reglab/housing_qa huggingface dataset:
215 ILCS 125/4-14
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. 1409.7)Sec. 4-14. Evidence of Coverage.(a) Every subscriber shall be issued an evidence of coverage, which  shall contain a clear and complete statement of:(1) The health services to which each enrollee is     entitled;(2) Eligibility requirements indicating the     conditions which must be met to enroll in a Health Care Plan;(3) Any limitation of the services, kinds of services     or benefits to be provided, and exclusions, including any reasonable deductibles, copayments, or other charges;(4) The terms or conditions upon which coverage may     be cancelled or otherwise terminated;(5) Where and in what manner information is available     as to where and how services may be obtained; and(6) The method for resolving complaints.(b) Any amendment to the evidence of coverage may be provided to the  subscriber in a separate document.  (Source: P.A. 97-1148, eff. 1-24-13.)
215 ILCS 125/4-15
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. 1409.8)Sec. 4-15.         (a) No contract or evidence of coverage for basic health  care services delivered, issued for delivery, renewed or amended by a  Health Maintenance Organization shall exclude coverage for emergency  transportation by  ambulance.  For the purposes of this Section, the term "emergency" means a need for  immediate medical attention resulting from a life threatening condition or  situation or a need for immediate medical attention as otherwise reasonably  determined by a physician, public safety official or other emergency  medical personnel.(b) Upon reasonable demand by a provider of emergency transportation  by ambulance, a Health Maintenance Organization shall promptly pay to the  provider, subject to  coverage limitations stated in the contract or evidence of coverage,  the  charges for emergency transportation by ambulance provided to an enrollee in a health care  plan arranged for by the Health Maintenance  Organization.  By  accepting any such payment from the Health Maintenance Organization, the  provider of emergency transportation by ambulance agrees not to seek any  payment from the enrollee for services provided to the enrollee.    (Source: P.A. 86-833; 86-1028.)
215 ILCS 125/4-16
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. 1409.9)Sec. 4-16.     Fibrocystic condition; denial of coverage.     No contract or  evidence of coverage issued by a Health  Maintenance Organization shall be denied by the Organization,  nor shall any contract or evidence of coverage contain any exception or  exclusion of benefits, solely because the enrollee has been diagnosed as  having a fibrocystic breast condition, unless the condition is diagnosed by  a  breast biopsy that demonstrates an increased disposition to the development  of breast cancer or unless the enrollee's medical history confirms a  chronic, relapsing, symptomatic breast condition.    (Source: P.A. 87-519; 87-1066.)
215 ILCS 125/4-17
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article IV - Delivery Of Services - Required Provisions And Marketing

Sec. 4-17. Basic outpatient preventive and primary health care services  for children.  In order to attempt to address the needs of children in Illinois  (i) without health care coverage, either through a parent's employment, through  medical assistance under the Illinois Public Aid Code, or any other health plan  or (ii) who lose medical assistance if and when their parents move from welfare  to work and do not find employment that offers health care coverage, a  health maintenance  organization may undertake to provide or arrange for and to  pay for or reimburse the cost of basic outpatient preventive and primary health  care services.  The Department shall promulgate rules to establish minimum  coverage and disclosure requirements.  These requirements at a minimum shall  include routine physical examinations and immunizations, sick visits,  diagnostic x-rays and laboratory services, and emergency outpatient services.  Coverage may also include preventive dental services, vision screening and one  pair of eyeglasses, prescription drugs, and mental health services.  The coverage may include any  reasonable co-payments, deductibles, and benefit maximums subject to  limitations established by the Director by rule.   Coverage shall be  limited to children who are 18 years of age or under, who have resided  in the State of Illinois for at least 30 days, and who do not qualify for  medical assistance under the Illinois Public Aid Code.  Any such coverage  shall be made available to an adult on behalf of such children  and shall not be funded through State appropriations.  In counties with  populations in excess of 3,000,000, the Director shall not approve any  arrangement under this Section unless and until an arrangement for at least one  health maintenance organization under  contract with the Department of Healthcare and Family Services (formerly        Illinois Department of Public Aid) for furnishing health  services pursuant to Section 5-11 of the Illinois Public Aid Code and for which  the requirements of 42 CFR 434.26(a) have been waived is approved.       (Source: P.A. 95-331, eff. 8-21-07.)
215 ILCS 125/4-18
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article IV - Delivery Of Services - Required Provisions And Marketing

Sec. 4-18.     Retirement facility residents.     With respect to an  enrollee who is a resident of a retirement facility consisting of a long-term  care facility, as defined in the Nursing Home Care Act, and residential  apartments, a contract or evidence of coverage issued, amended, delivered, or  renewed after the effective date of this amendatory Act of 1997 shall provide  that the enrollee's primary care physician must refer the enrollee to the  retirement facility's long-term care facility for Medicare covered skilled  nursing services if the primary care physician finds that:(1) it is in the best interests of the patient;(2) the facility, if not a participating provider in     the specific health maintenance organization, agrees during the preauthorization period to a negotiated rate for skilled nursing services covered in that organization's health care plan; and(3) the facility meets all the requirements of a     participating provider for skilled nursing services as defined and covered under the health maintenance organization's health care plan.Both the facility and the health maintenance organization must fully disclose  all pertinent information to consumers to assure that their decisions are based  upon full knowledge of the implications of their decision making.    (Source: P.A. 90-408, eff. 1-1-98; 90-655, eff. 7-30-98.)
215 ILCS 125/4-19
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article IV - Delivery Of Services - Required Provisions And Marketing

Sec. 4-19. Purchase of ophthalmic goods or services. A health maintenance organization may not require a provider, as a condition of participation in the health maintenance organization's health care plan, to purchase ophthalmic goods or services, including but not limited to eyeglass frames, in a quantity or dollar amount in excess of the quantity or dollar amount an enrollee purchases under the terms of the health care plan.  (Source: P.A. 93-1077, eff. 1-18-05.)
215 ILCS 125/4-20
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article IV - Delivery Of Services - Required Provisions And Marketing

(215 ILCS 125/4-20)Sec. 4-20. Deductibles and copayments.(a) A Health Maintenance Organization may require deductibles and copayments of enrollees as a  condition for the receipt of specific health care services, including basic  health care services. Deductibles and copayments shall be the only  allowable charges, other than premiums, assessed enrollees. Nothing within  this subsection (a) shall preclude the provider from charging reasonable  administrative fees, such as service fees for checks returned for non-sufficient  funds and missed appointments.(b) Deductibles and copayments shall be for specific dollar amounts or for  specific percentages of the cost of the health care services.(c) No combination of deductibles and copayments paid for the receipt of basic health care services may exceed the annual maximum out-of-pocket expenses of a high deductible health plan as defined in 26 U.S.C. 223.(d) Deductibles and copayments applicable to supplemental health care  services, catastrophic-only plans as defined under the federal Affordable Care Act, or pre-existing conditions are not subject to the annual limitations described in this Section.(e) This Section applies to enrollees and does not limit the health care plan payment for services provided by non-participating providers.(f) This Section applies to enrollees and does not limit the health care plan payment for services provided by non-participating providers.   (Source: P.A. 97-1148, eff. 1-24-13.)
215 ILCS 125/Art. 4.5 heading
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article IV.5 - Point-Of-Service Products

 ARTICLE 4.5.      POINT-OF-SERVICE PRODUCTS
215 ILCS 125/Art. V heading
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article V - General Provisions

 ARTICLE V.      GENERAL PROVISIONS
215 ILCS 125/5-1
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article V - General Provisions

 (from Ch. 111 1/2, par. 1409A)Sec. 5-1.   Section 155 of the Illinois Insurance Code shall apply to Health  Maintenance Organizations; except that no action shall be brought for an  unreasonable delay in the settling of a claim if the delay is caused by the  failure of the enrollee to execute a lien as requested by the health care plan.  (Source: P.A. 100-863, eff. 8-14-18.)
215 ILCS 125/5-2
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article V - General Provisions

 (from Ch. 111 1/2, par. 1410)Sec. 5-2.     Rules and regulations or licensing of producers.     The Director may promulgate such reasonable rules and regulations as are  necessary to provide for the licensing of producers.    (Source: P.A. 85-20.)
215 ILCS 125/5-3.1
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article V - General Provisions

Sec. 5-3.1.     Woman's health care provider.     Health  maintenance organizations are subject to the provisions of Section 356r  of the Illinois Insurance Code.    (Source: P.A. 89-514, eff. 7-17-96.)
215 ILCS 125/5-3.5
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article V - General Provisions

Sec. 5-3.5.     Illinois Health Insurance Portability and Accountability Act.       The provisions of this Act are subject to the Illinois Health Insurance  Portability and Accountability Act as provided in Section 15 of that Act.    (Source: P.A. 90-30, eff. 7-1-97.)
215 ILCS 125/5-3.6
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article V - General Provisions

Sec. 5-3.6.     Managed Care Reform and Patient Rights Act.     Health  maintenance organizations are subject to the provisions of the Managed Care  Reform and Patient Rights Act.    (Source: P.A. 91-617, eff. 1-1-00.)
215 ILCS 125/5-4
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article V - General Provisions

 (from Ch. 111 1/2, par. 1412)Sec. 5-4.         Examination of affairs and quality of services by the  Director; books and records.  The Director shall have with respect to health  maintenance organizations the powers of examination conferred upon him  relative to Sections 132 through 132.7 of the Illinois  Insurance Code. The Director of  Public Health shall make an examination concerning the quality of health  care services of any health maintenance organization and providers with  whom the organization has contracts, agreements, or other arrangements  pursuant to its health care plan as often as he deems it necessary for the  protection of the interest of the people of this State, but not less  frequently than once every 3 years.  The cost of any examination  shall be paid by the health maintenance organization being examined.The fee assessed against the organization being examined shall be  composed of a fixed annual fee plus an additional fee based on the  individual health maintenance organization's enrollment in Illinois.  The  revenues generated shall not exceed the estimated actual costs of the program.  The methodology for computing the fee to be assessed shall be  established by rule, pursuant to the Illinois  Administrative Procedure Act.Every health maintenance organization and provider shall submit its  books and records relating to the Health Care Plan to examination and  in every way facilitate them. For the purpose of examinations, the Director  and the Director of Public Health may administer oaths to  and examine the officers and agents of the health maintenance organization  and the principals of providers concerning their business.    (Source: P.A. 89-97, eff. 7-7-95.)
215 ILCS 125/5-7
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article V - General Provisions

 (from Ch. 111 1/2, par. 1415)Sec. 5-7.     Rules and regulations to carry out provisions of Act.     The Director may, after notice and hearing, promulgate reasonable rules  and regulations as are necessary and proper to:(1) Establish minimum coverage standards for basic health care services,  the application of which standards discriminate against no class of physician;(2) Establish specific standards, including standards for the full and  fair disclosure of health care services provided by group contracts or  evidences of coverage which may cover but shall not be limited to:(a) Coordination of benefits(b) Conversion(c) Cancellation and termination(d) Deductibles and co-payments(e) Pre-existing conditions; and(3) Otherwise carry out the provisions of this Act.    (Source: P.A. 86-620.)
215 ILCS 125/5-7.1
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article V - General Provisions

 (from Ch. 111 1/2, par. 1415.1)Sec. 5-7.1.         No health care plan shall include any provision which shall  have the effect of denying coverage to or on behalf of an enrollee under  such plan on the basis of a failure by the enrollee to file a notice of  claim within the time period required by the plan, provided such failure is  caused solely by the physical inability or mental incapacity of the  enrollee to file such notice  of claim because of a period of emergency hospitalization.    (Source: P.A. 86-784.)
215 ILCS 125/5-8
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article V - General Provisions

 (from Ch. 111 1/2, par. 1416)Sec. 5-8.         Grounds for denial, suspension or revocation of certificate of  authority-Hearing-Review under Administrative Review Law.(a) When the Director has cause to believe that grounds for the denial  of an application for a certificate of authority exists, or that grounds  for the suspension or revocation of a certificate of authority exists, he  shall issue an order to the organization or applicant stating the grounds  upon which the denial, suspension, or revocation is based.  The order shall  be sent to the organization or applicant by certified or registered mail  and to the Director of Public Health.  The organization or applicant may in  writing request a hearing within 30 days of receipt of the order.  If no  written request is made, the order shall be final upon the expiration of  said 30 days.(b) If the organization or applicant requests a hearing pursuant to  this Section, the Director shall issue a written notice of hearing sent to  the organization or applicant by certified or registered mail and to the  Director of Public Health, stating:(i) a specified time for the hearing, which may not be less than 20 nor  more than 30 days after receipt of the notice of hearing; and(ii) a specific place for the hearing, which may be either in the city  of Springfield or in the county where the organization's or applicant's  principal place of business is located.(c) If a hearing is requested, the Director of the Department of  Public Health or his  delegated representative, shall be in attendance at  the hearing and shall participate in the proceedings. The recommendations  and findings of the Director of the Department of Public Health with regard  to matters relating to the quality of health care services provided in  connection with any decision regarding denial, suspension or revocation of  a certificate of authority, shall be conclusive and binding upon the  Director.(d) After such hearing, or upon the failure of the organization or  applicant to appear at such hearing, the Director shall take such action as is  deemed advisable on written findings which shall be served on the  organization or applicant with a copy thereof to the Director of the  Department of Public Health. The action of the Director and the  recommendations and findings of the Director of the Department of Public  Health shall be subject to review under and in accordance with  the Administrative Review Law.    (Source: P.A. 86-620.)
215 ILCS 125/5-9
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article V - General Provisions

 (from Ch. 111 1/2, par. 1417)Sec. 5-9.     Violations-Class B misdemeanor-Cease and desist order.     (a)  Any organization which violates this Act shall be guilty of a Class B  misdemeanor.(b) The Director may issue to any organization subject to this Act,  a cease and desist order as provided in Article  XXIV, Section 401.1 of the "Illinois Insurance Code".(c) The Director may issue corrective orders to any organization  subject to this Act, as provided in Article XII 1/2, Sections 186.1 and  186.2 of the "Illinois Insurance Code".    (Source: P.A. 85-20.)
215 ILCS 125/5-10
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article V - General Provisions

(215 ILCS 125/5-10)Sec. 5-10. Health maintenance organizations; revenue data.(a)  No health maintenance organization shall pass the cost of the assessment imposed pursuant to Article V-H of the Illinois Public Aid Code on to consumers as a discrete addition to their premiums.(b) The Department shall provide the Department of Healthcare and Family Services with member months and premium revenue data needed for implementing the assessment imposed under Article V-H of the Illinois Public Aid Code.  (Source: P.A. 101-9, eff. 6-5-19; 101-608, eff. 12-13-19.)
215 ILCS 130/Art. 1 heading
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 130/ - Limited Health Service Organization Act.|Article 1 - Short Title And Definitions

 ARTICLE 1.      SHORT TITLE AND DEFINITIONS
215 ILCS 130/1001
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 130/ - Limited Health Service Organization Act.|Article 1 - Short Title And Definitions

 (from Ch. 73, par. 1501-1)Sec. 1001.     Short Title.     This Act may be cited as the Limited Health Service Organization Act.    (Source: P.A. 86-600.)
215 ILCS 130/1003
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 130/ - Limited Health Service Organization Act.|Article 1 - Short Title And Definitions

(215 ILCS 130/1003) (from Ch. 73, par. 1501-3)Sec. 1003.     Definition of admitted assets.     "Admitted assets" of a limited health service organization shall only  include the admitted assets and investments authorized or permitted for  health maintenance organizations by Sections 1-3 and 3-1 of the Health  Maintenance Organization Act, as now or hereafter amended.    (Source: P.A. 86-600.)
215 ILCS 130/Art. 2 heading
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 130/ - Limited Health Service Organization Act.|Article 2 - Certificate Of Authority; General Corporate And Financial Requirements

 ARTICLE 2.  CERTIFICATE OF AUTHORITY; GENERAL CORPORATE AND FINANCIAL REQUIREMENTS
215 ILCS 130/2002
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 130/ - Limited Health Service Organization Act.|Article 2 - Certificate Of Authority; General Corporate And Financial Requirements

 (from Ch. 73, par. 1502-2)Sec. 2002.     Issuance of certificate of authority.(a) Issuance of a certificate of authority shall be granted if the  following conditions are met:(1) The requirements of subsection (c) of Section     2001 have been fulfilled.(2) The persons responsible for conducting the     applicant's affairs are competent and trustworthy, possess good reputations and have had appropriate experience, training or education.(3) The applicant has demonstrated the willingness     and potential ability to assure that such limited health service will be provided in a manner to insure both availability and accessibility of adequate personnel and facilities and in a manner enhancing availability, accessibility, and continuity of service.(4) The applicant has arrangements for an ongoing     quality of health care assessment program concerning health care processes and outcomes.(5) The applicant is financially responsible and may     reasonably be expected to meet its obligations to enrollees and to prospective enrollees.  In making this determination, the Director shall consider:(A) the financial soundness of the applicant's         arrangements for limited health services and the minimum standard rates, copayments and other patient charges used in connection therewith.(B) the adequacy of working capital, other         sources of funding, and provisions for contingencies.(6) The limited health care plan furnishes limited     health services on a prepaid basis, through insurance or otherwise, except to the extent of reasonable requirements for copayments of a fixed amount.(7) The agreements with providers for the provision     of limited health services contain the provisions required by Section 2008 of this Act.(8) Any deficiencies identified by the Director have     been corrected.(b) No certificate of authority shall be issued if the initial minimum net  worth of the applicant is less than $100,000.  The initial net worth shall  be provided in cash and securities in combination and form acceptable to the  Director.    (Source: P.A. 86-600.)