Sec. 15.12. Medical assistance; coverage of child.

666 words·~3 min read·/il/chapter-215/act-165/15-12·

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(a)In this Section, "Medicaid" means medical assistance authorized under Section 1902 of the Social Security Act.

(b)A contract delivered, issued for delivery, renewed, or amended by a health services plan corporation may not contain any provision which limits or excludes payments of hospital or medical benefits coverage to or on behalf of the subscriber because the subscriber or any covered dependent is eligible for or receiving Medicaid benefits in this or any other state.

(c)To the extent that payment for covered expenses has been made under Article V, VI, or VII of the Illinois Public Aid Code for health care services provided to an individual, if a third party has a legal liability to make payments for those health care services, the State is considered to have acquired the rights of the individual to payment.

(d)If a child is covered under a voluntary health services plan in which the child's noncustodial parent is a beneficiary, the health services plan corporation shall:

(1)Provide necessary information to the child's custodial parent to enable the child to

obtain benefits under that voluntary health services plan.

(2)Permit the child's custodial parent (or the provider, with the custodial parent's

approval) to submit claims for payment for covered services without the approval of the noncustodial parent.

(3)Make payments on claims submitted in accordance with paragraph

(2)directly to the

custodial parent, the provider of health care services, or the state Medicaid agency.

(e)A health services plan corporation may not deny enrollment of a child under a voluntary health services plan in which the child's parent is a beneficiary on any of the following grounds:

(1)The child was born out of wedlock.

(2)The child is not claimed as a dependent on the parent's federal income tax return.

(3)The child does not reside with the parent or in the area covered by the plan.

(f)If a parent is required by a court or administrative order to provide coverage for a child under a voluntary health services plan and has a plan which offers coverage for eligible dependents, the health services plan corporation, upon receiving a copy of the order, shall:

(1)Upon application, permit the parent to enroll, as a subscriber to the plan, a child

who is otherwise eligible for that coverage, without regard to any enrollment season restrictions that might otherwise be applicable as to the time period within which a person may subscribe to the plan.

(2)Enroll the child as a subscriber to the plan upon application of the child's other

parent, the state agency administering the Medicaid program, or the state agency administering a program for enforcing child support and establishing paternity under 42 U.S.C. 651 through 669 (or another child support enforcement program), if the parent is a beneficiary to the plan but fails to apply for enrollment of the child.

(g)A health services plan corporation may not impose, on a state agency that has been assigned the rights of an individual who is a beneficiary to a voluntary health services plan who receives Medicaid benefits, requirements that are different from requirements applicable to an assignee of any other individual who is a beneficiary to that plan.

(h)Nothing in subsections

(e)and

(f)prevents a health services plan corporation from denying any such application if the child is not eligible for coverage according to the health services plan corporation's medical underwriting standards.

(i)The health services plan corporation may not disenroll (or otherwise eliminate coverage of) the child from the plan unless the corporation is provided satisfactory written evidence of either of the following:

(1)The court or administrative order is no longer in effect.

(2)The child is or will be enrolled in a comparable health care plan obtained by the

parent under such order and that enrollment is currently in effect or will take effect not later than the date the prior coverage is terminated.