Illinois (IL)
Individual Health Insurance Regulations

Learn more about Illinois Individual Health Insurance

When it comes to insurance, health insurance has always received precedence compared to other types of insurance. As an earning member of your family, it becomes your duty to safeguard your family against sickness or injuries. An appropriate health insurance can save you from huge medical bills and guarantee well-being of your family’s health. It is prudent to evaluate your budget and family’s health care needs, before purchasing health coverage. If you live in Illinois, you can choose from various options of health insurance. The Illinois Division of Insurance supervises the regulations under which the Illinois health insurers can sell private health insurance to individuals and families.

Illinois insurance regulations do not call for standardization of health insurance rates on the individual health insurance market and there are no premium cap restrictions imposed on insurance companies. In short, insurance companies can charge you what they want for health insurance, depending on several rating factors. There are some mandates on what levels of coverage and benefits must be offered, but these are fairly limited. Medically underwriting is permitted by the insurance companies, who may be selective on who they insure based on the applicants reported health status. An exclusionary rider may be added to a new individual health insurance policy, restricting the payment of medical expenses related to a disclosed pre-existing medical condition. Pre-existing medical conditions, even if not disclosed on an exclusionary rider, may be excluded from receiving benefits for up to 24 months. The health insurers can look-back in your 24-month health records to determine any pre-existing medical conditions. Insurance companies offering individual health insurance in Illinois are not required to give credit from prior creditable coverage.

Illinois (IL)
Small Group Health Insurance Regulations

In Illinois, any small group with 2-50 employees must be guaranteed approval of an application for health insurance, regardless of the health status of the employees to be insured under the group policy. No individual employee who is eligible to enroll in the group plan may be denied coverage based on health history. An employer may set a waiting period that must be the same for each new hire. This waiting period specifies when a new hire will be able to join the group health plan. For dependent coverage, newborn children are automatically covered under the group health plan for 31 days after birth. For any employee that does not have prior creditable coverage, the insurance company may impose a 12 month waiting period on pre-existing medical conditions. The insurance company may look back in the 6 month health history of the applicants for the presence of a pre-existing medical condition. Health insurance premiums are determined by the health status, age, health history, lifestyle habits of the applicants. Rates are capped at 25% of the insurance company’s index rate.

Illinois COBRA and Continuation Coverage

As is the same in all states, any Illinois employer with more than 20 employees must abide by federal COBRA regulations. Under the federal COBRA laws, the employer is obligated to provide the option to a departing employee to remain on the group health plan for a minimum of 18 months. In special cases, some persons may be entitled to 36 months of continued COBRA coverage under federal law. The COBRA recipient is responsible for paying the insurance premiums that the employer was paying for the coverage along with 2% administrative costs.

The mini-COBRA law in Illinois, enacted through the Illinois Health Insurance Continuation Rights (revised 12/03), applies to businesses with 20 or fewer employees. If any small business employee has been on the group health plan for at least 3 months, they must be offered mini-COBRA for a period of 9 months. This may be extended to 24 months in some cases, such as dependents that have lost group coverage due to divorce or death of the primary insured.

For those not eligible for COBRA, insurance companies may offer conversions plans to persons losing their group coverage. Once a person exhausts their COBRA, they may be eligible for guaranteed issue coverage under the Illinois Comprehensive Health Insurance Plan. This is the state’s risk pool plan, but it is only available to HIPAA eligible persons that are uninsurable otherwise.