Illinois Department of Insurance

Form ELC-1: Employee Leasing Company Registration

$1,000

• Name and official title of the officers and directors of the lessor and its predecessors, successors or alter egos in the preceding 5 years
• Name by jurisdiction of each name the employee leasing company, any owner, partner, officer or director has operated under in the preceding 5 years, including predecessor, successors, or alter ego name
• List of all owners, partners, corporate officers, shareholders with greater than 5% interest and limited liability company individuals who have a 5% or greater interest in the company

Form ELC-1: Employee Leasing Company Registration

$1,000

Annually by the date of issuance.

• Name and official title of the officers and directors of the lessor and its predecessors, successors or alter egos in the preceding 5 years
• Name by jurisdiction of each name the employee leasing company, any owner, partner, officer or director has operated under in the preceding 5 years, including predecessor, successors, or alter ego name
• List of all owners, partners, corporate officers, shareholders with greater than 5% interest and limited liability company individuals who have a 5% or greater interest in the company

Online

$1,000 for accredited organizations or $1,500 for unaccredited organizations.

• For each Independent Review Program submit:
  • The name, address, telephone number and hours of operation for the independent review program
  • The organization and governing structure of the independent review program
  • The number of reviews in Illinois for which an independent review is conducted by each independent review program for the current year
  • Number of reviews in Illinois for which an independent review was conducted for the previous calendar year for each independent review program
  • A copy of your most recent certificate from American Accreditation Healthcare Commission (URAC) Standards for Independent Review Organizations, if applicable
  • Written policies and procedures for protection of confidential information according to applicable State and federal laws for each independent review program
  • Biographical information for organization officers and directors
  • A list of all contracted reviewers, the physician's license number of each reviewer and his or her contact information and area of clinical expertise
• Written policies and procedures that govern all aspects of both the standard external review process and the expedited external review process

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$1,000 for accredited organizations or $1,500 for unaccredited organizations.

Biennially at least 30 days prior to the expiration date.

• A current copy of the applicable accreditation certificate from the American Accreditation Healthcare Commission (URAC) if applicable
• Any material changes to the information filed under your prior registration

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Within 30 days after the change.

50 IL Admin Code 4530.60

Any material changes in the information filed on the registration application must be reported.

Online

$0

Annually by March 1.

50 IL Admin Code 4530.50

Each independent review organization shall maintain written records in the aggregate, by state, and by health carrier on all requests for external review for which it conducted an external review during a calendar year and submit to the director in a report format.