State RegulationsIL specificDifficulty 2/5
Under the Illinois HMO Act, which official holds regulatory jurisdiction over health maintenance organizations operating in Illinois?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
The Illinois HMO Act, 215 ILCS 125, places health maintenance organizations under the supervision of the Director of Insurance, with the Illinois Department of Insurance administering the Act's requirements, including the duties in sections 4-1 through 4-16, and the implementing rules at 50 Ill. Adm. Code 5421. Producers should understand that HMO regulation is a state insurance function in Illinois.
Why the other options are wrong
- B) Federal health agencies administer federal programs, but regulatory jurisdiction over Illinois HMOs rests with the Director of Insurance under 215 ILCS 125.
- C) HMOs are not self-regulated; the HMO Act and 50 Ill. Adm. Code 5421 impose state supervision and requirements.
- D) The guaranty association addresses insolvency protection for policyholders; it has no regulatory jurisdiction over HMO operations.
Memory hook
In Illinois, the insurance Director, not Washington, watches the HMOs.