Effective 09/28/09

Individual Accident/Health

Individual accident and health policies;
Does not include limited benefit plans.

Word Document - Alteration of this document will result in rejection of the filing

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.

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

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.

215 ILCS 5/357.1
215 ILCS 5/357.11

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.

Effective June 1, 2009 a policy must continue to provide coverage for a dependent college student who has taken a medical leave of absence or reduced hours to part-time status due to a catastrophic illness or injury. Continuation is subject to all of the policy’s terms and conditions applicable to that form of insurance and shall terminate 12 months after the notice of the illness or injury or until coverage would have otherwise lapsed.

215 ILCS 5/155.36

Coverage of screening by low-dose mammography for all women over 35;

Coverage requires baseline mammogram for women 35-39 and annual mammogram for women 40 years of age and older.

For women under 40 with a family history of breast cancer or other risk factors mammograms must be provided at an age and intervals considered medically necessary.

Coverage includes a comprehensive ultrasound screening of an entire breast or breasts when a mammogram demonstrates medical necessity as described.

Coverage must be provided at no cost to the insured and shall not be applied to an annual or lifetime maximum benefit.

Clinical breast examinations must be covered:

(1) at a minimum every three years for women over 20 years of age but less than 40; and,
(2) annually for women 40 years of age and older.

215 ILCS 5/356z.11

215 ILCS 5/356z.14

Except as provided a health insurer issuing individual coverage must renew or continue in force coverage at the option of the individual except for:
a.) Nonpayment of premium;
b.) Fraud;
c.) Termination of the plan;
d.) Movement outside the service area; or
e.) Association membership ceases.

a.) A group health plan;

b.) Health insurance coverage;

c.) Part A or part B of title XVIII of the Social Security Act;

d.) Title XIX of the Social Security Act other than coverage consisting solely of benefits under Section 1928;

e.) Chapter 55 of title 10 of the United States Code;

f.) A medical care program of the Indian Health Service or of a tribal organization;

g.) A state health benefits risk pool;

h.) A health plan offered under chapter 89 of title 5, United States Code;

i.) A public health plan (as defined in regulations);

j.) A health benefit plan under Section 5(e) of the Peace Corps Act;

k.) Title XXI of the federal Social Security Act, a State Children's Health Insurance Program.

215 ILCS 5/143(1)

50 IL Adm. Code 2001.3

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 must comply with both provisions.