Illinois Administrative Code
Title 50 - INSURANCE
Part 2009 - COORDINATION OF BENEFITS
Section 2009.10 - Purpose and Applicability
Universal Citation: 50 IL Admin Code ยง 2009.10
Current through Register Vol. 48, No. 12, March 22, 2024
a) The purpose of this regulation is to:
1)
Permit, but not require, plans to include a coordination of benefits (COB)
provision;
2) Establish an order in
which plans pay their claims;
3)
Provide the authority for the orderly transfer of information needed to pay
claims promptly;
4) Reduce
duplication of benefits by permitting a reduction of the benefits paid by a
plan when the plan, pursuant to rules established by this Part, does not have
to pay its benefits first;
5)
Reduce claims payment delays; and
6) Make all contracts that contain a COB
provision consistent with this Part.
b) Applicability
1) This Part shall apply to all accident and
health insurance policies or contracts, and group subscriber certificates or
contracts issued thereunder, which are issued, delivered, amended or renewed in
this State on or after November 8, 1988 (the effective date of this
Part).
2) "Plan" does not include:
A) Hospital indemnity coverage benefits or
other fixed idemnity coverage;
B)
Accident only coverage;
C)
Specified disease or specified accident coverage;
D) Limited benefit health coverage;
E) School accident-type coverages that cover
students for accidents only, including athletic injuries, either on a 24-hour
basis or on a "to and from school" basis;
F) Benefits provided in long-term care
insurance policies for nonmedical services, for example, personal care, adult
day care, homemaker services, assistance with activities of daily living,
respite care and custodial care, or for contracts that pay a fixed daily
benefit without regard to expenses incurred or the receipt of
services;
G) Medicare supplement
policies;
H) A state plan under
Medicaid;
I) A governmental plan
that, by law, provides benefits that are in excess of those of any private
insurance plan or other nongovernmental plan; or
J) Disability income protection
coverage.
c) Any group policy subject to this Part that was issued before September 1, 2015 shall be brought into compliance with this Part by the later of:
1) The next anniversary date or renewal date
of the group policy; or
2) The
expiration of any applicable collectively bargained contract pursuant to which
it was written.
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