MR #14.29: Health Insurance Exclusion for All Kids Premium Level 2

11/7/14

Summary:

• The period during which a child can be ineligible for All Kids Premium Level 2 benefits due to a recent loss of insurance is shortened from 12 months to 3 months.
• The exceptions to the ineligibility period for children who had health insurance within the 3 months prior to the first date of Premium Level 2 coverage are revised to comply with federal and state law.

Under the Affordable Care Act and state law (Public Act 98-651), the period during which a child can be ineligible for All Kids Premium Level 2 benefits due to a recent loss of insurance is changed from 12 months to a maximum of 3 months. To qualify for All Kids Premium Level 2, a child cannot have had health insurance in the 3 months prior to the first date of Premium Level 2 coverage unless they meet one of the exceptions listed below:

• The child is a newborn under age 1 who does not have private or employer sponsored health insurance coverage,
• The child lost medical benefits under All Kids Assist, Share or Premium Level 1 in the 12 months prior to the month of application for All Kids,
• The premium paid by the family for coverage of the child under the group health plan exceeded 5% of household income,
• The child's parent is determined eligible for advance payment of a premium tax credit for enrollment in a Qualified Health Plan through the Marketplace because the employer sponsored insurance in which the family was enrolled is determined unaffordable,
• The cost of family coverage that includes the child exceeds 9.5% of the household income,
• The child lost coverage because the employer that had sponsored the coverage stopped offering coverage of dependents,
• A change in the parent's employment, including involuntary separation, resulted in the child's loss of employer-sponsored insurance (other than through full payment of the premium by the parent under COBRA), 
• The child has special health care needs, or
• The child lost insurance due to the parent's death or because the noncustodial parent canceled the insurance as part of a divorce.

MANUAL REVISIONS

[signed copy on file]

Michelle R. B. Saddler 

Secretary, Illinois Department of Human Services 

Julie Hamos 

Director, Illinois Department of Healthcare and Family Services