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(215 ILCS 125/4-17)
Sec. 4-17. Basic outpatient preventive and primary health care services
for children. In order to attempt to address the needs of children in Illinois
(i) without health care coverage, either through a parent's employment, through
medical assistance under the Illinois Public Aid Code, or any other health plan
or (ii) who lose medical assistance if and when their parents move from welfare
to work and do not find employment that offers health care coverage, a
health maintenance organization may undertake to provide or arrange for and to
pay for or reimburse the cost of basic outpatient preventive and primary health
care services. The Department shall promulgate rules to establish minimum
coverage and disclosure requirements. These requirements at a minimum shall
include routine physical examinations and immunizations, sick visits,
diagnostic x-rays and laboratory services, and emergency outpatient services.
Coverage may also include preventive dental services, vision screening and one
pair of eyeglasses, prescription drugs, and mental health services.
The coverage may include any
reasonable co-payments, deductibles, and benefit maximums subject to
limitations established by the Director by rule. Coverage shall be
limited to children who are 18 years of age or under, who have resided
in the State of Illinois for at least 30 days, and who do not qualify for
medical assistance under the Illinois Public Aid Code. Any such coverage
shall be made available to an adult on behalf of such children
and shall not be funded through State appropriations. In counties with
populations in excess of 3,000,000, the Director shall not approve any
arrangement under this Section unless and until an arrangement for at least one
health maintenance organization under
contract with the Department of Healthcare and Family Services (formerly
Illinois Department of Public Aid) for furnishing health
services pursuant to Section 5-11 of the Illinois Public Aid Code and for which
the requirements of 42 CFR 434.26(a) have been waived is approved.
(Source: P.A. 95-331, eff. 8-21-07.)
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