Illinois Compiled Statutes
Chapter 215 - INSURANCE
215 ILCS 97/ - Illinois Health Insurance Portability and Accountability Act.

(215 ILCS 97/1)
Sec. 1.
Short title.
This Act may be cited as the Illinois Health Insurance Portability and Accountability Act.

(Source: P.A. 90-30, eff. 7-1-97.)

(215 ILCS 97/5)
Sec. 5. Definitions.
"Affiliate" means a person that directly, or indirectly through one or more intermediaries, controls, is controlled by, or is under common control with the person specified.
"Beneficiary" has the meaning given such term under Section
3(8) of the Employee Retirement Income Security Act of 1974.
"Bona fide association" means, with respect to health
insurance coverage offered in a State, an association which:
"Church plan" has the meaning given that term under Section
3(33) of the Employee Retirement Income Security Act of 1974.
"COBRA continuation provision" means any of the following:
"Control" means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, the holding of policyholders' proxies by contract other than a commercial contract for goods or non-management services, or otherwise, unless the power is solely the result of an official position with or corporate office held by the person. Control is presumed to exist if any person, directly or indirectly, owns, controls, holds with the power to vote, or holds shareholders' proxies representing 10% or more of the voting securities of any other person or holds or controls sufficient policyholders' proxies to elect the majority of the board of directors of the domestic company. This presumption may be rebutted by a showing made in a manner as the Secretary may provide by rule. The Secretary may determine, after furnishing all persons in interest notice and opportunity to be heard and making specific findings of fact to support such determination, that control exists in fact, notwithstanding the absence of a presumption to that effect.
"Department" means the Department of Insurance.
"Employee" has the meaning given that term under Section 3(6)
of the Employee Retirement Income Security Act of 1974.
"Employer" has the meaning given that term under Section 3(5)
of the Employee Retirement Income Security Act of 1974, except
that the term shall include only employers of 2 or more
employees.
"Enrollment date" means, with respect to an individual covered under a group
health plan or group health insurance coverage, the date of enrollment of the
individual in the plan or coverage, or if earlier, the first day of the waiting
period for enrollment.
"Federal governmental plan" means a governmental plan established
or maintained for its employees by the government of
the United States or by any agency or instrumentality of that
government.
"Governmental plan" has the meaning given that term under
Section 3(32) of the Employee Retirement Income Security Act
of 1974 and any federal governmental plan.
"Group health insurance coverage" means, in connection with a
group health plan, health insurance coverage offered in
connection with the plan.
"Group health plan" means an employee welfare benefit plan (as
defined in Section 3(1) of the Employee Retirement Income
Security Act of 1974) to the extent that the plan provides
medical care (as defined in paragraph (2) of that Section and including items
and services paid for as medical care) to employees or their
dependents (as defined under the terms of the plan) directly
or through insurance, reimbursement, or otherwise.
"Health insurance coverage" means benefits consisting of
medical care (provided directly, through insurance or
reimbursement, or otherwise and including items and services paid for
as medical care) under any hospital or medical service policy
or certificate, hospital or medical service plan contract, or
health maintenance organization contract offered by a health
insurance issuer.
"Health insurance issuer" means an insurance company,
insurance service, or insurance organization (including a
health maintenance organization, as defined herein) which is
licensed to engage in the business of insurance in a state and
which is subject to Illinois law which regulates insurance (within the
meaning of Section 514(b)(2) of the Employee Retirement Income
Security Act of 1974). The term does not include a group
health plan.
"Health maintenance organization (HMO)" means:
"Individual health insurance coverage" means health insurance
coverage offered to individuals in the individual market, but
does not include short-term limited duration insurance.
"Individual market" means the market for health insurance
coverage offered to individuals other than in connection with a
group health plan.
"Large employer" means, in connection with a group health plan
with respect to a calendar year and a plan year, an employer
who employed an average of at least 51 employees on business
days during the preceding calendar year and who employs at
least 2 employees on the first day of the plan year.
"Large group market" means the health insurance market under
which individuals obtain health insurance coverage (directly
or through any arrangement) on behalf of themselves (and their
dependents) through a group health plan maintained by a large
employer.
"Late enrollee" means with respect to coverage under a group health plan, a
participant or beneficiary who enrolls under the plan other than during:
"Medical care" means amounts paid for:
"Nonfederal governmental plan" means a governmental plan that
is not a federal governmental plan.
"Network plan" means health insurance coverage of a health
insurance issuer under which the financing and delivery of
medical care (including items and services paid for as medical
care) are provided, in whole or in part, through a defined set
of providers under contract with the issuer.
"Participant" has the meaning given that term under Section
3(7) of the Employee Retirement Income Security Act of 1974.
"Person" means an individual, a corporation, a partnership, an association, a joint stock company, a trust, an unincorporated organization, any similar entity, or any combination of the foregoing acting in concert, but does not include any securities broker performing no more than the usual and customary broker's function or joint venture partnership exclusively engaged in owning, managing, leasing, or developing real or tangible personal property other than capital stock.
"Placement" or being "placed" for adoption, in connection
with any placement for adoption of a child with any person,
means the assumption and retention by the person of a legal
obligation for total or partial support of the child in
anticipation of adoption of the child. The child's placement
with the person terminates upon the termination of the legal
obligation.
"Plan sponsor" has the meaning given that term under Section
3(16)(B) of the Employee Retirement Income Security Act of
1974.
"Preexisting condition
exclusion" means, with respect to coverage, a
limitation or exclusion of benefits relating to a
condition based on the fact that the condition was
present before the date of enrollment for such
coverage, whether or not any medical advice,
diagnosis, care, or treatment was recommended or
received before such date.
"Small employer" means, in connection with a group
health plan with respect to a calendar year and a plan year,
an employer who employed an average of at least 2 but not more
than 50 employees on business days during the preceding calendar year and who
employs at least 2 employees on the first day
of the plan year.
"Small group market" means the health insurance market under
which individuals obtain health insurance coverage (directly
or through any arrangement) on behalf of themselves (and their
dependents) through a group health plan maintained by a small
employer.
"State" means each of the several States, the District of
Columbia, Puerto Rico, the Virgin Islands, Guam, American
Samoa, and the Northern Mariana Islands.
"Waiting period" means with respect to a group health plan and an individual
who is a potential participant or beneficiary in the plan, the period of time
that must pass with respect to the individual before the individual is eligible
to be covered for benefits under the terms of the plan.

(Source: P.A. 94-502, eff. 8-8-05.)

(215 ILCS 97/15)
Sec. 15.
Applicability and scope.
This Act applies to all health insurance policies and all health service
contracts issued, renewed, or delivered for issuance or renewal in this State
by a health insurance issuer after the effective date of this Act. Unless
otherwise
specifically provided by this Act, the standards and requirements imposed by
this Act shall supersede and replace any and all conflicting, inconsistent or
less restrictive standards or requirements contained in the Illinois Insurance
Code, the Health Maintenance Organization Act, the Limited Health Service
Organization Act, and the Voluntary Health Services Plans Act.

(Source: P.A. 90-30, eff. 7-1-97.)

(215 ILCS 97/20)
Sec. 20. Increased portability through prohibition of preexisting
condition exclusions.
(A) No health insurance coverage issued, amended, delivered, or renewed on or after the effective date of this amendatory Act of the 102nd General Assembly may impose any preexisting condition exclusion with respect to the plan or coverage. This provision does not apply to the provision of excepted benefits as described in paragraph (2) of subsection (C).
(B) (Blank).
(C) Rules relating to crediting previous coverage.
(D) (Blank).
(E) Certifications and disclosure of coverage.
(F) Special enrollment periods.
(G) Use of affiliation period by HMOs as alternative to preexisting
condition exclusion.
(Source: P.A. 102-775, eff. 5-13-22.)

(215 ILCS 97/25)
Sec. 25.

Prohibiting discrimination against individual
participants.
(A) In eligibility to enroll.
(B) In premium contributions.
(Source: P.A. 90-30, eff. 7-1-97.)

(215 ILCS 97/30)
Sec. 30.

Guaranteed renewability of coverage for employers
in the group market.
(A) In general. Except as provided in this Section, if a
health insurance issuer offers health insurance coverage
in the small or large group market in connection with a
group health plan, the issuer must renew or continue in
force such coverage at the option of the plan sponsor of
the plan.
(B) General exceptions. A health insurance issuer may
nonrenew or discontinue health insurance coverage
offered in connection with a group health plan in the
small or large group market based only on one or more of
the following:
(C) Requirements for uniform termination of coverage.
(D) Exception for uniform modification of coverage. At the
time of coverage renewal, a health insurance issuer may
modify the health insurance coverage for a product
offered to a group health plan:
(E) Application to coverage offered only through
associations. In applying this Section in the case of
health insurance coverage that is made available by a
health insurance issuer in the small or large group
market to employers only through one or more associations,
a reference to "plan sponsor" is deemed, with
respect to coverage provided to an employer member of
the association, to include a reference to such employer.

(Source: P.A. 90-30, eff. 7-1-97.)

(215 ILCS 97/35)
Sec. 35.
Disclosure of Information.
(A) Disclosure of information by health plan issuers. In
connection with the offering of any health insurance
coverage to a small employer, a health insurance issuer:
(B) Information described.
(Source: P.A. 90-30, eff. 7-1-97; 91-357, eff. 7-29-99.)

(215 ILCS 97/40)
Sec. 40.

Guaranteed availability of coverage for employers
in the group market.
(A) Issuance of coverage in the small group market.
(B) Special rules for network plans.
(C) Application of financial capacity limits.
(D) Exception to requirement for failure to meet certain minimum
participation or contribution rules.
(E) Exception for coverage offered only to bona fide association members.
Subsection (A) shall not apply to health insurance coverage offered by a
health insurance issuer if such coverage is made available in the small group
market only through one or more bona fide associations (as defined in Section
10).

(Source: P.A. 90-30, eff. 7-1-97.)

(215 ILCS 97/45)
Sec. 45.
Exclusion of certain plans.
(A) Exception for certain small group health plans. The requirements of
this Act
shall not apply to any group health plan (and health insurance
coverage offered in connection with a group health plan) for any plan year
if, on the first day of such plan year, such plan has less than 2
participants who are current employees.
(B) Limitation on application of provisions relating to
group health plans.
(C) Exception for certain benefits. The requirements of this Act
shall not
apply to any group health plan (or group health insurance coverage) in relation
to its provision of excepted benefits described in
Section 20(C)(2)(a).
(D) Exception for certain benefits if certain conditions met.
(E) Treatment of partnerships. For purposes of this Act:
(Source: P.A. 90-30, eff. 7-1-97.)

(215 ILCS 97/50)
Sec. 50. Guaranteed renewability of individual health insurance coverage.
(A) In general. Except as provided in this Section, a health insurance
issuer that provides individual health insurance coverage to an individual
shall renew or continue in force such coverage at the option of the individual.
(B) General exceptions. A health insurance issuer may nonrenew or
discontinue health insurance coverage of an individual in the individual market
based
only on one or more of the following:
(C) Requirements for uniform termination of coverage.
(D) Exception for uniform modification of coverage. At the time of coverage
renewal, a health insurance issuer may modify the health insurance coverage for
a policy form offered to individuals in the individual market so long as the
modification is consistent with Illinois law and effective on a uniform basis
among all individuals with that policy form.
(E) Application to coverage offered only through associations. In applying
this Section in the case of health insurance coverage that is made available by
a health insurance issuer in the individual market to individuals only through
one or more associations, a reference to an "individual" is deemed to include a
reference to such an association (of which the individual is a member).
The changes to this Section made by this amendatory Act of the 94th General Assembly apply only to discontinuances of coverage occurring on or after the effective date of this amendatory Act of the 94th General Assembly.

(Source: P.A. 94-502, eff. 8-8-05.)

(215 ILCS 97/60)
Sec. 60. Notice requirement. In any case where a health insurance issuer elects to uniformly modify coverage, uniformly terminate coverage, or discontinue coverage in a marketplace in accordance with Sections 30 and 50 of this Act, the issuer shall provide notice to the Department prior to notifying the plan sponsors, participants, beneficiaries, and covered individuals. The notice shall be sent by certified mail to the Department 90 days in advance of any notification of the company's actions sent to plan sponsors, participants, beneficiaries, and covered individuals. The notice shall include: (i) a complete description of the action to be taken, (ii) a specific description of the type of coverage affected, (iii) the total number of covered lives affected, (iv) a sample draft of all letters being sent to the plan sponsors, participants, beneficiaries, or covered individuals, (v) time frames for the actions being taken, (vi) options the plans sponsors, participants, beneficiaries, or covered individuals may have available to them under this Act, and (vii) any other information as required by the Department.
This Section applies only to discontinuances of coverage occurring on or after the effective date of this amendatory Act of the 94th General Assembly.

(Source: P.A. 94-502, eff. 8-8-05.)

(215 ILCS 97/85)
Sec. 85.
(Amendatory provisions; text omitted).

(Source: P.A. 90-30, eff. 7-1-97; text omitted.)

(215 ILCS 97/86)
Sec. 86.

The Small Employer Rating, Renewability and Portability Health
Insurance Act is amended by repealing Sections 1, 5, 10, 15, 20, and 55 on July
1, 1998.

(Source: P.A. 90-30, eff. 7-1-97.)

(215 ILCS 97/87)
Sec. 87.

The Small Employer Rating, Renewability and Portability Health
Insurance Act is amended by repealing Sections 25, 30, 35, 40, 45, and 50.

(Source: P.A. 90-30, eff. 7-1-97.)

(215 ILCS 97/92)
Sec. 92.
(Amendatory provisions; text omitted).

(Source: P.A. 90-30, eff. 7-1-97; text omitted.)

(215 ILCS 97/94)
Sec. 94.
(Amendatory provisions; text omitted).

(Source: P.A. 90-30, eff. 7-1-97; text omitted.)

(215 ILCS 97/96)
Sec. 96.
(Amendatory provisions; text omitted).

(Source: P.A. 90-30, eff. 7-1-97; text omitted.)

(215 ILCS 97/98)
Sec. 98.
(Amendatory provisions; text omitted).

(Source: P.A. 90-30, eff. 7-1-97; text omitted.)

(215 ILCS 97/99)
Sec. 99.
Effective date.
This Act takes effect on July 1, 1997.

(Source: P.A. 90-30, eff. 7-1-97.)