Ill. Admin. Code tit. 50, § 4510.40 - Rules
a) Enrollment
Required During Certain Periods
1) Carriers
shall accept applications from eligible persons for Child Only Plan coverage
during the open enrollment periods outlined in subsections (b), (c) and
(d).
2) Carriers shall also accept
applications from eligible persons for Child Only Plan coverage during a
special enrollment period outlined in subsection (d), if the application is
received within 30 days after a qualifying event.
3) Notwithstanding anything in this Part to
the contrary, a carrier is not required to accept applications from eligible
persons applying for a Child Only Plan during an open enrollment or special
enrollment period if those persons have comprehensive major medical coverage
available to be purchased by them at the time the Child Only Plan would become
effective.
4) Except during an open
enrollment period, carriers need not offer coverage to a Child Only applicant
who had a Child Only Plan with a carrier during the 12 months prior to the
application for Child Only coverage when that coverage was voluntarily
terminated.
5) Carriers issuing
Child Only Plans are not precluded from applying non-health related eligibility
rules to persons applying for that coverage; however, carriers must uniformly
apply those rules to all persons applying for a Child Only Plan .
b) Initial Open Enrollment
1) Carriers shall hold a one-time open
enrollment period within 60 days after May 27, 2011. The initial enrollment
period shall be no less than 31 days. During this open enrollment period, all
children under the age of 19 making application for Child Only Plan coverage
shall be offered coverage without any limitations or riders based on health
status.
2) Notice of this open
enrollment opportunity and instructions on how to enroll must be displayed
prominently on the carrier 's web site for the duration of the open enrollment
period.
3) Applications for
coverage during this initial open enrollment period shall become effective no
later than 30 days after the end of the initial enrollment period, except that,
if mutually agreed upon by the applicant and the carrier , an alternative
effective date may be selected.
c) Biannual Open Enrollment for New
Applicants
1) Each January and July, carriers
shall hold an open enrollment period for Child Only Plan applicants for the
duration of the entire month. During these open enrollment periods, all Child
Only Plan applicants under the age of 19 shall be offered coverage without any
limitations or riders based on health status.
2) Notice of the open enrollment opportunity
and open enrollment dates for new applicants, as well as the opportunity to
enroll due to a Qualifying Event , must be displayed prominently on the
carrier 's web site throughout the year.
3) Applications for coverage during a January
open enrollment period shall become effective no later than March 1 following
the open enrollment during which the application is received. Applications for
coverage during a July open enrollment period shall become effective no later
than September 1 following the open enrollment during which the application is
received.
d) Special
Enrollment
1) Notwithstanding anything in
this Part to the contrary, an eligible person may apply for a Child Only Plan
through a special enrollment opportunity when that person experiences a
qualifying event.
2) For purposes
of this Part, a qualifying event occurs only when:
A) A person 's major medical coverage is
involuntarily terminated, whether that coverage is provided to the person
directly as a policyholder or as a dependent; and
B) The person does not have other
comprehensive major medical coverage available to be purchased, whether by that
person directly as a policyholder or as a dependent.
3) An eligible person who experiences a
qualifying event shall have 30 days from the date of the qualifying event to
apply to a carrier for a Child Only Plan.
4) For purposes of this Part, a qualifying
event shall be considered to have occurred on the date that the person 's
previous major medical coverage was involuntarily terminated or notice of that
termination was provided, whichever is later.
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