Illinois Administrative Code › Title 50 - INSURANCE › Part 2040 - TEMPORARY HEALTH COVERAGE REQUIREMENTS DURING AN EPIDEMIC OR PUBLIC HEALTH EMERGENCY › Section 2040.30 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
Except as provided in this Section, terms used in this Part
				have the meanings given in Section 5 of the Illinois Health Insurance
				Portability and Accountability Act [215 ILCS 97]. The following definitions
				also apply to this Part:
"CMMS' enforcement discretion" means the non-enforcement policy
				expressed by the federal Centers for Medicare & Medicaid Services in the
				FAQ document dated March 24, 2020, addressed to "All Qualified Health Plan and
				Stand-alone Dental Plan Issuers on the Federally-facilitated Exchanges and
				State-based Exchanges on the Federal Platform", which had the subject heading
				"Payment and Grace Period Flexibilities Associated with the COVID-19 National
				Emergency" (Department of Health & Human Services, Centers for Medicare
				& Medicaid Services, 7500 Security Blvd., Mail Stop C4-21-26, Baltimore MD
				21244-1850) (no later editions or amendments included).
"Code" means the Illinois Insurance Code [215 ILCS 5].
"Cost-sharing" means any expenditure required by or on behalf
				of an enrollee related to health insurance coverage. Such term includes
				deductibles, coinsurance, copayments, or similar charges, but excludes
				premiums, balance billing amounts for non-network providers, and spending for
				non-covered services.
"COVID-19" means the respiratory disease recognized by the
				United States Centers for Disease Control and Prevention as "coronavirus
				disease 2019", or the novel coronavirus named "SARS-CoV-2" that causes this
				respiratory disease.
"Department" means the Illinois Department of Insurance.
"Employer" has the meaning ascribed in
				29 USC
				1003(5).
"Excepted benefits" has the meaning ascribed in the following
				federal regulations:
For individual health insurance coverage, the provisions in
				45 CFR 148.220;
				and
For group health insurance coverage, the provisions in
				45 CFR
				146.145(b).
"Exchange" means the Illinois Health Benefits Exchange
				established pursuant to
				42 USC
				18031(b) and
				215
				ILCS 122/5-5, also known as the Illinois Health Insurance Marketplace.
"Health care provider" or "Provider" has the meaning ascribed
				in Section 10 of the Managed Care Reform and Patient Rights Act.
"Health care services" has the meaning ascribed in Section 10
				of the Managed Care Reform and Patient Rights Act [215 ILCS 134].
"Health maintenance organization" has the meaning ascribed in
				Section 1-2(9) of the HMO Act.
"HMO Act" means the Health Maintenance Organization Act [215
				ILCS 125].
"Insured" means a resident, employee, employer, or other
				natural or legal person that has a policy, contract, certificate, or other
				agreement with an issuer for health insurance coverage.
"Issuer" means a "health insurance issuer" as defined in
				Section 5 of the Illinois Health Insurance Portability and Accountability
				Act.
"Non-network provider" means any provider that has not entered
				into an agreement described in Section 370i of the Code or Section 2-8 of the
				HMO Act.
"Qualified health plan" has the meaning given in
				45
				CFR 155.20.
"Short-term, limited-duration health insurance coverage" has
				the meaning ascribed in Section 5 of the Short-Term, Limited Duration Health
				Insurance Coverage Act [215 ILCS 190].
"Stand-alone dental plan" has the meaning ascribed in
				45
				CFR 156.400.
AGENCY NOTE: the FAQ document may be available online at
https://www.cms.gov/files/document/faqs-payment-and-grace-period-covid-19.pdf
.