Ill. Admin. Code tit. 50, § 4500.190
Eligibility and Special Rules on Advanced Payments of the Premium Tax Credit and Cost-Sharing Reductions
Effective Oct 28, 202549 Ill. Reg. 14672AUTHORITY: Implementing Sections 5-5, 5-10, 5-21, and 5-23 of the Illinois Health Benefits Exchange Law [215 ILCS 122], Sections 50 and 90 of the Grant Accountability and Transparency Act [30 ILCS 708], and 42 U.S.C. 18031, and authorized by Section 50 of the Grant Accountability and Transparency Act, Section 401 of the Illinois Insurance Code [215 ILCS 5], Section 10-10 of the Illinois Administrative Procedure Act [5 ILCS 100] and Section 5-23 of the Illinois Health Benefits Exchange Law.DEPARTMENT OF INSURANCE
- a) A tax filer is eligible for APTCs if the tax filer meets the criteria in 45 CFR 155.305(f).
- b) A tax filer is eligible for CSRs if the tax filer meets the criteria in 45 CFR 155.305(g).
- c) An applicant has the right to appeal an eligibility determination regarding APTCs and CSRs, including the amount calculated, as provided in 45 CFR Part 155, Subpart F.
- d) For plan years when Illinois operates a State-based Exchange on the Federal Platform, the Illinois Exchange will rely on HHS to determine eligibility for, calculate, and provide APTCs and CSRs and to conduct all related appeals.
- e) For plan years when Illinois operates a State-based Exchange, the Illinois Exchange will determine eligibility for, calculate, and provide information on APTCs and CSRs under this Section, and the Illinois Exchange will conduct related appeals under Section 4500.230. HHS will continue to make actual payments of the APTCs and, if applicable, CSRs.
(Source: Amended at 49 Ill. Reg. 14672, effective October 28, 2025)