reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 50 - INSURANCE › Part 4445 - IRS QUALIFICATION STATUS REQUIREMENTS FOR ARTICLE 4 FIREFIGHTER PENSION FUNDS › Subpart D - RULE ON 415 LIMITATIONS › Section 4445.180 - Benefits Not Taken into Account for 415(b) Limit

Current through Register Vol. 48, No. 28, July 12, 2024
For purposes of this Section, the following benefits shall
				  not be taken into account in applying these limits:
a) Any ancillary benefit that is not directly
				related to retirement income benefits;
b) That portion of any joint and survivor
				annuity that constitutes a qualified joint and survivor annuity;
c) Any other benefit not required under IRC
				section 415(b)(2) and related Treasury Regulations ( 26 CFR 1.415(b) ) to be
				taken into account for purposes of the limitation of IRC section
				415(b)(1).
Illinois Administrative Code › Title 50 - INSURANCE › Part 4445 - IRS QUALIFICATION STATUS REQUIREMENTS FOR ARTICLE 4 FIREFIGHTER PENSION FUNDS › Subpart D - RULE ON 415 LIMITATIONS › Section 4445.190 - Other Adjustments in 415(b) Limitation

Current through Register Vol. 48, No. 28, July 12, 2024
a) In the event the member's retirement
				benefits become payable before age 62, the limit prescribed by this Subpart
				shall be reduced in accordance with regulations issued by the Secretary of the
				Treasury pursuant to the provisions of IRC section 415(b), so that the limit
				(as so reduced) equals an annual straight life benefit (when the retirement
				income benefit begins) equivalent to a $160,000 (as adjusted) annual benefit
				beginning at age 62.
b) In the
				event the member's benefit is based on at least 15 years of service as a
				full-time employee of any fire department or on 15 years of military service,
				the adjustments provided for in subsection (a) shall not apply.
c) The reductions provided for in subsection
				(a) shall not be applicable to pre-retirement disability benefits or
				pre-retirement death benefits.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4445 - IRS QUALIFICATION STATUS REQUIREMENTS FOR ARTICLE 4 FIREFIGHTER PENSION FUNDS › Subpart D - RULE ON 415 LIMITATIONS › Section 4445.200 - Less than 10 Years of Service Adjustment for 415(b) Limitations

Current through Register Vol. 48, No. 28, July 12, 2024
The maximum retirement benefits payable to any member who has
				  completed less than 10 years of service shall be the amount determined under
				  Section
				  4445.150
				  multiplied by a fraction, the numerator of which is the number of the member's
				  years of service and the denominator of which is 10. The reduction provided by
				  this Section cannot reduce the maximum benefit below 10%. The reduction
				  provided by this Section shall not be applicable to pre-retirement disability
				  benefits or pre-retirement death benefits.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4445 - IRS QUALIFICATION STATUS REQUIREMENTS FOR ARTICLE 4 FIREFIGHTER PENSION FUNDS › Subpart D - RULE ON 415 LIMITATIONS › Section 4445.210 - $10,000 Limit

Current through Register Vol. 48, No. 28, July 12, 2024
Notwithstanding the foregoing, the retirement benefit payable
				  with respect to a member shall be deemed not to exceed the IRC section 415
				  limit if the benefits payable, with respect to the member under the plan and
				  under all other qualified defined benefit pension plans to which the member's
				  employer contributes, do not exceed $10,000 for the applicable limitation year
				  and for any prior limitation year, and the employer has not at any time
				  maintained a qualified defined contribution plan in which the member
				  participated.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4445 - IRS QUALIFICATION STATUS REQUIREMENTS FOR ARTICLE 4 FIREFIGHTER PENSION FUNDS › Subpart D - RULE ON 415 LIMITATIONS › Section 4445.220 - Effect of COLA without a Lump Sum Component on 415(b) Testing

Current through Register Vol. 48, No. 28, July 12, 2024
Effective on and after January 1, 2003, for purposes of
				  applying the IRC section 415(b) limit to a member with no lump sum benefit, the
				  following will apply:
a) a member's
				applicable 415(b) limit will be applied to the member's annual benefit in the
				member's first limitation year without regard to any automatic cost of living
				adjustments;
b) to the extent that
				the member's annual benefit equals or exceeds the limit, the member will no
				longer be eligible for cost of living increases until the benefit plus the
				accumulated increases are less than the 415(b) limit;
c) in any subsequent limitation year, a
				member's annual benefit, including any automatic cost of living increases,
				shall be tested under the then applicable 415(b) limit including any adjustment
				to the IRC section 415(b)(1)(A) dollar limit under IRC section 415(d), and the
				related Treasury Regulations ( 26 CFR 1.415(b) ).
Illinois Administrative Code › Title 50 - INSURANCE › Part 4445 - IRS QUALIFICATION STATUS REQUIREMENTS FOR ARTICLE 4 FIREFIGHTER PENSION FUNDS › Subpart D - RULE ON 415 LIMITATIONS › Section 4445.230 - Effect of COLA with a Lump Sum Component on 415(b) Testing

Current through Register Vol. 48, No. 28, July 12, 2024
On and after January 1, 2009, with respect to a member who
				  receives a portion of the member's annual benefit in a lump sum, a member's
				  applicable limit will be applied taking into consideration cost of living
				  increases as required by IRC section 415(b) and applicable Treasury Regulations
				  ( 26 CFR 1.415(b) ).
Illinois Administrative Code › Title 50 - INSURANCE › Part 4445 - IRS QUALIFICATION STATUS REQUIREMENTS FOR ARTICLE 4 FIREFIGHTER PENSION FUNDS › Subpart D - RULE ON 415 LIMITATIONS › Section 4445.250 - Service Purchases under IRC Section 415(n)

Current through Register Vol. 48, No. 28, July 12, 2024
a) Effective for permissive service credit
				contributions made in limitation years beginning after December 31, 1997, if a
				member makes one or more contributions to purchase permissive service credit
				under the plan, then the requirements of IRC section 415(n) will be treated as
				met only if:
1) the requirements of IRC
				section 415(b) are met, determined by treating the accrued benefit derived from
				all such contributions as an annual benefit for purposes of IRC section 415(b);
				or
2) the requirements of IRC
				section 415(b) are met, determined by treating all such contributions as annual
				additions for purposes of IRC section 415(c).
Illinois Administrative Code › Title 50 - INSURANCE › Part 4445 - IRS QUALIFICATION STATUS REQUIREMENTS FOR ARTICLE 4 FIREFIGHTER PENSION FUNDS › Subpart D - RULE ON 415 LIMITATIONS › Section 4445.260 - Modification of Contributions for 415(c) and 415(n) Purposes

Current through Register Vol. 48, No. 28, July 12, 2024
Notwithstanding any other provision of law to the contrary, a
				  pension fund may modify a request by a member to make a contribution under this
				  Part if the amount of the contribution would exceed the limits provided in IRC
				  section 415 by using the following methods:
a) If the law requires a lump sum payment for
				the purchase of service credit, a pension fund may establish a periodic payment
				plan for the member to avoid a contribution in excess of the limits under IRC
				section 415(c) or 415(n).
b) If
				payment pursuant to this Section will not avoid a contribution in excess of the
				limits imposed by IRC section 415(c) or 415(n), a pension fund may either
				reduce the member's contribution to an amount within the limits of those IRC
				sections or refuse the member's contribution.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4445 - IRS QUALIFICATION STATUS REQUIREMENTS FOR ARTICLE 4 FIREFIGHTER PENSION FUNDS › Subpart D - RULE ON 415 LIMITATIONS › Section 4445.270 - Repayments of Cashouts

Current through Register Vol. 48, No. 28, July 12, 2024
Any repayment of contributions (including interest) to a
				  pension fund with respect to an amount previously refunded upon a forfeiture of
				  service credit under a pension fund shall not be taken into account for
				  purposes of IRC section 415, in accordance with applicable Treasury Regulations
				  ( 26 CFR 1.415 ).
Illinois Administrative Code › Title 50 - INSURANCE › Part 4445 - IRS QUALIFICATION STATUS REQUIREMENTS FOR ARTICLE 4 FIREFIGHTER PENSION FUNDS › Subpart D - RULE ON 415 LIMITATIONS › Section 4445.280 - Reduction of Benefits Priority

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Reduction of benefits and/or contributions to all plans, when required, shall
				be accomplished by first reducing the member's defined benefit component under
				any defined benefit plans in which the member participated.
b) Except as otherwise provided in subsection
				(c), the reduction shall be made:
1) first,
				with respect to the plan in which the member most recently accrued benefits and
				thereafter in the priority determined by the plan and the plan administrator of
				the other plans; then
2) by
				reducing the member's defined contribution component benefit under any defined
				benefit plans; then
3) by reducing
				or allocating excess forfeitures for defined contribution plans in which the
				member participated, with the reduction to be made first with respect to the
				plan in which the member most recently accrued benefits and thereafter in the
				priority established by the plan and the plan administrator for the other
				plans.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4445 - IRS QUALIFICATION STATUS REQUIREMENTS FOR ARTICLE 4 FIREFIGHTER PENSION FUNDS › Subpart E - RULE ON GENERAL COMPLIANCE › Section 4445.290 - Compliance with Internal Revenue Code

Current through Register Vol. 48, No. 28, July 12, 2024
Each of the plans established under Article 4 of the Pension
				  Code is intended to be a qualified defined benefit plan under IRC sections
				  401(a) and 414(d).
Illinois Administrative Code › Title 50 - INSURANCE › Part 4445 - IRS QUALIFICATION STATUS REQUIREMENTS FOR ARTICLE 4 FIREFIGHTER PENSION FUNDS › Subpart E - RULE ON GENERAL COMPLIANCE › Section 4445.300 - Plan Termination

Current through Register Vol. 48, No. 28, July 12, 2024
Upon plan termination, a member's interest in a pension fund
				  will be nonforfeitable.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4445 - IRS QUALIFICATION STATUS REQUIREMENTS FOR ARTICLE 4 FIREFIGHTER PENSION FUNDS › Subpart E - RULE ON GENERAL COMPLIANCE › Section 4445.310 - Vesting and Forfeitures

Current through Register Vol. 48, No. 28, July 12, 2024
a) A plan
				member shall be 100% vested in his or her accumulated contributions at all
				times.
b) In conformity with IRC
				section 401(a)(8), any forfeitures of benefits by members or former members of
				the plan will not be used to pay benefit increases. However, forfeitures shall
				be used to reduce employer contributions.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4445 - IRS QUALIFICATION STATUS REQUIREMENTS FOR ARTICLE 4 FIREFIGHTER PENSION FUNDS › Subpart E - RULE ON GENERAL COMPLIANCE › Section 4445.320 - HEART Act

Current through Register Vol. 48, No. 28, July 12, 2024
The downstate firefighters' pension funds will operate in
				  compliance with USERRA, as required by Section 1-118 of the Pension Code, and
				  as amended and expanded by the HEART Act.
a) Effective with respect to deaths occurring
				on or after January 1, 2007, while a member is performing qualified military
				service (as defined in USERRA), to the extent required by IRC section
				401(a)(37), survivors of a member in a State or local retirement or pension
				system are entitled to any additional benefits that the system would provide if
				the member had resumed employment and then died, such as accelerated vesting or
				survivor benefits that are contingent on the member's death while employed. In
				any event, a deceased member's period of qualified military service must be
				counted for vesting purposes.
b)
				Beginning January 1, 2009, to the extent required by IRC sections 3401(h) and
				414(u)(12), an individual receiving differential wage payments (while the
				individual is performing qualified military service (as defined in USERRA))
				from an employer shall be treated as employed by that employer, and the
				differential wage payment shall be treated as compensation for purposes of
				applying the limits on annual additions under IRC section 415(c). This
				provision shall be applied to all similarly situated individuals in a
				reasonably equivalent manner.
c)
				Effective with respect to deaths and disabilities occurring on or after January
				1, 2007, while a member is performing qualified military service (as defined in
				USERRA), to the extent permitted by IRC section 414(u)(8), for benefit accrual
				purposes and, in the case of death, for vesting purposes, the member will be
				treated as having earned years of service for the period of qualified military
				service, having returned to employment on the day before the death and/or
				disability, and then having terminated on the date of death or disability. This
				provision applies only if the employer and the employee have made contributions
				equal to those that would have been made had the employee been active during
				the period of coverage. This provision shall be applied to all similarly
				situated individuals with respect to an employer in a reasonably equivalent
				manner.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4450 - MISTAKE IN BENEFIT UNDER ARTICLE 3 AND ARTICLE 4 PENSIONS › Section 4450.10 - Purpose

Current through Register Vol. 48, No. 28, July 12, 2024
This Part prescribes the annual interest rate payable by a
				pension fund when a benefit was mistakenly set too low and the process to be
				followed in rectifying the underpayment of benefits.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4450 - MISTAKE IN BENEFIT UNDER ARTICLE 3 AND ARTICLE 4 PENSIONS › Section 4450.20 - Prescribed Interest Rate

Current through Register Vol. 48, No. 28, July 12, 2024
This prescribed interest rate shall only apply to a benefit
				(and all subsequent benefits) that was mistakenly set too low if the first
				benefit is or was set on or after August 26, 2014. The annual interest rate
				payable by an Article 3 or Article 4 pension fund is prescribed at 1% when a
				lump sum payment is made by a pension fund to the recipient pursuant to
				Sections 3-144.2(b) and 4-138.10(b) of the Illinois Pension Code when a benefit
				was mistakenly set too low.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4450 - MISTAKE IN BENEFIT UNDER ARTICLE 3 AND ARTICLE 4 PENSIONS › Section 4450.30 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
"Illinois Pension Code" or "Code" means 45 ILCS 5.
"Department" means the Illinois Department of Insurance.
"Lump Sum" means the one payment to the recipient by a pension
				fund when a benefit was mistakenly set too low. A lump sum payment shall
				consist of two amounts:
the difference between the mistakenly set too low benefit and
				the correct level benefit for each such benefit payment; and
the application of the prescribed 1% annual interest rate to
				the difference derived under this definition from the date of each mistakenly
				set too low benefit to the date of payment of the lump sum.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4450 - MISTAKE IN BENEFIT UNDER ARTICLE 3 AND ARTICLE 4 PENSIONS › Section 4450.40 - Policy and Notification

Current through Register Vol. 48, No. 28, July 12, 2024
All Article 3 and Article 4 pension funds shall institute and
				maintain policies and procedures to discover and adjust any benefit that is set
				at an incorrect amount. Any pension fund that discovers and adjusts, if
				otherwise allowable by law, any benefit pursuant to this Part, shall notify the
				Public Pension Division of the Department, by mail, of that adjustment of
				benefit within 45 days after making the lump sum payment or adjustment. This
				notice shall contain the lump sum benefit payment amount, the interest portion
				of that amount, the dates and amounts of the incorrect benefits, the adjusted
				and corrected benefit amounts, the nature and description of the mistake, and
				the name of the recipient and pension fund.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4451 - TIE BREAKING WHEN CONDUCTING AND ADMINISTRATING A BOARD OF TRUSTEE ELECTION › Section 4451.10 - Purpose

Current through Register Vol. 48, No. 28, July 12, 2024
This Part prescribes the procedure for breaking a tie vote in
				the ballot selection of a Board of Trustee for the Police Officers' Pension
				Investment Fund (Article 22B of the Code) or the Firefighters' Pension
				Investment Fund (Article 22C of the Code).
Illinois Administrative Code › Title 50 - INSURANCE › Part 4451 - TIE BREAKING WHEN CONDUCTING AND ADMINISTRATING A BOARD OF TRUSTEE ELECTION › Section 4451.20 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
"Box" means a standard sized container in which confidential
				sealed envelopes are maintained.
"Candidate" means a person nominated for election.
"Code" means the Illinois Pension Code [40 ILCS 5].
"Department" means the Illinois Department of Insurance.
"Fund" means the Police Officers' Pension Investment Fund (see
				40 ILCS 5/22B-103) or the
				Firefighters' Pension Investment Fund (see
				40 ILCS 5/22C-103).
"Official Name" means the name as it appears on the written
				election ballot.
"Official Election Ballot" means the ballot used in the trustee
				election process.
"Pension Fund" means a fund that transferred securities, funds,
				assets, and moneys, and responsibility for custody and control of those
				securities, funds, assets, and moneys, to the fund and that was established
				pursuant to Article 3 (downstate police) or Article 4 (downstate firefighters)
				of the Code.
"Sealed Envelope" means a standard 41/8-inch by 91/2-inch
				Department mailing envelope holding a 3 by 5-inch index card with a typed
				official name of one tied candidate.
"Tie" means to have an equal number of votes cast between
				candidates in an election.
"Trustee" means a candidate elected or to be elected by
				eligible voters who voted or by the tie breaking procedure established in this
				Part.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4451 - TIE BREAKING WHEN CONDUCTING AND ADMINISTRATING A BOARD OF TRUSTEE ELECTION › Section 4451.30 - Prescribed Tie Breaker Procedure

Current through Register Vol. 48, No. 28, July 12, 2024
a)
			 The prescribed procedure shall only apply when a tie vote occurs in a fund's
			 Board of Trustee election process. After a review of the election count
			 provided by the fund, the Department will, within 3 business days, set a date,
			 time and place to conduct the tie breaker procedure with the corresponding
			 fund, which shall have a designee present. The fund and the Department shall
			 notify the candidates of a tie and the agreed upon date, time and place for the
			 tie breaker procedure, though the candidates' attendance shall not be required.
			 Candidates' contact information shall be provided by the fund. The agreed upon
			 date shall not exceed 10 business days after the election count. The Department
			 will maintain minutes of, and record, the tie breaker procedure.
b) At the tie breaker procedure, separate and
			 identical sealed envelopes for each tied candidate, with his or her official
			 name on the index card in the envelope, shall be placed in a box. After shaking
			 the box, the Director of the Department, or his or her designee, shall draw one
			 envelope. The tied candidate whose official name appears on the index card
			 within that sealed envelope shall be declared the winner.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4451 - TIE BREAKING WHEN CONDUCTING AND ADMINISTRATING A BOARD OF TRUSTEE ELECTION › Section 4451.40 - Policy and Notification

Current through Register Vol. 48, No. 28, July 12, 2024
The fund shall submit a copy of the official election ballots
				to the Department prior to the election. At the completion of the election
				count, the fund shall notify the Department in writing of the results within 2
				business days. The fund shall notify all Article 3 and Article 4 pension funds
				of the final election counts, including the tie breaker results, within two
				business days after the election count is concluded and after a tie breaker
				procedure is concluded. The notification shall be made by posting the results
				on the fund's official website.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4510 - MANDATORY CHILD ONLY OPEN ENROLLMENT PERIOD FOR INDIVIDUAL MARKET CARRIERS › Section 4510.10 - Scope and Purpose

Current through Register Vol. 48, No. 28, July 12, 2024
The purpose of this Part is to facilitate the implementation of
				certain provisions of the Patient Protection and Affordable Care Act of 2010,
				PL
				111-148, 124 Stat. 119 (2010), and the Health Care
				and Education Reconciliation Act of 2010,
				PL
				111-152, 124 Stat. 1029 (2010), together referred
				to as the "Affordable Care Act" (ACA), and regulations adopted by the U.S.
				Departments of Health and Human Services, Labor and Treasury to implement the
				ACA at 26 CFR 54 and 602, 29 CFR 2590, and 45 CFR 144, 146 and
				147.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4510 - MANDATORY CHILD ONLY OPEN ENROLLMENT PERIOD FOR INDIVIDUAL MARKET CARRIERS › Section 4510.20 - Applicability

Current through Register Vol. 48, No. 28, July 12, 2024
This Part applies to all carriers that issue Child Only
				coverage in the individual health insurance market with an effective date on or
				after September 23, 2010.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4510 - MANDATORY CHILD ONLY OPEN ENROLLMENT PERIOD FOR INDIVIDUAL MARKET CARRIERS › Section 4510.30 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
"Carrier" means an insurer or health maintenance organization
				issuing Child Only Plans.
"Child Only Plan" means renewable individual health insurance
				coverage (as defined in
				42
				USC 300gg-91 ) issued with an effective date
				on or after September 23, 2010 that provides coverage to an individual under
				the age of 19. This shall not include individual health insurance coverage that
				covers children under age 19 as dependents.
"Person" means a person under the age of 19.
"Qualifying Event" means an event described in Section
				5410.40(d)
				 that triggers a special enrollment
				opportunity for a person to enroll in a Child Only Plan.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4510 - MANDATORY CHILD ONLY OPEN ENROLLMENT PERIOD FOR INDIVIDUAL MARKET CARRIERS › Section 4510.40 - Rules

Current through Register Vol. 48, No. 28, July 12, 2024
a) Enrollment
			 Required During Certain Periods
1) Carriers
			 shall accept applications from eligible persons for Child Only Plan coverage
			 during the open enrollment periods outlined in subsections (b), (c) and
			 (d).
2) Carriers shall also accept
			 applications from eligible persons for Child Only Plan coverage during a
			 special enrollment period outlined in subsection (d), if the application is
			 received within 30 days after a qualifying event.
3) Notwithstanding anything in this Part to
			 the contrary, a carrier is not required to accept applications from eligible
			 persons applying for a Child Only Plan during an open enrollment or special
			 enrollment period if those persons have comprehensive major medical coverage
			 available to be purchased by them at the time the Child Only Plan would become
			 effective.
4) Except during an open
			 enrollment period, carriers need not offer coverage to a Child Only applicant
			 who had a Child Only Plan with a carrier during the 12 months prior to the
			 application for Child Only coverage when that coverage was voluntarily
			 terminated.
5) Carriers issuing
			 Child Only Plans are not precluded from applying non-health related eligibility
			 rules to persons applying for that coverage; however, carriers must uniformly
			 apply those rules to all persons applying for a Child Only Plan.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4510 - MANDATORY CHILD ONLY OPEN ENROLLMENT PERIOD FOR INDIVIDUAL MARKET CARRIERS › Section 4510.50 - Enforcement

Current through Register Vol. 48, No. 28, July 12, 2024
Pursuant to Article XXIV of the Illinois Insurance Code [ 215
				ILCS 5 /Art. XXIV], noncompliance with this Part may result, after proper
				notice and hearing, in the imposition of any of the sanctions made available in
				the Illinois statutes pertaining to the business of insurance or other laws,
				which include the imposition of fines, refund of excess premiums plus interest,
				restitution, issuance of cease and desist orders, and/or suspension or
				revocation of license or certificate of authority.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4515 - NAVIGATOR, IN-PERSON COUNSELOR AND CERTIFIED APPLICATION COUNSELOR CERTIFICATION › Section 4515.10 - Purpose

Current through Register Vol. 48, No. 28, July 12, 2024
The purpose of this Part is to establish certification criteria
				for Navigator, In-Person Counselor or Certified Application Counselor
				certification; establish pre-certification education requirements for
				applicants for Navigators, In-Person Counselors or Certified Application
				Counselors certification; and establish continuing education requirements for
				Navigators, In-Person Counselors or Certified Application Counselors.
				Additionally, this Part establishes disqualification and non-compliance penalty
				provisions and disqualifying offense review standards for Navigators, In-Person
				Counselors or Certified Application Counselors regardless of
				residency.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4515 - NAVIGATOR, IN-PERSON COUNSELOR AND CERTIFIED APPLICATION COUNSELOR CERTIFICATION › Section 4515.30 - Certification Required

Current through Register Vol. 48, No. 28, July 12, 2024
a) No
			 individual or entity shall act as, offer to act as, or advertise any service as
			 a Navigator, In-Person Counselor, Certified Application Counselor or Certified
			 Application Counselor Organization in this State unless the individual or
			 entity is certified by the Department pursuant to this Part.
b) The Director shall determine the length,
			 no less than 12 months, of the effectiveness of any certification issued
			 pursuant to this Part.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4515 - NAVIGATOR, IN-PERSON COUNSELOR AND CERTIFIED APPLICATION COUNSELOR CERTIFICATION › Section 4515.40 - Exemption from Certification

Current through Register Vol. 48, No. 28, July 12, 2024
a)
			 Government employees and their agents performing activities related to the
			 Marketplace are exempt from certification. Those individuals and entities may
			 not engage in Navigator, In-Person Counselor and Certified Application
			 Counselor prohibited conduct.
b)
			 The distribution of educational and informational materials relating to the
			 Marketplace authored or provided by a governmental authority is exempt from
			 certification.
c) The collection
			 from the public of requests for information or assistance relating to the
			 Marketplace in a manner approved by a governmental authority or a certified
			 Navigator, In-Person Counselor, Certified Application Counselor or Certified
			 Application Counselor Organization is exempt from certification.
d) The referral of inquiries from the public
			 relating to the Marketplace to an appropriate governmental authority or
			 certified Navigator, In-Person Counselor, Certified Application Counselor or
			 Certified Application Counselor Organization is exempt from
			 certification.
e) The exercise in
			 good faith by journalists and persons other than a certified Navigator,
			 In-Person Counselor or Certified Application Counselor of such person's U.S.
			 and Illinois constitutional right to speak, write and publish freely with
			 regard to the Marketplace is exempt from certification. The rights of a
			 certified Navigator, In-Person Counselor or Certified Application Counselor to
			 engage in Navigator, In-Person Counselor and Certified Application Counselor
			 prohibited conduct are expressly restricted.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4515 - NAVIGATOR, IN-PERSON COUNSELOR AND CERTIFIED APPLICATION COUNSELOR CERTIFICATION › Section 4515.50 - Application for Certification

Current through Register Vol. 48, No. 28, July 12, 2024
a) An
			 individual applying for a Navigator, In-Person Counselor or Certified
			 Application Counselor certification shall make application to the Department on
			 a form developed or accepted by the Director and declare under penalty of
			 refusal, suspension, or revocation of the certification that the statements
			 made in the application are true, correct, and complete to the best of the
			 individual's knowledge and belief. Before approving the application, the
			 Director shall find that the individual:
1)
			 Is at least 18 years of age;
2)
			 Maintains his or her principal place of business in the State;
3) Is not disqualified for having committed
			 any act that would be a ground for denial, suspension, or revocation of a
			 certification;
4) Has not had an
			 insurance producer license, Navigator certification, In-Person Counselor
			 certification, or Certified Application Counselor certification, or equivalent
			 license or certification denied, suspended, or revoked in any state, province,
			 district, or territory or by the United States Department of Health and Human
			 Services;
5) Has successfully
			 passed the applicable federal training program for Navigators, In-Person
			 Counselors or Certified Application Counselors;
6) Unless otherwise determined by the
			 Director, other than an applicant for Certified Application Counselor
			 certification, has submitted a full set of fingerprints to the Department and
			 successfully completed a criminal background check in a manner prescribed by
			 the Director. The Director may accept an equivalent criminal background check
			 performed by the Navigator entity, In-Person Counselor entity or Certified
			 Application Counselor Organization;
7) When applicable, has the written consent
			 of the Director pursuant to
			 18
			 USC 1033 or any successor statute regulating
			 crimes by or affecting persons engaged in the business of insurance whose
			 activities affect interstate commerce;
8) Possesses the requisite character and
			 integrity; and
9) Has identified
			 the entity with which the individual is affiliated and supervised, if
			 any.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4515 - NAVIGATOR, IN-PERSON COUNSELOR AND CERTIFIED APPLICATION COUNSELOR CERTIFICATION › Section 4515.60 - Certification Renewal

Current through Register Vol. 48, No. 28, July 12, 2024
a) A Navigator,
			 In-Person Counselor, Certified Application Counselor and Certified Application
			 Counselor Organization certification shall be valid for one year. A Navigator,
			 In-Person Counselor, Certified Application Counselor and Certified Application
			 Counselor Organization certification shall expire 12 months after
			 certification.
b) Thirty days prior
			 to the end of the 12 month period, a Navigator, In-Person Counselor, Certified
			 Application Counselor or Certified Application Counselor Organization may file
			 an application for renewal on the application prescribed by the
			 Director.
c) Prior to the filing
			 date for application for renewal of a certification, an individual Navigator,
			 In-Person Counselor and Certified Application Counselor shall complete the
			 applicable federal training course curriculum for recertification as provided
			 in Section
			 4515.100(b).
			 The individual, at the time of application, shall file with the Director, by a
			 method prescribed by the Director, proof of passing the applicable federal
			 training course curriculum. Any failure to fulfill the ongoing continuing
			 education requirements shall result in the expiration of the certification.
			 Individual Navigators, In-Person Counselors or Certified Application Counselors
			 whose certification has expired for failing to complete the continuing
			 education requirements may not apply for a certification until they have
			 provided satisfactory proof to the Director that they have completed the
			 required continuing education requirements and have filed an application for
			 certification.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4515 - NAVIGATOR, IN-PERSON COUNSELOR AND CERTIFIED APPLICATION COUNSELOR CERTIFICATION › Section 4515.70 - Navigator, In-Person Counselor and Certified Application Counselor Prohibited Conduct

Current through Register Vol. 48, No. 28, July 12, 2024
a) A Navigator,
			 In-Person Counselor, Certified Application Counselor and Certified Application
			 Counselor Organization may not:
1) sell,
			 solicit, or negotiate, as these terms are defined in Section 500-10 of the
			 Illinois Insurance Code, any of the classes of insurance enumerated in Section
			 4 of the Illinois Insurance Code;
2) offer advice about which health plan is
			 better or worse for a particular individual or employer;
3) recommend or endorse a particular health
			 plan or advise consumers about which health plan to choose;
4) provide any information or services
			 related to health benefit plans or other insurance products not offered in the
			 exchange, except for health care providers when furnishing information or
			 services related to a patient's existing health benefit plan or other existing
			 health insurance coverage;
5)
			 accept any compensation or consideration, directly or indirectly, from any
			 issuer of accident and health insurance or stop-loss insurance that is
			 dependent, in whole or in part, on whether a person enrolls in or purchases a
			 particular private health benefit plan; or
6) engage in any unfair method of competition
			 or any fraudulent, deceptive or dishonest act or practice with respect to the
			 Marketplace or with respect to that individual's or entity's absence of a
			 conflict of interest in connection with the enrollment of any individuals or
			 employees in a particular private health benefit plan.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4515 - NAVIGATOR, IN-PERSON COUNSELOR AND CERTIFIED APPLICATION COUNSELOR CERTIFICATION › Section 4515.80 - Reporting to the Director

Current through Register Vol. 48, No. 28, July 12, 2024
a) Each
			 certified Navigator, In-Person Counselor, Certified Application Counselor and
			 Certified Application Counselor Organization shall report to the Director any
			 administrative action taken by a governmental agency against that person in
			 this State or in any other jurisdiction within 30 calendar days after the final
			 disposition of the matter. This report shall include a copy of the order,
			 consent order, or other relevant legal documents.
b) Each certified Navigator, In-Person
			 Counselor, Certified Application Counselor and Certified Application Counselor
			 Organization shall immediately report to the Director any criminal prosecution
			 of that person taken in any jurisdiction. The report shall include a copy of
			 the initial complaint filed, the order resulting from the hearing, and any
			 other relevant legal documents. Failure to report within 30 days following the
			 hearing date shall be considered a violation of this Section.
c) An entity certified under this Part as a
			 Navigator, In-Person Counselor or Certified Application Counselor Organization
			 that terminates the employment, engagement, affiliation, or other relationship
			 with an individual Navigator, In-Person Counselor or Certified Application
			 Counselor shall notify the Director within 30 days following the effective date
			 of the termination, using a format prescribed by the Director, if the reason
			 for termination is one of the reasons set forth in Section
			 3125.70
			 or
			 3125.120,
			 or the entity has knowledge the navigator or certified application counselor
			 was found by a court or government body to have engaged in any of the
			 activities in Section
			 3125.70
			 or 3125.120. Upon the written request of the Director, the entity shall provide
			 additional information, documents, records, or other data pertaining to the
			 termination or activity of the individual.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4515 - NAVIGATOR, IN-PERSON COUNSELOR AND CERTIFIED APPLICATION COUNSELOR CERTIFICATION › Section 4515.100 - Responsibilities of the Applicant for the Navigator, In-Person Counselor or Certified Application Counselor Certification

Current through Register Vol. 48, No. 28, July 12, 2024
a) Prior to receiving approval for a
			 Navigator, In-Person Counselor or Certified Application Counselor
			 certification, the applicant must complete approved federal training courses
			 prescribed by the Director. Initial courses for Navigators, In-Person
			 Counselors and Certified Application Counselors will be provided online. An
			 applicant for a Navigator, In-Person Counselor or Certified Application
			 Counselor must complete the Director prescribed federal training courses within
			 12 months prior to certification.
b) Certified Navigator, In-Person Counselor
			 or Certified Application Counselor
1) Each
			 Navigator or In-Person Counselor shall complete 2 approved federal training
			 courses prescribed by the Director to satisfy continuing education requirements
			 prior to requesting a renewal of a certification. The training courses will be
			 provided online.
2) Each Certified
			 Application Counselor shall complete the same approved federal training courses
			 that are prescribed by the Director as initial courses to satisfy continuing
			 education requirements prior to requesting a renewal of a certification. The
			 training courses will be provided online.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4515 - NAVIGATOR, IN-PERSON COUNSELOR AND CERTIFIED APPLICATION COUNSELOR CERTIFICATION › Section 4515.120 - Certification Denial, Nonrenewal or Revocation

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Director may place on probation,
			 suspend, revoke, or refuse to issue or renew a Navigator, In-Person Counselor
			 or Certified Application Counselor's certificate or may levy a civil penalty in
			 accordance with this Section or take any combination of actions, for any one or
			 more of the following causes:
1) Providing
			 incorrect, misleading, incomplete, or materially untrue information in the
			 certificate application;
2)
			 Violating any insurance laws, or violating any rule, subpoena, or order of the
			 Director or of another state's insurance Director;
3) Obtaining or attempting to obtain a
			 certificate through misrepresentation or fraud;
4) Obtaining or attempting to obtain any
			 monies or properties from Illinois consumers while conducting navigator
			 business;
5) Intentionally
			 misrepresenting the terms of an actual or proposed insurance
			 contract;
6) Having been convicted
			 of a felony;
7) Having admitted or
			 been found to have committed any insurance unfair trade practice or
			 fraud;
8) Using fraudulent,
			 coercive, or dishonest practices, or demonstrating incompetence,
			 untrustworthiness or financial irresponsibility in the conduct of business in
			 this State or elsewhere;
9) Having
			 a Navigator, In-Person Counselor or Certified Application Counselor
			 certificate, or its equivalent, denied, suspended, or revoked in any other
			 state, province, district or territory;
10) Forging a name to an application for
			 insurance or to a document related to an insurance transaction;
11) Failing to comply with an administrative
			 or court order imposing a child support obligation;
12) Failing to pay Illinois state income tax
			 or penalty or interest or comply with any administrative or court order
			 directing payment of Illinois state income tax or failing to file a return or
			 to pay any final assessment of any tax due to the Illinois Department of
			 Revenue; or
13) Failing to make
			 satisfactory repayment to the Illinois Student Assistance Commission for a
			 delinquent or defaulted student loan.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4515 - NAVIGATOR, IN-PERSON COUNSELOR AND CERTIFIED APPLICATION COUNSELOR CERTIFICATION › Section 4515.130 - Regulatory Examinations

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
			 Director may examine any applicant for or holder of a Navigator, In-person
			 Counselor or Certified Application Counselor certificate or Navigator or
			 In-Person Counselor entity certificate.
b) All Navigators, In-Person Counselors or
			 Certified Application Counselors being examined must provide to the Director
			 convenient and free access, at all reasonable hours, at their offices, and/or
			 comply with any requests, to all books, records, documents and other papers
			 relating to the persons' navigator business affairs. The Navigator, In-Person
			 Counselor or Certified Application Counselor and employees must facilitate and
			 aid the Director in the examinations, as much as it is in their power to do
			 so.
c) The Director may designate
			 an examiner or examiners to conduct any examination under this Section. The
			 Director or his or her designee may administer oaths and examine under oath any
			 individual relative to the business of the person being examined.
d) The examiners designated by the Director
			 under this Section may make reports to the Director. A report alleging
			 substantive violations of Illinois insurance laws, this Part or any rules
			 prescribed by the Director must be in writing and be based upon facts
			 ascertained from the books, records, documents, papers, and other evidence
			 obtained by the examiners or from sworn or affirmed testimony of or written
			 affidavits from the Navigator, In-Person Counselor or Certified Application
			 Counselor employees or other individuals, as given to the examiners. The report
			 of an examination must be verified by the examiners.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4520 - MANAGED CARE REFORM & PATIENT RIGHTS › Section 4520.10 - Purpose

Current through Register Vol. 48, No. 28, July 12, 2024
This Part will implement the Managed Care Reform and Patient
				Rights Act [ 215 ILCS 134 ] in order to assure: the proper provision of
				information to enrollees by health care plans; the proper treatment of
				enrollees by health care plans; the proper treatment of health care providers
				by health care plans; and the proper oversight of health care plans by the
				Department of Insurance.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4520 - MANAGED CARE REFORM & PATIENT RIGHTS › Section 4520.20 - Applicability and Scope

Current through Register Vol. 48, No. 28, July 12, 2024
The requirements of this Part are applicable to:
a) Policies and contracts amended, delivered,
			 issued, or renewed by health care plans pursuant to the Act; and
b) The program of health benefits under the
			 State Employees Group Insurance Act, with the exception of the fee for service
			 program which only needs to comply with Section 85 and the definition of
			 "emergency medical condition" contained in Section 10 of the Act; the Counties
			 Code; the Illinois Municipal Code; the Comprehensive Health Insurance Plan Act;
			 the Health Maintenance Organization Act; the Limited Health Service
			 Organization Act, except for plans offering only dental services, or only
			 vision services; the Voluntary Health Services Plans Act; and the medical
			 assistance program and other programs administered by the Department of Public
			 Aid under the Illinois Public Aid Code, except that complaints shall be handled
			 consistent with the requirements of Section
			 5420.80(a)
			 of this Part; and
c) Third party
			 administrators, as defined in Article XXXI1/4 of the Code, and entities
			 regulated under Article XX1/2 of the Code, generally referred to as Preferred
			 Provider Organizations (PPOs) must comply with the requirements of Section
			 5420.90
			 and Exhibit C of this Part pursuant to Section 55 of the Act; and
d) Any person who conducts a utilization
			 review program in this State, except that the provisions of Section 85 of the
			 Act are not applicable to bodily injury liability claims (including uninsured
			 motorist and underinsured motorist coverage claims) arising under property and
			 casualty contracts issued under Class 2 and Class 3 of Section 4 of the Code [
			 215 ILCS 5/4
			 ] and does not include the retrospective review of a claim that is limited to
			 an evaluation of reimbursement levels, veracity of documentation, accuracy of
			 coding or adjudication for payment. Section 85 is also specifically applicable
			 to third party administrators, PPOs and insurance companies that transact the
			 kinds of insurance authorized under Class 1(b) or Class 2(a) of Section 4 of
			 the Code. For purposes of this Part, an entity shall be considered to be
			 conducting a utilization review program in this State if it evaluates the use
			 of health care services, procedures, and facilities by persons who are either
			 covered under contracts of insurance entered into in this State, or enrolled in
			 an entity licensed pursuant to the Health Maintenance Organization Act, the
			 Limited Health Service Organization Act or the Voluntary Health Services Plans
			 Act; and
e) Preferred provider
			 administrators, as defined in Section 370g(g) of the Code, and insurance
			 companies that transact the kinds of insurance authorized under Class 1(b) or
			 Class 2(a) of Section 4 of the Code must also comply with the definition of the
			 term emergency medical condition, as defined in Section 10 of the
			 Act.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4520 - MANAGED CARE REFORM & PATIENT RIGHTS › Section 4520.40 - Provision of Information

Current through Register Vol. 48, No. 28, July 12, 2024
Description of Coverage
A written summary of benefits and coverage (SBC) in accordance
				with 50 Ill. Adm. Code
				2001.10,
				must be provided to the enrollee by the health care plan.
Illinois Administrative Code › Title 50 - INSURANCE › Part 4520 - MANAGED CARE REFORM & PATIENT RIGHTS › Section 4520.50 - Notice of Nonrenewal or Termination

Current through Register Vol. 48, No. 28, July 12, 2024
a) All provider agreements shall provide for
			 at least 60 days notice by the provider for termination with cause, as defined
			 in the provider agreement, and at least 90 days notice by the provider for
			 termination without cause. Upon receipt of the notice, the health care plan
			 shall notify enrollees within 30 days after the termination and the proper
			 steps to be taken for selecting a new health care provider. In the event the
			 provider violates the provider agreement and does not give a notice of
			 termination in the appropriate timeframe, the health care plan must provide
			 immediate notice to the enrollees. The health care plan must inform the
			 Department immediately of any known or intended termination, with or without
			 cause, of an MCO.
b) A health care
			 plan must give at least 60 days notice of nonrenewal or termination of a health
			 care provider to the health care provider and to the enrollees served by the
			 health care provider. The notice shall include a name and address to which an
			 enrollee or health care provider may direct comments and concerns regarding the
			 nonrenewal or termination. Immediate written notice may be provided without 60
			 days notice when a health care provider's license has been disciplined by a
			 State licensing board. The notice shall inform the enrollee of the availability
			 of transitional services and that the enrollee must request transitional
			 services within 30 days from receipt of this notice.