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Illinois Compiled Statutes

Information maintained by the Legislative Reference Bureau
Updating the database of the Illinois Compiled Statutes (ILCS) is an ongoing process. Recent laws may not yet be included in the ILCS database, but they are found on this site as Public Acts soon after they become law. For information concerning the relationship between statutes and Public Acts, refer to the Guide.

Because the statute database is maintained primarily for legislative drafting purposes, statutory changes are sometimes included in the statute database before they take effect. If the source note at the end of a Section of the statutes includes a Public Act that has not yet taken effect, the version of the law that is currently in effect may have already been removed from the database and you should refer to that Public Act to see the changes made to the current law.

INSURANCE
(215 ILCS 5/) Illinois Insurance Code.

215 ILCS 5/511.111

    (215 ILCS 5/511.111) (from Ch. 73, par. 1065.58-111)
    (Section scheduled to be repealed on January 1, 2017)
    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.)

215 ILCS 5/511.112

    (215 ILCS 5/511.112) (from Ch. 73, par. 1065.58-112)
    (Section scheduled to be repealed on January 1, 2017)
    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
    
persons providing life, accident and health coverage for a plan;
        (2) Return contributions and premiums to a plan or
    
covered individual;
        (3) Commissions or administrative fees due to the
    
administrator when earned pursuant to written agreement; and
        (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
    
America or U.S. Government agency securities with maturities of not more than one year;
        (2) Certificates of deposit, with a maturity of not
    
more than one year, issued by financial institutions which are insured by the Federal Deposit Insurance Corporation (FDIC) or Federal Savings and Loan Insurance Corporation (FSLIC), so long as any such deposit does not exceed the maximum level of insurance protection provided to certificates of deposits held by such institutions;
        (3) Repurchase agreements with financial institutions
    
or government securities dealers recognized as primary dealers by the Federal Reserve System provided:
            (A) The value of the repurchase agreement is
        
collateralized with assets which are allowable investments for ATF funds; and
            (B) The collateral has a market value at the time
        
the repurchase agreement is entered into at least equal to the value of the repurchase agreement; and
            (C) The repurchase agreement does not exceed 30
        
days.
        (4) Commercial paper, provided the commercial paper
    
is rated at least P-1 by Moody's Investors Service, Inc. or at least A-1 by Standard & Poor's Corporation;
        (5) Money Market Funds, provided the money market
    
fund invests exclusively in assets which are allowable investments pursuant to (1) through (4) above for ATF funds;
        (6) Each investment transaction must be made in the
    
name of the administrator's ATF. The administrator must maintain evidence of any such investments. Each investment transaction must flow through the administrator's ATF.
    (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)(l) 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
    
a plan sponsor or insurer; and
        (ii) Claims and claim adjustment expenses received
    
and paid on behalf of a plan sponsor or insurer.
    (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
    
received and deposited by the administrator.
        (ii) The date and person to whom a disbursement is
    
made. If the amount disbursed does not agree with the amount billed or authorized, the administrator shall prepare a written record as to the reason.
        (iii) A description of the disbursement in such
    
detail to identify the source document substantiating the purpose of the disbursement.
    (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.)

215 ILCS 5/511.113

    (215 ILCS 5/511.113) (from Ch. 73, par. 1065.58-113)
    (Section scheduled to be repealed on January 1, 2017)
    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.)

215 ILCS 5/511.114

    (215 ILCS 5/511.114)
    (Section scheduled to be repealed on January 1, 2017)
    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.)

215 ILCS 5/511.118

    (215 ILCS 5/511.118)
    (Section scheduled to be repealed on January 1, 2017)
    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.)

215 ILCS 5/Art. XXXI.5

 
    (215 ILCS 5/Art. XXXI.5 heading)
ARTICLE XXXI 1/2.
THIRD PARTY PRESCRIPTION PROGRAMS

215 ILCS 5/512-1

    (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.)

215 ILCS 5/512-2

    (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.)

215 ILCS 5/512-3

    (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.)

215 ILCS 5/512-4

    (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.)

215 ILCS 5/512-5

    (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.)

215 ILCS 5/512-6

    (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.)

215 ILCS 5/512-7

    (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
    
least 30 days during which any pharmacy licensed under the Pharmacy Practice Act may elect to participate in the program under the program terms for at least one year.
        (2) If compliance with the requirements of this
    
subsection (b) would impair any provision of a contract between a program and any other person, and if the contract provision was in existence before January 1, 1990, then immediately after the expiration of those contract provisions the program shall comply with the requirements of this subsection (b).
        (3) This subsection (b) does not apply if:
            (A) the program administrator is a licensed
        
health maintenance organization that owns or controls a pharmacy and that enters into an agreement or contract with that pharmacy in accordance with subsection (a); or
            (B) the program administrator is a licensed
        
health maintenance organization that is owned or controlled by another entity that also owns or controls a pharmacy, and the administrator enters into an agreement or contract with that pharmacy in accordance with subsection (a).
            (4) This subsection (b) shall be inoperative
        
after October 31, 1992.
    (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
    
program; and
        (2) an expiration date if required under the
    
contractual arrangement or agreement between a provider of pharmaceutical services and prescription drug products and the third party prescription program administrator.
(Source: P.A. 95-689, eff. 10-29-07.)

215 ILCS 5/512-8

    (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.)

215 ILCS 5/512-9

    (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.)

215 ILCS 5/512-10

    (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.)

215 ILCS 5/Art. XXXI.75

 
    (215 ILCS 5/Art. XXXI.75 heading)
ARTICLE XXXI 3/4 PUBLIC INSURANCE ADJUSTERS
AND REGISTERED FIRMS
(Article scheduled to be repealed on January 1, 2017)

215 ILCS 5/512.51

    (215 ILCS 5/512.51) (from Ch. 73, par. 1065.59-51)
    (Section scheduled to be repealed on January 1, 2017)
    Sec. 512.51. Scope of Article. This Article shall apply to all Public Insurance Adjusters and Registered Firms as defined in Section 512.52.
(Source: P.A. 84-832.)

215 ILCS 5/512.52

    (215 ILCS 5/512.52) (from Ch. 73, par. 1065.59-52)
    (Section scheduled to be repealed on January 1, 2017)
    Sec. 512.52. Definitions. As used in this Article unless the context clearly otherwise requires:
    (a)   "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.
    (b) "Public Insurance Adjuster" means a person engaged in the business of adjusting insurance claims who is licensed pursuant to this Article.
    (c) "Registered Firm" means a person registered with the Director under Section 512.57.
    (d) "Compensation" shall include, but need not be limited to, the following:
        1. any assignment of insurance proceeds or a
    
percentage thereof;
        2. any agreement to make repairs for the amount of
    
the insurance proceeds payable;
        3. assertion of any lien against insurance proceeds
    
payable.
    (e) "Person" embraces both natural persons and business entities of whatever type.
(Source: P.A. 95-213, eff. 1-1-08.)