State RegulationsIL specificDifficulty 2/5
An individual A&H form sold in Illinois defines hospital in a way that excludes most facilities an ordinary purchaser would consider hospitals, shrinking the coverage without the applicant realizing it. Under the Illinois minimum-standards framework, how is this provision treated?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
50 Ill. Adm. Code 2007 prohibits provisions in individual A&H policies that mislead the applicant or encourage misrepresentation. A hidden, heavily narrowed definition of a core term like hospital defeats the standard meaning the regulation's definitions protect and misrepresents the extent of coverage, in tension with the misrepresentation prohibitions of 215 ILCS 5/149. The provision is prohibited on its own terms; it does not become lawful by being printed in the definitions section, and no applicant complaint is a precondition to the rule applying.
Why the other options are wrong
- A) Insurers may not define policy terms however they wish; 50 Ill. Adm. Code 2007 restricts misleading definitions in individual A&H policies.
- B) Placing the narrowed definition in the definitions section does not cure its misleading effect; the prohibition reaches the provision wherever it appears.
- D) The provision is prohibited under 50 Ill. Adm. Code 2007 regardless of whether any applicant files a complaint with the Illinois Department of Insurance.
Memory hook
Hiding a shrunken hospital in fine print misleads, and misleading is banned.