Ill. Admin. Code tit. 50 § 2013.60

Current through Register Vol. 48, No. 42, October 18, 2024

Section 2013.60 - Extension of Benefits

a) Every group contract subject to this Part must include a provision for a reasonable extension of benefits in the event of total disability on the date of discontinuance of the group contract as required by subsections (b) and (c) hereunder.

b) In the case of hospital and medical expense coverages and HMO plans, other than dental, pharmaceutical or other limited expense coverages, such extension will be considered "reasonable" if it provides for an extension until the earliest of the following:

1) the end of twelve months; or

2) the date the maximum benefit is reached; or

3) the end of total disability.

c) For other types of hospital or medical expenses plans, such as those limited to hospital expenses only, medical expenses only, or surgical expenses only, such extension will be considered "reasonable" if it provides for an extension until the earliest of the following:

1) ninety days; or

2) the date the maximum benefit is reached; or

3) the end of total disability.

d) In the case of a disability income contract providing benefits for loss of time from work, or specific indemnity during hospital confinement on an accrued liability basis, discontinuance of the group contract during a disability or confinement shall have no effect on benefits payable for that disability or confinement.

e) Any applicable extension of benefits or accrued liability shall be described in the group contract involved as well as in group certificates. All benefits payable during any period of extension of benefits or accrued liability will be subject to the group contract's regular benefit limits (e.g., benefits ceasing at exhaustion of a benefit period or of maximum benefits or benefit restrictions for services provided by unaffiliated providers of an HMO) but in no event shall benefits be reduced solely because of the discontinuance of the group contract except as otherwise permitted by this Part.

f) An extension of benefits need not be provided when an individual's coverage terminates under the group contract in accordance with the contract's eligibility and termination provisions.

Ill. Admin. Code tit. 50, § 2013.60

Amended at 18 Ill. Reg. 16921, effective November 15, 1994