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Illinois · Through at least Public Act 104-790

215 ILCS 97/65: Past-due premiums.

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Where this section sits in the code
  1. CHAPTER 215 INSURANCE
  2. Illinois Health Insurance Portability and Accountability Act.

(a) Except as provided in subsection (b) for a third plan or policy year, a health insurance issuer in the individual, small group, or large group market shall not deny coverage to an individual or employer due to the individual's or employer's failure to pay a premium owed under a prior policy, certificate, or contract of health insurance coverage, including by attributing payment of premium for a new policy, certificate, or contract of health insurance coverage to the prior policy, certificate, or contract. The use of "one," "first," "second," and "third" in this Section does not limit its applicability to situations when terminations or cancellations occur in consecutive plan or policy years.

(b) If a health insurance issuer terminates or cancels an individual or employer's coverage for nonpayment of premium in one plan or policy year and if the individual or employer enrolls in or purchases a new policy, certificate, or contract of health insurance coverage from the same issuer in a second plan or policy year, the issuer shall comply with subsection (a) if the individual or employer again enrolls in or purchases a new policy, certificate, or contract of health insurance coverage from the same issuer in a third plan or policy year unless:

(1) the individual or employer had past-due premiums from the first plan or policy year and all past-due amounts from the first and second years have not been paid; and

(2) during the second plan or policy year, the issuer offered a payment plan to the individual or employer under which all past-due premiums from the first plan or policy year would be spread out over 12 monthly billing periods starting with the bill for the first month of coverage in the second plan or policy year and the individual or employer failed to fulfill the requirements of the payment plan through the end of the 12-month period. As required by subsection (a), the issuer shall not attribute payments of premium for the new policy, certificate, or contract to amounts due under the payment plan.

(c) Except to the extent that a health insurance issuer must adhere to the terms of a payment plan it offers under paragraph (2) of subsection (b), nothing in this Section prohibits a health insurance issuer from pursuing the collection of past-due premiums from an individual or employer by any other means permitted by law.

(d) Nothing in this Section shall supersede the requirements of Sections 30 or 50 of this Act. Nothing in this Section shall supersede any requirements related to grace periods or binder payments under applicable law. Subsection (b) shall be inoperative if a court or the United States Department of Health and Human Services interprets any exception to a provision substantially similar to subsection (a) to violate 42 U.S.C. 300gg-1 or federal regulations thereunder.

(e) For purposes of this Section, amounts are not considered past due with respect to any portion of a plan or policy year falling after the effective date of a termination, cancellation, or rescission or after the issuer declines to effectuate coverage due to the individual or employer's failure to make a timely binder payment.

(f) This Section does not apply to a grandfathered health plan.

(g) For the purposes of this subsection, "renewal" means the continuation in force of an existing policy, certificate, or contract of health insurance coverage with the same issuer for a subsequent plan or policy year. This Section applies only to an individual or employer enrolling in or purchasing a new policy, certificate, or contract of health insurance coverage and shall not be construed to establish requirements or prohibitions for the renewal of an existing policy, certificate, or contract of health insurance coverage.

Collected 2026-09-15T04:46:30Z. Source file · JSON

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