Illinois Compiled Statutes 215 Insurance: Article IV - Delivery Of Services - Required Provisions And Marketing

• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-1
  Description and securing of services. Every Health Maintenance Organization shall at the time of enrollment and annually thereafter provide its enrollees a description of...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-2
  Medical assistance; coverage of child. (a) In this Section, "Medicaid" means medical assistance authorized under Section 1902 of the Social Security Act. (b) A...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-3
  (Repealed). (Source: Repealed by P.A. 89-183, eff. 1-1-96.)
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-4
  Sexual assault or abuse victims; coverage of expenses; recovery of State funds; reimbursement of Department of Public Health. (1) Contracts or evidences of coverage issued...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-5
  Organ Transplants. No contract or evidence of coverage issued by a health maintenance organization which provides coverage for health care services shall deny reimbursement...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-6
  Complaint handling procedure. (a) Every health maintenance organization shall establish and maintain a complaint system providing reasonable procedures for resolving complaints initiated by enrollees....
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-6.1
  Mammograms; mastectomies. (a) Every contract or evidence of coverage issued by a Health Maintenance Organization for persons who are residents of this State shall contain...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-6.2
  Breast implant removal. No contract offered by Health Maintenance Organizations shall deny coverage for the removal of breast implants when the removal of the...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-6.3
  Prescription drugs; cancer treatment. No health maintenance organization that provides coverage for prescribed drugs approved by the federal Food and Drug Administration for the treatment...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-6.4
  Post-parturition care. A health maintenance organization is subject to the provisions of Section 356s of the Illinois Insurance Code. (Source: P.A. 89-513, eff. 9-15-96;...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-6.5
  Required health benefits; Illinois Insurance Code requirements. A health maintenance organization is subject to the provisions of Sections 155.37, 356g.5, 356t, 356u, and 356z.1 of...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-7
  Solicitations of enrollees. Solicitations of enrollees by a Health Maintenance Organization authorized under this Act, or its representatives shall not be construed to be...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-8
  Newborn Infants. (1) No contract or evidence of coverage issued by a Health Maintenance Organization which provides for coverage of dependents of the principal...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-9
  Adopted children. No contract or evidence of coverage issued by a Health Maintenance Organization which provides for coverage of dependents of the principal enrollees...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-9.1
  Dependent Coverage Termination. (a) The attainment of a limiting age under a group contract or evidence of coverage which provides that coverage of a dependent...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-9.2
  Continuation of group HMO coverage after termination of employee or membership. A group contract delivered, issued for delivery, renewed, or amended in this State that...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-10
  (a) Medical Necessity - Dispute Resolution-Independent Second Opinion. Each Health Maintenance Organization shall provide a mechanism for the timely review by a physician holding...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-11
  Any person who enrolls recipients of Public Aid or Medicare in a health maintenance organization, either personally or by mail, shall, on or after...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-12
  Changes in Rate Methodology and Benefits, Material Modifications. A health maintenance organization shall file with the Director, prior to use, a notice of any...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-13
  Prior approval of policy forms. No health maintenance organization shall issue or deliver in this State a group contract or evidence of coverage, attach...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-14
  Evidence of Coverage. (a) Every subscriber shall be issued an evidence of coverage, which shall contain a clear and complete statement of: (1) The health...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-15
  (a) No contract or evidence of coverage for basic health care services delivered, issued for delivery, renewed or amended by a Health Maintenance Organization...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-16
  Fibrocystic condition; denial of coverage. No contract or evidence of coverage issued by a Health Maintenance Organization shall be denied by the Organization, nor...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-17
  Basic outpatient preventive and primary health care services for children. In order to attempt to address the needs of children in Illinois (i) without health...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-18
  Retirement facility residents. With respect to an enrollee who is a resident of a retirement facility consisting of a long-term care facility, as defined...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-19
  Purchase of ophthalmic goods or services. A health maintenance organization may not require a provider, as a condition of participation in the health maintenance organization's...
• Illinois Health Maintenance Organization Act. - 215 ILCS 125, Section 4-20
  Deductibles and copayments. (a) A Health Maintenance Organization may require deductibles and copayments of enrollees as a condition for the receipt of specific health care...

Last modified: February 18, 2015