Illinois Health Insurance Coverage...
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  What are your protections when buying Individual Health Insurance in the State of Illinois?

• Summary of your Protections.
     If you do not have access to employer-sponsored group insurance, you may want to buy an individual health plan from a private health insurance company or you may be eligible for coverage under a program offered by the State of Illinois, the Comprehensive Health Insurance Plan (CHIP). In Illinois – as in most other states – you have limited guaranteed access to private individual health insurance coverage. There are, however, some alternatives – such as COBRA coverage and CHIP coverage. This chapter summarizes your protections under different kinds of health plan coverage.
• When do Individual Insurers have to sell you Coverage?
     In Illinois, your ability to buy individual health coverage from a private insurance company may depend on your health status.
• In general, companies that sell individual health insurance in Illinois are free to turn you down because of your health status and other factors.
     When applying for individual coverage, you may be asked questions about health conditions you have now or have had in the past. Depending on your health status, insurers might refuse to sell you coverage or offer to sell you a policy that has special limitations on what it covers. If you are turned down or offered a policy with reductions or restrictions, you may be eligible for CHIP coverage.
• Under Illinois law, newborns are automatically covered under the parents’ individual health plan for the first 31 days, if the plan covers dependents.
     The insurer may require that the parent enroll the child within the 31 days in order to continue coverage beyond the 31 days.
• If you have a dependent, disable child, that child may remain covered under your fully insured group health plan after he reaches the age at which dependent coverage is usually terminated.
     The dependent adult will not be issued a separate policy but can remain on your policy, provided that it remains in force.
• What Will Your Individual Health Plan Cover?
     It depends on what you buy. Illinois does not require health insurers in the individual market to sell standardized policies. Health plans can design different policies and you will have to read and compare them carefully. However, Illinois does require all health plans to cover certain benefits – for example, diabetes care and mammography screening. Check with the Illinois Department of Insurance for more information about mandated benefits.
• There are different ways that individual health plans can exclude a pre-existing condition.
     The plan can impose an elimination rider, which is an amendment to your health insurance contract that permanently excludes coverage for a health condition, body part, or body system. Or a plan can impose an exclusion period for up to 24 months on any pre-existing condition.
     In addition, if you make a claim during the first 2 years of coverage, your plan can look back 12 months from the time of your application for any symptoms or signs that would have prompted a prudent person to seek medical care, or advice. If it finds such evidence, it can apply a 2 year pre-existing exclusion period for that condition.
• Pregnancy can be considered a pre-existing condition by individual health plans.
     Also, genetic information, without a health condition diagnosed by a health care professional, cannot be used as the basis of a pre-existing condition.
• Individual health plans do not have to give you credit for prior coverage, unlike group health plans.
• What can you be charged for Individual Health Insurance in Illinois?
     Generally, in Illinois, there are no limits on how much individual premiums can vary due to age, gender, health status, family size, and other factors.
• Your coverage cannot be canceled because you get sick.
     This is called guaranteed renewability. You have this protection provided that you pay the premiums, do not defraud the company, and, in the case of managed care plans, continue to live in the plan service area. However, guaranteed renewability does not protect you from having your premiums go up at renewal.
• Some insurance companies sell temporary health insurance policies.
     Temporary policies are not guaranteed renewable. They will only cover you for a limited time, such as 6 months. If you want to renew coverage under a temporary policy after it expires, you will have to reapply and there is no guarantee that coverage will be re-issued at all or at the same price.

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