Illinois Administrative Code
Title 50 - INSURANCE
Part 2051 - PREFERRED PROVIDER PROGRAMS
Section 2051.320 - Discounted Health Care Services Plan Requirements
Current through Register Vol. 48, No. 12, March 22, 2024
a) A DHCSP administrator shall have a written agreement between the administrator and its beneficiaries that specifies the benefits a beneficiary is to receive under the DHCSP and that complies with this Section. For insurers offering a DHCSP as part of a policy of insurance, the certificate or policy may act as the written agreement.
b) All agreements between DHCSP administrators and beneficiaries shall contain at a minimum:
c) If a DHCSP cancels a membership for any reason other than nonpayment of charges by the beneficiary, the DHCSP shall make a pro rata reimbursement of all periodic charges to the member.
d) DHCSP administrators must provide the following disclosures in writing to any prospective beneficiary of a DHCSP before purchase, as well as in all beneficiary agreements. If the initial contact with the prospective beneficiary is by telephone, the disclosures shall be made orally and included in the written agreement required by subsection (a). The disclosures shall also be provided on the first page of any advertisements, marketing materials or brochures relating to a DHCSP or, if that is not possible, on the first page listing plan information. The following disclosures must be prominently displayed:
e) Whenever a DHCSP is sold in conjunction with any other product that can be purchased separately, including a policy of insurance, the administrator or DHCSP administrator must provide in writing to the beneficiary the charges for the DHCSP product.
f) Any initial one-time processing, administrative or other such non-regular or periodic charge may not exceed $30.
g) A DHCSP administrator shall annually file with the Director a listing of all private label marketers with whom it has a direct or indirect contractual relationship respecting the marketing or use of the administrator's DHCSP under a name other than that of the administrator. A DHCSP administrator shall inform the Department of any additional private label marketers with whom it contracts and of any cancellation or non-renewal of a contract within 30 days after the execution, cancellation or non-renewal of those contracts. A listing of private label marketers must contain:
h) A DHCSP administrator shall ensure that any private label marketer whom it identifies under subsection (g) or with whom it has an obligation to identify under subsection (g):
i) A private label marketer that is not identified as such pursuant to subsection (g) must register as a DHCSP administrator under this Part.
j) A DHCSP shall identify specific providers in a beneficiary's area, confirm specific provider participation or provide a listing of participating providers by mail. Participating provider lists requested by phone must be sent within 3 working days. Any provider listing must include all participating providers with whom the administrator has contracted either directly or indirectly through another DHCSP administrator.