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90_HB1302
New Act
Creates the Healthy Start Insurance Plan Act.
Establishes the Healthy Start Insurance Plan to provide
insurance coverage for persons under the age of 19 whose
family meets certain income and residency criteria. Provides
that coverage under the Plan is secondary coverage. Provides
for payment of premiums of the coverage. Provides for the
Plan to be administered by the Comprehensive Health Insurance
Plan Board. Provides for coverage under the Plan to be made
available beginning July 1, 1998. Effective immediately.
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LRB9003882JSmg
1 AN ACT concerning health insurance for children.
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 Healthy Start Insurance Plan Act.
6 Section 5. Findings and declarations.
7 (a) About 310,000, or nearly 10% of more than 3,000,000
8 children in Illinois, have no health insurance coverage,
9 either through a parent's employment, through the State's
10 Medicaid program, or any other health plan.
11 (b) Parents moving from welfare to work will lose
12 Medicaid coverage for their children and are unlikely to be
13 offered health care coverage in low-skill and service sector
14 jobs. According to the General Accounting Office,
15 lower-income workers are less likely to work for a firm that
16 offers insurance and may find it too costly to purchase where
17 coverage it is available.
18 (c) Numerous states have implemented health insurance
19 programs for insured children in recognizing that access to
20 immunizations, ongoing check-ups, and other health services
21 helps children avoid serious health problems that can lead to
22 life-long physical and mental disabilities. Preventive care
23 is cost effective and can reduce expensive hospitalization.
24 (d) The State of Illinois may subsidize the cost of
25 health insurance policies offered. While serving as many
26 uninsured children as possible within the limits of
27 appropriations, the General Assembly is not guaranteeing
28 every family an entitlement to a health insurance policy
29 under this Act.
30 Section 10. Definitions.
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1 "Board" means the Illinois Comprehensive Health Insurance
2 Board.
3 "Eligible child" means a child who is 18 years of age or
4 less who has resided in the State of Illinois for 30 days and
5 who qualifies for enrollment in the Healthy Start Insurance
6 Plan under eligibility criteria set forth under Section 20 of
7 this Act.
8 "Family" means, in the case of a child who is a dependent
9 of another person or couple as defined by the Illinois Income
10 Tax Act, all persons for whom exemption is claimed in the
11 State income tax return of the person or couple whose
12 dependent the eligible child is.
13 "Health insurance coverage" means benefits consisting of
14 health services set forth under Section 15 of this Act,
15 provided under any health insurance plan offered by the
16 Board.
17 "Medical assistance" means the state medical assistance
18 or medical assistance no grant (MANG) programs provided under
19 Title XIX of the Social Security Act and Article V (Medical
20 Assistance) and VI (General Assistance) of the Illinois
21 Public Aid Code (or any successor program).
22 "Plan of operation" means the plan of operation of the
23 Healthy Start Insurance Plan, including articles, bylaws, and
24 operating rules, adopted by the board.
25 All other definitions in Section 2 of the Comprehensive
26 Health Insurance Plan shall apply to this Act, unless
27 otherwise indicated.
28 Section 15. Health services covered.
29 (a) The Healthy Start Insurance Plan (called "Healthy
30 Start Plan") is established to promote access to certain
31 health care services to assure healthy children. The
32 following health insurance coverage shall be offered to
33 children who are enrolled in the Healthy Start Plan:
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1 (1) Well-child examinations, including
2 immunizations;
3 (2) Out-patient medical care;
4 (3) Emergency room care;
5 (4) Prescription medications;
6 (5) Hearing and vision services;
7 (6) Dental care, including preventive and
8 restorative care;
9 (7) Case management;
10 (8) Home health care;
11 (9) Allied health services including early
12 intervention, physical, occupational, and speech therapy,
13 audiology; social work and nutritional services; and
14 parent or caregiver training.
15 (10) Out-patient mental health services; and
16 (11) Out-patient substance abuse treatment
17 services.
18 (b) Health insurance coverage under the Healthy Start
19 Plan shall be secondary to an insurance policy or benefit
20 program under which an eligible child may otherwise have
21 health insurance coverage.
22 Section 20. Eligibility for enrollment.
23 (a) A family may enroll an eligible child or children in
24 the Healthy Start Plan if the following criteria are met:
25 (1) The child's family has net family income equal
26 to or less than 250% of the federal poverty level and is
27 not eligible for medical assistance and is not otherwise
28 insured for a particular health service covered under the
29 Healthy Start Plan;
30 (2) The child's family pays an annual premium as
31 defined in Section 25; and
32 (3) The eligible child and his or her family meet
33 all other guidelines and requirements of the board.
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1 (b) The board may use Social Security numbers of
2 individuals as identifiers for purposes of administering the
3 Healthy Start Plan and may conduct data matches to verify
4 income. Applicants may be required to submit evidence of
5 family income to verify income eligibility for the Healthy
6 Start Plan.
7 (c) The period of a child's eligibility for the Healthy
8 Start Plan shall terminate on the last day of the month in
9 which the child's 19th birthday occurs.
10 Section 25. Premiums.
11 (a) The following annual premiums shall be required as a
12 condition of enrollment in the Healthy Start Plan:
13 (1) Families with net income equal to or less than
14 100% of the federal poverty level shall pay a premium of
15 $15 per child, but not more than $100 per family;
16 (2) Families with net income of more than 100%, but
17 less than 133%, of the federal poverty level shall pay a
18 premium of $50 per child.
19 (3) Families with net income of at least 133%, but
20 less than 185%, of the federal poverty level shall pay a
21 premium of $115 per child.
22 (4) Families with net income of at least 185%, but
23 less than 200%, of the federal poverty level shall pay a
24 premium of $225 per child.
25 (5) Families with net income of at least 200%, but
26 less than 230%, of the federal poverty level shall pay a
27 premium of $300 per child.
28 (6) Families with net income of at least 230%, but
29 less than 250%, of the federal poverty level shall pay a
30 premium of $375 per child.
31 (b) Total premium costs shall not exceed 5% of family
32 net income.
33 (c) An eligible child whose family has net family income
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1 greater than 250% of the federal poverty level may enroll in
2 the Plan if coverage is provided under guidelines and
3 requirements of the board. Families enrolling under this
4 subsection may be required to pay the full cost of health
5 insurance coverage as determined by the board.
6 Section 30. Administration.
7 (a) The Healthy Start Plan shall be administered by the
8 board. The board may adopt rules, policies, and procedures
9 as may be necessary or convenient for the implementation of
10 this Act and the operation of the Healthy Start Plan.
11 (b) In its plan of operation for the Healthy Start Plan,
12 the board shall:
13 (1) establish procedures for selecting an
14 administering carrier for the Healthy Start Plan that is
15 in conformance with Section 5 of the Comprehensive Health
16 Insurance Plan;
17 (2) create a Healthy Start Plan Fund, under
18 management of the board, to fund administrative expenses;
19 (3) establish procedures for the handling and
20 accounting of assets and moneys of the Healthy Start
21 Plan;
22 (4) establish procedures to (i) distribute
23 application forms and other information concerning the
24 Healthy Start Plan to, and accept completed applications
25 from, public health and health agencies and human
26 services agencies and schools and (ii) maintain public
27 awareness of the Healthy Start Plan and other publicly
28 subsidized medical assistance programs among families of
29 potentially eligible children;
30 (5) develop procedures for joint applications and
31 eligibility determination procedures, wherever possible,
32 for enrollment of eligible children in the Healthy Start
33 Plan and for medical assistance under the Illinois Public
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1 Aid Code (or any other successor program);
2 (6) determine qualifications and payment schedules
3 for the providers who are eligible to provide and receive
4 payment for health services included under Section 15 of
5 this Act;
6 (7) establish procedures for the redetermination of
7 eligibility under the Healthy Start Plan and the
8 reporting of changes in family income and for the
9 disenrollment of eligible children from the Healthy Start
10 Plan for failure of their families to pay a premium
11 required under this Act;
12 (8) establish procedures under which applicants and
13 participants may have grievances reviewed by a grievance
14 committee appointed by the board, and in conformance with
15 grievance procedures established for other plans
16 administered by the board; and
17 (9) provide for other matters as may be necessary
18 and proper for the execution of its powers, duties and
19 obligations under the Healthy Start Plan.
20 (b) The board shall submit a report to the General
21 Assembly, no later than April 1, 1998, containing:
22 (1) a plan for implementation of the Healthy Start
23 Plan beginning July 1, 1998;
24 (2) the rules, policies, and procedures that were
25 adopted by the board for implementation of the Healthy
26 Start Plan; and
27 (3) amounts necessary to be appropriated by the
28 General Assembly in order to subsidize the premiums paid
29 by families of eligible children to implement the Healthy
30 Start Plan.
31 Section 35. Federal waivers. The board shall work with
32 the appropriate State agencies to apply for any federal
33 waivers necessary to implement the Healthy Start Plan,
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1 including those to allow enrollees in State health care
2 programs to assign the federal health insurance credit
3 component of the earned income tax credit to the State of
4 Illinois.
5 Section 40. Exclusion of persons or medical conditions
6 prohibited.
7 (a) No employer, association, or any other group that
8 makes health insurance available to its employees or members
9 shall refer any previously covered individual employee,
10 member, or dependent thereof to the Healthy Start Plan or
11 arrange for any individual employee, member, or dependent
12 thereof to apply for the Healthy Start Plan for the purpose
13 of the selecting out of these persons from a health insurance
14 policy, plan, or arrangement.
15 (b) It shall constitute unfair competition for purposes
16 of Article XXVI of the Illinois Insurance Code for any
17 insurer, insurance producer, or administrator to refer any
18 individual employee, member, or the dependent thereof to the
19 Healthy Start Plan or arrange for any individual employee,
20 member, or dependent thereof to apply for the Healthy Start
21 Plan for the purpose of the selecting out or otherwise
22 excluding those persons or medical conditions that were
23 previously covered by that employer or association from a
24 group health insurance policy, plan, or arrangement provided
25 other employees or members.
26 Section 99. Effective date. This Act takes effect upon
27 becoming law.