215 ILCS 125/ – Health Maintenance Organization Act | Midpage

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Illinois Compiled Statutes

125

215 ILCS 125/

Health Maintenance Organization Act

1-1215 Ilcs 125/1-1 1-2Definitions 1-3Definitions of admitted assets 2-1Certificate of authority - Exception for corporate employee programs - Applications - Material modification of operation 2-10Directors 2-2Determination by Director 2-3.1215 Ilcs 125/2-3.1 2-3Powers of health maintenance organizations 2-4Required minimum net worth; special contingent reserve; deficiency; impairment 2-5Claims Liabilities 2-6Statutory deposits 2-7215 Ilcs 125/2-7 2-8Provider agreements 2-9Subordinated Indebtedness 3-1Investment Regulations 4-1Description and securing of services 4-10Medical necessity; dispute resolution; independent second opinion 4-11215 Ilcs 125/4-11 4-12Changes in rate methodology and benefits, material modifications 4-13Prior approval of policy forms 4-14Evidence of Coverage 4-15215 Ilcs 125/4-15 4-16Fibrocystic condition; denial of coverage 4-17Basic outpatient preventive and primary health care services for children 4-18Retirement facility residents 4-19Purchase of ophthalmic goods or services 4-2Medical assistance; coverage of child 4-20Deductibles and copayments 4-3215 Ilcs 125/4-3 4-4Sexual assault or abuse victims; coverage of expenses; recovery of State funds; reimbursement of Department of Public Health 4-5Organ Transplants 4-6.1Mammograms; mastectomies 4-6.2Breast implant removal 4-6.3Prescription drugs; cancer treatment 4-6.4Post-parturition care 4-6.5Required health benefits; Illinois Insurance Code requirements 4-6Complaint handling procedure 4-7Solicitations of enrollees 4-8Newborn Infants 4-9.1Dependent Coverage Termination 4-9.2Continuation of group HMO coverage after termination of employee or membership 4-9Adopted children 4.5-1Point-of-service health service contracts 5-1215 Ilcs 125/5-1 5-10Health maintenance organizations; revenue data 5-2Rules and regulations or licensing of producers 5-3.1Access to obstetrical and gynecological care 5-3.5Illinois Health Insurance Portability and Accountability Act 5-3.6Managed Care Reform and Patient Rights Act 5-3215 Ilcs 125/5-3 5-4Examination of affairs and quality of services by the Director; books and records 5-5Suspension, revocation, or denial of certification of authority 5-6Supervision of rehabilitation, liquidation or conservation by the Director 5-7.1215 Ilcs 125/5-7.1 5-7Rules and regulations to carry out provisions of Act 5-8Grounds for denial, suspension or revocation of certificate of authority-Hearing-Review under Administrative Review Law 5-9Violations-Class B misdemeanor-Cease and desist order