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Illinois Compiled Statutes
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INSURANCE (215 ILCS 5/) Illinois Insurance Code. 215 ILCS 5/347
(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
(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
(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
(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
(215 ILCS 5/Art. XIXA heading)
ARTICLE XIXA.
LONG-TERM CARE INSURANCE
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215 ILCS 5/351A-1
(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 | | insurance policy, the person who seeks to contract for benefits.
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(2) In the case of a group long-term care insurance
| | policy, the proposed certificate holder.
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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
| | to a trust or to the trustee or trustees of a fund established by one or more employers or labor organizations, or a combination thereof, for employees or former employees, or a combination thereof, or for members or former members, or a combination thereof, of the labor organizations.
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(2) Any professional, trade or occupational
| | association for its members or former or retired members, or combination thereof, if such association:
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(A) is composed of individuals all of whom are or
| | were actively engaged in the same profession, trade or occupation; and
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(B) has been maintained in good faith for
| | purposes other than obtaining insurance.
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(3) An association or a trust or the trustee or
| | trustees of a fund established, created or maintained for the benefit of members of one or more associations. Prior to advertising, marketing or offering such policy within this State, the association or associations, or the insurer of the association or associations, shall file evidence with the Director that the association or associations have at the outset a minimum of 100 members and have been organized and maintained in good faith for purposes other than that of obtaining insurance, have been in active existence for at least one year, and have a constitution and by-laws which provide that:
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(A) the association or associations hold regular
| | meetings not less than annually to further the purposes of the members;
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(B) except for credit unions, the association or
| | associations collect dues or solicit contributions from members; and
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(C) the members have voting privileges and
| | representation on the governing board and committees.
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Thirty days after such filing the association or
| | associations will be deemed to satisfy such organizational requirements, unless the Director makes a finding that the association or associations do not satisfy those organizational requirements.
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(4) A group other than as described in paragraph (1),
| | (2) or (3) of this subsection (e), subject to a finding by the Director that:
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(A) the issuance of the group policy is not
| | contrary to the best interest of the public;
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(B) the issuance of the group policy would result
| | in economies of acquisition or administration; and
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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
| | contract is coverage of qualified long-term care services. A contract shall not fail to satisfy the requirements of this subparagraph by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate.
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(2) The contract does not pay or reimburse expenses
| | incurred for services or items to the extent that the expenses are reimbursable under Title XVIII of the Social Security Act, as amended, or would be so reimbursable but for the application of a deductible or coinsurance amount. The requirements of this subparagraph do not apply to expenses that are reimbursable under Title XVIII of the Social Security Act only as a secondary payor. A contract shall not fail to satisfy the requirements of this subparagraph by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate.
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(3) The contract is guaranteed renewable within the
| | meaning of Section 7702(B)(b)(1)(C) of the Internal Revenue Code of 1986, as amended.
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(4) The contract does not provide for a cash
| | surrender value or other money that can be paid, assigned, pledged as collateral for a loan, or borrowed except as provided in subparagraph (5).
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(5) All refunds of premiums and all policyholder
| | dividends or similar amounts under the contract are to be applied as a reduction in future premiums or to increase future benefits, except that a refund on the event of death of the insured or a complete surrender or cancellation of the contract cannot exceed the aggregate premiums paid under the contract.
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(6) The contract meets the consumer protection
| | provisions set forth in Section 7702B(g) of the Internal Revenue Code of 1986, as amended.
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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
(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
(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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