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Model Application Template for the State Children’s Health Insurance Program

Effective Date:

Approval Date: September 19, 2002 16 KidCare Share and KidCare Premium, the Department defines a family as the child applying for the program and the following persons who live with the child:

1) The child’s parent(s). 2) The spouse of the child’s parent(s). 3) Children under age 19 of the parent(s) or the parent’s spouse. 4) The spouse of the child. 5) The children of the child.

The number of persons in the family determines the applicable income standard.

If the monthly countable income of a child is above 133 percent and at or below 150 percent of the Federal Poverty Level for the applicable income standard, the child is enrolled in KidCare Share. If the monthly countable income of a child is above 150 percent and at or below 185 percent of the Federal Poverty Level for the number of persons in the income standard, the child is enrolled in KidCare Premium.

All applicants are notified in writing, regarding the outcome of their eligibility determination.

Eligibility determinations made by the fifteenth day of the month are effective in the first day of the following month. Eligibility determinations made after the fifteenth day of the month are effective no later than the first day of the second month following that determination. A child may obtain coverage for the period of time beginning two weeks prior to the date of initial application and continuing until coverage under KidCare Share or Premium is effective.

Monthly identification cards are issued for each family with a child enrolled under KidCare Share and KidCare Premium.

The duration of financial eligibility for KidCare Share and KidCare Premium is 12 months. The 12 months of financial eligibility commences when the first child in a family is covered under a plan. Children added to a plan after the eligibility period begins are eligible for the balance of the 12 month eligibility period. Before any 12 month period of eligibility ends, families are allowed to reapply to determine eligibility for another 12 months.

Illinois is committed to prompt review of KidCare applications. The state