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90_HB1302eng
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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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 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 "Department" means the Department of Human Services.
4 "Eligible child" means a child who has resided in the
5 State of Illinois for 30 days and (i) who is 8 years of age
6 or less in fiscal year 1999, or who is 10 years of age or
7 less in fiscal year 2000, or who is 12 years of age or less
8 in 2001, and who qualifies for enrollment in the Healthy
9 Start Insurance Plan under eligibility criteria set forth
10 under subsection (a) of Section 20 of this Act; or (ii) a
11 child who is 12 years of age or less prior to fiscal year
12 2002 and qualifies for enrollment in the Healthy Start
13 Insurance Plan under subsection (a) of Section 20 of this
14 Act.
15 "Family" means, in the case of a child who is a dependent
16 of another person or couple as defined by the Illinois Income
17 Tax Act, all persons for whom exemption is claimed in the
18 State income tax return of the person or couple whose
19 dependent the eligible child is.
20 "Health insurance coverage" means benefits consisting of
21 health services set forth under Section 15 of this Act,
22 provided under any health insurance plan offered by the
23 Department.
24 "Medical assistance" means the state medical assistance
25 or medical assistance no grant (MANG) programs provided under
26 Title XIX of the Social Security Act and Article V (Medical
27 Assistance) and VI (General Assistance) of the Illinois
28 Public Aid Code (or any successor program).
29 "Plan market rate" means the costs of Healthy Start
30 Insurance Plan coverage charged by at least 5 of the largest
31 health insurance issuers providing to residents of Illinois
32 health insurance coverage that is substantially similar to
33 the coverage offered by the Plan.
34 "Plan of operation" means the plan of operation of the
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1 Healthy Start Insurance Plan, including articles, bylaws, and
2 operating rules, adopted by the Department.
3 All other definitions in Section 2 of the Comprehensive
4 Health Insurance Plan shall apply to this Act, unless
5 otherwise indicated.
6 Section 15. Health services covered.
7 (a) The Healthy Start Insurance Plan (called "Healthy
8 Start Plan") is established to promote access to certain
9 health care services to assure healthy children. The
10 following health insurance coverage shall be offered to
11 children who are enrolled in the Healthy Start Plan, subject
12 to such separate co-payments, exclusions, and other
13 limitations on benefits as the Department shall establish and
14 approve:
15 (1) Well-child examinations, including
16 immunizations;
17 (2) Out-patient medical care, including laboratory
18 and x-ray services;
19 (3) Emergency room care;
20 (4) Prescription medications;
21 (5) Hearing and vision services;
22 (6) Dental care, including preventive and
23 restorative care, but excluding orthodontic care;
24 (7) Home health care;
25 (8) Allied health services, including physical,
26 occupational, and speech therapy, audiology, social work,
27 and nutritional services;
28 (9) Out-patient mental health services; and
29 (10) Out-patient substance abuse treatment
30 services.
31 (b) Health insurance coverage under the Healthy Start
32 Plan shall be secondary to an insurance policy or benefit
33 program under which an eligible child may otherwise have
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1 health insurance coverage.
2 Section 20. Eligibility for enrollment.
3 (a) A family may enroll an eligible child or children in
4 the Healthy Start Plan, within the limits of available
5 appropriations, if the following criteria are met:
6 (1) The child's family has gross family income
7 equal to or less than 250% of the federal poverty level
8 and is not eligible for medical assistance and is not
9 otherwise insured for a particular health service covered
10 under the Healthy Start Plan;
11 (2) The child's family pays an annual premium as
12 defined in Section 25; and
13 (3) The eligible child and his or her family meet
14 all other guidelines and requirements of the Department.
15 (b) The Department may use Social Security numbers of
16 individuals as identifiers for purposes of administering the
17 Healthy Start Plan and may conduct data matches to verify
18 income. Applicants may be required to submit evidence of
19 family income to verify income eligibility for the Healthy
20 Start Plan.
21 (c) The period of a child's eligibility for the Healthy
22 Start Plan shall terminate on the last day of the month in
23 which the child's birthday occurs at the age that he or she
24 is no longer an "eligible child" pursuant to Section 10 of
25 this Act.
26 Section 25. Premiums.
27 (a) The following annual premiums shall be required as a
28 condition of enrollment in the Healthy Start Plan, provided
29 that total premium costs shall not exceed 5% of family gross
30 income:
31 (1) Families with gross income equal to or less
32 than 100% of the federal poverty level shall pay a
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1 premium that is no more than 5% of the Plan market rate.
2 (2) Families with gross income of more than 100%,
3 but less than 133%, of the federal poverty level shall
4 pay a premium that is no more than 10% of the Plan market
5 rate.
6 (3) Families with gross income of at least 133%,
7 but less than 185%, of the federal poverty level shall
8 pay a premium that is no more than 20% of the Plan market
9 rate.
10 (4) Families with gross income of at least 185%,
11 but less than 200%, of the federal poverty level shall
12 pay a premium that is no more than 40% of the Plan market
13 rate.
14 (5) Families with gross income of at least 200%,
15 but less than 230%, of the federal poverty level shall
16 pay a premium that is no more than 60% of the Plan market
17 rate.
18 (6) Families with gross income of at least 230%,
19 but less than 250%, of the federal poverty level shall
20 pay a premium that is no more than 75% of the Plan market
21 rate.
22 (b) Total premium costs shall not exceed 5% of family
23 net income.
24 (c) An eligible child whose family has gross family
25 income greater than 250% of the federal poverty level may
26 enroll in the Plan if coverage is provided under guidelines
27 and requirements of the Department. Families enrolling under
28 this subsection may be required to pay the full cost of
29 health insurance coverage as determined by the Department.
30 (d) An eligible child who is 18 years of age or less
31 prior to fiscal year 2002 and whose gross family income is
32 less than 250% of the federal poverty level shall be
33 permitted to enroll in the Plan but shall be required to pay
34 the full cost of health insurance coverage as determined by
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1 the Department.
2 (e) The Department may establish family premium rates
3 for families who enroll in the Plan with 2 or more eligible
4 children.
5 Section 30. Administration.
6 (a) The Healthy Start Plan shall be administered by the
7 Department. The Department may adopt rules, policies, and
8 procedures as may be necessary or convenient for the
9 implementation of this Act and the operation of the Healthy
10 Start Plan.
11 (b) In its plan of operation for the Healthy Start Plan,
12 the Department shall:
13 (1) establish procedures for selecting an
14 administrator for the Healthy Start Plan that is in
15 conformance with Section 5 of the Comprehensive Health
16 Insurance Plan;
17 (2) create a Healthy Start Plan Fund, under
18 management of the Department, to fund administrative
19 expenses;
20 (3) establish procedures for the handling and
21 accounting of assets and moneys of the Healthy Start
22 Plan;
23 (4) establish procedures to (i) distribute
24 application forms and other information concerning the
25 Healthy Start Plan to, and accept completed applications
26 from, public health and health agencies and human
27 services agencies and schools and (ii) maintain public
28 awareness of the Healthy Start Plan and other publicly
29 subsidized medical assistance programs among families of
30 potentially eligible children;
31 (5) develop procedures for joint applications and
32 eligibility determination procedures, wherever possible,
33 for enrollment of eligible children in the Healthy Start
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1 Plan and for medical assistance under the Illinois Public
2 Aid Code (or any other successor program);
3 (6) determine qualifications and payment schedules
4 for the providers who are eligible to provide and receive
5 payment for health services included under Section 15 of
6 this Act;
7 (7) establish procedures for the redetermination of
8 eligibility under the Healthy Start Plan and the
9 reporting of changes in family income and for the
10 disenrollment of eligible children from the Healthy Start
11 Plan for failure of their families to pay a premium
12 required under this Act;
13 (8) establish procedures under which applicants and
14 participants may have grievances reviewed by a grievance
15 committee appointed by the Department, and in conformance
16 with grievance procedures established for other plans
17 administered by the Department; and
18 (9) provide for other matters as may be necessary
19 and proper for the execution of its powers, duties and
20 obligations under the Healthy Start Plan.
21 (c) The Department shall submit a report to the General
22 Assembly, no later than April 1, 1998, containing:
23 (1) a plan for implementation of the Healthy Start
24 Plan beginning January 1, 1999;
25 (2) the rules, policies, and procedures that were
26 adopted by the Department for implementation of the
27 Healthy Start Plan; and
28 (3) amounts necessary to be appropriated by the
29 General Assembly in order to subsidize the premiums paid
30 by families of eligible children to implement the Healthy
31 Start Plan.
32 (d) The Department of Human Services may enter into an
33 intergovernmental agreement under which it delegates any or
34 all of its powers and duties under this Act to the Board or
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1 the Department of Public Aid.
2 Section 35. Federal waivers. The Department shall work
3 with the appropriate State agencies to apply for any federal
4 waivers necessary to implement the Healthy Start Plan,
5 including those to allow enrollees in State health care
6 programs to assign the federal health insurance credit
7 component of the earned income tax credit to the State of
8 Illinois.
9 Section 40. Exclusion of persons or medical conditions
10 prohibited.
11 (a) No employer, association, or any other group that
12 makes health insurance available to its employees or members
13 shall refer any previously covered individual employee,
14 member, or dependent thereof to the Healthy Start Plan or
15 arrange for any individual employee, member, or dependent
16 thereof to apply for the Healthy Start Plan for the purpose
17 of the selecting out of these persons from a health insurance
18 policy, plan, or arrangement.
19 (b) It shall constitute unfair competition for purposes
20 of Article XXVI of the Illinois Insurance Code for any
21 insurer, insurance producer, or administrator to refer any
22 individual employee, member, or the dependent thereof to the
23 Healthy Start Plan or arrange for any individual employee,
24 member, or dependent thereof to apply for the Healthy Start
25 Plan for the purpose of the selecting out or otherwise
26 excluding those persons or medical conditions that were
27 previously covered by that employer or association from a
28 group health insurance policy, plan, or arrangement provided
29 other employees or members.
30 Section 99. Effective date. This Act takes effect upon
31 becoming law.