Applicability and Scope

Section 2035.10  Applicability and Scope a)         This Part applies to any issuer, nonfederal governmental payor, or utilization review organization regarding their requirements for or use of utilization review for any of the following types of coverage, excluding excepted benefits: 1)         any group or individual policy, certificate, or evidence of coverage of accident and health insurance subject to the Code; 2)         any group or individual health care plan contract, certificate, or evidence of coverage subject to the HMO Act; or 3)         any coverage for health benefits under a nonfederal governmental plan provided under the State Employees Group Insurance Act of 1971 [5 ILCS 375], the Counties Code [55 ILCS 5], the Illinois Municipal Code [65 ILCS 5], or the School Code [105 ILCS 5]. b)         Nothing contained in this Part shall be construed to restrict any clinical justifications available for covering treatments on an experimental or investigational basis.