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92_HB0023ham002
LRB9200767DJgcam04
1 AMENDMENT TO HOUSE BILL 23
2 AMENDMENT NO. . Amend House Bill 23, AS AMENDED, by
3 replacing the 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", consistent with Department rules under the
11 Medical Assistance and Children's Health Insurance programs,
12 means a group of people who live together and who include
13 minor children and their adult caretaker relatives. This may
14 include parents or other blood-related adults when they are
15 the children's caretaker. "Family" also includes the spouses
16 of those parents or caretaker relatives. "Family" also
17 includes any other persons who are defined as covered family
18 members under employer-provided or private health insurance
19 for which a single "family coverage" premium is paid.
20 "Medical Assistance Program" is the health care benefit
21 program provided under Article V of the Illinois Public Aid
22 Code.
23 "Program" means the Family Health Insurance Program.
24 Section 15. Operation of the program. The Family Health
25 Insurance Program is created. The program shall operate
26 subject to appropriation and shall be administered by the
27 Department. Except as otherwise provided in this Act, the
28 program is subject to the same rules and requirements as the
29 Children's Health Insurance Program. Families have the
30 option for their children to participate only in the
31 Children's Health Insurance Program, even if the parents are
32 eligible for coverage under this Act.
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1 Section 20. Eligibility.
2 (a) The Department shall be responsible for all
3 determinations of eligibility for the program.
4 (b) To be eligible for health insurance coverage under
5 the program, a family must include a child who meets the
6 non-financial and financial eligibility requirements for
7 health coverage under the Children's Health Insurance Program
8 or non-spend-down coverage under the Medical Assistance
9 Program.
10 (c) A family determined eligible for the program remains
11 eligible for 12 months, as long as it meets the following
12 criteria:
13 (1) The family is an Illinois resident as defined in
14 rules.
15 (2) At least one child in the family remains under
16 the age of 19.
17 (3) The family is not excluded under subsection (d).
18 The Department shall determine each family's eligibility
19 at least once each year.
20 (d) A family is not eligible for coverage under the
21 program if it meets any of the following criteria:
22 (1) A premium required under the program is not
23 paid. The Department shall adopt rules governing periods
24 of coverage in the event of loss of eligibility due to
25 unpaid premiums, waiting periods and conditions for
26 re-enrollment, grace periods, notices, and hearing
27 procedures relevant to this subsection.
28 (2) There is no longer a child in the family
29 eligible under the Children's Health Insurance Program or
30 non-spend-down Medical Assistance.
31 (3) The family is eligible for health insurance
32 under the State of Illinois health benefits plan on the
33 basis of a family member's employment with a public
34 agency.
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1 Section 25. Health benefits for families.
2 (a) Subject to appropriation, the Department shall
3 provide health benefits coverage to eligible families by
4 doing either of the following or a combination if required
5 for federal approval:
6 (1) Subsidizing the cost of a family's coverage, for
7 families with a member who has access to
8 employer-provided or private family health coverage.
9 (2) Providing the family with health benefits that,
10 subject to appropriation and without regard to any
11 applicable cost-sharing under Section 30, are identical
12 to the benefits provided under the State's approved plan
13 under Title XIX of the Social Security Act or any waivers
14 granted by the federal Health Care Financing
15 Administration, for families that do not have access to
16 employer-provided family health coverage or for whom
17 subsidization of that coverage under paragraph (1) is not
18 cost-effective for the State, as determined by the
19 Department pursuant to rules. Providers of health
20 benefits under this paragraph (2) must be approved by the
21 Department to provide health care under the Illinois
22 Public Aid Code and shall be reimbursed at the same rate
23 as providers under the State's approved plan under Title
24 XIX of the Social Security Act. Any copayments required
25 under Section 30 may be paid to the Department or
26 retained by the provider, as provided by rule.
27 (b) The Department may provide the subsidy pursuant to
28 subdivision (a)(1) directly to an insurance company, as a
29 rebate to the family for premiums paid through payroll
30 deduction, or in any other manner the Department deems
31 cost-effective and accurate and best suited to accomplish the
32 purposes of the program. The Department may also take
33 appropriate measures to ensure that employers do not take
34 unfair advantage of the subsidies provided under subdivision
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1 (a)(1) by increasing the subsidized employees' share of the
2 premium for health insurance by amounts out-of-proportion to
3 any increase in the actual total cost of the insurance.
4 (c) The Department may deny subsidization of coverage if
5 the coverage fails to meet minimum benchmark standards
6 adopted by the Department in rules. To be eligible for
7 inclusion in the program, the plan must contain at least
8 comprehensive major medical coverage of physician and
9 hospital inpatient services. The Department may deny
10 subsidization of coverage for a family under subdivision
11 (a)(1) if it is more cost-effective to provide coverage for
12 the family under subdivision (a)(2).
13 (d) The Department may limit the monthly subsidy to an
14 amount equal to the average monthly cost of providing
15 coverage to comparable parents under subdivision (a)(2), or a
16 larger amount established by the Department by rule. The
17 Department, to the extent it imposes this limitation, must
18 set this "average monthly cost" prospectively based on the
19 prior fiscal year's experience adjusted for
20 incurred-but-not-reported claims and estimated increases or
21 decreases in the cost of medical care. The subsidy may not
22 exceed the amount of the family's share of the premium for
23 the health insurance.
24 Section 30. Cost-sharing.
25 (a) A family enrolled in a health benefits program under
26 subdivision (a)(2) of Section 25 is subject to the following
27 cost-sharing requirements to the extent permitted by federal
28 requirements in waivers governing the funding of the program:
29 (1) A copayment may not be required for well-baby or
30 well-child care, including age-appropriate immunizations
31 as required under federal law.
32 (2) Health insurance premiums for a family whose
33 household income is equal to or greater than 150% of the
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1 poverty guidelines updated annually in the Federal
2 Register by the U.S. Department of Health and Human
3 Services under authority of 42 U.S.C. 9902(2) must be
4 payable monthly, subject to rules adopted by the
5 Department for grace periods and advance payments, and
6 must be as follows:
7 (A) $25 for a family composed of 2 covered
8 persons.
9 (B) $30 for a family composed of 3 covered
10 persons.
11 (C) $35 for a family composed of at least one
12 covered adult and 3 or more covered dependents.
13 (3) Copayments for a family whose income is at or
14 below 150% of the poverty guidelines updated annually in
15 the Federal Register by the U.S. Department of Health and
16 Human Services under authority of 42 U.S.C. 9902(2), at a
17 minimum and to the extent permitted under federal law,
18 must be $2 for each medical visit and each prescription
19 provided under this Act.
20 (4) Copayments for a family whose income is greater
21 than 150% of the poverty guidelines updated annually in
22 the Federal Register by the U.S. Department of Health and
23 Human Services under authority of 42 U.S.C. 9902(2), at a
24 minimum and to the extent permitted under federal law,
25 must be as follows:
26 (A) $5 for each medical visit.
27 (B) $3 for each generic prescription and $5 for
28 each brand-name prescription.
29 (C) $25 for each emergency room use for a
30 non-emergency situation as defined by the Department by
31 rule.
32 (5) The maximum allowable amount of out-of-pocket
33 expenses for copayments is $100 per family per year.
34 (b) A family whose health benefits coverage is subsidized
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1 under subdivision (a)(1) of Section 25 is subject to (i) the
2 cost-sharing provisions of the employer-provided or private
3 family health coverage under which a family member is
4 covered, (ii) the requirements imposed by the federal
5 government under any waivers governing federal funding of the
6 program, or (iii) both.
7 Section 35. Funding.
8 (a) The program is not an entitlement and shall not be
9 construed to create an entitlement. Eligibility for the
10 program is subject to appropriation of moneys by the State
11 and federal governments to fund the program.
12 (b) Any requirement imposed under this Act and any
13 implementation of this Act by the Department shall cease in
14 the event that moneys are not available for those purposes.
15 Section 40. Medical Assistance Plan amendments; federal
16 waivers.
17 (a) The Department shall amend the State's Medical
18 Assistance Plan and the State Children's Health Insurance
19 Plan to the extent required to implement this Act and to the
20 extent permitted by federal law in order to secure federal
21 matching funds for the health coverages provided and
22 administrative expenses incurred under this Act.
23 (b) Promptly after the effective date of this Act, the
24 Department shall request any necessary waivers of federal
25 requirements in order to allow receipt of federal funding for
26 the health coverages subsidized or provided and
27 administrative expenses incurred under this Act.
28 Section 45. Contracts with non-governmental bodies. All
29 contracts with non-governmental bodies that are determined by
30 the Department to be necessary for the implementation of this
31 Act are deemed to be purchase of care as defined in the
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1 Illinois Procurement Code.
2 Section 50. Implementation date. The Department must
3 begin implementing this Act on the effective date of this
4 Act. Health benefits coverage may not be subsidized or
5 provided under the program, and applications for enrollment
6 in the program may not be taken, until January 1, 2002 at the
7 earliest. Thereafter, the Department may delay implementation
8 of any portions of the program as to which federal matching
9 funds are not yet approved.
10 Section 55. Repealer. This Act is repealed on June 30,
11 2007.
12 Section 90. The Illinois Health Insurance Portability
13 and Accountability Act is amended by changing Section 20 as
14 follows:
15 (215 ILCS 97/20)
16 Sec. 20. Increased portability through limitation on
17 preexisting condition exclusions.
18 (A) Limitation of preexisting condition exclusion
19 period; crediting for periods of previous coverage. Subject
20 to subsection (D), a group health plan, and a health
21 insurance issuer offering group health insurance coverage,
22 may, with respect to a participant or beneficiary, impose a
23 preexisting condition exclusion only if:
24 (1) the exclusion relates to a condition (whether
25 physical or mental), regardless of the cause of the
26 condition, for which medical advice, diagnosis, care, or
27 treatment was recommended or received within the 6-month
28 period ending on the enrollment date;
29 (2) the exclusion extends for a period of not more
30 than 12 months (or 18 months in the case of a late
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1 enrollee) after the enrollment date; and
2 (3) the period of any such preexisting condition
3 exclusion is reduced by the aggregate of the periods of
4 creditable coverage (if any, as defined in subsection
5 (C)(1)) applicable to the participant or beneficiary as
6 of the enrollment date.
7 (B) Preexisting condition exclusion. A group health
8 plan, and health insurance issuer offering group health
9 insurance coverage, may not impose any preexisting condition
10 exclusion relating to pregnancy as a preexisting condition.
11 Genetic information shall not be treated as a condition
12 described in subsection (A)(1) in the absence of a diagnosis
13 of the condition related to such information.
14 (C) Rules relating to crediting previous coverage.
15 (1) Creditable coverage defined. For purposes of
16 this Act, the term "creditable coverage" means, with
17 respect to an individual, coverage of the individual
18 under any of the following:
19 (a) A group health plan.
20 (b) Health insurance coverage.
21 (c) Part A or part B of title XVIII of the
22 Social Security Act.
23 (d) Title XIX of the Social Security Act,
24 other than coverage consisting solely of benefits
25 under Section 1928.
26 (e) Chapter 55 of title 10, United States
27 Code.
28 (f) A medical care program of the Indian
29 Health Service or of a tribal organization.
30 (g) A State health benefits risk pool.
31 (h) A health plan offered under chapter 89 of
32 title 5, United States Code.
33 (i) A public health plan (as defined in
34 regulations).
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1 (j) A health benefit plan under Section 5(e)
2 of the Peace Corps Act (22 U.S.C. 2504(e)).
3 (k) Title XXI of the federal Social Security
4 Act, State Children's Health Insurance Program.
5 (l) Coverage under the Family Health Insurance
6 Program Act.
7 Such term does not include coverage consisting
8 solely of coverage of excepted benefits.
9 (2) Excepted benefits. For purposes of this Act,
10 the term "excepted benefits" means benefits under one or
11 more of the following:
12 (a) Benefits not subject to requirements:
13 (i) Coverage only for accident, or
14 disability income insurance, or any combination
15 thereof.
16 (ii) Coverage issued as a supplement to
17 liability insurance.
18 (iii) Liability insurance, including
19 general liability insurance and automobile
20 liability insurance.
21 (iv) Workers' compensation or similar
22 insurance.
23 (v) Automobile medical payment insurance.
24 (vi) Credit-only insurance.
25 (vii) Coverage for on-site medical
26 clinics.
27 (viii) Other similar insurance coverage,
28 specified in regulations, under which benefits
29 for medical care are secondary or incidental to
30 other insurance benefits.
31 (b) Benefits not subject to requirements if
32 offered separately:
33 (i) Limited scope dental or vision
34 benefits.
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1 (ii) Benefits for long-term care, nursing
2 home care, home health care, community-based
3 care, or any combination thereof.
4 (iii) Such other similar, limited
5 benefits as are specified in rules.
6 (c) Benefits not subject to requirements if
7 offered, as independent, noncoordinated benefits:
8 (i) Coverage only for a specified disease
9 or illness.
10 (ii) Hospital indemnity or other fixed
11 indemnity insurance.
12 (d) Benefits not subject to requirements if
13 offered as separate insurance policy. Medicare
14 supplemental health insurance (as defined under
15 Section 1882(g)(1) of the Social Security Act),
16 coverage supplemental to the coverage provided under
17 chapter 55 of title 10, United States Code, and
18 similar supplemental coverage provided to coverage
19 under a group health plan.
20 (3) Not counting periods before significant breaks
21 in coverage.
22 (a) In general. A period of creditable
23 coverage shall not be counted, with respect to
24 enrollment of an individual under a group health
25 plan, if, after such period and before the
26 enrollment date, there was a 63-day period during
27 all of which the individual was not covered under
28 any creditable coverage.
29 (b) Waiting period not treated as a break in
30 coverage. For purposes of subparagraph (a) and
31 subsection (D)(3), any period that an individual is
32 in a waiting period for any coverage under a group
33 health plan (or for group health insurance coverage)
34 or is in an affiliation period (as defined in
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1 subsection (G)(2)) shall not be taken into account
2 in determining the continuous period under
3 subparagraph (a).
4 (4) Method of crediting coverage.
5 (a) Standard method. Except as otherwise
6 provided under subparagraph (b), for purposes of
7 applying subsection (A)(3), a group health plan, and
8 a health insurance issuer offering group health
9 insurance coverage, shall count a period of
10 creditable coverage without regard to the specific
11 benefits covered during the period.
12 (b) Election of alternative method. A group
13 health plan, or a health insurance issuer offering
14 group health insurance, may elect to apply
15 subsection (A)(3) based on coverage of benefits
16 within each of several classes or categories of
17 benefits specified in regulations rather than as
18 provided under subparagraph (a). Such election
19 shall be made on a uniform basis for all
20 participants and beneficiaries. Under such election
21 a group health plan or issuer shall count a period
22 of creditable coverage with respect to any class or
23 category of benefits if any level of benefits is
24 covered within such class or category.
25 (c) Plan notice. In the case of an election
26 with respect to a group health plan under
27 subparagraph (b) (whether or not health insurance
28 coverage is provided in connection with such plan),
29 the plan shall:
30 (i) prominently state in any disclosure
31 statements concerning the plan, and state to
32 each enrollee at the time of enrollment under
33 the plan, that the plan has made such election;
34 and
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1 (ii) include in such statements a
2 description of the effect of this election.
3 (d) Issuer notice. In the case of an election
4 under subparagraph (b) with respect to health
5 insurance coverage offered by an issuer in the small
6 or large group market, the issuer:
7 (i) shall prominently state in any
8 disclosure statements concerning the coverage,
9 and to each employer at the time of the offer
10 or sale of the coverage, that the issuer has
11 made such election; and
12 (ii) shall include in such statements a
13 description of the effect of such election.
14 (5) Establishment of period. Periods of creditable
15 coverage with respect to an individual shall be
16 established through presentation or certifications
17 described in subsection (E) or in such other manner as
18 may be specified in regulations.
19 (D) Exceptions:
20 (1) Exclusion not applicable to certain newborns.
21 Subject to paragraph (3), a group health plan, and a
22 health insurance issuer offering group health insurance
23 coverage, may not impose any preexisting condition
24 exclusion in the case of an individual who, as of the
25 last day of the 30-day period beginning with the date of
26 birth, is covered under creditable coverage.
27 (2) Exclusion not applicable to certain adopted
28 children. Subject to paragraph (3), a group health plan,
29 and a health insurance issuer offering group health
30 insurance coverage, may not impose any preexisting
31 condition exclusion in the case of a child who is adopted
32 or placed for adoption before attaining 18 years of age
33 and who, as of the last day of the 30-day period
34 beginning on the date of the adoption or placement for
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1 adoption, is covered under creditable coverage.
2 The previous sentence shall not apply to coverage
3 before the date of such adoption or placement for
4 adoption.
5 (3) Loss if break in coverage. Paragraphs (1) and
6 (2) shall no longer apply to an individual after the end
7 of the first 63-day period during all of which the
8 individual was not covered under any creditable coverage.
9 (E) Certifications and disclosure of coverage.
10 (1) Requirement for Certification of Period of
11 Creditable Coverage.
12 (a) A group health plan, and a health
13 insurance issuer offering group health insurance
14 coverage, shall provide the certification described
15 in subparagraph (b):
16 (i) at the time an individual ceases to
17 be covered under the plan or otherwise becomes
18 covered under a COBRA continuation provision;
19 (ii) in the case of an individual
20 becoming covered under such a provision, at the
21 time the individual ceases to be covered under
22 such provision; and
23 (iii) on the request on behalf of an
24 individual made not later than 24 months after
25 the date of cessation of the coverage described
26 in clause (i) or (ii), whichever is later.
27 The certification under clause (i) may be provided,
28 to the extent practicable, at a time consistent with
29 notices required under any applicable COBRA
30 continuation provision.
31 (b) The certification described in this
32 subparagraph is a written certification of:
33 (i) the period of creditable coverage of
34 the individual under such plan and the coverage
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1 (if any) under such COBRA continuation
2 provision; and
3 (ii) the waiting period (if any) (and
4 affiliation period, if applicable) imposed with
5 respect to the individual for any coverage
6 under such plan.
7 (c) To the extent that medical care under a
8 group health plan consists of group health insurance
9 coverage, the plan is deemed to have satisfied the
10 certification requirement under this paragraph if
11 the health insurance issuer offering the coverage
12 provides for such certification in accordance with
13 this paragraph.
14 (2) Disclosure of information on previous benefits.
15 In the case of an election described in subsection
16 (C)(4)(b) by a group health plan or health insurance
17 issuer, if the plan or issuer enrolls an individual for
18 coverage under the plan and the individual provides a
19 certification of coverage of the individual under
20 paragraph (1):
21 (a) upon request of such plan or issuer, the
22 entity which issued the certification provided by
23 the individual shall promptly disclose to such
24 requesting plan or issuer information on coverage of
25 classes and categories of health benefits available
26 under such entity's plan or coverage; and
27 (b) such entity may charge the requesting plan
28 or issuer for the reasonable cost of disclosing such
29 information.
30 (3) Rules. The Department shall establish rules to
31 prevent an entity's failure to provide information under
32 paragraph (1) or (2) with respect to previous coverage of
33 an individual from adversely affecting any subsequent
34 coverage of the individual under another group health
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1 plan or health insurance coverage.
2 (4) Treatment of certain plans as group health plan
3 for notice provision. A program under which creditable
4 coverage described in subparagraph (c), (d), (e), or (f)
5 of Section 20(C)(1) is provided shall be treated as a
6 group health plan for purposes of this Section.
7 (F) Special enrollment periods.
8 (1) Individuals losing other coverage. A group
9 health plan, and a health insurance issuer offering group
10 health insurance coverage in connection with a group
11 health plan, shall permit an employee who is eligible,
12 but not enrolled, for coverage under the terms of the
13 plan (or a dependent of such an employee if the dependent
14 is eligible, but not enrolled, for coverage under such
15 terms) to enroll for coverage under the terms of the plan
16 if each of the following conditions is met:
17 (a) The employee or dependent was covered
18 under a group health plan or had health insurance
19 coverage at the time coverage was previously offered
20 to the employee or dependent.
21 (b) The employee stated in writing at such
22 time that coverage under a group health plan or
23 health insurance coverage was the reason for
24 declining enrollment, but only if the plan sponsor
25 or issuer (if applicable) required such a statement
26 at such time and provided the employee with notice
27 of such requirement (and the consequences of such
28 requirement) at such time.
29 (c) The employee's or dependent's coverage
30 described in subparagraph (a):
31 (i) was under a COBRA continuation
32 provision and the coverage under such provision
33 was exhausted; or
34 (ii) was not under such a provision and
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1 either the coverage was terminated as a result
2 of loss of eligibility for the coverage
3 (including as a result of legal separation,
4 divorce, death, termination of employment, or
5 reduction in the number of hours of employment)
6 or employer contributions towards such coverage
7 were terminated.
8 (d) Under the terms of the plan, the employee
9 requests such enrollment not later than 30 days
10 after the date of exhaustion of coverage described
11 in subparagraph (c)(i) or termination of coverage or
12 employer contributions described in subparagraph
13 (c)(ii).
14 (2) For dependent beneficiaries.
15 (a) In general. If:
16 (i) a group health plan makes coverage
17 available with respect to a dependent of an
18 individual,
19 (ii) the individual is a participant
20 under the plan (or has met any waiting period
21 applicable to becoming a participant under the
22 plan and is eligible to be enrolled under the
23 plan but for a failure to enroll during a
24 previous enrollment period), and
25 (iii) a person becomes such a dependent
26 of the individual through marriage, birth, or
27 adoption or placement for adoption,
28 then the group health plan shall provide for a
29 dependent special enrollment period described in
30 subparagraph (b) during which the person (or, if not
31 otherwise enrolled, the individual) may be enrolled
32 under the plan as a dependent of the individual, and
33 in the case of the birth or adoption of a child, the
34 spouse of the individual may be enrolled as a
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1 dependent of the individual if such spouse is
2 otherwise eligible for coverage.
3 (b) Dependent special enrollment period. A
4 dependent special enrollment period under this
5 subparagraph shall be a period of not less than 30
6 days and shall begin on the later of:
7 (i) the date dependent coverage is made
8 available; or
9 (ii) the date of the marriage, birth, or
10 adoption or placement for adoption (as the case
11 may be) described in subparagraph (a)(iii).
12 (c) No waiting period. If an individual seeks
13 to enroll a dependent during the first 30 days of
14 such a dependent special enrollment period, the
15 coverage of the dependent shall become effective:
16 (i) in the case of marriage, not later
17 than the first day of the first month beginning
18 after the date the completed request for
19 enrollment is received;
20 (ii) in the case of a dependent's birth,
21 as of the date of such birth; or
22 (iii) in the case of a dependent's
23 adoption or placement for adoption, the date of
24 such adoption or placement for adoption.
25 (G) Use of affiliation period by HMOs as alternative to
26 preexisting condition exclusion.
27 (1) In general. A health maintenance organization
28 which offers health insurance coverage in connection with
29 a group health plan and which does not impose any
30 pre-existing condition exclusion allowed under subsection
31 (A) with respect to any particular coverage option may
32 impose an affiliation period for such coverage option,
33 but only if:
34 (a) such period is applied uniformly without
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1 regard to any health status-related factors; and
2 (b) such period does not exceed 2 months (or 3
3 months in the case of a late enrollee).
4 (2) Affiliation period.
5 (a) Defined. For purposes of this Act, the
6 term "affiliation period" means a period which,
7 under the terms of the health insurance coverage
8 offered by the health maintenance organization, must
9 expire before the health insurance coverage becomes
10 effective. The organization is not required to
11 provide health care services or benefits during such
12 period and no premium shall be charged to the
13 participant or beneficiary for any coverage during
14 the period.
15 (b) Beginning. Such period shall begin on the
16 enrollment date.
17 (c) Runs concurrently with waiting periods.
18 An affiliation period under a plan shall run
19 concurrently with any waiting period under the plan.
20 (3) Alternative methods. A health maintenance
21 organization described in paragraph (1) may use
22 alternative methods, from those described in such
23 paragraph, to address adverse selection as approved by
24 the Department.
25 (Source: P.A. 90-30, eff. 7-1-97; 90-736, eff. 8-12-98.)
26 Section 95. The Children's Health Insurance Program Act
27 is amended by changing Section 20 as follows:
28 (215 ILCS 106/20)
29 (Section scheduled to be repealed on July 1, 2002)
30 Sec. 20. Eligibility.
31 (a) To be eligible for this Program, a person must be a
32 person who has a child eligible under this Act and who is
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1 eligible under a waiver of federal requirements pursuant to
2 an application made pursuant to subdivision (a)(1) of Section
3 40 of this Act or who is a child who:
4 (1) is a child who is not eligible for medical
5 assistance;
6 (2) is a child whose annual household income, as
7 determined by the Department, is above 133% of the
8 federal poverty level and at or below 185% of the federal
9 poverty level; provided, that the Department may
10 establish the upper limit of eligibility at 200% of the
11 federal poverty level as part of acquiring federal
12 waivers from the federal Health Care Financing
13 Administration allowing Illinois to claim favorable
14 levels of federal matching funds to provide health
15 insurance to adult caretaker relatives of children under
16 the Family Health Insurance Program Act;
17 (3) is a resident of the State of Illinois; and
18 (4) is a child who is either a United States
19 citizen or included in one of the following categories of
20 non-citizens:
21 (A) unmarried dependent children of either a
22 United States Veteran honorably discharged or a
23 person on active military duty;
24 (B) refugees under Section 207 of the
25 Immigration and Nationality Act;
26 (C) asylees under Section 208 of the
27 Immigration and Nationality Act;
28 (D) persons for whom deportation has been
29 withheld under Section 243(h) of the Immigration
30 and Nationality Act;
31 (E) persons granted conditional entry under
32 Section 203(a)(7) of the Immigration and Nationality
33 Act as in effect prior to April 1, 1980;
34 (F) persons lawfully admitted for permanent
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1 residence under the Immigration and Nationality Act;
2 and
3 (G) parolees, for at least one year, under
4 Section 212(d)(5) of the Immigration and Nationality
5 Act.
6 Those children who are in the categories set forth in
7 subdivisions (4)(F) and (4)(G) of this subsection, who enter
8 the United States on or after August 22, 1996, shall not be
9 eligible for 5 years beginning on the date the child entered
10 the United States.
11 (b) A child who is determined to be eligible for
12 assistance shall remain eligible for 12 months, provided the
13 child maintains his or her residence in the State, has not
14 yet attained 19 years of age, and is not excluded pursuant to
15 subsection (c). Eligibility shall be re-determined by the
16 Department at least annually.
17 (c) A child shall not be eligible for coverage under
18 this Program if:
19 (1) the premium required pursuant to Section 30 of
20 this Act has not been paid. If the required premiums are
21 not paid the liability of the Program shall be limited to
22 benefits incurred under the Program for the time period
23 for which premiums had been paid. If the required
24 monthly premium is not paid, the child shall be
25 ineligible for re-enrollment for a minimum period of 3
26 months. Re-enrollment shall be completed prior to the
27 next covered medical visit and the first month's required
28 premium shall be paid in advance of the next covered
29 medical visit. The Department shall promulgate rules
30 regarding grace periods, notice requirements, and hearing
31 procedures pursuant to this subsection;
32 (2) the child is an inmate of a public institution
33 or a patient in an institution for mental diseases; or
34 (3) the child is a member of a family that is
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1 eligible for health benefits covered under the State of
2 Illinois health benefits plan on the basis of a member's
3 employment with a public agency.
4 (Source: P.A. 90-736, eff. 8-12-98.)".