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=
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| Public Act =
095-0436 | ||
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AN ACT =
concerning=20
regulation. | ||
Be it =
enacted=20
by the People of the State of Illinois, | ||
represented in the General Assembly:=20
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Section =
5.=20
The Illinois Insurance Code is amended by =
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changing Section 363 as follows:=20
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(215 ILCS =
5/363) (from Ch. 73, par.=20
975) | ||
Sec. 363. =
Medicare supplement policies; minimum standards.=20
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(1) =
Except as=20
otherwise specifically provided therein, | ||
this Section and Section 363a of this Code =
shall apply=20
to: | ||
contracts delivered or =
issued=20
for delivery in this State on | ||
and after January 1, =
1989; and=20
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supplement policies or =
subscriber contracts, which | ||
certificates are =
issued or=20
issued for delivery in this | ||
State on and after =
January 1,=20
1989. | ||
This =
Section=20
shall not apply to "Accident Only" or | ||
"Specified Disease" types of policies. The =
provisions=20
of this | ||
Section are not intended to prohibit or apply =
to=20
policies or | ||
health care benefit plans, including group =
conversion=20
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policies, provided to Medicare eligible =
persons, which=20
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policies or plans are not marketed or =
purported or=20
held to be | ||
Medicare supplement policies or benefit plans. =
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(2) For =
the=20
purposes of this Section and Section 363a, the |
following terms have the following meanings:=20
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issued for delivery in =
this=20
State under a group Medicare |
supplement policy.=20
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policy of accident and =
health=20
insurance, as defined in |
paragraph (a) of =
subsection=20
(2) of Section 355a of this |
Code, or a group =
policy or=20
certificate delivered or issued |
for delivery in this =
State by=20
an insurer, fraternal benefit |
society, voluntary =
health=20
service plan, or health |
maintenance =
organization,=20
other than a policy issued |
pursuant to a contract =
under=20
Section 1876 of the federal |
Social Security Act =
(42 U.S.C.=20
Section 1395 et seq.) or a |
policy issued under a=20
demonstration project specified in 42 |
U.S.C. Section =
1395ss(g)(1),=20
or any similar organization, |
that is advertised, =
marketed,=20
or designed primarily as a |
supplement to =
reimbursements=20
under Medicare for the |
hospital, medical, or =
surgical=20
expenses of persons |
eligible for Medicare. =
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benefit societies, =
voluntary=20
health service plans, health |
maintenance =
organizations, or=20
any other entity providing |
Medicare supplement =
insurance,=20
unless the context clearly |
indicates otherwise.=20
|
Act, Title XVIII of =
the Social=20
Security Amendments of 1965. |
(3) No =
Medicare=20
supplement insurance policy, contract, or |
certificate, that provides benefits that =
duplicate=20
benefits |
provided by Medicare, shall be issued or =
issued for=20
delivery in |
this State after December 31, 1988. No such =
policy,=20
contract, |
or certificate shall provide lesser benefits =
than=20
those |
required under this Section or the existing =
Medicare=20
Supplement |
Minimum Standards Regulation, except where =
duplication=20
of |
Medicare benefits would result.=20
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(4) =
Medicare=20
supplement policies or certificates shall |
have a notice prominently printed on the first =
page of=20
the |
policy or attached thereto stating in =
substance that=20
the |
policyholder or certificate holder shall have =
the=20
right to |
return the policy or certificate within 30 =
days of its=20
delivery |
and to have the premium refunded directly to =
him or=20
her in a |
timely manner if, after examination of the =
policy or=20
|
certificate, the insured person is not =
satisfied for=20
any |
reason. |
(5) A =
Medicare=20
supplement policy or certificate may not |
deny a claim for losses incurred more than 6 =
months=20
from the |
effective date of coverage for a preexisting=20
condition. The |
policy may not define a preexisting condition =
more=20
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restrictively than a condition for which =
medical=20
advice was |
given or treatment was recommended by or =
received from=20
a |
physician within 6 months before the effective =
date of=20
|
coverage. |
(6) An =
issuer=20
of a Medicare supplement policy shall: =
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age who meets any =
of the=20
following criteria: |
day =
on which the person enrolls for benefits under =
|
the =
insurer goes out of business, withdraws from the =
|
reason of =
disability each=20
type of Medicare supplement |
policy the issuer =
makes=20
available to persons eligible for |
Medicare by reason =
of=20
age; |
Medicare by reason =
of=20
disability and who are under the age |
of 65 premium rates =
for any=20
medical supplemental insurance |
benefit plan =
offered by the=20
issuer that exceed the issuer's |
highest rate on the =
current=20
rate schedule filed with the |
Division of =
Insurance for=20
that plan to individuals who are |
age 65 or older;=20
and |
(d), for 6 months =
after the=20
effective date of this |
amendatory Act of =
the 95th=20
General Assembly, to any person =
|
who had enrolled =
for=20
benefits under Medicare Part B prior |
to this amendatory =
Act of=20
the 95th General Assembly who |
otherwise would =
have been=20
eligible for coverage under item |
(a).=20
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regulations for the following purposes:=20
|
provisions of Medicare =
policies and certificates. The |
standards shall be in=20
accordance with the requirements of |
this Code. No =
requirement of=20
this Code relating to minimum |
required policy =
benefits,=20
other than the minimum standards |
contained in this =
Section and=20
Section 363a, shall apply to |
medicare supplement =
policies=20
and certificates. The |
standards may cover, =
but are=20
not limited to the following: |
comply =
with subsection (7) of Section 363a.=20
|
policy =
or certificate. |
claims payments, =
marketing=20
practices, compensation |
arrangements, and =
reporting=20
practices for Medicare |
supplement policies.=20
|
supplement insurance =
benefits=20
and premiums of Medicare |
supplement policies =
and=20
certificates to conform to |
Medicare program =
revisions.=20
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(Source: P.A. 88-313; 89-484, eff.=20
6-21-96.) =
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