Illinois insurance law and regulation
News that affects your health insurance and planning
December 29, 2020 – On January 1, 2021 Illinois becomes the second state in the country to limit out-of-pocket costs for prescription insulin by capping copayments at $100 for a 30-day supply regardless of the type and amount of insulin needed. The new law provides that the limitation on insulin costs also applies to provisions requiring coverage of certain diabetes items to be subject to the same coverage, deductible, co-payment, and co-insurance provisions under a policy.
January 27, 2020 – The Illinois Department of Health published data showing that the number of abortions performed in the state declined significantly over the past several decades but bucked the trend with an increase in 2018. Observers speculate that the increase is caused by individuals coming from other states that have more restrictive abortion laws. Both federal and state laws allow Medicaid to cover abortions in Illinois and this remains a controversial topic nationwide. The larger topic of “medical migration” is important to us at Freedom Benefits because we expect that people will travel and sometimes even relocate to states that offer access to more comprehensive medical coverage that they need.
December 22, 2019 – Illinois became the first state in the country this year to cap insulin costs at $100 a month for insured patients, regardless of how much insulin they require per month. While the cost of insulin production has not changed in the past decade, the cost of insulin itself has continued to rise at alarming rates. According to a study by the American Diabetes Association, the average price of insulin in the United States has nearly tripled between 2002 and 2013. Most diabetics need several vials per month, raising the cost of surviving for millions of Americans by thousands of dollars each year. The most popular forms of insulin can sometimes cost over $400 per vial without cost controls.
May 26, 2019 – Status of alternative non-ACA health plans: Illinois does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage, permits insurers to sell non-compliant transitional policies in the individual market and limits the sale of short-term coverage more strictly than the federal government by limiting the initial contract duration of underwritten short-term coverage to 6 months.
April 17, 2019 – In 2016 the state of Illinois stopped paying the full cost for vaccinations for children on Medicaid. Thousands of fewer children were immunized. Now pediatricians are warning the state that thousands of children are at risk of measles where the cost of treatment will likely far more costly than the vaccinations.
March 22, 2019 – Illinois is reportedly one of the only states not following the federally-mandated law requiring coverage for their children who have autism. Parents may need to seek treatment out-of-state where these services are provided. Since low income families are the ones most affected, finding care may not be easy. Some families facing severe hardship may even need to consider relocating to another state that provides autism care for low income children.
November 13, 2018 – Illinois has a high impact program that brings resources to HIV patients. Care Connect website at www.hivcareconnect.com points out the program’s benefits for HIV patients. The website includes links to services such as the state’s HIV/AIDS hotline: (800) 243-2437. Statewide, close to 40,000 people are living with HIV alone or AIDS.
The history of health care planning in Illinois (Information is outdated and links may be expired)
12/5/2015 Blue Cross Blue Shield of Illinois, that state’s largest health insurer, reports that about 200 small businesses have purchased group health insurance through SHOP, the small business health insurance exchange. This is about 1% of the insurer’s total small business customers.
11/17/2014 More than 400 health insurance choices are available to Illinois residents for 2015 although some may still consider the price to be unaffordable and the high deductibles and out-of-pocket expenses to make the insurance unattractive. If possible, OnlineNavigator suggests combining the least expensive primary coverage with an employer-paid pre-tax Supplemental Accident Insurance for the best value for overall coverage.
2/11/ 2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at (800) 609-0683 ext. 1.
10/7/2013 The Illinois Policy Institute released a report stating that the ACA is driving down employment in Illinois and that the law is negatively impacting an already unstable economy. Illinois already has the second highest unemployment rate in the nation at 9.2 percent. The report states that employers are reducing work hours to avoid Obamacare penalties. The loss in hours equates to 66,000 retail, food, and merchandise jobs since 2011. The group indicates that the lowest wage sectors are the hardest hit after they studied the effects in retail, food, and merchandise industries – where average hours were closest to 30 hours per week prior to the ACA. The report says that all three sectors have dipped below 30 hours per week, the threshold for a full-time worker under the law.
7/26/2013 Affordable Smart Term Life Insurance is now available to most Illinois residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.
3/11/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.
5/26/2012 The Illinois legislature voted to cut $50 million from Family Care, a health-insurance program for adults with children by tightening the eligibility requirements for the program. An additional $35 million will be cut from dental care coverage for adults on Medicaid. Governor Quinn indicated that he will sign the bill. We do not have an estimate of how many people will be affected in the state. Lawmakers expect those squeezed from coverage will be able to find affordable alternatives elsewhere on their own. While commercial insurance is available, the premium cost and the out-of-pocket costs make these programs less attractive than Medicaid for some people currently enrolled in the state programs.
2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS)reported that as of June 30, 2011 Blue Cross Blue Shield of Illinois is the state’s largest health insurance provider and as such, earns the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.
8/19/2011 Beacon Therapeutic Schools in Cook County and the Chicago suburbs received a federal grant of $409,958 to help uninsured teens enroll in Medicaid or CHIP.
7/27/2011 Parents are reminded that the children’s’ health insurance open enrollment period ends on Sunday July 31 so applications should be submitted online before that date. See www.uhcenrollment.com for details on the UnitedHealthOne insurance products orwww.celticenrollment.com for information on Celtic Insurance individual health insurance plans.
2/12/2011 With dozens of health plans choices available online offering a wide range of pricing and benefits, how do you find the best combination of price and benefits? Celtic Insurance realizes that the choices can be overwhelming; the company offers more than 40 possible health plan designs in many parts of the United States. A new feature called “Help Me Choose” lets users easily and quickly select the benefits they value most and narrows the list down to a few of the best choices. No personal information is required other than zip code and date of birth.
1/30/2011 Patients with health insurance and a credit card now have access to VIP treatment when care is needed at a hospital emergency room. Ingalls Family Care Centers in Flossmoor, Tinley Park, and Calumet City joined the growing list of hospitals that allows patients to use InQuickER, a reservation system that books appointments and reduces waiting time in the emergency room. The reservation system makes check-in easier by recording your insurance and payment information in advance. The service costs $15 to $25. Of course the nature unpredictable medical emergencies mean that the service cannot absolutely guarantee that you’ll be seen immediately at your appointment time, but you get a full refund if not treated within 15 minutes after arrival. The InQuickER service works in conjunction with any of the private health insurance plans listed here at FreedomBenefits.net but is not available to uninsured patients.
1/19/2011 Child-only health insurance for children with significant medical problems will be available through an open enrollment period mandated by federal state law during the months of January and July. All children, regardless of medical condition, continue to be eligible for insurance when applying as a dependent on a parent’s policy and healthy children are eligible for child-only insurance at any time. When applying for child-only insurance for more than one child, make a separate application for each child.
12/16/2010 Illinois Department of Insurance officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.
In its initial federal grant request for the insurance exchange project, Illinois said that it would: 1) Conduct comprehensive review of the status of health coverage in Illinois, 2) Develop structure and timeline for implementation of an Exchange that follows recommendations of Health Reform Implementation Council, 3) Assess resources needed for the implementation of an Exchange, 4) Confer with State agencies about Exchange infrastructure, 5) Involve stakeholders to ensure transparency, 6) Draft legislation that will enable an Exchange, and 7) Perform strategic planning on the operational, financial, technical requirements to sustain an Exchange.
The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.
5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in Illinois is now available at Freedom Benefits.
5/11/2010 Illinois Auditor General’s Office released a shocking report about the “AllKids” CHIP health plan. Among the findings: 70% of last year’s payments were for children of illegal immigrants and many claims paid were not legitimate. HFS director pledges to tighten up eligibility and internal accountability of the health plan. When combined with other recent news, we expect this will contribute to a greater need for low cost basic commercial health insurance for low income families in Illinois.
4/15/2010 Illinois Comprehensive Health Insurance Plan (CHIP) has decided not to participate in the temporary high-risk pool program but to establish a new state high risk pool for those persons who have not previously had insurance coverage for six months and have a pre-existing condition. Those rates will be announced in the near future but are expected to be significantly higher than other insurance options. Recently passed federal health care reforms gives the state an option to elect this course of action even though the likely result is a reduction in the number of people who will opt to purchase insurance. Illinois residents with pre-existing conditions will continue to be eligible for commercial health insurance (like those listed under “Covering the Gaps in Obamacare” section above but these plans may place a waiting period or limitation on coverage for pre-existing conditions. This type of limited benefit coverage may be the best temporary solution for those who are unable to afford full medical coverage.
11/12/2009 A new law creates a uniform small-employer group health status questionnaire and an individual health statement for use on January 1, 2011 and an orthotics and prosthetics mandate now applies to health carriers and HMOs for policies amended, delivered, issued, or renewed six months after the effective date of the amendatory act.