Ill. Admin. Code tit. 50, § 2051.330 - Insurer Requirements
a) As
required by Section 143(1) of the Code and consistent with the requirements of
50 Ill. Adm. Code 916, insurers must file the following compliance documents in
the format prescribed in the Insurer Filing Requirements Form, located under
"Managed Care License/Registration Information" on the Department 's website at
http://insurance.illinois.gov/company/companyMain.html,
each time a policy incorporating a preferred provider arrangement is filed, or
when the insurer markets, leases, sells or otherwise issues DHCSPs to
beneficiaries, either directly or indirectly, independent of insurance
coverage:
1) Sample copies of all payor
agreements as required by Section
2051.280,
when applicable, and provider agreements as required by Section
2051.290.
If the terms and conditions in the agreements include significant, substantial
or material changes or additions, the filing of one complete sample of each
type of agreement, together with a description of all variable terms and
conditions, will satisfy this requirement;
3) Network availability and adequacy
requirements pursuant to Section
2051.310;
and
4) DHCSPs' requirements
pursuant to Section
2051.320,
if applicable.
b) When
incorporated in a policy filing, the filing requirements of subsection (a) may
be waived if the preferred provider arrangement information had previously been
filed and is identified in the subsequent filing.
c) Any material changes or additions to the
preferred provider program filed in accordance with subsection (a) must be
reported to the Director within 30 days after the end of the month of each
change or addition. The change or addition shall be filed informationally in
accordance with Section 143(1) of the Code and consistent with the requirements
of 50 Ill. Adm. Code 916. A material change or addition includes any
modification of the information required by this Part that has significant
effect on the operation of the administrator or DHCSP administrator or on the
availability and accessibility of health care.
d) All advertising and solicitation by an
insurer regarding a DHCSP must comply with the requirements established by
Section
2051.360.
e) Insurers may not market EPO plans in this
State, except when such an arrangement is shown to be in the best interest of
the beneficiaries and has been expressly approved by the Director in
writing.
f) Insurers offering a
DHCSP as part of a policy of insurance must set off the DHCSP provisions from
the insurance coverage and disclose information as required by Section
2051.320(d)(3)
through (5).
Notes
Amended at 37 Ill. Reg. 2895, effective March 4, 2013
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