Illinois § 4-14 Evidence of Coverage

Illinois Statutes

§ 4-14 — Evidence of Coverage

Illinois·Topic REGULATION·Ch. 215 INSURANCE·Act 215 ILCS 125/ Health Maintenance Organization Act.·Art. Article IV - Delivery Of Services - Required Provisions And Marketing

(a)Every subscriber shall be issued an evidence of coverage, which shall contain a clear and complete statement of:

(1)The health services to which each enrollee is entitled;

(2)Eligibility requirements indicating the conditions which must be met to enroll in a Health Care Plan;

(3)Any limitation of the services, kinds of services or benefits to be provided, and exclusions, including any reasonable deductibles, copayments, or other charges;

(4)The terms or conditions upon which coverage may be cancelled or otherwise terminated;

(5)Where and in what manner information is available as to where and how services may be obtained; and (6) The method for resolving complaints.

(b)Any amendment to the evidence of coverage may be provided to the subscriber in a separate document.

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(a) Every subscriber shall be issued an evidence of coverage, which shall contain a clear and complete statement of: (1) The health services to which each enrollee is entitled; (2) Eligibility requirements indicating the conditions which must be met to enroll in a Health Care Plan; (3) Any limitation of the services, kinds of services or benefits to be provided, and exclusions, including any reasonable deductibles, copayments, or other charges; (4) The terms or conditions upon which coverage may be cancelled or otherwise terminated; (5) Where and in what manner information is available as to where and how services may be obtained; and (6) The method for resolving complaints. (b) Any amendment to the evidence of coverage may be provided to the subscriber in a separate document.

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