Section 128.210  Eligibility Exclusions and Terminations

a)         A veteran or spouse shall not be determined eligible for Veterans Care if:

1)         The veteran or spouse is an inmate of a public institution.

2)         The veteran or spouse is a resident of a nursing facility.

b)         A veteran's coverage under the program shall be terminated if the veteran:

1)         Loses his or her Illinois residency.  If the spouse loses Illinois residency, only the spouse loses eligibility.

2)         Attains 65 years of age.  If the spouse attains 65 years of age before the veteran, only the spouse loses eligiblity.

3)         Becomes enrolled in Veterans Administration healthcare, medical assistance under the Public Aid Code or health benefits including rebates under the Children's Health Insurance Program Act (CHIPA).  If the spouse becomes enrolled in VA Healthcare, medical assistance under the Public Aid Code or CHIPA, only the spouse loses eligiblity.

4)         Meets the provisions of subsection (a) of this Section.

5)         Fails to pay the premium as specified in Section 128.330.

6)         Fails to report to the Department changes that affect eligibility for the program.

7)         Asks the Department to terminate the coverage.

8)         Is no longer eligible based on any other applicable State or federal law or regulation.

9)         Failed to provide eligibility information that was truthful and accurate to the best of the veteran's knowledge and belief and that affected the veteran's eligibility.

10)         Was incorrectly determined eligible.

11)         Fails to complete the redetermination of eligibility within the required timeframes or provide proof of on-going eligibility.

12)         Becomes a resident of a nursing facility or inmate in a public institution.  If the spouse becomes a resident of a nursing facility or inmate in a public institution, only the spouse loses eligibility.

c)         Following termination of a veteran's coverage under the program, the following action is required before the veteran and spouse can be re-enrolled:

1)         A new application must be completed and the veteran must be determined otherwise eligible.

2)         There must be full payment of premiums due under this Part for periods in which a premium was owed and not paid.

3)         If the termination was the result of non-payment of premiums, the veteran and spouse are ineligible for the program for three months, starting with the first month of cancellation or termination from coverage, before becoming eligible for re-enrollment.

4)         If there was an unpaid premium from a previous coverage period, the unpaid premium, in addition to the first month's premium, must be paid before new coverage may begin.

(Source:  Amended at 36 Ill. Reg. 17062, effective November 26, 2012)