(215 ILCS 125/4-2)
(from Ch. 111 1/2, par. 1408.2)
Medical assistance; coverage of child.
(a) In this Section, "Medicaid" means medical assistance authorized under
Section 1902 of the Social Security Act.
(b) A contract or
evidence of coverage delivered, issued for delivery, renewed, or amended by
a Health Maintenance Organization may not contain any provision
limits or excludes payments of health care services
to or on behalf of the enrollee because the enrollee or any covered
dependent is eligible for or is 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 health care plan of a Health Maintenance
Organization in which
the child's noncustodial parent is an enrollee, the Health Maintenance
(1) Provide necessary information to the child's
custodial parent to enable the child to obtain benefits under that health care 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 Maintenance Organization may not deny enrollment of a child
health care plan in which the child's parent is an enrollee on any of the
(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 service area covered by the health care plan.
(f) If a parent is required by a court or administrative order to provide
coverage for a child under a health care plan in which the parent is enrolled,
and that offers coverage for eligible
dependents, the Health Maintenance Organization,
upon receiving a copy of the order, shall:
(1) Upon application, permit the parent to enroll in
the health care 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 enroll in the plan.
(2) Enroll the child in the health care 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 enrolled in the health care plan but fails to apply for enrollment of the child.
(g) A Health Maintenance Organization may not impose, on a state agency that
has been assigned
rights of an enrollee in a health care plan who
receives Medicaid benefits, requirements that are different from requirements
applicable to an assignee of any other enrollee in that health care
(h) Nothing in subsections (e) and (f) prevents a Health Maintenance
Organization from denying any such application if the child is not eligible for
according to the Health Maintenance Organization's medical underwriting
(i) The Health Maintenance Organization may not disenroll (or otherwise
of) the child from the health
care plan unless the Health Maintenance Organization is provided
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 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.
(Source: P.A. 89-183, eff. 1-1-96.)