reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 50 - INSURANCE › Part 2001 - CONSTRUCTION AND FILING OF ACCIDENT AND HEALTH INSURANCE POLICY FORMS › Subpart A - PROVISIONS APPLICABLE TO INDIVIDUAL AND GROUP POLICIES › Section 2001.1 - Applicability

Current through Register Vol. 48, No. 28, July 12, 2024
Unless otherwise provided, this Subpart is applicable to all
				  individual and group accident and health policies and certificates, including
				  coverage provided by a Health Maintenance Organization, except to the extent
				  that such policies, certificates or coverage provides for excepted benefits or
				  short-term, limited-duration health insurance coverage. Sections
				  2001.3
				  and
				  2001.13
				  apply to all individual and group policies, certificates, and coverage
				  regardless of whether they provide excepted benefits or short-term,
				  limited-duration health insurance coverage.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2001 - CONSTRUCTION AND FILING OF ACCIDENT AND HEALTH INSURANCE POLICY FORMS › Subpart A - PROVISIONS APPLICABLE TO INDIVIDUAL AND GROUP POLICIES › Section 2001.3 - Discretionary Clauses Prohibited

Current through Register Vol. 48, No. 28, July 12, 2024
No policy, contract, certificate, endorsement, rider
				  application or agreement offered or issued in this State, by a health carrier,
				  to provide, deliver, arrange for, pay for or reimburse any of the costs of
				  health care services or of a disability may contain a provision purporting to
				  reserve discretion to the health carrier to interpret the terms of the
				  contract, or to provide standards of interpretation or review that are
				  inconsistent with the laws of this State.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2001 - CONSTRUCTION AND FILING OF ACCIDENT AND HEALTH INSURANCE POLICY FORMS › Subpart A - PROVISIONS APPLICABLE TO INDIVIDUAL AND GROUP POLICIES › Section 2001.4 - Guaranteed Availability and Renewability of Coverage

Current through Register Vol. 48, No. 28, July 12, 2024
a) Guaranteed Availability of Coverage in the
				Individual and Group Market Subject to subsections (b) through (d), a health
				insurance issuer that offers health insurance coverage in the individual or
				group market in this State must offer to any individual or employer in this
				State all products that are approved for sale in the applicable market, and
				must accept any individual or employer that applies for any of those products.
				(
				45 CFR
				147.106 )
b) Enrollment Periods
A health insurance issuer may restrict enrollment in health
				  insurance coverage to open or special enrollment periods.
1) Open Enrollment Periods
A) Group Market
A health insurance issuer in the group market must allow an
				  employer to purchase health insurance coverage for a group health plan at any
				  point during the year. In the case of health insurance coverage offered in the
				  small group market, a health insurance issuer may limit the availability of
				  coverage to an annual enrollment period that begins November 15 and extends
				  through December 15 of each year in the case of a plan sponsor that is unable
				  to comply with a material plan provision relating to employer contribution or
				  group participation rules as defined in
				  45 CFR
				  147.106(b)(3), pursuant to
				  215
				  ILCS 97/30(B)(3) and, in the case of
				  a QHP offered in the Small Business Health Option Program (SHOP), as permitted
				  by
				  45 CFR
				  156.285(c). With respect to
				  coverage in the small group market, and in the large group market if such
				  coverage is offered in a SHOP in a state, coverage must become effective
				  consistent with the dates described in
				  45 CFR
				  155.725(h).
B) Individual Market
A health insurance issuer in the individual market must allow
				  an individual to purchase health insurance coverage during the initial and
				  annual open enrollment periods described in
				  45 CFR
				  155.410(b) and (e). Coverage
				  must become effective consistent with the dates described in
				  45 CFR
				  155.410(c) and (f).
Illinois Administrative Code › Title 50 - INSURANCE › Part 2001 - CONSTRUCTION AND FILING OF ACCIDENT AND HEALTH INSURANCE POLICY FORMS › Subpart A - PROVISIONS APPLICABLE TO INDIVIDUAL AND GROUP POLICIES › Section 2001.5 - Prohibition of Preexisting Condition Exclusions

Current through Register Vol. 48, No. 28, July 12, 2024
a) No Preexisting Condition Exclusions
1) In General
A group health plan, or a health insurance issuer offering
				  group or individual health insurance coverage, may not impose any preexisting
				  condition exclusion (as defined in Section
				  2001.2
				  ). (
				  45 CFR
				  147.108(a) )
2) Subsection (a) is illustrated
				by the examples appearing in 45 CFR
.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2001 - CONSTRUCTION AND FILING OF ACCIDENT AND HEALTH INSURANCE POLICY FORMS › Subpart A - PROVISIONS APPLICABLE TO INDIVIDUAL AND GROUP POLICIES › Section 2001.6 - No Lifetime or Annual Limits

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Prohibition
1) Lifetime Limits
Except as provided in subsection (b), a group health plan, or
				  a health insurance issuer offering group or individual health insurance
				  coverage, may not establish any lifetime limit on the dollar amount of benefits
				  for any individual.
2)
				Annual Limits
A) General Rule
Except as provided in subsections (a)(2)(B), (b) and (d), a
				  group health plan, or a health insurance issuer offering group or individual
				  health insurance coverage, may not establish any annual limit on the dollar
				  amount of benefits for any individual.
B) Exception for Health Flexible Spending
				Arrangements
A health flexible spending arrangement (as defined in section
				  106(c)(2) of the Internal Revenue Code (
				  26 USC
				  106(c)(2) ) is not subject
				  to the requirement in subsection (a)(2)(A). (
				  45 CFR
				  147.126 )
Illinois Administrative Code › Title 50 - INSURANCE › Part 2001 - CONSTRUCTION AND FILING OF ACCIDENT AND HEALTH INSURANCE POLICY FORMS › Subpart A - PROVISIONS APPLICABLE TO INDIVIDUAL AND GROUP POLICIES › Section 2001.7 - Prohibition on Rescissions

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Prohibition on Rescissions
1) A group health
				plan, or a health insurance issuer offering group or individual health
				insurance coverage, must not rescind coverage under the plan, or under the
				policy, certificate, or contract of insurance, with respect to an individual
				(including a group to which the individual belongs or family coverage in which
				the individual is included) once the individual is covered under the plan or
				coverage, unless the individual (or a person seeking coverage on behalf of the
				individual) performs an act, practice or omission that constitutes fraud, or
				unless the individual makes an intentional misrepresentation of material fact,
				as prohibited by the terms of the plan or coverage. A group health plan, or a
				health insurance issuer offering group or individual health insurance coverage,
				must provide at least 30 days advance written notice to each participant (in
				the individual market, primary subscriber) who would be affected before
				coverage may be rescinded under this subsection (a)(1), regardless of, in the
				case of group coverage, whether the coverage is insured or self-insured, or
				whether the rescission applies to an entire group or only to an individual
				within the group. (This subsection (a)(1) applies regardless of any
				contestability period that may otherwise apply.)
2) For purposes of this Section, a rescission
				is a cancellation or discontinuance of coverage that has retroactive effect.
				For example, a cancellation that treats a policy as void from the time of the
				individual's or group's enrollment is a rescission. As another example, a
				cancellation that voids benefits paid up to a year before the cancellation is
				also a rescission for this purpose. A cancellation or discontinuance of
				coverage is not a rescission if:
A) The
				cancellation or discontinuance of coverage has only a prospective effect;
				or
B) The cancellation or
				discontinuance of coverage is effective retroactively to the extent it is
				attributable to a failure to timely pay required premiums or contributions
				towards the cost of coverage. (
				45 CFR
				147.128 )
3) This subsection (a) is illustrated by the
				examples appearing in
				45 CFR
				147.128.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2001 - CONSTRUCTION AND FILING OF ACCIDENT AND HEALTH INSURANCE POLICY FORMS › Subpart A - PROVISIONS APPLICABLE TO INDIVIDUAL AND GROUP POLICIES › Section 2001.9 - Prohibiting Discrimination Against Participants and Beneficiaries Based on Health Status

Current through Register Vol. 48, No. 28, July 12, 2024
a) Health
				Factors
1) The term health factor means, in
				relation to an individual, any of the following health status-related factors:
A) Health status;
B) Medical condition (including both physical
				and mental illnesses), as defined in
				45 CFR
				144.103;
C) Claims experience;
D) Receipt of health care;
E) Medical history;
F) Genetic information, as defined in
				45
				CFR 146.122(a);
G) Evidence of insurability; or
H) Disability.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2001 - CONSTRUCTION AND FILING OF ACCIDENT AND HEALTH INSURANCE POLICY FORMS › Subpart A - PROVISIONS APPLICABLE TO INDIVIDUAL AND GROUP POLICIES › Section 2001.10 - Summary of Benefits and Coverage and Uniform Glossary

Current through Register Vol. 48, No. 28, July 12, 2024
a) Summary of Benefits and Coverage in
				General
A group health plan (and its administrator as defined in
				  section 3(16)(A) of ERISA), and a health insurance issuer offering group or
				  individual health insurance coverage, is required to file for the Director's
				  approval prior to use a written summary of benefits and coverage (SBC) for each
				  benefit package and provide the SBC without charge to entities and individuals
				  described in this subsection (a) in accordance with this Section.
1) SBC Provided by a Group Health Insurance
				Issuer to a Group Health Plan
A) Upon
				Application
A health insurance issuer offering group health insurance
				  coverage must provide the SBC to a group health plan (or its sponsor) upon
				  application for health coverage, as soon as practicable following receipt of
				  the application, but in no event later than seven business days following
				  receipt of the application.
B) By First Day of Coverage (If There Are
				Changes)
If there is any change in the information required to be in
				  the SBC that was provided upon application and before the first day of
				  coverage, the issuer must update and provide a current SBC to the plan (or its
				  sponsor) no later than the first day of coverage.
C) Upon Renewal
If the issuer renews or reissues the policy, certificate or
				  contract of insurance (for example, for a succeeding policy year), the issuer
				  must provide a new SBC as follows:
i)
				If written application is required (in either paper or electronic form) for
				renewal or reissuance, the SBC must be provided no later than the date the
				written application materials are distributed.
ii) If renewal or reissuance is automatic,
				the SBC must be provided no later than 30 days prior to the first day of the
				new plan or policy year; however, with respect to an insured plan, if the
				policy, certificate or contract of insurance has not been issued or renewed
				before such 30-day period, the SBC must be provided as soon as practicable but
				in no event later than seven business days after issuance of the new policy,
				certificate or contract of insurance, or the receipt of written confirmation of
				intent to renew, whichever is earlier.
D) Upon Request
If a group health plan (or its sponsor) requests an SBC or
				  summary information about a health insurance product from a health insurance
				  issuer offering group health insurance coverage, an SBC must be provided as
				  soon as practicable, but in no event later than seven business days following
				  receipt of the request.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2001 - CONSTRUCTION AND FILING OF ACCIDENT AND HEALTH INSURANCE POLICY FORMS › Subpart A - PROVISIONS APPLICABLE TO INDIVIDUAL AND GROUP POLICIES › Section 2001.11 - Essential Health Benefits

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Coverage for Essential Health Benefits Package
1) A health insurance issuer that offers
				health insurance coverage in the individual or small group market shall ensure
				that the coverage includes an essential health benefits (EHB) package in
				accordance with the requirements in subsections (b) and (c). (See
				42 USC
				300gg-6(a).)
2) The provisions of this Section regarding
				the inclusion of essential pediatric oral care benefits shall be deemed to be
				satisfied for qualified health plans made available in the small group market
				or individual market in Illinois outside the Health Benefits Exchange, issued
				for policy or plan years beginning on or after January 1, 2015, that do not
				include the essential pediatric oral care benefits if the health insurance
				issuer has obtained reasonable assurance that the pediatric oral care benefits
				are provided to the purchaser or enrollee of the qualified health plan. The
				health insurance issuer shall be deemed to have obtained reasonable assurance
				that the pediatric oral care benefits are provided to the purchaser of the
				qualified health plan if:
A) At least one
				Exchange certified stand-alone dental plan that offers the minimum essential
				pediatric oral care benefits that are required under subsection (c)(1)(J) and
				it is available for purchase by the small group or individual
				purchaser;
B) The health insurance
				issuer prominently discloses to the purchaser, or enrollee in the case of a
				group plan, in a form approved by the Director, at the time that it offers the
				qualified health plan, that the plan does not provide the essential pediatric
				oral care benefits; and
C) The
				health insurance issuer has received and kept records of written, verbal or
				electronic confirmation from the purchaser, or enrollee in the case of a group
				plan, that he or she has obtained, or is obtaining, other coverage that
				includes essential pediatric oral care benefits.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2001 - CONSTRUCTION AND FILING OF ACCIDENT AND HEALTH INSURANCE POLICY FORMS › Subpart A - PROVISIONS APPLICABLE TO INDIVIDUAL AND GROUP POLICIES › Section 2001.12 - Cost-Sharing

Current through Register Vol. 48, No. 28, July 12, 2024
a) Cost-Sharing
				Under Group Health Plans
A group health plan shall ensure that any annual cost-sharing
				  imposed under the plan does not exceed the limitations provided for under
				  subsections (a)(1) and (2). (See
				  42 USC
				  300gg - 6(b).) Requirements relating to
				  cost-sharing are:
1) Annual Limitation
				on Cost-Sharing
A) 2014
The cost-sharing incurred under a health plan with respect to
				  self-only coverage or coverage other than self-only coverage for a plan year
				  beginning in 2014 shall not exceed the dollar amounts in effect under
				  26 USC
				  223(c)(2)(A)(ii) for
				  self-only and family coverage, respectively, for taxable years beginning in
				  2014.
B) 2015 and Later
In the case of any plan year beginning in a calendar year
				  after 2014, the limitation under this subsection (a)(1)(B) shall:
i) in the case of self-only coverage, be
				equal to the dollar amount under subsection (a)(1)(A) for self-only coverage
				for plan years beginning in 2014, increased by an amount equal to the product
				of that amount and the premium adjustment percentage under subsection (a)(4)
				for the calendar year; and
ii) in
				the case of other coverage, twice the amount in effect under subsection
				(a)(1)(B)(i).
C) If the
				amount of any increase under subsection (a)(1)(B)(i) is not a multiple of $50,
				such increase shall be rounded to the next lowest multiple of $50.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2001 - CONSTRUCTION AND FILING OF ACCIDENT AND HEALTH INSURANCE POLICY FORMS › Subpart A - PROVISIONS APPLICABLE TO INDIVIDUAL AND GROUP POLICIES › Section 2001.13 - Corporate Name Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
The name of the actual health insurance issuer shall be
				  stated on all of its forms. Policy forms or other items incorporated by
				  reference shall not use a trade name, any insurance group designation, name of
				  the parent company of the issuer, name of a particular division of the issuer,
				  service mark, slogan, symbol or other device that, without disclosing the name
				  of the actual issuer, would have the capacity and tendency to mislead or
				  deceive as to the true identity of the issuer.
a) There must be printed at the head of the
				policy the name of the issuer or issuers issuing the policy and the location of
				the home office of the issuer or issuers. Devices, emblems or designs, and
				dates as are appropriate for the issuer issuing the policy may also be
				added.
b) The complete issuer name,
				as registered with the Department, shall appear in the footer on all forms
				filed with the Department.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2001 - CONSTRUCTION AND FILING OF ACCIDENT AND HEALTH INSURANCE POLICY FORMS › Subpart B - PROVISIONS APPLICABLE TO INDIVIDUAL POLICIES › Section 2001.110 - Applicability

Current through Register Vol. 48, No. 28, July 12, 2024
This Subpart shall apply to:
a) Individual accident and health policy,
				certificate, endorsement, rider and application forms filed with the Department
				by both foreign and domestic companies with respect to Section 143, Article IX
				and Article XX of the Code.
b) This
				Part shall also apply to individual policy, certificate, endorsement, rider and
				application forms filed in accordance with Section 356a of the Code.
c) The filing procedure for accident and
				health forms as required by Section 355 of the Code.
d) The filing procedure for accident and
				health insurance policy forms prescribed by 50 Ill. Adm. Code 916.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2001 - CONSTRUCTION AND FILING OF ACCIDENT AND HEALTH INSURANCE POLICY FORMS › Subpart B - PROVISIONS APPLICABLE TO INDIVIDUAL POLICIES › Section 2001.120 - Construction of Accident and Health Insurance Policy Forms

Current through Register Vol. 48, No. 28, July 12, 2024
a) Section 356a - Form of Policy
Each policy form of a domestic company that is issued for
				  delivery to a person residing in another state must be approved by the Director
				  unless that policy form is subject to approval or disapproval by the other
				  state.
b) Section
				357.1 -
				Accident and Health Policy Provisions Required
1) In order to expedite departmental action
				on policies submitted for approval, it is requested that companies adhere to
				the statutory wording and order of the required provisions. Policies submitted
				that include variations from the statutory words and order must be accompanied
				by a complete list of all variations and a justification for each. Extensive
				variations, without adequate justification, will only result in delay in the
				processing of the policies. The companies' cooperation in keeping variations to
				a minimum is essential.
2) Each
				provision of Sections
				357.2
				through 357.113 of the Code must be preceded by a caption and, if the captions
				differ in any respect from the captions appearing in the law, changes must be
				clearly indicated and justified pursuant to subsection (b)(1).
3) Numbering of the "Required Provisions"
				will not be required.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2001 - CONSTRUCTION AND FILING OF ACCIDENT AND HEALTH INSURANCE POLICY FORMS › Subpart B - PROVISIONS APPLICABLE TO INDIVIDUAL POLICIES › Section 2001.130 - Filing of Policy Forms

Current through Register Vol. 48, No. 28, July 12, 2024
a) Policy
				forms, riders and endorsements must be formally filed pursuant to 50 Ill. Adm.
				Code 916 as follows:
1) Two copies of all
				forms shall be submitted in blank. If the form does not clearly indicate the
				place for the name of the insured, the time the insurance becomes effective,
				and the benefits, it will be required that the forms be completed at the time
				of issuance.
2) Each form must bear
				an identifying form number in the lower left corner of the first page. The form
				number is limited to 30 characters. No other date, except the inclusion of a
				printing date and/or designation of a state where a special edition is required
				will be permitted in this space.
3)
				The insurer shall file a letter of submission, or provide the following
				information in the Filing Description field under the General Information tab
				in the System for Electronic Rate and Form Filing (SERFF), containing:
A) The name of the form, if any, and
				identifying form number;
B) Whether
				the submission is a new form;
C) If
				the form is intended to supersede another, the form number of the form replaced
				and the date it was approved by the Department, with all changes from the
				previously approved form highlighted. Any changes not highlighted will not be
				deemed to be approved.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2001 - CONSTRUCTION AND FILING OF ACCIDENT AND HEALTH INSURANCE POLICY FORMS › Subpart C - PROVISIONS APPLICABLE TO GROUP POLICIES › Section 2001.210 - Applicability

Current through Register Vol. 48, No. 28, July 12, 2024
This Subpart is applicable to all group accident and health
				  policies except to the extent that they provide excepted
				  benefits.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2001 - CONSTRUCTION AND FILING OF ACCIDENT AND HEALTH INSURANCE POLICY FORMS › Subpart C - PROVISIONS APPLICABLE TO GROUP POLICIES › Section 2001.220 - Ban on Excessive Waiting Periods

Current through Register Vol. 48, No. 28, July 12, 2024
A group health plan, and a health insurance issuer offering
				  group health insurance coverage, must not apply any waiting period that exceeds
				  90 days (
				  42 USC
				  300gg-7 ).
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Section 2002.10 - Authority

Current through Register Vol. 48, No. 28, July 12, 2024
This Part is issued by the Director of Insurance pursuant to
				Section 401 of the Illinois Insurance Code which empowers the Director " . . .
				to make reasonable rules and regulations as may be necessary for making
				effective . . ." the insurance laws of this State. This Part implements Article
				XXVI and Section 149 of the Illinois Insurance Code by establishing minimum
				standards, guidelines, and interpretations for the form, content, practice and
				method of advertising policies of accident and sickness insurance offered for
				sale in Illinois.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Section 2002.20 - Purpose

Current through Register Vol. 48, No. 28, July 12, 2024
The purpose of this Part is to assure truthful and adequate
				disclosure of all material and relevant information in the advertising of
				accident and sickness insurance. This purpose is intended to be accomplished by
				the establishment of, and adherence to, certain minimum standards and
				guidelines of conduct in the advertising of accident and sickness insurance in
				a manner which prevents unfair competition among insurers and is conducive to
				the accurate presentation and description to the insurance buying public of a
				policy of such insurance offered through various advertising media. The
				Guideline for this Section is found in Appendix A, Illustration
				A.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Section 2002.30 - Applicability

Current through Register Vol. 48, No. 28, July 12, 2024
a) This Part shall
			 apply to any accident and sickness insurance "advertisement" as that term is
			 hereinafter defined in Section
			 2002.40, unless
			 otherwise specified in this Part, intended for presentation, distribution or
			 dissemination in this State when such presentation, distribution or
			 dissemination is made either directly or indirectly by or on behalf of an
			 insurer, agent or broker as those terms are defined in the Insurance Code of
			 this State and this Part. The Guideline for this subsection (a) is found in
			 Appendix A, Illustration B.
b)
			 Every insurer shall establish and at all times maintain a system of control
			 over the content, form and method of dissemination of all advertisements of its
			 policies. All such advertisements, regardless of by whom written, created,
			 designed or presented, shall be the responsibility of the insurer whose
			 policies are so advertised. The Guideline for this subsection (b) is found in
			 Appendix A, Illustration C.
c) This
			 Part shall apply to advertisements both inside and outside the Illinois Health
			 Insurance Marketplace. Policies and rates shall not be constructed or marketed
			 in a way that discourages use of the Illinois Health Insurance Marketplace. A
			 certificate of compliance with this Part must be submitted annually to the
			 Illinois Department of Insurance (Department) in accordance with Section
			 2002.180.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Section 2002.50 - Method of Disclosure of Required Information

Current through Register Vol. 48, No. 28, July 12, 2024
All information required to be disclosed by this Part shall be
				set out conspicuously and in close conjunction with the statements to which
				such information relates or under appropriate captions of such prominence that
				it shall not be minimized, rendered obscure or presented in an ambiguous
				fashion or intermingled with the context of the advertisement so as to be
				confusing or misleading. The Guideline for this Section is found in Appendix A,
				Illustration F.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Section 2002.60 - Form and Content of Advertisements

Current through Register Vol. 48, No. 28, July 12, 2024
a) The format and content of an advertisement
			 of an accident or sickness insurance policy shall be sufficiently complete and
			 clear to avoid deception or the capacity or tendency to mislead or deceive.
			 Whether an advertisement has a capacity or tendency to mislead or deceive shall
			 be determined by the Director of Insurance from the overall impression that the
			 advertisement may be reasonably expected to create upon a person of average
			 education or intelligence within the segment of the public to which it is
			 directed. The Guideline for this paragraph (a) is found in Appendix A,
			 Illustration G.
b) Advertisements
			 shall be truthful and not misleading in fact or in implication. Words or
			 phrases, the meaning of which is clear only by implication or by familiarity
			 with insurance terminology, shall not be used. The Guideline for this paragraph
			 (b) is found in Appendix A, Illustration H.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Section 2002.80 - Necessity for Disclosing Policy Provisions Relating to Renewability, Cancellability and Termination

Current through Register Vol. 48, No. 28, July 12, 2024
When an advertisement, which is an invitation to contract,
				refers to either a dollar amount or a period of time for which any benefit is
				payable, or the cost of the policy, or specific policy benefit, or the loss for
				which such benefit is payable, it shall disclose the provisions relating to
				renewability, cancellability and termination and any modification of benefits,
				losses covered or premiums because of age or for other reasons, in a manner
				which shall not minimize or render obscure the qualifying conditions. The
				Guideline for this Section is found in Appendix A, Illustration
				U.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Section 2002.90 - Testimonials or Endorsements by Third Parties

Current through Register Vol. 48, No. 28, July 12, 2024
a) Testimonials used in advertisements must
			 be genuine, represent the current opinion of the author, be applicable to the
			 policy advertised and be accurately reproduced. The insurer, in using a
			 testimonial, makes as its own all of the statements contained therein, and the
			 advertisement, including such statements, is subject to all the provisions of
			 this Part. The Guideline for this paragraph (a) is found in Appendix A,
			 Illustration V.
b) If the person
			 making a testimonial, an endorsement or an appraisal has a financial interest
			 in the insurer or a related entity as a stockholder, director, officer,
			 employee, or otherwise, such fact shall be disclosed in the advertisement. If a
			 person is compensated for making a testimonial, endorsement or appraisal, such
			 fact shall be disclosed in the advertisement by language substantially as
			 follows: "Paid Endorsement." This Part does not require disclosure of union
			 "scale" wages required by union rules if the payment is actually for such
			 "scale" for TV or radio performances. The payment of substantial amounts,
			 directly or indirectly, for "travel and entertainment" for filming or recording
			 of TV or radio advertisements remove the filming or recording from the category
			 of an unsolicited testimonial and require disclosure of such compensation. This
			 subsection does not apply to an institutional advertisement which has as its
			 sole purpose the promotion of the insurer. The Guideline for this paragraph (b)
			 is found in Appendix A, Illustration W.
c) An advertisement shall not state or imply
			 that an insurer or a policy has been approved or endorsed by an individual,
			 group of individuals, society, association or other organizations, unless such
			 is the fact, and unless any proprietary relationship between an organization
			 and the insurer is disclosed. If the entity making the endorsement or
			 testimonial has been formed by the insurer or is owned or controlled by the
			 insurer or the person or persons who own or control the insurer, such fact
			 shall be disclosed in the advertisement. The Guideline for this paragraph (c)
			 is found in Appendix A, Illustration X.
d) When a testimonial refers to benefits
			 received under a policy, the specific claim data, including claim number, date
			 of loss, and other pertinent information shall be retained by the insurer for
			 inspection for a period of four years or until the filing of the next regular
			 report of examination of the insurer, whichever is the longer period of time.
			 The Guideline for this paragraph (d) is found in Appendix A, Illustration
			 Y.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Section 2002.100 - Use of Statistics

Current through Register Vol. 48, No. 28, July 12, 2024
a) An
			 advertisement relating to the dollar amounts of claims paid, the number of
			 persons insured, or similar statistical information relating to any insurer or
			 policy shall not use irrelevant facts, and shall not be used unless it
			 accurately reflects all of the relevant facts. Such an advertisement shall not
			 imply that such statistics are derived from the policy advertised unless such
			 is the fact, and when applicable to other policies or plans shall specifically
			 so state. The Guideline for this paragraph (a) is found in Appendix A,
			 Illustration Z.
b) An advertisement
			 shall not represent or imply that claim settlements by the insurer are
			 "liberal" or "generous," or use words of similar import, or that claim
			 settlements are or will be beyond the actual terms of the contract. An unusual
			 amount paid for a unique claim for the policy advertised is misleading and
			 shall not be used. The Guideline for this paragraph (b) is found in Appendix A,
			 Illustration AA.
c) The source of
			 any statistics used in an advertisement shall be identified in such
			 advertisement. The Guideline for this paragraph (c) is found in Appendix A,
			 Illustration BB.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Section 2002.110 - Identification of Plan or Number of Policies

Current through Register Vol. 48, No. 28, July 12, 2024
a) When a choice of the amount of benefits is
			 referred to, an advertisement which is an invitation to contract shall disclose
			 that the amount of benefits provided depends upon the plan selected and that
			 the premium will vary with the amount of the benefits selected.
b) When an advertisement which is an
			 invitation to contract refers to various benefits which may be contained in two
			 or more policies, other than group master policies, the advertisement shall
			 disclose that such benefits are provided only through a combination of such
			 policies.
c) The Guideline for
			 paragraphs (a) and (b) is found in Appendix A, Illustration CC.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Section 2002.120 - Disparaging Comparisons and Statements

Current through Register Vol. 48, No. 28, July 12, 2024
An advertisement shall not directly or indirectly make unfair
				or incomplete comparisons of policies or benefits or comparisons of
				non-comparable policies of other insurers, and shall not disparage competitors,
				their policies, services or business methods, and shall not disparage or
				unfairly minimize competing methods of marketing insurance. The Guideline for
				this Section is found in Appendix A, Illustration DD.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Section 2002.130 - Jurisdictional Licensing and Status of Insurer

Current through Register Vol. 48, No. 28, July 12, 2024
a) An advertisement which is intended to be
			 seen or heard beyond the limits of the jurisdiction in which the insurer is
			 licensed shall not imply licensing beyond those limits. The Guideline for this
			 paragraph (a) is found in Appendix A, Illustration EE.
b) An advertisement shall not create the
			 impression directly or indirectly that the insurer, its financial condition or
			 status, or the payment of its claims, or the merits, desirability, or
			 advisability of its policy forms or kinds or plans of insurance are approved,
			 endorsed or accredited by any division or agency of this State or the United
			 States Government. The Guideline for this paragraph (b) is found in Appendix A,
			 Illustration FF.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Section 2002.140 - Identity of Insurer

Current through Register Vol. 48, No. 28, July 12, 2024
a) The name of
			 the actual insurer shall be stated in all of its advertisements. The form
			 number or numbers of the policy advertised shall be stated in an advertisement
			 which is an invitation to contract. An advertisement shall not use a trade
			 name, any insurance group designation, name of the parent company of the
			 insurer, name of a particular division of the insurer, service mark, slogan,
			 symbol or other device which without disclosing the name of the actual insurer
			 would have the capacity and tendency to mislead or deceive as to the true
			 identity of the insurer.
b) No
			 advertisement shall use any combination of words, symbols or physical materials
			 which by their content, phraseology, shape, color or other characteristics are
			 so similar to combination of words, symbols or physical materials used by
			 agencies of the federal government or of this State, or otherwise appear to be
			 of such a nature that it tends to confuse or mislead prospective insureds into
			 believing that the solicitation is in some manner connected with an agency of
			 the municipal, state, or federal government.
c) The Guideline for paragraphs (a) and (b)
			 is found in Appendix A, Illustration GG.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Section 2002.150 - Group or Quasi-Group Implications

Current through Register Vol. 48, No. 28, July 12, 2024
An advertisement of a particular policy shall not state or
				imply that prospective insureds become group or quasi-group members covered
				under a group policy and as such enjoy special rates or underwriting
				privileges, unless such is the fact. The Guideline for this Section is found in
				Appendix A, Illustration HH.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Section 2002.170 - Statements About an Insurer

Current through Register Vol. 48, No. 28, July 12, 2024
An advertisement shall not contain statements which are untrue
				in fact, or by implication misleading, with respect to the assets, corporate
				structure, financial standing, age or relative position of the insurer in the
				insurance business. An advertisement shall not contain a recommendation by any
				commercial rating system unless it clearly indicates the purpose of the
				recommendations and the limitations of the scope and extent of the
				recommendation. The Guideline for this Section is found in Appendix A,
				Illustration NN.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Section 2002.180 - Enforcement Procedures

Current through Register Vol. 48, No. 28, July 12, 2024
a)
			 Advertising File. Each insurer shall maintain at its home or principal office a
			 complete file containing every printed, published or prepared advertisement of
			 its individual policies and typical printed, published or prepared
			 advertisements of its blanket, franchise and group policies hereafter
			 disseminated in this or any other state whether or not licensed in that other
			 state, with a notation attached to each advertisement that shall indicate the
			 manner and extent of distribution and the form number of any policy advertised.
			 The file shall be subject to regular and periodic inspection by the Department.
			 All such advertisements shall be maintained in the file for a period of either
			 four years or until the filing of the next regular report of examination of the
			 insurer, whichever is the longer period of time.
b) Certificate of Compliance. With respect to
			 those health insurance policies offered on the Illinois Health Insurance
			 Marketplace, each insurer shall prepare and maintain a certificate of
			 compliance that will be filed with the Department annually on or before March
			 15 of the year immediately following the year pertaining to the certificate.
			 With respect to those health insurance policies not offered on the Illinois
			 Health Insurance Marketplace, each insurer shall prepare and maintain a
			 certificate of compliance that will be placed on file with the insurer,
			 together with the materials identified in subsection (a). The certificates
			 shall be executed by an authorized officer of the insurer. The certificate
			 shall state that, to the best of the authorized officer's knowledge,
			 information and belief, the advertisements disseminated by the insurer during
			 the preceding statement year complied, or were made to comply in all respects,
			 with the provisions of this Part and the Insurance Laws of this State as
			 implemented and interpreted by this Part.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Section 2002.190 - Severability Provision

Current through Register Vol. 48, No. 28, July 12, 2024
If any Section or portion of a Section of this Part or the
				applicability thereof to any person or circumstance is held invalid by a court,
				the remainder of the Part, or the applicability of such provision to other
				persons or circumstances, shall not be affected thereby.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Appendix A - Guidelines › ILLUSTRATION A - Guideline to Section 2002.20

Current through Register Vol. 48, No. 28, July 12, 2024
Disclosure is one of the principal objectives of this Part
				  and this Section states specifically that the Part shall assure "truthful and
				  adequate disclosure of all material and relevant information." This Part
				  specifically prohibits some previous advertising techniques.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Appendix A - Guidelines › ILLUSTRATION B - Guideline to Section 2002.30(a)

Current through Register Vol. 48, No. 28, July 12, 2024
a) If an
				advertisement is circulated in Illinois from a medium published in a locality
				bordering Illinois, which has substantial circulation in Illinois, the
				advertisement must either comply with this Part, disclaim the availability of
				the product advertised for Illinois residents or the company must decline issue
				of the policy explaining to the applicant that the advertisement does not meet
				Illinois advertising standards.
b)
				If an advertisement appears in a regional publication which has a substantial
				amount of its circulation in Illinois, the ad will be considered "intended" for
				use in Illinois and it must either comply with this Part, disclaim the
				availability of the product advertised for Illinois residents or the company
				must decline issue of the policy explaining to the applicant that the
				advertisement does not meet Illinois advertising standards.
c) This Part applies to group and blanket as
				well as individual accident and sickness insurance. Certain distinctions,
				however, are applicable to these categories. Among them is the level of
				conversance with insurance, a factor which is covered by Section
				2002.60(a)
				of this Part.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Appendix A - Guidelines › ILLUSTRATION C - Guideline to Section 2002.30(b)

Current through Register Vol. 48, No. 28, July 12, 2024
a) This
				Section holds a company responsible for the actions of an agent or employee
				unless the company can demonstrate that it had no prior knowledge of the
				actions and unless the company can demonstrate to the satisfaction of the
				Director of Insurance that it has an adequate system of control as described in
				Section
				2002.30(b)
				of this Part.
b) It is recognized
				that there are three kinds of advertisements:
1) offer to contract,
2) offer to inquire, and
3) institutional advertisements.
These distinctions are made since, historically, different
				  provisions in a policy were required or not required to be disclosed depending
				  on the kind of advertisement; the company's attention is directed to Sections
				  2002.40,
				  2002.70(b)(1),
				  and Section
				  2002.80
				  in determining those provisions that must be disclosed.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Appendix A - Guidelines › ILLUSTRATION D - Guideline to Section 2002.40(a)

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				scope of the term "advertisement" extends to the use of all media for
				communication to the general public (Section
				2002.40(a)
				) and to the use of all media for communication by agents, brokers and
				solicitors.
b) The definition of
				"advertisement" includes advertising material included with a policy when the
				policy is delivered and material used in the solicitation of renewals and
				reinstatements.
c) The definition
				of "advertisement" does not include:
1)
				material to be used solely for the training and education of an insurer's
				employees, agents or brokers unless such training or educational materials are
				for the presentation to the public of accident and health policies;
2) material in house organs of
				insurers;
3) communications within
				an insurer's own organization not intended for dissemination to the
				public;
4) individual
				communications of a personal nature with current policyholders other than
				material urging such policyholders to increase or expand coverages;
5) court approved material ordered by a court
				to be disseminated to policyholders;
6) a general announcement from a group or
				blanket policyholder to eligible individuals on an employment or membership
				list that a contract or program has been written or arranged, provided the
				announcement clearly indicates that it is preliminary to the issuance of a
				booklet or certificate; or
7)
				correspondence between an insurer and prospective group or blanket policyholder
				which follows the initial presentation of a group or blanket policy to the
				prospective policyholder, as long as such correspondence relates to the same
				program as initially presented.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Appendix A - Guidelines › ILLUSTRATION E - Guideline to Section 2002.40(h)

Current through Register Vol. 48, No. 28, July 12, 2024
In Section
				  2002.40(h),
				  the language "except disability, waiver of premium and double indemnity
				  benefits included in life insurance and annuity contracts" means except
				  disability, waiver of premium and double indemnity benefits included in life
				  insurance, endowment or annuity contracts or contracts supplemental thereto
				  which contain only such provisions which:
a) provide additional benefits in case of
				death or dismemberment or loss of sight by accident, or as
b) operate to safeguard such contracts
				against lapse or to give a special surrender value or special benefit or an
				annuity in the event that the insured or annuitant shall become totally and
				permanently disabled as defined by the contract or supplemental
				contract.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2002 - ADVERTISING OF ACCIDENT AND SICKNESS INSURANCE › Appendix A - Guidelines › ILLUSTRATION F - Guideline to Section 2002.50

Current through Register Vol. 48, No. 28, July 12, 2024
a) This Section
				permits the use of either of the following alternative methods of disclosure:
1) The first alternative provides for the
				disclosure of exceptions, limitations, reductions and other restrictions
				conspicuously and in close conjunction with the statements to which such
				information relates. This may be accomplished by disclosure in the description
				of the related benefits or in a paragraph set out in close conjunction with the
				description of policy benefits.
2)
				The second alternative provides for the disclosure of exceptions, limitations,
				reductions and other restrictions not in conjunction with the provisions
				describing policy benefits but under appropriate captions of such prominence
				that the information shall not be minimized, rendered obscure or otherwise made
				to appear unimportant. The phrase "under appropriate captions" means that the
				title must be accurately descriptive of the captioned material. Appropriate
				captions include the following: "Exceptions," "Exclusions," "Conditions Not
				Covered" and "Exceptions and Reduction." The use of captions such as, or
				similar to, the following are not acceptable because they do not provide
				adequate notice of the significance of the material: "Extent of Coverage,"
				"Only these Exclusions" or "Minimum Limitations."