Exams / Illinois Accident and Health Insurance Producer License / 215 ILCS 97/25
215 ILCS 97/25 — what it says, and how the exam tests it
This section is cited by 5 of our practice questions and is tested on the Illinois Accident and Health Insurance Producer License.
The text
215 ILCS 97/25. Sec. 25. Prohibiting discrimination against individual participants. (A) In eligibility to enroll. (1) In general. Subject to paragraph (2), a group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on any of the following health status-related factors in relation to the individual or a dependent of the individual: (a) Health status. (b) Medical condition (including both physical and mental illnesses). (c) Claims experience. (d) Receipt of health care. (e) Medical history. (f) Genetic information. (g) Evidence of insurability (including conditions arising out of acts of domestic violence). (h) Disability. (2) No application to benefits or exclusions. To the extent consistent with Section 20, the provisions of paragraph (1) shall not be construed: (a) to require a group health plan, or group health insurance coverage, to provide particular benefits other than those provided under the terms of such plan or coverage; or (b) to prevent such a plan or coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage. (3) Construction. For purposes of paragraph (1), rules for eligibility to enroll under a plan include rules defining any applicable waiting periods for such enrollment. (B) In premium contributions. (1) In general. A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, may not require any individual (as a condition of enrollment or continued enrollment under the plan) to pay a premium or contribution which is greater than such premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health status-related factor in relation to the individual or to an individual enrolled under the plan as a dependent of the individual. (2) Construction. Nothing in paragraph (1) shall be construed: (a) to restrict the amount that an employer may be charged for coverage under a group health plan; or (b) to prevent a group health plan, and a health insurance issuer offering group health insurance coverage, from…
Public record. Read the full, current section at the official source: www.ilga.gov
How it comes up on the exam
Practice questions written from this section — answers and explanations are in the drill.
- Under 215 ILCS 97/25, for purposes of the prohibition against eligibility discrimination, rules for eligibility to enroll under a group health plan include rules defining which of the following?
drill Illinois Statutes and Regulations Pertinent to Accident and Health Insurance Only → - Under 215 ILCS 97/25, a group health plan may NOT require an individual to pay a higher premium based on health status-related factors. However, a plan may modify copayments or deductibles in return for adherence to what?
drill Illinois Statutes and Regulations Pertinent to Accident and Health Insurance Only → - Under 215 ILCS 97/25, a group health plan may NOT establish eligibility rules based on health status-related factors. Which of the following is listed as a health status-related factor?
drill Illinois Statutes and Regulations Pertinent to Accident and Health Insurance Only →