215 ILCS 125/5-6
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article V - General Provisions

 (from Ch. 111 1/2, par. 1414)Sec. 5-6.         Supervision of rehabilitation, liquidation or  conservation by the Director.(a) For purposes of the rehabilitation, liquidation or conservation of a  health maintenance organization, the operation of a health maintenance  organization in this State  constitutes a form of insurance protection which should be governed by the  same provisions governing the rehabilitation, liquidation or conservation  of insurance companies.  Any rehabilitation, liquidation or conservation of a Health Maintenance  Organization shall be based upon the grounds set forth in and subject  to the provisions of the laws of this State  regarding the rehabilitation, liquidation, or conservation of an insurance  company and shall be conducted under the supervision of the Director.  Insolvency, as a ground for rehabilitation, liquidation, or conservation  of a Health Maintenance Organization, shall be recognized when  a Health Maintenance  Organization cannot be expected to satisfy its financial obligations when  such obligations are to become due  or when the Health Maintenance Organization has neglected to correct  within the time prescribed by subsection (c) of Section 2-4, a deficiency  occurring due to such organization's prescribed minimum net worth or special  contingent reserve being impaired.  For purpose of determining the priority  of distribution of general assets, claims of enrollees and enrollees'  beneficiaries shall have the same priority as established by Section 205 of  the Illinois Insurance Code for policyholders and beneficiaries of insureds  of insurance companies.  If an enrollee is liable to any provider for  services provided pursuant to and covered by the health care plan, that  liability shall have the status of an enrollee claim for distribution of  general assets.Any provider who is obligated by statute or agreement to hold enrollees  harmless from liability for services provided pursuant to and covered by a  health care plan shall have a priority of distribution of the general  assets immediately following that of enrollees and enrollees' beneficiaries  as described herein, and immediately preceding the priority of distribution  described in paragraph (e) of subsection (1) of Section 205 of the Illinois  Insurance Code.(b) For purposes of Articles XIII and XIII-1/2 of the Illinois Insurance  Code, organizations in the following categories shall be deemed to be a  "domestic company" and a "domiciliary company":(i) a corporation authorized under the Dental Service     Plan Act or the Voluntary Health Services Plans Act;(ii) a corporation organized under the laws of this     State; or(iii) a corporation organized under the laws of     another state, 20% or more of the enrollees of which are residents of this State, except where such a corporation is, in its state of incorporation, subject to rehabilitation, liquidation and conservation under the laws relating to insurance companies.(c) In the event of the insolvency of a health maintenance organization,  no enrollee of such organization shall be liable to any provider for medical  services rendered by such provider, except for applicable  co-payments or deductibles for covered services or fees for services not  covered by the health maintenance organization, with respect to the amounts  such provider is not paid by the Association pursuant to the provisions of  Section 6-8 (8)(b) and (c).  No provider, whether or not the provider is  obligated by statute or agreement to hold enrollees harmless from liability,  shall seek to recover any such amount from any enrollee until the Association  has made a final determination of its liability (or the resolution of any  dispute or litigation resulting therefrom) with respect to the matters  specified in such provisions.  In the event that the provider seeks to recover  such amounts before the Association's final determination of its liability (or  the resolution of any dispute or litigation resulting therefrom), the provider  shall be liable for all reasonable costs and attorney fees incurred by the  Director or the Association in enforcing this provision or any court orders  related hereto.    (Source: P.A. 89-206, eff. 7-21-95; 90-177, eff. 7-23-97; 90-372, eff.  7-1-98; 90-655, eff. 7-30-98.)