215 ILCS 125/4-13
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article IV - Delivery Of Services - Required Provisions And Marketing

 (from Ch. 111 1/2, par. 1409.6)Sec. 4-13.     Prior approval of policy forms.     No health maintenance  organization shall issue or deliver in this State a group contract or  evidence of coverage, attach an endorsement or rider thereto, incorporate  by reference bylaws or other matter therein, or use an application blank in  this State until the form and content of the group contract or evidence of  coverage, endorsement, rider, bylaw, or other matter incorporated by  reference or application blank has been filed with and approved by the  Director, except that any such endorsement or rider that is to be attached  to a group contract or evidence of coverage after the date the group contract  or evidence of coverage is issued must be filed with, reviewed, and approved by  the Director before the date it is attached to a group contract or evidence of  coverage issued or delivered in this State. The Director shall withhold  approval of any such group contract, evidence of coverage, endorsement, rider,  bylaw, or other matter incorporated by reference or application blank if it  contains provisions that may encourage misrepresentation or that are unjust,  unfair, inequitable, ambiguous, misleading, inconsistent, deceptive, or  contrary to the law or public policy of this State or contains exceptions and  conditions that unreasonably or deceptively affect the risk purported to be  assumed in the general coverage of the group contract or evidence of coverage.  The Director shall not withhold approval of a form under this Section solely  because of the absence of coverage for mental health services if the Department  of Children and Family Services presents evidence that coverage of mental  health services for clients of that Department will be provided by another  entity.  In all cases the Director shall approve or disapprove any such form  within 60 days after submission unless the Director extends by not more than an  additional 30 days the period within which he shall approve or disapprove any  such form by giving written notice to the organization of the extension before  expiration of the initial 60-day period.The Director shall withdraw his approval of a group contract or evidence of  coverage, endorsement, rider, bylaw, or other matter incorporated by reference  or application blank if he subsequently determines that the group contract or  evidence of coverage, endorsement, rider, bylaw, other matter, or application  blank is misrepresentative, unjust, unfair, inequitable, ambiguous, misleading,  inconsistent, deceptive, or contrary to the law or public policy of this State,  or contains exceptions or conditions that unreasonably or deceptively affect  the risk purported to be assumed in the general coverage of the group contract  or evidence of coverage. The Director shall not withdraw approval of a form  under this Section solely because of the absence of coverage for mental health  services if the Department of Children and Family Services presents evidence  that coverage of mental health services for clients of that Department is being  or will be provided by another entity.If a previously approved group contract or evidence of coverage,  endorsement, rider, bylaw, or other matter incorporated by reference or  application blank is withdrawn for use, the Director shall serve upon the  company an order of withdrawal of use, either personally or by mail. If the  service is by mail, the service shall be completed if the notice is deposited  in the post office, postage prepaid, addressed to the health maintenance  organization's last known address specified in the records of the Department of  Insurance.  The order of withdrawal of use shall take effect 30 days from the  date of mailing but shall be stayed if within the 30-day period a written  request for hearing is filed with the Director.  The hearing shall be held at  the time and place designated in the order given by the Director.  The hearing  may be held either in the City of Springfield, the City of Chicago, or in the  county where the principal business address of the health maintenance  organization is located.The action of the Director in disapproving or withdrawing the form shall be  subject to judicial review under the Administrative Review Law.    (Source: P.A. 88-487.)