IL Health Insurance Law Flashcards
Ads must be kept for…
4 years
Ads must disclose…
Elimination/waiting periods; exclusions for pre-existing conditions; source of stats; insurer’s name; any compensation paid for testimonials
Ads can’t…
Frame exclusions as positive; badmouth government insurance options; disparage the competition; frame a product as a “limited time offer” unless it’s true
Probationary periods for illnesses can’t last longer than…
60 days
Accident-only policies need to cover…
Accidents right away
If insurer cancels or non-renews, pregnancy benefits…
Ned to remain in effect for a reasonable time
Pre-existing conditions are those from as far back as…
2 years when applying
Most policies must be guaranteed renewable regardless of…
Deteriorating health
The cost of riders must be…
Disclosed
Applications need to determine if…
Policy is meant to replace another policy
Policies must include…
10 day free-look
Insurers must offer major medical insurance to…
All small groups (2-50) regardless of health
Group plans must be…
Guaranteed Renewable
Insurers that end group coverage must continue…
To cover disabled members for a limited time
Group replacements must carry over deductibles paid within…
90 days of the change
Major medical insurance for groups can’t reject or charge a member more because of…
Health
Pre-existing conditions are those within…
6 months before joining the group
Before the ACA, pre-existing conditions could be excluded for no more than…
1 year
IL Group Health Continuation Law
Employee can keep group coverage for 12 months after leaving group
IL Group Health Continuation Law applies to groups smaller than
20
IL MCR Supplements cannot sell…
Duplicate coverage, multiple policies or coverage that already exists under MCR
Producer compensation for replacing insurance can’t be more than…
Renewing existing coverage
IL MCR Supplement coverage must be…
Guaranteed Renewable
IL MCR Supplement coverage must include…
30 day free-look
LTC Producers need an…
Accident/health license
LTC producers must complete what before selling?
8 hour LTC course
Every 2 years, LTC producers must take what to keep selling?
4 hour LTC course
IL LTC insurance can’t be limited to…
Skilled care or require prior hospitalization
IL LTC insurance must disclose whether policy is..
Tax-qualified
IL LTC insurance must include…
30 day free-look
IL LTC benefit triggers can’t be more restrictive than…
Inability to perform 3 ADLs or cognitive impairment
IL LTC insurance must offer…
Inflation protection
IL LTC insurance must include…
Non-forfeiture benefits
IL LTC: If home care is covered…
Adult day care is covered
IL LTC: Pre-existing conditions are those within…
6 months before applying
IL LTC: Must be at least…
Guaranteed renewable
IL LTC: Price increases based on age can only be until…
65
IL LTC: Must have what grace period?
30 day
IL LTC: Must be able to designate…
Third party who will receive cancelation notices
IL Short-Term Health Insurance
Health insurance must be in place for less than 6 months
IL STC is not…
Guaranteed renewable
IL STC can’t be sold without…
First page disclosures
First-Page Disclosures
Might not offer essential health benefits set by federal law; might not have consumer protections for pre-existing conditions
IL HMO: Must cover out-of-network care and…
Ambulances in emergencies
IL HMO: Must cover reconstructive surgery after…
Mastectomy
IL HMO: Must cover mammograms but…
Can set limits on frequency
IL HMO: Must provide certificates to members within…
30 days
IL HMO: Need a what to deal with disputes?
Grievance committee
IL HMO: Consumers can still…
Complain to the state
Accident and health insurers can’t discriminate based on…
Disability, unless it’s actuarily justified
Accident and health insurers can’t discriminate based purely on basis of…
Blindness
IL Guaranty Association: For health insurer solvency, funds can pay up to…
$500K
IL Guaranty Association: For disability and LTC, funds can pay up to…
$300K
IL Guaranty Association: Ads can’t mention the fund to…
Reassure shoppers
IL Guaranty Association: Doesn’t apply to…
Dental or vision insurance
IL Limited Health Service Organizations provide…
Dental or vision care in manner similar to HMO
IL Limited Health Service Organization rules are similar to those for…
HMO’s
IL Limited Health Service Organization requires what to sell?
Accident and health license
