215 ILCS 125/4-2
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 125/ - Health Maintenance Organization Act.|Article IV - Delivery Of Services - Required Provisions And Marketing

 (from Ch. 111 1/2, par. 1408.2)Sec. 4-2.     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  which  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  Organization shall:(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  under the  health care plan in which the child's parent is an enrollee 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 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  the  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  plan.(h) Nothing in subsections (e) and (f) prevents a Health Maintenance  Organization from denying any such application if the child is not eligible for  coverage  according to the Health Maintenance Organization's medical underwriting  standards.(i) The Health Maintenance Organization may not disenroll (or otherwise  eliminate coverage  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     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.   (Source: P.A. 89-183, eff. 1-1-96.)