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 09/16/09

Line(s) of   Line(s) of  
Business   Insurance  

Individual Disability Income

  

Individual Disability Income Policies

  
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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)"		  
Outline of Coverage 50 IL Adm. Code 2007.80b) An Outline of Coverage must be submitted with a uniform transmittal document and contain a unique filing number.  
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).		  
Rates 215 ILCS 5/355 Rates must be submitted with a uniform transmittal document and contain a unique filing number.  
GENERAL REQUIREMENTS FOR ALL FILINGS REFERENCE DESCRIPTION OF REVIEW STANDARDS REQUIREMENTS   
Accident and Health Required Provisions 215 ILCS 5/357.1 Each accident and health policy must contain the provisions contained in 3/357.2-3/357.13  
Form of Policy 215 ILCS 5/356a No policy of accident and health insurance may be delivered or issued for deliver to any person in this state unless it adheres to the provisions of this section.  
Entire Contract 215 ILCS 5/357.1
215 ILCS 5/357.2		 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 5/357.1
215 ILCS 5/357.3		 A policy is incontestable two years from the date of issue except for fraudulent misstatements made by the applicant on the application.  
Notice of Claim 215 ILCS 5/357.1
215 ILCS 5/357.6		 Written notice of claim should be submitted to the company within 20 days of the occurrence or commencement of any loss.  
Legal Action 215 ILCS 5/357.1
215 ILCS 5/357.12		 No such action shall be brought after 3 years from the date of due proof of loss is required to be furnished.  
Claim Forms 215 ILCS 5/357.1
215 ILCS 5/357.7		 The company shall furnish those forms needed to submit proofs of loss within 15 days.  
Payment of Claims 215 ILCS 5/357.1
215 ILCS 5/357.10		 Benefits may be assigned.  
Timely Payment of Claims 215 ILCS 5/357.1
215 ILCS 5/357.9a		 Periodic payment of accrued indemnities for loss-of-time coverage must commence no later than 30 days after receipt of due proof of loss.  
Grace Period 215 ILCS 5/357.1
215 ILCS 5/357.4		 A grace period of not less than 7 days (weekly premium), 10 days (monthly premium) and 31 days for all other policies is required.  
Proof of Loss 215 ILCS 5/357.1
215 ILCS 5/357.8		 Written proofs of loss should be submitted to the company within 90 days of loss.  
Physical examinations and autopsy 215 ILCS 5/357.1
215 ILCS 5/357.11		 Insurers, at their own expense, have the right and opportunity to examine the insured when, and as reasonably often as required, during a claim's pending period. It may also conduct an autopsy in the case of death when law does not forbid it.  
Change of Beneficiary 215 ILCS 5/357.1
215 ILCS 5/357.13		 The individual designating a beneficiary retains the right to change that designation unless he/she makes that designation irrevocable.  
Reinstatement 215 ILCS 5/357.1
215 ILCS 5/357.5		 A policy may be reinstated with or without an application as provided.  
ADMINISTRATIVE CODE PROVISIONS      
Renewability 50 IL. Adm. Code 2007.80(a)(1) The renewal provision must appear on the first page of the policy.  
Renewability to Age 65 50 IL Adm. Code 2007.50 If a policy is guaranteed renewable to age 65, it must contain a definition for a retired person. ("When through a specific provision of a policy, disability coverage is provided to a retired person, such definition shall not require more than the insured be completely unable to engage in the normal activities of a retired person of like age and good health.")  
Pre-Existing Conditions 50 IL. Adm. Code 2005
50 IL. Adm. Code 2007.80(a)(5)		 The minimum definition for pre-existing condition is included within Rule 2005. A separate paragraph concerning pre-existing conditions limitations must be included in the contract that limits such conditions.  
Free Look 50 IL. Adm. Code 2007.80(a)(7)
215 ILCS 5/355a (5)(a)		 The policy must contain a 10-day free look provision.  
Replacement Question 50 IL. Adm. Code 2007.90a) The application must contain a replacement question designed to elicit information concerning whether the policy will replace any existing accident and health coverage.  
Terms not Permitted 50 IL. Adm. Code 2007.50
50 IL Adm. Code 2001.20 h) 2)		 "External," "Violent," "Visible" or similar words of description or characterization are not allowed. The use of the term, "independent of all other causes" is ambiguous when used in the definition of injury and is not allowed.  
Totally Disabled defined 50 IL Adm. Code 2007.70 b) 1) N) Total disability is the complete incapacity of the insured, due to the injury or illness, to engage in any occupation for pay or profit; or, if unemployed to engage in the normal activities of a person of the same age; and requires the regular care of a physician other than him/herself.  
Exclusions not Permitted 50 IL Adm. Code 2603.30(a)(11)
215 ILCS 5/143(1)
50 IL Adm. Code 2007.60 e)
50 IL Adm. Code 2007.60 g)

Insurers may not exclude hyperemisis gravidarum or pre-eclampsia or eclampsia as a complication of pregnancy.

Insurers may also not limit, reduce or exclude liability for loss resulting from purely accidental circumstances such as involuntary or unintentional ingestion or inhalation of poison, poisonous gases or fumes.

  
No Reduction for SSN cost-of-living increase 50 IL Adm. Code 2007.70 b) 6)
215 ILCS 5/355.1		 There shall be no reduction in benefits by reason of any cost-of-living increase designated as such under the Federal Social Security Act.  
Return of Premium 50 IL. Adm. Code 2007.60(c)(1-8) This benefit may be offered for this type of coverage (usually filed as an optional endorsement rider). The benefit must meet the requirements listed within the regulation.  
Waiver of Premium 50 IL Adm. Code 2001.20 (u) (1,2,3, & 4) The policy may contain a waiver of premium provision.  
Accidental Circumstances 50 IL. Adm. Code 2007.60(g) No policy may limit, exclude or reduce benefits for loss due to purely accidental circumstances.  
Minimum Standards 50 IL. Adm. Code 2007.70 This section of the Rule outlines minimum standards for accident and health benefits.  
Recurrent Disabilities 50 IL Adm. Code 2007.70 b) 1) H) A recurrent disability provision must specify that no separation period be greater than six months.  
Required Disclosures 50 IL. Adm. Code 2007.80 This section of the Rule contains guidelines on required policy and disclosure provisions.  
Exclusion (Body System) 50 IL. Adm. Code 2001.20(q) This Rule disallows the exclusion of any body system (i.e. illnesses related to the cardio-vascular system are not covered).  
Discrimination 50 IL. Adm. Code 2603 Provides guidelines on unfair discrimination based on sex, sexual preference or marital status.  
Right of Reimbursement and Subrogation 50 IL Adm Code 2020 Provides guidelines for reimbursement and subrogation rights due to negligence of a third party.  
OPTIONAL PROVISIONS      
Change of Occupation 215 ILCS 5/357.15 An insured who is injured or becomes sick after having changed occupations to one classified as either more or less hazardous, will have a suitable premium adjustment made as provided.  
Misstatement of Age 215 ILCS 5/357.16 If the age of the insured has been misstated, all amounts payable under this policy shall be such as the premium paid would have purchased at the correct age.  
Other Insurance in Company 215 ILCS 5/357.17 Excess coverage protection provisions.  
Insurance with Other Companies 215 ILCS 5/357.19 Excess coverage protection provisions for insurance with other companies for indemnity type policies.  
Relation of earnings to insurance 215 ILCS 5/357.20 This provision provides a formula to protect insurers from paying more in benefits than the insured's monthly earnings.  
Unpaid Premium 215 ILCS 5/357.21 Upon the payment of a claim under the policy, any premium then due and unpaid or covered by any note or written order may be deducted.  
Cancellation 215 ILCS 5/357.22 Cancellation provisions with prior notification requirements. Insurers must provide no less than 30 days notice.  
Disclosure of Conformity with State Statutes 215 ILCS 5/357.23 Any provision of the policy, which, on its effective date, is in conflict with the statutes of the state in which the insured resides on such date, is hereby amended to conform to the minimum requirements of such statutes.  
Illegal Occupation 215 ILCS 5/357.24 An insurer shall not be liable for any loss to which a contributing cause was the insured's commission of or attempt to commit a felony or to which a contributing cause was the insured's being engaged in an illegal occupation.  
Intoxicants and Narcotics 215 ILCS 5/357.25 An insurer shall not be liable for any loss sustained or contracted in consequence of the insured's being intoxicated or under the influence of any narcotic unless administered on the advice of a physician.  
Pro-rata Refund 215 ILCS 5/357.31 Insurers must provide pro-rata refunds of premium upon receipt of proper notification of insured's death. Refund may not be based on short-rate table.  
GENERAL INFORMATION      
Applicability of Mandated Benefits 215 ILCS 5/356z.15 This provision lists sections of the Insurance Code that are inapplicable to certain policies.  
Discretionary Authority 215ILCS 5/143(1)
50 IL Adm. Code 2001.3		 Insurers are not permitted to place discretionary authority language in contracts of accident and health.  
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.

 
Cancer Clinical Trials 215 ILCS 5/364.01 Insurers may not cancel or nonrenew any individual's coverage due to participation in a qualified cancer clinical trial. Guidelines are provided.  
DEPARTMENT POSITIONS      
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.