Illinois Statutes and Regulations Pertinent to Accident & Health Only

If a loss covered by a policy is continuing at the same time the policy is terminated, how long is coverage for the loss extended?

1 year

MEDICARE SUPPLEMENTS- DISCLOSURE REQUIREMENTS- -outline of coverage must be represented to applicants at the time the app is taken: (2)

1. If the actual policy issued differs from what was described in the outline of coverage, a revised outline of coverage must be presented with the policy at delivery 2. all applicants for medicare supplement policies must ackknowledge receipt of the outline in writing

How long must advertisements be kept on file?

4 years

What is a long-term care partnership insurance policy?

A LTC partnership policy is any long-term care policy approved as a partnership policy by the Director and designed to provide benefits on an expense-incurred or prepaid basis for necessary care as a result of limited functional capacity in a setting other than an acute care unit of a hospital, for at least one year from the date of claim after a considerable elimination period.

What type of information should be disclosed in an individual policy?

A provision describing a policy's renewability, and definitions of phrases like "usual and customary" must be included

1. printed and published 2. audiovisual materials 3. descriptive literature 4. radio and television scripts 5. billboards 6. illustrations 7. form letters 8. sales talks and presentations

ACCIDENT AND HEALTH ADVERTISING includes: (8)

Renewability, cancelability, and termination and any modification of benefits or premiums because of age or other reasons must be disclosed

ACCIDENT HEALTH AND ADVERTISING :

civil penalty of at least $200 and no more than $10,000

ACCIDENT HEALTH AND ADVERTISING: penalties for violations: an insurer or producer who knowingly violates the advertising regulations is guilty of a business offense and subject to........................

May accident policies contain a probationary period?

Accident policies may not contain a probationary or waiting period.

What are the eligibility requirements for coverage through the Health Insurance Marketplace?

Be a U.S. citizen or lawful resident, live in the United States, and not be incarcerated

MANDATORY AGENT PRACTICES: in all medicare supplement sales situations PRODUCERS must have : - this must state whether the policy conforms with the minimum standards for all medicare supplement policies issued in illinois and must be signed by the applicant

Complete a policy checklist

What is the purpose of the Insurance Guaranty Association?

It protects policyowners, insureds, beneficiaries, annuitants, payees, and assignees against insurer insolvency.

no prior institutionalization

LTC policies may ____________ require insureds first to be hospitalized before qualifying for benefits

6 months

LTC- policies and group certificates may only exclude coverage for pre-existing conditions that were diagnosed or treated within the previous ______ months

MUST BE GUARENTEED RENEWAL

LTC-POLICY TERMINATION: except for nonpayment of premiums, LTC policies cannot be cancelled or not renewed- they must be _______

EACH INSURED COVERED FOR 6 CONSECUTIVE MONTHS BEFORE

LTC: conversion and continuation privileges: if a group LTC policy is terminated for any reason except nonpayment of premium__________________ the termination must be given the right to convert to a comparable individual policy, without having to provide evidence of insurability.

any PRODUCER or COMPANY that sells a medicare supplement policy that has not been approved by the director commits a class 3 felony if it is done knowingly and may be fined =$10,000

MEDICARE SUPPLEMENTS- DISCLOSURE REQUIREMENTS- penalties-

No medicare supplement policy can include a probationary period of more than 6 months

MEDICARE SUPPLEMENTS: EXCLUSIONS AND LIMITATIONS -

What is the renewability requirement for Medicare supplement policies issued in this state?

Medigap policies must be guaranteed renewable

How long is a free-look period in Medicare supplement policies?

The required free-look (right to return) period is 30 days

MEDICARE SUPPLEMENTS- DISCLOSURE REQUIREMENTS-PROHIBITED AGENT PRACTICE: PRODUCERS are prohibited from engaging in-------

They may not in any way imply that they are affiliated with or endorsed by medicare or the federal government

What is the minimum standards definition of medicare supplements

To protect senior consumers, medicare supplement policies are held to strict NAIC standards and guidelines, as are the insurers tat issue them and the producers who sell them.

this is a disclosure requirement for medicare supplement policies issued in illiniois- -any ___- that describes medicare supplement policy must clearly explain that the product described is an insurance product and that neither the company nor the producer is affiliated with Medicare or the federal government

advertising

Under the PPACA, what is the limiting age for coverage of children of the insured?

age 26

MEDICARE SUPPLEMENTS: EXCLUSIONS AND LIMITS: Suspension by the policy holder

all medicare supplement policies must provide for a suspension of benefits and premiums (up to 24 months) in the event the policyholder applies for and its entitled to medicaid benefits

this is a minimum standard that medicare supplement policies may exclude coverage of (_______ ___ _____) no longer than 6 months from the date of policy issue

limited pre-existing condition restriction:

If it is determined that a sale will replace another medicare supplement policty, the insurer or agent must give the applicant:

notice regarding replacement

long term care insurance

outline for coverage: - a description of the principla benefits and coverage provided by the policy - a decription of the proncipal exclusions, reductions, and limitations contained on the policy -a description of the policy's terms for renewal -terms under which the polocy (or group certerficate may be returned and premiums refunded -a statement that the outline of coverage is a summary only and not a contract -a brief description of the relationship between cost of care and policy benefits

all, ful, complete, comprehensive, unlimited, up to, as high as, or similar terminology that exggerates benefits or terms of a policy or tax free, extra cash, extra income

the content of an advertisement must be suffiiently clear to avoid deception or the tendency to mislead or deceive, they MAY NOT USE WORDS OR PHRASES:

what is the basic purpose of the guidelines of the minimum standards for medicare supplements?

to ensure standardized overages and simplify terms and benefits of such policies

Medicare supplements

to fill the gaps created by medicare part a & b deductibles and copayments, senior citizens may purchase group or individual __________