Ill. Admin. Code tit. 50, § 1705.30 - Construction of Accident and Health Forms
a) A separate certificate which provides for
the payment of benefits as a result of bodily injury, disablement or death by
accident and against disablement resulting from sickness or old age, and every
benefit appertaining thereto, as provided for by subsection (2) of Section 288
of the Illinois Insurance Code, must be issued in accordance with Article XX of
the Code and of Rules and Regulations pertaining to construction and filing of
Accident and Health forms issued by the Department. (See Section
1705.10(b)
of this Part relative to accident and health benefits provided in or
supplemental to life certificates.)
b) Section 306 of the Illinois Insurance Code
(Ill. Rev. Stat. 1981, ch. 73, par. 918) may not be interpreted so as to allow
an accident and health certificate to require that the insured must first seek
the services of a Society's hospital before benefits of a certificate will be
paid for expenses incurred and services rendered.
c) Societies issuing accident and health
certificates under the authority of Section 288 of the Code are not qualified
to issue the types of accident and health certificates authorized by Section
367 of the Code (Ill. Rev. Stat. 1981, ch. 73, par. 979) except that type
described in paragraph (4) of Section 367 and commonly known as "Family Group
Accident and Health"; nor is any Society qualified to issue the types of
certificates authorized by Section 367(a) of the Code.
d) A certificate issued by Societies of the
type authorized by paragraph (4) of Section 367 of the Code may insure, either
originally or by subsequent amendment, and only upon the application of an
adult member of a family, who is deemed the certificateholder and beneficial
member of the Society, any two or more eligible members of that family.
Eligible members of a family include a husband, a wife, dependent children or
any children under a specified age which may not exceed 19 years, and any other
person dependent upon the certificateholder.
e) Societies issuing accident and health
certificates under Section 288 of the Code are qualified to issue the type of
accident and health certificate authorized by Section 368 of the Code, (Ill.
Rev. Stat. 1981, ch. 73, par. 980) but such certificates may be issued only
upon the signed application of a person who is deemed to be the
certificateholder and beneficial member of the Society.
Notes
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