations, firms or individuals is controlled
by a common employer through stock ownership, contract or otherwise.
(Source: P.A. 81-1361.)
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(215 ILCS 5/901) (from Ch. 73, par. 1065.601)
Sec. 901.
Group legal expense insurance authorized.) Any insurance company
authorized to write legal expense insurance in this State shall have the
power to issue group legal expense insurance policies. No policy,
certificate, endorsement, rider, or application which becomes or is designed
to become a part of any such policy of group legal expense insurance may
be issued or delivered in this State unless a copy of the form shall have
been filed with the Director of Insurance in accordance with Section 143
of this Code. Such policy, certificate, endorsement, rider, or application
must contain those provisions required by Sections 902 through 906
of the Code.
No such policy, certificate, endorsement, application or rider
shall contain any provision which would interfere with the freedom of choice
by the insured in the selection
of attorneys except that the insurer
may select and contract with attorneys to verify plan coverage and to provide
the insureds with legal services which consist of initial advice and consultation.
Nothing herein shall prevent an insured, after plan coverage has been verified,
from choosing to go directly to his or her own attorney of choice for initial
advice and consultation, subject to applicable policy limitations.
Every such policy, certificate, endorsement, application or rider shall
prominently display language advising the insured of such freedom of choice
by the insured in the selection of attorneys
and that no company issuing such policy, certificate, endorsement, application
or rider may require, suggest or recommend the use of any attorney
or firm of attorneys, provided, however, that dissemination by an insurer
of the names of attorneys who have agreed to accept legal expense insurance
benefits as payment for certain legal services shall not constitute a requirement,
suggestion or recommendation of the use of any attorney or firm of attorneys.
The foregoing shall not prohibit referral of insured by the insurer to
any lawyer referral service authorized or operated by a state, county, local
or other bar association.
Any insurance company issuing such policies shall in no way interfere with
the attorney-client relationship nor with the independent exercise of professional
judgment by any attorney.
(Source: P.A. 83-774.)
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(215 ILCS 5/902) (from Ch. 73, par. 1065.602)
Sec. 902. Entire contract specified. Each group legal expense insurance
policy shall provide that the policy, the application of the employer, or
executive officer or trustee of any association, and the individual applications,
if any, of the employees, members or employees of members insured shall
constitute the entire contract between the parties, and that all statements
made by the employer, or the executive officer or trustee, or by the individual
employees, members or employees of members shall, in the absence of fraud,
be deemed representations and not warranties, and that no such statement
shall be used in defense to a claim under the policy, unless it is contained
in a written application.
(Source: P.A. 99-642, eff. 7-28-16.)
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(215 ILCS 5/903) (from Ch. 73, par. 1065.603)
Sec. 903.
Certificates Required.) Each group legal expense insurance
policy shall provide that the insurer shall issue to the employer, or to
the executive officer or trustee of the association, for delivery to the
employee, member or employee of a member, who is insured under such policy,
an individual certificate setting forth a statement as to the insurance
protection to which he or she is entitled and to whom payable, if appropriate.
(Source: P.A. 81-1361.)
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(215 ILCS 5/904) (from Ch. 73, par. 1065.604)
Sec. 904.
New Members of Group.) Each group legal expense insurance policy
shall provide that to the group or class thereof originally insured
shall be added from time to time all new employees of the employer, members
of the association or employees of members eligible to and applying for
insurance in such group or class, but participation in the group plan shall
not be required as a condition of employment, nor shall any member not participating
in the plan be coerced or discriminated against.
(Source: P.A. 81-1361.)
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(215 ILCS 5/905) (from Ch. 73, par. 1065.605)
Sec. 905.
Conversion Rights.) Each group legal expense insurance policy
shall provide that any member of the group shall have the right to convert
his group policy to an individual standard policy of insurance in the same
company as offered by the insurer to the non-group insureds upon termination
of his connection with the group extending to him or her the same limits of coverage.
(Source: P.A. 81-1361.)
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(215 ILCS 5/906) (from Ch. 73, par. 1065.606)
Sec. 906.
Cancellation Restricted.
An insurer may not cancel the coverage
of an individual member of a group to which the insurer provides coverage
under a group legal expense insurance policy except for the nonpayment of
premium by such member, or the group policyholder if premium is paid or
collected by it for transmittal to the insurer or unless the insurance for
the entire group is cancelled. In the event of cancellation the insurer shall:
(1) If it has in its actual possession the names and addresses of individual
members insured under such group legal expense insurance policy, deliver
to the individual member written notice of cancellation stating when, not
less than 30 days thereafter, such cancellation shall be effective provided,
however, that if such cancellation is the result of nonpayment of premium
by such member or the group policyholder, a notice of 10 days shall be sufficient.
(2) In the event the insurer does not administer the group legal expense
insurance policy and is not in actual possession of the names and addresses
of individual members insured under such policy, the insurer shall deliver
to the employer or to the executive officer or trustee of the association for delivery
to the employee, member or employee of a member who is insured under such
policy individual notice of cancellation forms stating when, not less than
30 days thereafter, such cancellation shall be effective provided, however,
that if such cancellation is the result of nonpayment of premium a notice
of 10 days shall be sufficient. The insurer shall not be required to furnish
notice of cancellation under this Section to the group policyholder when
an individual member's insurance is terminated by reason of nonpayment of
premium unless it has specific knowledge of the individual's failure to pay premium.
Delivery shall be considered effective by the mailing of such notice if
subsection (1) above is applicable to the last address of the member as
shown on the records of the insurer, and under subsection (2) by the mailing
of such notice to the last address of the group policyholder as shown on
the records of the insurer.
(Source: P.A. 81-1361.)
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(215 ILCS 5/Art. XL heading) ARTICLE XL.
INSURANCE INFORMATION
AND PRIVACY PROTECTION
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(215 ILCS 5/1001) (from Ch. 73, par. 1065.701)
Sec. 1001.
Purpose.
The purpose of this Article is to establish standards
for the collection, use and disclosure of information gathered in connection
with insurance transactions by insurance institutions, agents or
insurance-support
organizations; to maintain a balance between the need for information by
those conducting the business of insurance and the public's need for fairness
in insurance information practices, including the need to minimize
intrusiveness;
to establish a regulatory mechanism to enable natural persons to ascertain
what information is being or has been collected about them in connection
with insurance transactions and to have access to such information for the
purpose of verifying or disputing its accuracy; to limit the disclosure
of information collected in connection with insurance transactions; and
to enable insurance applicants and policyholders to obtain the reasons for
any adverse underwriting decision. Further, this Article shall grant the
Director the authority to enforce Title V of the Gramm-Leach-Bliley Act (Public
Law 106-102, 106th Congress).
(Source: P.A. 92-556, eff. 6-24-02.)
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(215 ILCS 5/1002) (from Ch. 73, par. 1065.702)
Sec. 1002.
Scope.
(A) The obligations imposed by this Article shall
apply to those insurance institutions, agents or insurance-support organizations
which, on or after the effective date of this Article:
(1) in the case of life, health or disability insurance:
(a) collect, receive or maintain information in connection with insurance
transactions which pertains to natural persons who are residents of this State, or
(b) engage in insurance transactions with applicants, individuals or policyholders
who are residents of this State, and
(2) in the case of property or casualty insurance:
(a) collect, receive or maintain information in connection with insurance
transactions involving policies, contracts or certificates of insurance
delivered, issued for delivery or renewed in this State, or
(b) engage in insurance transactions involving policies, contracts or
certificates of insurance delivered, issued for delivery or renewed in this State.
(B) The rights granted by this Article shall extend to:
(1) in the case of life, health or disability insurance, the following
persons who are residents of this State:
(a) natural persons who are the subject of information collected, received
or maintained in connection with insurance transactions, and
(b) applicants, individuals or policyholders who engage in or seek to
engage in insurance transactions, and
(2) in the case of property or casualty insurance, the following persons:
(a) natural persons who are the subject of information collected, received
or maintained in connection with insurance transactions involving policies,
contracts or certificates of insurance delivered, issued for delivery or
renewed in this State, and
(b) applicants, individuals or policyholders who engage in or seek to
engage in insurance transactions involving policies, contracts or certificates
of insurance delivered, issued for delivery or renewed in this State.
(C) For purposes of this Section, a person shall be considered a resident
of this State if the person's last known mailing address, as shown in the
records of the insurance institution, agent or insurance-support organization,
is located in this State.
(D) Notwithstanding subsections (A) and (B) above, this Article shall not apply
to information collected from the public records of a governmental authority
and maintained by an insurance institution or its representatives for the
purpose of insuring the title to real property located in this State.
(Source: P.A. 81-1430.)
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(215 ILCS 5/1003) (from Ch. 73, par. 1065.703)
Sec. 1003.
Definitions.
As used in this Article:
(A) "Adverse underwriting decision" means:
(1) any of the following actions with respect to | ||
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(a) a declination of insurance coverage,
(b) a termination of insurance coverage,
(c) failure of an agent to apply for insurance | ||
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(d) in the case of a property or casualty | ||
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(i) placement by an insurance institution or | ||
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(ii) the charging of a higher rate on the | ||
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(e) in the case of life, health or disability | ||
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(2) Notwithstanding paragraph (1) above, the | ||
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(a) the termination of an individual policy form | ||
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(b) a declination of insurance coverage solely | ||
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(c) the rescission of a policy.
(B) "Affiliate" or "affiliated" means a person that directly, or indirectly
through one or more intermediaries, controls, is controlled by or is under
common control with another person.
(C) "Agent" means an individual, firm, partnership, association or
corporation who is involved in the solicitation, negotiation or binding of
coverages for or on applications or policies of insurance, covering property or
risks located in this State. For the purposes of this Article, both "Insurance
Agent" and "Insurance Broker", as defined in Section 490, shall be considered
an agent.
(D) "Applicant" means any person who seeks to contract for insurance
coverage other than a person seeking group insurance that is not individually
underwritten.
(E) "Director" means the Director of Insurance.
(F) "Consumer report" means any written, oral or other communication of
information bearing on a natural person's credit worthiness, credit standing,
credit capacity, character, general reputation, personal characteristics
or mode of living which is used or expected to be used in connection with
an insurance transaction.
(G) "Consumer reporting agency" means any person who:
(1) regularly engages, in whole or in part, in the | ||
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(2) obtains information primarily from sources other | ||
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(3) furnishes consumer reports to other persons.
(H) "Control", including the terms "controlled by" or "under
common control with", means the possession, direct or indirect, of the power
to direct or cause the direction of the management and policies of a person,
whether through the ownership of voting securities, by contract other than
a commercial contract for goods or nonmanagement services, or otherwise,
unless the power is the result of an official position with or corporate
office held by the person.
(I) "Declination of insurance coverage" means a denial, in
whole or in part, by an insurance institution or agent of requested insurance
coverage.
(J) "Individual" means any natural person who:
(1) in the case of property or casualty insurance, is | ||
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(2) in the case of life, health or disability | ||
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(3) is a past, present or proposed policyowner;
(4) is a past or present applicant;
(5) is a past or present claimant; or
(6) derived, derives or is proposed to derive | ||
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(K) "Institutional source" means any person or governmental entity that
provides information about an individual to an agent, insurance institution or
insurance-support organization, other than:
(1) an agent,
(2) the individual who is the subject of the | ||
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(3) a natural person acting in a personal capacity | ||
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(L) "Insurance institution" means any corporation, association, partnership,
reciprocal exchange, inter-insurer, Lloyd's insurer, fraternal benefit society
or other person engaged in the business of insurance, health maintenance
organizations as defined in Section 2 of the Health Maintenance Organization
Act,
voluntary health services plans as defined in Section 2 of the Voluntary Health
Services Plans Act, and dental service plans as defined in Section 4 of the
Dental Service Plan Act. "Insurance institution" shall not include agents or
insurance-support organizations.
(M) "Insurance-support organization" means:
(1) any person who regularly engages, in whole or in | ||
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(a) the furnishing of consumer reports or | ||
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(b) the collection of personal information from | ||
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(2) Notwithstanding paragraph (1) above, the | ||
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(N) "Insurance transaction" means any transaction involving
insurance primarily for personal, family or household needs rather than
business or professional needs which entails:
(1) the determination of an individual's eligibility | ||
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(2) the servicing of an insurance application, | ||
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(O) "Investigative consumer report" means a consumer report
or portion thereof in which information about a natural person's character,
general
reputation, personal characteristics or mode of living is obtained through personal
interviews with the person's neighbors, friends, associates, acquaintances
or others who may have knowledge concerning such items of information.
(P) "Medical-care institution" means any facility or institution
that is licensed to provide health care services to natural persons, including
but not limited to: hospitals, skilled nursing facilities, home-health
agencies, medical clinics, rehabilitation agencies and public-health
agencies and health-maintenance organizations.
(Q) "Medical professional" means any person licensed or certified
to provide health care services to natural persons, including but not limited
to, a physician, dentist, nurse, optometrist, chiropractor, naprapath,
pharmacist, physical or occupational therapist, psychiatric social worker,
speech therapist, clinical dietitian or clinical psychologist.
(R) "Medical-record information" means personal information which:
(1) relates to an individual's physical or mental | ||
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(2) is obtained from a medical professional or | ||
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(S) "Person" means any natural person, corporation, association,
partnership or other legal entity.
(T) "Personal information" means any individually identifiable
information gathered in connection with an insurance transaction from which
judgments can be made about an individual's character, habits, avocations,
finances, occupation, general reputation, credit, health or any other personal
characteristics. "Personal information" includes an individual's name and
address and "medical-record information" but does not include "privileged
information".
(U) "Policyholder" means any person who:
(1) in the case of individual property or casualty | ||
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(2) in the case of individual life, health or | ||
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(3) in the case of group insurance which is | ||
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(V) "Pretext interview" means an interview whereby a person,
in an attempt to obtain information about a natural person, performs one or
more of the following acts:
(1) pretends to be someone he or she is not,
(2) pretends to represent a person he or she is not | ||
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(3) misrepresents the true purpose of the interview, | ||
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(4) refuses to identify himself or herself upon | ||
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(W) "Privileged information" means any individually identifiable
information that: (1) relates to a claim for insurance benefits or
a civil or criminal proceeding involving an individual, and (2) is
collected in connection with or in reasonable anticipation
of a claim for insurance benefits or civil or criminal proceeding involving
an individual; provided,
however, information otherwise meeting the requirements of this subsection
shall nevertheless be considered "personal information" under this Article
if it is disclosed in violation of Section 1014 of this Article.
(X) "Residual market mechanism" means an association, organization
or other entity described in Article XXXIII
of this Act, or Section 7-501 of The
Illinois Vehicle Code.
(Y) "Termination of insurance coverage" or "termination of
an insurance policy" means either a cancellation or nonrenewal of an insurance
policy, in whole or in part, for any reason other than the failure to pay
a premium as required by the policy.
(Z) "Unauthorized insurer" means an insurance institution that has not
been granted a certificate of authority by the Director to transact the
business of insurance in this State.
(Source: P.A. 90-7, eff. 6-10-97; 90-177, eff. 7-23-97; 90-372,
eff. 7-1-98; 90-655, eff. 7-30-98.)
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(215 ILCS 5/1004) (from Ch. 73, par. 1065.704)
Sec. 1004.
Pretext Interviews.
No insurance institution, agent or insurance-support
organization shall use or authorize the use of pretext interviews to obtain
information in connection with an insurance transaction; provided, however,
a pretext interview may be undertaken to obtain information
from a person or institution
that does not have a generally or statutorily recognized privileged relationship
with the person about whom the information relates for the
purpose of investigating a claim where, based upon specific information
available for review by the Director, there is a reasonable basis for
suspecting criminal activity, fraud, material misrepresentation or material
nondisclosure in connection with the claim.
(Source: P.A. 82-108.)
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(215 ILCS 5/1005) (from Ch. 73, par. 1065.705)
Sec. 1005.
Notice of Insurance Information Practices.
(A) An insurance
institution or agent shall provide a notice of information practices
to all applicants or policyholders in connection with insurance transactions
as provided below:
(1) in the case of an application for insurance, a notice shall be provided
no later than:
(a) at the time of the delivery of the insurance policy or certificate
when personal information is collected only from the applicant or from
public records, or
(b) at the time the collection of personal information is initiated when
personal information is collected from a source other than
the applicant or public records;
(2) in the case of a policy renewal, a notice shall be provided no later
than the policy renewal date, except
that no notice shall be required in connection with a policy renewal if:
(a) personal information is collected only from the policyholder or
from public records, or
(b) a notice meeting the requirements of this Section has been given within
the previous 24 months; or
(3) in the case of a policy reinstatement or change in insurance benefits,
a notice shall be provided no later than the time a request for a policy
reinstatement or change in insurance benefits is received by the insurance
institution, except that no notice shall be required if personal information
is collected only from the policyholder or from public records.
(B) The notice required by subsection (A) shall be in writing
and shall state:
(1) whether personal information may be collected from persons other than
the individual or individuals proposed for coverage;
(2) the types of personal information that may be collected and the types
of sources and investigative techniques that may be used to collect such information;
(3) the types of disclosures identified in subsections
(B), (C), (D), (E), (F), (I),
(K), (L) and (N) of Section 1014 of this Article and the
circumstances under which such disclosures may be made without prior authorization;
provided, however,
only those circumstances need be described which occur with such frequency
as to indicate a general business practice;
(4) a description of the rights established under Sections 1009 and
1010 of this Article and the manner in which such rights may be exercised; and
(5) that information obtained from a report prepared by an
insurance-support organization may be retained by the insurance-support
organization and disclosed
to other persons.
(C) In lieu of the notice prescribed in subsection (B), the insurance
institution or agent may provide an abbreviated notice informing the applicant
or policyholder that:
(1) personal information may be collected from persons other than the
individual or individuals proposed for coverage,
(2) such information as well as other personal or privileged information
subsequently collected by the insurance institution or agent may in certain
circumstances be disclosed to third parties without authorization,
(3) a right of access and correction exists with respect to all personal
information collected, and
(4) the notice prescribed in subsection (B) will be furnished to the applicant
or policyholder upon request.
(D) The obligations imposed by this Section upon an insurance institution
or agent may be satisfied by another insurance institution or agent
authorized to act on its behalf.
(Source: P.A. 82-108.)
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(215 ILCS 5/1006) (from Ch. 73, par. 1065.706)
Sec. 1006.
Marketing and Research Surveys.
An insurance institution or
agent shall clearly specify those questions designed to obtain information
solely for marketing or research purposes
from an individual in connection with an insurance transaction.
(Source: P.A. 82-108.)
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(215 ILCS 5/1007) (from Ch. 73, par. 1065.707)
Sec. 1007.
Content of Disclosure Authorization Forms.
Notwithstanding
any other provision
of law of this State, no insurance institution, agent or insurance-support
organization may utilize as its disclosure authorization form
in connection with insurance transactions a
form or statement which authorizes the disclosure of personal or privileged
information about an individual to the insurance institution,
agent or insurance-support organization unless the form or statement:
(A) is written in plain language;
(B) is dated;
(C) specifies the types of persons authorized to disclose information
about the individual;
(D) specifies the nature of the information authorized to be disclosed;
(E) names the insurance institution or agent and identifies
by generic reference representatives of the insurance institution to whom
the individual is authorizing information to be disclosed;
(F) specifies the purposes for which the information is collected;
(G) specifies the length of time such authorization shall remain valid,
which shall be no longer than:
(1) in the case of authorizations signed for the purpose of collecting
information in connection with an application for an insurance policy, a
policy reinstatement or a request for change in policy benefits:
(a) 30 months from the date the authorization is signed if the application
or request involves life, health or disability insurance,
(b) one year from the date the authorization is signed if the application
or request involves property or casualty insurance;
(2) in the case of authorizations signed for the purpose of collecting
information in connection with a claim for benefits under an insurance policy,
(a) the term of coverage of the policy if the claim is for a health insurance benefit,
(b) the duration of the claim if the claim is not for a health insurance
benefit; and
(H) advises the individual or a person authorized to act on behalf of
the individual that the individual or the individual's authorized representative
is entitled to receive a copy of the authorization form.
(Source: P.A. 82-108.)
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(215 ILCS 5/1008) (from Ch. 73, par. 1065.708)
Sec. 1008.
Investigative Consumer Reports.
(A) No insurance institution,
agent or insurance-support organization may prepare or request an investigative
consumer report about an individual in connection with an insurance transaction
involving
an application for insurance, a policy renewal, a policy reinstatement or
a change in insurance benefits unless the insurance institution or agent
informs the individual:
(1) that he or she may request to be interviewed in connection with the
preparation of the investigative consumer report, and
(2) that upon a request pursuant to Section 1009, he or she is entitled to
receive a copy of the investigative consumer report.
(B) If an investigative consumer report is to be prepared by an insurance
institution or agent, the insurance institution or agent shall institute
reasonable procedures to conduct a personal interview requested by an individual.
(C) If an investigative consumer report is to be prepared by an insurance-support
organization, the insurance institution or agent desiring such report shall
inform the insurance-support organization whether a personal interview has
been requested by the individual. The insurance-support organization shall
institute reasonable procedures to conduct such interviews, if requested.
(Source: P.A. 82-108.)
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(215 ILCS 5/1009) (from Ch. 73, par. 1065.709)
Sec. 1009.
Access to Recorded Personal Information.
(A) If any individual, after proper identification, submits a written request
to an insurance institution, agent or insurance-support organization for
access to recorded personal information about the individual which is
reasonably described
by the individual and reasonably locatable and retrievable by the insurance
institution, agent or insurance-support organization, the insurance institution,
agent or insurance-support organization shall within 30 business days from
the date such request is received:
(1) inform the individual of the nature and substance of such recorded
personal information in writing, by telephone or by other oral communication,
whichever the insurance institution, agent or insurance-support organization prefers;
(2) permit the individual to see and copy, in person, such recorded personal
information pertaining to him or her or to obtain a copy of such recorded
personal information by mail, whichever the individual prefers, unless such
recorded personal information is in coded form, in which case an accurate
translation in plain language shall be provided in writing;
(3) disclose to the individual the identity, if recorded, of those persons
to whom the insurance institution, agent or insurance-support organization
has disclosed such personal information within 2 years prior to such
request, and if the identity is not recorded, the names of those insurance
institutions, agents, insurance-support organizations or other persons to
whom such information is normally disclosed; and
(4) provide the individual with a summary of the procedures by which he
or she may request correction, amendment or deletion of recorded personal information.
(B) Any personal information provided pursuant to subsection (A) above
shall identify the source of the information if such source is an institutional source.
(C) Medical-record information supplied by a medical-care institution
or medical professional and requested under subsection (A), together with
the identity of the medical professional or medical care institution which
provided such information, shall be supplied either directly to the individual
or to a medical professional designated by the individual and licensed to
provide medical care with respect to the condition to which the information
relates, whichever the insurance institution, agent or insurance-support
organization prefers. If it elects to disclose the information to a medical
professional designated by the individual, the insurance institution, agent
or insurance-support organization shall notify the individual, at the time
of the disclosure, that it has provided the information to the medical professional.
(D) Except for personal information provided under Section 1011, an insurance
institution, agent or insurance-support organization may charge a reasonable
fee to cover the costs incurred in providing a copy of recorded personal
information to individuals.
(E) The obligations imposed by this Section upon an insurance institution
or agent may be satisfied by another insurance institution or agent authorized
to act on its behalf. With respect to the copying and disclosure of recorded
personal information pursuant to a request under subsection (A), an insurance
institution, agent or insurance-support organization may make arrangements
with an insurance-support organization or a consumer reporting agency
to copy and disclose recorded personal
information on its behalf.
(F) The rights granted to individuals in this Section shall extend to
all natural persons to the extent information about them is collected and
maintained by an insurance institution, agent or insurance-support organization
in connection with an insurance transaction. The rights granted to all natural
persons by this subsection shall not extend to information about them that
relates to and is collected in connection with or in reasonable anticipation
of a claim or civil or criminal proceeding involving them.
(G) For purposes of this Section, the term "insurance-support organization"
does not include "consumer reporting agency".
(Source: P.A. 82-108.)
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(215 ILCS 5/1010) (from Ch. 73, par. 1065.710)
Sec. 1010.
Correction, Amendment or Deletion of Recorded Personal Information.
(A) Within 30 business days from the date of receipt of a written
request from an individual to correct, amend or delete any recorded
personal information
about the individual within its possession, an insurance institution, agent
or insurance-support organization shall either:
(1) correct, amend or delete the portion of the recorded personal information
in dispute; or
(2) notify the individual of:
(a) its refusal to make such correction, amendment or deletion,
(b) the reasons for the refusal, and
(c) the individual's right to file a statement as provided
in subsection (C).
(B) If the insurance institution, agent or insurance-support organization
corrects, amends or deletes recorded personal information in accordance
with paragraph (1) of subsection (A) above, the insurance institution, agent
or insurance-support organization shall so notify the individual in writing
and furnish the correction, amendment or fact of deletion to:
(1) any person specifically designated by the individual who may have,
within the preceding 2 years, received such recorded personal information;
(2) any insurance-support organization whose primary source of personal
information is insurance institutions, if the insurance-support organization
has systematically received such recorded personal information from the
insurance institution within the preceding 7 years; provided, however, that
the correction, amendment or fact of deletion need not be furnished
if the insurance-support organization no longer maintains recorded personal
information about the individual; and
(3) any insurance-support organization that furnished the personal information
that has been corrected, amended or deleted.
(C) Whenever an individual disagrees with an insurance institution's,
agent's or insurance-support organization's refusal to correct, amend or
delete recorded personal information, the individual shall be permitted
to file with the insurance institution, agent or insurance-support organization:
(1) a concise statement setting forth what the individual thinks is the
correct, relevant or fair information, and
(2) a concise statement of the reasons why the individual disagrees with
the insurance institution's, agent's or insurance-support organization's
refusal to correct, amend or delete recorded personal information.
(D) In the event an individual files either statement as described in
subsection (C) above, the insurance institution, agent or support organization shall:
(1) file the statement with the disputed personal information and provide
a means by which anyone reviewing the disputed personal information will
be made aware of the individual's statement and have access to it, and
(2) in any subsequent disclosure by the insurance institution, agent or
support organization of the recorded personal information that is the subject
of disagreement, clearly identify the matter or matters in dispute and
provide the individual's statement along with the recorded personal information
being disclosed; and
(3) furnish the statement to the persons and in the manner specified in
subsection (B) above.
(E) The rights granted to individuals in this Section shall extend to
all natural persons to the extent information about them is collected and
maintained by an insurance institution, agent or insurance-support organization
in connection with an insurance transaction. The rights granted to all
natural persons by this subsection shall not extend to information about
them that relates to and is collected in connection with or in reasonable
anticipation of a claim or civil or criminal proceeding involving them.
(F) For purposes of this Section, the term "insurance-support organization"
does not include "consumer reporting agency".
(Source: P.A. 82-108.)
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(215 ILCS 5/1011) (from Ch. 73, par. 1065.711)
Sec. 1011.
Reasons for Adverse Underwriting Decisions.
(A) In the event
of an adverse underwriting decision the insurance institution or agent responsible
for the decision shall:
(1) either provide the applicant, policyholder or individual proposed
for coverage with the specific reason or reasons for the adverse underwriting
decision in writing or advise such person that upon written request he or
she may receive the specific reason or reasons in writing, and
(2) provide the applicant, policyholder or individual proposed for coverage
with a summary of the rights established under subsection (B) and Sections
1009 and 1010 of this Article.
(B) Upon receipt of a written request within 90 business days from the
date of the mailing of notice or other communication of an adverse underwriting
decision to an applicant, policyholder or individual proposed for coverage,
the insurance institution or agent shall furnish to such person within 21
business days from the date of receipt of such written request:
(1) the specific reason or reasons for the adverse underwriting decision,
in writing, if such information was not initially furnished in writing pursuant
to paragraph (1) of subsection (A);
(2) the specific items of personal and privileged information that
support those reasons; provided, however:
(a) the insurance institution or agent shall not be required to furnish
specific items of privileged information if it has reasonable suspicion,
based upon specific information available for review by the Director, that
the applicant, policyholder
or individual proposed for coverage has engaged in criminal activity,
fraud, material misrepresentation
or material nondisclosure, and
(b) specific items of medical-record information supplied by a medical-care
institution or medical professional shall be disclosed either directly to
the individual about whom the information relates or to a medical professional
designated by the individual and licensed to provide medical care with respect
to the condition to which the information relates, whichever the insurance
institution or agent prefers; and
(3) the names and addresses of the institutional sources that supplied
the specific items of information pursuant to paragraph (2) of
subsection (B); provided, however, that the identity of any medical professional
or medical-care institution shall be disclosed either directly to the individual
or to the
designated medical professional, whichever the insurance institution or agent prefers.
(C) The obligations imposed by this Section upon an insurance institution
or agent may be satisfied by another insurance institution or agent authorized
to act on its behalf.
(D) When an adverse underwriting decision results solely from an oral
request or inquiry, the explanation of reasons and summary of rights required
by subsection (A) may be given orally.
(Source: P.A. 82-108.)
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(215 ILCS 5/1012) (from Ch. 73, par. 1065.712)
Sec. 1012.
Information Concerning Previous Adverse Underwriting Decisions.
No insurance institution, agent or insurance-support organization may seek
information in connection with an insurance transaction concerning:
(A) any previous adverse underwriting decision experienced by an individual, or
(B) any previous insurance coverage obtained by an individual through
a residual market mechanism,
unless such inquiry also requests the reasons for any previous adverse underwriting
decision or the reasons why insurance coverage was previously obtained through
a residual market mechanism.
(Source: P.A. 81-1430.)
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(215 ILCS 5/1013) (from Ch. 73, par. 1065.713)
Sec. 1013.
Previous Adverse Underwriting Decisions.
No insurance institution
or agent may base an adverse underwriting decision in whole or in part:
(A) on the fact of a previous adverse underwriting decision or on
the fact that an individual previously obtained insurance coverage through
a residual market mechanism; provided, however, an insurance institution
or agent may base an adverse underwriting decision on further information
obtained from an
insurance institution or agent responsible for a previous adverse underwriting decision;
(B) on personal information received from an insurance-support organization
whose primary source of information is insurance institutions; provided,
however, an insurance institution or agent may base an adverse underwriting
decision on further personal information obtained as the result of information
received from such insurance-support organization.
(Source: P.A. 82-108.)
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(215 ILCS 5/1014) (from Ch. 73, par. 1065.714)
Sec. 1014.
Disclosure Limitations and Conditions.
An insurance institution,
agent or insurance-support organization shall not disclose any personal
or privileged information about an individual collected or received in connection
with an insurance transaction unless the disclosure is:
(A) with the written authorization of the individual, provided:
(1) if such authorization is submitted by another insurance institution,
agent or insurance-support organization, the
authorization meets the requirements of Section 1007 of this Article, or
(2) if such authorization is submitted by a person other
than an insurance
institution, agent or insurance-support organization, the authorization is:
(a) dated,
(b) signed by the individual, and
(c) obtained one year or less prior to the date a disclosure is sought
pursuant to this subsection; or
(B) to a person other than an insurance institution, agent or insurance-support
organization, provided such disclosure is reasonably necessary:
(1) to enable such person to perform a business, professional or insurance
function for the disclosing insurance institution, agent or insurance-support
organization and such person agrees not to disclose the information further
without the individual's written authorization unless the further disclosure:
(a) would otherwise be permitted by this Section if made by an insurance
institution, agent, or insurance-support organization, or
(b) is reasonably necessary for such person to perform its function for
the disclosing insurance institution, agent, or insurance-support organization, or
(2) to enable such person to provide information to the disclosing insurance
institution, agent, or insurance-support organization for the purpose of:
(a) determining an individual's eligibility for an insurance benefit or payment, or
(b) detecting or preventing criminal activity, fraud, material misrepresentation
or material nondisclosure in connection with an insurance transaction; or
(C) to an insurance institution, agent, insurance-support organization
or self-insurer, provided the information disclosed is limited to that which
is reasonably necessary:
(1) to detect or prevent criminal activity, fraud, material misrepresentation
or material nondisclosure in connection with insurance transactions, or
(2) for either the disclosing or receiving insurance institution, agent
or insurance-support organization to perform its function in connection
with an insurance transaction involving the individual; or
(D) to a medical care institution or medical professional for the purpose of:
(1) verifying insurance coverage or benefits,
(2) informing an individual of a medical problem of which the individual
may not be aware, or
(3) conducting an operations or services audit,
provided only such information
is disclosed as is reasonably necessary to accomplish the foregoing purposes; or
(E) to an insurance regulatory authority; or
(F) to a law enforcement or other governmental authority:
(1) to protect the interests of the insurance institution, agent or insurance-support
organization in preventing or prosecuting the perpetration of
fraud upon it, or
(2) if the insurance institution, agent or insurance-support organization
reasonably believes that illegal activities have been conducted by the individual; or
(G) otherwise permitted or required by law; or
(H) in response to a facially valid administrative or judicial order,
including a search warrant or subpoena; or
(I) made for the purpose of conducting actuarial or
research studies provided:
(1) no individual may be identified in any actuarial or research
report,
(2) materials allowing the individual to be identified are returned or
destroyed as soon as they are no longer needed, and
(3) the actuarial or research organization agrees not to disclose the
information unless the disclosure would otherwise be permitted by this Section
if made by an insurance institution, agent or insurance-support organization; or
(J) to a party or a representative of a party to a proposed or consummated
sale, transfer, merger or consolidation of all or part of the business of
the insurance institution, agent or insurance support organization, provided:
(1) prior to the consummation of the sale, transfer, merger or consolidation
only such information is disclosed as is reasonably necessary to enable the
recipient to make business decisions about the purchase, transfer, merger
or consolidation, and
(2) the recipient agrees not to disclose the information unless the disclosure
would otherwise be permitted by this Section if made by an insurance institution,
agent or insurance-support organization; or
(K) to a person whose only use of such information will be in
connection with the marketing of a product or service, provided:
(1) no medical-record information, privileged information,
or personal information relating to an individual's character, personal
habits, mode of living or general reputation is disclosed, and no classification
derived from such information is disclosed,
(2) the individual has been given an opportunity to indicate
that he or she does not want personal information disclosed for marketing purposes and
has given no indication that he or she does not want the information disclosed, and
(3) the person receiving such information agrees not to use
it except in connection with the marketing of a product or service; or
(L) to an affiliate whose only use of the information will be in connection
with an audit of the insurance institution or agent or the marketing
of an insurance product or service, provided the affiliate agrees not to
disclose the information for any other purpose or to unaffiliated
persons; or
(M) by a consumer reporting agency, provided:
the disclosure is to a person other than an insurance institution or agent; or
(N) to a group policyholder for the purpose of reporting claims experience
or conducting an audit of the insurance institution's or agent's operations
or services, provided the information disclosed is reasonably necessary
for the group policyholder to conduct the review or audit; or
(O) to a professional peer review organization for the purpose of reviewing
the service or conduct of a medical-care institution or medical professional; or
(P) to a governmental authority for the purpose of determining the individual's
eligibility for health benefits for which the governmental authority may be liable; or
(Q) to a certificateholder or policyholder for the purpose of providing
information regarding the status of an insurance transaction; or
(R) to a lienholder, mortgagee, assignee, lessee, or other person shown
on the records of an insurance institution or agent as having a legal or
beneficial interest in a policy of insurance; provided that information
disclosed is limited to that which is reasonably necessary to permit such
person to protect its interest in such policy.
(Source: P.A. 82-108.)
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(215 ILCS 5/1015) (from Ch. 73, par. 1065.715)
Sec. 1015.
Powers of Director.
(A) The Director shall have power to examine and investigate into the affairs
of every insurance institution or agent doing business in this State to
determine whether the insurance institution or agent has been or is engaged
in any conduct in violation of this Article.
(B) The Director shall have the power to examine and investigate into
the affairs of every insurance-support organization acting on behalf of
an insurance institution or agent which either transacts business in this
State or transacts business outside this State that has an effect on a person
residing in this State, in order to determine whether such insurance-support
organization has been or is engaged in any conduct in violation of this Article.
(Source: P.A. 81-1430.)
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(215 ILCS 5/1016) (from Ch. 73, par. 1065.716)
Sec. 1016.
Hearings, Witnesses, Appearances, Production of Books and Service
of Process.
(A) Whenever the Director has reason to believe that an insurance institution,
agent or insurance-support organization has been or is engaged in conduct
in this State which violates this Article, or if the Director believes that
an insurance-support organization has been or is engaged in conduct outside
this State which has an effect on a person residing in this State and violates
this Article, the Director shall issue and serve upon such insurance institution,
agent or insurance-support organization a statement of charges and notice
of hearing to be held at a time and place fixed in the notice. Such hearing
shall be conducted pursuant to Sections 401, 402 and 403 of this Act, and any
applicable rules of the Department.
(B) At the time and place fixed for such hearing the insurance institution,
agent or insurance-support organization charged shall have an opportunity
to answer the charges against it and present evidence on its behalf. Upon
good cause shown, the Director shall permit any adversely affected person
to intervene, appear and be heard at such hearing by counsel or in person.
(Source: P.A. 81-1430.)
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(215 ILCS 5/1017) (from Ch. 73, par. 1065.717)
Sec. 1017.
Service of Process - Insurance-Support Organizations.
For
the purpose of this Article, an insurance-support organization transacting
business outside this State which has an effect on a person residing in
this State shall be
deemed to have appointed the Director to accept service of process on its
behalf, provided the Director causes a copy of such service to be mailed
forthwith by registered mail to the insurance-support organization at its
last known principal place of business. The return postcard receipt for
such mailing shall be sufficient proof that the same was properly mailed
by the Director.
(Source: P.A. 81-1430.)
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(215 ILCS 5/1018) (from Ch. 73, par. 1065.718)
Sec. 1018.
Cease and Desist Orders and Reports.
(A) If, after a hearing, the Director determines that the insurance institution,
agent or insurance-support organization charged has engaged in conduct or
practices in violation of this Article, he shall reduce his findings to
writing and shall issue and cause to be served upon such insurance institution,
agent or insurance-support organization a copy of such findings and an order
requiring such insurance institution, agent or insurance-support organization
to cease and desist from the conduct or practices constituting a violation
of this Article.
(B) If, after a hearing, the Director determines that the insurance institution,
agent or insurance-support organization charged has not engaged in conduct
or practices in violation of this Article, he shall prepare a written report
which sets forth findings of fact and conclusions of law. Such report shall
be served upon the insurance institution, agent or insurance-support organization
charged and upon the person or persons, if any, whose rights under this
Article were allegedly violated.
(Source: P.A. 81-1430.)
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(215 ILCS 5/1019) (from Ch. 73, par. 1065.719)
Sec. 1019.
Judicial Review.
(1) Any order or decision made, issued or
executed by the Director under this Article whereby any person or company
is aggrieved is subject to review by the Circuit Court of Sangamon County.
(2) The Administrative Review Law, as now or hereafter amended, and the
rules adopted pursuant thereto, applies to and governs all proceedings for
review of final administrative decisions of the Director provided for in
this Section. The term "administrative decision" is defined as in Section
3-101 of the Code of Civil Procedure.
(Source: P.A. 82-783.)
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(215 ILCS 5/1020) (from Ch. 73, par. 1065.720)
Sec. 1020.
Penalties.
(A) In any case where a hearing pursuant to Section
1016 results in the finding of a knowing violation of this Article, the
Director may, in addition to the issuance of a cease and desist order as
prescribed in Section 1018, order payment of a monetary penalty of not more
than $1,000 for each violation but not to exceed $20,000 in the aggregate
for multiple violations.
(B) Any person who violates a cease and desist order of the Director under
Section 1018 of this Article may, after notice and hearing and upon order
of the Director, be subject to one or more of the following penalties, at
the discretion of the Director:
(1) a monetary fine of not more than $20,000 for each | ||
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(2) a monetary fine of not more than $100,000 if the | ||
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(3) suspension or revocation of an insurance | ||
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(Source: P.A. 93-32, eff. 7-1-03.)
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(215 ILCS 5/1021) (from Ch. 73, par. 1065.721)
Sec. 1021.
Individual Remedies.
(A) If
any insurance institution, agent or insurance-support organization fails
to comply with Sections 1009, 1010 or 1011 of this Article with respect
to the rights granted under those Sections, any person whose rights are
violated may apply to the circuit court of this State, or any other court
of competent jurisdiction, for appropriate equitable relief.
(B) An insurance institution, agent or insurance-support organization
which discloses information in violation of Section 1014 of this Article
shall be liable for damages sustained by the individual about whom the information
relates; provided, however, that no individual shall be entitled to a monetary
award which exceeds the actual damages sustained by the individual as a
result of a violation of Section 1014 of this Article.
(C) In any action brought pursuant to this Section, the court may award
the cost of the action and reasonable attorney's fees to the prevailing party.
(D) An action under this Section must be brought within 2 years from the
date the alleged violation is or should have been discovered.
(E) Except as specifically provided in this Section, there shall be no
remedy or recovery available to individuals, in law or in equity, for occurrences
constituting a violation of any provision of this Article.
(Source: P.A. 82-108.)
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(215 ILCS 5/1022) (from Ch. 73, par. 1065.722)
Sec. 1022.
Immunity.
No cause of action in the nature of defamation,
invasion of privacy or negligence shall arise against any person for disclosing
personal or privileged information in accordance with this Article, nor
shall such a cause of action arise against any person for furnishing personal
or privileged information to an insurance institution, agent or insurance-support
organization; provided, however, this Section shall provide no immunity
for disclosing or furnishing false information with malice or willful intent
to injure any person.
(Source: P.A. 82-108.)
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(215 ILCS 5/1023) (from Ch. 73, par. 1065.723)
Sec. 1023.
Obtaining Information Under False Pretenses.
Any person
who knowingly and willfully obtains information about an individual from
an insurance institution, agent or insurance-support organization under
false pretenses shall be guilty of a Class 4 felony.
(Source: P.A. 81-1430.)
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(215 ILCS 5/1023.5)
Sec. 1023.5.
Federal privacy protections.
(A) In addition to the requirements of this Article, licensees shall comply
with the privacy protection provisions of Title V of the federal
Gramm-Leach-Bliley Act (Public Law 106-102, 106th Congress).
(B) The Director shall have authority to enforce the requirements of the
privacy protection provisions of Title V of the federal Gramm-Leach-Bliley Act,
employing powers granted to him under this Article and this Code.
(C) The Director shall make reasonable rules as may be necessary to make
effective the privacy provisions of Title V of the federal Gramm-Leach-Bliley
Act (Public Law 106-102, 106th Congress).
(D) For purposes of this Section, "licensee" means all insurers, insurance
producers, and other persons licensed or required to be licensed, authorized or
required to be authorized, registered or required to be registered, or
domiciled, pursuant to this Code or any other insurance law
of this State administered by the Department. "Licensee" also includes
unauthorized insurers who accept business placed through a licensed surplus
line
producer in this State, but only in regard to the surplus line placements
placed pursuant to Section 445 of this Code. However, this Section does not
apply to "service contract providers" as defined by the Service Contract Act.
(Source: P.A. 92-556, eff. 6-24-02.)
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(215 ILCS 5/1024) (from Ch. 73, par. 1065.724)
Sec. 1024.
This Article takes effect on July 1, 1981.
The rights granted
under Sections 1009, 1010 and 1014 of this Article shall take effect on July 1, 1981,
regardless of the date of the collection or receipt of the information which
is the subject of such Sections.
(Source: P.A. 81-1430.)
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(215 ILCS 5/Art. XLI heading) ARTICLE XLI.
RISK RETENTION ARRANGEMENTS FOR
BANKING ASSOCIATIONS
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(215 ILCS 5/1101) (from Ch. 73, par. 1065.801)
Sec. 1101.
Scope of Article.
This Article applies only to trusts
sponsored by domestic banking associations and organized under this
Article to provide casualty insurance authorized under Section 5 of the
Illinois Banking Act, as now or hereafter amended, for
association member banks.
(Source: P.A. 84-1431.)
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(215 ILCS 5/1102) (from Ch. 73, par. 1065.802)
Sec. 1102.
Definitions.
As used in this Article, the following terms
have the following meanings:
(1) "Banking association" means any Illinois corporation, whether
for-profit or not-for-profit, which functions as a professional or trade
association of dues-paying member commercial banks. For purposes of this
Article, "banking association" does not include any corporation which
directly or indirectly (a) accepts deposits which the depositor has a right
to withdraw on demand by check or negotiable order, or (b) engages in the
business of making loans, or both.
(2) "Trust sponsor" means a banking association which has created a risk
retention trust under this Article.
(3) "Pool retention fund" means a separate fund maintained for
payment of first dollar claims, up to a specific amount per claim
("specific retention") and up to an aggregate amount for a 12-month period
("aggregate retention").
(4) "Contingency reserve fund" means a separate fund maintained for
payment of claims in excess of the pool retention fund amount.
(5) "Coverage grant" means the document describing specific
coverages and terms of coverage which are provided by a risk retention trust
created under this Article.
(6) "Licensed service company" means an entity licensed under Section
464a of the Illinois Insurance Code to perform claims adjusting, loss
control and data processing.
(Source: P.A. 84-1431.)
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(215 ILCS 5/1103) (from Ch. 73, par. 1065.803)
Sec. 1103.
Name.
The corporate name of any trust organized under this
Article shall not be the same as or deceptively similar to the name of any
domestic insurance company or of any foreign or alien insurance company
authorized to transact business in this State.
(Source: P.A. 84-1431.)
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(215 ILCS 5/1104) (from Ch. 73, par. 1065.804)
Sec. 1104.
Principal Office and Place of Business.
The principal
office of any trust organized under this Article shall be located in this State.
(Source: P.A. 84-1431.)
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(215 ILCS 5/1105) (from Ch. 73, par. 1065.805)
Sec. 1105.
Risk Retention Trust.
(1) Any banking association which has
been in existence for a period of not less than 2 years may create a risk
retention trust for the pooling of risks in order to provide
casualty coverage authorized under Section 5 of the Illinois Banking Act,
as now or hereafter amended, for its member banks. Such trust
shall be administered by at least 3 trustees who are appointed by the trust
sponsor and who represent association member banks which have agreed in
writing to participate in the trust.
(2) The trustees shall appoint a qualified administrator who shall
administer the affairs of the risk retention trust.
(3) The trustees shall retain a licensed service company to perform
claims adjusting, loss control and data processing.
(4) The trust sponsor, the trustees and the trust administrator shall be
fiduciaries of the trust.
(5) Any trust created under this Article shall be consummated by a
written trust agreement and shall be subject to the laws of this State
governing the creation and operation of trusts, to the extent not
inconsistent with this Article.
(Source: P.A. 84-1431.)
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(215 ILCS 5/1106) (from Ch. 73, par. 1065.806)
Sec. 1106.
Trust - Participation.
(1) A banking association and its member banks
may participate in any trust created under this Article if it:
(a) Meets the underwriting standards for acceptance into the trust;
(b) Files a written application for coverage, agreeing to meet
all of the membership conditions of the trust;
(c) Is a member of the association sponsoring the trust;
(d) Agrees to meet the ongoing loss control provisions and risk pooling
arrangements set forth by the
trustees;
(e) Pays its premium contribution on a timely basis as required; and
(f) Pays its predetermined annual required contribution into the
contingency reserve fund.
(2) Any bank accepted for trust membership and participating in the
trust under this Article shall be liable for payment to the trust
of the amount of its annual premium contribution and its annual
predetermined contingency reserve fund contribution.
(Source: P.A. 84-1431.)
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(215 ILCS 5/1107) (from Ch. 73, par. 1065.807)
Sec. 1107.
Trust - Coverage Grants - Payment of Claims.
(1) No risk
retention trust created under this Article may issue coverage grants until
it has procured 100 bonafide applications for coverage with the first
premium contribution in cash for each kind of coverage which the trust
undertakes to write, and has a contingency reserve fund of at least
$2,500,000. Every trust subject to this Article must have, and at all times
maintain a pool retention fund at least equal to its unpaid liabilities and
an unimpaired minimum contingency reserve fund of $1,500,000.
The contingency reserve fund requirements shall be deemed satisfied if
the required contribution into such fund by any participating member bank
is obtained by a certificate of deposit redeemable by the trust in an
amount not greater than the amount insured by the Federal Deposit Insurance Corporation.
(2) Every coverage grant issued or delivered in this State by any trust
subject to this Article shall provide for the liability of trust
members to the extent that funds are needed to pay a member's share of the
depleted contingency reserve fund needed to maintain the reserves required
by this Section.
(3) The Director may after notice and hearing suspend or revoke the
license of any trust that
fails to maintain the minimum reserves required by this Section.
(4) All claims shall first be paid from the pool retention fund.
If that fund becomes depleted, any additional claims shall be paid from
the contingency reserve fund.
(5) On the basis of an annual independent certified audit,
the Director may require the risk retention trust to purchase insurance in amounts
required to provide additional protection to member banks in excess of the
contingency reserve fund.
(Source: P.A. 84-1431.)
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(215 ILCS 5/1108) (from Ch. 73, par. 1065.808)
Sec. 1108.
Trust; filing requirements; records.
(1) Any risk
retention trust
created under this Article shall file with the Director:
(a) A statement of intent to provide named coverages.
(b) The trust agreement between the trust sponsor and | ||
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(c) Signed risk pooling agreements from each trust | ||
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(d) By April 1 of each year a financial statement for | ||
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(e) The name of a bank or trust company with whom the | ||
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(f) Copies of coverage grants it will issue.
(2) The Director of Insurance shall charge, collect and give proper
acquittances for the payment of the following fees and charges:
(a) For filing trust instruments, amendments thereto | ||
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(b) For copies of papers or records per page, $2.
(c) For certificate to copy of paper, $10.
(d) For filing an application for the licensing of a | ||
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(3) The trust shall keep its books and records in accordance with the
provisions of Section 133 of this Code. The Director may examine such
books and records from time to time as provided in Sections 132
through 132.7 of this Code
and may charge the expense of such examination to the trust as provided in
subsection (3) of Section 408 of this Code.
(4) Trust funds established under this Section and all persons
interest therein or dealing therewith shall be subject to the provisions of
Sections 133, 144.1, 149, 401, 401.1, 402, 403, 403A, 412, and all of the
provisions of Articles VII, VIII, XII 1/2 and XIII of the Code, as amended.
Except as otherwise provided in this Section, trust funds established
under and which fully comply with this Section, shall not be subjected to
any other provision of the Code.
(5) The Director of Insurance may make reasonable rules and regulations
pertaining to the standards of coverage and administration of the trust
authorized by this Section. Such rules may include but need not be limited
to reasonable standards
for fiduciary duties of the trustees, standards for the investment of
funds, limitation of risks assumed, minimum size, capital, surplus,
reserves, and contingency reserves.
(Source: P.A. 93-32, eff. 7-1-03.)
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(215 ILCS 5/1109) (from Ch. 73, par. 1065.809)
Sec. 1109.
Illinois Insurance Guaranty Fund - Inapplicability.
The
provisions of Article XXXIV of this Code shall not apply to any risk
retention trust created under this Article.
(Source: P.A. 84-1431.)
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(215 ILCS 5/Art. XLII heading) ARTICLE XLII.
INSURANCE COST CONTAINMENT
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(215 ILCS 5/1200) (from Ch. 73, par. 1065.900)
Sec. 1200.
This Article shall be known and may be cited as the
"Illinois Insurance Cost Containment Act".
(Source: P.A. 84-1431.)
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(215 ILCS 5/1201) (from Ch. 73, par. 1065.901)
Sec. 1201.
Purpose of Article.
The purpose of this Article is to
promote the public welfare by studying the relationship of insurance
premium and related income as compared to insurance costs and expenses. The
General Assembly finds and declares that stabilizing the cost of insurance
is a vital concern to the people of this State.
It is the legislative intent, pursuant to this declared public concern, to
develop measures which will stabilize prices while continuing to provide
quality insurance products to all sectors of the citizenry. It is the
express intent of this Article to permit and encourage competition between
companies on a sound financial basis to the fullest extent possible and to
establish a mechanism to ensure the provision of adequate insurance at
reasonable rates to the citizens of this State.
The General Assembly finds that while the gathering of insurance
cost data has been attempted on a voluntary basis in the past, the lack
of a uniform system for the collection and analysis of data and the lack
of full participation by insurers has led to inadequate and unusable data.
In order to remedy this problem, the General Assembly find it necessary to
create a mandated uniform system in Illinois for the collection, analysis
and distribution of insurance cost data.
(Source: P.A. 84-1431.)
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(215 ILCS 5/1202) (from Ch. 73, par. 1065.902)
Sec. 1202. Duties. The Director shall:
(a) determine the relationship of insurance premiums | ||
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(b) study the insurance system in the State of | ||
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(c) respond to the requests by agencies of government | ||
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(d) make an interim report to the General Assembly no | ||
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(Source: P.A. 99-642, eff. 7-28-16; 100-23, eff. 7-6-17.)
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(215 ILCS 5/1203) (from Ch. 73, par. 1065.903)
Sec. 1203.
Powers and Additional Duties.
(a) The Director
may enter into any agreement with any corporation,
association or other entity he or she deems appropriate to undertake the process
described in this Article for the compilation and analysis of data
collected by the Department and may conduct or contract for studies on
insurance-related questions carried out in pursuance of the purposes of
this Article. The agreement may provide for the corporation, association or
entity to prepare and distribute or make available data to insurers,
government and the general public.
(b) The Director shall require, and the designated corporation,
association or entity shall prepare, semi-annual basic reports in the
aggregate on insurance cost trends in Illinois. The Director shall provide
these reports to the General Assembly, and upon request, to the public.
(c) Prior to the release or dissemination of these reports, the Director
or the designated corporation, association or entity, shall permit insurers
the opportunity to verify the accuracy of any information pertaining to the
insurer. The insurer may submit to the Director any corrections or errors
in the compilation of the data together with any supporting evidence and
documents the insurer may provide.
(Source: P.A. 84-1431.)
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(215 ILCS 5/1204) (from Ch. 73, par. 1065.904)
Sec. 1204. (A) The Director shall promulgate rules and regulations
which shall require each insurer licensed to write property or casualty
insurance in the State and each syndicate doing business on the Illinois
Insurance Exchange to record and report its loss and expense experience
and other data as may be necessary to assess the relationship of
insurance premiums and related income as compared to insurance costs and
expenses. The Director may designate one or more rate service
organizations or advisory organizations to gather and compile such
experience and data. The Director shall require each insurer licensed to
write property or casualty insurance in this State and each syndicate doing
business on the Illinois Insurance Exchange to submit a report, on
a form furnished by the Director, showing its direct writings in this
State and companywide.
(B) Such report required by subsection (A) of this Section may include,
but not be limited to, the following specific types of insurance written by
such insurer:
(1) Political subdivision liability insurance | ||
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(a) municipalities;
(b) school districts;
(c) other political subdivisions;
(2) Public official liability insurance;
(3) Dram shop liability insurance;
(4) Day care center liability insurance;
(5) Labor, fraternal or religious organizations | ||
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(6) Errors and omissions liability insurance;
(7) Officers and directors liability insurance | ||
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(a) non-profit entities;
(b) for-profit entities;
(8) Products liability insurance;
(9) Medical malpractice insurance;
(10) Attorney malpractice insurance;
(11) Architects and engineers malpractice insurance; | ||
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(12) Motor vehicle insurance reported separately for | ||
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(a) motor vehicle physical damage insurance;
(b) motor vehicle liability insurance.
(C) Such report may include, but need not be limited to the following data,
both
specific to this State and companywide, in the aggregate or by type of
insurance for the previous year on a calendar year basis:
(1) Direct premiums written;
(2) Direct premiums earned;
(3) Number of policies;
(4) Net investment income, using appropriate | ||
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(5) Losses paid;
(6) Losses incurred;
(7) Loss reserves:
(a) Losses unpaid on reported claims;
(b) Losses unpaid on incurred but not reported | ||
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(8) Number of claims:
(a) Paid claims;
(b) Arising claims;
(9) Loss adjustment expenses:
(a) Allocated loss adjustment expenses;
(b) Unallocated loss adjustment expenses;
(10) Net underwriting gain or loss;
(11) Net operation gain or loss, including net | ||
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(12) Any other information requested by the Director.
(C-3) Additional information by an advisory organization as defined in Section 463 of this Code. (1) An advisory organization as defined in Section | ||
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(a) paid and incurred losses for each of the past | ||
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(b) medical payments and medical charges, if | ||
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(c) the following indemnity payment information: | ||
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(d) injuries by frequency and severity; (e) by class of employee. (2) The report filed with the Secretary of Financial | ||
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(3) Reports required under this subsection (C-3) | ||
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(D) In addition to the information which may be requested under
subsection (C), the Director may also request on a companywide, aggregate
basis, Federal Income Tax recoverable, net realized capital gain or loss,
net unrealized capital gain or loss, and all other expenses not requested
in subsection (C) above.
(E) Violations - Suspensions - Revocations.
(1) Any company or person subject to this Article, | ||
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(2) No forfeiture liability under paragraph (1) of | ||
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(3) No forfeiture liability under paragraph (1) of | ||
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(4) All administrative hearings conducted pursuant to | ||
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(5) The civil penalty forfeitures provided for in | ||
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(6) In any case where the Director issues a notice of | ||
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(7) When any person or company has a license or | ||
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(8) When any person or company has a license or | ||
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(9) No suspension or revocation under this Section | ||
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(Source: P.A. 103-426, eff. 8-4-23.) |
(215 ILCS 5/1205) (from Ch. 73, par. 1065.905)
Sec. 1205.
Employees and Professional Consultants.
The Department may
employ and fix the compensation of such employees, and may enter into
contractual agreements with technical and professional consultants as it
deems necessary to expedite the purposes of this Article.
(Source: P.A. 84-1431.)
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(215 ILCS 5/1206) (from Ch. 73, par. 1065.906)
Sec. 1206. Expenses. The companies required to file reports under this
Article shall pay a reasonable fee established by the Director sufficient
to cover the total cost of the Department incident to or associated
with the administration and enforcement of this Article, including the
collection, analysis and distribution of the insurance cost data, the
conversion of hard copy reports to tape, and the compilation and
analysis of basic reports.
The Director may establish a schedule of fees for this purpose.
Expenses for additional reports shall be billed
to those requesting the reports. Any such fees collected under this Section
shall be paid to the Director of Insurance and deposited into the Technology Management
Revolving Fund and credited to the account of the
Department of Insurance.
(Source: P.A. 100-23, eff. 7-6-17.)
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(215 ILCS 5/Art. XLIII heading) ARTICLE XLIII.
Mortgage Insurance Consolidation
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(215 ILCS 5/1300) (from Ch. 73, par. 1065.1000)
Sec. 1300.
Title.
This Article may be cited as the Mortgage Insurance
Consolidation Law.
(Source: P.A. 86-378.)
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(215 ILCS 5/1301) (from Ch. 73, par. 1065.1001)
Sec. 1301.
Purpose.
The purpose of this Article is to protect the
interests of Illinois insureds by:
(1) establishing minimum standards and procedures for the effectuation
of mortgage insurance consolidations;
(2) establishing disclosure requirements specific to mortgage insurance
consolidations and requiring insurers to make such disclosures on a timely
basis;
(3) clarifying the applicability of the unfair rate discrimination
provisions of this Code to consolidations involved in loan transfers so as
to prevent premium increases for consumers resulting from mandatory premium
recalculation;
(4) requiring that group mortgage life insurance certificates
contain minimum standard provisions including conversion rights; and
(5) preventing the arbitrary termination of mortgage insurance coverage
in connection with consolidations.
(Source: P.A. 86-378.)
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(215 ILCS 5/1302) (from Ch. 73, par. 1065.1002)
Sec. 1302.
Scope.
(a) This Article applies:
(1) To all insurance companies authorized to transact the business of
insurance in this State of the kind or kinds of business described in Class
1(a) and (b) and Class 2(a) of Section 4 of this Code except for the kind
or kinds of business described in Article IX 1/2 of this Code.
(2) To all mortgage insurance coverage offered, issued, or issued
for delivery in this State, by mail or otherwise,
in connection with consolidations regardless of whether the financial
institution involved is located in or outside Illinois.
(3) To all consolidations whether the old coverage is provided under an
individual or group policy.
(b) Except as otherwise specifically provided, it is not intended that
this Article conflict with or supersede any other provisions of this Code,
or any rules promulgated by the Department of Insurance implementing any
such provisions.
(Source: P.A. 86-378.)
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(215 ILCS 5/1303) (from Ch. 73, par. 1065.1003)
Sec. 1303. Definitions. The following definitions shall apply to
this Article:
"Consolidation" means any transaction in which a financial institution
makes its premium collection services available to its mortgage debtors in
connection with a particular insurer's ("new insurer") offer of mortgage
insurance, which offer is made to debtors who, immediately prior to the
offer, had mortgage insurance with another insurer ("old insurer") and were
paying premiums for that insurance with their monthly mortgage payments.
"Financial institution" or "servicer" means any entity or organization
that services mortgage loans by collecting and accounting for monthly mortgage
insurance premiums as part of the debtor's monthly mortgage payment for one
or more insurers.
"Insured" means the individual loan customer or certificate holder.
"Loan transfer" means a transaction in which the servicing of a block of
mortgage loans is transferred from one servicer to another servicer.
This shall include, but not be limited to, mergers or acquisitions.
"Loan transfer consolidation" means a consolidation in which coverage is
limited to insureds whose mortgage loans have been sold or transferred in
the secondary market from one servicer to another.
"Group-to-group consolidation" means a consolidation in which coverages
under both the old plan and the new plan is provided under group policies.
"Mortgage insurance" means mortgage life insurance (term or ordinary),
mortgage disability insurance, mortgage accidental death insurance, or any
combination thereof, including both individual and group policies, and
any certificates issued thereunder, on credit transactions of more than 10
years duration and written in connection with a credit transaction that is
secured by a first mortgage or deed of trust and made to finance the
purchase of real property or the construction of a dwelling thereon or to
refinance a prior credit transaction made for such a purpose.
"New coverage" or "new plan" means the mortgage insurance coverage or
plan for which a financial institution collects premium beginning on the
effective date of a consolidation.
"New insurer" means any insurer who offers mortgage insurance coverage to
borrowers of the financial institution who can no longer remit monthly
premiums for the old insurer along with their monthly mortgage payment.
"Old coverage" or "old plan" means the mortgage insurance coverage or
plan for which a financial institution collects premiums immediately prior
to a consolidation.
"Old insurer" means any insurer for whom a financial institution will no
longer make its premium collection facilities available for all or some
of the insurer's policyholders or certificate holders.
(Source: P.A. 100-201, eff. 8-18-17.)
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(215 ILCS 5/1304) (from Ch. 73, par. 1065.1004)
Sec. 1304.
General requirements.
Except as provided in Section 1305, no
insurer shall participate in any consolidation unless, in addition to all
other requirements provided by law, it complies with the following:
(1) The new insurer must calculate premiums for the new coverage on the
basis of its own rates, the prospective insured's then attained age, if
applicable, and the amount of insurance offered.
(2) Notice of the new premium shall be mailed, together with the offer
of new coverage, to the prospective insured at least 30 days prior to the
effective date of the new coverage.
(3) The new coverage shall be put into effect only after the new insurer
receives an application which has been signed by the prospective insured.
(4) Whenever the existing coverage is provided under individual
policies, the new insurer shall comply with the requirements of Part 917 of
Title 50 of the Illinois Administrative Code, promulgated by the Department of Insurance.
(5) All riders which are a part of the existing insurance shall be
offered without proof of insurability to all policyholders (or certificate
holders) obtained by consolidation, including, but not limited to, waiver
of premium and accidental death insurance.
(6) Prospective insureds shall be given the option to name the
beneficiary of their choice by the new insurer, if the previous beneficiary
is other than a financial institution.
(7) Regulations including, but not limited to, those promulgated by the
Department of Insurance implementing Sections 143, 149, 151, 236, 237, 421,
424 and 507.1 of this Code concerning misrepresentations to any
policyholder for the purpose of inducing or tending to induce such
policyholder to lapse, forfeit or surrender his insurance, unfair or
deceptive practices, complaints, solicitation and replacement of life
insurance, compensation, and rebating shall be complied with.
(Source: P.A. 86-378.)
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(215 ILCS 5/1305) (from Ch. 73, par. 1065.1005)
Sec. 1305.
Loan transfer consolidations.
In a consolidation conducted
as a result of a loan transfer, the offer of new coverage may be based on
the same premium the insured was paying for his old coverage only if, in
addition to all other requirements provided by law, the following conditions
are met:
(1) Both the old and the new coverage must be provided under a group policy.
(2) An offer of new coverage must be made as soon as reasonably possible
after the loan transfer. If an offer of new coverage is not made within 30
days after the loan transfer, or at least 30 days prior to the proposed
effective date of the new coverage, the insurer shall notify the debtor,
in writing, that he has the right to an unconditional refund of all
premiums paid for the new coverage as long as he exercises that right, in
writing, within 30 days from the date of the notification.
(3) The new coverage offered to the prospective insured must be the same
as the old coverage, including all supplemental benefits provided under the
old plan. If the coverage offered is not the same, then all the
requirements of Section 1304 shall apply.
(4) In addition to the requirements of Section 1307, the certificate
shall contain the following notice, printed in bold type on page one of
the certificate:
IMPORTANT NOTICE
This certificate is issued to you in connection with a mortgage insurance
consolidation. It is the intention of the Company to provide you group
coverage which is equal to or better than the group coverage you had
before. To the extent the benefits provided or the provisions of your
prior certificate of insurance are more liberal than those under this
certificate, the provisions of your prior certificate will control.
Therefore, you should keep your old certificate along with this certificate
for comparison purposes.
(5) The information contained in the notice prescribed by paragraph (4)
shall also be disclosed in writing (separate from the certificate of
insurance) to each prospective insured at the time the offer of new
coverage is made.
(6) Only the group coverage written in connection with the loans which are
the subject of the loan transfer may be consolidated pursuant to this Section.
(7) Payment of the required premium shall constitute acceptance of the
new coverage if:
(A) such acceptance mechanism is clearly explained to the debtor; and
(B) All other disclosure requirements of this Article are met.
(8) Regulations including, but not limited to, those promulgated by the
Department of Insurance implementing Sections 143, 149, 151, 236, 237, 421,
424 and 507.1 of this Code concerning misrepresentations to any
policyholder for the purpose of inducing or tending to induce such
policyholder to lapse, forfeit or surrender his insurance, unfair or
deceptive practices, complaints, solicitation and replacement of life
insurance, compensation and rebating shall be complied
with.
(9) If an insurer charges debtor insureds the same premium for the new
coverage that they were paying for the old coverage, and, as a result,
debtor insureds of a financial institution are charged different premium
rates for the same coverage, such rate differences shall not constitute
unfair discrimination under Sections 236 and 364 of this Code provided all
the other applicable requirements of this Code are met.
(Source: P.A. 86-378.)
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(215 ILCS 5/1306) (from Ch. 73, par. 1065.1006)
Sec. 1306.
Out-of-state consolidations.
If Illinois residents whose
loans are serviced outside Illinois are involved in a group-to-group
consolidation by an out-of-state servicer, Section 1305 may be employed if
the Illinois residents are an incidental part of the consolidation.
Otherwise the provisions of this Article shall apply to any consolidation
insofar as it involves Illinois residents. For purposes of this provision
"incidental" shall mean that the Illinois residents comprise less than 25%
or 100 lives of the total lives involved in the consolidation, whichever
is less.
(Source: P.A. 86-378.)
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(215 ILCS 5/1307) (from Ch. 73, par. 1065.1007)
Sec. 1307.
Group certificates.
No insurer may participate in a
group-to-group consolidation or a loan transfer consolidation unless in
addition to all other requirements provided by law, it complies with
the following:
(1) A group certificate must be delivered to each debtor insured under
the new plan, which certificate shall include the following information:
(A) the name or names of the single or joint insureds;
(B) identification of the insured mortgage;
(C) the amount of insurance under the new plan;
(D) the premium for the new coverage;
(E) the effective date of the new coverage;
(F) the beneficiary for the new coverage.
(2) The new coverage offered to the prospective insured must be the same
coverage as the old coverage, including all supplemental benefits, or the
same type of coverage as the old coverage, whichever is otherwise required
by this Article.
(3) A group certificate evidencing the new coverage may not include a
contestability clause or, in the case of mortgage life insurance, a
provision excluding suicide.
(Source: P.A. 86-378.)
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(215 ILCS 5/1308) (from Ch. 73, par. 1065.1008)
Sec. 1308.
Conversion privilege.
Notwithstanding the provisions of
Section 231.1(H) of this Code, all group mortgage life insurance policies
and any certificates issued thereunder shall include a conversion privilege
permitting a debtor insured to convert, without evidence of insurability,
to an individual policy of decreasing term insurance within 30 days of the
date the debtor insured's group coverage is terminated for any reason other
than the nonpayment of premiums. The initial amount of coverage under the
individual policy shall be an amount equal to the amount of coverage
terminated under the group policy and shall decrease over a term that
corresponds with the scheduled term of the insured debtor's mortgage loan.
The premium for the individual policy shall be the same
premium the debtor insured was paying under the group policy.
(Source: P.A. 86-378.)
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(215 ILCS 5/1309) (from Ch. 73, par. 1065.1009)
Sec. 1309.
Required disclosures.
(a) In conjunction with the offer of new
coverage involving any consolidation, the new insurer shall disclose in
writing to each insured under the old plan or plans at least 30 days prior
to the effective date of the new coverage the following:
(1) Identification of the insured mortgage.
(2) The name of the insured or insureds.
(3) Name of the owner of the individual policy or master policy (if
group insurance) under both the new and old plans, if known.
(4) The premium for the new and old coverage.
(5) Amount of coverage for both the new and old plans. If the amount of
coverage for the old plan is not known, a statement that the amount may be
scheduled and it may be less than or greater than the amount of the loan
and the insured should check the policy schedule for an exact amount of
coverage.
(6) Effective dates of the old coverage if the contestable or suicide
period have not expired as of the effective date of the new coverage. If
the new insurer waives the contestable and suicide period, then the
effective date of the old coverage does not need to be disclosed.
(7) Name of the beneficiary under the old plan, if known.
(8) A statement as to whether the old plan was an individual or group
plan and a statement as to whether the new plan is an individual or a
group plan.
(9) A statement that neither the old plan or new plan is required.
(10) A statement that the prospective insured may have the right to
continue or convert his old coverage by paying premiums directly to the old
insurer, and what the prospective insured must do to keep the old coverage
in effect including, but not limited to, the name and address of the
company involved, the policy number or other information which reasonably
identifies the insured's plan of coverage, the amount of the premium and
where it is to be sent.
(11) A statement that the mortgage payment will be reduced by the amount
of the old plan premium if the new plan is not accepted.
(12) Name and home office address of the new and old insurer, as well as
the address and phone number for the customer services office for Illinois
insureds.
(13) The effective date of the new coverage.
(14) Whether premium rates under the new plan are guaranteed.
(15) Material differences, if any between the new plan and the old plan.
(b) Any insurer which fails to provide the written notice required by
subsection (a) at least 30 days prior to the effective date of the new
coverage shall notify the debtor, in writing, that he has the right to an
unconditional refund of all premiums paid for the new coverage as long as
he exercises that right, in writing, within 30 days from that notification.
(Source: P.A. 86-378.)
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(215 ILCS 5/1310) (from Ch. 73, par. 1065.1010)
Sec. 1310.
Compensation.
No sponsorship fees, or other special fees
designed to induce their participation, shall be paid to a financial
institution in connection with any mortgage consolidation, and any
compensation paid to either the financial institution or any of its
representatives shall be only in accordance with Section 151 and all other
applicable provisions of this Code.
(Source: P.A. 86-378.)
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(215 ILCS 5/1311) (from Ch. 73, par. 1065.1011)
Sec. 1311.
No group policy or group certificate of mortgage insurance
used in connection with a consolidation, nor any application, endorsement
or rider which becomes a part of any such group policy or certificate, may
be issued or delivered in this State until a copy of the form has been
filed with and approved by the Director.
(Source: P.A. 86-378.)
|
(215 ILCS 5/1312) (from Ch. 73, par. 1065.1012)
Sec. 1312.
The Director is authorized to adopt such rules governing
mortgage insurance consolidations as he deems necessary to implement or
enforce this Article.
(Source: P.A. 86-378.)
|
(215 ILCS 5/Art. XLIV heading) Article XLIV.
FINANCIAL INSTITUTIONS
INSURANCE SALES LAW
|
(215 ILCS 5/1400)
Sec. 1400.
Title.
This Article may be cited as the Financial Institutions
Insurance Sales Law.
(Source: P.A. 90-41, eff. 10-1-97.)
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(215 ILCS 5/1401)
Sec. 1401.
Purpose.
The purpose of this Article is to increase the
availability of insurance products to the citizens of this State by expanding
those businesses authorized to sell insurance products to include financial
institutions, and to protect the interests of the citizens of this State by
regulating their authority to do so. This Article does not apply to activities
or services conducted in this State by or for a financial institution that do
not require
licensure as an insurance producer, temporary
insurance producer, limited insurance representative, or registered firm.
(Source: P.A. 90-41, eff. 10-1-97.)
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(215 ILCS 5/1402)
Sec. 1402.
Definitions.
For the purposes of this Article:
"Financial institution" means:
(1) a State bank, a national bank, or an out-of-state | ||
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(2) a foreign banking corporation, as that term is | ||
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(3) a corporate fiduciary, as that term is defined in | ||
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(4) a savings bank organized under the Savings Bank | ||
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(5) an association or federal association, as those | ||
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(6) an out-of-state savings and loan association | ||
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(7) a credit union as defined in the Illinois Credit | ||
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To the extent that any entity other than a financial institution conducts
insurance activities in this State on behalf of or on the premises of the
financial
institution, such entity shall be subject to this Article for the purposes of
those activities.
"Insurance" means all lines of insurance defined and regulated as insurance
under this Code, but for the purposes of this Article, "insurance" shall not
include the following lines of insurance, provided that this paragraph shall
not be deemed to preclude or otherwise limit regulation of the following lines
of insurance pursuant to and to the extent otherwise provided by any other
insurance law of this State:
(1) credit life, credit accident and health, credit | ||
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(2) extended service contracts and warranty | ||
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(3) insurance obtained by the debtor to provide | ||
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(4) insurance placed by a financial institution on | ||
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(5) title insurance regulated by the Title Insurance | ||
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(6) private mortgage insurance and financial | ||
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(Source: P.A. 90-41, eff. 10-1-97.)
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(215 ILCS 5/1403)
Sec. 1403. Licensure requirements for financial institutions.
(a) A financial institution transacting insurance business in this State
shall register with the Director pursuant to the Illinois Insurance Code and
shall be subject to the laws, rules, and penalties of the Illinois Insurance
Code.
(b) The solicitation and sale of insurance by a financial institution
shall be conducted only by individuals who have been issued and maintain an
insurance producer's license pursuant to the Illinois Insurance Code and shall
be subject to the laws, rules, and penalties of the Illinois Insurance Code.
(c) For the purposes of this Section, a "financial institution" means the
subsidiary of a financial institution when the financial institution is
transacting insurance business in this State only through the subsidiary. For
the purposes of Section 499.1 of the Illinois Insurance Code, a financial
institution shall be deemed to be a corporation.
(d) Nothing in Section 500-100 of this Code shall be construed to require a limited lines producer license or any other form or class of producer's license for financial institutions, or their employees, if the financial institution has purchased or sponsored a group credit life, credit accident and health, credit casualty, credit property, or other group credit insurance policy or program under which the financial institution enrolls or performs other administrative services, or both, to enable individuals to purchase insurance coverage under the group credit insurance policy sold by a licensed producer in compliance with Section 155.56. A financial institution that performs enrollment or other administrative services, or both, with respect to its group credit insurance policies or programs shall be deemed to be in compliance with paragraph (2) of subsection (b) of Section 500-20 of this Code. (Source: P.A. 100-349, eff. 8-25-17.)
|
(215 ILCS 5/1404)
Sec. 1404.
Subsidiaries or divisions.
A financial institution shall not
qualify for registration as a registered firm under Section 499.1 of
this Code unless: (1) it establishes a separate subsidiary that
acts as the registered firm or (2) it is otherwise permitted by law to sell
insurance directly through the financial institution, and it establishes a
separate division within the financial institution to conduct the business of
the registered firm. The subsidiary or division acting as a registered firm
shall maintain records for insurance transactions that are
separate and distinct from the records of the financial institution.
(Source: P.A. 90-41, eff. 10-1-97.)
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(215 ILCS 5/1405)
Sec. 1405.
Extensions of credit.
A financial institution shall not delay
or impede the completion of a loan transaction or other transactions involving
the extension of credit for the purpose of influencing a customer's selection
of any insurance product.
(Source: P.A. 90-41, eff. 10-1-97.)
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(215 ILCS 5/1406)
Sec. 1406.
Insurance and financial institution products.
(a) No financial institution may offer banking products or services, or fix
or vary the consideration of the offer, on a condition or requirement that the
customer obtain insurance from the financial institution or any affiliate of
the financial institution.
(b) A financial institution that offers banking products or services in
conformity with the provisions of Section 106 of the Bank Holding Company Act
Amendments of 1970 (12 U.S.C. 1972) shall be deemed to be in compliance with
the provisions of subsection (a) of this Section.
(c) No financial institution shall require that a customer or prospective
customer of the financial institution purchase an insurance product from any
particular registered firm or insurance producer as a condition for the lending
of money or extension of credit, the establishment or maintenance of a
checking, savings, or other deposit account, or the establishment or
maintenance
of a trust account.
(Source: P.A. 90-41, eff. 10-1-97.)
|
(215 ILCS 5/1407)
Sec. 1407.
Rebating and discounting.
(a) No financial institution may offer a rebate on
an insurance product in violation of Section 151 of this
Code.
(b) No financial institution may offer a discount on a loan or extension of
credit for the purpose of inducing the customer to purchase insurance required
in connection with the loan or extension of credit.
(Source: P.A. 90-41, eff. 10-1-97.)
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(215 ILCS 5/1408)
Sec. 1408.
Discrimination prohibited.
No financial institution may:
(1) require as a condition of providing any product or service or renewal of
any contract for providing a product or service to any customer, that the
customer acquire, finance, or negotiate any policy or contract of insurance
through a particular insurer, insurance producer, or registered firm;
(2) in connection with a loan or extension of credit that requires a borrower
to obtain insurance, reject an insurance policy solely because the policy has
been issued or underwritten by any person who is not associated with the
financial institution;
(3) impose any discriminatory requirement on any insurance producer who is
not associated with the financial institution that is not imposed on any
insurance producer who is associated with the financial institution; or
(4) if the financial institution is a registered firm, require any debtor,
insurer, or insurance producer to pay a separate charge in connection with the
handling of insurance
that is required under a contract, unless: (i) the financial institution is the
registered firm
providing the insurance, (ii) if the financial institution is not the
registered
firm providing the insurance, the charge would be uniformly applied if the
financial institution was the registered firm providing the insurance, or (iii)
the charge is otherwise permitted by this Code or other
applicable State or federal law.
(Source: P.A. 90-41, eff. 10-1-97.)
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(215 ILCS 5/1409)
Sec. 1409.
Disclosure.
A financial institution shall clearly and
conspicuously disclose in any written advertisement or promotional or
informational material regarding an insurance product that the insurance
offered, recommended, sponsored, or sold:
(1) is not a deposit;
(2) is not insured by the Federal Deposit Insurance Corporation, or in the
case of a credit union, by the National Credit Union Share Insurance Fund;
(3) is not guaranteed by the financial institution or an affiliated insured
depository institution; and
(4) where appropriate, involves investment risk, including potential loss of
principal.
(Source: P.A. 90-41, eff. 10-1-97.)
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(215 ILCS 5/1410)
Sec. 1410.
Misleading advertising.
No financial institution or registered
firm may employ any advertisement that would mislead or otherwise cause a
reasonable person to believe mistakenly that the State of Illinois or the
federal government is responsible for the insurance sales activities of the
financial institution or stands behind the financial institution's credit, or
that the financial institution, the State of Illinois, or the federal
government guarantees any returns on insurance products or is a source of
payment of any insurance obligation of or sold by the financial institution.
(Source: P.A. 90-41, eff. 10-1-97.)
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(215 ILCS 5/1411)
Sec. 1411.
Commissions and compensation.
No financial institution shall
pay, directly or indirectly, any commission, service fee, brokerage, or other
valuable consideration to any person for services as an insurance producer,
temporary insurance producer, or limited insurance representative, or for such
services by the person's members, officers, directors or employees, unless the
person, and any member, officer, director, or employee performing the service,
held a valid license regarding the class of insurance as to which the service
was rendered, or unless the person was a properly registered firm at the time
the service was performed. No person, other than a person properly licensed
or registered in accordance with Article XXXI of this Code at
the time the person performs services as an insurance producer, temporary
insurance producer, or limited insurance representative, shall accept any
commission, service fee, brokerage, or other valuable consideration for such
services. This Section shall not prevent payment or receipt of:
(1) renewal or other deferred commissions to or by any person entitled
thereto under this Section;
(2) fees to or by a financial institution or any other person for services
that do not require licensure as an insurance producer, temporary insurance
producer, limited insurance representative,
or registered firm; or
(3) consideration paid to a financial institution by a registered firm,
insurance producer, insurance company, or any other person pursuant to any
lease
agreement.
(Source: P.A. 90-41, eff. 10-1-97.)
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(215 ILCS 5/1412)
Sec. 1412.
Solicitations to loan applicants.
(a) A financial institution that
requires a customer to obtain insurance in connection with a loan or extension
of credit and that offers that insurance either directly or through an
affiliate shall clearly disclose to the customer in writing at the time of
written application or at closing if no written application is obtained
in a form substantially similar to the following:
"You may obtain insurance required in connection with | ||
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(b) This Section shall not apply when a financial institution is contacting
a customer in the course of direct or mass marketing to a group of persons in a
manner that bears no relation to the customer's loan application or credit
decision.
(Source: P.A. 90-41, eff. 10-1-97.)
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(215 ILCS 5/1413)
Sec. 1413.
Separate physical location and sales force when insurance is
solicited or sold in connection with a loan.
(a) An employee of a financial institution may not solicit or sell
insurance at the same desk where a loan transaction is conducted when the
insurance is solicited or sold in connection with the same loan.
(b) A loan officer of a financial institution
who is involved in the application, solicitation, or closing of a loan
transaction may not solicit or sell insurance in connection with the same loan,
but such loan officer may refer the loan customer to another insurance producer
who is not involved in the application, solicitation, or closing of the same
loan transaction.
(c) Subsections (a) and (b) of this Section shall not apply to a financial
institution, other than a credit union, or a branch location of a financial
institution, other than a credit union, that has less than
$100,000,000 in deposits.
(d) Subsections (a) and (b) of this Section shall not apply to a credit
union or a branch location of a credit union that has less than $30,000,000 in
deposits.
(Source: P.A. 90-41, eff. 10-1-97.)
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(215 ILCS 5/1414)
Sec. 1414.
Signage.
Signs concerning the availability of insurance
products offered by the financial institution or by any registered firm shall
be
clearly displayed in the same area where applications for loans or other
extensions of
credit are being taken or closed and shall include the disclosure set forth in
subsection (a) of Section 1412.
(Source: P.A. 90-41, eff. 10-1-97.)
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(215 ILCS 5/1415)
Sec. 1415.
Confidential customer information.
(a) A financial institution that is a registered firm may not release a
customer's insurance information to any person other than an officer, director,
employee, agent, or affiliate of the financial institution without the written
consent of the customer. For the purposes of this Section, "insurance
information" means information concerning the premiums, terms and conditions
of
insurance coverage, insurance claims, and the insurance history of a customer
contained in the financial institution's records.
(b) Subsection (a) of this Section shall not apply to:
(1) names, addresses, and telephone numbers derived | ||
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(2) the release of insurance information as otherwise | ||
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(c) A financial institution shall not require premium information when
requiring evidence of insurance in connection with a loan or extension of
credit and shall not use such premium information for the purpose of soliciting
insurance without the written consent of the customer.
(d) A financial institution may not use health information obtained from a
customer's insurance records for any purpose other than for its activities as a
registered firm pursuant to this Code.
(Source: P.A. 90-41, eff. 10-1-97.)
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(215 ILCS 5/1416)
Sec. 1416.
Prohibited defenses.
A violation of any provision of this Article shall not be used as a
defense by any person in any action by a financial institution to recover the
amount owing on any loan or extension of credit.
(Source: P.A. 90-41, eff. 10-1-97.)
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(215 ILCS 5/Art. XLV heading)
ARTICLE XLV. PUBLIC ADJUSTERS
(Source: P.A. 96-1332, eff. 1-1-11.) |
(215 ILCS 5/1501)
Sec. 1501. Short title. This Article may be cited as the Public Adjusters Law.
(Source: P.A. 96-1332, eff. 1-1-11.) |
(215 ILCS 5/1505)
Sec. 1505. Purpose and scope. This Article governs the qualifications and procedures for the licensing of public adjusters. It specifies the duties of and restrictions on public adjusters, which include limiting their licensure to assisting insureds in first party claims.
(Source: P.A. 96-1332, eff. 1-1-11.) |
(215 ILCS 5/1510) Sec. 1510. Definitions. In this Article: "Adjusting a claim for loss or damage covered by an insurance contract" means negotiating values, damages, or depreciation or applying the loss circumstances to insurance policy provisions. "Adjusting insurance claims" means representing an insured with an insurer for compensation and, while representing that insured, either negotiating values, damages, or depreciation or applying the loss circumstances to insurance policy provisions. "Business entity" means a corporation, association, partnership, limited liability company, limited liability partnership, or other legal entity. "Department" means the Department of Insurance. "Director" means the Director of Insurance. "Fingerprints" means an impression of the lines on the finger taken for the purpose of identification. The impression may be electronic or in ink converted to electronic format. "Home state" means the District of Columbia and any state or territory of the United States where the public adjuster's principal place of residence or principal place of business is located. If neither the state in which the public adjuster maintains the principal place of residence nor the state in which the public adjuster maintains the principal place of business has a substantially similar law governing public adjusters, the public adjuster may declare another state in which it becomes licensed and acts as a public adjuster to be the home state. "Individual" means a natural person. "Person" means an individual or a business entity. "Public adjuster" means any person who, for compensation or any other thing of value on behalf of the insured: (i) acts, aids, or represents the insured solely in | ||
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(ii) advertises for employment as a public adjuster | ||
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(iii) directly or indirectly solicits business, | ||
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"Uniform individual application" means the current version of the National Association of Directors (NAIC) Uniform Individual Application for resident and nonresident individuals. "Uniform business entity application" means the current version of the National Association of Insurance Commissioners (NAIC) Uniform Business Entity Application for resident and nonresident business entities.
"Webinar" means an online educational presentation during which a live and participating instructor and participating viewers, whose attendance is periodically verified throughout the presentation, actively engage in discussion and in the submission and answering of questions. (Source: P.A. 102-135, eff. 7-23-21; 103-216, eff. 1-1-24.) |
(215 ILCS 5/1515) Sec. 1515. License required. (a) A person shall not act, advertise, solicit, or hold himself out as a public adjuster or to be in the business of adjusting insurance claims in this State, nor attempt to obtain a contract for public adjusting services, unless the person is licensed as a public adjuster in accordance with this Article. (b) A person licensed as a public adjuster shall not misrepresent to a claimant that he or she is an adjuster representing an insurer in any capacity, including acting as an employee of the insurer or acting as an independent adjuster unless so appointed by an insurer in writing to act on the insurer's behalf for that specific claim or purpose. A licensed public adjuster is prohibited from charging that specific claimant a fee when appointed by the insurer and the appointment is accepted by the public adjuster. (c) A business entity acting as a public adjuster is required to obtain a public adjuster license. Application shall be made using the Uniform Business Entity Application. Before approving the application, the Director shall find that: (1) the business entity has paid the required fees | ||
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(2) all officers, shareholders, and persons with | ||
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(d) Notwithstanding subsections (a) through (c) of this Section, a license as a public adjuster shall not be required of the following: (1) an attorney admitted to practice in this State, | ||
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(2) a person who negotiates or settles claims arising | ||
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(3) a person employed only for the purpose of | ||
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(4) a licensed health care provider, or employee of a | ||
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(5) a person who settles subrogation claims between | ||
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(e) All contracts entered into that are in violation of this Section are void and invalid.
(Source: P.A. 103-216, eff. 1-1-24.) |
(215 ILCS 5/1520)
Sec. 1520. Application for license. (a) A person applying for a public adjuster license shall make application to the Director on the appropriate uniform application or other application prescribed by the Director. (b) The applicant shall declare under penalty of perjury and under penalty of refusal, suspension, or revocation of the license that the statements made in the application are true, correct, and complete to the best of the applicant's knowledge and belief. (c) In order to make a determination of license eligibility, the Director is authorized to require all applicants for licensing, including renewal applicants, to undergo a fingerprint-based criminal history record check for the first year following the effective date of this amendatory Act of the 97th General Assembly. The fingerprints and the fee required to perform the criminal history record checks shall be submitted to the Illinois State Police and the Federal Bureau of Investigation (FBI) to conduct a State and national criminal history record check. The Illinois State Police and the Federal Bureau of Investigation shall furnish to the Department of Insurance all records of convictions, unless or until expunged, pursuant to the fingerprint-based criminal history records check. The Illinois State Police shall charge a fee for conducting such checks, which fee shall be deposited into the State Police Services Fund and shall not exceed the cost of the inquiry. The applicant shall be required to pay all fees associated with conducting the criminal history record check. (d) The Director may adopt rules to establish procedures necessary to carry out the requirements of subsection (c) of this Section. (e) The Director is authorized to submit electronic fingerprint records and necessary identifying information to the NAIC, its affiliates, or subsidiaries for permanent retention in a centralized repository. The purpose of such a centralized repository is to provide Directors with access to fingerprint records in order to perform criminal history record checks. (f) Until such time as the Director can obtain and receive national criminal history records, the applicant shall obtain a copy of his or her fingerprints and complete criminal history record from the FBI Criminal Justice Information Services Division and the Illinois State Police and provide such information to the Department of Insurance.
(Source: P.A. 102-538, eff. 8-20-21.) |
(215 ILCS 5/1525) Sec. 1525. Resident license. (a) Before issuing a public adjuster license to an applicant under this Section, the Director shall find that the applicant: (1) is eligible to designate this State as his or her | ||
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(2) is sufficiently rehabilitated in cases in which | ||
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(3) is trustworthy, reliable, competent, and of good | ||
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(4) is financially responsible to exercise the | ||
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(5) maintains an office in the home state of | ||
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(b) In addition to satisfying the requirements of subsection (a) of this Section, an individual shall: (1) be at least 18 years of age; (2) have successfully passed the public adjuster | ||
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(3) designate a licensed individual public adjuster | ||
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(4) designate only licensed individual public | ||
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(c) The Director may require any documents reasonably necessary to verify the information contained in the application.
(Source: P.A. 100-286, eff. 1-1-18.) |
(215 ILCS 5/1530) Sec. 1530. Examination. (a) An individual applying for a public adjuster license under this Article must pass a written examination unless he or she is exempt pursuant to Section 1535 of this Article. The examination shall test the knowledge of the individual concerning the duties and responsibilities of a public adjuster and the insurance laws and regulations of this State. Examinations required by this Section shall be developed and conducted under rules and regulations prescribed by the Director. (b) The Director may make arrangements, including contracting with an outside testing service, for administering examinations and collecting the nonrefundable fee. Each individual applying for an examination shall remit a nonrefundable fee as prescribed by the Director. An individual who fails to appear for the examination as scheduled or fails to pass the examination shall reapply for an examination and remit all required fees and forms before being rescheduled for another examination. An individual who fails to pass the examination on his or her first attempt must wait 7 days prior to rescheduling an examination. An individual who fails to pass the examination on his or her second or subsequent attempt must wait 30 days prior to rescheduling an examination.
(Source: P.A. 99-266, eff. 1-1-16.) |
(215 ILCS 5/1535)
Sec. 1535. Exemptions from examination. (a) An individual who applies for a public adjuster license in this State who was previously licensed as a public adjuster in another state based on a public adjuster examination shall not be required to complete any examination. This exemption is only available if (i) the person is currently licensed in that state or if the application is received within 12 months of the cancellation of the applicant's previous license; and (ii) if the prior state issues a certification that, at the time of cancellation, the applicant was in good standing in that state or the state's producer database records or records maintained by the NAIC, its affiliates, or subsidiaries, indicate that the public adjuster is or was licensed in good standing. (b) A person licensed as a public adjuster in another state based on a public adjuster examination who moves to this State shall submit an application within 90 days of establishing legal residence to become a resident licensee pursuant to Section 1525 of this Article. No prelicensing examination shall be required of that person to obtain a public adjuster license. (c) An individual who applies for a public adjuster license in this State who was previously licensed as a public adjuster in this State shall not be required to complete any prelicensing examination. This exemption is only available if the application is received within 12 months of the cancellation of the applicant's previous license in this State and if, at the time of cancellation, the applicant was in good standing in this State.
(Source: P.A. 96-1332, eff. 1-1-11; 97-207, eff. 7-28-11.) |
(215 ILCS 5/1540)
Sec. 1540. Nonresident license reciprocity. (a) Unless denied licensure pursuant to Section 1555 of this Article, a nonresident person shall receive a nonresident public adjuster license if: (1) the person is currently licensed as a resident | ||
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(2) the person has submitted the proper request for | ||
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(3) the person has submitted or transmitted to the | ||
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(4) the person's home state awards nonresident public | ||
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(b) The Director may verify the public adjuster's licensing status through the producer database maintained by the NAIC, its affiliates, or subsidiaries. (c) As a condition to continuation of a public adjuster license issued under this Section, the licensee shall maintain a resident public adjuster license in his or her home state. The nonresident public adjuster license issued under this Section shall terminate and be surrendered immediately to the Director if the home state public adjuster license terminates for any reason, unless the public adjuster has been issued a license as a resident public adjuster in his or her new home state. Notification to the state or states where the nonresident license is issued must be made as soon as possible, yet no later than 30 days of change in new state resident license. The licensee shall include his or her new and old address on the notification. A new state resident license is required for nonresident licenses to remain valid. The new state resident license must have reciprocity with the licensing nonresident state or states for the nonresident license not to terminate.
(Source: P.A. 96-1332, eff. 1-1-11; 97-813, eff. 7-13-12.) |
(215 ILCS 5/1545)
Sec. 1545. License. (a) Unless denied licensure under this Article, persons who have met the requirements of this Article shall be issued a public adjuster license. (b) A public adjuster license shall remain in effect unless revoked, terminated, or suspended as long as the requirements for license renewal are met by the due date. (c) The licensee shall inform the Director by any means acceptable to the Director of a change of address, change of legal name, or change of information submitted on the application within 30 days of the change. (d) A licensed public adjuster shall be subject to Article XXVI of this Code. (e) A public adjuster who allows his or her license to lapse may, within 12 months from the due date of the renewal, be issued a new public adjuster license without necessity of passing a written examination. However, a penalty in the amount of double the unpaid renewal fee shall be required for the issue of the new public adjuster license. (f) A licensed public adjuster that is unable to comply with license renewal procedures due to military service or a long-term medical disability may request a waiver of the procedures in subsection (e) of this Section. The public adjuster may also request a waiver of any examination requirement, fine, or other sanction imposed for failure to comply with renewal procedures. (g) The license shall contain the licensee's name, city and state of business address, personal identification number, the date of issuance, the expiration date, and any other information the Director deems necessary. (h) In order to assist in the performance of the Director's duties, the Director may contract with non-governmental entities, including the NAIC or any affiliates or subsidiaries that the NAIC oversees, to perform any ministerial functions, including the collection of fees and data, related to licensing that the Director may deem appropriate.
(Source: P.A. 96-1332, eff. 1-1-11.) |
(215 ILCS 5/1550) Sec. 1550. Applicant convictions. (a) The Director and the Department shall not require applicants to report the following information and shall not collect or consider the following criminal history records in connection with a public adjuster license application: (1) Juvenile adjudications of delinquent minors as | ||
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(2) Law enforcement records, court records, and | ||
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(3) Records of arrest not followed by a formal charge | ||
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(4) Records of arrest where charges were dismissed | ||
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(5) Convictions overturned by a higher court. (6) Convictions or arrests that have been sealed or | ||
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(b) The Director, upon a finding that an applicant for a license under this Act was previously convicted of any felony or a misdemeanor involving dishonesty or fraud, shall consider any mitigating factors and evidence of rehabilitation contained in the applicant's record, including any of the following factors and evidence, to determine if a license may be denied because the prior conviction will impair the ability of the applicant to engage in the position for which a license is sought: (1) the bearing, if any, of the offense for which | ||
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(2) whether the conviction suggests a future | ||
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(3) if the applicant was previously licensed or | ||
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(4) whether 5 years since a felony conviction or 3 | ||
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(5) successful completion of sentence and, for | ||
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(6) evidence of the applicant's present fitness and | ||
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(7) evidence of rehabilitation or rehabilitative | ||
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(8) any other mitigating factors that contribute to | ||
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(c) If a nonresident licensee meets the standards set forth in items (1) through (4) of subsection (a) of Section 1540 and has received consent pursuant to 18 U.S.C. 1033(e)(2) from his or her home state, the Director shall grant the nonresident licensee a license. (d) If the Director refuses to issue a license to an applicant based on a conviction or convictions, in whole or in part, then the Director shall notify the applicant of the denial in writing with the following included in the notice of denial: (1) a statement about the decision to refuse to issue | ||
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(2) a list of convictions that the Director | ||
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(3) a list of the convictions that were the sole or | ||
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(4) a summary of the appeal process or the earliest | ||
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(Source: P.A. 103-216, eff. 1-1-24.) |
(215 ILCS 5/1555) Sec. 1555. License denial, nonrenewal, or revocation. (a) The Director may place on probation, suspend, revoke, deny, or refuse to issue or renew a public adjuster's license or may levy a civil penalty or any combination of actions, for any one or more of the following causes: (1) providing incorrect, misleading, incomplete, or | ||
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(2) violating any insurance laws, or violating any | ||
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(3) obtaining or attempting to obtain a license | ||
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(4) improperly withholding, misappropriating, or | ||
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(5) intentionally misrepresenting the terms of an | ||
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(6) having been convicted of any felony or a | ||
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(7) having admitted or been found to have committed | ||
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(8) using fraudulent, coercive, or dishonest | ||
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(9) having an insurance license or public adjuster | ||
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(10) forging another's name to an application for | ||
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(11) cheating, including improperly using notes or | ||
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(12) knowingly accepting insurance business from or | ||
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(13) failing to comply with an administrative or | ||
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(14) failing to pay State income tax or comply with | ||
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(15) failing to comply with or having violated any of | ||
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(16) failing to maintain the records required by | ||
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(b) If the action by the Director is to nonrenew, suspend, or revoke a license or to deny an application for a license, the Director shall notify the applicant or licensee and advise, in writing, the applicant or licensee of the reason for the suspension, revocation, denial, or nonrenewal of the applicant's or licensee's license. The applicant or licensee may make written demand upon the Director within 30 days after the date of mailing for a hearing before the Director to determine the reasonableness of the Director's action. The hearing must be held within not fewer than 20 days nor more than 30 days after the mailing of the notice of hearing and shall be held pursuant to 50 Ill. Adm. Code 2402. (c) The license of a business entity may be suspended, revoked, or refused if the Director finds, after hearing, that an individual licensee's violation was known or should have been known by one or more of the partners, officers, or managers acting on behalf of the business entity and the violation was neither reported to the Director, nor corrective action taken. (d) In addition to or in lieu of any applicable denial, suspension or revocation of a license, a person may, after hearing, be subject to a civil penalty. In addition to or instead of any applicable denial, suspension, or revocation of a license, a person may, after hearing, be subject to a civil penalty of up to $10,000 for each cause for denial, suspension, or revocation, however, the civil penalty may total no more than $100,000. (e) The Director shall retain the authority to enforce the provisions of and impose any penalty or remedy authorized by this Article against any person who is under investigation for or charged with a violation of this Article even if the person's license or registration has been surrendered or has lapsed by operation of law. (f) Any individual whose public adjuster's license is revoked or whose application is denied pursuant to this Section shall be ineligible to apply for a public adjuster's license for 5 years. A suspension pursuant to this Section may be for any period of time up to 5 years.
(Source: P.A. 103-216, eff. 1-1-24.) |
(215 ILCS 5/1560) Sec. 1560. Bond or letter of credit. (a) Prior to the issuance of a license as a public adjuster and for the duration of the license, the applicant shall secure evidence of financial responsibility in a format prescribed by the Director through a surety bond or irrevocable letter of credit, subject to all of the following requirements: (1) A surety bond executed and issued by an insurer | ||
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(A) shall be in the minimum amount of $50,000; (B) shall be in favor of this State and shall | ||
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(C) shall not be terminated unless at least 30 | ||
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(2) An irrevocable letter of credit issued by a | ||
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(A) shall be in the minimum amount of $50,000; (B) shall be to an account to the Director and | ||
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(C) shall not be terminated unless at least 30 | ||
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(b) The issuer of the evidence of financial responsibility shall notify the Director upon termination of the bond or letter of credit, unless otherwise directed by the Director. (c) The Director may ask for the evidence of financial responsibility at any time he or she deems relevant. (d) The authority to act as a public adjuster shall automatically terminate if the evidence of financial responsibility terminates or becomes impaired.
(Source: P.A. 103-216, eff. 1-1-24.) |
(215 ILCS 5/1563)
Sec. 1563. Fees. The fees required by this Article
are as follows: (1) Public adjuster license fee of $250, payable once | ||
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(2) Business entity license fee of $250, payable once | ||
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(3) Application fee of $50 for processing each | ||
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(Source: P.A. 100-863, eff. 8-14-18.) |
(215 ILCS 5/1565)
Sec. 1565. Continuing education. (a) An individual who holds a public adjuster license and who is not exempt under subsection (b) of this Section shall satisfactorily complete a minimum of 24 hours of continuing education courses, including 3 hours of classroom or webinar ethics instruction, reported on a biennial basis in conjunction with the license renewal cycle. The Director may not approve a course of study unless the course provides for
classroom, seminar, or self-study instruction methods. A course
given in a combination instruction method of classroom or seminar
and self-study shall be deemed to be a self-study course unless the
classroom or seminar certified hours meets or exceeds two-thirds of
the total hours certified for the course. The self-study material used
in the combination course must be directly related to and complement
the classroom portion of the course in order to be considered for
credit. An instruction method other than classroom or seminar shall
be considered as self-study methodology. Self-study credit hours
require the successful completion of an examination covering the
self-study material. The examination may not be self-evaluated.
However, if the self-study material is completed through the use of
an approved computerized interactive format whereby the computer
validates the successful completion of the self-study material, no
additional examination is required. The self-study credit hours
contained in a certified course shall be considered classroom hours
when at least two-thirds of the hours are given as classroom or
seminar instruction. The public adjuster must complete the course in advance of the renewal date to
allow the education provider time to report the credit to the
Department. (b) This Section shall not apply to: (1) licensees not licensed for one full year prior to | ||
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(2) licensees holding nonresident public adjuster | ||
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(c) Only continuing education courses approved by the Director shall be used to satisfy the continuing education requirement of subsection (a) of this Section.
(Source: P.A. 102-135, eff. 7-23-21.) |
(215 ILCS 5/1570) Sec. 1570. Public adjuster fees. (a) A public adjuster shall not pay a commission, service fee, or other valuable consideration to a person for investigating or settling claims in this State if that person is required to be licensed under this Article and is not so licensed. (b) A person shall not accept a commission, service fee, or other valuable consideration for investigating or settling claims in this State if that person is required to be licensed under this Article and is not so licensed. (c) A public adjuster may pay or assign commission, service fees, or other valuable consideration to persons who do not investigate or settle claims in this State, unless the payment would violate State law. (d) If the loss giving rise to the claim for which the public adjuster was retained arises from damage to property that is anything but a personal residence, a public adjuster may not charge, agree to, or accept any compensation, payment, commission, fee, or other valuable consideration in excess of 10% of the amount of the insurance settlement claim paid by the insurer on any claim resulting from a catastrophic event, unless approved in writing by the Director. Application for exception to the 10% limit must be made in writing. The request must contain specific reasons as to why the consideration should be in excess of 10% and proof that the policyholder would accept the consideration. The Director must act on any request within 5 business days after receipt of the request. For the purpose of this subsection (d), "catastrophic event" means an occurrence of widespread or severe damage or loss of property producing an overwhelming demand on State and local response resources and mechanisms and a severe long-term effect on general economic activity, and that severely affects State, local, and private sector capabilities to begin to sustain response activities resulting from any catastrophic cause, including, but not limited to, fire, including arson (provided the fire was not caused by the willful action of an owner or resident of the property), flood, earthquake, wind, storm, explosion, or extended periods of severe inclement weather as determined by declaration of a State of disaster by the Governor. This declaration may be made on a county-by-county basis and shall be in effect for 90 days, but may be renewed for 30-day intervals thereafter. (e) If the loss giving rise to the claim for which the public adjuster was retained arises from damage to a personal residence, a public adjuster may not charge, agree to, or accept any compensation, payment, commission, fee, or other valuable consideration in excess of 10% of the amount of the insurance settlement claim paid by the insurer on any claim. (Source: P.A. 103-216, eff. 1-1-24.) |
(215 ILCS 5/1575) Sec. 1575. Contract between public adjuster and insured. (a) Public adjusters shall ensure that all contracts for their services are in writing and contain the following terms: (1) legible full name of the adjuster signing the | ||
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(2) permanent home state business address, email | ||
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(3) license number; (4) title of "Public Adjuster Contract"; (5) the insured's full name, street address, | ||
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(6) a description of the loss and its location; (7) description of services to be provided to the | ||
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(8) signatures of the public adjuster and the insured; (9) date and time the contract was signed by the | ||
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(10) attestation language stating that the public | ||
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(11) full salary, fee, commission, compensation, or | ||
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(b) The contract may specify that the public adjuster shall be named as a co-payee on an insurer's payment of a claim. (1) If the compensation is based on a share of the | ||
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(2) Initial expenses to be reimbursed to the public | ||
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(3) Compensation provisions in a public adjuster | ||
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(c) If the insurer, not later than 5 business days after the date on which the loss is reported to the insurer, either pays or commits in writing to pay to the insured the policy limit of the insurance policy, the public adjuster shall: (1) not receive a commission consisting of a | ||
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(2) inform the insured that loss recovery amount | ||
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(3) be entitled only to reasonable compensation from | ||
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(d) A public adjuster shall provide the insured a written disclosure concerning any direct or indirect financial interest that the public adjuster has with any other party who is involved in any aspect of the claim, other than the salary, fee, commission, or other consideration established in the written contract with the insured, including, but not limited to, any ownership of or any compensation expected to be received from, any construction firm, salvage firm, building appraisal firm, board-up company, or any other firm that provides estimates for work, or that performs any work, in conjunction with damages caused by the insured loss on which the public adjuster is engaged. The word "firm" shall include any corporation, partnership, association, joint-stock company, or person. (e) A public adjuster contract may not contain any contract term that: (1) allows the public adjuster's percentage fee to be | ||
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(2) requires the insured to authorize an insurance | ||
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(3) precludes a public adjuster or an insured from | ||
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(4) includes any hold harmless agreement that | ||
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(5) provides power of attorney by which the public | ||
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(f) The following provisions apply to a contract between a public adjuster and an insured: (1) Prior to the signing of the contract, the public | ||
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"Property insurance policies obligate the insured to | ||
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(A) "Company adjuster" means the insurance | ||
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(B) "Independent adjuster" means the insurance | ||
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(C) "Public adjuster" means the insurance | ||
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(2) The insured is not required to hire a public | ||
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(3) The public adjuster is not a representative or | ||
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(4) The salary, fee, commission, or other | ||
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(g) The contracts shall be executed in duplicate to provide an original contract to the public adjuster, and an original contract to the insured. The public adjuster's original contract shall be available at all times for inspection without notice by the Director. (h) The public adjuster shall provide the insurer or its authorized representative for receiving notice of loss or damage with an exact copy of the contract with the insured by email no later than 5 business days after execution of the contract, authorizing the public adjuster to represent the insured's interest. (i) The public adjuster shall give the insured written notice of the insured's rights as a consumer under the law of this State. (j) A public adjuster shall not provide services, other than emergency services, until a written contract with the insured has been executed, on a form filed with and approved by the Director, and an exact copy of the contract has been provided to the insurer in accordance with subsection (h). At the option of the insured, any such contract shall be voidable for 5 business days after the contract is received by the insurer. The insured may void the contract by notifying the public adjuster in writing by (i) registered or certified mail, return receipt requested, to the address shown on the contract, (ii) personally serving the notice on the public adjuster, or (iii) sending an email to the email address shown on the contract. (k) If the insured exercises the right to rescind the contract, anything of value given by the insured under the contract will be returned to the insured within 15 business days following the receipt by the public adjuster of the cancellation notice. (l) All contracts entered into that are in violation of this Section are void and invalid.
(Source: P.A. 103-216, eff. 1-1-24.) |
(215 ILCS 5/1580)
Sec. 1580. Escrow or trust accounts.
A public adjuster who receives, accepts, or holds any funds on behalf of an insured towards the settlement of a claim for loss or damage shall deposit the funds in a non-interest bearing escrow or trust account in a financial institution that is insured by an agency of the federal government in the public adjuster's home state or where the loss occurred.
(Source: P.A. 96-1332, eff. 1-1-11.) |
(215 ILCS 5/1585) Sec. 1585. Record retention. (a) A public adjuster shall maintain a complete record of each transaction as a public adjuster. The records required by this Section shall include the following: (1) name of the insured; (2) date, location and amount of the loss; (3) a copy of the contract between the public | ||
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(4) name of the insurer, amount, expiration date and | ||
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(5) itemized statement of the insured's recoveries; (6) itemized statement of all compensation received | ||
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(7) a register of all monies received, deposited, | ||
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(8) name of public adjuster who executed the contract; (9) name of the attorney representing the insured, if | ||
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(10) evidence of financial responsibility in a format | ||
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(b) Records shall be maintained for at least 7 years after the termination of the transaction with an insured and shall be open to examination by the Director at all times. (c) Records submitted to the Director in accordance with this Section that contain information identified in writing as proprietary by the public adjuster shall be treated as confidential by the Director and shall not be subject to the Freedom of Information Act.
(Source: P.A. 103-216, eff. 1-1-24.) |
(215 ILCS 5/1590) Sec. 1590. Standards of conduct of public adjuster. (a) A public adjuster is obligated, under his or her license, to serve with objectivity and complete loyalty for the interests of his client alone, and to render to the insured such information, counsel, and service, as within the knowledge, understanding, and opinion in good faith of the licensee, as will best serve the insured's insurance claim needs and interest. (b) A public adjuster may not propose or attempt to propose to any person that the public adjuster represent that person while a loss-producing occurrence is continuing, nor while the fire department or its representatives are engaged at the damaged premises, nor between the hours of 7:00 p.m. and 8:00 a.m. (c) A public adjuster shall not permit an unlicensed employee or representative of the public adjuster to conduct business for which a license is required under this Article. (d) A public adjuster shall not have a direct or indirect financial interest in any aspect of the claim, other than the salary, fee, commission, or other consideration established in the written contract with the insured, unless full written disclosure has been made to the insured as set forth in subsection (d) of Section 1575. (e) A public adjuster shall not acquire any interest in the salvage of property subject to the contract with the insured unless the public adjuster obtains written permission from the insured after settlement of the claim with the insurer as set forth in subsection (d) of Section 1575 of this Article. (f) The public adjuster shall abstain from referring or directing the insured to get needed repairs or services in connection with a loss from any person, unless disclosed to the insured: (1) with whom the public adjuster has a direct or | ||
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(2) from whom the public adjuster may receive direct | ||
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(g) The public adjuster shall disclose to an insured if he or she has any interest or will be compensated by any construction firm, salvage firm, building appraisal firm, board-up company, or any other firm that performs any work in conjunction with damages caused by the insured loss. The word "firm" shall include any corporation, partnership, association, joint-stock company or individual as set forth in Section 1575 of this Article. (h) Any compensation or anything of value in connection with an insured's specific loss that will be received by a public adjuster shall be disclosed by the public adjuster to the insured in writing including the source and amount of any such compensation. (i) In all cases where the loss giving rise to the claim for which the public adjuster was retained arise from damage to a personal residence, the insurance proceeds shall be delivered to the named insured or his or her designee. Where proceeds paid by an insurance company are paid jointly to the insured and the public adjuster, the insured shall release such portion of the proceeds that are due the public adjuster within 30 calendar days after the insured's receipt of the insurance company's check, money order, draft, or release of funds. If the proceeds are not so released to the public adjuster within 30 calendar days, the insured shall provide the public adjuster with a written explanation of the reason for the delay. (j) Public adjusters shall adhere to the following general ethical requirements: (1) a public adjuster shall not undertake the | ||
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(2) a public adjuster shall not knowingly make any | ||
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(3) no public adjuster, while so licensed by the | ||
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(4) the contract shall not be construed to prevent an | ||
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(5) a public adjuster shall not enter into a contract | ||
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(6) a public adjuster shall ensure that all contracts | ||
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(7) a public adjuster shall not advance money or any | ||
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(k) A public adjuster may not agree to any loss settlement without the insured's knowledge and consent and shall, upon the insured's request, provide the insured with a document setting forth the scope, amount, and value of the damages prior to request by the insured for authority to settle the loss. (l) A public adjuster shall not provide legal advice or representation to the insured or engage in the unauthorized practice of law. (m) A public adjuster shall not represent that he or she is a representative of an insurance company, a fire department, or the State of Illinois, that he or she is a fire investigator, that his or her services are required for the insured to submit a claim to the insured's insurance company, or that he or she may provide legal advice or representation to the insured. A public adjuster may represent that he or she has been licensed by the State of Illinois.
(Source: P.A. 103-216, eff. 1-1-24.) |
(215 ILCS 5/1595)
Sec. 1595. Reporting of actions. (a) The public adjuster shall report to the Director any administrative action taken against the public adjuster in another jurisdiction or by another governmental agency in this State within 30 days of the final disposition of the matter. This report shall include a copy of the order, consent to order, or other relevant legal documents. (b) Within 30 days of the initial pretrial hearing date, the public adjuster shall report to the Director any criminal prosecution of the public adjuster taken in any jurisdiction. The report shall include a copy of the initial complaint filed, the order resulting from the hearing, and any other relevant legal documents.
(Source: P.A. 96-1332, eff. 1-1-11.) |
(215 ILCS 5/1600)
Sec. 1600. Examinations. (a) The Director shall have the power to examine any applicant or any person licensed or registered pursuant to this Article. (b) Every person being examined and its officers, directors, and members must provide to the Director convenient and free access, at all reasonable hours, to all books, records, documents, and other papers relating to its public adjusting affairs. The officers, directors, members, and employees must facilitate and aid in such examinations so far as it is in their power to do so. (c) Examiners may be designated by the Director. Such examiners shall make their reports to the Director pursuant to this Section. Any report alleging substantive violations shall be in writing and shall be based upon the facts ascertained from the books, records, documents, papers, and other evidence obtained by the examiners or ascertained from the testimony of the officers, directors, members, or other individuals examined under oath or ascertained by notarized affidavits received by the examiners. The reports shall be verified by the examiners.
(Source: P.A. 96-1332, eff. 1-1-11.) |
(215 ILCS 5/1605)
Sec. 1605. Injunctive relief. Any person who acts as or holds himself out to be a public adjuster without holding a valid and current license to do so is hereby declared to be inimical to the public welfare and to constitute a public nuisance. The Director may report such practice to the Attorney General of the State of Illinois whose duty it is to apply forthwith by complaint on relation of the Director in the name of the people of the State of Illinois, as plaintiff, for injunctive relief in the circuit court of the county where such practice occurred to enjoin the person from engaging in such practice; and upon the filing of a verified petition in such court, the court, if satisfied by affidavit or otherwise that the person has been engaged in such practice without a valid and current license to do so, may enter a temporary restraining order without notice or bond enjoining the defendant from such further practice. A copy of the verified complaint shall be served upon the defendant and the proceedings shall thereafter be conducted as in other civil cases. If it is established that the defendant has been or is engaged in such unlawful practice, then the court may enter an order or judgment perpetually enjoining the defendant from such further practice. In all proceedings hereunder, the court, in its discretion, may apportion the costs among the parties interested in the action, including the costs of filing the complaint, service of process, witness fees and expenses, court reporter charges, and reasonable attorney fees. In case of violation of any injunctive order entered under the provisions of this Section, the court may try and punish the offender for contempt of court. Such injunction proceedings shall be in addition to, and not in lieu of, all penalties and other remedies.
(Source: P.A. 96-1332, eff. 1-1-11.) |
(215 ILCS 5/1610)
Sec. 1610. Additional penalties.
In addition to any other penalty set forth in this Article, any person violating Section 1605 of this Code shall be guilty of a Class A misdemeanor and any person misappropriating or converting any monies collected as a public adjuster, whether licensed or not, shall be guilty of a Class 4 felony.
(Source: P.A. 96-1332, eff. 1-1-11.) |
(215 ILCS 5/1615)
Sec. 1615. Rules.
The Director shall promulgate reasonable rules as are necessary or proper to carry out the purposes of this Article.
(Source: P.A. 96-1332, eff. 1-1-11.) |
(215 ILCS 5/Art. XLVI heading) ARTICLE XLVI. TRAVEL INSURANCE
(Source: P.A. 102-212, eff. 10-28-21.) |
(215 ILCS 5/1620) Sec. 1620. Short title. This Article may be cited as the Travel Insurance Act.
(Source: P.A. 102-212, eff. 10-28-21.) |
(215 ILCS 5/1625) Sec. 1625. Scope and purposes. (a) The purpose of this Article is to promote the public welfare by creating a comprehensive legal framework within which travel insurance may be sold in this State. (b) This Article applies to travel insurance that covers any resident of this State, and is sold, solicited, negotiated, or offered in this State, and policies and certificates that are delivered or issued for delivery in this State. This Article does not apply to cancellation fee waivers or travel assistance services except as expressly provided in this Article. (c) All other applicable provisions of this State's insurance laws shall continue to apply to travel insurance, except that the specific provisions of this Article shall supersede any general provisions of law that would otherwise be applicable to travel insurance.
(Source: P.A. 102-212, eff. 10-28-21.) |
(215 ILCS 5/1630) Sec. 1630. Definitions. As used in this Article: "Aggregator site" means a website that provides access to information regarding insurance products from more than one insurer, including product and insurer information, for use in comparison shopping. "Blanket travel insurance" means a policy of travel insurance issued to any eligible group providing coverage for specific classes of persons defined in the policy with coverage provided to all members of the eligible group without a separate charge to individual members of the eligible group. "Cancellation fee waiver" means a contractual agreement between a supplier of travel services and its customer to waive some or all of the nonrefundable cancellation fee provisions of the supplier's underlying travel contract with or without regard to the reason for the cancellation or form of reimbursement. A "cancellation fee waiver" is not insurance. "Eligible group", solely for the purposes of travel insurance, means 2 or more persons who are engaged in a common enterprise, or have an economic, educational, or social affinity or relationship, including, but not limited to, any of the following: (1) any entity engaged in the business of | ||
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(2) any college, school, or other institution of | ||
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(3) any employer covering any group of employees, | ||
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(4) any sports team, camp, or sponsor of any | ||
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(5) any religious, charitable, recreational, | ||
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(6) any financial institution or financial | ||
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(7) any incorporated or unincorporated | ||
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(8) any trust or the trustees of a fund | ||
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(9) any entertainment production company covering | ||
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(10) any volunteer fire department, ambulance, | ||
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(11) preschools, day care institutions for | ||
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(12) any automobile or truck rental or leasing | ||
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(13) any other group where the Director has | ||
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"Fulfillment materials" means documentation sent to the purchaser of a travel protection plan confirming the purchase and providing the travel protection plan's coverage and assistance details. "Group travel insurance" means travel insurance issued to any eligible group. "Limited lines travel insurance producer" means one of the following: (1) a licensed managing general agent or | ||
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(2) a licensed insurance producer, including a | ||
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(3) a travel administrator. "Offering and disseminating" means the following: (1) Providing information to a prospective or | ||
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(2) Referring specific questions regarding coverage | ||
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(3) Disseminating and processing applications for | ||
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(4) Collecting premiums from a prospective or | ||
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(5) Receiving and recording information from a | ||
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"Primary policyholder" means an individual person who elects and purchases individual travel insurance. "Travel administrator" means a person who directly or indirectly underwrites, collects charges, collateral, or premiums from, or adjusts or settles claims on residents of this State in connection with travel insurance, except that a person shall not be considered a travel administrator if that person's only actions that would otherwise cause the person to be considered a travel administrator are among the following: (1) a person working for a travel administrator to | ||
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(2) an insurance producer selling insurance or | ||
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(3) a travel retailer offering and disseminating | ||
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(4) an individual adjusting or settling claims in | ||
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(5) a business entity that is affiliated with a | ||
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"Travel assistance services" means noninsurance services for which the consumer is not indemnified based on a fortuitous event, and where providing the service does not result in transfer or shifting of risk that would constitute the business of insurance. "Travel assistance services" include, but are not limited to: security advisories; destination information; vaccination and immunization information services; travel reservation services; entertainment; activity and event planning; translation assistance; emergency messaging; international legal and medical referrals; medical case monitoring; coordination of transportation arrangements; emergency cash transfer assistance; medical prescription replacement assistance; passport and travel document replacement assistance; lost luggage assistance; concierge services; and any other service that is furnished in connection with planned travel. "Travel assistance services" are not insurance and are not related to insurance. "Travel insurance" means insurance coverage for personal risks incident to planned travel, including, but not limited to: (1) the interruption or cancellation of a trip or | ||
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(2) the loss of baggage or personal effects; (3) damages to accommodations or rental vehicles; (4) sickness, accident, disability, or death | ||
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(5) emergency evacuation; (6) repatriation of remains; or (7) any other contractual obligations to indemnify | ||
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"Travel insurance" does not include major medical plans that provide comprehensive medical protection for travelers with trips lasting 6 months or longer, including those working overseas as expatriates or as military personnel on deployment. "Travel insurance business entity" means a licensed insurance producer designated by an insurer as set forth in subsection (h) of Section 1635. "Travel protection plans" means plans that provide one or more of the following: travel insurance, travel assistance services, and cancellation fee waivers. "Travel retailer" means a business organization that makes, arranges, or offers travel services and, with respect to travel insurance, is limited to offering and disseminating as defined in this Section, unless otherwise licensed under subsection (b) of Section 1635.
(Source: P.A. 102-212, eff. 10-28-21.) |
(215 ILCS 5/1635) Sec. 1635. Licensing and registration. (a) The Director may issue to a travel insurance business entity that registers travel retailers under its license as described in paragraph (2) of subsection (c) of this Section a producer license as provided in paragraph (6) of subsection (a) of Section 500-35 of this Code. A travel insurance business entity license issued under this Section shall also authorize any employee of the travel insurance business entity to act individually on behalf and under the supervision of the travel insurance business entity licensee with respect to the coverage specified in this Section. Each travel insurance business entity licensed under this Section shall pay the Department a fee of $500 for its initial license and $500 for each renewal license, payable on May 31 annually. (b) The Director may issue to a travel retailer a limited lines producer license. A travel retailer license issued under this Section shall also authorize any employee of the travel retailer limited line licensee to act individually on behalf and under the supervision of the travel retailer limited line licensee with respect to the coverage specified in this Section. (c) Notwithstanding any other provision of law, a travel retailer may do the limited activities of offering and disseminating travel insurance on behalf of and under the license of a supervising travel insurance business entity if the following conditions are met: (1) the travel insurance business entity or travel | ||
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(A) a description of the material terms or the | ||
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(B) a description of the process for filing a | ||
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(C) a description of the review or cancellation | ||
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(D) the identity and contact information of the | ||
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(2) at the time of licensure, the travel insurance | ||
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(3) the travel insurance business entity has | ||
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(4) the travel insurance business entity has paid all | ||
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(5) the travel insurance business entity requires | ||
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(d) Any travel retailer offering or disseminating travel insurance shall make available to prospective purchasers brochures or other written materials that: (1) provide the identity and contact information of | ||
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(2) explain that the purchase of travel insurance is | ||
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(3) explain that an unlicensed travel retailer is | ||
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(e) A travel retailer's employee or authorized representative who is not licensed as an insurance producer may not: (1) evaluate or interpret the technical terms, | ||
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(2) evaluate or provide advice concerning a | ||
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(3) hold himself, herself, or itself out as a | ||
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(f) A travel retailer whose insurance-related activities, and those of its employees and authorized representatives, are limited to offering and disseminating travel insurance on behalf of and under the direction of a travel insurance business entity meeting the conditions stated in this Section is authorized to do so and receive related compensation upon registration by the travel insurance business entity as described in paragraph (2) of subsection (c) of this Section. (g) Travel insurance may be provided under an individual policy or under a group, blanket, or master policy. (h) As the insurer designee, the travel insurance business entity is responsible for the acts of the travel retailer that is registered under its license. (i) Any entity that violates any provision of this Article shall be subject to all appropriate regulatory action as set forth in this Code. (j) Any person licensed in a major line of authority as an insurance producer is authorized to sell, solicit, and negotiate travel insurance. A property and casualty insurance producer is not required to become appointed by an insurer in order to sell, solicit, or negotiate travel insurance.
(Source: P.A. 102-212, eff. 10-28-21.) |
(215 ILCS 5/1640) Sec. 1640. Travel protection plans. Travel protection plans may be offered for one price for the combined features that the travel protection plan offers in this State if: (1) the travel protection plan clearly discloses to | ||
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(2) the fulfillment materials: (A) describe and delineate the travel | ||
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(B) include the travel insurance disclosures | ||
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(Source: P.A. 102-212, eff. 10-28-21.) |
(215 ILCS 5/1645) Sec. 1645. Sales practices. (a) All persons offering travel insurance to residents of this State are subject to the Unfair Methods of Competition and Unfair and Deceptive Acts and Practices Article of this Code, except as otherwise provided in this Section. In the event of a conflict between this Article and other provisions of this Code regarding the sale and marketing of travel insurance and travel protection plans, the provisions of this Article shall control. (b) Offering or selling a travel insurance policy that could never result in payment of any claims for any insured under the policy is an unfair trade practice under Section 424. (c) Marketing of travel insurance policies shall comply with the following: (1) All documents provided to consumers before the | ||
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(2) For travel insurance policies or certificates | ||
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(3) The fulfillment materials and the information | ||
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(A) 15 days following the date of delivery of the | ||
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(B) 10 days following the date of delivery of the | ||
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(4) The company shall disclose in the policy | ||
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(5) Where travel insurance is marketed directly to | ||
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(d) No person offering, soliciting, or negotiating travel insurance or travel protection plans on an individual or group basis may do so by using negative option or opt out, which would require a consumer to take an affirmative action to deselect coverage, such as unchecking a box on an electronic form, when the consumer purchases a trip. (e) It shall be an unfair trade practice under Section 424 to market blanket travel insurance coverage as free. (f) Where a consumer's destination jurisdiction requires insurance coverage, it shall not be an unfair trade practice to require that a consumer choose between the following options as a condition of purchasing a trip or travel package: (1) purchasing the coverage required by the | ||
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(2) agreeing to obtain and provide proof of | ||
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(Source: P.A. 102-212, eff. 10-28-21.) |
(215 ILCS 5/1650) Sec. 1650. Travel insurance administrators. (a) Notwithstanding any other provisions of this Code, no entity shall act or represent itself as a travel administrator for travel insurance in this State unless that entity: (1) is a licensed property and casualty insurance | ||
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(2) holds a valid managing general agent license in | ||
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(3) holds a valid third-party administrator license | ||
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(b) An insurer is responsible for the acts of a travel administrator administering travel insurance underwritten by the insurer, and is responsible for ensuring that the travel administrator maintains all books and records relevant to the insurer to be made available by the travel administrator to the Director upon request.
(Source: P.A. 102-212, eff. 10-28-21.) |
(215 ILCS 5/1655) Sec. 1655. Policy. (a) Notwithstanding any other provision of this Code, travel insurance shall be classified and filed for purposes of rates and forms under an inland marine line of insurance; however, travel insurance that provides coverage for sickness, accident, disability, or death occurring during travel, either exclusively, or in conjunction with related coverages of emergency evacuation or repatriation of remains, or incidental limited property and casualty benefits such as baggage or trip cancellation may be filed under either an accident and health line of insurance or an inland marine line of insurance. (b) Travel insurance may be in the form of an individual, group, master, or blanket policy. (c) Eligibility and underwriting standards for travel insurance may be developed and provided based on travel protection plans designed for individual or identified marketing or distribution channels, provided those standards also meet this State's underwriting standards for inland marine.
(Source: P.A. 102-212, eff. 10-28-21; 102-672, eff. 11-30-21.) |
(215 ILCS 5/1660) Sec. 1660. Rules. The Department may adopt rules to implement this Article.
(Source: P.A. 102-212, eff. 10-28-21.) |
(215 ILCS 5/Art. XLVII heading) (This Section may contain text from a Public Act with a delayed effective date)ARTICLE XLVII. INSURANCE BUSINESS TRANSFERS
(Source: P.A. 103-75, eff. 1-1-25.) |
(215 ILCS 5/1701) (This Section may contain text from a Public Act with a delayed effective date) Sec. 1701. Short title. This Article may be cited as the Insurance Business Transfer Law.
(Source: P.A. 103-75, eff. 1-1-25.) |
(215 ILCS 5/1703) (This Section may contain text from a Public Act with a delayed effective date) Sec. 1703. Purpose and intent. The purpose of this Article is to provide a mechanism for insurers to transfer or
assume blocks of insurance business in an efficient and
cost-effective manner that provides needed legal finality for
such transfers in order to provide for improved operational
and capital efficiency for insurance companies, while protecting the interests of the policyholders, reinsurers, and claimants of the subject business. This new process is intended to stimulate the
economy by attracting segments of the insurance industry to this State, make this State an attractive home jurisdiction
for insurance companies, encourage economic growth and
increased investment in the financial services sector, and
increase the availability of quality insurance industry jobs
in this State. These purposes are accomplished by providing a
basis and procedures for the transfer and statutory novation
of policies from a transferring insurer to an assuming insurer
by way of an insurance business transfer without the
affirmative consent of policyholders or reinsureds, but with consideration of their interests. This Article
establishes the requirements for notice and disclosure and standards and procedures for the approval of the transfer and
novation by a court pursuant to an insurance
business transfer plan. This Article does not limit or restrict
other means of effecting a transfer or novation.
(Source: P.A. 103-75, eff. 1-1-25.) |
(215 ILCS 5/1705) (This Section may contain text from a Public Act with a delayed effective date) Sec. 1705. Definitions. As used in this Article: "Affiliate" means a person that directly or indirectly,
through one or more intermediaries, controls, is controlled
by, or is under common control with the person specified. "Applicant" means a transferring insurer or reinsurer applying under this Article. "Assuming insurer" means an insurer domiciled in Illinois and authorized to transact the type of business described in clause (c) of Class 1, clauses (b) through (l) of Class 2, or Class 3 of Section 4 that
seeks to assume policies from a
transferring insurer pursuant to this Article. "Court" means the circuit court of Sangamon County or Cook County. "Department" means the Department of Insurance. "Director" means the Director of Insurance. "Implementation order" means an order issued by a court
under this Article. "Insurance business transfer" means a transfer and
novation that, once approved pursuant to this Article, transfers
insurance obligations or risks, or both, of existing or
in-force contracts of insurance or reinsurance from a
transferring insurer to an assuming insurer, and effects a
novation of the transferred contracts of insurance or
reinsurance with the result that the assuming insurer becomes
directly liable to the policyholders of the transferring
insurer and the transferring insurer's insurance obligations
or risks, or both, under the contracts are extinguished. "Insurance business transfer plan" means the plan
submitted to the Department to accomplish the transfer and
novation pursuant to an insurance business transfer, including
any associated transfer of assets and rights from or on behalf
of the transferring insurer to the assuming insurer. An "insurance business transfer plan" is limited to the types of insurance described in clause (c) of Class 1, clauses (b) through (l) of Class 2, or Class 3 of Section 4. "Independent expert" means the impartial person procured to assist the Director and the court in connection with their review of a proposed transaction. The independent expert shall: (i) have no current or past, direct or indirect, | ||
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(ii) have not been employed by or acted as an | ||
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(iii) not currently be appointed by the Director to | ||
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(iv) receive no compensation in connection with the | ||
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"Insurer" means an insurance, surety, or reinsurance
company, corporation, partnership, association, society,
order, individual, or aggregation of individuals engaging in
or proposing or attempting to engage in insurance
or surety business, including the exchanging of reciprocal or
inter-insurance contracts between individuals, partnerships,
and corporations. "Policy" means a policy, certificate of
insurance, or a contract of reinsurance pursuant to which an
insurer agrees to assume an obligation or risk, or both, of the
policyholder or to make payments on behalf of, or to, the
policyholder or its beneficiaries, and includes property and
casualty insurance. "Policy" does not include any policy, contract, or certificate of life, accident, or health insurance, including those defined in clause (a) or (b) of Class 1 or clause (a) of Class 2 of Section 4. "Policyholder" means an insured or a reinsured under a
policy that is part of the subject business. "State guaranty association" means the Illinois Insurance Guaranty Fund, the Illinois Life and Health Guaranty Association, or any similar organization in another state. "Subject business" means the policy or policies that are
the subject of the insurance business transfer plan. "Transfer and novation" means the transfer of insurance
obligations or risks, or both, of existing or in-force
policies from a transferring insurer to an assuming insurer
that is intended to effect a novation of the transferred
policies with the result that the assuming insurer becomes
directly liable to the policyholders of the transferring
insurer on the transferred policies and the transferring
insurer's obligations or risks, or both, under the transferred
policies are extinguished. "Transferring insurer" means an insurer or reinsurer that
transfers and novates or seeks to transfer and novate
obligations or risks, or both, under one or more policies to an
assuming insurer pursuant to an insurance business transfer
plan.
(Source: P.A. 103-75, eff. 1-1-25.) |
(215 ILCS 5/1710) (This Section may contain text from a Public Act with a delayed effective date) Sec. 1710. Court authority. Notwithstanding any other
provision of law, a court may issue any order, process, or
judgment that is necessary or appropriate to carry out the
provisions of this Article. No provision of this Article shall be
construed to preclude a court from, on its own motion, taking
any action or making any determination necessary or
appropriate to enforce or implement court orders or rules or
to prevent an abuse of power.
(Source: P.A. 103-75, eff. 1-1-25.) |
(215 ILCS 5/1715) (This Section may contain text from a Public Act with a delayed effective date) Sec. 1715. Notice requirements. (a) Whenever notice is required to be given by an
applicant under this Article, except as otherwise permitted by a
court or the Director, the applicant shall within 15 days
after the event triggering the requirement transmit the
notice: (1) to the chief insurance regulator in each | ||
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(A) in which the applicant holds or has ever held | ||
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(B) in which policies that are part of the | ||
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(2) to the National Conference of Insurance Guaranty | ||
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(A) in which the applicant holds or has ever held | ||
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(B) in which policies that are part of the | ||
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(3) to reinsurers of the applicant pursuant to the | ||
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(4) to all policyholders holding policies that are | ||
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(5) by publication in a newspaper of general | ||
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(b) If notice is given in accordance with this Section,
any orders under this Article shall be conclusive with respect to
all intended recipients of the notice whether or not they
receive actual notice. (c) If this Article requires that the applicant provide notice
but the Director has been named receiver of the applicant pursuant to Article XIII, the
Director shall provide the required notice. (d) Notice under this Section may take the form of
first-class mail, facsimile, or electronic notice. The court may order that notice take a specific form.
(Source: P.A. 103-75, eff. 1-1-25.) |
(215 ILCS 5/1720) (This Section may contain text from a Public Act with a delayed effective date) Sec. 1720. Application procedure. (a) Before filing an insurance business transfer plan, the applicant shall file with the Department a notice of its intention to file a plan and shall pay the required fee. Upon request, the applicant and the assuming insurer shall provide the Department with any information necessary for the Department to procure an independent expert that meets the requirements of this Article. (b) An insurance business transfer plan shall be filed by
the applicant with the Director for his or her review and
approval. The plan may be supplemented by other information
deemed necessary by the Director, and shall contain the
following information or an explanation as to why the
following information is not included: (1) the name, address, and telephone number of the | ||
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(2) a summary of the insurance business transfer | ||
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(3) an identification and description of the subject | ||
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(4) the most recent audited financial statements and | ||
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(5) the most recent actuarial report and opinion that | ||
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(6) pro forma financial statements showing the | ||
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(7) officers' certificates of the transferring | ||
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(8) a proposal for plan implementation and | ||
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(9) a full description as to how notice under the | ||
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(10) a description of any reinsurance arrangements | ||
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(11) a description of any guarantees or additional | ||
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(12) a statement describing the assuming insurer's | ||
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(13) a description of how the transferring and | ||
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(14) a description of the financial implications of | ||
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(15) an analysis of the assuming insurer's | ||
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(16) an evaluation of the competency, experience, and | ||
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(17) a certified statement that the transaction is | ||
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(18) evidence of approval or nonobjection of the | ||
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(19) a report from the independent expert that shall | ||
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(A) a statement of the independent expert's | ||
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(B) a certified statement from the independent | ||
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(C) a description of the scope of the report; (D) a summary of the terms of the insurance | ||
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(E) a listing and summaries of documents, | ||
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(F) the extent to which the independent expert | ||
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(G) the people on whom the independent expert has | ||
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(H) the independent expert's opinion of the | ||
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(i) transferring policyholders, reinsurers, | ||
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(ii) policyholders, reinsurers, and claimants | ||
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(iii) policyholders, reinsurers, and | ||
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(I) the facts and circumstances supporting each | ||
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(J) consideration as to whether the security | ||
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(c) The independent expert's report as required by
paragraph (19) of subsection (b) shall also include, but not be
limited to, a review of and report on the following: (1) analysis of the transferring insurer's actuarial | ||
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(2) analysis of the financial condition of the | ||
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(3) review of the plans or proposals the assuming | ||
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(4) whether the proposed transfer has a material, | ||
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(5) analysis of the assuming insurer's corporate | ||
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(6) analysis of whether any policyholder or group of | ||
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(7) any other information that the Director requests | ||
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(d) After the
receipt of a complete insurance business transfer plan,
the Director shall review the plan to determine if the applicant is authorized
to submit it to a court. (e) The Director shall authorize the submission of the
insurance business transfer plan to a court unless he or she
finds that the insurance business transfer would have a
material adverse impact on the interests of policyholders,
reinsurers, or claimants that are part of the subject
business. (f) If the Director determines that the insurance business
transfer would have a material adverse impact on the interests
of policyholders, reinsurers, or claimants that are part of
the subject business, he or she shall notify the applicant and
specify any modifications, supplements, or amendments and any
additional information or documentation with respect to the
plan that must be provided to the Director before he or she
shall allow the applicant to proceed with the court filing. (g) The applicant shall have 30 days following the date
the Director notifies him or her of a determination under
subsection (f) to file an amended insurance business transfer
plan providing the modifications, supplements, or amendments
and additional information or documentation as requested by
the Director. If necessary, the applicant may request in
writing an extension of time of 30 days. If the applicant does
not make an amended filing within the time period provided in
this subsection, including any extension of time granted by
the Director, the insurance business transfer plan filing
shall terminate and a subsequent filing by the applicant shall
be considered a new filing which shall require compliance with
all provisions of this Article as if the prior filing had never
been made. (h)
When the modification, supplement, amendment, or
additional information requested in subsection (f) is
received, the Director shall review the amended plan in accordance with subsection (c). (i) If the Director determines that the plan may proceed
with the court filing, the Director shall confirm that fact in
writing to the applicant.
(Source: P.A. 103-75, eff. 1-1-25.) |
(215 ILCS 5/1725) (This Section may contain text from a Public Act with a delayed effective date) Sec. 1725. Application to the court for approval of a plan. (a) Within 30 days after notice from the Director that the applicant may proceed with the court filing, the applicant shall apply to the court for approval of the insurance business transfer plan. Upon written request by the applicant, the Director may extend the period for filing an application with the court for an additional 30 days. (b) The applicant shall inform the court of the reasons why he or she petitions the court to find no material adverse impact to policyholders, reinsurers, or claimants affected by the proposed transfer. (c) The application shall be in the form of a verified petition for implementation of the insurance business transfer plan in the court. The petition shall include the insurance business transfer plan and shall identify any documents and witnesses which the applicant intends to present at a hearing regarding the petition. (d) The Director shall be a party to the proceedings before the court concerning the petition and shall be served with copies of all filings. The Director's position in the proceeding shall not be limited by his or her initial review of the plan. The Director shall have all the rights of a litigant under the Illinois Supreme Court Rules and the Code of Civil Procedure, including, but not limited to, the right to appeal. (e) Following the filing of the petition, the applicant shall file a motion for a scheduling order setting a hearing on the petition. (f) Within 15 days after receipt of the scheduling order, the applicant shall cause notice of the hearing to be provided in accordance with the notice provisions of Section 1715. Following the date of distribution of the notice, there shall be a 60-day comment period. The notice and all comments received shall be part of the court record. (g) The notice shall be filed with and approved by the court before distribution, and the Director shall be given the opportunity to review and comment on the sufficiency of the notice before court approval. The notice shall state or provide: (1) the date and time of the approval hearing; (2) the name, address, and telephone number of the | ||
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(3) that the recipient may comment on or object to | ||
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(4) the procedures and deadline for submitting | ||
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(5) a summary of any effect that the transfer and | ||
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(6) a statement that the assuming insurer is | ||
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(7) a statement regarding whether any policyholder | ||
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(8) that recipients shall not have the opportunity to | ||
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(9) contact information for the Department where | ||
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(10) information on how an electronic copy of the | ||
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(11) any other information that the court may | ||
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(h) Any person, including by their legal representative, who considers himself, herself, or itself to be adversely affected can present evidence or comments to the court at the approval hearing. Any person participating in the approval hearing must follow the process established by the court and shall bear his or her own costs and attorney's fees.
(Source: P.A. 103-75, eff. 1-1-25.) |
(215 ILCS 5/1730) (This Section may contain text from a Public Act with a delayed effective date) Sec. 1730. Approval; denial; insurance business transfer plans. (a) After the comment period pursuant to subsection (f) of Section 1725 has ended the insurance business transfer plan shall be presented by the applicant for approval by the court. (b) At any time before the court issues an order approving the insurance business transfer plan, the applicant may withdraw the petition without prejudice. (c) If the court finds that the implementation of the insurance business transfer plan would not materially adversely affect the interests of policyholders, reinsurers, or claimants that are part of the subject business, the court shall enter a judgment and implementation order. The judgment and implementation order shall: (1) order implementation of the insurance business | ||
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(2) order a statutory novation with respect to all | ||
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(3) release the transferring insurer from all | ||
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(4) authorize and order the transfer of property | ||
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(5) order that the applicant provide notice of the | ||
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(6) make such other provisions with respect to | ||
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(d) If the court finds that the insurance business transfer plan should not be approved, the court by its order shall deny the petition. (e) The applicant shall have 30 days following the withdrawal or denial of the petition to file an amended business transfer plan with the Director in accordance with Section 1720. (f) Nothing in this Section in any way affects the right of appeal of any party.
(Source: P.A. 103-75, eff. 1-1-25.) |
(215 ILCS 5/1735) (This Section may contain text from a Public Act with a delayed effective date) Sec. 1735. Rules. The Department may adopt rules that are consistent with the provisions of this Article.
(Source: P.A. 103-75, eff. 1-1-25.) |
(215 ILCS 5/1740) (This Section may contain text from a Public Act with a delayed effective date) Sec. 1740. Confidentiality. The portion of the application for an insurance business transfer that would otherwise be confidential, including any documents, materials, communications, or other information submitted to the Director in contemplation of such application, shall not lose such confidentiality, except (i) the Director may disclose confidential information as needed to procure the independent expert and ensure that the expert meets the requirements under this Article and (ii) if the Director determines that disclosure of confidential information is necessary to fully and fairly advise policyholders and others entitled to notice of the material implications of the insurance business transfer plan.
(Source: P.A. 103-75, eff. 1-1-25.) |
(215 ILCS 5/1745) (This Section may contain text from a Public Act with a delayed effective date) Sec. 1745. Department oversight. Insurers engaging in an insurance business transfer under this Article consent to the jurisdiction of the Director with regard to any aspect of the transferred business or business transfer plan, including the authority of the Director to conduct financial analysis and examinations, regardless of whether the insurer has a certificate of authority or another basis for the Director's jurisdiction exists.
(Source: P.A. 103-75, eff. 1-1-25.) |
(215 ILCS 5/1750) (This Section may contain text from a Public Act with a delayed effective date) Sec. 1750. Fees and costs. (a) All expenses incurred by the Director for the compensation, costs, and expenses of the independent expert and any consultants retained by the independent expert incurred in fulfilling the obligations of the independent expert under this Article shall be paid by the applicant. (b) The Director may retain the services of any attorneys, actuaries, accountants, and other professionals and specialists as may be reasonably necessary to assist the Director in reviewing the insurance business transfer plan. All expenses incurred by the Director in connection with proceedings under this Article, including, but not limited to, expenses for the services of any attorneys, actuaries, accountants, and other professionals and specialists, shall be paid by the applicant. (c) The transferring insurer and the assuming insurer shall jointly be obligated to pay all debts incurred pursuant to this Section. Nothing in this Article shall be construed to create any duty for the independent expert to any party other than the Department or a court. (d) Failure to pay any of the requisite fees or costs within 30 days after demand shall be grounds for the Director to request that a court dismiss the petition for approval of the insurance business transfer plan before the filing of an implementation order by the court or, if after the filing of an implementation order, the Director may suspend or revoke the assuming insurer's certificate of authority to transact insurance business in this State. The Director may also take any other action authorized by law against an insurer who fails to pay the requisite fees or costs.
(Source: P.A. 103-75, eff. 1-1-25.) |