Section 123.210  Eligibility Exclusions and Terminations

a)         A child shall not be determined eligible for coverage under the program if:

1)         The child is an inmate of a public institution.

2)         The child is a patient in an institution for mental diseases.

b)         Termination of a child's coverage under the program shall be initiated upon the occurrence of any of the following events:

1)         A child becomes ineligible due to:

A)        Losing his or her Illinois residency.

B)        Attaining 19 years of age.

C)        Becoming enrolled in medical assistance under 89 Ill. Adm. Code 118 or 120 or for health care benefits under 89 Ill. Adm. Code 125.

D)        Meeting the provisions of subsections (a)(1) and (2).

E)        The required premiums as specified in Section 123.330 are not paid in a timely manner as specified in Section 123.340.

F)         The family fails to report to the Department changes in information that impacts upon the child's eligibility for the program.

G)        The family makes a request to the Department to terminate the child's coverage.

H)        The Department determines that the child is no longer eligible based on any other applicable State or federal law or regulation.

I)         The Department determines that an applicant failed to provide eligibility information that was truthful and accurate to the best of the applicant's knowledge and belief and that affected the child's eligibility determination.

J)         The Department determines that the child's eligibility was incorrectly determined.

c)         Following termination of a child's coverage under the program, the following action is required before the child can be re-enrolled:

1)         The child must be found eligible;

2)         There must be full payment of premiums due under this Part or 89 Ill. Adm. Code 125 for periods in which a premium was owed and not paid for the child;

3)         Any overpayment of rebates paid on behalf of the child under 89 Ill. Adm. Code 125 must be repaid to the Department.  A rebate overpayment shall be considered repaid if the Department can recoup the overpayment out of future rebate payments; and

4)         The first month's premium must be paid if there was an unpaid premium on the date the child's previous coverage was canceled.

d)         A certificate of prior creditable coverage will be issued when an individual's coverage is terminated under the All Kids Health Plan.

(Source:  Amended at 38 Ill. Reg. 5989, effective February 26, 2014)