Illinois Administrative Code
Title 50 - INSURANCE
Part 2035 - MEDICAL NECESSITY CRITERIA FOR SERIOUS MENTAL ILLNESSES FOR INDIVIDUALS UNDER THE AGE OF 26
Section 2035.10 - Applicability and Scope
Universal Citation: 50 IL Admin Code ยง 2035.10
Current through Register Vol. 48, No. 12, March 22, 2024
a) This Part applies to any issuer, nonfederal governmental payor, or utilization review organization regarding their requirements for or use of utilization review for any of the following types of coverage, excluding excepted benefits:
1) any group or individual policy,
certificate, or evidence of coverage of accident and health insurance subject
to the Code;
2) any group or
individual health care plan contract, certificate, or evidence of coverage
subject to the HMO Act; or
3) any
coverage for health benefits under a nonfederal governmental plan provided
under the State Employees Group Insurance Act of 1971 [5 ILCS 375], the
Counties Code [55 ILCS 5], the Illinois Municipal Code [65 ILCS 5], or the
School Code [105 ILCS 5].
b) Nothing contained in this Part shall be construed to restrict any clinical justifications available for covering treatments on an experimental or investigational basis.
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