Contact Person: Illinois Department of Insurance 320 West Washington Street
Cindy Colonius Review Requirements Checklist Springfield, IL 62767-0001
217-782-4572    
Cindy.Colonius@Illinois.gov

Effective 3/10/09
Line(s) of   Line(s) of  
Business   Insurance  

Group Accident/Health Stand Alone Dental

  

Large and Small Group Dental Products using either a PPO or an indemnity delivery platform.

  
Click here for interactive version of this document to be down loaded and submitted with this filing

Word Document - Alteration of this document will result in rejection of the filing
Illinois Insurance Code Link Illinois Compiled Statutes Online
Illinois Administrative Code Link Administrative Regulations Online
Product Coding Matrix Product Coding Matrix
REVIEW REQUIREMENTS REFERENCE

DESCRIPTION OF REVIEW

STANDARDS REQUIREMENTS

 LOCATION OF STANDARD IN FILING
    NOTE: These brief summaries do not include all requirements of all laws, regulations, bulletins, or requirements, so review actual law, regulation, bulletin, or requirement for details to ensure that forms are fully compliant before filing with the Department of Insurance.  
FORM FILING REQUIREMENTS  REFERENCE DESCRIPTION OF REVIEW STANDARDS REQUIREMENTS LOCATION OF STANDARD IN FILING
Uniform Transmittal Document (Etrans) 50 IL Adm Code 916 Form filings must now be submitted either by SERFF or CD-ROM. Please visit the Department's web site for the Universal Transmittal Document (Etrans) by clicking this link.
Scroll down to "Universal Transmittal Document Software (Etrans)"		  
Form Filing Requirements for Certificates intended for out-of-state use.

215 ILCS 5/352(c)

50 IL Adm. Code 2021.40

 Policies sitused in Illinois, but intended for insureds who neither work in nor reside in Illinois, must be filed on an informational basis to claim exemption from Illinois mandates and other required provisions.
Insurers not specifically filing under the exemption provided by 215 ILCS 5/352(c) must submit such filings for approval. 		 
Review Requirements Checklist Go to Review Requirements Checklists on DOI web site. See next column

Each filing must include a completed Review Requirements Checklist that must contain a completed “Location of Standard in Filing” column for each required element of the filing. Please indicate the proper page # and form # for each entry.

  
Cover Letter and Letter of Submission

50 IL Adm. Code 1405.20 (e)
50 IL Adm. Code 2001.30 (a) (3)

50 IL Adm. Code 916.40 (b)

In addition to referencing any previously approved form number(s) as required by 50 IL Adm. Code 1405.20(e), those references must also include the filing number and SERFF tracking number (if applicable and available) for the referenced forms.

Letters of submission must generally describe the intent and use of the form being filed and, if applicable, how it will be used with any previously approved form(s).		  
GENERAL REQUIREMENTS FOR ALL FILINGS REFERENCE DESCRIPTION OF REVIEW STANDARDS REQUIREMENTS   
Entire Contract 215 ILCS 5/367(2)(a) The policy, including the application and any amendments and riders, constitutes the entire contract of insurance and no change is valid unless approved by an executive officer of the company and unless such approval be endorsed hereon or attached hereto.  
Time Limit on Certain Defenses 215 ILCS 5/357.3
215 ILCS 5/367(2)		 A policy is incontestable two years from the date of issue except for fraudulent misstatements made by the applicant on the application.  
Timely Payment of Claims 215 ILCS 5/357.9 Claims must be paid within 30 days following receipt of written due proof of loss.  
Coordination of Benefits 215 ILCS 5/367(11a &b)
50 IL Adm Code 2009		 Based on same premise as NAIC Model with some language variance.  
Dental Care Patient Protection Act 215 ILCS 109/25 The Act requires Managed Care Dental plans to file a written consumer summary information description. The insurer must also file its grievance procedure and its list of participating providers.  
Spousal continuation 215 ILCS 5/367.2 Spousal and dependent continuation rights in case of death, divorce or retirement.  
Dependent continuation 215 ILCS 5/367.2-5 Continuation rights for an insured's dependent child in the event of the death of the insured and the child is not eligible for coverage as a dependent under 215 ILCS 5/367.2.  
Extended age dependent continuation 215 ILCS 5/356z.12

Effective June 1, 2009 a policy that includes dependent coverage must allow unmarried dependents under the age of 26 to apply for coverage. Additionally, polices must allow military veteran dependents under the age of 30 to apply for coverage if the veteran is an Illinois resident, not married; has served in the active or a reserve components of the U.S. Armed Forces (including the National Guard) and has received a release or discharge other than dishonorable.
Policies in force as of June 1, 2009 must provide for a 90 day open enrollment period for all dependents that meet the criteria described above beginning on the policy renewal date, but no later than May 31, 2010. Insurers may not apply requirements for creditable coverage, continuous coverage or breaks in coverage during the initial enrollment period. However, preexisting condition limitations may be applied if creditable coverage has not been established.
Policies issued on or after June 1, 2009 must also provide for a 90 day open enrollment applicable to policies issued on or before May 31, 2010.
Insurers must provide an annual 30 day open enrollment period.
The law does not change HIPAA special enrollment requirements.

The attached link provides FAQ information from our web site.		  
Non-Participating Provider Services 215 ILCS 5/356z.2 A notice must be provided to consumers explaining that a larger out-of-pocket expense may occur if non-participating providers are used. Provision must use same language as in statute, but may be modified to suit insurer terminology.  
GENERAL INFORMATION      
Discretionary Authority

215 ILCS 5/143(1)

50 IL Adm. Code 2001.3

 Insurers are not permitted to place discretionary authority language in contracts of accident and health.  
Rate Filings 50 IL Adm. Code 916.40 e) and f) Rule 916 does not require the filing of Group Rates, except for Credit, Medicare Supplement and Long Term Care, which do need to be filed. Rates also need to be provided for individual accident and health filings.  
HIV/AIDS Questions on Application 215 ILCS 5/143(1)
Questions designed to elicit information regarding AIDS, ARC and HIV must be specifically related to the testing, diagnosis or treatment done by a physician or an appropriately licensed clinical professional acting within the scope of his/her license.
  
Use of SSN on ID Cards

815 ILCS 505 2QQ

215 ILCS 138/15

The focus of HB 4712 is on any card required for an individual to access products or services, while SB 2545 is more limited in that it just focuses on insurance cards.

HB 4712 prevents a person from:

· Publicly posting or displaying an individual's SSN;

· Printing an individual's SSN on any card required for the individual to access products or services, however, an entity providing an insurance card must print on the card a unique identification number as required by 215 ILCS 138/15.

· Being required to transmit an SSN over the Internet to access a web site unless the connection is secure or the SSN is encrypted;

· Requiring the individual to use his/her SSN to access a web site unless a PIN number or other authentication device is also used; and,

· Printing an individual's SSN on any materials mailed to an individual unless required by state or federal law.

Insurers are required to comply with both provisions.

 
DEPARTMENT POSITIONS      
Prohibited Terms 215 ILCS 5/143(1)
50 IL Adm. Code 2001.20 h) 2)		 Policies may not use terms such as "external" and "violent".  
Intoxication Definition 215 ILCS 5/143(1) An intoxication definition must be included in the policy if it is listed as an exclusion. A reasonable example would be, "Intoxication means that which is defined and determined by the laws of the jurisdiction where the loss or cause of the loss was incurred."