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.
Most Common Major Medical Health Insurance Plans
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.
- 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.
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.
Other Illinois Health Insurance Options
The State of Illinois has a number of programs to help residents who are
uninsured or underinsured. These include:
- IPXP
The Illinois Pre-existing Condition Insurance Plan is a federally funded high- risk insurance
program. To qualify enrollees must be a U.S. citizen, national, or legal citizen; be uninsured
for 6 months and have a pre-existing medical condition. Enrollees will be required to pay a premium
and out of pocket costs. For more information visit www.insurance.illinois.gov/ipxp
- 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.
Regulating Agency and Other Resources
The Illinois Department of Insurance regulates health insurance in the state.
Get access 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/
Related Illinois Health Insurance Articles
New Health Insurance Plan for the Uninsured Launches in Illinois
Shopping for Health Insurance Quotes: Understanding Waiting Periods
Understanding Health Insurance Quotes: Premiums, Coinsurance, Copayments & Deductibles
Group Health Insurance Rates for a Group of One
Last Updated 8/27/2010