Illinois Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
Illinois Comprehensive Health Insurance Plan / ICHIP
Insurance Regulation Establishing Risk Pool
Illinois General Assembly
Insurance Statute 215 ILCS 105
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. Plan 2 is available to supplemental Medicare Part A and B for persons that are under age 65 and on Medicare due to a disability or end-stage renal disease. Plan 3 is a PPO plan that is available to persons that are eligible for the traditional ICHIP plan. Plan 5 is available to federally qualified persons under HIPAA regulations that have lost continuous coverage under a group health plan. Plans P and T are available to persons that qualify for federal tax credit under the Trade Act of 2002.
Plan Benefits
Plan 2, 3 and 5 have deductible options ranging from $500 to $5,000 and annual out-of-pocket maximums ranging from $2,000 to $6,500. Plans 3 and 5 provide out-of-network benefits and the annual out-of-pocket maximums are increased by $4,500 when using our of network providers. Each plan has a 20% coinsurance in-network and plans 3 and 5 have a 40% coinsurance for out-of-network treatments.
Maximum Benefit Limits
The maximum payable lifetime benefit for all ICHIP plans is $1,000,000.
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 – Plans 2 and 3 – 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
- Persons eligible for Medicare are not eligible for Plan 3
- Refer to plan brochure for circumstances that cause ineligibility
The HIPAA CHIP – Plan 5 – Eligibility requirements
- Must be a resident of Illinois for at least 180 days
- 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 must not be eligible for other group health insurance coverage, Medicare, Medicaid or must not have other health insurance coverage
- Refer to plan brochure for other circumstances that cause ineligibility
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 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 CHIP Plans 2 and 3 have a 6 month exclusionary period for pre-existing medical conditions. The HIPAA-CHIP plan does not have a waiting period for pre-existing medical condition benefits.
Illinois Comprehensive Health Insurance Plan Contact Information
Illinois Comprehensive Health Insurance Plan
320 West Washington Street, Suite 700
Springfield, IL 62701-1150
Phone: 800-962-8384
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