Illinois Health Insurance Guide

Health Insurance Resources for IL State Residents

If you are a resident of Illinois, you have access to many types of health insurance. You may receive your Illinois health insurance coverage through your place of employment, through your spouse or partner’s employer-provided plan, through your membership in a trade association or union, or you may purchase health insurance as an individual or small employer. Here are the various health care insurance plans available in Illinois, along with some general guidelines.

Major medical health insurance plans are the most common

These plans typically include coverage benefits for routine visits to health care providers, prescription drugs and hospitalization. Different plans available include:

Health Maintenance Organizations. Also called HMOs or managed care, these plans offer affordable health care through doctors and hospitals that contract with the network provider. You select a primary care physician (PCP) who must authorize any referrals to in-network specialists. Costs are contained by staying in network. If you go outside the network, you may receive little or no reimbursement for services. HMOs are often offered as part of an employer’s group plan and are also available to individuals. Services covered tend to be quite comprehensive, so HMO premiums can actually be higher than the more flexible PPOs.

Preferred Provider Organizations. Like HMOs, PPOs have a network of providers you can use. Unlike HMOs, you do not need a referral from a primary care physician to see a specialist and receive the plan’s discounted rate for services. If you go outside the network, both your deductibles and co-pays may be significantly higher. PPOs are available to individuals as well as employers.

Indemnity Plans. Illinois residents can also choose major medical health care insurance through indemnity plans. These are extremely flexible in that you are not restricted to a network. However, many indemnity plans don’t cover preventive care or routine office visits. Premiums, deductibles and co-payments on these plans are typically high.

The best health insurance coverage for you is the plan that provides the coverage you need at a price you can afford. If you are purchasing individual health insurance coverage in Illinois, issuing companies are required by state law to give you a minimum of 10 days to review your policy and return it for a full refund of any premium paid.

Note that no company selling individual health insurance in Illinois is required to issue a policy. Applications are first underwritten based on many criteria and the company has the option to issue the policy you apply for, issue it with stated exclusions for a limited or unlimited period, issue it with an additional premium, or decline to issue.

Self-Insured Health Plans
Self-insured programs may also be available through your place of employment or membership in an association. The plan’s sponsor, rather than an insurance company, assumes the risk for any claims you incur. Coverage under such programs will differ depending on plan. Illinois state mandates or insurance laws do not apply to self-insured plans, which are usually regulated by the U.S. Department of Labor, unless the plans are sponsored through a school district, municipality or church.

Other Illinois Health Insurance Options
The State of Illinois has a number of programs to help residents who are uninsured or underinsured. These include:

Illinois Medicaid – a state-federal cooperative program
Health Benefits for Works with Disabilities – For disabled individuals aged 16 to 65. Unlike other Medicaid programs, HBWD allows you to have assets up to $25,000. It also encourages enrollees to work and increase the number of hours they work.
All Kids – For uninsured children whose families earn to much to qualify for other state programs such as Medicaid, but not enough to purchase private health care insurance. Parents pay premiums but at a significantly adjusted rate. All Kids has a Moms & Babies program specifically to pregnant women.
Family Care – Similar to All Kids, with some restrictions that require that the qualifying adult be a parent or relative and living with the children.
Healthy Women – This is a voluntary, confidential program providing family planning and related reproductive healthcare free of charge to women 19 to 44. Women who qualify automatically receive an Illinois Healthy Women card when they lose regular medical benefits.
CHIP - The Illinois Comprehensive Health Insurance Program (CHIP) is for residents who are uninsurable on the individual market, under 65 and not enrolled in Medicare. There are a variety of eligibility criteria.
Your Healthcare Plus - Illinois also has several programs to assist people with specific health problems.

The Illinois Department of Insurance regulates health insurance in the state. Get access to Illinois to free IL health insurance quotes

Illinois Department of Insurance
The Illinois Department of Insurance mission is to: “To protect consumers by providing assistance and information, by efficiently regulating the insurance industry's market behavior and financial solvency, and by fostering a competitive insurance marketplace." Visit the Illinois Department of Insurance at http://insurance.illinois.gov/

Consumer hotlines for the Illinois Department of Insurance Include:

Office of Consumer Health Insurance
877/527-9431 (Toll-Free)

Medicare Beneficiaries & Caregivers Inquiries
Senior Health Insurance Program (SHIP)
800/548-9034 (Toll-Free)

All Other Consumer & Healthcare Provider
Inquiries Consumer Assistance Hotline
866/445-5364 (Toll-Free)

Illinois Department of Public Health
The mission of the Illinois Department of Public Health is to promote the health of the people of Illinois through the prevention and control of disease and injury.
535 West Jefferson Street
Springfield, IL 62761
Phone: (217) 782-4977
Fax 217-782-3987
TTY 800-547-0466
http://www.idph.state.il.us/

Illinois Comprehensive Health Insurance Plan
The Illinois General Assembly has created the Comprehensive Health Insurance Plan which provides access to health insurance coverage for certain Illinois residents who have been denied major medical coverage by private insurers because of their health.
http://www.chip.state.il.us/

Illinois Department of Health and Family Services
The Illinois Department of Healthcare and Family Services (HFS) is responsible for providing healthcare coverage for adults and children who qualify for Medicaid, and for providing Child Support Enforcement services to help ensure that Illinois children receive financial support from both parents.
http://www.hfs.illinois.gov/
201 South Grand Avenue East
Springfield, IL 62763-0001
Phone: 217-782-1200
TTY: 1-800-526-5812

(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/

Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/