WAG 06-08-05

IES Phase 2 Process

new text For all additions other than deemed newborns, form 243A-C Request for Medical Benefits for Another Household Member is required and asks for the person's income, tax filer and relationship information. When a request to add a child to an existing medical case is received, proof of the child's own countable income is required. See PM 15-06-01-h to determine if a child's income is countable under MAGI budgeting. Do not re-verify countable parental or sibling income, only verify the child's own income if such income is reported.

Starting with IES Phase 2, IES will pend the medical request if the child's reported countable income is not verified.

If a family completes the appropriate form to add a child, revised textand the child qualifies for All Kids Share or Premium, add the child prospectively for the current effective month. For All Kids Premium, the premium will be increased, if appropriate, for the month the child is added.

new text Due to continuous eligibility policy (see PM 18-05-01), the child who is already in the case can not be moved to a higher cost program based on the new household information, but can move to a less costly program. Coverage for the child who is added shall continue for the remainder of the original 12-month eligibility period.

Prior Coverage and Backdating

The first time the child receives All Kids Share or Premium Level 1, unless the child has previously received Rebate, the child can also receive prior coverage for 2 weeks prior to the date the request to add the child is signed. See PM 06-08-03-e for information about prior coverage.

For All Kids Premium Level 2, prior coverage is not available to children other than newborns. Newborns can receive medical benefits under Premium Level 2 effective with the month of birth if the child was born to parents who are Illinois residents at the time of birth and the signed request is made prior to the first day of the fourth month after the month of birth. Up to a 3 month backdate may be requested by the parents if they are willing to pay the child's premium from the earliest month of the backdate through the current processing month.

Example: An infant is born July 30, 2016. The newborn may be retroactively enrolled if an application is received before November 1, 2016. The parents may choose to start All Kids Premium Level 2 coverage for the newborn July 1, August 1, September 1 or October 1. Premiums will be due for the first and every subsequent month of coverage.

Some newborns qualify for health insurance new text (third party liability or TPL) from the date of birth through 30 days because the newborn's mother was covered on the health insurance. For Premium Level 2, the child may qualify if the insurance ends after birth. If the family requests a medical backdate, the backdate cannot be authorized over a month insurance was active.

Legacy Process

If a family completes the appropriate form to add a child to an existing All Kids Share or Premium case, add the child for the current effective month from the day the signed form is received. For All Kids Premium, the premium will be increased, if appropriate, for the month the child is added unless the child is added for the month following the processing month.

Due to computer cut off dates and the timing of the receipt of requests to add a family member, some families may not be charged a premium for a month prior to the regular roll month.

Example: A Form 243C is received on 09/14/10 to request the addition of a child to an All Kids Premium Level 2 case. The worker adds the child on 09/21/10. The child gets All Kids Premium for 10/10 but is not billed for that month. The family's premium increases in 11/10.

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When adding a child to an active All Kids Share or Premium case, do not do a new eligibility determination unless the family requests one. If the family requests that eligibility be redetermined, ask for verification of current income.

If income increases and is now above the All Kids Share or current Premium Level standard, add the child and do not change the case until renewal.

The first time the child receives All Kids Share or Premium Level 1, unless the child has previously received Rebate, the child can also receive prior coverage for 2 weeks prior to the date the request to add the child is signed. See PM 06-08-03-e for information about prior coverage.

For All Kids Premium Level 2, prior coverage is not available to children other than newborns. Newborns can receive medical benefits under Premium Level 2 effective with the month of birth if the child was born to parents who are Illinois residents at the time of birth and the signed request is made prior to the first day of the fourth month after the month of birth. Up to a 3 month backdate may be requested by the parents if they are willing to pay the child's premium from the earliest month of the backdate through the current processing month.

Example: An infant is born July 30, 2010. The newborn may be retroactively enrolled if an application is received before November 1, 2010. The parents may choose to start All Kids Premium Level 2 coverage for the newborn July 1, August 1, September 1 or October 1. Premiums will be due for the first and every subsequent month of coverage.

Some newborns qualify for health insurance from the date of birth through 30 days because the newborn's mother was covered on the health insurance. For Premium Level 2, the child may qualify if the insurance ends after birth. If the family requests a medical backdate, the backdate cannot be authorized over a month insurance was active.