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Illinois Risk Pool - Health Insurance Provided for the Uninsurable

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FAQ

Acronym or name of the risk pool: Illinois comprehensive health insurance plan or ICHIP.

Regulation establishing risk pool: Illinois General Assembly under insurance statute 215 ILCS 105.

Funding: It is partially funded by payment of premiums from the participants. HIPAA plans are funded through assessment of insurance companies that are operating in Illinois.

Plans offered: 5 plan options are available through ICHIP programmes. Plan 2 is an option for people under supplemental Medicare part A or B. It is available for people under 65 years of age and people who are under Medicare and are disabled or at the end stage of a renal disease. Plan 3 is a PPO type of plan available for people qualifying for ICHIP plan. Plan 5 is open to people who qualify under a federal law and have had their group plans terminated. Plans P and T is for people qualifying for federal tax credit as related to the trade act of 2002.

Plan benefit: For plans 2, 3 and 5, the deductibles range between $500 and $5000. The annual out of pocket limits range between $2000 and $6500. Out of network benefits are provided for plans 3 and 5. The plans have a 20% coinsurance for in network services. Plans 3 and 5 have a 40% coinsurance rate for treatments conducted out of network.

ICHIP brochure: http://www.chip.state.il.us/downloads/broch1104.pdf

Maximum benefit limits: The maximum lifetime payable benefits for all plans are $1000000.

Eligibility: The conditions for eligibility vary from plan to plan. They are as follows:

Traditional CHIP-plans 2, 3: (1) The applicant has to be a resident of Illinois for a minimum of 6 months. He needs to be a US citizen or a person with legal alien status. (2) The person must have applied for insurance to a carrier in the last 9 months and been declined for health reasons. (3) He must have been approved for health insurance but premiums were higher than the minimum offered by CHIP. (4) The person has a medical condition identified as presumptive by CHIP. (5) Persons eligible for Medicare are not eligible for plan 3.

The HIPAA CHIP plan 5: (1) The applicant has to be a resident of Illinois for a minimum of 6 months, he needs to be a US citizen or a person with legal alien status. (2) The person must have applied for insurance to a carrier and been declined for health reasons. (3) He must have been approved for health insurance but premiums were higher than the minimum offered by CHIP. (4) The person must qualify under HIPAA regulations. (5) The gap in insurance coverage may not be more than 90 days while applying for this coverage. (6) The applicant may not qualify for coverage under Medicare and Medicaid.

Enrollment periods: Illinois is one of the states where a cap is present on the number of enrollments in a regular pool. The HIPAA pool takes enrollments that have been applied for within 90 days of the end of the previous cover.

Premium payments: Premiums are dependent on the health plan you select. It is also determined by your age, sex, your county of residence and whether you are a smoker.

Premium calculations: The board decides on the monthly premiums and it is usually restricted to a percentage of the standard risk rate. This refers to other benefits that people in Illinois can obtain from private health insurance providers. The rate cannot exceed 150% of the standard risk rate. The minimum rate is 125%.

Pre existing condition waiting period: Plans 2 and 3 offered by CHIP have a 6 month exclusion period for conditions that are pre existing. The HIPAA CHIP plan does not have this exclusionary period.

Contact information: Illinois comprehensive health insurance plan. 320 west Washington Street, suite 700. Springfield, Illinois 627011150. Phone-8009628384. ICHIP Website.

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