Contact Person: Illinois Division of Insurance 320 West Washington Street
Cindy Colonius Review Requirements Checklist Springfield, IL 62767-0001
217-782-4572    
Cindy.Colonius@Illinois.gov

Effective 1/01/08

Line(s) of   Line(s) of  
Business   Insurance  

Group Disability Income

  

Group Disability Income Policies

  
Click here for interactive version of this document to be down loaded and submitted with this filing

Word Document - Alteration of this document will result in rejection of the filing
Illinois Insurance Code Link Illinois Compiled Statutes Online
Illinois Administrative Code Link Administrative Regulations Online
Product Coding Matrix Product Coding Matrix
REVIEW REQUIREMENTS REFERENCE

DESCRIPTION OF REVIEW

STANDARDS REQUIREMENTS

 LOCATION OF STANDARD IN FILING
    NOTE: These brief summaries do not include all requirements of all laws, regulations, bulletins, or requirements, so review actual law, regulation, bulletin, or requirement for details to ensure that forms are fully compliant before filing with the Department of Insurance.  
FORM FILING REQUIREMENTS  REFERENCE DESCRIPTION OF REVIEW STANDARDS REQUIREMENTS LOCATION OF STANDARD IN FILING
Uniform Transmittal Document (Etrans) 50 IL Adm Code 916 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)"		  
Form Filing Requirements for Certificates intended for out-of-state use.

215 ILCS 5/352(c)

50 IL Adm. Code 2021.40

 Policies sitused in Illinois, but intended for insureds who neither work in nor reside in Illinois, must be filed on an informational basis to claim exemption from Illinois mandates and other required provisions.
Insurers not specifically filing under the exemption provided by 215 ILCS 5/352(c) must submit such filings for approval. 		 
Review Requirements Checklist Go to Review Requirements Checklists on DOI web site. See next column

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.

 
Cover Letter and Letter of Submission

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

50 IL Adm. Code 916.40 (b)

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.

Letters of submission must generally describe the intent and use of the form being filed and, if applicable, how it will be used with any previously approved form(s).		  
GENERAL REQUIREMENTS FOR ALL FILINGS REFERENCE DESCRIPTION OF REVIEW STANDARDS REQUIREMENTS   
Entire Contract 215 ILCS 5/367(2)(a) The policy, including the application and any amendments and riders, constitutes the entire contract of insurance and no change is valid unless approved by an executive officer of the company and unless such approval be endorsed hereon or attached hereto.  
Time Limit on Certain Defenses 215 ILCS 5/357.3
215 ILCS 5/367(2)		 A policy is incontestable two years from the date of issue except for fraudulent misstatements made by the applicant on the application.  
Discontinuance and replacement of coverage 215 ILCS 5/367i
50 IL Adm Code 2013		 A policy shall provide a reasonable extension of benefits (up to 12 months) in the event of total disability on the date the policy is discontinued. In case of discontinuance the prior plan shall be liable only to the extent of its accrued liabilities and extension of benefits.  
No Reduction for SSN cost-of-living increase 215 ILCS 5/355.1 There shall be no reduction in benefits by reason of any cost-of-living increase designated as such under the Federal Social Security Act.  
ADMINISTRATIVE CODE PROVISIONS      
Pre-existing Conditions 50 IL Adm. Code 2005 The definition must indicate that a preexisting condition be diagnosed or treated by a physician up to 24 months prior to the effective date or produced symptoms within 12 months. The preexisting condition may be excluded for up to 24 months.  
Exclusions not permitted 50 IL Adm. Code 2603.30(a)
215 ILCS 5/143(1)		 Insurers may not exclude hyperemisis gravidarum or pre-eclampsia or eclampsia as a complication of pregnancy. They may also not limit, reduce or exclude liability for loss resulting from purely accidental circumstances such as involuntary or unintentional ingestion or inhalation of poison, poisonous gases or fumes.  
Discrimination 50 IL. Adm. Code 2603 Provides guidelines on unfair discrimination based on sex, sexual preference or marital status.  
GENERAL INFORMATION      
Discretionary Authority

215 ILCS 5/143(1)

50 IL Adm. Code 2001.3

 Insurers are not permitted to place discretionary authority language in contracts of accident and health.  
Right of Reimbursement and Subrogation 50 IL Adm Code 2020 Provides guidelines for reimbursement and subrogation rights due to negligence of a third party.  
HIV/AIDS Questions on Application 215 ILCS 5/143(1)
Questions designed to elicit information regarding AIDS, ARC and HIV must be specifically related to the testing, diagnosis or treatment done by a physician or an appropriately licensed clinical professional acting within the scope of his/her license.
  
Use of SSN on ID Cards

815 ILCS 505 2QQ

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.

 
Cancer Clinical Trials 215 ILCS 5/364.01 Insurers may not cancel or nonrenew any individual's coverage due to participation in a qualified cancer clinical trial. Guidelines are provided.