MR #15.22: All Kids Premium Level 2 Insurance Policy Clarifications

Helping Families. Supporting Communities. Empowering Individuals.

Illinois Department of Healthcare and Family ServicesIllinois Department of Human Services

11/05/15

Summary:

  • Clarifies that a child must be uninsured to qualify for All Kids Premium Level 2 coverage unless the child lost medical benefits under All Kids Assist, Share or Premium Level 1 in the 12 months prior to the month of application.
  • Clarifies that children who recently lost other insurance coverage must be uninsured for at least 90 days before they can receive All Kids Premium Level 2 coverage unless they meet one of the exemptions to the ineligibility period.
  • Effective immediately, a child who lost insurance that was provided through the Health Insurance Marketplace is exempt from the requirement to be uninsured for at least 90 days.
  • Adds a definition for children with 'Special Health Care Needs'.

  1. Children With Other Insurance
  2. Children Who Recently Lost Other Insurance
    1. Special Health Care Needs
  3. MANUAL REVISIONS

Children With Other Insurance

To qualify for All Kids Premium Level 2, a child must be uninsured unless the following exception applies: the child lost medical benefits under All Kids Assist, Share or Premium Level 1 in the 12 months prior to the month of application.

Children Who Recently Lost Other Insurance

For All Kids Premium Level 2, for a child whose health insurance ended, the coverage must have ended at least 90 days prior to the first date of Premium Level 2 coverage unless they meet one of the exemptions described in PM 06-08-02-a.

A child who lost insurance that was provided through the Health Insurance Marketplace is also exempt from the requirement to be uninsured for at least 90 days.

Special Health Care Needs

A child with a special health care need is exempt from the 3 month ineligibility period after a recent loss of insurance. A special health care need is defined as:

  • "The child is pregnant, or has a serious illness or chronic physical, developmental, behavioral or emotional condition.
    • Serious illness is a condition that if not treated may result in death, disability, disfigurement, or dysfunction.
    • Chronic illness is a medical condition that requires frequent and ongoing treatment and that if not properly treated will seriously affect the person's overall health."

If the applicant reports that the child is pregnant, or is chronically or seriously ill and informs you of the child's condition, waive the 3 month period of ineligibility only for the child who has the special health care need. Document the reason in case comments. Proof of the health condition is not required.

MANUAL REVISIONS

[signed copy on file]

James T. Dimas

Secretary-designate, Illinois Department of Human Services

Felicia F. Norwood

Director, Illinois Department of Healthcare and Family Services