(215 ILCS 5/356i)
(from Ch. 73, par. 968i)
Medical assistance; coverage of child.
(a) In this Section, "Medicaid" means medical assistance authorized under
Section 1902 of the Social Security Act.
(b) An individual or group
policy of accident and health insurance that is delivered or issued for
delivery to any person in this State or renewed or amended may not contain
any provision which limits or excludes payments of hospital or
benefits coverage to or on behalf of the insured because the insured 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 an accident and health insurance policy
issued to the child's noncustodial parent, the issuer of the policy shall do
all of the following:
(1) Provide necessary information to the child's
custodial parent to enable the child to obtain benefits under that coverage.
(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) An insurer may not deny enrollment of a child under the accident and
health insurance coverage of the child's parent on any of the following
(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 insurer's service area.
(f) If a parent is required by a court or administrative order to provide
accident and health insurance coverage for a child and the parent is insured
under a plan that offers coverage
for eligible dependents, the insurer, upon receiving a copy of the order,
(1) Upon application, permit the parent to add to the
parent's coverage such a child who is otherwise eligible for that coverage, without regard to any enrollment season restrictions.
(2) Add the child to the parent's coverage 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 covered but fails to apply for coverage for the child.
(g) An insurer may not impose, on a state agency that has been assigned the
rights of a covered individual who
receives Medicaid benefits, requirements that are different from requirements
applicable to an assignee of any other individual covered under the same
(h) Nothing in subsections (e) and (f) prevents an
insurer from denying any such application if the child is not eligible for
coverage according to the insurer's medical underwriting standards.
(i) The insurer may not eliminate coverage of such a child unless the
satisfactory written evidence of either of the following:
(1) The court or administrative order is no longer in
(2) The child is or will be covered under a
comparable health care plan obtained by the parent under such order and that coverage is currently in effect or will take effect not later than the date the prior coverage is terminated.
(Source: P.A. 89-183, eff. 1-1-96.)