215 ILCS 5/351A-1
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XIXA - Long-Term Care Insurance

 (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.(2) In the case of a group long-term care insurance     policy, the proposed certificate holder.(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.(2) Any professional, trade or occupational     association for its members or former or retired members, or combination thereof, if such association:(A) is composed of individuals all of whom are or         were actively engaged in the same profession, trade or occupation; and(B) has been maintained in good faith for         purposes other than obtaining insurance.(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:(A) the association or associations hold regular         meetings not less than annually to further the purposes of the members;(B) except for credit unions, the association or         associations collect dues or solicit contributions from members; and(C) the members have voting privileges and         representation on the governing board and committees.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.(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:(A) the issuance of the group policy is not         contrary to the best interest of the public;(B) the issuance of the group policy would result         in economies of acquisition or administration; and(C) the benefits are reasonable in relation to         the premiums charged.(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.(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.(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.(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).(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.(6) The contract meets the consumer protection     provisions set forth in Section 7702B(g) of the Internal Revenue Code of 1986, as amended."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.)