Illinois Health Insurance

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Illinois Health Insurance Assistance

A new Illinois private health insurance plan may be right for you if:

• You are self employed
• Your employer does not offer a group plan
• You are enrolled in a group plan, but it does not cover spouses or dependents
• You are enrolled in a health plan, but the premiums are too high
• You are enrolled in a health plan, but your benefits needs have changed

We can help you compare Illinois individual and family health insurance products and select the plan best suited to your health care needs.

Finding Affordable Illinois
Individual or Family Health Insurance

If both you and your spouse or domestic partner are looking for a new Illinois health insurance plan, we recommend you review health insurance quotes both together and separately to find the solution that is most affordable.

Though it varies by health insurance company, Illinois health insurance rates for couples can significantly differ from the cost of buying separate policies. Sometimes it costs more. Sometimes it costs less. Different insurance companies use different rating methods.

Couples with greater age differences are more likely to see meaningful rate variations. In summary, couples sometimes benefit by evaluating both combined and separate coverage.

Health Insurance Law Protections

Illinois residents have legal protection when they purchase individual and family health insurance.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Those needing individual health insurance when leaving an employer-sponsored plan are protected under the HIPAA federal law, which limits Illinois health insurance companies in imposing a waiting period for pre-existing health conditions. However, this law is often misunderstood.

HIPPA Limitations and Misconceptions
We get frequent calls from folks who believe HIPAA entitles them to affordable private health insurance, but it does not work that way. If you have disqualifying health conditions an Illinois health insurance company can still decline to insure you under an individual or family policy. HIPAA does not change that.

If necessary continuity of coverage conditions are met, HIPAA requires the insurance company not apply the pre-existing condition exclusion -- but only if they agree to insure you in the first place. In addition, HIPAA does not prevent an Illinois health insurance company from placing exclusionary coverage waivers (distinct from the pre-existing condition exclusion) or from assessing additional premium charges on an individual or family health insurance policy involving pre-existing conditions.

COBRA (Consolidated Omnibus Budget Reconciliation Act)
Under the COBRA federal law Illinois residents can continue, subject to duration limits, health coverage from a prior employer. If you would like to learn more about how COBRA could impact you, visit:

• Basic Rules of COBRA Continuation
• Tips on Getting the Most from COBRA Continuation

Illinois Prohibition against Unwarranted Rescissions
After an Illinois resident is accepted into a private health plan, Illinois state law prohibits (in absence of fraud or material misrepresentation) insurers from canceling coverage if the person becomes sick or is injured.

Mandated Benefits
Illinois requires certain benefits in individual/family health insurance policies. It is a reasonably extensive list. Some noteworthy Illinois private health insurance benefit mandates include:

• Autism Spectrum Disorders
• Colorectal Cancer Screening
• Contraceptives
• HPV Vaccine
• Mammograms
• Maternity - Complications of Pregnancy
• Organ Transplants
• Preventive Care Services

National Health Insurance Reform (ObamaCare)
The Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act of 2010 will overhaul the whole system. Some facets have already gone into effect, though the most meaningful provisions do not begin until 2014. Review our health care reform implementation summary.

Other Illinois Health Insurance Sources

We are in the business of marketing private health insurance to Illinois residents who can afford to buy it. It is no secret that health insurance can be expensive, though we do our best to help our customers find the most affordable quality coverage.

Illinois residents who cannot afford private coverage or who are unable to qualify due to pre-existing medical conditions should explore the following:

• Illinois Department of HealthCare and Family Services (HFS)
  Numerous Illinois Medicaid programs are administered through HFS, including FamilyCare, All Kids, Health Woman and the Illinois Breast and Cervical Cancer program. Eligibility is based on income, age and other factors. If you think you may qualify for a HFS program you should visit the website or phone HFS.
• Illinois Pre-Existing Condition Insurance Plan (IPXP)
  Implemented as a consequence of national health care reform, IPXP is a transitional (until 2014) health insurance program for uninsured Illinois residents. IPXP enrollees are not subject to a pre-existing condition exclusion.

  Enrollees are required to pay a premium and out-of-pocket costs. Eligibility criteria for IPXP includes:

  • Reside in the State of Illinois
  • Be a U.S. citizen, national, or legal resident
  • Be able to pay the premium and out-of-pocket costs
  • Be uninsured for six months
  • Have a pre-existing condition.

  People who enroll in the IPXP program are not charged a higher premium because of their medical condition. Program participants pay comparable premium rates to healthy people in the individual insurance market. By law, premiums may vary only on the basis of age, geographic area and tobacco use.

• Illinois Comprehensive Health Insurance Plan (ICHIP)
  This is the long-established Illinois high risk pool for people who have necessary financial resources but, due to pre-existing conditions, are unable to qualify for private health insurance. Premiums charged are established by law at from 125%-150% of the average rates charged individuals for comparable major medical coverage by five or more of the largest insurance companies in the individual health insurance market in Illinois.

  With ICHIP pre-existing conditions are immediately covered only if you are considered "HIPAA eligible" with qualifying prior continuous coverage. If you are not considered "HIPAA eligible" ICHIP coverage is subject to a 6-month pre-existing condition waiting period.

  ICHIP eligibility requirements include:

  • You have applied for individual health insurance and have been rejected because of a pre-existing condition.
  • You have an individual policy that is substantially similar to CHIP which costs them more than they would pay for CHIP coverage.
  • You have one of 31 presumptive medical conditions, i.e., conditions presumed to result in automatic rejection by an insurance company.

IPXP or ICHIP?

There is some eligibility overlap between IPXP and ICHIP, and people who would have previously enrolled in ICHIP may now find IPXP to be the more attractive alternative. If you have been without coverage for six or more months and you are eligible for both plans, you should contact each to gather information and determine which will provide you the better overall health insurance value.

In our view a primary advantage of ICHIP versus IPXP is that ICHIP does not require you be uninsured for six months. But if you have already been uninsured for at least six months and you have a serious pre-existing medical condition that requires immediate care, then IPXP will almost surely be the better alternative as they will not subject you to a pre-existing condition exclusion.

Health Insurance-Relevant Illinois Government Agencies

Blue Cross IL Traditional PPO Blue Cross IL HSA-Compatible

HumanaOne Traditional PPO HumanaOne HSA-Compatible

UnitedHealthcare / Golden Rule

Aetna PPO and HSA

HSA Overview HSA Contributions HSA Distributions HSA Administrators

Q&A - Individual Health Insurance Health Insurance Glossary Helpful Resource Websites More Websites of Interest

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