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90_HB3525
215 ILCS 125/4-9.1 from Ch. 111 1/2, par. 1409.2-1
Amends the Health Maintenance Organization Act. Makes a
technical change in a Section concerning termination of
dependent coverage.
LRB9009779JSgc
LRB9009779JSgc
1 AN ACT to amend the Health Maintenance Organization Act
2 by changing Section 4-9.1.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Health Maintenance Organization Act is
6 amended by changing Section 4-9.1 as follows:
7 (215 ILCS 125/4-9.1) (from Ch. 111 1/2, par. 1409.2-1)
8 Sec. 4-9.1. Dependent Coverage Termination.
9 (a) The attainment of a limiting age under a group
10 contract or evidence of coverage that which provides that
11 coverage of a dependent person of an enrollee shall terminate
12 upon attainment of the limiting age for dependent persons
13 does not operate to terminate the coverage of a person who,
14 because of a handicapped condition that occurred before
15 attainment of the limiting age, is incapable of
16 self-sustaining employment and is dependent on his or her
17 parents or other care providers for lifetime care and
18 supervision.
19 (b) For purposes of subsection (a), "dependent on other
20 care providers" is defined as requiring a Community
21 Integrated Living Arrangement, group home, supervised
22 apartment, or other residential services licensed or
23 certified by the Department of Human Services (as successor
24 to the Department of Mental Health and Developmental
25 Disabilities), the Department of Public Health, or the
26 Department of Public Aid.
27 (c) Proof of such incapacity and dependency shall be
28 furnished to the health maintenance organization by the
29 enrollee within 31 days of a request for the information by
30 the health maintenance organization and subsequently as may
31 be required by the health maintenance organization, but not
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1 more frequently than annually. In the absence of proof
2 submitted within 31 days of the such inquiry that such
3 dependent is a disabled and dependent person, the health
4 maintenance organization may terminate coverage of such
5 person at or after attainment of the limiting age. In the
6 absence of such inquiry, coverage of any disabled and
7 dependent person shall continue through the term of the group
8 contract or evidence of coverage or any extension or renewal
9 thereof.
10 (Source: P.A. 88-309; 89-507, eff. 7-1-97.)