Illinois Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
Illinois Comprehensive Health Insurance Plan / ICHIP
Funding
Funds to operate ICHIP come from premiums collected and state general funds. HIPAA eligible plans are funded by premium payments and assessments paid by the insurance companies operating in the State of Illinois.
Plans Offered
There are 5 plan options available through the ICHIP program. The Medicare Plan is the only plan available to eligible persons who are enrolled in both Parts A and B of Medicare due to disability or end-stage renal disease since they are not eligible for all other CHIP benefit plans. The Traditional Plan is a PPO plan available only to eligible persons who qualify for coverage because they have been denied major medical coverage due to their health by private insurers and are not eligible for Medicare. The HIPAA Plan, also a PPO plan, is available only to federally eligible individuals who qualify for coverage because they have had prior creditable coverage and meet the other HIPAA requirements. Finally, The HIPAA-HCTC Plans are PPO plans offered only to persons that qualify for federal tax credit under the Trade Act of 2002.
Plan Benefits
All the ICHIP Plans have five deductible options ranging from $500 to $5,000. The Medicare Plan does not provide coverage for prescription drugs (except in very limited circumstances). Once all appropriate deductibles are met for the Traditional Plans, the HIPAA Plans and the HIPAA-HCTC Plans, you will have to co-pay 20% of the covered costs when receiving treatment from a PPO provider. However, if you receive treatment from a Non-PPO provider, you will be responsible to pay 40% of the covered charges. The Traditional HDHP Plan, the HIPAA-HDHP Plan, and the HIPAA-HCTC Plans with HDHP (High Deductible Health Plans) deductibles have a choice of the following deductibles: $1,200, $2,000 and $5,200.
Maximum Benefit Limits
The maximum payable lifetime benefit for all ICHIP plans is $2,000,000.
Eligibility
There are various options for qualifying for coverage under an ICHIP plan. Each of these plan types has different eligibility requirements, as is outlined below.
The Traditional CHIP and Medicare Plans Eligibility requirements
- Must be a U.S. Citizen or legal permanent resident alien
- Must be a resident of Illinois for at least 180 days
- You must have applied for standard issue health insurance in the past 9 months and received a letter of declination due to health reasons
- Or, you were approved for an individual health insurance policy, but at a rate that is higher than what similar coverage would cost you on a CHIP plan
- Or, you have one of the medical conditions that are listed by ICHIP as a presumptive medical condition
- If you are eligible or enrolled in only Part A or only Part B of Medicare, you are not eligible for and cannot enroll in the Medicare Plan. If either Part A or Part B of Medicare coverage is dropped or discontinued, you can no longer participate in the Medicare Plan. If you are eligible for Part B, but choose not to enroll in it for any reason, you are not eligible for and cannot enroll in the Medicare Plan.
- Refer to plan brochure for circumstances that cause ineligibility
The HIPAA Plan Eligibility requirements
- Must be a resident of Illinois
- You must qualify under federal eligibility requirements governed by HIPAA law that states that any person that has had a minimum of 18 months of continuous coverage, most recently under a group health plan
- You may not have had more than a 90 day break in previous coverage before applying for HIPAA-CHIP coverage
- You have had your most recent creditable coverage under group health insurance coverage provided by a health insurance issuer, a group health plan, a governmental plan or a church plan
- You must not receive, be approved to receive or be eligible for coverage under a group health plan, Part A or Part B of Medicare due to age or Medicaid/medical assistance
- You must not have any other health insurance coverage
- You must not have had your most recent coverage terminated due to nonpayment of premium or fraud
The HIPAA-HCTC Plan Eligibility Requirements
- You must register with and be approved for the HCTC program as TAA certified or as a PBGC pensioner
- You must be a United States citizen or lawful permanent resident alien
- You must be a resident of Illinois
- You have had at least a total of three months of prior creditable coverage
- You have no more than a 63-day break between periods of creditable coverage
- You must have completed, signed and submitted the proper application for coverage that is received by the CHIP Board Office within 63 days of the date your last creditable coverage ended
- You must not be enrolled in a health plan maintained by the current or former employer of the HCTC eligible individual or spouse if such employer pays at least 50% of the cost of coverage
- You must not be entitled to Medicare Part A or enrolled in Medicare Part B
- You must not be enrolled in the Federal Employees Health Benefit Program (FEHBP), Medicaid/medical assistance or State Children”s Health Insurance Program (SCHIP)
- You must not be entitled to health coverage through the U. S. Military health system (TRICARE/CHAMPUS).
Enrollment Periods
Illinois is one of the few states that place a cap on the number of persons that can be enrolled in the regular pool. Contact CHIP for estimated waiting period lengths. The HIPAA eligible pool is always open to new enrollment but enrollment must be made within 90 days of losing your prior group health insurance.
Premium Payments
Premiums are based on your health plan selection, your deductible, your gender, your age and your county of residence.
Premium Calculations
Premiums charged under the CHIP plan are established by law and set at 125% to 150% of the average standard risk rates charged for similar type plans available to qualified individuals in the State of Illinois.
Pre-Existing Condition Waiting Periods
Illinois Traditional Plans and Medicare Plans have a 6 month exclusionary period for pre-existing medical conditions. The HIPAA Plans and HIPAA-HCTC Plans do not have a waiting period for pre-existing medical condition benefits. However, individuals who have satisfied similar pre-existing condition exclusion under a prior individual policy that was involuntarily terminated due to the insolvency of the issuer of that policy, and who has applied for the Traditional Plans within 90 days following the involuntary termination of that individual health insurance policy would be covered immediately.
Illinois Comprehensive Health Insurance Plan Contact Information
Illinois Comprehensive Health Insurance Plan
320 West Washington Street, Suite 700
Springfield, IL 62701-1150
Phone: 866-851-2751
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