Effective 1/01/08

Group Accident/Health

H15G

Large and Small group Accident/Health Policies (POS products must be filed with an HMO base. The Accident/Health portion may only be the out-of-network benefits.)

H15G.001
H15G.002
H15G.003
H16G.001C
H16G.002C
H16G.003C

Uniform Transmittal Document (Etrans)

Form filings must now be submitted either by SERFF or CD-ROM. Please visit the Division's web site for the Universal Transmittal Document (Etrans) by clicking this link.
Scroll down to "Universal Transmittal Document Software (Etrans)"

215 ILCS 5/352(c)

50 IL Adm. Code 2021.40

Each filing must include a completed Review Requirements Checklist that must contain a completed “Location of Standard in Filing” column for each required element of the filing. Please indicate the proper page # and form # for each entry. The checklists may be found at this link.

50 IL Adm. Code 1405.20 (e)
50 IL Adm. Code 2001.30 (a) (3)

In addition to referencing any previously approved form number(s) as required by 50 IL Adm. Code 1405.20(e), those references must also include the filing number and SERFF tracking number (if applicable and available) for the referenced forms.

Periodic payments must be made within 60 days of insured's selection of a provider or effective date of selection, whichever is later. In case of retrospective enrollment only 30 days after notice by employer to insurer. Subsequent payments must be in monthly periodic cycle. Penalty payment of 9% per year.

Payments other than periodic must be made within 30 days after receipt of due proof of loss. Same penalty provisions.

215 ILCS 5/367(11a &b)

50 IL Adm Code 2009

215 ILCS 5/367i

50 IL Adm Code 2013

Coverage of screening by low-dose mammography for all women over 35;

Coverage requires baseline mammogram for women 35-39 and annual mammogram for women 40 years of age and older.

For women under 40 with a family history of breast cancer or other risk factors mammograms must be provided at an age and intervals considered medically necessary.

Coverage includes a comprehensive ultrasound screening of an entire breast or breasts when a mammogram demonstrates medical necessity as described

Clinical breast examinations must be covered:

(1) at a minimum every three years for women over 20 years of age but less than 40; and,
(2) annually for women 40 years of age and older.

215 ILCS 5/356g(b)

215 ILCS 5/367(12)

50 IL Adm Code 2016

215 ILCS 5/370c

215 ILCS 5/370c(b)(1)-(8)

Bulletin 99-6

The coverage must meet the minimum requirements of the Mental Health Parity Act. Please see Division Bulletin 99-6
Benefits for mental/nervous may not be combined with benefits for alcohol and substance abuse.

The benefit for serious mental illness, based on medical necessity, in addition to requiring 45 days of inpatient treatment also requires 60 outpatient visits and an additional 20 outpatient visits for speech therapy for the treatment of pervasive developmental disorders.

Benefits for serious mental illness are not applicable for small group.

Coverage must include annual cervical smear or Pap smear test for female insureds,including surveillance tests for ovarian cancer for female insureds who are at risk for ovarian cancer; and,

Annual digital rectal examination and prostate-specific antigen test for males upon recommendation of physician. Must include asymptomatic men age 50 and over; African-American men age 40 and over; and men age 40 and over with family history of prostate cancer.

a.) A group health plan;

b.) Health insurance coverage;

) Part A or part B of title XVIII of the Social Security Act;

d.) Title XIX of the Social Security Act other than coverage consisting solely of benefits under Section 1928;

e.) Chapter 55 of title 10 of the United States Code;

f.) A medical care program of the Indian Health Service or of a tribal organization;

g.) A state health benefits risk pool;

h.) A health plan offered under chapter 89 of title 5, United States Code;

i.) A public health plan (as defined in regulations);

j.) A health benefit plan under Section 5(e) of the Peace Corps Act;

k.) Title XXI of the federal Social Security Act, a State Children's Health Insurance Program.

215 ILCS 5/143(1)

50 IL Adm. Code 2001.3

815 ILCS 505 2QQ HB 4712

215 ILCS 138/15

The focus of HB 4712 is on any card required for an individual to access products or services, while SB 2545 is more limited in that it just focuses on insurance cards.

HB 4712 prevents a person from:

· Publicly posting or displaying an individual's SSN;

· Printing an individual's SSN on any card required for the individual to access products or services, however, an entity providing an insurance card must print on the card a unique identification number as required by 215 ILCS 138/15.

· Being required to transmit an SSN over the Internet to access a web site unless the connection is secure or the SSN is encrypted;

· Requiring the individual to use his/her SSN to access a web site unless a PIN number or other authentication device is also used; and,

· Printing an individual's SSN on any materials mailed to an individual unless required by state or federal law.

Insurers are required to comply with both provisions.

215 ILCS 5/143(1)

50 IL Adm Code 2001.20 h) 2)