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92_HB0023ham001
LRB9200767DJmgam04
1 AMENDMENT TO HOUSE BILL 23
2 AMENDMENT NO. . Amend House Bill 23 by replacing the
3 title of the bill with the following:
4 "AN ACT in relation to health."; and
5 by replacing everything after the enacting clause with the
6 following:
7 "Section 1. Short title. This Act may be cited as the
8 Family Health Insurance Program Act.
9 Section 5. Legislative intent. The General Assembly
10 finds that, for the economic and social benefit of all
11 citizens of this State, it is important to enable low-income
12 families with children to access health benefits coverage,
13 especially for preventive and maintenance health care. This
14 helps these families to maintain and succeed in their work
15 efforts. Coverage of the entire family also promotes the
16 goals of the Children's Health Insurance Program. The
17 General Assembly recognizes that assistance to help families
18 purchase health benefits must be provided in a fair and
19 equitable fashion and must treat families at the same income
20 level in a similar fashion. The State of Illinois should
21 also help low-income families transition from a program in
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1 which the State helps the family to secure the family's
2 health coverage to a program in which the family is covered
3 by private or employer-based insurance without help from a
4 State program.
5 Section 10. Definitions.
6 "Children's Health Insurance Program" means the program
7 of health insurance provided under the Children's Health
8 Insurance Program Act.
9 "Department" means the Department of Public Aid.
10 "Family" means a group of people who live together and
11 who include minor children and their parents or other
12 blood-related adults who are the children's caretaker
13 relatives, and the spouses of those parents or caretaker
14 relatives. "Family" also includes any other persons who are
15 defined as covered family members under employer-provided or
16 private health insurance for which a single "family coverage"
17 premium is paid.
18 "Medical Assistance Program" is the health care benefit
19 program provided under Article V of the Illinois Public Aid
20 Code.
21 "Non-spend-down" Medical Assistance means benefits under
22 the Medical Assistance Program for which the beneficiary
23 qualifies without any required financial contribution.
24 "Program" means the Family Health Insurance Program.
25 Section 15. Operation of the program. The Family Health
26 Insurance Program is created. The program shall operate
27 subject to appropriation and shall be administered by the
28 Department. Except as otherwise provided in this Act, the
29 program is subject to the same rules and requirements as the
30 Children's Health Insurance Program. Families have the
31 option to participate only in the Children's Health Insurance
32 Program, even if they are eligible for coverage under this
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1 Act.
2 Section 20. Eligibility.
3 (a) The Department shall make all determinations of
4 eligibility for the program.
5 (b) To be eligible for health insurance coverage under
6 the program, a family must include a child who meets the
7 non-financial and financial eligibility requirements for
8 health coverage under the Children's Health Insurance Program
9 or non-spend-down coverage under the Medical Assistance
10 Program.
11 (c) A family determined eligible for the program remains
12 eligible for 12 months, as long as it meets the following
13 criteria:
14 (1) The family maintains a residence within
15 Illinois.
16 (2) At least one child in the family remains under
17 the age of 19.
18 (3) The family is not excluded under subsection (d).
19 The Department shall determine each family's eligibility
20 at least once each year.
21 (d) A family is not eligible for coverage under the
22 program if it meets any of the following criteria:
23 (1) A premium required under the program is not
24 paid. The Department shall adopt rules governing periods
25 of coverage in the event of loss of eligibility due to
26 unpaid premiums, waiting periods and conditions for
27 re-enrollment, grace periods, notices, and hearing
28 procedures relevant to this subsection.
29 (2) There is no longer a child in the family
30 eligible under the Children's Health Insurance Program or
31 non-spend-down Medical Assistance.
32 (3) The family is eligible for health insurance
33 under the State of Illinois health benefits plan on the
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1 basis of a family member's employment with a public
2 agency, or the whole family is eligible for
3 non-spend-down Medical Assistance.
4 Section 25. Health benefits for families.
5 (a) Subject to appropriation, the Department shall
6 provide health benefits coverage to eligible families by
7 doing either of the following:
8 (1) Subsidizing the cost of a family's coverage, for
9 families with a member who has access to
10 employer-provided family health coverage.
11 (2) Providing the family with health benefits that,
12 subject to appropriation and without regard to any
13 applicable cost-sharing under Section 30, are identical
14 to the benefits provided under the State's approved plan
15 under Title XIX of the Social Security Act or any waivers
16 granted by the federal Health Care Financing
17 Administration, for families that do not have access to
18 employer-provided family health coverage or for whom
19 subsidization of that coverage under paragraph (1) is not
20 cost-effective for the State, as determined by the
21 Department pursuant to rules. Providers of health
22 benefits under this paragraph (2) must be approved by the
23 Department to provide health care under the Illinois
24 Public Aid Code and shall be reimbursed at the same rate
25 as providers under the State's approved plan under Title
26 XIX of the Social Security Act. Any copayments required
27 under Section 30 may be paid to the Department or
28 retained by the provider, as provided by rule.
29 (b) The Department may provide the subsidy pursuant to
30 subdivision (a)(1) directly to an insurance company, as a
31 rebate to the family for premiums paid through payroll
32 deduction, or in any other manner the Department deems
33 cost-effective and accurate and best suited to accomplish the
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1 purposes of the program. The Department may also take
2 appropriate measures to ensure that employers do not take
3 unfair advantage of the subsidies provided under subdivision
4 (a)(1) by increasing the subsidized employees' share of the
5 premium for health insurance by amounts out-of-proportion to
6 any increase in the actual total cost of the insurance.
7 (c) The Department may not deny subsidization of coverage
8 to a family with a member who has access to an
9 employer-provided health plan under subdivision (a)(1)
10 because the plan does not meet federal benchmarking standards
11 or cost-sharing and contribution requirements. To be
12 eligible for inclusion in the program, the plan must contain
13 comprehensive major medical coverage of physician and
14 hospital inpatient services. The Department may not deny
15 subsidization of coverage for a family under subdivision
16 (a)(1) because the employer-based plan offers benefits in
17 addition to coverage of physician and hospital inpatient
18 services. The Department may deny subsidization of coverage
19 for a family under subdivision (a)(1) if it is more
20 cost-effective to provide coverage for the family under
21 subdivision (a)(2).
22 (d) The monthly dollar amount of the subsidy for family
23 coverage under subdivision (a)(1) shall be an amount that
24 allows the family to pay no more than 2% of its average net
25 income per month toward its share of the premium for the
26 health insurance.
27 The Department, however, may limit the monthly subsidy to
28 an amount equal to the average monthly cost of providing
29 coverage to identically configured families under subdivision
30 (a)(2), or a larger amount established by the Department by
31 rule. The Department, to the extent it imposes this
32 limitation, must set this "average monthly cost"
33 prospectively based on the prior fiscal year's experience
34 adjusted for incurred-but-not-reported claims and estimated
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1 increases or decreases in the cost of medical care. The
2 subsidy may not exceed the amount of the family's share of
3 the premium for the health insurance.
4 Section 30. Cost-sharing.
5 (a) A family enrolled in a health benefits program under
6 subdivision (a)(2) of Section 25 is subject to the following
7 cost-sharing requirements to the extent permitted by federal
8 requirements in waivers governing the funding of the program:
9 (1) A copayment may not be required for well-baby or
10 well-child care, including age-appropriate immunizations
11 as required under federal law.
12 (2) Health insurance premiums for a family whose
13 household income is equal to or greater than 150% of the
14 poverty guidelines updated annually in the Federal
15 Register by the U.S. Department of Health and Human
16 Services under authority of 42 U.S.C. 9902(2) must be
17 payable monthly, subject to rules adopted by the
18 Department for grace periods and advance payments, and
19 must be as follows:
20 (A) $25 for a family composed of an adult and
21 one dependent.
22 (B) $30 for a family composed of an adult and 2
23 dependents.
24 (C) $35 for a family composed of an adult and 3
25 or more dependents.
26 (3) Copayments for a family whose income is less
27 than 150% of the poverty guidelines updated annually in
28 the Federal Register by the U.S. Department of Health and
29 Human Services under authority of 42 U.S.C. 9902(2), at a
30 minimum and to the extent permitted under federal law,
31 must be $2 for each medical visit and each prescription
32 provided under this Act.
33 (4) Copayments for a family whose income is equal to
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1 or greater than 150% of the poverty guidelines updated
2 annually in the Federal Register by the U.S. Department
3 of Health and Human Services under authority of 42 U.S.C.
4 9902(2), at a minimum and to the extent permitted under
5 federal law, must be as follows:
6 (A) $5 for each medical visit.
7 (B) $3 for each generic prescription and $5 for
8 each brand-name prescription.
9 (C) $25 for each emergency room use for a
10 non-emergency situation as defined by the Department by
11 rule.
12 (5) The maximum allowable amount of out-of-pocket
13 expenses for copayments is $100 per family per year.
14 (b) A family whose health benefits coverage is subsidized
15 under subdivision (a)(1) of Section 25 is subject to (i) the
16 cost-sharing provisions of the employer-provided family
17 health coverage to which a family member has access, (ii) the
18 requirements imposed by the federal government under any
19 waivers governing federal funding of the program, or (iii)
20 both.
21 Section 35. Funding.
22 (a) The program is not an entitlement and shall not be
23 construed to create an entitlement. Eligibility for the
24 program is subject to appropriation of moneys by the State
25 and federal governments to fund the program.
26 (b) Any requirement imposed under this Act and any
27 implementation of this Act by the Department shall cease in
28 the event that moneys are not available for those purposes.
29 Section 40. Medical Assistance Plan amendments; federal
30 waivers.
31 (a) The Department shall amend the State's Medical
32 Assistance Plan to the extent permitted by federal law in
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1 order to secure federal matching funds for the health
2 coverages provided and administrative expenses incurred under
3 this Act.
4 (b) Promptly after the effective date of this Act, the
5 Department shall request any necessary waivers of federal
6 requirements in order to allow receipt of federal funding for
7 the health coverages subsidized or provided and
8 administrative expenses incurred under this Act. The
9 Department must implement the program, however, even if the
10 federal government denies all or some of the requested
11 waivers, to the extent that State appropriations permit.
12 Section 45. Contracts with non-governmental bodies. All
13 contracts with non-governmental bodies that are determined by
14 the Department to be necessary for the implementation of this
15 Act are deemed to be purchase of care as defined in the
16 Illinois Procurement Code.
17 Section 50. Implementation date. The Department must
18 begin implementing this Act on the effective date of this
19 Act. Health benefits coverage may not be subsidized or
20 provided under the program, and applications for enrollment
21 in the program may not be taken, until January 1, 2002 at the
22 earliest. Portions of the program as to which the Department
23 is awaiting federal action on a waiver request may be
24 implemented upon learning of the federal decision on the
25 request.
26 Section 55. Repealer. This Act is repealed on June 30,
27 2007.
28 Section 90. The Illinois Health Insurance Portability
29 and Accountability Act is amended by changing Section 20 as
30 follows:
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1 (215 ILCS 97/20)
2 Sec. 20. Increased portability through limitation on
3 preexisting condition exclusions.
4 (A) Limitation of preexisting condition exclusion
5 period; crediting for periods of previous coverage. Subject
6 to subsection (D), a group health plan, and a health
7 insurance issuer offering group health insurance coverage,
8 may, with respect to a participant or beneficiary, impose a
9 preexisting condition exclusion only if:
10 (1) the exclusion relates to a condition (whether
11 physical or mental), regardless of the cause of the
12 condition, for which medical advice, diagnosis, care, or
13 treatment was recommended or received within the 6-month
14 period ending on the enrollment date;
15 (2) the exclusion extends for a period of not more
16 than 12 months (or 18 months in the case of a late
17 enrollee) after the enrollment date; and
18 (3) the period of any such preexisting condition
19 exclusion is reduced by the aggregate of the periods of
20 creditable coverage (if any, as defined in subsection
21 (C)(1)) applicable to the participant or beneficiary as
22 of the enrollment date.
23 (B) Preexisting condition exclusion. A group health
24 plan, and health insurance issuer offering group health
25 insurance coverage, may not impose any preexisting condition
26 exclusion relating to pregnancy as a preexisting condition.
27 Genetic information shall not be treated as a condition
28 described in subsection (A)(1) in the absence of a diagnosis
29 of the condition related to such information.
30 (C) Rules relating to crediting previous coverage.
31 (1) Creditable coverage defined. For purposes of
32 this Act, the term "creditable coverage" means, with
33 respect to an individual, coverage of the individual
34 under any of the following:
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1 (a) A group health plan.
2 (b) Health insurance coverage.
3 (c) Part A or part B of title XVIII of the
4 Social Security Act.
5 (d) Title XIX of the Social Security Act,
6 other than coverage consisting solely of benefits
7 under Section 1928.
8 (e) Chapter 55 of title 10, United States
9 Code.
10 (f) A medical care program of the Indian
11 Health Service or of a tribal organization.
12 (g) A State health benefits risk pool.
13 (h) A health plan offered under chapter 89 of
14 title 5, United States Code.
15 (i) A public health plan (as defined in
16 regulations).
17 (j) A health benefit plan under Section 5(e)
18 of the Peace Corps Act (22 U.S.C. 2504(e)).
19 (k) Title XXI of the federal Social Security
20 Act, State Children's Health Insurance Program.
21 (l) Coverage under the Family Health Insurance
22 Program Act.
23 Such term does not include coverage consisting
24 solely of coverage of excepted benefits.
25 (2) Excepted benefits. For purposes of this Act,
26 the term "excepted benefits" means benefits under one or
27 more of the following:
28 (a) Benefits not subject to requirements:
29 (i) Coverage only for accident, or
30 disability income insurance, or any combination
31 thereof.
32 (ii) Coverage issued as a supplement to
33 liability insurance.
34 (iii) Liability insurance, including
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1 general liability insurance and automobile
2 liability insurance.
3 (iv) Workers' compensation or similar
4 insurance.
5 (v) Automobile medical payment insurance.
6 (vi) Credit-only insurance.
7 (vii) Coverage for on-site medical
8 clinics.
9 (viii) Other similar insurance coverage,
10 specified in regulations, under which benefits
11 for medical care are secondary or incidental to
12 other insurance benefits.
13 (b) Benefits not subject to requirements if
14 offered separately:
15 (i) Limited scope dental or vision
16 benefits.
17 (ii) Benefits for long-term care, nursing
18 home care, home health care, community-based
19 care, or any combination thereof.
20 (iii) Such other similar, limited
21 benefits as are specified in rules.
22 (c) Benefits not subject to requirements if
23 offered, as independent, noncoordinated benefits:
24 (i) Coverage only for a specified disease
25 or illness.
26 (ii) Hospital indemnity or other fixed
27 indemnity insurance.
28 (d) Benefits not subject to requirements if
29 offered as separate insurance policy. Medicare
30 supplemental health insurance (as defined under
31 Section 1882(g)(1) of the Social Security Act),
32 coverage supplemental to the coverage provided under
33 chapter 55 of title 10, United States Code, and
34 similar supplemental coverage provided to coverage
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1 under a group health plan.
2 (3) Not counting periods before significant breaks
3 in coverage.
4 (a) In general. A period of creditable
5 coverage shall not be counted, with respect to
6 enrollment of an individual under a group health
7 plan, if, after such period and before the
8 enrollment date, there was a 63-day period during
9 all of which the individual was not covered under
10 any creditable coverage.
11 (b) Waiting period not treated as a break in
12 coverage. For purposes of subparagraph (a) and
13 subsection (D)(3), any period that an individual is
14 in a waiting period for any coverage under a group
15 health plan (or for group health insurance coverage)
16 or is in an affiliation period (as defined in
17 subsection (G)(2)) shall not be taken into account
18 in determining the continuous period under
19 subparagraph (a).
20 (4) Method of crediting coverage.
21 (a) Standard method. Except as otherwise
22 provided under subparagraph (b), for purposes of
23 applying subsection (A)(3), a group health plan, and
24 a health insurance issuer offering group health
25 insurance coverage, shall count a period of
26 creditable coverage without regard to the specific
27 benefits covered during the period.
28 (b) Election of alternative method. A group
29 health plan, or a health insurance issuer offering
30 group health insurance, may elect to apply
31 subsection (A)(3) based on coverage of benefits
32 within each of several classes or categories of
33 benefits specified in regulations rather than as
34 provided under subparagraph (a). Such election
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1 shall be made on a uniform basis for all
2 participants and beneficiaries. Under such election
3 a group health plan or issuer shall count a period
4 of creditable coverage with respect to any class or
5 category of benefits if any level of benefits is
6 covered within such class or category.
7 (c) Plan notice. In the case of an election
8 with respect to a group health plan under
9 subparagraph (b) (whether or not health insurance
10 coverage is provided in connection with such plan),
11 the plan shall:
12 (i) prominently state in any disclosure
13 statements concerning the plan, and state to
14 each enrollee at the time of enrollment under
15 the plan, that the plan has made such election;
16 and
17 (ii) include in such statements a
18 description of the effect of this election.
19 (d) Issuer notice. In the case of an election
20 under subparagraph (b) with respect to health
21 insurance coverage offered by an issuer in the small
22 or large group market, the issuer:
23 (i) shall prominently state in any
24 disclosure statements concerning the coverage,
25 and to each employer at the time of the offer
26 or sale of the coverage, that the issuer has
27 made such election; and
28 (ii) shall include in such statements a
29 description of the effect of such election.
30 (5) Establishment of period. Periods of creditable
31 coverage with respect to an individual shall be
32 established through presentation or certifications
33 described in subsection (E) or in such other manner as
34 may be specified in regulations.
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1 (D) Exceptions:
2 (1) Exclusion not applicable to certain newborns.
3 Subject to paragraph (3), a group health plan, and a
4 health insurance issuer offering group health insurance
5 coverage, may not impose any preexisting condition
6 exclusion in the case of an individual who, as of the
7 last day of the 30-day period beginning with the date of
8 birth, is covered under creditable coverage.
9 (2) Exclusion not applicable to certain adopted
10 children. Subject to paragraph (3), a group health plan,
11 and a health insurance issuer offering group health
12 insurance coverage, may not impose any preexisting
13 condition exclusion in the case of a child who is adopted
14 or placed for adoption before attaining 18 years of age
15 and who, as of the last day of the 30-day period
16 beginning on the date of the adoption or placement for
17 adoption, is covered under creditable coverage.
18 The previous sentence shall not apply to coverage
19 before the date of such adoption or placement for
20 adoption.
21 (3) Loss if break in coverage. Paragraphs (1) and
22 (2) shall no longer apply to an individual after the end
23 of the first 63-day period during all of which the
24 individual was not covered under any creditable coverage.
25 (E) Certifications and disclosure of coverage.
26 (1) Requirement for Certification of Period of
27 Creditable Coverage.
28 (a) A group health plan, and a health
29 insurance issuer offering group health insurance
30 coverage, shall provide the certification described
31 in subparagraph (b):
32 (i) at the time an individual ceases to
33 be covered under the plan or otherwise becomes
34 covered under a COBRA continuation provision;
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1 (ii) in the case of an individual
2 becoming covered under such a provision, at the
3 time the individual ceases to be covered under
4 such provision; and
5 (iii) on the request on behalf of an
6 individual made not later than 24 months after
7 the date of cessation of the coverage described
8 in clause (i) or (ii), whichever is later.
9 The certification under clause (i) may be provided,
10 to the extent practicable, at a time consistent with
11 notices required under any applicable COBRA
12 continuation provision.
13 (b) The certification described in this
14 subparagraph is a written certification of:
15 (i) the period of creditable coverage of
16 the individual under such plan and the coverage
17 (if any) under such COBRA continuation
18 provision; and
19 (ii) the waiting period (if any) (and
20 affiliation period, if applicable) imposed with
21 respect to the individual for any coverage
22 under such plan.
23 (c) To the extent that medical care under a
24 group health plan consists of group health insurance
25 coverage, the plan is deemed to have satisfied the
26 certification requirement under this paragraph if
27 the health insurance issuer offering the coverage
28 provides for such certification in accordance with
29 this paragraph.
30 (2) Disclosure of information on previous benefits.
31 In the case of an election described in subsection
32 (C)(4)(b) by a group health plan or health insurance
33 issuer, if the plan or issuer enrolls an individual for
34 coverage under the plan and the individual provides a
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1 certification of coverage of the individual under
2 paragraph (1):
3 (a) upon request of such plan or issuer, the
4 entity which issued the certification provided by
5 the individual shall promptly disclose to such
6 requesting plan or issuer information on coverage of
7 classes and categories of health benefits available
8 under such entity's plan or coverage; and
9 (b) such entity may charge the requesting plan
10 or issuer for the reasonable cost of disclosing such
11 information.
12 (3) Rules. The Department shall establish rules to
13 prevent an entity's failure to provide information under
14 paragraph (1) or (2) with respect to previous coverage of
15 an individual from adversely affecting any subsequent
16 coverage of the individual under another group health
17 plan or health insurance coverage.
18 (4) Treatment of certain plans as group health plan
19 for notice provision. A program under which creditable
20 coverage described in subparagraph (c), (d), (e), or (f)
21 of Section 20(C)(1) is provided shall be treated as a
22 group health plan for purposes of this Section.
23 (F) Special enrollment periods.
24 (1) Individuals losing other coverage. A group
25 health plan, and a health insurance issuer offering group
26 health insurance coverage in connection with a group
27 health plan, shall permit an employee who is eligible,
28 but not enrolled, for coverage under the terms of the
29 plan (or a dependent of such an employee if the dependent
30 is eligible, but not enrolled, for coverage under such
31 terms) to enroll for coverage under the terms of the plan
32 if each of the following conditions is met:
33 (a) The employee or dependent was covered
34 under a group health plan or had health insurance
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1 coverage at the time coverage was previously offered
2 to the employee or dependent.
3 (b) The employee stated in writing at such
4 time that coverage under a group health plan or
5 health insurance coverage was the reason for
6 declining enrollment, but only if the plan sponsor
7 or issuer (if applicable) required such a statement
8 at such time and provided the employee with notice
9 of such requirement (and the consequences of such
10 requirement) at such time.
11 (c) The employee's or dependent's coverage
12 described in subparagraph (a):
13 (i) was under a COBRA continuation
14 provision and the coverage under such provision
15 was exhausted; or
16 (ii) was not under such a provision and
17 either the coverage was terminated as a result
18 of loss of eligibility for the coverage
19 (including as a result of legal separation,
20 divorce, death, termination of employment, or
21 reduction in the number of hours of employment)
22 or employer contributions towards such coverage
23 were terminated.
24 (d) Under the terms of the plan, the employee
25 requests such enrollment not later than 30 days
26 after the date of exhaustion of coverage described
27 in subparagraph (c)(i) or termination of coverage or
28 employer contributions described in subparagraph
29 (c)(ii).
30 (2) For dependent beneficiaries.
31 (a) In general. If:
32 (i) a group health plan makes coverage
33 available with respect to a dependent of an
34 individual,
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1 (ii) the individual is a participant
2 under the plan (or has met any waiting period
3 applicable to becoming a participant under the
4 plan and is eligible to be enrolled under the
5 plan but for a failure to enroll during a
6 previous enrollment period), and
7 (iii) a person becomes such a dependent
8 of the individual through marriage, birth, or
9 adoption or placement for adoption,
10 then the group health plan shall provide for a
11 dependent special enrollment period described in
12 subparagraph (b) during which the person (or, if not
13 otherwise enrolled, the individual) may be enrolled
14 under the plan as a dependent of the individual, and
15 in the case of the birth or adoption of a child, the
16 spouse of the individual may be enrolled as a
17 dependent of the individual if such spouse is
18 otherwise eligible for coverage.
19 (b) Dependent special enrollment period. A
20 dependent special enrollment period under this
21 subparagraph shall be a period of not less than 30
22 days and shall begin on the later of:
23 (i) the date dependent coverage is made
24 available; or
25 (ii) the date of the marriage, birth, or
26 adoption or placement for adoption (as the case
27 may be) described in subparagraph (a)(iii).
28 (c) No waiting period. If an individual seeks
29 to enroll a dependent during the first 30 days of
30 such a dependent special enrollment period, the
31 coverage of the dependent shall become effective:
32 (i) in the case of marriage, not later
33 than the first day of the first month beginning
34 after the date the completed request for
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1 enrollment is received;
2 (ii) in the case of a dependent's birth,
3 as of the date of such birth; or
4 (iii) in the case of a dependent's
5 adoption or placement for adoption, the date of
6 such adoption or placement for adoption.
7 (G) Use of affiliation period by HMOs as alternative to
8 preexisting condition exclusion.
9 (1) In general. A health maintenance organization
10 which offers health insurance coverage in connection with
11 a group health plan and which does not impose any
12 pre-existing condition exclusion allowed under subsection
13 (A) with respect to any particular coverage option may
14 impose an affiliation period for such coverage option,
15 but only if:
16 (a) such period is applied uniformly without
17 regard to any health status-related factors; and
18 (b) such period does not exceed 2 months (or 3
19 months in the case of a late enrollee).
20 (2) Affiliation period.
21 (a) Defined. For purposes of this Act, the
22 term "affiliation period" means a period which,
23 under the terms of the health insurance coverage
24 offered by the health maintenance organization, must
25 expire before the health insurance coverage becomes
26 effective. The organization is not required to
27 provide health care services or benefits during such
28 period and no premium shall be charged to the
29 participant or beneficiary for any coverage during
30 the period.
31 (b) Beginning. Such period shall begin on the
32 enrollment date.
33 (c) Runs concurrently with waiting periods.
34 An affiliation period under a plan shall run
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1 concurrently with any waiting period under the plan.
2 (3) Alternative methods. A health maintenance
3 organization described in paragraph (1) may use
4 alternative methods, from those described in such
5 paragraph, to address adverse selection as approved by
6 the Department.
7 (Source: P.A. 90-30, eff. 7-1-97; 90-736, eff. 8-12-98.)
8 Section 95. The Children's Health Insurance Program Act
9 is amended by changing Section 20 as follows:
10 (215 ILCS 106/20)
11 (Section scheduled to be repealed on July 1, 2002)
12 Sec. 20. Eligibility.
13 (a) To be eligible for this Program, a person must be a
14 person who has a child eligible under this Act and who is
15 eligible under this Act and who is eligible under a waiver of
16 federal requirements pursuant to an application made pursuant
17 to subdivision (a)(1) of Section 40 of this Act or who is a
18 child who:
19 (1) is a child who is not eligible for medical
20 assistance;
21 (2) is a child whose annual household income, as
22 determined by the Department, is above 133% of the
23 federal poverty level and at or below 185% of the federal
24 poverty level; provided, that the Department may
25 establish the upper limit of eligibility at 200% of the
26 federal poverty level as part of acquiring federal
27 waivers from the federal Health Care Financing
28 Administration allowing Illinois to claim favorable
29 levels of federal matching funds to provide health
30 insurance to families under the Family Health Insurance
31 Program Act;
32 (3) is a resident of the State of Illinois; and
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1 (4) is a child who is either a United States
2 citizen or included in one of the following categories of
3 non-citizens:
4 (A) unmarried dependent children of either a
5 United States Veteran honorably discharged or a
6 person on active military duty;
7 (B) refugees under Section 207 of the
8 Immigration and Nationality Act;
9 (C) asylees under Section 208 of the
10 Immigration and Nationality Act;
11 (D) persons for whom deportation has been
12 withheld under Section 243(h) of the Immigration
13 and Nationality Act;
14 (E) persons granted conditional entry under
15 Section 203(a)(7) of the Immigration and Nationality
16 Act as in effect prior to April 1, 1980;
17 (F) persons lawfully admitted for permanent
18 residence under the Immigration and Nationality Act;
19 and
20 (G) parolees, for at least one year, under
21 Section 212(d)(5) of the Immigration and Nationality
22 Act.
23 Those children who are in the categories set forth in
24 subdivisions (4)(F) and (4)(G) of this subsection, who enter
25 the United States on or after August 22, 1996, shall not be
26 eligible for 5 years beginning on the date the child entered
27 the United States.
28 (b) A child who is determined to be eligible for
29 assistance shall remain eligible for 12 months, provided the
30 child maintains his or her residence in the State, has not
31 yet attained 19 years of age, and is not excluded pursuant to
32 subsection (c). Eligibility shall be re-determined by the
33 Department at least annually.
34 (c) A child shall not be eligible for coverage under
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1 this Program if:
2 (1) the premium required pursuant to Section 30 of
3 this Act has not been paid. If the required premiums are
4 not paid the liability of the Program shall be limited to
5 benefits incurred under the Program for the time period
6 for which premiums had been paid. If the required
7 monthly premium is not paid, the child shall be
8 ineligible for re-enrollment for a minimum period of 3
9 months. Re-enrollment shall be completed prior to the
10 next covered medical visit and the first month's required
11 premium shall be paid in advance of the next covered
12 medical visit. The Department shall promulgate rules
13 regarding grace periods, notice requirements, and hearing
14 procedures pursuant to this subsection;
15 (2) the child is an inmate of a public institution
16 or a patient in an institution for mental diseases; or
17 (3) the child is a member of a family that is
18 eligible for health benefits covered under the State of
19 Illinois health benefits plan on the basis of a member's
20 employment with a public agency.
21 (Source: P.A. 90-736, eff. 8-12-98.)".