Accident and Health Insurance (individual and group provisions)

What this document is

215 ILCS 5, Article XX - Accident and Health Insurance (individual and group provisions) is a state statute published by Illinois General Assembly, Legislative Reference Bureau (ilga.gov). It is one of the Illinois documents that insurance license exam questions are written from, including illinois life & health practice questions. This page summarizes it and points to the official version, which is the text to rely on.

Sections cited in practice questions

Each practice answer shows the exact passage it comes from. These are sections of this document that questions cite, with a short excerpt from the source text.

• 215 ILCS 5 § 357.7 ("CLAIM FORMS")

  “The company, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within 15 days after the giving of such notice the claimant shall be deemed to have complied with the requirements of...”

• 215 ILCS 5 § 357.22 ("CANCELLATION")

  “In the event of cancellation, the company will return promptly the unearned portion of any premium paid. If the insured cancels, the earned premium shall be computed by the use of the short-rate table last filed with the state official having supervision of insurance in the state where the insured...”

• 215 ILCS 5 § 356L (notice of claim; emergency hospitalization)

  “No individual policy of accident or health insurance shall include any provision which shall have the effect of denying coverage to or on behalf of an insured under such policy on the basis of a failure by the insured to file a notice of claim within the time period required by the policy, provided...”

• 215 ILCS 5 § 357.1 (Accident and health policy provisions required)

  “Except as provided in section 357.26 of this article each accident and health policy delivered or issued for delivery to any person in this State shall contain the provisions set forth in sections 357.2 through 357.13 in the words in which the same appear in the specified sections; provided,...”

• 215 ILCS 5 § 357.9 ("TIME OF PAYMENT OF CLAIMS")

  “All claims and indemnities payable under the terms of a policy of accident and health insurance shall be paid within 30 days following receipt by the insurer of due proof of loss. Failure to pay within such period shall entitle the insured to interest at the rate of 9 per cent per annum from the...”

• 215 ILCS 5/357.15 ("CHANGE OF OCCUPATION")

  “Sec. 357.15. "CHANGE OF OCCUPATION: If the insured be injured or contract sickness after having changed his occupation to one classified by the company as more hazardous than that stated in this policy or while doing for compensation anything pertaining to an occupation so classified, the company...”

• 215 ILCS 5/367e, condition 8 (Continuation of group hospital, surgical and major medical coverage)

  “8. Continuation shall not be available for any employee who was discharged because of the commission of a felony in connection with his work, or because of theft in connection with his work, for which the employer was in no way responsible; provided the employee admitted his commission of the...”

• 215 ILCS 5/356d(2) (Conversion privileges for insured former spouses)

  “(2) Every policy which contains a provision for termination of coverage of the spouse upon dissolution of marriage shall contain a provision to the effect that upon the entry of a valid judgment of dissolution of marriage between the insured parties the spouse whose marriage was dissolved shall be...”

• 215 ILCS 5/367e.1(A)(6) (Group accident and health insurance conversion privilege)

  “(6) The insurer shall not be required to issue a converted policy covering any person if such person is or could be covered by Medicare (Title XVIII of the United States Social Security Act as added by the Social Security Amendments of 1965 or as later amended or superseded). Furthermore, the...”

• 215 ILCS 5/364 (Discrimination prohibited; meaning of physician and doctor)

  “Nothing in this provision shall prohibit an insurer from providing incentives for insureds to utilize the services of a particular hospital or person. It is hereby expressly provided that whenever the terms "physician" or "doctor" appear or are used in any way in any policy of accident or health...”

• 215 ILCS 5/357.4 ("GRACE PERIOD")

  “A grace period of ....(insert a number not less than "7" for weekly premium policies, "10" for monthly premium policies and "31" for all other policies) days will be granted for the payment of each premium falling due after the first premium, during which grace period the policy shall continue in force.”

• 215 ILCS 5/357.5 ("REINSTATEMENT")

  “if the company or such agent requires an application for reinstatement and issues a conditional receipt for the premium tendered, the policy will be reinstated upon approval of such application by the company or, lacking such approval, upon the 45th day following the date of such conditional...”

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More Illinois sources

• 50 Ill. Adm. Code Part 2904 - Assigned Risk Procedures, workers' compensation (complete Part: Secs. 2904.10 through 2904.240, 24 sections)Regulation
• 50 Ill. Adm. Code Part 3113 - Premium Fund Trust Account (complete Part: Secs. 3113.10 through 3113.70 and Exhibit A, 8 sections)Regulation
• 50 Ill. Adm. Code Part 919 - Improper Claims Practice (complete Part: Secs. 919.10 through 919.100 and Exhibit A, 11 sections)Regulation
• 50 Ill. Adm. Code Part 924 - Equipment Exclusion (complete Part: Secs. 924.10 through 924.50, 5 sections)Regulation
• 215 ILCS 157, Use of Credit Information in Personal Insurance Act (complete Act, Secs. 1 through 99, 15 sections)State statute
• 215 ILCS 5/ Illinois Insurance Code, Article XXVI - Unfair Methods of Competition and Unfair and Deceptive Acts and Practices (Secs. 421-434)State statute
• 215 ILCS 5/ Illinois Insurance Code, Article XXXI - Insurance Producers (selected Secs. 500-15 through 500-120)State statute
• 215 ILCS 5, Article VIIA - Advisory Organizations (Secs. 123A-1 through 123A-15, 15 sections)State statute