Illinois Individual Health Plans

In Illinois, those employed by large companies generally have group health insurance coverage. Retirees age 65 and older are covered by Medicare, and there are government programs available for the poor and the almost-poor. Nearly everyone else – entrepreneurs, commission-based sales personnel, private contractors, freelancers and other self-employed people – must obtain private health insurance. Fortunately, there are many different Illinois individual health plans available to choose from.

Consumers should verify that an insurance company offering Illinois individual health plans is authorized to do business by the Illinois Insurance Department. While consumers can deal directly with a sales agent, they should do at least their preliminary research on the Internet: determining the best health health insurance plan for their particular situation, getting Illinois health insurance quotes and comparing policies. This can save a significant amount of time, especially when the application itself is filed online.

What Kind of Coverage to Purchase

Among the major choices to make is the type of coverage to purchase: traditional major medical, HMO (Health Maintenance Organization) or Preferred Provider Organization (PPO). Traditional major medical insurance usually doesn’t restrict policyholders in their choice of healthcare providers, and pays a percentage of the healthcare charges after an annual deductible has been met. The higher the percentage paid, the higher the monthly premium will be. In addition, most major medical policies offer the applicant a choice among deductibles, with higher deductibles resulting in lower premiums.

An HMO negotiates preferential rates with a network of health care providers and restricts its members to those providers – except in emergencies, HMOs won’t pay for any services their members receive from out-of-network providers. HMO premiums are much lower than either traditional major medical or PPO policies, and in many cases, only a small co-pay is required when receiving medical services, with no further fees, charges or claims.

A PPO is like a hybrid of a traditional major medical policy and an HMO. Preferential rates are negotiated with the provider network, and it costs less for policyholders to visit providers in the network, but if policyholders visit providers outside the network, the PPO will pay part of the charge. PPO premiums generally are higher than HMOs and lower than traditional major medical plans.

Once the research is done and the consumer decides which of the Illinois individual health plans to enroll in, it’s simply a matter of completing an application, which is reviewed by the insurance company. The application must be thoroughly and honestly completed, though – failure to disclose a medical situation or prior treatment may result in cancellation of the policy at some point in the future.

What to do if an Application is Rejected

If a consumer applies for one of the Illinois individual health plans from an insurance company and is turned down, the Illinois Comprehensive Health Insurance Plan (CHIP) can provide coverage. In fact, if the consumer has a medical condition included on a list called “Presumptive Medical Conditions,” the application can be filed directly with Illinois CHIP, because it’s presumed that people with those conditions will be denied coverage under any of the Illinois individual health plans.

Another option expected to be available for Illinois residents in August 2010 is the Illinois Pre-Existing Condition Insurance Plan (IPXP), a transitional program to provide health insurance for uninsured Illinois residents with pre-existing conditions. IPXP will terminate in 2014, when insurance companies will no longer be permitted to deny coverage to those with pre-existing conditions.

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