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INSURANCE215 ILCS 125/Art. VI
(215 ILCS 125/) Health Maintenance Organization Act.
(215 ILCS 125/Art. VI heading)
ORGANIZATION GUARANTY ASSOCIATION
215 ILCS 125/6-1
(215 ILCS 125/6-1)
(from Ch. 111 1/2, par. 1418.1)
This Article shall be known and may be cited as the
"Illinois Health Maintenance Organization Guaranty Association Law".
(Source: P.A. 85-20.)
215 ILCS 125/6-2
(215 ILCS 125/6-2)
(from Ch. 111 1/2, par. 1418.2)
The purpose of this Article is to protect
enrollees of health care plans who reside in this State, and their
beneficiaries, payees and assignees, subject to certain limitations,
against failure in the performance of contractual obligations due to the
impairment or insolvency of the organization operating such health care
plans. Nonresident enrollees of such health care plans shall be
protected by this Association if: (1) they reside in states which have
associations similar to the Association created by this Article; (2) they
are not eligible for coverage by such associations; (3) the organization which
operates such health care plan never held a license or certificate of
authority in such states; and (4) such organization was domiciled in this
State. To provide this protection, (1) an association of health
maintenance organizations is created to enable the guaranty of payment
of benefits and of continuation of coverages, either on a prepaid or
indemnity basis, (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 health care plan
impairments or insolvencies.
(Source: P.A. 86-620.)
215 ILCS 125/6-3
(215 ILCS 125/6-3)
(from Ch. 111 1/2, par. 1418.3)
This Article applies to direct individual contracts,
group contracts and certificates issued thereunder, or
any other evidence of coverage, each of which provides for coverage under a
health care plan, and has been issued by organizations licensed to transact
health maintenance organization business in this State under the Health
Maintenance Organization Act, but not to any business of such organization
not transacted under its health maintenance organization certificate of
(Source: P.A. 92-370, eff. 8-15-01.)
215 ILCS 125/6-4
(215 ILCS 125/6-4)
(from Ch. 111 1/2, par. 1418.4)
This Article shall be construed to
effect the purpose under Section 6-2.
(Source: P.A. 96-1450, eff. 8-20-10.)
215 ILCS 125/6-5
(215 ILCS 125/6-5)
(from Ch. 111 1/2, par. 1418.5)
As used in this Act:
(1) "Association" means the Illinois Health Maintenance Organization
Guaranty Association created under Section 6-6.
(2) "Director" means the Director of Insurance of this State.
(3) "Contractual obligation" means any obligation of the member
organization under covered
health care plan certificates.
(4) "Covered person" means any enrollee who is entitled to the
protection of the Association as described in Section 6-2.
(5) "Covered health care plan certificate" means any health care plan
certificate, contract or other evidence of coverage within the scope
of this Article under Section 6-3.
(6) "Fund" means the fund created under Section 6-6.
(7) "Impaired organization" means a member organization deemed by the
Director after the effective date of this Article to be potentially unable
to fulfill its contractual obligations and not an insolvent organization.
(8) "Insolvent organization" means a member organization which
becomes insolvent and is placed under a final order of liquidation or
rehabilitation by a court of competent jurisdiction.
(9) "Member organization" means any person licensed or who holds a
certificate of authority to transact in this
State any kind of business to which this Article applies under
Section 6-3. For purposes of this Article "member organization" includes
any person whose certificate of authority may have been suspended pursuant
to Section 5-5 of this Act.
(10) "Premiums" means direct gross premiums or subscriptions
received on covered health care plan certificates. "Premiums" does not include amounts or considerations received for policies, contracts, or certificates or for the portions of policies, contracts, or certificates for which coverage is not provided.
(11) "Person" means any individual, corporation, partnership,
association or voluntary organization.
(12) "Resident" means any person who resides in this State at the time the
organization is issued a Notice of Impairment by the Director or at the time a
complaint for liquidation or rehabilitation is filed and to whom
contractual obligations are owed. 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.
(Source: P.A. 96-1450, eff. 8-20-10.)
215 ILCS 125/6-6
(215 ILCS 125/6-6)
(from Ch. 111 1/2, par. 1418.6)
Creation of the Association.
There is created a
non-profit legal entity to be known as the Illinois Health Maintenance
Organization Guaranty Association. All member organizations are and must
remain members of the Association as a condition of their authority to
transact business in this State. The Association must perform its
functions under the plan of operation established and approved under
Section 6-10 and must exercise its powers through a board of directors
established under Section 6-7. For purposes of administration and
assessment, the Association must maintain the Health Maintenance
Organization Fund. The Association shall be supervised by the Director and
is subject to this Act and the applicable provisions of the Illinois
(Source: P.A. 85-20.)
215 ILCS 125/6-7
(215 ILCS 125/6-7)
(from Ch. 111 1/2, par. 1418.7)
Board of Directors.
The board of directors of the
Association consists of not less than 7 nor more than 11
terms as established in the plan of operation. The members of the board
are to be selected by member organizations subject to the approval of the
Director, except the Director shall name 2 members who are
current enrollees, one of whom is over 50 years of age. Vacancies on the
board must be filled for the remaining period
of the term in the manner described in the plan of operation. To select
the initial board of directors, and initially organize the Association,
the Director must give notice to all member organizations of the time and
place of the organizational meeting. In determining voting rights at the
organizational meeting each member organization is entitled to one vote in
person or by proxy. If the board of directors is not selected at
the organizational meeting, the Director may appoint the initial members.
In approving selections or in appointing members to the board, the
Director must consider, whether all member organizations are
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
(Source: P.A. 91-617, eff. 1-1-00.)
215 ILCS 125/6-8
(215 ILCS 125/6-8)
(from Ch. 111 1/2, par. 1418.8)
Powers and duties of the Association.
In addition to
the powers and duties enumerated in other Sections of this Article, the
Association shall have the powers set forth in this Section.
(1) If a domestic organization is an impaired organization, the Association
may, subject to any conditions imposed by the Association other than
those which impair the contractual obligations of the impaired organization,
and approved by the impaired organization and the Director:
(a) guarantee, assume, or reinsure, or cause to be
guaranteed, assumed or reinsured, any or all of the covered health care plan certificates of covered persons of the impaired organization;
(b) provide such monies, pledges, notes, guarantees,
or other means as are proper to effectuate paragraph (a), and assure payment of the contractual obligations of the impaired organization pending action under paragraph (a); and
(c) loan money to the impaired organization.
(2) If a domestic, foreign, or alien organization is an insolvent
organization, the Association shall, subject to the approval of the Director:
(a) guarantee, assume, indemnify or reinsure or cause
to be guaranteed, assumed, indemnified or reinsured the covered health care plan benefits of covered persons of the insolvent organization; however, in the event that the Director of Healthcare and Family Services (formerly Director of the Department of Public Aid) assigns individuals that are recipients of public aid from an insolvent organization to another organization, the Director of Healthcare and Family Services shall, before fixing the rates to be paid by the Department of Healthcare and Family Services to the transferee organization on account of such individuals, consult with the Director of the Department of Insurance as to the reasonableness of such rates in light of the health care needs of such individuals and the costs of providing health care services to such individuals;
(b) assure payment of the contractual obligations of
the insolvent organization to covered persons;
(c) make payments to providers of health care, or
indemnity payments to covered persons, so as to assure the continued payment of benefits substantially similar to those provided for under covered health care plan certificate issued by the insolvent organization to covered persons; and
(d) provide such monies, pledges, notes, guaranties,
or other means as are reasonably necessary to discharge such duties.
This subsection (2) shall not apply when the
Director has determined that the foreign or alien organization's
domiciliary jurisdiction or state of entry provides, by statute, protection
substantially similar to that provided by this Article for residents of
this State and such protection will be provided in a timely manner.
(3) 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 organization's business by
reason of any action taken or any failure to take any action by the
impaired or insolvent organization at any time.
(4) 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 organization, the Director shall have the powers and duties of
the Association under this Article with regard to such insolvent organization.
(5) 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
(6) The Association has standing to appear before any court concerning
all matters germane to the powers and duties of
the Association, including, but not limited to, proposals for reinsuring
or guaranteeing the covered health care plan certificates of the impaired
or insolvent organization and the determination of the covered health care plan
certificates and contractual obligations.
(7) (a) Any person receiving benefits under this Article is deemed
to have assigned the rights under the covered health care plan
certificates to the Association to the extent of the benefits received
because of this Article whether the benefits are payments of contractual
obligations or continuation of coverage. The Association may require an
assignment to it of such rights by any payee, enrollee or beneficiary as a
condition precedent to the receipt of any rights or benefits conferred by
this Article upon such person. The Association is subrogated to these
rights against the assets of any insolvent organization and against any
other party who may be liable to such payee, enrollee or beneficiary.
(b) The subrogation rights of the Association under this subsection
have the same priority against the assets of the insolvent organization as
that possessed by the person entitled to receive benefits under this
(8) (a) The contractual obligations of the insolvent organization for
which the Association becomes or may become liable are as great as but no
greater than the contractual obligations of the insolvent organization would
have been in the absence of an insolvency unless such obligations are
reduced as permitted by subsection (3), but the aggregate liability of the
Association shall not exceed $500,000 with respect to any one natural person.
(b) Furthermore, the Association shall not be required to pay, and shall
have no liability to, any provider of health care services to an enrollee:
(i) if such provider, or his or its affiliates or
members of his immediate family, at any time within the one year prior to the date of the issuance of the first order, by a court of competent jurisdiction, of conservation, rehabilitation or liquidation pertaining to the health maintenance organization:
(A) was a securityholder of such organization
(but excluding any securityholder holding an equity interest of 5% or less);
(B) exercised control over the organization by
means such as serving as an officer or director, through a management agreement or as a principal member of a not-for-profit organization;
(C) had a representative serving by virtue of his
or her official position as a representative of such provider on the board of any entity which exercised control over the organization;
(D) received provider payments made by such
organization pursuant to a contract which was not a product of arms-length bargaining; or
(E) received distributions other than for
physician services from a not-for-profit organization on account of such provider's status as a member of such organization.
For purposes of this subparagraph (i), the terms
"affiliate," "person," "control" and "securityholder" shall have the meanings ascribed to such terms in Section 131.1 of the Illinois Insurance Code; or
(ii) if and to the extent such a provider has agreed
by contract not to seek payment from the enrollee for services provided to such enrollee or if, and to the extent, as a matter of law such provider may not seek payment from the enrollee for services provided to such enrollee; or
(iii) related to any policy, contract, or certificate
providing any hospital, medical, prescription drug, or other health care benefits pursuant to Part C or Part D of Subchapter XVIII, Chapter 7 of Title 42 of the United States Code (commonly known as Medicare Part C & D) or any regulations issued pursuant thereto; or
(iv) for any portion of a policy, contract, or
certificate to the extent that the assessments required by this Article with respect to the policy or contract are preempted or otherwise not permitted by federal or State law; or
(v) for any obligation that does not arise under the
express written terms of the policy or contract issued by the organization to the contract owner or policy owner, including without limitation:
(A) claims based on marketing materials;
(B) claims based on side letters, riders, or
other documents that were issued by the insurer without meeting applicable policy form filing or approval requirements;
(C) misrepresentations of or regarding policy
(D) extra-contractual claims; or
(E) claims for penalties or consequential or
(c) In no event shall the Association be required to pay any provider
participating in the insolvent organization
any amount for in-plan services rendered by such provider prior to the
insolvency of the organization in excess of (1) the amount
provided by a capitation contract between a physician provider and the
insolvent organization for such services; or (2) the
amounts provided by contract between a hospital provider and the Department of Healthcare and Family Services (formerly
Public Aid) for similar services to recipients of public aid; or (3) in the
event neither (1) nor (2) above is applicable, then the amounts paid under
the Medicare area prevailing rate for the area where the services were
provided, or if no such rate exists with respect to such services, then 80%
of the usual and customary rates established by the Health Insurance
Association of America. The payments required to be made by the Association
under this Section shall constitute full and complete payment for such
provider services to the enrollee.
(d) The Association shall not be required to pay more than an
aggregate of $300,000 for any organization which is declared to be
insolvent prior to July 1, 1987, and such funds shall be distributed first
to enrollees who are not public aid recipients pursuant to a plan
recommended by the Association and approved by the Director and the court
having jurisdiction over the liquidation.
(9) The Association may:
(a) Enter into such contracts as are necessary or
proper to carry out the provisions and purposes of this Article.
(b) Sue or be sued, including taking any legal
actions necessary or proper for recovery of any unpaid assessments under Section 6-9. The Association shall not be liable for punitive or exemplary damages.
(c) Borrow money to effect the purposes of this
Article. Any notes or other evidence of indebtedness of the Association not in default are legal investments for domestic organizations and may be carried as admitted assets.
(d) Employ or retain such persons as are necessary to
handle the financial transactions of the Association, and to perform such other functions as become necessary or proper under this Article.
(e) Negotiate and contract with any liquidator,
rehabilitator, conservator, or ancillary receiver to carry out the powers and duties of the Association.
(f) Take such legal action as may be necessary to
avoid payment of improper claims.
(g) Exercise, for the purposes of this Article and to
the extent approved by the Director, the powers of a domestic organization, but in no case may the Association issue evidence of coverage other than that issued to perform the contractual obligations of the impaired or insolvent organization.
(h) Exercise all the rights of the Director under
Section 193(4) of the Illinois Insurance Code with respect to covered health care plan certificates after the association becomes obligated by statute.
(i) Request information from a person seeking
coverage from the Association in order to aid the Association in determining its obligations under this Article with respect to the person and the person shall promptly comply with the request.
(j) Take other necessary or appropriate action to
discharge its duties and obligations under this Article or to exercise its powers under this Article.
(10) The obligations of the Association under this Article shall not
relieve any reinsurer, insurer or other person of its obligations to the
insolvent organization (or its conservator, rehabilitator, liquidator or
similar official) or its enrollees, including without limitation any
reinsurer, insurer or other person liable to the insolvent insurer (or its
conservator, rehabilitator, liquidator or similar official) or its
enrollees under any contract of reinsurance, any contract providing stop
loss coverage or similar coverage or any health care contract. With
respect to covered health care plan certificates 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 organization arising after the date of the order of
liquidation or rehabilitation under any contract of reinsurance, any
contract providing stop loss coverage or similar coverages or any health
care service contract to which the insolvent organization was a party, on
the terms set forth under such contract, to the extent that such contract
provides coverage for health care services provided after the date of the
order of liquidation or rehabilitation. As a condition to making this
election, the Association must pay premiums for coverage relating to
periods after the date of the order of liquidation or rehabilitation.
(11) The Association shall be entitled to collect premiums due under or with
respect to covered health care certificates for a period from the date on which
the domestic, foreign, or alien organization became an insolvent organization
until the Association no longer has obligations under subsection (2) of
this Section with respect to such certificates. The Association's
obligations under subsection (2) of this Section with respect to
any covered health care plan certificates shall terminate in the event that
all such premiums due under or with respect to such covered health care plan
certificates are not paid to the Association (i) within 30 days of the
Association's demand therefor, or (ii) in the event that such certificates
provide for a longer grace period for payment of premiums after notice of
non-payment or demand therefor, within the lesser of (A) the period provided
for in such certificates or (B) 60 days.
(12) 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.
(13) 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.
(14) 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.
(Source: P.A. 95-331, eff. 8-21-07; 96-1450, eff. 8-20-10; 96-1509, eff. 1-27-11; 97-333, eff. 8-12-11.)
215 ILCS 125/6-9
(215 ILCS 125/6-9)
(from Ch. 111 1/2, par. 1418.9)
(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 organizations, 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 organizations
and shall accrue interest from the due date at such adjusted rate as is
established under Section 531.09 of the Illinois Insurance 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
of meeting administrative costs and other general expenses and examinations conducted under the authority of the Director under subsection (5) of Section 6-12.
(b) Class B assessments shall be made to the extent
necessary to carry out the powers and duties of the Association under Section 6-8 with regard to an impaired or insolvent domestic organization or insolvent foreign or alien organizations.
(3)(a) The amount of any Class A assessment shall be determined by the
Board and may be made on a non-pro rata basis.
(b) Class B assessments against member organizations shall
be in the proportion that the premiums received on health maintenance
organization business in this State
by each assessed member organization on covered health care plan certificates for
the calendar year preceding the assessment bears to such premiums received
on health maintenance organization business in this State for the calendar
year preceding the assessment by all assessed member organizations.
(c) Assessments to meet the requirements of the Association
with respect to an impaired or insolvent organization 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)(a) The Association may abate or defer, in whole or in part, the
assessment of a member organization if, in the opinion of the board,
payment of the assessment would endanger the ability of the member
organization to fulfill its contractual obligations.
(b) The total of all assessments upon a member organization
may not in any one calendar year exceed 2% of such organization's premiums
in this State during the calendar year preceding the assessment on the
covered health care plan certificates.
(5) In the event an assessment against a member organization is abated,
or deferred, in whole or in part, because of the limitations set forth in
subsection (4) of this Section, the amount by which such assessment is
abated or deferred, may be assessed against the other member organizations
in a manner consistent with the basis for assessments set forth in this
Section. If the maximum assessment, together with the other assets of the
Association, does not provide in any one year an amount sufficient to carry
out the responsibilities of the Association, the necessary additional funds
may be assessed as soon thereafter as permitted by this Article.
(6) The board may, by an equitable method as established in the
plan of operation, refund to member organizations, in proportion to the
contribution of each organization, the amount by which the assets of the fund
exceed the amount the board finds is necessary to carry out during the coming
year the obligations of the Association, including
assets accruing from net realized gains and income from investments. A
reasonable amount may be retained in the fund to provide moneys 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 organization, in determining its rates
to consider the amount reasonably necessary to meet its assessment
obligations under this Article.
(9) The Association must issue to each organization paying a
Class B assessment under this Article a certificate of contribution,
in a form prescribed by 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 organization in its financial statement as
an admitted asset in such form and for such amount, if any, and period of
time as the Director may approve, provided the organization shall in any
event at its option have the right to show a certificate of contribution as
an 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 organizations in order to aid in the exercise of its power under this Section and member organizations shall promptly comply with a request.
(Source: P.A. 96-1450, eff. 8-20-10.)
215 ILCS 125/6-10
(215 ILCS 125/6-10)
(from Ch. 111 1/2, par. 1418.10)
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 90 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 organizations 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
(b) Establish the amount and method of reimbursing
members of the board of directors under Section 6-7;
(c) Establish regular places and times for meetings
of the board of directors;
(d) Establish procedures for records to be kept of
all financial transactions of the Association, its agents, and the board of directors;
(e) Establish the procedures whereby selections for
the board of directors will be made and submitted to the Director;
(f) Establish any additional procedures for
assessments under Section 6-9; and
(g) Contain additional provisions necessary or proper
for the execution of the powers and duties of the Association.
(4) The plan of operation shall establish a procedure for protest by
any member organization of assessments made by the Association pursuant to
Section 6-9. Such procedures shall require that:
(a) A member organization that wishes to protest all
or part of an assessment shall pay when due the full amount of the assessment as set forth in the notice provided by the Association. The payment shall be available to meet Association obligations during the pendency of the protest or any subsequent appeal. Payment shall be accompanied by a statement in writing that the payment is made under protest and setting forth a brief statement of the grounds for the protest.
(b) Within 30 days following the payment of an
assessment under protest by any protesting member organization, the Association must notify the member organization in writing of its determination with respect to the protest unless the Association notifies the member that additional time is required to resolve the issues raised by the protest.
(c) In the event the Association determines that the
protesting member organization is entitled to a refund, such refund shall be made within 30 days following the date upon which the Association makes its determination.
(d) The decision of the Association with respect to a
protest may be appealed to the Director pursuant to subsection (3) of Section 6-11.
(e) In the alternative to rendering a decision with
respect to any protest based on a question regarding the assessment base, the Association may refer such protests to the Director for final decision, with or without a recommendation from the Association.
(f) Interest on any refund due a protesting member
organization shall be paid at the rate actually earned by the Association.
(5) The plan of operation may provide that any or all powers and duties
of the Association, except those under paragraph (c) of subsection (10)
of Section 6-8 and Section 6-9 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 Article.
(Source: P.A. 96-1450, eff. 8-20-10.)
215 ILCS 125/6-11
(215 ILCS 125/6-11)
(from Ch. 111 1/2, par. 1418.11)
Duties and Powers of the Director.
In addition to
the duties and powers enumerated elsewhere in this Article, the Director
shall have the powers set forth in this Section.
(1) The Director must:
(a) Upon request of the board of directors, provide
the Association with a statement of the premiums in the appropriate states for each member organization.
(b) Notify the board of directors of the existence of
an impaired or insolvent organization not later than 3 days after a determination of impairment or insolvency is made or when the Director receives notice of impairment or insolvency.
(c) Give notice to an impaired organization as
required by Section 2-4 of this Act. Notice to the impaired organization shall constitute notice to its shareholders, if any.
(d) In any liquidation or rehabilitation proceeding
involving a domestic organization, be appointed as the liquidator or rehabilitator. If a foreign or alien member organization is subject to a liquidation proceeding in its domiciliary jurisdiction or state of entry, the Director may be appointed conservator.
(2) The Director may suspend or revoke, after notice and hearing,
the certificate of authority to transact business in this State of any member
organization which fails to pay an assessment when due or fails to comply
with the plan of operation. As an alternative the Director may levy a
forfeiture on any member organization which fails to pay an assessment when
due. Such forfeiture may not exceed 5% of the unpaid assessment per month,
but no forfeiture may be less than $100 per month.
(3) Any action of the board of directors or the Association may be
appealed to the Director by any member organization or any other person
adversely affected by such action if such appeal is taken
within 30 days of the action being appealed. Any final action or order of
the Director is subject to judicial review in a court of competent
(4) The liquidator, rehabilitator, or conservator of any impaired
organization may notify all interested persons of the effect of this Article.
(Source: P.A. 86-620
215 ILCS 125/6-12
(215 ILCS 125/6-12)
(from Ch. 111 1/2, par. 1418.12)
Prevention of Insolvencies.
To aid in the detection and
prevention of organization insolvencies or impairments:
(1) It shall be the duty of the Director:
(a) To notify the appropriate regulatory authority of all other
states, territories of the United States, and the District of Columbia when
he takes any of the following actions against a member organization:
(i) revocation of license;
(ii) suspension of license;
(iii) makes any formal order, except for an order issued pursuant to
Article XII 1/2 of the Illinois Insurance Code, that such company
restrict its subscriptions,
obtain additional contributions to surplus, withdraw from the State,
reinsure all or any part of its business, or increase capital, surplus or
any other account for the security of enrollees or creditors.
Such notice shall be transmitted to all regulatory authorities within 30 days
following the action taken or the date on which the action occurs.
(b) To report to the board of directors when he has taken any of the actions
set forth in subparagraph (a) of this paragraph or has received a report
from any other regulatory authority indicating that any such action has
been taken in another state. Such report to the board of directors shall
contain all significant details of the action taken or the report received
from another regulatory authority.
(2) The Director may seek the advice and recommendations of the board
of directors concerning any matter affecting his duties and responsibilities
regarding the financial condition of member organizations and organizations
seeking admission to transact business in this State.
(3) The board of directors may, upon majority vote, make reports and
recommendations to the Director upon any matter germane to the liquidation,
rehabilitation or conservation of any member organization. Such reports
and recommendations shall not be considered public documents.
(4) The board of directors may, upon majority vote, make recommendations
to the Director for the detection and prevention of health maintenance
(5) The board of directors shall, at the conclusion of any
health maintenance organization insolvency in which the Association was
obligated to make payments, prepare a report to the Director containing
such information as it may have in its possession bearing on the history
and causes of such insolvency. The board shall cooperate
with the boards of directors of guaranty associations in other states in
preparing a report on the history and causes for insolvency of a particular
organization, and may adopt by reference any report prepared by such other
(Source: P.A. 86-620.)
215 ILCS 125/6-13
(215 ILCS 125/6-13)
(from Ch. 111 1/2, par. 1418.13)
In the event the aggregate Class A and B
assessments for all member organizations do not exceed $3,000,000 in any one
calendar year, no member organization shall receive a tax offset. However, in
any one calendar year 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 five calendar years following the year in which such assessment was
paid, and ending prior to January 1, 2003, and each member organization may
offset the proportionate amount of
such excess paid by the organization 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 on
and after January 1, 2004.
(Source: P.A. 93-29, eff. 6-20-03.)
215 ILCS 125/6-14
(215 ILCS 125/6-14)
(from Ch. 111 1/2, par. 1418.14)
(1) 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 6-8. 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 organization, upon the termination of the impairment or
insolvency of the organization, or upon the order of a court of competent
jurisdiction. Nothing in this subsection (1) limits the duty of the
Association to submit a report of its activities under Section 6-15.
(2) For the purpose of carrying out its obligations under this Article,
the Association is deemed to be a creditor of the impaired or insolvent
organization to the extent of assets attributable to covered health care plan
certificates reduced by any amounts to which the Association is entitled as
subrogee (under subsection (7) of Section 6-8). All assets of the impaired
or insolvent organization attributable to covered health care plan
certificates must be used to continue all covered health care plan
certificates and pay all contractual obligations of the impaired
organization as required by this Article. "Assets attributable to covered
health care plan certificates", as used in this subsection (2), is that
proportion of the assets which the reserves that should have been
established for such health care plan certificates bear to the reserve that
should have been established for all health care plan certificates of the
impaired or insolvent organization.
(3) (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 of the impaired or insolvent organization, and any other party
with a bona fide interest, in making an equitable distribution of the
ownership rights of such impaired or insolvent organization. In such a
determination, consideration must be given to the welfare of the enrollees
of the continuing or successor organization.
(b) No distribution to stockholders, if any, of an impaired or insolvent
organization may be made until and unless the total
amount of valid claims of the Association for funds expended in carrying
out its powers and duties under Section 6-8, with respect to such organization
have been fully recovered by the Association.
(4) (a) If an order for liquidation or rehabilitation of an organization
domiciled in this State has been entered, the receiver appointed under such
order has a right to recover on behalf of the organization, from any
affiliate that controlled it, the amount of distributions, other than stock
dividends paid by the organization 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 distribution is recoverable if the organization shows that when
paid the distribution was lawful and reasonable, and that the organization
did not know and could not reasonably have known that the distribution
might adversely affect the ability of the organization to fulfill its
(c) Any person who was an affiliate that controlled the organization 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 organization 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 (4) of this Section is
the amount needed in excess of all other available assets of the insolvent
organization to pay the contractual obligations of the insolvent organization.
(e) If any person liable under paragraph (c) of subsection (4) of this
Section is insolvent, all its affiliates that controlled it at the time the
distribution was paid are jointly and severally liable for any resulting
deficiency in the amount recovered from the insolvent affiliate.
(Source: P.A. 86-620.)
215 ILCS 125/6-15
(215 ILCS 125/6-15)
(from Ch. 111 1/2, par. 1418.15)
Examination of the Association - Annual Report.
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. 86-620.)
215 ILCS 125/6-16
(215 ILCS 125/6-16)
(from Ch. 111 1/2, par. 1418.16)
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. 85-20.)
215 ILCS 125/6-17
(215 ILCS 125/6-17)
(from Ch. 111 1/2, par. 1418.17)
There is no liability on the part of and
no cause of action of any nature may arise against any member organization
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. 85-20.)
215 ILCS 125/6-18
(215 ILCS 125/6-18)
(from Ch. 111 1/2, par. 1418.18)
Stay of Proceedings - Reopening Default Judgments.
All proceedings in which the insolvent organization 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.)
215 ILCS 125/6-19
(215 ILCS 125/6-19)
(from Ch. 111 1/2, par. 1418.19)
Prohibited Advertisement of Action of the Health Maintenance
Organization Guaranty Association in solicitation of enrollees. No person,
including an organization, agent
or affiliate of an organization 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 which
uses the existence of the Health Maintenance Organization Guaranty Association
of this State for the purpose of solicitation of enrollees in health care plans
covered by this Article; provided, however, that this Section shall not
apply to the Illinois Health Maintenance Organization Guaranty Association or
any other entity which does not operate health care plans.
(Source: P.A. 85-20.)