Full Text of HB0806 94th General Assembly
HB0806enr 94TH GENERAL ASSEMBLY
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| AN ACT concerning State government.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 1. Short title. This Act may be cited as the | 5 |
| Covering ALL KIDS Health Insurance Act. | 6 |
| Section 5. Legislative intent. The General Assembly finds | 7 |
| that, for the economic and social benefit of all residents of | 8 |
| the State, it is important to enable all children of this State | 9 |
| to access affordable health insurance that offers | 10 |
| comprehensive coverage and emphasizes preventive healthcare. | 11 |
| Many children in working families, including many families | 12 |
| whose family income ranges between $40,000 and $80,000, are | 13 |
| uninsured. Numerous studies, including the Institute of | 14 |
| Medicine's report, "Health Insurance Matters", demonstrate | 15 |
| that lack of insurance negatively affects health status. The | 16 |
| General Assembly further finds that access to healthcare is a | 17 |
| key component for children's healthy development and | 18 |
| successful education. The effects of lack of insurance also | 19 |
| negatively impact those who are insured because the cost of | 20 |
| paying for care to the uninsured is often shifted to those who | 21 |
| have insurance in the form of higher health insurance premiums. | 22 |
| A Families USA 2005 report indicates that family premiums in | 23 |
| Illinois are increased by $1,059 due to cost-shifting from the | 24 |
| uninsured. It is, therefore, the intent of this legislation to | 25 |
| provide access to affordable health insurance to all uninsured | 26 |
| children in Illinois. | 27 |
| Section 10. Definitions. In this Act: | 28 |
| "Application agent" means an organization or individual, | 29 |
| such as a licensed health care provider, school, youth service | 30 |
| agency, employer, labor union, local chamber of commerce, | 31 |
| community-based organization, or other organization, approved |
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| by the Department to assist in enrolling children in the | 2 |
| Program.
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| "Child" means a person under the age of 19.
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| "Department" means the Department of Healthcare and Family | 5 |
| Services.
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| "Medical assistance" means health care benefits provided | 7 |
| under Article V of the Illinois Public Aid Code.
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| "Program" means the Covering ALL KIDS Health Insurance | 9 |
| Program.
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| "Resident" means an individual (i) who is in the State for | 11 |
| other than a temporary or transitory purpose during the taxable | 12 |
| year or (ii) who is domiciled in this State but is absent from | 13 |
| the State for a temporary or transitory purpose during the | 14 |
| taxable year.
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| Section 15. Operation of Program. The Covering ALL KIDS | 16 |
| Health Insurance Program is created. The Program shall be | 17 |
| administered by the Department of Healthcare and Family | 18 |
| Services. The Department shall have the same powers and | 19 |
| authority to administer the Program as are provided to the | 20 |
| Department in connection with the Department's administration | 21 |
| of the Illinois Public Aid Code and the Children's Health | 22 |
| Insurance Program Act. The Department shall coordinate the | 23 |
| Program with the existing children's health programs operated | 24 |
| by the Department and other State agencies. | 25 |
| Section 20. Eligibility. | 26 |
| (a) To be eligible for the Program, a person must be a | 27 |
| child:
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| (1) who is a resident of the State of Illinois; and
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| (2) who is ineligible for medical assistance under the | 30 |
| Illinois Public Aid Code or benefits under the Children's | 31 |
| Health Insurance Program Act; and
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| (3) either (i) who has been without health insurance | 33 |
| coverage for a period set forth by the Department in rules, | 34 |
| but not less than 6 months during the first month of |
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| operation of the Program, 7 months during the second month | 2 |
| of operation, 8 months during the third month of operation, | 3 |
| 9 months during the fourth month of operation, 10 months | 4 |
| during the fifth month of operation, 11 months during the | 5 |
| sixth month of operation, and 12 months thereafter, (ii) | 6 |
| whose parent has lost employment that made available | 7 |
| affordable dependent health insurance coverage, until such | 8 |
| time as affordable employer-sponsored dependent health | 9 |
| insurance coverage is again available for the child as set | 10 |
| forth by the Department in rules, (iii) who is a newborn | 11 |
| whose responsible relative does not have available | 12 |
| affordable private or employer-sponsored health insurance, | 13 |
| or (iv) who, within one year of applying for coverage under | 14 |
| this Act, lost medical benefits under the Illinois Public | 15 |
| Aid Code or the Children's Health Insurance Program Act. | 16 |
| An entity that provides health insurance coverage (as | 17 |
| defined in Section 2 of the Comprehensive Health Insurance Plan | 18 |
| Act) to Illinois residents shall provide health insurance data | 19 |
| match to the Department of Healthcare and Family Services for | 20 |
| the purpose of determining eligibility for the Program under | 21 |
| this Act. | 22 |
| The Department of Healthcare and Family Services, in | 23 |
| collaboration with the Department of Financial and | 24 |
| Professional Regulation, Division of Insurance, shall adopt | 25 |
| rules governing the exchange of information under this Section. | 26 |
| The rules shall be consistent with all laws relating to the | 27 |
| confidentiality or privacy of personal information or medical | 28 |
| records, including provisions under the Federal Health | 29 |
| Insurance Portability and Accountability Act (HIPAA). | 30 |
| (b) The Department shall monitor the availability and | 31 |
| retention of employer-sponsored dependent health insurance | 32 |
| coverage and shall modify the period described in subdivision | 33 |
| (a)(3) if necessary to promote retention of private or | 34 |
| employer-sponsored health insurance and timely access to | 35 |
| healthcare services, but at no time shall the period described | 36 |
| in subdivision (a)(3) be less than 6 months.
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| (c) The Department, at its discretion, may take into | 2 |
| account the affordability of dependent health insurance when | 3 |
| determining whether employer-sponsored dependent health | 4 |
| insurance coverage is available upon reemployment of a child's | 5 |
| parent as provided in subdivision (a)(3). | 6 |
| (d) A child who is determined to be eligible for the | 7 |
| Program shall remain eligible for 12 months, provided that the | 8 |
| child maintains his or her residence in this State, has not yet | 9 |
| attained 19 years of age, and is not excluded under subsection | 10 |
| (e). | 11 |
| (e) A child is not eligible for coverage under the Program | 12 |
| if: | 13 |
| (1) the premium required under Section 40 has not been | 14 |
| timely paid; if the required premiums are not paid, the | 15 |
| liability of the Program shall be limited to benefits | 16 |
| incurred under the Program for the time period for which | 17 |
| premiums have been paid; if the required monthly premium is | 18 |
| not paid, the child is ineligible for re-enrollment for a | 19 |
| minimum period of 3 months; re-enrollment shall be | 20 |
| completed before the next covered medical visit, and the | 21 |
| first month's required premium shall be paid in advance of | 22 |
| the next covered medical visit; or | 23 |
| (2) the child is an inmate of a public institution or | 24 |
| an institution for mental diseases.
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| (f) The Department shall adopt eligibility rules, | 26 |
| including, but not limited to: rules regarding annual renewals | 27 |
| of eligibility for the Program; rules providing for | 28 |
| re-enrollment, grace periods, notice requirements, and hearing | 29 |
| procedures under subdivision (e)(1) of this Section; and rules | 30 |
| regarding what constitutes availability and affordability of | 31 |
| private or employer-sponsored health insurance, with | 32 |
| consideration of such factors as the percentage of income | 33 |
| needed to purchase children or family health insurance, the | 34 |
| availability of employer subsidies, and other relevant | 35 |
| factors. |
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| Section 25. Enrollment in Program. The Department shall | 2 |
| develop procedures to allow application agents to assist in | 3 |
| enrolling children in the Program or other children's health | 4 |
| programs operated by the Department. At the Department's | 5 |
| discretion, technical assistance payments may be made | 6 |
| available for approved applications facilitated by an | 7 |
| application agent. | 8 |
| Section 30. Program outreach and marketing. The Department | 9 |
| may provide grants to application agents and other | 10 |
| community-based organizations to educate the public about the | 11 |
| availability of the Program. The Department shall adopt rules | 12 |
| regarding performance standards and outcomes measures expected | 13 |
| of organizations that are awarded grants under this Section, | 14 |
| including penalties for nonperformance of contract standards. | 15 |
| Section 35. Health care benefits for children. | 16 |
| (a) The Department shall purchase or provide health care | 17 |
| benefits for eligible children that are identical to the | 18 |
| benefits provided for children under the Illinois Children's | 19 |
| Health Insurance Program Act, except for non-emergency | 20 |
| transportation.
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| (b) As an alternative to the benefits set forth in | 22 |
| subsection (a), and when cost-effective, the Department may | 23 |
| offer families subsidies toward the cost of privately sponsored | 24 |
| health insurance, including employer-sponsored health | 25 |
| insurance.
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| (c) Notwithstanding clause (i) of subdivision (a)(3) of | 27 |
| Section 20, the Department may consider offering, as an | 28 |
| alternative to the benefits set forth in subsection (a), | 29 |
| partial coverage to children who are enrolled in a | 30 |
| high-deductible private health insurance plan.
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| (d) Notwithstanding clause (i) of subdivision (a)(3) of | 32 |
| Section 20, the Department may consider offering, as an | 33 |
| alternative to the benefits set forth in subsection (a), a | 34 |
| limited package of benefits to children in families who have |
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| private or employer-sponsored health insurance that does not | 2 |
| cover certain benefits such as dental or vision benefits.
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| (e) The content and availability of benefits described in | 4 |
| subsections (b), (c), and (d), and the terms of eligibility for | 5 |
| those benefits, shall be at the Department's discretion and the | 6 |
| Department's determination of efficacy and cost-effectiveness | 7 |
| as a means of promoting retention of private or | 8 |
| employer-sponsored health insurance.
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| Section 40. Cost-sharing. | 10 |
| (a) Children enrolled in the Program under subsection (a) | 11 |
| of Section 35 are subject to the following cost-sharing | 12 |
| requirements:
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| (1) The Department, by rule, shall set forth | 14 |
| requirements concerning co-payments and coinsurance for | 15 |
| health care services and monthly premiums. This | 16 |
| cost-sharing shall be on a sliding scale based on family | 17 |
| income. The Department may periodically modify such | 18 |
| cost-sharing.
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| (2) Notwithstanding paragraph (1), there shall be no | 20 |
| co-payment required for well-baby or well-child health | 21 |
| care, including, but not limited to, age-appropriate | 22 |
| immunizations as required under State or federal law.
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| (b) Children enrolled in a privately sponsored health | 24 |
| insurance plan under subsection (b) of Section 35 are subject | 25 |
| to the cost-sharing provisions stated in the privately | 26 |
| sponsored health insurance plan.
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| (c) Notwithstanding any other provision of law, rates paid | 28 |
| by the Department shall not be used in any way to determine the | 29 |
| usual and customary or reasonable charge, which is the charge | 30 |
| for health care that is consistent with the average rate or | 31 |
| charge for similar services furnished by similar providers in a | 32 |
| certain geographic area. | 33 |
| Section 45. Study. | 34 |
| (a) The Department shall conduct a study that includes, but |
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| is not limited to, the following: | 2 |
| (1) Establishing estimates, broken down by regions of | 3 |
| the State, of the number of children with and without | 4 |
| health insurance coverage; the number of children who are | 5 |
| eligible for Medicaid or the Children's Health Insurance | 6 |
| Program, and, of that number, the number who are enrolled | 7 |
| in Medicaid or the Children's Health Insurance Program; and | 8 |
| the number of children with access to dependent coverage | 9 |
| through an employer, and, of that number, the number who | 10 |
| are enrolled in dependent coverage through an employer. | 11 |
| (2) Surveying those families whose children have | 12 |
| access to employer-sponsored dependent coverage but who | 13 |
| decline such coverage as to the reasons for declining | 14 |
| coverage. | 15 |
| (3) Ascertaining, for the population of children | 16 |
| accessing employer-sponsored dependent coverage or who | 17 |
| have access to such coverage, the comprehensiveness of | 18 |
| dependent coverage available, the amount of cost-sharing | 19 |
| currently paid by the employees, and the cost-sharing | 20 |
| associated with such coverage. | 21 |
| (4) Measuring the health outcomes or other benefits for | 22 |
| children utilizing the Covering ALL KIDS Health Insurance | 23 |
| Program and analyzing the effects on utilization of | 24 |
| healthcare services for children after enrollment in the | 25 |
| Program compared to the preceding period of uninsured | 26 |
| status. | 27 |
| (b) The studies described in subsection (a) shall be | 28 |
| conducted in a manner that compares a time period preceding or | 29 |
| at the initiation of the program with a later period. | 30 |
| (c) The Department shall submit the preliminary results of | 31 |
| the study to the Governor and the General Assembly no later | 32 |
| than July 1, 2008 and shall submit the final results to the | 33 |
| Governor and the General Assembly no later than July 1, 2010. | 34 |
| Section 50. Consultation with stakeholders. The Department | 35 |
| shall present details regarding implementation of the Program |
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| to the Medicaid Advisory Committee, and the Committee shall | 2 |
| serve as the forum for healthcare providers, advocates, | 3 |
| consumers, and other interested parties to advise the | 4 |
| Department with respect to the Program. | 5 |
| Section 55. Charge upon claims and causes of action; right | 6 |
| of subrogation; recoveries. Sections 11-22, 11-22a, 11-22b, | 7 |
| and 11-22c of the Illinois Public Aid Code apply to health care | 8 |
| benefits provided to children under this Act, as provided in | 9 |
| those Sections. | 10 |
| Section 60. Federal financial participation. The | 11 |
| Department shall request any necessary state plan amendments or | 12 |
| waivers of federal requirements in order to allow receipt of | 13 |
| federal funds for implementing any or all of the provisions of | 14 |
| the Program. The failure of the responsible federal agency to | 15 |
| approve a waiver or other State plan amendment shall not | 16 |
| prevent the implementation of any provision of this Act. | 17 |
| Section 65. Emergency rulemaking. The Department may adopt | 18 |
| rules necessary to establish and implement this Act through the | 19 |
| use of emergency rulemaking in accordance with Section 5-45 of | 20 |
| the Illinois Administrative Procedure Act. For the purposes of | 21 |
| that Act, the General Assembly finds that the adoption of rules | 22 |
| to implement this Act is deemed an emergency and necessary for | 23 |
| the public interest, safety, and welfare. This Section is | 24 |
| repealed on July 1, 2008. | 25 |
| Section 90. The Illinois Public Aid Code is amended by | 26 |
| changing Sections 11-22, 11-22a, 11-22b, and 11-22c as follows:
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| (305 ILCS 5/11-22) (from Ch. 23, par. 11-22)
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| Sec. 11-22. Charge upon claims and causes of action for | 29 |
| injuries. The Illinois Department shall have a charge upon all | 30 |
| claims, demands and
causes of action for injuries to an | 31 |
| applicant for or recipient of (i)
financial aid under Articles |
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| III, IV, and V or (ii) health care benefits provided under the | 2 |
| Covering ALL KIDS Health Insurance Act for the total
amount of
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| medical assistance provided the recipient from the time of | 4 |
| injury to the
date of recovery upon such claim, demand or cause | 5 |
| of action. In addition, if
the applicant or recipient was | 6 |
| employable, as defined by the Department, at
the time of the | 7 |
| injury, the Department shall also have a charge upon any
such | 8 |
| claims, demands and causes of action for the total amount of | 9 |
| aid
provided to the recipient and his
dependents, including all | 10 |
| cash assistance and medical assistance
only to the extent | 11 |
| includable in the claimant's action, from the
time of injury to | 12 |
| the date of recovery upon such
claim, demand or cause of | 13 |
| action. Any definition of "employable"
adopted by the | 14 |
| Department shall apply only to persons above the age of
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| compulsory school attendance.
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| If the injured person was employable at the time of the | 17 |
| injury and is
provided aid under Articles III, IV, or V and any | 18 |
| dependent or
member of his family is provided aid under Article | 19 |
| VI, or vice versa,
both the Illinois Department and the local | 20 |
| governmental unit shall have
a charge upon such claims, demands | 21 |
| and causes of action for the aid
provided to the injured person | 22 |
| and any
dependent member of his family, including all cash | 23 |
| assistance, medical
assistance and food stamps, from the time | 24 |
| of the injury to the date
of recovery.
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| "Recipient", as used herein, means (i) in the case of | 26 |
| financial aid provided under this Code, the grantee of record | 27 |
| and any
persons whose needs are included in the financial aid | 28 |
| provided to the
grantee of record or otherwise met by grants | 29 |
| under the appropriate
Article of this Code for which such | 30 |
| person is eligible and (ii) in the case of health care benefits | 31 |
| provided under the Covering ALL KIDS Health Insurance Act, the | 32 |
| child to whom those benefits are provided .
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| In each case, the notice shall be served by certified mail | 34 |
| or
registered mail, upon the party or parties against whom the | 35 |
| applicant or
recipient has a claim, demand or cause of action. | 36 |
| The notice shall
claim the charge and describe the interest the |
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| Illinois Department, the
local governmental unit, or the | 2 |
| county, has in the claim, demand, or
cause of action. The | 3 |
| charge shall attach to any verdict or judgment
entered and to | 4 |
| any money or property which may be recovered on account
of such | 5 |
| claim, demand, cause of action or suit from and after the time
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| of the service of the notice.
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| On petition filed by the Illinois Department, or by the | 8 |
| local
governmental unit or county if either is claiming a | 9 |
| charge, or by the
recipient, or by the defendant, the court, on | 10 |
| written notice to all
interested parties, may adjudicate the | 11 |
| rights of the parties and enforce
the charge. The court may | 12 |
| approve the settlement of any claim, demand
or cause of action | 13 |
| either before or after a verdict, and nothing in this
Section | 14 |
| shall be construed as requiring the actual trial or final
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| adjudication of any claim, demand or cause of action upon which | 16 |
| the
Illinois Department, the local governmental unit or county | 17 |
| has charge.
The court may determine what portion of the | 18 |
| recovery shall be paid to
the injured person and what portion | 19 |
| shall be paid to the Illinois
Department, the local | 20 |
| governmental unit or county having a charge
against the | 21 |
| recovery.
In making this determination, the court shall conduct | 22 |
| an evidentiary hearing
and shall consider competent evidence | 23 |
| pertaining
to the following matters:
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| (1) the amount of the charge sought to be enforced | 25 |
| against the recovery
when expressed as a percentage of the | 26 |
| gross amount of the recovery; the
amount of the charge | 27 |
| sought to be enforced against the recovery when expressed
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| as a percentage of the amount obtained by subtracting from | 29 |
| the gross amount
of the recovery the total attorney's fees | 30 |
| and other costs incurred by the
recipient incident to the | 31 |
| recovery; and whether the Department, unit of
local | 32 |
| government or county seeking to enforce the charge against | 33 |
| the recovery
should as a matter of fairness and equity bear | 34 |
| its proportionate share of
the fees and costs incurred to | 35 |
| generate the recovery from which the charge
is sought to be | 36 |
| satisfied;
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| (2) the amount, if any, of the attorney's fees and | 2 |
| other costs incurred
by the recipient incident to the | 3 |
| recovery and paid by the recipient up to the
time of | 4 |
| recovery, and the amount of such fees and costs remaining | 5 |
| unpaid
at the time of recovery;
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| (3) the total hospital, doctor and other medical | 7 |
| expenses incurred for
care and treatment of the injury to | 8 |
| the date of recovery therefor, the portion
of such expenses | 9 |
| theretofore paid by the recipient, by insurance provided
by | 10 |
| the recipient, and by the Department, unit of local | 11 |
| government and county
seeking to enforce a charge against | 12 |
| the recovery, and the amount of such
previously incurred | 13 |
| expenses which remain unpaid at the time of recovery
and by | 14 |
| whom such incurred, unpaid expenses are to be paid;
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| (4) whether the recovery represents less than | 16 |
| substantially full
recompense
for the injury and the | 17 |
| hospital, doctor and other medical expenses incurred
to the | 18 |
| date of recovery for the care and treatment of the injury, | 19 |
| so that
reduction of the charge sought to be enforced | 20 |
| against the recovery would
not likely result in a double | 21 |
| recovery or unjust enrichment to the recipient;
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| (5) the age of the recipient and of persons dependent | 23 |
| for support upon
the recipient, the nature and permanency | 24 |
| of the recipient's injuries as
they affect not only the | 25 |
| future employability and education of the recipient
but | 26 |
| also the reasonably necessary and foreseeable future | 27 |
| material, maintenance,
medical, rehabilitative and | 28 |
| training needs of the recipient, the cost of
such | 29 |
| reasonably necessary and foreseeable future needs, and the | 30 |
| resources
available to meet such needs and pay such costs;
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| (6) the realistic ability of the recipient to repay in | 32 |
| whole or in part
the charge sought to be enforced against | 33 |
| the recovery when judged in light
of the factors enumerated | 34 |
| above.
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| The burden of producing evidence sufficient to support the | 36 |
| exercise by
the court of its discretion to reduce the amount of |
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| a proven charge sought
to be enforced against the recovery | 2 |
| shall rest with the party seeking such reduction.
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| The court may reduce and apportion the Illinois
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| Department's lien proportionate to the recovery of the | 5 |
| claimant. The court may
consider the nature and extent of the | 6 |
| injury, economic and noneconomic
loss, settlement offers, | 7 |
| comparative negligence as it applies to the case
at hand, | 8 |
| hospital costs, physician costs, and all other appropriate | 9 |
| costs.
The Illinois Department shall pay its pro rata share of | 10 |
| the attorney fees
based on the Illinois Department's lien as it | 11 |
| compares to the total
settlement agreed upon. This Section | 12 |
| shall not affect the priority of an
attorney's lien under the | 13 |
| Attorneys Lien Act. The charges of
the Illinois Department | 14 |
| described in this Section, however, shall take
priority over | 15 |
| all other liens and charges existing under the laws of the
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| State of Illinois with the exception of the attorney's lien | 17 |
| under said statute.
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| Whenever the Department or any unit of local government
has | 19 |
| a statutory charge under this Section against a recovery for | 20 |
| damages
incurred by a recipient because of its advancement of | 21 |
| any assistance, such
charge shall not be satisfied out of any | 22 |
| recovery until the attorney's claim
for fees is satisfied, | 23 |
| irrespective of whether or not an action based on
recipient's | 24 |
| claim has been filed in court.
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| This Section shall be inapplicable to any claim, demand or | 26 |
| cause of
action arising under (a) the Workers' Compensation Act | 27 |
| or the predecessor
Workers' Compensation Act
of
June 28, 1913, | 28 |
| (b) the Workers' Occupational Diseases Act or the predecessor
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| Workers' Occupational
Diseases Act of March 16, 1936; and (c) | 30 |
| the Wrongful Death Act.
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| (Source: P.A. 91-357, eff. 7-29-99; 92-111, eff. 1-1-02.)
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| (305 ILCS 5/11-22a) (from Ch. 23, par. 11-22a)
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| Sec. 11-22a. Right of Subrogation. To the extent of the | 34 |
| amount of (i) medical
assistance provided by the Department to | 35 |
| or on behalf of a recipient under
Article V or VI or (ii) |
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| health care benefits provided for a child under the Covering | 2 |
| ALL KIDS Health Insurance Act , the Department shall be
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| subrogated
to any right of
recovery such recipient may have | 4 |
| under the terms of any private or public
health care coverage | 5 |
| or casualty coverage, including coverage under the
"Workers' | 6 |
| Compensation Act", approved July 9, 1951, as amended, or the
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| "Workers' Occupational Diseases Act", approved July 9, 1951, as | 8 |
| amended,
without the necessity of assignment of claim or other | 9 |
| authorization to secure
the right of recovery to the | 10 |
| Department. To enforce its subrogation right, the
Department | 11 |
| may (i) intervene or join in an action or proceeding brought by | 12 |
| the
recipient, his or her guardian, personal representative, | 13 |
| estate, dependents, or
survivors against any person or public | 14 |
| or private entity that may be liable;
(ii) institute and | 15 |
| prosecute legal proceedings against any person or public or
| 16 |
| private entity that may be liable for the cost of such | 17 |
| services; or (iii)
institute and prosecute legal proceedings, | 18 |
| to the extent necessary to reimburse
the Illinois Department | 19 |
| for its costs, against any noncustodial parent who (A)
is | 20 |
| required by court or administrative order to provide insurance | 21 |
| or other
coverage of the cost of health care services for a | 22 |
| child eligible for medical
assistance under this Code and (B) | 23 |
| has received payment from a third party for
the costs of those | 24 |
| services but has not used the payments to reimburse either
the | 25 |
| other parent or the guardian of the child or the provider of | 26 |
| the services.
| 27 |
| (Source: P.A. 92-111, eff. 1-1-02.)
| 28 |
| (305 ILCS 5/11-22b) (from Ch. 23, par. 11-22b)
| 29 |
| Sec. 11-22b. Recoveries.
| 30 |
| (a) As used in this Section:
| 31 |
| (1) "Carrier" means any insurer, including any private | 32 |
| company,
corporation, mutual association, trust fund, | 33 |
| reciprocal or interinsurance
exchange authorized under the | 34 |
| laws of this State to insure persons against
liability or | 35 |
| injuries caused to another and any insurer providing
benefits |
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| under a policy of bodily injury liability insurance covering
| 2 |
| liability arising out of the ownership, maintenance or use of a | 3 |
| motor
vehicle which provides uninsured motorist endorsement or | 4 |
| coverage.
| 5 |
| (2) "Beneficiary" means any person or their dependents who | 6 |
| has received
benefits or will be provided benefits under this | 7 |
| Code or under the Covering ALL KIDS Health Insurance Act
| 8 |
| because of an injury for
which another person may be liable. It | 9 |
| includes such beneficiary's guardian,
conservator or other | 10 |
| personal representative, his estate or survivors.
| 11 |
| (b) (1) When benefits are provided or will be provided to a | 12 |
| beneficiary
under this Code or under the Covering ALL KIDS | 13 |
| Health Insurance Act because of an injury for which another | 14 |
| person is liable, or
for which a carrier is liable in | 15 |
| accordance with the provisions of any
policy of insurance | 16 |
| issued pursuant to the Illinois Insurance Code, the
Illinois | 17 |
| Department shall have a right to recover from such person or | 18 |
| carrier
the reasonable value of benefits so provided. The | 19 |
| Attorney General may, to
enforce such right, institute and | 20 |
| prosecute legal proceedings against the
third person or carrier | 21 |
| who may be liable for the injury in an appropriate
court, | 22 |
| either in the name of the Illinois Department or in the name of | 23 |
| the
injured person, his guardian, personal representative, | 24 |
| estate, or survivors.
| 25 |
| (2) The Department may:
| 26 |
| (A) compromise or settle and release any such claim for | 27 |
| benefits
provided under this Code, or
| 28 |
| (B) waive any such claims for benefits provided under | 29 |
| this Code, in
whole or in part, for the convenience of the | 30 |
| Department or if the Department
determines that collection | 31 |
| would result in undue hardship upon the person who
suffered | 32 |
| the injury or, in a wrongful death action, upon the heirs | 33 |
| of the
deceased.
| 34 |
| (3) No action taken on behalf of the Department pursuant to | 35 |
| this Section
or any judgment rendered in such action shall be a | 36 |
| bar to any action upon
the claim or cause of action of the |
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| beneficiary, his guardian, conservator,
personal | 2 |
| representative, estate, dependents or survivors against the | 3 |
| third
person who may be liable for the injury, or shall operate | 4 |
| to deny to the
beneficiary the recovery for that portion of any | 5 |
| damages not covered hereunder.
| 6 |
| (c) (1) When an action is brought by the Department | 7 |
| pursuant to
subsection (b), it shall be commenced within the | 8 |
| period prescribed by
Article XIII of the Code of Civil | 9 |
| Procedure.
| 10 |
| However, the Department may not commence the action prior | 11 |
| to 5 months
before the end of the applicable period prescribed | 12 |
| by Article XIII of the
Code of Civil Procedure. Thirty days | 13 |
| prior to commencing an action, the
Department shall notify the | 14 |
| beneficiary of the Department's intent to
commence such an | 15 |
| action.
| 16 |
| (2) The death of the beneficiary does not abate any right | 17 |
| of action
established by subsection (b).
| 18 |
| (3) When an action or claim is brought by persons entitled | 19 |
| to bring such
actions or assert such claims against a third | 20 |
| person who may be liable for
causing the death of a | 21 |
| beneficiary, any settlement, judgment or award
obtained is | 22 |
| subject to the Department's claim for reimbursement of the
| 23 |
| benefits provided to the beneficiary under this Code or under | 24 |
| the Covering ALL KIDS Health Insurance Act .
| 25 |
| (4) When the action or claim is brought by the beneficiary | 26 |
| alone and
the beneficiary incurs a personal liability to pay | 27 |
| attorney's fees and
costs of litigation, the Department's claim | 28 |
| for reimbursement of the
benefits provided to the beneficiary | 29 |
| shall be the full amount of benefits
paid on behalf of the | 30 |
| beneficiary under this Code or under the Covering ALL KIDS | 31 |
| Health Insurance Act less a pro rata
share which represents the | 32 |
| Department's reasonable share of attorney's fees
paid by the | 33 |
| beneficiary and that portion of the cost of litigation expenses
| 34 |
| determined by multiplying by the ratio of the full amount of | 35 |
| the
expenditures of the full amount of the judgment, award or | 36 |
| settlement.
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| (d) (1) If either the beneficiary or the Department brings | 2 |
| an action or
claim against such third party or carrier, the | 3 |
| beneficiary or the
Department shall within 30 days of filing | 4 |
| the action give to the other
written notice by personal service | 5 |
| or registered mail of the action or
claim and of the name of | 6 |
| the court in which the
action or claim is brought. Proof of | 7 |
| such notice shall be filed in such
action or claim. If an | 8 |
| action or claim is brought by either the Department
or the | 9 |
| beneficiary, the other may, at any time before trial on the | 10 |
| facts,
become a party to such action or claim or shall | 11 |
| consolidate his action or
claim with the other if brought | 12 |
| independently.
| 13 |
| (2) If an action or claim is brought by the Department | 14 |
| pursuant to
subsection (b)(1), written notice to the | 15 |
| beneficiary, guardian, personal
representative, estate or | 16 |
| survivor given pursuant to this Section shall
advise him of his | 17 |
| right to intervene in the proceeding, his right to obtain
a | 18 |
| private attorney of his choice and the Department's right to | 19 |
| recover the
reasonable value of the benefits provided.
| 20 |
| (e) In the event of judgment or award in a suit or claim | 21 |
| against such
third person or carrier:
| 22 |
| (1) If the action or claim is prosecuted by the beneficiary | 23 |
| alone, the
court shall first order paid from any judgment or | 24 |
| award the
reasonable litigation expenses incurred in | 25 |
| preparation and prosecution of
such action or claim, together | 26 |
| with reasonable attorney's fees, when an
attorney has been | 27 |
| retained. After payment of such expenses and attorney's
fees | 28 |
| the court shall, on the application of the Department, allow
as | 29 |
| a first lien against the amount of such judgment or award the | 30 |
| amount of
the Department's expenditures for the benefit of the | 31 |
| beneficiary under this
Code or under the Covering ALL KIDS | 32 |
| Health Insurance Act , as provided in subsection (c)(4).
| 33 |
| (2) If the action or claim is prosecuted both by the | 34 |
| beneficiary and the
Department, the court shall first order | 35 |
| paid from any judgment or
award the reasonable litigation | 36 |
| expenses incurred in preparation and
prosecution of such action |
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| or claim, together with reasonable attorney's
fees for | 2 |
| plaintiffs attorneys based solely on the services rendered for | 3 |
| the
benefit of the beneficiary. After payment of such expenses | 4 |
| and attorney's
fees, the court shall apply out of the balance | 5 |
| of such judgment or award an
amount sufficient to reimburse the | 6 |
| Department the full amount of benefits
paid on behalf of the | 7 |
| beneficiary under this Code or under the Covering ALL KIDS | 8 |
| Health Insurance Act .
| 9 |
| (f) The court shall, upon further application at any time
| 10 |
| before the judgment or award is satisfied, allow as a further | 11 |
| lien the
amount of any expenditures of the Department in | 12 |
| payment of additional
benefits arising out of the same cause of | 13 |
| action or claim provided on
behalf of the beneficiary under | 14 |
| this Code or under the Covering ALL KIDS Health Insurance Act , | 15 |
| when such benefits were
provided or became payable subsequent | 16 |
| to the original order.
| 17 |
| (g) No judgment, award, or settlement in any action or | 18 |
| claim by a
beneficiary to recover damages for injuries, when | 19 |
| the Department has an
interest, shall be satisfied without | 20 |
| first giving the Department notice and
a reasonable opportunity | 21 |
| to perfect and satisfy its lien.
| 22 |
| (h) When the Department has perfected a lien upon a | 23 |
| judgment or award in
favor of a beneficiary against any third | 24 |
| party for an injury for which the
beneficiary has received | 25 |
| benefits under this Code or under the Covering ALL KIDS Health | 26 |
| Insurance Act , the Department shall be
entitled to a writ of | 27 |
| execution as lien claimant to enforce payment of said
lien | 28 |
| against such third party with interest and other accruing costs | 29 |
| as in
the case of other executions. In the event the amount of | 30 |
| such judgment or
award so recovered has been paid to the | 31 |
| beneficiary, the Department shall
be entitled to a writ of | 32 |
| execution against such beneficiary to the extent of
the | 33 |
| Department's lien, with interest and other accruing costs as in | 34 |
| the case
of other executions.
| 35 |
| (i) Except as otherwise provided in this Section, | 36 |
| notwithstanding any
other provision of law, the entire amount |
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| of any settlement of the injured
beneficiary's action or claim, | 2 |
| with or without suit, is subject to the
Department's claim for | 3 |
| reimbursement of the benefits provided and any lien
filed | 4 |
| pursuant thereto to the same extent and subject to the same
| 5 |
| limitations as in Section 11-22 of this Code.
| 6 |
| (Source: P.A. 92-651, eff. 7-11-02.)
| 7 |
| (305 ILCS 5/11-22c) (from Ch. 23, par. 11-22c)
| 8 |
| Sec. 11-22c. (a) As used in this Section, "recipient" means | 9 |
| any person
receiving financial assistance under Article IV or | 10 |
| Article VI of this Code or receiving health care benefits under | 11 |
| the Covering ALL KIDS Health Insurance Act .
| 12 |
| (b) If a recipient maintains any suit, charge or other | 13 |
| court or
administrative action against an employer seeking back | 14 |
| pay for a period
during which the recipient received financial | 15 |
| assistance under Article IV
or Article VI of this Code or | 16 |
| health care benefits under the Covering ALL KIDS Health | 17 |
| Insurance Act , the recipient shall report such fact to the
| 18 |
| Department. To the extent of the amount of assistance provided | 19 |
| to or on
behalf of the recipient under Article IV or Article VI | 20 |
| or health care benefits provided under the Covering ALL KIDS | 21 |
| Health Insurance Act , the Department may
by intervention or | 22 |
| otherwise without the necessity of assignment of claim,
attach | 23 |
| a lien on the recovery of back wages equal to the amount of
| 24 |
| assistance provided by the Department to the recipient under | 25 |
| Article IV or
Article VI or under the Covering ALL KIDS Health | 26 |
| Insurance Act .
| 27 |
| (Source: P.A. 86-497.)
| 28 |
| Section 97. Severability. If any provision of this Act or | 29 |
| its application to any person or circumstance is held invalid, | 30 |
| the invalidity of that provision or application does not affect | 31 |
| other provisions or applications of this Act that can be given | 32 |
| effect without the invalid provision or application, and to | 33 |
| this end the provisions of this Act are severable. |
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| 1 |
| Section 98. Repealer. This Act is repealed on July 1, | 2 |
| 2011.
| 3 |
| Section 99. Effective date. This Act takes effect July 1, | 4 |
| 2006. |
|