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92_HB0023eng HB0023 Engrossed LRB9200767JSpc 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 HB0023 Engrossed -2- LRB9200767JSpc 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: HB0023 Engrossed -3- LRB9200767JSpc 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 HB0023 Engrossed -4- LRB9200767JSpc 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 HB0023 Engrossed -5- LRB9200767JSpc 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 HB0023 Engrossed -6- LRB9200767JSpc 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 HB0023 Engrossed -7- LRB9200767JSpc 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, 2002 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. HB0023 Engrossed -8- LRB9200767JSpc 1 Section 55. Repealer. This Act is repealed on June 30, 2 2007. 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 HB0023 Engrossed -9- LRB9200767JSpc 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: HB0023 Engrossed -10- LRB9200767JSpc 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. HB0023 Engrossed -11- LRB9200767JSpc 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. HB0023 Engrossed -12- LRB9200767JSpc 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 HB0023 Engrossed -13- LRB9200767JSpc 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. HB0023 Engrossed -14- LRB9200767JSpc 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 HB0023 Engrossed -15- LRB9200767JSpc 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, HB0023 Engrossed -16- LRB9200767JSpc 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 HB0023 Engrossed -17- LRB9200767JSpc 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). HB0023 Engrossed -18- LRB9200767JSpc 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 HB0023 Engrossed -19- LRB9200767JSpc 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 HB0023 Engrossed -20- LRB9200767JSpc 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 HB0023 Engrossed -21- LRB9200767JSpc 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.)