(215 ILCS 165/15.12)
(from Ch. 32, par. 609.12)
Medical assistance; coverage of child.
(a) In this Section, "Medicaid" means medical assistance authorized under
Section 1902 of the Social Security Act.
contract delivered, issued for delivery, renewed, or amended by a health
services plan corporation may not contain any
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
(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
has been assigned the rights of an individual who is a beneficiary to a
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
(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
(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.)