Illinois Laws And Statues Pertinent To Health And Accident Only

Front 1

Benefits and premiums under a Medicare supplement policy may be suspended for up to ______months at the request of the policyholder if he/she becomes eligible for Medicaid. The policyholder must notify the insurer within _____days of eligibility.

Back 1

24 months

90 days

Front 2

Free look period for Medicare policy

Back 2

30 days w/ in its delivery

Front 3

An individual who becomes eligible for Medicare through disability before the age of 65 may not be denied coverage under a Medicare supplement policy if he or she

*
Applies for the policy within ________________
*
Has Medicare and an employer group health plan that _____________
*
Is insured by a Medicare Advantage plan that _______
*
Is insured by a _______ and ________

Back 3

6 months of the 1st day of enrolling for benefits under Medicare Part B;

terminates or stops providing supplemental health benefits;

includes an HMO, a PPO and a Private Fee-for-Service or Medicare select plan and loses this coverage

Medicare supplement policy /loses this coverage.

Front 4

Must provide LTC coverage for at least ________

Back 4

12 consecutive months

Front 5

LTC must cover necessary or medically necessary care services, provided in a

Back 5

setting other than an acute care unit of a hospital.

Front 6

No policy may contain renewal provisions less favorable than _______. No long-term care policy may be cancelled, nonrenewed or otherwise terminated because of the deterioration of the mental or physical health of the insured.

Back 6

"guaranteed renewable"

Front 7

number of days notice the insurer gives to the insured before the policy is terminated or lapses

Back 7

30 days

Front 8

long-term care insurance policy called a _______ is designed to avert the need for people to impoverish themselves before Medicaid takes over their nursing home expenses.

Long-term care partnership insurance policy is any long-term care policy approved as a partnership policy by the _______and issued for delivery to any resident of Illinois which is designed to provide benefits on an expense-incurred or prepaid basis for necessary care as a result of limited functional capacity in a setting other than an acute care unit of a hospital, for at least

Back 8

partnership policy

director

one year from the date of claim after a considerable elimination period.

Front 9

A traditional long-term care insurance policy (if it provides for home health or community care services) must provide total home health or community care coverage in the amount equal at least ____% of one year's coverage available for nursing home benefits under the policy.

Back 9

50%

Front 10

An insurer or insurance producer who is found to have violated any requirement of Illinois relating to the regulation of traditional long-term care policies, or the marketing of such insurance, will be subject to a fine of ________or ________, whichever is greater.

Back 10

up to three times the amount of any commissions paid of each policy involved in the violation,

up to $10,000

Front 11

Preexisting Illness (conditions) may not be defined more restrictively than a condition which:

*
Was diagnosed before coverage began and treated within __months prior to the effective date of coverage;
*
Was diagnosed before coverage began and probably existed without needing to be treated within __months prior to the effective date of coverage; or
*
Evidently existed before coverage began because unmistakable symptoms which ordinarily cause someone to seek treatment appeared within __months prior to the effective date of coverage.

Back 11

24

24

12

Front 12

#
Accidental injury - may not refer to as:

Back 12

"accidental means" or use words such as "external", "violent" or "visible".

Front 13

Accident policies ___contain a probationary period. The probationary period under sickness policies may not exceed _____________

Back 13

may not

6 months except for certain specified causes not treated on an emergency basis.

Front 14

Coverage may not be issued as a dividend unless _________

Back 14

a cash equivalent is also offered as an option.

Front 15

Hospital confinement indemnity coverage may not exclude emergency confinement in a _____

Back 15

federally operated hospital.

Front 16

Accidental death and dismemberment benefits must be payable if the loss occurs within __days of the accident.

Back 16

90

Front 17

Disability income benefits must be payable if the loss occurs within __days of the accident.

Back 17

30

Front 18

In the event a discontinued policy is replaced by another grobe liable only to the extent of its ______________

Back 18

accrued liabilities and extension of benefits.

Front 19

Companies transacting health insurance in the state of Illinois must not discriminate between ______________________ and ____________________

Back 19

the insured of the same class of risk in the issuance of policies or in the amount of premiums or rates charged for insurance.

Front 20

was created as a nonprofit legal entity to protect the insured and their beneficiaries against insolvent or impaired insurers.

Back 20

Illinois Life and Health Insurance Guaranty Association

Front 21

limit on 1 life insurance policy

Back 21

$300,000, but no more than 100,000 in net cash surrender

Front 22

limit on 1 health insurance policy

Back 22

300,000 in health insurance benefits, including any net cash surrender and net cash withdrawal values;

Front 23

limit on 1 life for present value of annuity benefits

Back 23

$100,000 in the present value of annuity benefits, including net cash surrender and net cash withdrawal values; or

Front 24

limit on 1 life for unallocated annuity contract,

Back 24

$5,000,000 to any one contract holder covered by any unallocated annuity contract, regardless of the number of contracts held.

Front 25

In order to transact business in the State of Illinois an organization must be a member of the _________

Back 25

Health Maintenance Organization Guaranty Association.

Front 26

The Health Maintenance Organization Guaranty Association may assess member organizations for funds to support the power and duties that are the responsibility of the Association. The assessment of funds is due within __________

Back 26

30 days after written notice from the Association.

Front 27

The board of directors of the Health Maintenance Organization Guaranty Association consists of 7 to 11 members selected from member organizations subject to the approval of the Director.

Back 27

7 to 11

member organizations subject to the approval of the Director.