325 ILCS 20/13.25

(325 ILCS 20/13.25)

(Section scheduled to be repealed on July 1, 2026)

Sec. 13.25.

Private insurance; exemption.

(a) The lead
agency shall establish procedures for a
family, whose child is eligible to receive early
intervention
services, to apply for an exemption restricting the
use of
its private insurance plan or policy based on
material risk
of loss of coverage as authorized under subsection (c) of this Section.

(b) The lead agency shall make a final determination on a request
for an
exemption within 10 business days after its receipt of a
written
request for an exemption at the regional intake
entity.
During that 10 days, no claims may be filed
against the
insurance plan or policy. If the exemption is
granted, it
shall be noted on the individualized family service
plan, and
the family and the providers serving the family
shall be
notified in writing of the exemption.

(c) An exemption may be granted on the basis of material risk of loss of
coverage only if the family
submits documentation with its request for an exemption that
establishes (i) that the
insurance plan or policy covering the child is an
individually
purchased plan or policy and has been purchased by a
head of a
household that is not eligible for a group medical insurance
plan, (ii) that the policy or plan has a
lifetime cap that applies to one or more specific types of early
intervention services specified in the family's individualized family service
plan, and that coverage could be exhausted during the period covered by the
individualized
family service plan, or
(iii) proof of another risk that the lead agency, in its discretion, may have
additionally established and defined as a ground for exemption by rule.

(d) An exemption under this Section based on material risk of loss of
coverage may apply
to all
early intervention services and all plans or
policies
insuring the child, may be limited to one or more
plans or
policies, or may be limited to one or more types
of early
intervention services in the child's individualized
family
services plan.

(Source: P.A. 92-307, eff. 8-9-01.)