(215 ILCS 130/3007) (from Ch. 73, par. 1503-7)
Sec. 3007.
Prior approval of policy forms.
(a) No limited health
service organization shall issue or deliver, in this State, a group
contract or evidence of coverage, attach an endorsement or rider thereto,
incorporate by reference, bylaws or other matter therein or use an
application blank in this State until the form and content of such group
contract or evidence of coverage, endorsement, rider, bylaw or other matter
incorporated by reference or application blank has been filed with and
approved by the Director and, provided further, except that any such
endorsement or rider which is to be attached to a group contract or
evidence of coverage subsequent to the date the group contract or evidence
of coverage is issued must be filed with, reviewed and approved by the
Director prior to the date it is attached to a group contract or evidence
of coverage issued or delivered in this State. The Director shall withhold
approval of any such group contract, evidence of coverage, endorsement,
rider, bylaw or other matter incorporated by reference or application blank
if it contains provisions which may encourage misrepresentation or are
unjust, unfair, inequitable, ambiguous, misleading, inconsistent,
deceptive, contrary to law or to the public policy of this State, or
contains exceptions and conditions that unreasonably or deceptively affect
the risk purported to be assumed in the general coverage of the group
contract or evidence of coverage. In all cases the Director shall approve
or disapprove any such form within 60 days after submission unless the
Director extends, by not more than an additional 30 days, the period within
which he shall approve or disapprove any such form by giving written notice
to the organization of such extension before expiration of the initial 60
day period. The Director shall withdraw his approval of a group contract
or evidence of coverage, endorsement rider, bylaw or other matter
incorporated by reference or application blank if he subsequently
determines that such group contract or evidence of coverage, endorsement,
rider, bylaw, other matter incorporated by reference or
application blank is misrepresentative, unjust, unfair, unequitable,
ambiguous, misleading, inconsistent, deceptive, contrary to law or public
policy of this State, or contains exceptions or conditions which
unreasonably or deceptively affect the risk purported to be assumed in the
general coverage of the group contract or evidence of coverage.
(b) If a previously approved group contract or evidence of coverage,
endorsement, rider, bylaw or other matter incorporated by reference or
application blank is withdrawn from use, the Director shall serve upon the
company an order of withdrawal of use, either personally or by mail, and if
by mail, such service shall be completed if such notice is deposited in the
post office, postage prepaid, addressed to the limited health service
organization's last known address specified in the records of the
Department of Insurance. The order of withdrawal of use shall take effect
30 days from the date of mailing, but shall be stayed if within the 30 day
period a written request for hearing is filed with the Director. Such
hearing shall be held at such time and place as designated in the order
given by the Director. The hearing may be held either in the City of
Springfield, the City of Chicago or in the county where the principal
business address of the limited health service organization is located.
The action of the Director in disapproving or withdrawing such form shall
be subject to judicial review under the Administrative Review Law, as now or
hereafter amended.
(Source: P.A. 86-600.)
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