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92_HB0023ham001 LRB9200767DJmgam04 1 AMENDMENT TO HOUSE BILL 23 2 AMENDMENT NO. . Amend House Bill 23 by replacing the 3 title of the bill with the following: 4 "AN ACT in relation to health."; and 5 by replacing everything after the enacting clause with the 6 following: 7 "Section 1. Short title. This Act may be cited as the 8 Family Health Insurance Program Act. 9 Section 5. Legislative intent. The General Assembly 10 finds that, for the economic and social benefit of all 11 citizens of this State, it is important to enable low-income 12 families with children to access health benefits coverage, 13 especially for preventive and maintenance health care. This 14 helps these families to maintain and succeed in their work 15 efforts. Coverage of the entire family also promotes the 16 goals of the Children's Health Insurance Program. The 17 General Assembly recognizes that assistance to help families 18 purchase health benefits must be provided in a fair and 19 equitable fashion and must treat families at the same income 20 level in a similar fashion. The State of Illinois should 21 also help low-income families transition from a program in -2- LRB9200767DJmgam04 1 which the State helps the family to secure the family's 2 health coverage to a program in which the family is covered 3 by private or employer-based insurance without help from a 4 State program. 5 Section 10. Definitions. 6 "Children's Health Insurance Program" means the program 7 of health insurance provided under the Children's Health 8 Insurance Program Act. 9 "Department" means the Department of Public Aid. 10 "Family" means a group of people who live together and 11 who include minor children and their parents or other 12 blood-related adults who are the children's caretaker 13 relatives, and the spouses of those parents or caretaker 14 relatives. "Family" also includes any other persons who are 15 defined as covered family members under employer-provided or 16 private health insurance for which a single "family coverage" 17 premium is paid. 18 "Medical Assistance Program" is the health care benefit 19 program provided under Article V of the Illinois Public Aid 20 Code. 21 "Non-spend-down" Medical Assistance means benefits under 22 the Medical Assistance Program for which the beneficiary 23 qualifies without any required financial contribution. 24 "Program" means the Family Health Insurance Program. 25 Section 15. Operation of the program. The Family Health 26 Insurance Program is created. The program shall operate 27 subject to appropriation and shall be administered by the 28 Department. Except as otherwise provided in this Act, the 29 program is subject to the same rules and requirements as the 30 Children's Health Insurance Program. Families have the 31 option to participate only in the Children's Health Insurance 32 Program, even if they are eligible for coverage under this -3- LRB9200767DJmgam04 1 Act. 2 Section 20. Eligibility. 3 (a) The Department shall make all determinations of 4 eligibility for the program. 5 (b) To be eligible for health insurance coverage under 6 the program, a family must include a child who meets the 7 non-financial and financial eligibility requirements for 8 health coverage under the Children's Health Insurance Program 9 or non-spend-down coverage under the Medical Assistance 10 Program. 11 (c) A family determined eligible for the program remains 12 eligible for 12 months, as long as it meets the following 13 criteria: 14 (1) The family maintains a residence within 15 Illinois. 16 (2) At least one child in the family remains under 17 the age of 19. 18 (3) The family is not excluded under subsection (d). 19 The Department shall determine each family's eligibility 20 at least once each year. 21 (d) A family is not eligible for coverage under the 22 program if it meets any of the following criteria: 23 (1) A premium required under the program is not 24 paid. The Department shall adopt rules governing periods 25 of coverage in the event of loss of eligibility due to 26 unpaid premiums, waiting periods and conditions for 27 re-enrollment, grace periods, notices, and hearing 28 procedures relevant to this subsection. 29 (2) There is no longer a child in the family 30 eligible under the Children's Health Insurance Program or 31 non-spend-down Medical Assistance. 32 (3) The family is eligible for health insurance 33 under the State of Illinois health benefits plan on the -4- LRB9200767DJmgam04 1 basis of a family member's employment with a public 2 agency, or the whole family is eligible for 3 non-spend-down Medical Assistance. 4 Section 25. Health benefits for families. 5 (a) Subject to appropriation, the Department shall 6 provide health benefits coverage to eligible families by 7 doing either of the following: 8 (1) Subsidizing the cost of a family's coverage, for 9 families with a member who has access to 10 employer-provided family health coverage. 11 (2) Providing the family with health benefits that, 12 subject to appropriation and without regard to any 13 applicable cost-sharing under Section 30, are identical 14 to the benefits provided under the State's approved plan 15 under Title XIX of the Social Security Act or any waivers 16 granted by the federal Health Care Financing 17 Administration, for families that do not have access to 18 employer-provided family health coverage or for whom 19 subsidization of that coverage under paragraph (1) is not 20 cost-effective for the State, as determined by the 21 Department pursuant to rules. Providers of health 22 benefits under this paragraph (2) must be approved by the 23 Department to provide health care under the Illinois 24 Public Aid Code and shall be reimbursed at the same rate 25 as providers under the State's approved plan under Title 26 XIX of the Social Security Act. Any copayments required 27 under Section 30 may be paid to the Department or 28 retained by the provider, as provided by rule. 29 (b) The Department may provide the subsidy pursuant to 30 subdivision (a)(1) directly to an insurance company, as a 31 rebate to the family for premiums paid through payroll 32 deduction, or in any other manner the Department deems 33 cost-effective and accurate and best suited to accomplish the -5- LRB9200767DJmgam04 1 purposes of the program. The Department may also take 2 appropriate measures to ensure that employers do not take 3 unfair advantage of the subsidies provided under subdivision 4 (a)(1) by increasing the subsidized employees' share of the 5 premium for health insurance by amounts out-of-proportion to 6 any increase in the actual total cost of the insurance. 7 (c) The Department may not deny subsidization of coverage 8 to a family with a member who has access to an 9 employer-provided health plan under subdivision (a)(1) 10 because the plan does not meet federal benchmarking standards 11 or cost-sharing and contribution requirements. To be 12 eligible for inclusion in the program, the plan must contain 13 comprehensive major medical coverage of physician and 14 hospital inpatient services. The Department may not deny 15 subsidization of coverage for a family under subdivision 16 (a)(1) because the employer-based plan offers benefits in 17 addition to coverage of physician and hospital inpatient 18 services. The Department may deny subsidization of coverage 19 for a family under subdivision (a)(1) if it is more 20 cost-effective to provide coverage for the family under 21 subdivision (a)(2). 22 (d) The monthly dollar amount of the subsidy for family 23 coverage under subdivision (a)(1) shall be an amount that 24 allows the family to pay no more than 2% of its average net 25 income per month toward its share of the premium for the 26 health insurance. 27 The Department, however, may limit the monthly subsidy to 28 an amount equal to the average monthly cost of providing 29 coverage to identically configured families under subdivision 30 (a)(2), or a larger amount established by the Department by 31 rule. The Department, to the extent it imposes this 32 limitation, must set this "average monthly cost" 33 prospectively based on the prior fiscal year's experience 34 adjusted for incurred-but-not-reported claims and estimated -6- LRB9200767DJmgam04 1 increases or decreases in the cost of medical care. The 2 subsidy may not exceed the amount of the family's share of 3 the premium for the health insurance. 4 Section 30. Cost-sharing. 5 (a) A family enrolled in a health benefits program under 6 subdivision (a)(2) of Section 25 is subject to the following 7 cost-sharing requirements to the extent permitted by federal 8 requirements in waivers governing the funding of the program: 9 (1) A copayment may not be required for well-baby or 10 well-child care, including age-appropriate immunizations 11 as required under federal law. 12 (2) Health insurance premiums for a family whose 13 household income is equal to or greater than 150% of the 14 poverty guidelines updated annually in the Federal 15 Register by the U.S. Department of Health and Human 16 Services under authority of 42 U.S.C. 9902(2) must be 17 payable monthly, subject to rules adopted by the 18 Department for grace periods and advance payments, and 19 must be as follows: 20 (A) $25 for a family composed of an adult and 21 one dependent. 22 (B) $30 for a family composed of an adult and 2 23 dependents. 24 (C) $35 for a family composed of an adult and 3 25 or more dependents. 26 (3) Copayments for a family whose income is less 27 than 150% of the poverty guidelines updated annually in 28 the Federal Register by the U.S. Department of Health and 29 Human Services under authority of 42 U.S.C. 9902(2), at a 30 minimum and to the extent permitted under federal law, 31 must be $2 for each medical visit and each prescription 32 provided under this Act. 33 (4) Copayments for a family whose income is equal to -7- LRB9200767DJmgam04 1 or greater than 150% of the poverty guidelines updated 2 annually in the Federal Register by the U.S. Department 3 of Health and Human Services under authority of 42 U.S.C. 4 9902(2), at a minimum and to the extent permitted under 5 federal law, must be as follows: 6 (A) $5 for each medical visit. 7 (B) $3 for each generic prescription and $5 for 8 each brand-name prescription. 9 (C) $25 for each emergency room use for a 10 non-emergency situation as defined by the Department by 11 rule. 12 (5) The maximum allowable amount of out-of-pocket 13 expenses for copayments is $100 per family per year. 14 (b) A family whose health benefits coverage is subsidized 15 under subdivision (a)(1) of Section 25 is subject to (i) the 16 cost-sharing provisions of the employer-provided family 17 health coverage to which a family member has access, (ii) the 18 requirements imposed by the federal government under any 19 waivers governing federal funding of the program, or (iii) 20 both. 21 Section 35. Funding. 22 (a) The program is not an entitlement and shall not be 23 construed to create an entitlement. Eligibility for the 24 program is subject to appropriation of moneys by the State 25 and federal governments to fund the program. 26 (b) Any requirement imposed under this Act and any 27 implementation of this Act by the Department shall cease in 28 the event that moneys are not available for those purposes. 29 Section 40. Medical Assistance Plan amendments; federal 30 waivers. 31 (a) The Department shall amend the State's Medical 32 Assistance Plan to the extent permitted by federal law in -8- LRB9200767DJmgam04 1 order to secure federal matching funds for the health 2 coverages provided and administrative expenses incurred under 3 this Act. 4 (b) Promptly after the effective date of this Act, the 5 Department shall request any necessary waivers of federal 6 requirements in order to allow receipt of federal funding for 7 the health coverages subsidized or provided and 8 administrative expenses incurred under this Act. The 9 Department must implement the program, however, even if the 10 federal government denies all or some of the requested 11 waivers, to the extent that State appropriations permit. 12 Section 45. Contracts with non-governmental bodies. All 13 contracts with non-governmental bodies that are determined by 14 the Department to be necessary for the implementation of this 15 Act are deemed to be purchase of care as defined in the 16 Illinois Procurement Code. 17 Section 50. Implementation date. The Department must 18 begin implementing this Act on the effective date of this 19 Act. Health benefits coverage may not be subsidized or 20 provided under the program, and applications for enrollment 21 in the program may not be taken, until January 1, 2002 at the 22 earliest. Portions of the program as to which the Department 23 is awaiting federal action on a waiver request may be 24 implemented upon learning of the federal decision on the 25 request. 26 Section 55. Repealer. This Act is repealed on June 30, 27 2007. 28 Section 90. The Illinois Health Insurance Portability 29 and Accountability Act is amended by changing Section 20 as 30 follows: -9- LRB9200767DJmgam04 1 (215 ILCS 97/20) 2 Sec. 20. Increased portability through limitation on 3 preexisting condition exclusions. 4 (A) Limitation of preexisting condition exclusion 5 period; crediting for periods of previous coverage. Subject 6 to subsection (D), a group health plan, and a health 7 insurance issuer offering group health insurance coverage, 8 may, with respect to a participant or beneficiary, impose a 9 preexisting condition exclusion only if: 10 (1) the exclusion relates to a condition (whether 11 physical or mental), regardless of the cause of the 12 condition, for which medical advice, diagnosis, care, or 13 treatment was recommended or received within the 6-month 14 period ending on the enrollment date; 15 (2) the exclusion extends for a period of not more 16 than 12 months (or 18 months in the case of a late 17 enrollee) after the enrollment date; and 18 (3) the period of any such preexisting condition 19 exclusion is reduced by the aggregate of the periods of 20 creditable coverage (if any, as defined in subsection 21 (C)(1)) applicable to the participant or beneficiary as 22 of the enrollment date. 23 (B) Preexisting condition exclusion. A group health 24 plan, and health insurance issuer offering group health 25 insurance coverage, may not impose any preexisting condition 26 exclusion relating to pregnancy as a preexisting condition. 27 Genetic information shall not be treated as a condition 28 described in subsection (A)(1) in the absence of a diagnosis 29 of the condition related to such information. 30 (C) Rules relating to crediting previous coverage. 31 (1) Creditable coverage defined. For purposes of 32 this Act, the term "creditable coverage" means, with 33 respect to an individual, coverage of the individual 34 under any of the following: -10- LRB9200767DJmgam04 1 (a) A group health plan. 2 (b) Health insurance coverage. 3 (c) Part A or part B of title XVIII of the 4 Social Security Act. 5 (d) Title XIX of the Social Security Act, 6 other than coverage consisting solely of benefits 7 under Section 1928. 8 (e) Chapter 55 of title 10, United States 9 Code. 10 (f) A medical care program of the Indian 11 Health Service or of a tribal organization. 12 (g) A State health benefits risk pool. 13 (h) A health plan offered under chapter 89 of 14 title 5, United States Code. 15 (i) A public health plan (as defined in 16 regulations). 17 (j) A health benefit plan under Section 5(e) 18 of the Peace Corps Act (22 U.S.C. 2504(e)). 19 (k) Title XXI of the federal Social Security 20 Act, State Children's Health Insurance Program. 21 (l) Coverage under the Family Health Insurance 22 Program Act. 23 Such term does not include coverage consisting 24 solely of coverage of excepted benefits. 25 (2) Excepted benefits. For purposes of this Act, 26 the term "excepted benefits" means benefits under one or 27 more of the following: 28 (a) Benefits not subject to requirements: 29 (i) Coverage only for accident, or 30 disability income insurance, or any combination 31 thereof. 32 (ii) Coverage issued as a supplement to 33 liability insurance. 34 (iii) Liability insurance, including -11- LRB9200767DJmgam04 1 general liability insurance and automobile 2 liability insurance. 3 (iv) Workers' compensation or similar 4 insurance. 5 (v) Automobile medical payment insurance. 6 (vi) Credit-only insurance. 7 (vii) Coverage for on-site medical 8 clinics. 9 (viii) Other similar insurance coverage, 10 specified in regulations, under which benefits 11 for medical care are secondary or incidental to 12 other insurance benefits. 13 (b) Benefits not subject to requirements if 14 offered separately: 15 (i) Limited scope dental or vision 16 benefits. 17 (ii) Benefits for long-term care, nursing 18 home care, home health care, community-based 19 care, or any combination thereof. 20 (iii) Such other similar, limited 21 benefits as are specified in rules. 22 (c) Benefits not subject to requirements if 23 offered, as independent, noncoordinated benefits: 24 (i) Coverage only for a specified disease 25 or illness. 26 (ii) Hospital indemnity or other fixed 27 indemnity insurance. 28 (d) Benefits not subject to requirements if 29 offered as separate insurance policy. Medicare 30 supplemental health insurance (as defined under 31 Section 1882(g)(1) of the Social Security Act), 32 coverage supplemental to the coverage provided under 33 chapter 55 of title 10, United States Code, and 34 similar supplemental coverage provided to coverage -12- LRB9200767DJmgam04 1 under a group health plan. 2 (3) Not counting periods before significant breaks 3 in coverage. 4 (a) In general. A period of creditable 5 coverage shall not be counted, with respect to 6 enrollment of an individual under a group health 7 plan, if, after such period and before the 8 enrollment date, there was a 63-day period during 9 all of which the individual was not covered under 10 any creditable coverage. 11 (b) Waiting period not treated as a break in 12 coverage. For purposes of subparagraph (a) and 13 subsection (D)(3), any period that an individual is 14 in a waiting period for any coverage under a group 15 health plan (or for group health insurance coverage) 16 or is in an affiliation period (as defined in 17 subsection (G)(2)) shall not be taken into account 18 in determining the continuous period under 19 subparagraph (a). 20 (4) Method of crediting coverage. 21 (a) Standard method. Except as otherwise 22 provided under subparagraph (b), for purposes of 23 applying subsection (A)(3), a group health plan, and 24 a health insurance issuer offering group health 25 insurance coverage, shall count a period of 26 creditable coverage without regard to the specific 27 benefits covered during the period. 28 (b) Election of alternative method. A group 29 health plan, or a health insurance issuer offering 30 group health insurance, may elect to apply 31 subsection (A)(3) based on coverage of benefits 32 within each of several classes or categories of 33 benefits specified in regulations rather than as 34 provided under subparagraph (a). Such election -13- LRB9200767DJmgam04 1 shall be made on a uniform basis for all 2 participants and beneficiaries. Under such election 3 a group health plan or issuer shall count a period 4 of creditable coverage with respect to any class or 5 category of benefits if any level of benefits is 6 covered within such class or category. 7 (c) Plan notice. In the case of an election 8 with respect to a group health plan under 9 subparagraph (b) (whether or not health insurance 10 coverage is provided in connection with such plan), 11 the plan shall: 12 (i) prominently state in any disclosure 13 statements concerning the plan, and state to 14 each enrollee at the time of enrollment under 15 the plan, that the plan has made such election; 16 and 17 (ii) include in such statements a 18 description of the effect of this election. 19 (d) Issuer notice. In the case of an election 20 under subparagraph (b) with respect to health 21 insurance coverage offered by an issuer in the small 22 or large group market, the issuer: 23 (i) shall prominently state in any 24 disclosure statements concerning the coverage, 25 and to each employer at the time of the offer 26 or sale of the coverage, that the issuer has 27 made such election; and 28 (ii) shall include in such statements a 29 description of the effect of such election. 30 (5) Establishment of period. Periods of creditable 31 coverage with respect to an individual shall be 32 established through presentation or certifications 33 described in subsection (E) or in such other manner as 34 may be specified in regulations. -14- LRB9200767DJmgam04 1 (D) Exceptions: 2 (1) Exclusion not applicable to certain newborns. 3 Subject to paragraph (3), a group health plan, and a 4 health insurance issuer offering group health insurance 5 coverage, may not impose any preexisting condition 6 exclusion in the case of an individual who, as of the 7 last day of the 30-day period beginning with the date of 8 birth, is covered under creditable coverage. 9 (2) Exclusion not applicable to certain adopted 10 children. Subject to paragraph (3), a group health plan, 11 and a health insurance issuer offering group health 12 insurance coverage, may not impose any preexisting 13 condition exclusion in the case of a child who is adopted 14 or placed for adoption before attaining 18 years of age 15 and who, as of the last day of the 30-day period 16 beginning on the date of the adoption or placement for 17 adoption, is covered under creditable coverage. 18 The previous sentence shall not apply to coverage 19 before the date of such adoption or placement for 20 adoption. 21 (3) Loss if break in coverage. Paragraphs (1) and 22 (2) shall no longer apply to an individual after the end 23 of the first 63-day period during all of which the 24 individual was not covered under any creditable coverage. 25 (E) Certifications and disclosure of coverage. 26 (1) Requirement for Certification of Period of 27 Creditable Coverage. 28 (a) A group health plan, and a health 29 insurance issuer offering group health insurance 30 coverage, shall provide the certification described 31 in subparagraph (b): 32 (i) at the time an individual ceases to 33 be covered under the plan or otherwise becomes 34 covered under a COBRA continuation provision; -15- LRB9200767DJmgam04 1 (ii) in the case of an individual 2 becoming covered under such a provision, at the 3 time the individual ceases to be covered under 4 such provision; and 5 (iii) on the request on behalf of an 6 individual made not later than 24 months after 7 the date of cessation of the coverage described 8 in clause (i) or (ii), whichever is later. 9 The certification under clause (i) may be provided, 10 to the extent practicable, at a time consistent with 11 notices required under any applicable COBRA 12 continuation provision. 13 (b) The certification described in this 14 subparagraph is a written certification of: 15 (i) the period of creditable coverage of 16 the individual under such plan and the coverage 17 (if any) under such COBRA continuation 18 provision; and 19 (ii) the waiting period (if any) (and 20 affiliation period, if applicable) imposed with 21 respect to the individual for any coverage 22 under such plan. 23 (c) To the extent that medical care under a 24 group health plan consists of group health insurance 25 coverage, the plan is deemed to have satisfied the 26 certification requirement under this paragraph if 27 the health insurance issuer offering the coverage 28 provides for such certification in accordance with 29 this paragraph. 30 (2) Disclosure of information on previous benefits. 31 In the case of an election described in subsection 32 (C)(4)(b) by a group health plan or health insurance 33 issuer, if the plan or issuer enrolls an individual for 34 coverage under the plan and the individual provides a -16- LRB9200767DJmgam04 1 certification of coverage of the individual under 2 paragraph (1): 3 (a) upon request of such plan or issuer, the 4 entity which issued the certification provided by 5 the individual shall promptly disclose to such 6 requesting plan or issuer information on coverage of 7 classes and categories of health benefits available 8 under such entity's plan or coverage; and 9 (b) such entity may charge the requesting plan 10 or issuer for the reasonable cost of disclosing such 11 information. 12 (3) Rules. The Department shall establish rules to 13 prevent an entity's failure to provide information under 14 paragraph (1) or (2) with respect to previous coverage of 15 an individual from adversely affecting any subsequent 16 coverage of the individual under another group health 17 plan or health insurance coverage. 18 (4) Treatment of certain plans as group health plan 19 for notice provision. A program under which creditable 20 coverage described in subparagraph (c), (d), (e), or (f) 21 of Section 20(C)(1) is provided shall be treated as a 22 group health plan for purposes of this Section. 23 (F) Special enrollment periods. 24 (1) Individuals losing other coverage. A group 25 health plan, and a health insurance issuer offering group 26 health insurance coverage in connection with a group 27 health plan, shall permit an employee who is eligible, 28 but not enrolled, for coverage under the terms of the 29 plan (or a dependent of such an employee if the dependent 30 is eligible, but not enrolled, for coverage under such 31 terms) to enroll for coverage under the terms of the plan 32 if each of the following conditions is met: 33 (a) The employee or dependent was covered 34 under a group health plan or had health insurance -17- LRB9200767DJmgam04 1 coverage at the time coverage was previously offered 2 to the employee or dependent. 3 (b) The employee stated in writing at such 4 time that coverage under a group health plan or 5 health insurance coverage was the reason for 6 declining enrollment, but only if the plan sponsor 7 or issuer (if applicable) required such a statement 8 at such time and provided the employee with notice 9 of such requirement (and the consequences of such 10 requirement) at such time. 11 (c) The employee's or dependent's coverage 12 described in subparagraph (a): 13 (i) was under a COBRA continuation 14 provision and the coverage under such provision 15 was exhausted; or 16 (ii) was not under such a provision and 17 either the coverage was terminated as a result 18 of loss of eligibility for the coverage 19 (including as a result of legal separation, 20 divorce, death, termination of employment, or 21 reduction in the number of hours of employment) 22 or employer contributions towards such coverage 23 were terminated. 24 (d) Under the terms of the plan, the employee 25 requests such enrollment not later than 30 days 26 after the date of exhaustion of coverage described 27 in subparagraph (c)(i) or termination of coverage or 28 employer contributions described in subparagraph 29 (c)(ii). 30 (2) For dependent beneficiaries. 31 (a) In general. If: 32 (i) a group health plan makes coverage 33 available with respect to a dependent of an 34 individual, -18- LRB9200767DJmgam04 1 (ii) the individual is a participant 2 under the plan (or has met any waiting period 3 applicable to becoming a participant under the 4 plan and is eligible to be enrolled under the 5 plan but for a failure to enroll during a 6 previous enrollment period), and 7 (iii) a person becomes such a dependent 8 of the individual through marriage, birth, or 9 adoption or placement for adoption, 10 then the group health plan shall provide for a 11 dependent special enrollment period described in 12 subparagraph (b) during which the person (or, if not 13 otherwise enrolled, the individual) may be enrolled 14 under the plan as a dependent of the individual, and 15 in the case of the birth or adoption of a child, the 16 spouse of the individual may be enrolled as a 17 dependent of the individual if such spouse is 18 otherwise eligible for coverage. 19 (b) Dependent special enrollment period. A 20 dependent special enrollment period under this 21 subparagraph shall be a period of not less than 30 22 days and shall begin on the later of: 23 (i) the date dependent coverage is made 24 available; or 25 (ii) the date of the marriage, birth, or 26 adoption or placement for adoption (as the case 27 may be) described in subparagraph (a)(iii). 28 (c) No waiting period. If an individual seeks 29 to enroll a dependent during the first 30 days of 30 such a dependent special enrollment period, the 31 coverage of the dependent shall become effective: 32 (i) in the case of marriage, not later 33 than the first day of the first month beginning 34 after the date the completed request for -19- LRB9200767DJmgam04 1 enrollment is received; 2 (ii) in the case of a dependent's birth, 3 as of the date of such birth; or 4 (iii) in the case of a dependent's 5 adoption or placement for adoption, the date of 6 such adoption or placement for adoption. 7 (G) Use of affiliation period by HMOs as alternative to 8 preexisting condition exclusion. 9 (1) In general. A health maintenance organization 10 which offers health insurance coverage in connection with 11 a group health plan and which does not impose any 12 pre-existing condition exclusion allowed under subsection 13 (A) with respect to any particular coverage option may 14 impose an affiliation period for such coverage option, 15 but only if: 16 (a) such period is applied uniformly without 17 regard to any health status-related factors; and 18 (b) such period does not exceed 2 months (or 3 19 months in the case of a late enrollee). 20 (2) Affiliation period. 21 (a) Defined. For purposes of this Act, the 22 term "affiliation period" means a period which, 23 under the terms of the health insurance coverage 24 offered by the health maintenance organization, must 25 expire before the health insurance coverage becomes 26 effective. The organization is not required to 27 provide health care services or benefits during such 28 period and no premium shall be charged to the 29 participant or beneficiary for any coverage during 30 the period. 31 (b) Beginning. Such period shall begin on the 32 enrollment date. 33 (c) Runs concurrently with waiting periods. 34 An affiliation period under a plan shall run -20- LRB9200767DJmgam04 1 concurrently with any waiting period under the plan. 2 (3) Alternative methods. A health maintenance 3 organization described in paragraph (1) may use 4 alternative methods, from those described in such 5 paragraph, to address adverse selection as approved by 6 the Department. 7 (Source: P.A. 90-30, eff. 7-1-97; 90-736, eff. 8-12-98.) 8 Section 95. The Children's Health Insurance Program Act 9 is amended by changing Section 20 as follows: 10 (215 ILCS 106/20) 11 (Section scheduled to be repealed on July 1, 2002) 12 Sec. 20. Eligibility. 13 (a) To be eligible for this Program, a person must be a 14 person who has a child eligible under this Act and who is 15 eligible under this Act and who is eligible under a waiver of 16 federal requirements pursuant to an application made pursuant 17 to subdivision (a)(1) of Section 40 of this Act or who is a 18 child who: 19 (1) is a child who is not eligible for medical 20 assistance; 21 (2) is a child whose annual household income, as 22 determined by the Department, is above 133% of the 23 federal poverty level and at or below 185% of the federal 24 poverty level; provided, that the Department may 25 establish the upper limit of eligibility at 200% of the 26 federal poverty level as part of acquiring federal 27 waivers from the federal Health Care Financing 28 Administration allowing Illinois to claim favorable 29 levels of federal matching funds to provide health 30 insurance to families under the Family Health Insurance 31 Program Act; 32 (3) is a resident of the State of Illinois; and -21- LRB9200767DJmgam04 1 (4) is a child who is either a United States 2 citizen or included in one of the following categories of 3 non-citizens: 4 (A) unmarried dependent children of either a 5 United States Veteran honorably discharged or a 6 person on active military duty; 7 (B) refugees under Section 207 of the 8 Immigration and Nationality Act; 9 (C) asylees under Section 208 of the 10 Immigration and Nationality Act; 11 (D) persons for whom deportation has been 12 withheld under Section 243(h) of the Immigration 13 and Nationality Act; 14 (E) persons granted conditional entry under 15 Section 203(a)(7) of the Immigration and Nationality 16 Act as in effect prior to April 1, 1980; 17 (F) persons lawfully admitted for permanent 18 residence under the Immigration and Nationality Act; 19 and 20 (G) parolees, for at least one year, under 21 Section 212(d)(5) of the Immigration and Nationality 22 Act. 23 Those children who are in the categories set forth in 24 subdivisions (4)(F) and (4)(G) of this subsection, who enter 25 the United States on or after August 22, 1996, shall not be 26 eligible for 5 years beginning on the date the child entered 27 the United States. 28 (b) A child who is determined to be eligible for 29 assistance shall remain eligible for 12 months, provided the 30 child maintains his or her residence in the State, has not 31 yet attained 19 years of age, and is not excluded pursuant to 32 subsection (c). Eligibility shall be re-determined by the 33 Department at least annually. 34 (c) A child shall not be eligible for coverage under -22- LRB9200767DJmgam04 1 this Program if: 2 (1) the premium required pursuant to Section 30 of 3 this Act has not been paid. If the required premiums are 4 not paid the liability of the Program shall be limited to 5 benefits incurred under the Program for the time period 6 for which premiums had been paid. If the required 7 monthly premium is not paid, the child shall be 8 ineligible for re-enrollment for a minimum period of 3 9 months. Re-enrollment shall be completed prior to the 10 next covered medical visit and the first month's required 11 premium shall be paid in advance of the next covered 12 medical visit. The Department shall promulgate rules 13 regarding grace periods, notice requirements, and hearing 14 procedures pursuant to this subsection; 15 (2) the child is an inmate of a public institution 16 or a patient in an institution for mental diseases; or 17 (3) the child is a member of a family that is 18 eligible for health benefits covered under the State of 19 Illinois health benefits plan on the basis of a member's 20 employment with a public agency. 21 (Source: P.A. 90-736, eff. 8-12-98.)".