reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 50 - INSURANCE › Part 2040 - TEMPORARY HEALTH COVERAGE REQUIREMENTS DURING AN EPIDEMIC OR PUBLIC HEALTH EMERGENCY › Section 2040.60 - Minimum Employment Required for Statutory Continuation Coverages

Current through Register Vol. 48, No. 28, July 12, 2024
a) For an employer
			 that employs 20 or more employees, as long as one person remains actively
			 employed, an issuer shall not directly or indirectly prohibit an eligible
			 employee from electing to continue coverage under a COBRA continuation
			 provision using the normal notice and election procedures provided under the
			 Employee Retirement Income Security Act of 1974 (29 USC
			 1001 et seq.).
b) For any employer with group health
			 insurance coverage, as long as at least one person remains actively employed
			 and enrolled in the coverage, an issuer shall not directly or indirectly
			 prohibit an eligible employee from electing to continue coverage under the
			 State continuation coverage required by Section 4-9.2 of the HMO Act.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2040 - TEMPORARY HEALTH COVERAGE REQUIREMENTS DURING AN EPIDEMIC OR PUBLIC HEALTH EMERGENCY › Section 2040.70 - Special Enrollment Effective Date for Off-Exchange Coverage

Current through Register Vol. 48, No. 28, July 12, 2024
a) For health
			 insurance coverage that is not issued through the Exchange, an issuer shall
			 waive the normal special enrollment procedures for an employee or former
			 employee who has lost coverage under their employer or former employer's group
			 health plan or group health insurance coverage to the extent necessary to allow
			 the employee or former employee to obtain or enroll under health insurance
			 coverage effective the day after his or her prior coverage terminated. This
			 requirement applies even if the employee or former employee previously had the
			 opportunity to enroll under the new health insurance coverage. Otherwise,
			 existing requirements for limited and special enrollment periods contained in
			 Title 45 of the Code of Federal Regulations and 50 Ill. Adm. Code
			 2001.4
			 continue to apply.
b) An issuer may
			 make the retroactive extension of coverage optional to the applicant rather
			 than automatic.
c) An issuer shall
			 notify the applicant of the amount of premiums due and the due date based on
			 the effective coverage date, accounting for the availability of an extension on
			 the due dates under Section 2040.40.
d) This Section applies with respect to
			 employees or former employees whose coverage terminates on or after the
			 Governor declares a disaster in all counties of the State. However, existing
			 requirements for the length of the enrollment period in 50 Ill. Adm. Code
			 2001.4
			 continue to apply to each applicant.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2040 - TEMPORARY HEALTH COVERAGE REQUIREMENTS DURING AN EPIDEMIC OR PUBLIC HEALTH EMERGENCY › Section 2040.80 - Access to Covered Prescription Drugs

Current through Register Vol. 48, No. 28, July 12, 2024
This Section applies to health insurance coverage that covers
				prescription drugs.
a) An issuer shall
			 cover off-formulary prescription drugs if there is not a formulary drug
			 available to treat the insured. The issuer shall do so without any prior
			 authorization or step-therapy requirements that are separate from or redundant
			 to any requirements already satisfied for the unavailable formulary drug. No
			 greater cost-sharing shall be imposed than would apply to the formulary drug.
			 Group health insurance coverage is subject to this subsection even if it is not
			 provided by a health maintenance organization.
b) To the extent consistent with clinical
			 guidelines, an issuer shall cover an insured to obtain at least a 90-day supply
			 upon refill of a covered maintenance medication, though exceptions may be made
			 for drug classes that are prone to misuse, such as opioids, benzodiazepines,
			 and stimulants. Group health insurance coverage is subject to this subsection
			 only if it is provided by a health maintenance organization.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2051 - PREFERRED PROVIDER PROGRAMS › Section 2051.210 - Purpose

Current through Register Vol. 48, No. 28, July 12, 2024
a) The purpose of
			 this Part is to implement Article XX1/2 of the Illinois Insurance Code, which,
			 in part, provides for the regulation of preferred provider programs for health
			 care benefit plans and for the provision of workers' compensation medical
			 benefits by employers, including those programs that provide insureds or
			 beneficiaries access to discounted health care provider fees. This Part defines
			 the authority of an administrator to operate preferred provider programs in
			 this State, establishes criteria for the registration of administrators with
			 the Director of Insurance and establishes appropriate fees for the registration
			 and regulation of programs. This Part also establishes requirements for any
			 person, partnership or corporation engaged in any conduct regulated by the Act,
			 including, but not limited to, administrators, discounted health care services
			 plan administrators, and insurers that, under Sections 370h and 370i of the
			 Act, enters into a preferred provider arrangement or offers a preferred
			 provider program. The entity must comply with this Part when offering
			 incentives to insureds or beneficiaries to utilize the services of contracted
			 providers. This Part does not apply to employee benefit trust funds, other
			 ERISA exempt organizations, self-funded State of Illinois health benefit plans,
			 Medicare approved prescription drug plans or any State of Illinois discount
			 drug program, except as otherwise set forth in this Part.
b) This Part also implements Section
			 8.1 a of the Workers'
			 Compensation Act [820 ILCS 305 ], which provides for the regulation of certain
			 preferred provider programs for the provision of health care services to
			 employees under the Workers' Compensation Act. This Part defines the authority
			 of a workers' compensation preferred provider program administrator to operate
			 the preferred provider programs in this State, establishes criteria for the
			 registration of those administrators with the Director of Insurance and
			 establishes appropriate fees for the registration and regulation of the
			 programs. This Part also establishes requirements for any person, partnership
			 or corporation engaged in any conduct regulated by Section 8.1a, including, but
			 not limited to, workers' compensation preferred provider program
			 administrators, employers, including self-funded employers, and insurers that
			 offer a preferred provider program. The entity must comply with this Part when
			 requiring employees to make a choice of a health care services provider from
			 within the preferred provider program under Section 8(a)(4) of the Workers'
			 Compensation Act.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2051 - PREFERRED PROVIDER PROGRAMS › Section 2051.230 - Administrators Not to Assume Underwriting Risk

Current through Register Vol. 48, No. 28, July 12, 2024
An administrator may negotiate and make arrangements with
				providers in compliance with the Act, and market and otherwise make available
				such arrangements to insurance companies, HMO's, limited health service
				organizations, health service corporations, fraternal benefit societies,
				self-insuring employers or health and welfare trust funds and to their
				subscribers; provided, however, that in performing these functions the
				administrator shall not accept any underwriting risk in the form of a premium
				or capitation payment for its services.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2051 - PREFERRED PROVIDER PROGRAMS › Section 2051.240 - Registration, Renewals and Appeals

Current through Register Vol. 48, No. 28, July 12, 2024
a)
			 No person, partnership or corporation shall act as an administrator until that
			 person, partnership or corporation has registered with the Director as required
			 by this Section. In addition, all administrators shall annually renew their
			 registration with the Director as required by this Section.
b) Upon the filing of an application to
			 register as a preferred provider program administrator and the payment of the
			 registration fee required by Section
			 2051.250, the Director shall
			 register the applicant if the Director finds that the applicant:
1) Has provided a detailed plan of
			 operation;
2) Is competent and
			 trustworthy and intends to act in good faith in the capacity authorized by the
			 license;
3) Has a good business
			 reputation and has had experience, training or education so as to be qualified
			 in the business for which the license is applied for; and
4) Has incorporated under the laws of this
			 State or, if a foreign corporation or limited liability corporation, is
			 authorized to transact business in this State.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2051 - PREFERRED PROVIDER PROGRAMS › Section 2051.250 - Fees

Current through Register Vol. 48, No. 28, July 12, 2024
On or after January 1, 2010, each new administrator doing
				business in this State shall pay to the Director an initial registration fee of
				$1000. Each administrator doing business in this State shall annually pay to
				the Director a renewal fee of $500 in order to maintain the
				registration.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2051 - PREFERRED PROVIDER PROGRAMS › Section 2051.270 - Organizational Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
Upon application for registration, administrators must file the
				following information:
a) An
			 organizational chart describing the relationship between the administrator, its
			 parent organization and any affiliates, including the state of domicile and the
			 primary business of each entity;
b)
			 Proof of registration with the Illinois Secretary of State and the company's
			 FEIN;
c) Names, addresses, official
			 positions and biographical affidavits of the person or persons responsible for
			 the conduct of the affairs of the administrator. The biographical affidavits
			 shall include, but not be limited to, the following information: identifying
			 information of the administrator; affiant's identifying and contact
			 information; affiant's educational, residential and employment history;
			 affiant's professional, business and technical licenses and memberships; a
			 complete history of affiant's fidelity bonding; criminal charges and
			 convictions; civil, regulatory, administrative and disciplinary actions in an
			 individual or corporate capacity; a complete history of affiant's bankruptcy,
			 insolvency, liens and foreclosures in an individual or corporate capacity;
			 affiant's consent to release background reports to the Department and consent
			 for third parties to cooperate in the gathering of background information; and
			 affiant's and his or her immediate family's equity holdings in any entity
			 subject to insurance regulation. The Department will accept the biographical
			 affidavit, and any supplement thereto, obtained from the website of the NAIC or
			 the Department. A copy of the NAIC Biographical Affidavit form is available
			 under "Managed Care License/Registration Information" on the Department's
			 website at
http://insurance.illinois.gov/company/companyMain.html
;
			 and
d) Location of all
			 administrative offices of the administrator located in this State and regular
			 business hours during which offices are open.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2051 - PREFERRED PROVIDER PROGRAMS › Section 2051.280 - Health Care Preferred Provider Program Payor Agreements

Current through Register Vol. 48, No. 28, July 12, 2024
Administrators shall file with the Department a sample copy of
				all payor agreements. WC PPPs are exempt from the requirements of this Section,
				but must instead comply with the requirements of Section
				2051.285.
				These agreements shall contain at a minimum:
a) Terms requiring and specifying all
			 incentives to be provided to the insured or beneficiary to utilize services of
			 a provider that has entered into an agreement with the administrator;
b) Terms stating that, whenever an
			 administrator or a preferred provider finds it medically necessary to refer a
			 beneficiary to a non-preferred provider, the payor shall ensure that the
			 beneficiary so referred shall incur no greater out of pocket liability than had
			 the beneficiary received services from a preferred provider. This subsection
			 does not apply to a beneficiary who willfully chooses to access a non-preferred
			 provider for health care services available through the administrator's panel
			 of participating providers. In these circumstances, the contractual
			 requirements for non-preferred provider reimbursements will apply. This
			 subsection does not apply to administrators offering only a DHCSP;
c) Terms requiring that both the payor's and
			 administrator's name and toll-free telephone numbers be contained on all
			 beneficiaries' identification cards;
d) Terms specifying that only the payor may
			 assume any underwriting risk when that risk is part of the delivery of
			 services.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2051 - PREFERRED PROVIDER PROGRAMS › Section 2051.285 - Workers' Compensation Preferred Provider Program Payor Agreements

Current through Register Vol. 48, No. 28, July 12, 2024
Any payor agreements between WC PPP administrators and payors
				shall contain, at a minimum:
a) Terms
			 requiring and specifying all incentives to be provided to the insured to
			 utilize services of a provider that has entered into an agreement with the
			 administrator;
b) Terms stating
			 that, whenever an administrator or a preferred provider finds it medically
			 necessary to refer a beneficiary to a non-preferred provider because the
			 preferred provider program does not contain a provider who can provide the
			 approved treatment, and if the beneficiary has complied with any reasonable
			 pre-authorization requirements, the payor shall ensure that the beneficiary so
			 referred shall incur no greater liability than had the beneficiary received
			 services from a preferred provider, except as provided under Section
			 8.1 a(c)(2) and
			 Section 8.2(e) of the Workers' Compensation Act;
c) Terms stating that, whenever an
			 administrator or a preferred provider finds it medically necessary to refer a
			 beneficiary to a non-preferred provider because the preferred provider program
			 does not contain a provider who can provide the approved treatment, and if the
			 beneficiary has complied with any reasonable pre-authorization requirements
			 consistent with Section 8.1a of the Workers' Compensation Act, the WC PPP shall
			 ensure that the covered employee will be provided the covered services by a
			 non-preferred provider in accordance with the fees established by the Workers'
			 Compensation Fee Schedule (see 50 Ill. Adm. Code
			 9110.90
			 and the WCC website at https://iwcc.ingenix.com/ iwcc.asp).
Illinois Administrative Code › Title 50 - INSURANCE › Part 2051 - PREFERRED PROVIDER PROGRAMS › Section 2051.290 - Health Care Preferred Provider Program Administrator Provider Agreements

Current through Register Vol. 48, No. 28, July 12, 2024
Administrators shall file a sample of copy of all provider
				agreements. WC PPPs are exempt from the requirements of this Section, but must
				instead comply with the requirements of Section
				2051.295.
				The agreements shall contain, at a minimum:
a) A provision identifying the specific
			 covered health care services for which the preferred provider will be
			 responsible, including any discount services, copayments, benefit maximums,
			 limitations and exclusions, as well as any discount amount or discounted fee
			 schedule reflecting discounted rates;
b) A provision requiring the provider to
			 comply with applicable administrative policies and procedures of the
			 administrator including, but not limited to credentialing or recredentialing
			 requirements; and, except for DHCSP administrators, utilization review
			 requirements, and referral procedures;
c) Medical Records
1) A provision requiring that, when payments
			 are due to the provider for services rendered to a beneficiary, the provider
			 must maintain and make medical records available:
A) To the administrator and/or insurer for
			 the purpose of determining, on a concurrent or retrospective basis, the medical
			 necessity and appropriateness of care provided to beneficiaries;
B) To appropriate State and federal
			 authorities and their agents involved in assessing the accessibility and
			 availability of care or investigating member grievances or complaints;
			 and
C) To show compliance with the
			 applicable State and federal laws related to privacy and confidentiality of
			 medical records.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2051 - PREFERRED PROVIDER PROGRAMS › Section 2051.295 - Workers' Compensation Preferred Provider Program Provider Agreements

Current through Register Vol. 48, No. 28, July 12, 2024
All provider agreements between providers and insurers,
				employers or WC PPP administrators with regard to a WC PPP shall contain, at a
				minimum:
a) A provision stating,
			 within the preamble, that the agreement conforms to the requirements of Section
			 8.1 a of the Illinois
			 Workers' Compensation Act;
b) A
			 provision identifying the specific covered health care services for which the
			 preferred provider will be responsible, including any discount services,
			 limitations and exclusions, as well as any discount amount or discounted fee
			 schedule reflecting discounted rates;
c) A provision requiring the provider to
			 comply with applicable administrative policies and procedures of the
			 administrator, including, but not limited to, credentialing or recredentialing
			 requirements, utilization review requirements, and referral
			 procedures;
d) A provision
			 requiring that, when payments are due to the provider for services rendered to
			 a beneficiary, the provider must maintain and make the beneficiary's medical
			 records available:
1) To the administrator
			 and/or payor for the purpose of determining, on a concurrent or retrospective
			 basis, the compensability, medical necessity and appropriateness of care
			 provided to beneficiaries;
2) To
			 appropriate State and federal authorities and their agents involved in
			 assessing the accessibility and availability of care or investigating member
			 grievances or complaints; and
3) To
			 show compliance with the applicable State and federal laws related to privacy
			 and confidentiality of medical records;
Illinois Administrative Code › Title 50 - INSURANCE › Part 2051 - PREFERRED PROVIDER PROGRAMS › Section 2051.300 - Requirements for Agreements with Other Administrators

Current through Register Vol. 48, No. 28, July 12, 2024
a) Before entering into a contract with
			 another administrator to administer programs, policies or subscriber contracts
			 in this State as provided by Section 370i(b)(2) of the Act, an administrator
			 shall perform due diligence to ensure the other entity is properly registered
			 under this Part or otherwise appropriately licensed under the Code.
b) Any provider contract or preferred
			 provider program that is sold, leased, assigned, assumed or otherwise delegated
			 must have the terms of that transaction affecting the provision of health care
			 services by providers, including any additional discount, repricing or other
			 consideration, clearly described in the contract. The administrator or payor
			 accessing the provider network shall be contractually obligated to comply with
			 all applicable terms, limitations and conditions of the provider network
			 contract, including all appendices, policies and fee schedules. An
			 administrator shall provide to the provider upon request a written or
			 electronic list of all current payors to which the provider contract or program
			 has been sold, leased, assigned, assumed or otherwise delegated.
c) An administrator shall approve in writing,
			 prior to use, all advertisements, marketing materials, brochures and, if
			 applicable, identification cards used by any other administrator to market,
			 promote, sell or enroll members in its preferred provider program.
d) No preferred provider program may be sold,
			 leased, assigned, assumed or otherwise delegated to another administrator
			 without the prior written consent of the providers contracting under the
			 program. A clause within the provider contract allowing assignment will be
			 deemed consent so long as the assignment is in accordance with terms of the
			 contract. The assignee must comply with all the terms and conditions of the
			 contract being assigned, including all checklists, policies and fee
			 schedules.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2051 - PREFERRED PROVIDER PROGRAMS › Section 2051.320 - Discounted Health Care Services Plan Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
a) A DHCSP administrator shall have a written
			 agreement between the administrator and its beneficiaries that specifies the
			 benefits a beneficiary is to receive under the DHCSP and that complies with
			 this Section. For insurers offering a DHCSP as part of a policy of insurance,
			 the certificate or policy may act as the written agreement.
b) All agreements between DHCSP
			 administrators and beneficiaries shall contain at a minimum:
1) A provision establishing the right of the
			 beneficiary to cancel the plan, in writing, at any time. If a beneficiary
			 cancels within 30 days after the date of receipt of the identification card and
			 other membership materials, the beneficiary will be reimbursed all money paid
			 except any fee authorized by subsection (f);
2) A provision establishing that
			 beneficiaries will have free access to DHCSP providers without restrictions
			 such as waiting periods, notification periods, etc. (except for hospital
			 discounts);
3) A provision allowing
			 a beneficiary to modify the method of payment upon request, unless a specific
			 method of payment is stipulated within the agreement. DHCSP administrators must
			 discontinue using any automatic account withdrawals, including, but not limited
			 to, electronic fund transfers and automatic credit card and/or debit card
			 charges, upon receiving a beneficiary's written request to terminate or alter
			 the method of payment;
4) The
			 procedures for filing complaints with the plan and the availability and contact
			 information for the Illinois Department of Insurance. These procedures must
			 contain, at a minimum, a statement that the DHCSP shall provide specific
			 contact information for the Department upon request.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2051 - PREFERRED PROVIDER PROGRAMS › Section 2051.330 - Insurer Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
a) As
			 required by Section 143(1) of the Code and consistent with the requirements of
			 50 Ill. Adm. Code 916, insurers must file the following compliance documents in
			 the format prescribed in the Insurer Filing Requirements Form, located under
			 "Managed Care License/Registration Information" on the Department's website at
http://insurance.illinois.gov/company/companyMain.html
,
			 each time a policy incorporating a preferred provider arrangement is filed, or
			 when the insurer markets, leases, sells or otherwise issues DHCSPs to
			 beneficiaries, either directly or indirectly, independent of insurance
			 coverage:
1) Sample copies of all payor
			 agreements as required by Section
			 2051.280,
			 when applicable, and provider agreements as required by Section
			 2051.290.
			 If the terms and conditions in the agreements include significant, substantial
			 or material changes or additions, the filing of one complete sample of each
			 type of agreement, together with a description of all variable terms and
			 conditions, will satisfy this requirement;
2) Valid and current signed administrator
			 agreements pursuant to Section
			 2051.300;
3) Network availability and adequacy
			 requirements pursuant to Section
			 2051.310;
			 and
4) DHCSPs' requirements
			 pursuant to Section
			 2051.320,
			 if applicable.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2051 - PREFERRED PROVIDER PROGRAMS › Section 2051.350 - Maintenance of Records

Current through Register Vol. 48, No. 28, July 12, 2024
a) All
			 administrators shall maintain detailed books and records of all of their
			 transactions as an administrator of preferred provider programs. The records
			 required to be maintained by this Section shall include, but are not limited
			 to:
1) Books and records of ATF transactions
			 required by Section
			 2051.340;
2) Books and records regarding all funds
			 received or disbursed by the administrator;
3) All contracts or agreements with
			 providers, insurers or other payors of the services under a PPP; and
4) All documents relating to the
			 administrator's PPP, including but not limited to beneficiary disclosure
			 documents required by Section 370m of the Act, beneficiary complaints and
			 documents relating to the administrator's utilization review program.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2051 - PREFERRED PROVIDER PROGRAMS › Section 2051.360 - Advertising and Solicitation

Current through Register Vol. 48, No. 28, July 12, 2024
a) No
			 administrator or its representative shall cause, or knowingly permit the use
			 of, advertising, solicitation, or any form of evidence of coverage that
			 encourages misrepresentation, or is untrue, misleading or deceptive, unjust,
			 unfair, inequitable, ambiguous, inconsistent, or contrary to law or to the
			 public policy of this State;
b) No
			 administrator may represent or describe itself in its name, contracts or
			 literature as a "health maintenance organization" or "HMO", nor may it hold
			 itself out or represent itself as being an insurance company, limited health
			 service organization or a health service corporation, unless such is the
			 case;
c) No DHCSP administrator may
			 use the following terms in its advertisements, marketing material, brochures or
			 DHCSP cards: "health plan", "coverage", "copay", "copayments", "deductible",
			 "preexisting conditions", "guaranteed issue", "premium", or other terms in a
			 manner that could reasonably mislead an individual into believing that the
			 product being offered is health insurance;
d) No DHCSP administrator may use language in
			 its advertisements, marketing material, brochures or DHCSP cards with respect
			 to being "licensed" or "registered" by the Department in a manner that could
			 mislead an individual into believing that the DHCSP is health
			 insurance;
e) Whether an
			 advertisement has a capacity or tendency to mislead or deceive shall be
			 determined by the Director 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;
f) If the Director finds
			 that any advertisement of a preferred provider program has materially failed to
			 comply with this Part, the Director may, pursuant to the authority in Section
			 149 of the Code, by Order, require the administrator to publish in the same or
			 similar medium an approved correction or retraction of any untrue, misleading
			 or deceptive statement contained in the advertising. The Director may prohibit
			 the administrator from publishing or distributing, or allowing to be published
			 or distributed on its behalf, the advertisement or any new materially revised
			 advertisement without first having filed a copy of the advertisement with the
			 Director 30 days prior to its publication or distribution, or within any
			 shorter period specified in the Order.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2201 - LOSS AND LOSS RESERVES › Section 2201.10 - Application and Scope

Current through Register Vol. 48, No. 28, July 12, 2024
This Rule applies to all insurance companies authorized to
				transact the kind or kinds of business enumerated in Class 2 of Section 4 of
				the Illinois Insurance Code. (Ill. Rev. Stat. 1981, ch. 73, par.
				616).
Illinois Administrative Code › Title 50 - INSURANCE › Part 2201 - LOSS AND LOSS RESERVES › Section 2201.20 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
"Compensation" shall relate to all insurance effected by virtue
				of statutes providing compensation to employees for personal injury or
				occupational disease irrespective of fault of the employer;
"Earned premiums" shall include gross premiums charged on all
				policies written, including all determined excess and additional premiums, less
				return premiums to policyholders, but excluding amounts returned as dividends
				or unabsorbed surplus, and less reinsurance premiums and premiums on policies
				cancelled, and less unearned premiums on policies in force; provided, that any
				participating company which has charged in its premiums a loading solely for
				dividends shall not be required to include such loading in its earned premiums,
				provided a statement of the amount of such loading has been filed with and
				approved by the Director;
"Liability" shall relate to all insurances except Workmen's
				Compensation insurance against loss or damage from accident to or injuries or
				occupational disease suffered by an employee or other person, including death
				or disability and insurance against damage to or destruction of another
				person's property, for all of which the insured is liable; the definition is
				extended with respect to Automobile Liability to include all coverages required
				by statute ("No-Fault"). This subsection shall apply to lines of business
				described in the Annual Statement as Automobile Liability and Liability Other
				Than Automobile. For accident years 1970 and prior, liability shall be
				separated into bodily injury and property damage wherever this separation
				appears in the Annual Statement.
"Loss expense" shall include, but not be limited to, all
				payments made, due, or to become due for legal expenses, salaries and expenses
				of investigators, adjusters and field men, rents, stationery, telegraph and
				telephone charges, postage, salaries, and expenses or office employees, home
				office expenses and all other payments made or to be made on account of claims,
				whether such payments will be allocated to specific claims or be unallocated
				but required in the discharge of the company's claim liability.
"Loss incurred" means amounts paid and payable to or on behalf
				of claimants, including amounts paid and payable for medical and surgical
				attendance.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2201 - LOSS AND LOSS RESERVES › Section 2201.30 - Loss and Loss Expense Reserves

Current through Register Vol. 48, No. 28, July 12, 2024
The company shall keep a complete and itemized record showing
				all losses and claims on which it has received notice, including all notices
				received by it of the occurrence of any event which may result in a loss. Such
				record shall be opened in chronological receipt order, with each notice of loss
				or claim identified by appropriate number or coding.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2301 - STANDARD FIRE POLICY › Section 2301.10 - Authority

Current through Register Vol. 48, No. 28, July 12, 2024
This Rule is promulgated by the Director of Insurance under
				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. The purpose of this Part is to
				implement Section 397 of the Illinois Insurance Code.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2301 - STANDARD FIRE POLICY › Section 2301.20 - Scope

Current through Register Vol. 48, No. 28, July 12, 2024
This Part shall apply to any company licensed to do an
				insurance business in this State that is transacting the kind of business
				described as Class 3(a) of Section 4 of the Illinois Insurance Code (Ill. Rev
				Stat. 1981, ch. 73, par. 616). This Part shall apply to all policy forms on
				file with the Department on or after November 1, 1975, as well as all policy
				forms filed after that date.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2301 - STANDARD FIRE POLICY › Section 2301.30 - Form

Current through Register Vol. 48, No. 28, July 12, 2024
The printed form of the policy together with optional first
				page thereof is available from the state of Illinois Department of Insurance,
				320 West Washington, Springfield Illinois 62706, and is hereby designated as
				the Standard Policy for fire and lightning insurance of the State of Illinois.
				All policies or contracts of such insurance issued or delivered by an insurer
				subject to the provisions of the Illinois Insurance Code or by any agent or
				representative thereof on any property in this State shall conform to such form
				of Standard Policy or, if another form is used, shall for the purpose of
				concurrence of contract be deemed to be the Standard Policy.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2301 - STANDARD FIRE POLICY › Section 2301.40 - Information To Be Printed on Policy

Current through Register Vol. 48, No. 28, July 12, 2024
There shall be printed at the head of the policy, the spacing
				of which, as to the first page, shall be optional, the name of the insurer or
				insurers issuing the policy; the location of the Home Office thereof; a
				statement of whether the insurer is a stock, mutual, reciprocal, Lloyds or
				alien insurer, or an insurer operating under a charter by Special Act of the
				Legislature of any state. There may be added thereto such devices, emblems or
				designs and dates as are appropriate for the insurer issuing the policy, and a
				statement of the plan of operation in this State.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2301 - STANDARD FIRE POLICY › Section 2301.50 - Contingent Liability of Members or Subscribers

Current through Register Vol. 48, No. 28, July 12, 2024
In a policy in which contingent liability of members or
				subscribers is provided for, the provision therefor shall be plainly stated in
				each policy with prominence equal to the indemnifying clause. Any insurer may
				also print upon the policy such regulations or provisions as may be required by
				its home state or such as may be appropriate to or required by its form of
				organization or plan of operation. There may be substituted for the word
				"Company" where it appears in the policy, another term more accurately
				descriptive of the insurer.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2301 - STANDARD FIRE POLICY › Section 2301.60 - Contracts or Endorsements Against Other Perils

Current through Register Vol. 48, No. 28, July 12, 2024
Appropriate forms of contracts or endorsements, whereby the
				interest in the property described in such policy shall be insured against
				other perils which the insurer is empowered to assume, may be used in
				connection with the Standard Policy. Such other contracts or endorsements
				attached to or printed thereon may contain provisions and stipulations
				inconsistent with the Standard Policy to the extent they are applicable only to
				such other perils. Subject to the approval of the Director, the first page of
				the Standard Policy may be rearranged to provide space for the listing of rates
				and premiums for coverages insured thereunder or under endorsements attached or
				printed thereon, and such other data as may be appropriately included for
				duplication on daily reports for office records.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2301 - STANDARD FIRE POLICY › Section 2301.70 - Binder or Other Contract for Temporary Insurance

Current through Register Vol. 48, No. 28, July 12, 2024
Binder or other contract for temporary insurance may be made,
				and shall be deemed to include all the terms of the Standard Policy and all
				such applicable endorsements as may be designated in such binder or contract of
				temporary insurance, except that the cancellation clause of such Standard
				Policy, and the clause thereof specifying the hour of the day at which the
				insurance shall commence, may be superseded by the express terms of such binder
				or contract of temporary insurance.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2301 - STANDARD FIRE POLICY › Section 2301.80 - Filing of Form

Current through Register Vol. 48, No. 28, July 12, 2024
The form of Standard Policy and the form of other basic
				contracts, riders or endorsements to be attached to the Standard Policy to be
				used by each insurer shall be filed with the Director of Insurance by each
				insurer or by an organization, bureau or association of which it is a member,
				according to the requirements and subject to the provisions of Section 143 of
				the Illinois Insurance Code (Ill. Rev. Stat. 1981, ch. 73, par.
				755).
Illinois Administrative Code › Title 50 - INSURANCE › Part 2301 - STANDARD FIRE POLICY › Section 2301.90 - Applicability

Current through Register Vol. 48, No. 28, July 12, 2024
The provisions of this Part shall not be applicable to policies
				of fire insurance on any vehicle, motor or otherwise, to policies of marine and
				transportation insurance, or to policies of reinsurance between
				insurers.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2301 - STANDARD FIRE POLICY › Section 2301.110 - Optional Information

Current through Register Vol. 48, No. 28, July 12, 2024
The information on the filing back of the Standard Five Policy
				is optional, however, there shall be a form number and edition identification
				on the policy (this form is available from the Department of Insurance, 320
				West Washington, Springfield, Illinois, 62706).
Illinois Administrative Code › Title 50 - INSURANCE › Part 2302 - REQUIRED PROCEDURES FOR GROUP INLAND MARINE INSURANCE › Section 2302.20 - Purpose and Scope

Current through Register Vol. 48, No. 28, July 12, 2024
a) The purpose
			 of this Part is to establish a uniform procedure under which all companies must
			 file with and secure approval of the Director of Insurance for group or master
			 policy-certificate inland marine insurance forms, rules, and rates before their
			 use in Illinois.
b) This Part is
			 applicable to group or master-policy certificate inland marine insurance
			 regulated by Section 400.1 of the Code involving personal property owned by,
			 being purchased by, or pledged as collateral by individuals, and not used in
			 any business, trade or profession. Other types of group or master-policy
			 certificate inland marine insurance are exempt from filing under this
			 Part.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2302 - REQUIRED PROCEDURES FOR GROUP INLAND MARINE INSURANCE › Section 2302.30 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
"Code" means the Illinois Insurance Code [ 215 ILCS 5 ].
"Company", as used in this Part, means any entity defined as a
				"company" in Section 2 of the Code and that issues or delivers in the State of
				Illinois any policy, contract or certificate of Group Inland Marine and
				Transportation insurance that falls within Class 3, Clause (d) of Section 4 of
				the Code and any other incidental or supplemental classes and clauses.
"Department" means the Illinois Department of Insurance.
"Director" means the Director of the Illinois Department of
				Insurance.
"SERFF" means System for Electronic Rate and Form
				Filing.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2302 - REQUIRED PROCEDURES FOR GROUP INLAND MARINE INSURANCE › Section 2302.40 - Procedure

Current through Register Vol. 48, No. 28, July 12, 2024
a) Forms
1) All companies must file, using the System
			 for Electronic Rate and Form Filing (SERFF):
A) Copies of all policy forms and, for mutual
			 companies, a separate proxy signature line for the insured to sign, if
			 applicable;
B) Copies of generally
			 used endorsement forms on these kinds of business;
C) Copies of all application forms used on
			 these kinds of business, including a separate proxy signature line for the
			 insured to sign, if applicable;
D)
			 A copy of the declaration page, in non-individualized, template form, absent
			 personal policyholder information; and
E) A copy of the policy jacket, if used by
			 the company.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2302 - REQUIRED PROCEDURES FOR GROUP INLAND MARINE INSURANCE › Section 2302.50 - 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 of that Section or portion of a Section to any person or
				circumstances, is held invalid by a court, the remainder of this Part or the
				applicability of the provision to other persons or circumstances shall not be
				affected by that determination of invalidity.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2401 - AGREEMENTS FOR APPORTIONMENT OF PROPERTY AND CASUALTY INSURANCE › Section 2401.10 - Authority

Current through Register Vol. 48, No. 28, July 12, 2024
This Part is promulgated by the Director of Insurance under
				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. It is the purpose of this Part
				to implement Sections 429, 478.1 and 530 of the Illinois Insurance Code and
				Section 7-501 of the Illinois Safety Responsibility Law (Ill. Rev. Stat. 1981,
				ch. 95½, par. 7-501).
Illinois Administrative Code › Title 50 - INSURANCE › Part 2401 - AGREEMENTS FOR APPORTIONMENT OF PROPERTY AND CASUALTY INSURANCE › Section 2401.20 - Plan of Operation

Current through Register Vol. 48, No. 28, July 12, 2024
The plans of operation governing the rates, rules and rating
				plans applicable to casualty and property coverages assigned pursuant to
				Section 7-501 of the Illinois Safety Responsibility Law and Sections 478.1 and
				523 of the Illinois Insurance Code shall be those plans in effect on the
				effective date of this regulation. The organization approved by the Director to
				administer the assignment of automobile liability, automobile physical damage
				and uninsured motorists coverage is the Illinois Automobile Insurance Plan. The
				organization approved by the Director to administer the placement of basic
				property insurance is the Illinois Fair Plan Association. These organizations
				are hereby designated by the Director of Insurance to implement rates, rules
				and rating plans under this regulation until further notice of the Director of
				Insurance.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2401 - AGREEMENTS FOR APPORTIONMENT OF PROPERTY AND CASUALTY INSURANCE › Section 2401.30 - Unfair Method of Competition

Current through Register Vol. 48, No. 28, July 12, 2024
Insurers shall not be deemed guilty of an unfair method of
				competition if;
a) such insurers agree
			 to provide a method for the equitable apportionment among them of property and
			 casualty insurance for applicants who are in good faith entitled to, but are
			 unable to procure, such insurance through ordinary methods,
b) such insurers agree with each other to
			 adhere and bind themselves to rates, rules and regulated plans for insurance
			 written for such applicants provided such rates, rules and rating plans have
			 been filed prior to the proposed effective date and approved by the Director of
			 Insurance prior to their use, and
c) such insurers agree to an annual review of
			 rates subject to approval by the Director of Insurance to their continued
			 use.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2402 - ADMINISTRATIVE HEARING PROCEDURES › Section 2402.10 - Authority

Current through Register Vol. 48, No. 28, July 12, 2024
This Rule 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 Rule implements Section
				402 and 403 of the Illinois Insurance Code by establishing guidelines and
				procedures for the conduct of hearings under the jurisdiction of the Department
				of Insurance.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2402 - ADMINISTRATIVE HEARING PROCEDURES › Section 2402.30 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
"Department" means the Department of Insurance and the staff
				and employees of the Department.
"Director" means the Director of the Illinois Department of
				Insurance.
"Hearing" means any hearing authorized by the Illinois
				Insurance Code.
"Hearing Officer" means the presiding official designated by
				the Director to conduct a hearing.
"License" means the whole or part of any Department permit,
				certificate, approval, registration, charter, membership, statutory exemption,
				or any other form of permission.
"Licensing" means the Department process of granting, renewing,
				denying, revoking, suspending, annulling, withdrawing, limiting, amending,
				modifying or conditioning a license.
"Order" means the whole or any part of the final decision of
				the Director in any hearing.
"Party" means individuals, partnerships, corporations,
				associations, or public or private organizations of any character or any other
				governmental agency properly seeking and entitled to intervene in any
				Department proceeding.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2402 - ADMINISTRATIVE HEARING PROCEDURES › Section 2402.40 - Filing

Current through Register Vol. 48, No. 28, July 12, 2024
a Documents and
			 requests permitted or required to be filed with the Department in connection
			 with a hearing shall be addressed to and mailed to or filed in person with the
			 Department of Insurance, 320 W. Washington Street, Springfield IL 62767, or 122
			 S. Michigan Ave., 19th Floor, Chicago IL 60603, in
			 duplicate. The offices of the Department are open for filing, inspection and
			 copying of public documents from 8:30 a.m. to 5:00 p.m., Monday through Friday,
			 except on National and State legal holidays.
b By agreement of the parties or by order of
			 the hearing officer, filing of these documents may also be accomplished by
			 email or facsimile to the office of the Department and opposing party (or
			 opposing party's counsel). Any filings by email or facsimile must be received
			 by the recipient no later than 5:00 p.m. on the date filing is due.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2402 - ADMINISTRATIVE HEARING PROCEDURES › Section 2402.50 - Form of Documents

Current through Register Vol. 48, No. 28, July 12, 2024
a)
			 Documents shall clearly show the file Hearing Number and the title of the
			 proceedings in connection with which they are filed.
b) Except as otherwise provided, 2 copies of
			 all documents including notices, motions, and petitions, shall be filed with
			 the Department.
c) Documents shall
			 be typewritten or reproduced from typewritten copy on letter or legal size
			 white paper.
d) One copy of each
			 document filed shall be signed by the party or by his authorized representative
			 or attorney.