Illinois Compiled Statutes 215 ILCS 125 Health Maintenance Organization Act. Section 6-5

    (215 ILCS 125/6-5) (from Ch. 111 1/2, par. 1418.5)

    Sec. 6-5. Definitions. As used in this Act:

    (1) "Association" means the Illinois Health Maintenance Organization Guaranty Association created under Section 6-6.

    (2) "Director" means the Director of Insurance of this State.

    (3) "Contractual obligation" means any obligation of the member organization under covered health care plan certificates.

    (4) "Covered person" means any enrollee who is entitled to the protection of the Association as described in Section 6-2.

    (5) "Covered health care plan certificate" means any health care plan certificate, contract or other evidence of coverage within the scope of this Article under Section 6-3.

    (6) "Fund" means the fund created under Section 6-6.

    (7) "Impaired organization" means a member organization deemed by the Director after the effective date of this Article to be potentially unable to fulfill its contractual obligations and not an insolvent organization.

    (8) "Insolvent organization" means a member organization which becomes insolvent and is placed under a final order of liquidation or rehabilitation by a court of competent jurisdiction.

    (9) "Member organization" means any person licensed or who holds a certificate of authority to transact in this State any kind of business to which this Article applies under Section 6-3. For purposes of this Article "member organization" includes any person whose certificate of authority may have been suspended pursuant to Section 5-5 of this Act.

    (10) "Premiums" means direct gross premiums or subscriptions received on covered health care plan certificates. "Premiums" does not include amounts or considerations received for policies, contracts, or certificates or for the portions of policies, contracts, or certificates for which coverage is not provided.

    (11) "Person" means any individual, corporation, partnership, association or voluntary organization.

    (12) "Resident" means any person who resides in this State at the time the organization is issued a Notice of Impairment by the Director or at the time a complaint for liquidation or rehabilitation is filed and to whom contractual obligations are owed. A person may be a resident of only one state which, in the case of a person other than a natural person, shall be its principal place of business.

(Source: P.A. 96-1450, eff. 8-20-10.)

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Last modified: February 18, 2015