State of Illinois
92nd General Assembly
Legislation

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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
 
                            -2-                LRB9215468JSpc
 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:
 
                            -3-                LRB9215468JSpc
 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
 
                            -4-                LRB9215468JSpc
 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
 
                            -5-                LRB9215468JSpc
 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
 
                            -6-                LRB9215468JSpc
 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
 
                            -7-                LRB9215468JSpc
 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.
 
                            -8-                LRB9215468JSpc
 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
 
                            -9-                LRB9215468JSpc
 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:
 
                            -10-               LRB9215468JSpc
 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.
 
                            -11-               LRB9215468JSpc
 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.
 
                            -12-               LRB9215468JSpc
 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
 
                            -13-               LRB9215468JSpc
 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.
 
                            -14-               LRB9215468JSpc
 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
 
                            -15-               LRB9215468JSpc
 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,
 
                            -16-               LRB9215468JSpc
 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
 
                            -17-               LRB9215468JSpc
 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).
 
                            -18-               LRB9215468JSpc
 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
 
                            -19-               LRB9215468JSpc
 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
 
                            -20-               LRB9215468JSpc
 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
 
                            -21-               LRB9215468JSpc
 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.)

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