Illinois Compiled Statutes 215 Insurance: Article -

• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 1
  Short title. This Act may be cited as the Health Carrier External Review Act. (Source: P.A. 96-857, eff. 7-1-10.)
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 5
  Purpose and intent. The purpose of this Act is to provide uniform standards for the establishment and maintenance of external review procedures to assure that...
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 10
  Definitions. For the purposes of this Act: "Adverse determination" means: (1) a determination by a health carrier or its designee utilization review organization that, based...
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 15
  Applicability and scope. (a) Except as provided in subsection (b) of this Section, this Act shall apply to all health carriers. (b) The provisions of...
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 20
  Notice of right to external review. (a) At the same time the health carrier sends written notice of a covered person's right to appeal a...
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 25
  Request for external review. A covered person or the covered person's authorized representative may make a request for a standard external or expedited external review...
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 30
  Exhaustion of internal appeal process. (a) Except as provided in subsection (b) of this Section, a request for an external review shall not be made...
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 35
  Standard external review. (a) Within 4 months after the date of receipt of a notice of an adverse determination or final adverse determination, a covered...
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 40
  Expedited external review. (a) A covered person or a covered person's authorized representative may file a request for an expedited external review with the Director...
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 42
  External review of experimental or investigational treatment adverse determinations. (a) Within 4 months after the date of receipt of a notice of an adverse determination...
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 45
  Binding nature of external review decision. An external review decision is binding on the health carrier. An external review decision is binding on the covered...
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 50
  Approval of independent review organizations. (a) The Director shall approve independent review organizations eligible to be assigned to conduct external reviews under this Act. (b)...
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 55
  Minimum qualifications for independent review organizations. (a) To be approved to conduct external reviews, an independent review organization shall have and maintain written policies and...
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 60
  Hold harmless for independent review organizations. No independent review organization or clinical reviewer working on behalf of an independent review organization or an employee, agent...
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 65
  External review reporting requirements. (a) Each health carrier shall maintain written records in the aggregate, by state, and for each type of health benefit plan...
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 70
  Funding of external review. The health carrier shall be solely responsible for paying the cost of external reviews conducted by independent review organizations. (Source: P.A....
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 75
  Disclosure requirements. (a) Each health carrier shall include a description of the external review procedures in, or attached to, the policy, certificate, membership booklet, and...
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 80
  Administration and enforcement. (a) The Director of Insurance may adopt rules necessary to implement the Department's responsibilities under this Act. (b) The Director is authorized...
• Illinois Insurance: Article -
  Amendatory provisions; text omitted
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 90
  (Amendatory provisions; text omitted). (Source: P.A. 96-857, eff. 7-1-10; text omitted.)
• Illinois Insurance: Article -
  Amendatory provisions; text omitted
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 95
  (Amendatory provisions; text omitted). (Source: P.A. 96-857, eff. 7-1-10; text omitted.)
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 96
  No acceleration or delay. Where this Act makes changes in a statute that is represented in this Act by text that is not yet or...
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 97
  Severability. The provisions of this Act are severable under Section 1.31 of the Statute on Statutes. (Source: P.A. 96-857, eff. 7-1-10.)
• Illinois Health Carrier External Review Act. - 215 ILCS 180, Section 99
  Effective date. This Act takes effect January 1, 2010, except that the changes to Section 155.36 of the Illinois Insurance Code and Sections 40 and...

Last modified: February 18, 2015