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92_SB1825
LRB9215468JSpc
1 AN ACT in relation to health.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 1. Short title. This Act may be cited as the
5 Family Health Insurance Program Act.
6 Section 5. Legislative intent. The General Assembly
7 finds that, for the economic and social benefit of all
8 citizens of this State, it is important to enable low-income
9 families with children to access health benefits coverage,
10 especially for preventive and maintenance health care. This
11 helps these families to maintain and succeed in their work
12 efforts. Coverage of the entire family also promotes the
13 goals of the Children's Health Insurance Program. The
14 General Assembly recognizes that assistance to help families
15 purchase health benefits must be provided in a fair and
16 equitable fashion and must treat families at the same income
17 level in a similar fashion. The State of Illinois should
18 also help low-income families transition from a program in
19 which the State helps the family to secure the family's
20 health coverage to a program in which the family is covered
21 by private or employer-based insurance without help from a
22 State program.
23 Section 10. Definitions.
24 "Children's Health Insurance Program" means the program
25 of health insurance provided under the Children's Health
26 Insurance Program Act.
27 "Department" means the Department of Public Aid.
28 "Family", consistent with Department rules under the
29 Medical Assistance and Children's Health Insurance programs,
30 means a group of people who live together and who include
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1 minor children and their adult caretaker relatives. This may
2 include parents or other blood-related adults when they are
3 the children's caretaker. "Family" also includes the spouses
4 of those parents or caretaker relatives. "Family" also
5 includes any other persons who are defined as covered family
6 members under employer-provided or private health insurance
7 for which a single "family coverage" premium is paid.
8 "Medical Assistance Program" is the health care benefit
9 program provided under Article V of the Illinois Public Aid
10 Code.
11 "Program" means the Family Health Insurance Program.
12 Section 15. Operation of the program. The Family Health
13 Insurance Program is created. The program shall operate
14 subject to appropriation and shall be administered by the
15 Department. Except as otherwise provided in this Act, the
16 program is subject to the same rules and requirements as the
17 Children's Health Insurance Program. Families have the
18 option for their children to participate only in the
19 Children's Health Insurance Program, even if the parents are
20 eligible for coverage under this Act.
21 Section 20. Eligibility.
22 (a) The Department shall be responsible for all
23 determinations of eligibility for the program.
24 (b) To be eligible for health insurance coverage under
25 the program, a family must include a child who meets the
26 non-financial and financial eligibility requirements for
27 health coverage under the Children's Health Insurance Program
28 or non-spend-down coverage under the Medical Assistance
29 Program.
30 (c) A family determined eligible for the program remains
31 eligible for 12 months, as long as it meets the following
32 criteria:
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1 (1) The family is an Illinois resident as defined in
2 rules.
3 (2) At least one child in the family remains under
4 the age of 19.
5 (3) The family is not excluded under subsection (d).
6 The Department shall determine each family's eligibility
7 at least once each year.
8 (d) A family is not eligible for coverage under the
9 program if it meets any of the following criteria:
10 (1) A premium required under the program is not
11 paid. The Department shall adopt rules governing periods
12 of coverage in the event of loss of eligibility due to
13 unpaid premiums, waiting periods and conditions for
14 re-enrollment, grace periods, notices, and hearing
15 procedures relevant to this subsection.
16 (2) There is no longer a child in the family
17 eligible under the Children's Health Insurance Program or
18 non-spend-down Medical Assistance.
19 (3) The family is eligible for health insurance
20 under the State of Illinois health benefits plan on the
21 basis of a family member's employment with a public
22 agency.
23 Section 25. Health benefits for families.
24 (a) Subject to appropriation, the Department shall
25 provide health benefits coverage to eligible families by
26 doing either of the following or a combination if required
27 for federal approval:
28 (1) Subsidizing the cost of a family's coverage, for
29 families with a member who has access to
30 employer-provided or private family health coverage.
31 (2) Providing the family with health benefits that,
32 subject to appropriation and without regard to any
33 applicable cost-sharing under Section 30, are identical
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1 to the benefits provided under the State's approved plan
2 under Title XIX of the Social Security Act or any waivers
3 granted by the federal Health Care Financing
4 Administration, for families that do not have access to
5 employer-provided family health coverage or for whom
6 subsidization of that coverage under paragraph (1) is not
7 cost-effective for the State, as determined by the
8 Department pursuant to rules. Providers of health
9 benefits under this paragraph (2) must be approved by the
10 Department to provide health care under the Illinois
11 Public Aid Code and shall be reimbursed at the same rate
12 as providers under the State's approved plan under Title
13 XIX of the Social Security Act. Any copayments required
14 under Section 30 may be paid to the Department or
15 retained by the provider, as provided by rule.
16 (b) The Department may provide the subsidy pursuant to
17 subdivision (a)(1) directly to an insurance company, as a
18 rebate to the family for premiums paid through payroll
19 deduction, or in any other manner the Department deems
20 cost-effective and accurate and best suited to accomplish the
21 purposes of the program. The Department may also take
22 appropriate measures to ensure that employers do not take
23 unfair advantage of the subsidies provided under subdivision
24 (a)(1) by increasing the subsidized employees' share of the
25 premium for health insurance by amounts out-of-proportion to
26 any increase in the actual total cost of the insurance.
27 (c) The Department may deny subsidization of coverage if
28 the coverage fails to meet minimum benchmark standards
29 adopted by the Department in rules. To be eligible for
30 inclusion in the program, the plan must contain at least
31 comprehensive major medical coverage of physician and
32 hospital inpatient services. The Department may deny
33 subsidization of coverage for a family under subdivision
34 (a)(1) if it is more cost-effective to provide coverage for
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1 the family under subdivision (a)(2).
2 (d) The Department may limit the monthly subsidy to an
3 amount equal to the average monthly cost of providing
4 coverage to comparable parents under subdivision (a)(2), or a
5 larger amount established by the Department by rule. The
6 Department, to the extent it imposes this limitation, must
7 set this "average monthly cost" prospectively based on the
8 prior fiscal year's experience adjusted for
9 incurred-but-not-reported claims and estimated increases or
10 decreases in the cost of medical care. The subsidy may not
11 exceed the amount of the family's share of the premium for
12 the health insurance.
13 Section 30. Cost-sharing.
14 (a) A family enrolled in a health benefits program under
15 subdivision (a)(2) of Section 25 is subject to the following
16 cost-sharing requirements to the extent permitted by federal
17 requirements in waivers governing the funding of the program:
18 (1) A copayment may not be required for well-baby or
19 well-child care, including age-appropriate immunizations
20 as required under federal law.
21 (2) Health insurance premiums for a family whose
22 household income is equal to or greater than 150% of the
23 poverty guidelines updated annually in the Federal
24 Register by the U.S. Department of Health and Human
25 Services under authority of 42 U.S.C. 9902(2) must be
26 payable monthly, subject to rules adopted by the
27 Department for grace periods and advance payments, and
28 must be as follows:
29 (A) $25 for a family composed of 2 covered
30 persons.
31 (B) $30 for a family composed of 3 covered
32 persons.
33 (C) $35 for a family composed of at least one
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1 covered adult and 3 or more covered dependents.
2 (3) Copayments for a family whose income is at or
3 below 150% of the poverty guidelines updated annually in
4 the Federal Register by the U.S. Department of Health and
5 Human Services under authority of 42 U.S.C. 9902(2), at a
6 minimum and to the extent permitted under federal law,
7 must be $2 for each medical visit and each prescription
8 provided under this Act.
9 (4) Copayments for a family whose income is greater
10 than 150% of the poverty guidelines updated annually in
11 the Federal Register by the U.S. Department of Health and
12 Human Services under authority of 42 U.S.C. 9902(2), at a
13 minimum and to the extent permitted under federal law,
14 must be as follows:
15 (A) $5 for each medical visit.
16 (B) $3 for each generic prescription and $5 for
17 each brand-name prescription.
18 (C) $25 for each emergency room use for a
19 non-emergency situation as defined by the Department by
20 rule.
21 (5) The maximum allowable amount of out-of-pocket
22 expenses for copayments is $100 per family per year.
23 (b) A family whose health benefits coverage is subsidized
24 under subdivision (a)(1) of Section 25 is subject to (i) the
25 cost-sharing provisions of the employer-provided or private
26 family health coverage under which a family member is
27 covered, (ii) the requirements imposed by the federal
28 government under any waivers governing federal funding of the
29 program, or (iii) both.
30 Section 35. Funding.
31 (a) The program is not an entitlement and shall not be
32 construed to create an entitlement. Eligibility for the
33 program is subject to appropriation of moneys by the State
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1 and federal governments to fund the program.
2 (b) Any requirement imposed under this Act and any
3 implementation of this Act by the Department shall cease in
4 the event that moneys are not available for those purposes.
5 Section 40. Medical Assistance Plan amendments; federal
6 waivers.
7 (a) The Department shall amend the State's Medical
8 Assistance Plan and the State Children's Health Insurance
9 Plan to the extent required to implement this Act and to the
10 extent permitted by federal law in order to secure federal
11 matching funds for the health coverages provided and
12 administrative expenses incurred under this Act.
13 (b) Promptly after the effective date of this Act, the
14 Department shall request any necessary waivers of federal
15 requirements in order to allow receipt of federal funding for
16 the health coverages subsidized or provided and
17 administrative expenses incurred under this Act.
18 Section 45. Contracts with non-governmental bodies. All
19 contracts with non-governmental bodies that are determined by
20 the Department to be necessary for the implementation of this
21 Act are deemed to be purchase of care as defined in the
22 Illinois Procurement Code.
23 Section 50. Implementation date. The Department must
24 begin implementing this Act on the effective date of this
25 Act. Health benefits coverage may not be subsidized or
26 provided under the program, and applications for enrollment
27 in the program may not be taken, until January 1, 2003 at the
28 earliest. Thereafter, the Department may delay implementation
29 of any portions of the program as to which federal matching
30 funds are not yet approved.
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1 Section 55. Repealer. This Act is repealed on July 1,
2 2008.
3 Section 90. The Illinois Health Insurance Portability
4 and Accountability Act is amended by changing Section 20 as
5 follows:
6 (215 ILCS 97/20)
7 Sec. 20. Increased portability through limitation on
8 preexisting condition exclusions.
9 (A) Limitation of preexisting condition exclusion
10 period; crediting for periods of previous coverage. Subject
11 to subsection (D), a group health plan, and a health
12 insurance issuer offering group health insurance coverage,
13 may, with respect to a participant or beneficiary, impose a
14 preexisting condition exclusion only if:
15 (1) the exclusion relates to a condition (whether
16 physical or mental), regardless of the cause of the
17 condition, for which medical advice, diagnosis, care, or
18 treatment was recommended or received within the 6-month
19 period ending on the enrollment date;
20 (2) the exclusion extends for a period of not more
21 than 12 months (or 18 months in the case of a late
22 enrollee) after the enrollment date; and
23 (3) the period of any such preexisting condition
24 exclusion is reduced by the aggregate of the periods of
25 creditable coverage (if any, as defined in subsection
26 (C)(1)) applicable to the participant or beneficiary as
27 of the enrollment date.
28 (B) Preexisting condition exclusion. A group health
29 plan, and health insurance issuer offering group health
30 insurance coverage, may not impose any preexisting condition
31 exclusion relating to pregnancy as a preexisting condition.
32 Genetic information shall not be treated as a condition
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1 described in subsection (A)(1) in the absence of a diagnosis
2 of the condition related to such information.
3 (C) Rules relating to crediting previous coverage.
4 (1) Creditable coverage defined. For purposes of
5 this Act, the term "creditable coverage" means, with
6 respect to an individual, coverage of the individual
7 under any of the following:
8 (a) A group health plan.
9 (b) Health insurance coverage.
10 (c) Part A or part B of title XVIII of the
11 Social Security Act.
12 (d) Title XIX of the Social Security Act,
13 other than coverage consisting solely of benefits
14 under Section 1928.
15 (e) Chapter 55 of title 10, United States
16 Code.
17 (f) A medical care program of the Indian
18 Health Service or of a tribal organization.
19 (g) A State health benefits risk pool.
20 (h) A health plan offered under chapter 89 of
21 title 5, United States Code.
22 (i) A public health plan (as defined in
23 regulations).
24 (j) A health benefit plan under Section 5(e)
25 of the Peace Corps Act (22 U.S.C. 2504(e)).
26 (k) Title XXI of the federal Social Security
27 Act, State Children's Health Insurance Program.
28 (l) Coverage under the Family Health Insurance
29 Program Act.
30 Such term does not include coverage consisting
31 solely of coverage of excepted benefits.
32 (2) Excepted benefits. For purposes of this Act,
33 the term "excepted benefits" means benefits under one or
34 more of the following:
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1 (a) Benefits not subject to requirements:
2 (i) Coverage only for accident, or
3 disability income insurance, or any combination
4 thereof.
5 (ii) Coverage issued as a supplement to
6 liability insurance.
7 (iii) Liability insurance, including
8 general liability insurance and automobile
9 liability insurance.
10 (iv) Workers' compensation or similar
11 insurance.
12 (v) Automobile medical payment insurance.
13 (vi) Credit-only insurance.
14 (vii) Coverage for on-site medical
15 clinics.
16 (viii) Other similar insurance coverage,
17 specified in regulations, under which benefits
18 for medical care are secondary or incidental to
19 other insurance benefits.
20 (b) Benefits not subject to requirements if
21 offered separately:
22 (i) Limited scope dental or vision
23 benefits.
24 (ii) Benefits for long-term care, nursing
25 home care, home health care, community-based
26 care, or any combination thereof.
27 (iii) Such other similar, limited
28 benefits as are specified in rules.
29 (c) Benefits not subject to requirements if
30 offered, as independent, noncoordinated benefits:
31 (i) Coverage only for a specified disease
32 or illness.
33 (ii) Hospital indemnity or other fixed
34 indemnity insurance.
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1 (d) Benefits not subject to requirements if
2 offered as separate insurance policy. Medicare
3 supplemental health insurance (as defined under
4 Section 1882(g)(1) of the Social Security Act),
5 coverage supplemental to the coverage provided under
6 chapter 55 of title 10, United States Code, and
7 similar supplemental coverage provided to coverage
8 under a group health plan.
9 (3) Not counting periods before significant breaks
10 in coverage.
11 (a) In general. A period of creditable
12 coverage shall not be counted, with respect to
13 enrollment of an individual under a group health
14 plan, if, after such period and before the
15 enrollment date, there was a 63-day period during
16 all of which the individual was not covered under
17 any creditable coverage.
18 (b) Waiting period not treated as a break in
19 coverage. For purposes of subparagraph (a) and
20 subsection (D)(3), any period that an individual is
21 in a waiting period for any coverage under a group
22 health plan (or for group health insurance coverage)
23 or is in an affiliation period (as defined in
24 subsection (G)(2)) shall not be taken into account
25 in determining the continuous period under
26 subparagraph (a).
27 (4) Method of crediting coverage.
28 (a) Standard method. Except as otherwise
29 provided under subparagraph (b), for purposes of
30 applying subsection (A)(3), a group health plan, and
31 a health insurance issuer offering group health
32 insurance coverage, shall count a period of
33 creditable coverage without regard to the specific
34 benefits covered during the period.
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1 (b) Election of alternative method. A group
2 health plan, or a health insurance issuer offering
3 group health insurance, may elect to apply
4 subsection (A)(3) based on coverage of benefits
5 within each of several classes or categories of
6 benefits specified in regulations rather than as
7 provided under subparagraph (a). Such election
8 shall be made on a uniform basis for all
9 participants and beneficiaries. Under such election
10 a group health plan or issuer shall count a period
11 of creditable coverage with respect to any class or
12 category of benefits if any level of benefits is
13 covered within such class or category.
14 (c) Plan notice. In the case of an election
15 with respect to a group health plan under
16 subparagraph (b) (whether or not health insurance
17 coverage is provided in connection with such plan),
18 the plan shall:
19 (i) prominently state in any disclosure
20 statements concerning the plan, and state to
21 each enrollee at the time of enrollment under
22 the plan, that the plan has made such election;
23 and
24 (ii) include in such statements a
25 description of the effect of this election.
26 (d) Issuer notice. In the case of an election
27 under subparagraph (b) with respect to health
28 insurance coverage offered by an issuer in the small
29 or large group market, the issuer:
30 (i) shall prominently state in any
31 disclosure statements concerning the coverage,
32 and to each employer at the time of the offer
33 or sale of the coverage, that the issuer has
34 made such election; and
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1 (ii) shall include in such statements a
2 description of the effect of such election.
3 (5) Establishment of period. Periods of creditable
4 coverage with respect to an individual shall be
5 established through presentation or certifications
6 described in subsection (E) or in such other manner as
7 may be specified in regulations.
8 (D) Exceptions:
9 (1) Exclusion not applicable to certain newborns.
10 Subject to paragraph (3), a group health plan, and a
11 health insurance issuer offering group health insurance
12 coverage, may not impose any preexisting condition
13 exclusion in the case of an individual who, as of the
14 last day of the 30-day period beginning with the date of
15 birth, is covered under creditable coverage.
16 (2) Exclusion not applicable to certain adopted
17 children. Subject to paragraph (3), a group health plan,
18 and a health insurance issuer offering group health
19 insurance coverage, may not impose any preexisting
20 condition exclusion in the case of a child who is adopted
21 or placed for adoption before attaining 18 years of age
22 and who, as of the last day of the 30-day period
23 beginning on the date of the adoption or placement for
24 adoption, is covered under creditable coverage.
25 The previous sentence shall not apply to coverage
26 before the date of such adoption or placement for
27 adoption.
28 (3) Loss if break in coverage. Paragraphs (1) and
29 (2) shall no longer apply to an individual after the end
30 of the first 63-day period during all of which the
31 individual was not covered under any creditable coverage.
32 (E) Certifications and disclosure of coverage.
33 (1) Requirement for Certification of Period of
34 Creditable Coverage.
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1 (a) A group health plan, and a health
2 insurance issuer offering group health insurance
3 coverage, shall provide the certification described
4 in subparagraph (b):
5 (i) at the time an individual ceases to
6 be covered under the plan or otherwise becomes
7 covered under a COBRA continuation provision;
8 (ii) in the case of an individual
9 becoming covered under such a provision, at the
10 time the individual ceases to be covered under
11 such provision; and
12 (iii) on the request on behalf of an
13 individual made not later than 24 months after
14 the date of cessation of the coverage described
15 in clause (i) or (ii), whichever is later.
16 The certification under clause (i) may be provided,
17 to the extent practicable, at a time consistent with
18 notices required under any applicable COBRA
19 continuation provision.
20 (b) The certification described in this
21 subparagraph is a written certification of:
22 (i) the period of creditable coverage of
23 the individual under such plan and the coverage
24 (if any) under such COBRA continuation
25 provision; and
26 (ii) the waiting period (if any) (and
27 affiliation period, if applicable) imposed with
28 respect to the individual for any coverage
29 under such plan.
30 (c) To the extent that medical care under a
31 group health plan consists of group health insurance
32 coverage, the plan is deemed to have satisfied the
33 certification requirement under this paragraph if
34 the health insurance issuer offering the coverage
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1 provides for such certification in accordance with
2 this paragraph.
3 (2) Disclosure of information on previous benefits.
4 In the case of an election described in subsection
5 (C)(4)(b) by a group health plan or health insurance
6 issuer, if the plan or issuer enrolls an individual for
7 coverage under the plan and the individual provides a
8 certification of coverage of the individual under
9 paragraph (1):
10 (a) upon request of such plan or issuer, the
11 entity which issued the certification provided by
12 the individual shall promptly disclose to such
13 requesting plan or issuer information on coverage of
14 classes and categories of health benefits available
15 under such entity's plan or coverage; and
16 (b) such entity may charge the requesting plan
17 or issuer for the reasonable cost of disclosing such
18 information.
19 (3) Rules. The Department shall establish rules to
20 prevent an entity's failure to provide information under
21 paragraph (1) or (2) with respect to previous coverage of
22 an individual from adversely affecting any subsequent
23 coverage of the individual under another group health
24 plan or health insurance coverage.
25 (4) Treatment of certain plans as group health plan
26 for notice provision. A program under which creditable
27 coverage described in subparagraph (c), (d), (e), or (f)
28 of Section 20(C)(1) is provided shall be treated as a
29 group health plan for purposes of this Section.
30 (F) Special enrollment periods.
31 (1) Individuals losing other coverage. A group
32 health plan, and a health insurance issuer offering group
33 health insurance coverage in connection with a group
34 health plan, shall permit an employee who is eligible,
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1 but not enrolled, for coverage under the terms of the
2 plan (or a dependent of such an employee if the dependent
3 is eligible, but not enrolled, for coverage under such
4 terms) to enroll for coverage under the terms of the plan
5 if each of the following conditions is met:
6 (a) The employee or dependent was covered
7 under a group health plan or had health insurance
8 coverage at the time coverage was previously offered
9 to the employee or dependent.
10 (b) The employee stated in writing at such
11 time that coverage under a group health plan or
12 health insurance coverage was the reason for
13 declining enrollment, but only if the plan sponsor
14 or issuer (if applicable) required such a statement
15 at such time and provided the employee with notice
16 of such requirement (and the consequences of such
17 requirement) at such time.
18 (c) The employee's or dependent's coverage
19 described in subparagraph (a):
20 (i) was under a COBRA continuation
21 provision and the coverage under such provision
22 was exhausted; or
23 (ii) was not under such a provision and
24 either the coverage was terminated as a result
25 of loss of eligibility for the coverage
26 (including as a result of legal separation,
27 divorce, death, termination of employment, or
28 reduction in the number of hours of employment)
29 or employer contributions towards such coverage
30 were terminated.
31 (d) Under the terms of the plan, the employee
32 requests such enrollment not later than 30 days
33 after the date of exhaustion of coverage described
34 in subparagraph (c)(i) or termination of coverage or
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1 employer contributions described in subparagraph
2 (c)(ii).
3 (2) For dependent beneficiaries.
4 (a) In general. If:
5 (i) a group health plan makes coverage
6 available with respect to a dependent of an
7 individual,
8 (ii) the individual is a participant
9 under the plan (or has met any waiting period
10 applicable to becoming a participant under the
11 plan and is eligible to be enrolled under the
12 plan but for a failure to enroll during a
13 previous enrollment period), and
14 (iii) a person becomes such a dependent
15 of the individual through marriage, birth, or
16 adoption or placement for adoption,
17 then the group health plan shall provide for a
18 dependent special enrollment period described in
19 subparagraph (b) during which the person (or, if not
20 otherwise enrolled, the individual) may be enrolled
21 under the plan as a dependent of the individual, and
22 in the case of the birth or adoption of a child, the
23 spouse of the individual may be enrolled as a
24 dependent of the individual if such spouse is
25 otherwise eligible for coverage.
26 (b) Dependent special enrollment period. A
27 dependent special enrollment period under this
28 subparagraph shall be a period of not less than 30
29 days and shall begin on the later of:
30 (i) the date dependent coverage is made
31 available; or
32 (ii) the date of the marriage, birth, or
33 adoption or placement for adoption (as the case
34 may be) described in subparagraph (a)(iii).
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1 (c) No waiting period. If an individual seeks
2 to enroll a dependent during the first 30 days of
3 such a dependent special enrollment period, the
4 coverage of the dependent shall become effective:
5 (i) in the case of marriage, not later
6 than the first day of the first month beginning
7 after the date the completed request for
8 enrollment is received;
9 (ii) in the case of a dependent's birth,
10 as of the date of such birth; or
11 (iii) in the case of a dependent's
12 adoption or placement for adoption, the date of
13 such adoption or placement for adoption.
14 (G) Use of affiliation period by HMOs as alternative to
15 preexisting condition exclusion.
16 (1) In general. A health maintenance organization
17 which offers health insurance coverage in connection with
18 a group health plan and which does not impose any
19 pre-existing condition exclusion allowed under subsection
20 (A) with respect to any particular coverage option may
21 impose an affiliation period for such coverage option,
22 but only if:
23 (a) such period is applied uniformly without
24 regard to any health status-related factors; and
25 (b) such period does not exceed 2 months (or 3
26 months in the case of a late enrollee).
27 (2) Affiliation period.
28 (a) Defined. For purposes of this Act, the
29 term "affiliation period" means a period which,
30 under the terms of the health insurance coverage
31 offered by the health maintenance organization, must
32 expire before the health insurance coverage becomes
33 effective. The organization is not required to
34 provide health care services or benefits during such
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1 period and no premium shall be charged to the
2 participant or beneficiary for any coverage during
3 the period.
4 (b) Beginning. Such period shall begin on the
5 enrollment date.
6 (c) Runs concurrently with waiting periods.
7 An affiliation period under a plan shall run
8 concurrently with any waiting period under the plan.
9 (3) Alternative methods. A health maintenance
10 organization described in paragraph (1) may use
11 alternative methods, from those described in such
12 paragraph, to address adverse selection as approved by
13 the Department.
14 (Source: P.A. 90-30, eff. 7-1-97; 90-736, eff. 8-12-98.)
15 Section 95. The Children's Health Insurance Program Act
16 is amended by changing Section 20 as follows:
17 (215 ILCS 106/20)
18 (Section scheduled to be repealed on July 1, 2002)
19 Sec. 20. Eligibility.
20 (a) To be eligible for this Program, a person must be a
21 person who has a child eligible under this Act and who is
22 eligible under a waiver of federal requirements pursuant to
23 an application made pursuant to subdivision (a)(1) of Section
24 40 of this Act or who is a child who:
25 (1) is a child who is not eligible for medical
26 assistance;
27 (2) is a child whose annual household income, as
28 determined by the Department, is above 133% of the
29 federal poverty level and at or below 185% of the federal
30 poverty level; provided, that the Department may
31 establish the upper limit of eligibility at 200% of the
32 federal poverty level as part of acquiring federal
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1 waivers from the federal Health Care Financing
2 Administration allowing Illinois to claim favorable
3 levels of federal matching funds to provide health
4 insurance to adult caretaker relatives of children under
5 the Family Health Insurance Program Act;
6 (3) is a resident of the State of Illinois; and
7 (4) is a child who is either a United States
8 citizen or included in one of the following categories of
9 non-citizens:
10 (A) unmarried dependent children of either a
11 United States Veteran honorably discharged or a
12 person on active military duty;
13 (B) refugees under Section 207 of the
14 Immigration and Nationality Act;
15 (C) asylees under Section 208 of the
16 Immigration and Nationality Act;
17 (D) persons for whom deportation has been
18 withheld under Section 243(h) of the Immigration
19 and Nationality Act;
20 (E) persons granted conditional entry under
21 Section 203(a)(7) of the Immigration and Nationality
22 Act as in effect prior to April 1, 1980;
23 (F) persons lawfully admitted for permanent
24 residence under the Immigration and Nationality Act;
25 and
26 (G) parolees, for at least one year, under
27 Section 212(d)(5) of the Immigration and Nationality
28 Act.
29 Those children who are in the categories set forth in
30 subdivisions (4)(F) and (4)(G) of this subsection, who enter
31 the United States on or after August 22, 1996, shall not be
32 eligible for 5 years beginning on the date the child entered
33 the United States.
34 (b) A child who is determined to be eligible for
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1 assistance shall remain eligible for 12 months, provided the
2 child maintains his or her residence in the State, has not
3 yet attained 19 years of age, and is not excluded pursuant to
4 subsection (c). Eligibility shall be re-determined by the
5 Department at least annually.
6 (c) A child shall not be eligible for coverage under
7 this Program if:
8 (1) the premium required pursuant to Section 30 of
9 this Act has not been paid. If the required premiums are
10 not paid the liability of the Program shall be limited to
11 benefits incurred under the Program for the time period
12 for which premiums had been paid. If the required
13 monthly premium is not paid, the child shall be
14 ineligible for re-enrollment for a minimum period of 3
15 months. Re-enrollment shall be completed prior to the
16 next covered medical visit and the first month's required
17 premium shall be paid in advance of the next covered
18 medical visit. The Department shall promulgate rules
19 regarding grace periods, notice requirements, and hearing
20 procedures pursuant to this subsection;
21 (2) the child is an inmate of a public institution
22 or a patient in an institution for mental diseases; or
23 (3) the child is a member of a family that is
24 eligible for health benefits covered under the State of
25 Illinois health benefits plan on the basis of a member's
26 employment with a public agency.
27 (Source: P.A. 90-736, eff. 8-12-98.)