50 Ill. Adm. Code 1705.30
Construction of Accident and Health Forms
Section 1705
Section 1705.30 Construction
of Accident and Health Forms
a) A separate certificate which provides for the payment of
benefits as a result of bodily injury, disablement or death by accident and
against disablement resulting from sickness or old age, and every benefit
appertaining thereto, as provided for by subsection (2) of Section 288 of the
Illinois Insurance Code, must be issued in accordance with Article XX of the
Code and of Rules and Regulations pertaining to construction and filing of
Accident and Health forms issued by the Department. (See Section 1705.10(b) of
this Part relative to accident and health benefits provided in or supplemental
to life certificates.)
b) Section 306 of the Illinois Insurance Code (Ill. Rev. Stat.
1981, ch. 73, par. 918) may not be interpreted so as to allow an accident and
health certificate to require that the insured must first seek the services of
a Society's hospital before benefits of a certificate will be paid for expenses
incurred and services rendered.
c) Societies issuing accident and health certificates under the
authority of Section 288 of the Code are not qualified to issue the types of
accident and health certificates authorized by Section 367 of the Code (Ill.
Rev. Stat. 1981, ch. 73, par. 979) except that type described in paragraph (4)
of Section 367 and commonly known as "Family Group Accident and
Health"; nor is any Society qualified to issue the types of certificates
authorized by Section 367(a) of the Code.
d) A certificate issued by Societies of the type authorized by
paragraph (4) of Section 367 of the Code may insure, either originally or by
subsequent amendment, and only upon the application of an adult member of a
family, who is deemed the certificateholder and beneficial member of the
Society, any two or more eligible members of that family. Eligible members of
a family include a husband, a wife, dependent children or any children under a
specified age which may not exceed 19 years, and any other person dependent
upon the certificateholder.
e) Societies issuing accident and health certificates under Section
288 of the Code are qualified to issue the type of accident and health
certificate authorized by Section 368 of the Code, (Ill. Rev. Stat. 1981, ch.
73, par. 980) but such certificates may be issued only upon the signed
application of a person who is deemed to be the certificateholder and
beneficial member of the Society.