Illinois § 12-4.45

§ 12-4.45.

Third party liability. (a) To the extent authorized under federal law, the Department of Healthcare and Family Services shall identify individuals receiving services under medical assistance programs funded or partially funded by the State who may be or may have been covered by a third party health insurer, the period of coverage for such individuals, and the nature of coverage. A company, as defined in Section 5.5 of the Illinois Insurance Code and Section 2 of the Comprehensive Health Insurance Plan Act, must provide the Department eligibility information in a federally recommended or mutually agreed-upon format that includes at a minimum: (1) The names, addresses, dates, and sex of primary covered persons. (2) The policy group numbers of the covered persons. (3) The names, dates of birth, and sex of covered dependents, and the relationship of dependents to the primary covered person. (4) The effective dates of coverage for each covered person. (5) The generally defined covered services information, such as drugs, medical, or any other similar description of services covered. (b) The Department may impose an administrative penalty on a company that does not comply with the request for information made under Section 5.5 of the Illinois Insurance Code and paragraph (3) of subsection (a) of Section 20 of the Covering ALL KIDS Health Insurance Act. The amount of the penalty shall not exceed $10,000 per day for each day of noncompliance that occurs after the 180th day after the date of the request. The first day of the 180-day period commences on the business day following the date of the correspondence requesting the information sent by the Department to the company. The amount shall be based on: (1) The seriousness of the violation, including the nature, circumstances, extent, and gravity of the violation. (2) The economic harm caused by the violation. (3) The history of previous violations. (4) The amount necessary to deter a future violation. (5) Efforts to correct the violation. (6) Any other matter that justice may require. (c) The enforcement of the penalty may be stayed during the time the order is under administrative review if the company files an appeal. (d) The Attorney General may bring suit on behalf of the Department to collect the penalty. (e) Recoveries made by the Department in connection with the imposition of an administrative penalty as provided under this Section shall be deposited into the Public Aid Recoveries Trust Fund created under Section 12-9. (Source: P.A. 98-130, eff. 8-2-13; 98-756, eff. 7-16-14.)