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Illinois Health Insurance
Health insurance is one indispensable alternative that we cannot do without. Definitely, buying suitable health insurance coverage for your family can be expensive as well as needs a comprehensive evaluation of all future risks and its effect on your finances. More than 47 million Americans are uninsured, majority of whom are the working families. These families often expose themselves to the crushing medical expenses of the lack of proper health coverage. However, for those families who are not covered under their employers’ group plan, there are low-cost state sponsored health insurance programs.
According to the America's 2008 Health Rankings, Illinois holds 31st place in the healthiest states list. The state was at 25th and 27th spot in 2006 and 2007 respectively. The prevalence of binge drinking, rising crime rate, low public health funding has contributed to decline of healthcare system in the state. Illinois, having the population of more than twelve million citizens, boasts of both private-market and public health insurance alternatives. The private-market health insurance comprises of numerous types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-priced health coverage to the uninsurable residents of Illinois who meet specific eligibility requirements.
The Illinois Division of Insurance is in charge for regulating all types of insurance sold in the state of Illinois including health insurance policies offered by private-market health insurers or public health coverage programs. However, approximately 13.7% of the population remains uninsured, which is the biggest health issue for the Illinois lawmakers. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, approximately 34.1% uninsured Illinois residents come under the above 200% FPL category.
Choosing a health plan is not as simple as it was before. Before buying a particular health policy, consult with a licensed health insurance agent/broker to avail the appropriate health insurance alternatives.
Individual/Family Health Insurance
Below is the guidelines for applying for and obtaining individual health insurance in the state of Illinois. These regulations apply to all insurance companies offering individual or family health insurance in Illinois:
| Medical Underwriting | Yes |
Pre-Existing Condition Exclusion Period | 24 months |
Look Back Period | 24 months |
Look Back Standard | Prudent standard and Objective standard |
Mandatory Benefits | Cancer screening for women including screening of breast cancer and cervical cancer, IP mastectomy stay (length to be determined by the physician), reconstructive surgery after mastectomy, osteoporosis screening, direct access to OB/GYNs, Infertility coverage and maternity care |
Market Rate Restrictions | None |
Guaranteed Issue Options | None |
Small Group Health Insurance
Below is the guidelines for small group health insurance in the state of Illinois. These regulations apply to all insurance companies offering small group health insurance in Illinois:
| Small Group Size | 2-50 |
Employee Qualifications | Two employees must be present for half of the preceding calendar quarter and work 20 hrs/week for coverage |
Guaranteed Issue | Yes |
Premium Rating Factors | Rate Bands |
Rate Adjustment Factors | 25% |
Look-Back Period | 6 months |
Pre-existing condition exclusionary period | 12 months |
Mandatory Benefits | Same as individual |
State Cobra Variations for Small Groups
Below are the COBRA guidelines for small groups in the state of Illinois. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:
| Mini-Cobra Option | Yes |
Eligible Group Sizes | 2-19 |
Extension of Benefits Period - Standard | 9 months |
Extension of Benefits Period - Disabled | 9 months |
Maximum Premium Increase | 100% |
State Legislation Reference | The Illinois Health Insurance Continuation Rights (revised 12/03) |
Additional Notes | Only individuals that have been insured under the group’s medical insurance policy for 3 months are eligible for Illinois mini-Cobra and acceptance must be given with 10 days of the notification date. |
State Sponsored Health Insurance Programs
There are several state sponsored health insurance programs in the State of Illinois to assist those without insurance in obtaining adequate coverage.
High-Risk Pools
Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Illinois is summarized in the chart below:
| Plan Name | The Illinois Comprehensive Health Insurance Plan (CHIP) |
Website | |
Phone Number | 866-851-2751 |
HIPPA Eligibility Required? | Yes |
Available Carriers | Blue Cross Blue Shield of Illinois |
Pre-Existing Condition Waiting Period | 6 months |
Enrollment Periods | Open to New Enrollment |
Premium Limits | Between 125% to 150% of standard rates |
Lifetime Maximum Benefit | $2 million |
Special Notes |
|
Children’s Health Insurance Program
Through shared funding from the federal government, the State of Illinois provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:
| Program Name | All Kids |
Website | |
Phone Number | 866-255-5437 |
Apply Online | Yes |
Age Limits | Under 18 |
Insurance Carrier | Options based on county of residence |
Length of Coverage | 12 months |
Residency Requirements | Illinois residents, U.S. citizens, legal immigrants |
Other Eligibility Requirements |
|
Pre-Existing Condition Exclusions | No |
Cost | Monthly premium based on number of children in family, plus co-pay for each service |
Medicaid
Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Illinois:
| Governing Agency | Illinois Department of Healthcare and Family Services |
Website | |
Phone Number | 217-782-1200 |
Residency Requirements | Illinois resident, U.S. citizen, non-citizen legal immigrant |
Federal Poverty Line Income Limits | Children ages 1-19: 133% FPL (and Non-Working Parents) |
Additional Resources
Illinois Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Illinois’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Illinois: At-A-Glance
Provides all-inclusive health data of Illinois. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.
