Health Insurance in Illinois

Health Insurance in Illinois

Health insurance is one indispensable alternative that we cannot do without. Definitely, buying suitable health insurance coverage for your family can be expensive as well as needs a comprehensive evaluation of all future risks and its effect on your finances. More than 47 million Americans are uninsured, majority of whom are the working families. These families often expose themselves to the crushing medical expenses of the lack of proper health coverage. However, for those families who are not covered under their employers’ group plan, there are low-cost state sponsored health insurance programs.

According to the America’s 2008 Health Rankings, Illinois holds 31st place in the healthiest states list. The state was at 25th and 27th spot in 2006 and 2007 respectively. The prevalence of binge drinking, rising crime rate, low public health funding has contributed to decline of healthcare system in the state. Illinois, having the population of more than twelve million citizens, boasts of both private-market and public health insurance alternatives. The private-market health insurance comprises of numerous types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-priced health coverage to the uninsurable residents of Illinois who meet specific eligibility requirements.

The Illinois Division of Insurance is in charge for regulating all types of insurance sold in the state of Illinois including health insurance policies offered by private-market health insurers or public health coverage programs. However, approximately 13.7% of the population remains uninsured, which is the biggest health issue for the Illinois lawmakers. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, approximately 34.1% uninsured Illinois residents come under the above 200% FPL category.

Choosing a health plan is not as simple as it was before. Before buying a particular health policy, consult with a licensed health insurance agent/broker to avail the appropriate health insurance alternatives.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Illinois. These regulations apply to all insurance companies offering individual or family health insurance in Illinois:

Medical Underwriting
Pre-Existing Condition Exclusion Period
24 months
Look Back Period
24 months
Look Back Standard
Prudent standard and Objective standard
Mandatory Benefits
Cancer screening for women including screening of breast cancer and cervical cancer, IP mastectomy stay (5length to be determined by the physician), reconstructive surgery after mastectomy, osteoporosis screening, direct access to OB/GYNs, Infertility coverage and maternity care
Market Rate Restrictions
Guaranteed Issue Options
Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Illinois. These regulations apply to all insurance companies offering small group health insurance in Illinois:

Small Group Size
Employee Qualifications
Two employees must be present for half of the preceding calendar quarter and work 20 hrs/week for coverage
Guaranteed Issue
Premium Rating Factors
Rate Bands
Rate Adjustment Factors
Look-Back Period
6 months
Pre-existing condition exclusionary period
12 months
Mandatory Benefits
Same as individual
State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Illinois. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option
Eligible Group Sizes
Extension of Benefits Period – Standard
9 months
Extension of Benefits Period – Disabled
9 months
Maximum Premium Increase
State Legislation Reference
The Illinois Health Insurance Continuation Rights (5revised 12/03)
Additional Notes
Only individuals that have been insured under the group’s medical insurance policy for 3 months are eligible for Illinois mini-Cobra and acceptance must be given with 10 days of the notification date.
State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Illinois to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Illinois is summarized in the chart below:

Plan Name
The Illinois Comprehensive Health Insurance Plan (5CHIP)
Phone Number
HIPPA Eligibility Required?
Available Carriers
Blue Cross Blue Shield of Illinois
Pre-Existing Condition Waiting Period
6 months
Enrollment Periods
Open to New Enrollment
Premium Limits
Between 125% to 150% of standard rates
Lifetime Maximum Benefit
$2 million
Special Notes
Previous coverage must be terminated for reasons other than nonpayment of premium or fraud
Cannot be eligible for COBRA, or government programs (5must have exhausted this option)
Must prove denial of coverage or offer of higher premium than CHIP
Children’s Health Insurance Program

Through shared funding from the federal government, the State of Illinois provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name
All Kids
Phone Number
Apply Online
Age Limits
Under 18
Insurance Carrier
Options based on county of residence
Length of Coverage
12 months
Residency Requirements
Illinois residents, U.S. citizens, legal immigrants
Other Eligibility Requirements
To qualify the children should be uninsured for 12 months and meet certain income requirements
If already insured, income limit is approximately 250% of FPL
Pre-Existing Condition Exclusions
Monthly premium based on number of children in family, plus co-pay for each service

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Illinois:

Governing Agency
Illinois Department of Healthcare and Family Services
Phone Number
Residency Requirements
Illinois resident, U.S. citizen, non-citizen legal immigrant
Federal Poverty Line Income Limits
Children ages 1-19: 133% FPL (5and Non-Working Parents)
Pregnant Women and Infants: 200% of the FPL if the mother is enrolled in Medicaid at the time of birth. If not, infants with family incomes of 133% FPL
Working Parents: 140% FPL
Aged, blind or disabled: 85% FPL
SSI recipients: 40% FPL
Medically Needy Individual: 40% FPL, Couple: 39%
Additional Resources

Illinois Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Illinois’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by
The guide created by provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Illinois: At-A-Glance
Provides all-inclusive health data of Illinois. is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.