As an Illinois resident, you have rights under federal and state law that will protect you when you seek to buy, keep, or switch your health insurance, even if you have a serious health condition.

How am I protected?
Numerous state and federal laws make it easier for people with pre-existing conditions to get or keep health insurance, or to change from one health plan to another. A federal law, known as the Health Insurance Portability and Accountability Act (HIPAA) sets national standards for all health plans. In addition, states can pass different reforms for the health plans they regulate (fully insured group health plans and individual health insurance), so your protections may vary if you leave Illinois.

In Illinois, as in many other states, your health insurance options are somewhat dependent on your health status. Even if you are sick, however, the laws protect you in the following ways:

• Coverage under your group health plan (if your employer offers one) cannot be denied or limited, nor can you be required to pay more, because of your health status. This is called nondiscrimination.
• All group health plans in Illinois must limit exclusion of pre-existing conditions. There are rules about what counts as a pre-existing condition and how long you must wait before a new group health plan will begin to pay for care for that condition. Generally, if you join a new group health plan, your old coverage will be credited toward the pre-existing condition exclusion period, provided you did not have a long break in coverage.
• Your health insurance cannot be canceled because you get sick. Most health insurance is guaranteed renewable.
• If you are a small employer buying a group health plan, you cannot be turned down because of the health status, age, or any factor that might predict the use of health services of those in your group. All fully insured health plans for small employers must be sold on a guaranteed-issue basis.
• If you leave your job, you may be able to remain in your old group health plan for a certain length of time. This is called COBRA or state continuation coverage. It can help when you are between jobs or waiting for a new health plan to cover your pre-existing condition.
  If you lose your group health plan and meet other qualifications, you will be HIPAA eligible. If so, you can buy an individual health insurance policy from the Illinois Comprehensive Health Insurance Plan (CHIP). You will not face a new pre-existing condition exclusion period.
• If you have had difficulty obtaining affordable individual health insurance because of your health condition or if you have one of 31 presumptive medical conditions, you may also be eligible for a CHIP policy. In this case you may face a new preexisting condition exclusion period.
• If you have low or modest household income, you may be eligible for free or subsidized health coverage for yourself or members of your family. The Illinois Medicaid program offers free or subsidized health coverage for pregnant women, families with children, elderly, and disabled individuals with very low incomes. In addition, some women who are diagnosed with breast or cervical cancer may be eligible for medical care through Medicaid.
• If your children are 18 years old or younger and meet certain financial qualifications, you may be able to buy insurance for them or receive assistance paying for private health insurance through the Illinois KidCare Program.
  

What are the limits on my protections?

• If you change jobs, you usually cannot take your old health benefits with you. Your new health plan may not cover all of the benefits or the same doctors that your old plan did.
• Employers are not required to provide health benefits for their employees, so if you change jobs, you may find that your new employer does not offer you health coverage. Employers are required only to make sure that any health benefits they do offer do not discriminate based on health status.
• If you get a new job with health benefits, your coverage may not start right away. Employers can require waiting periods before your health benefits begin.
• If you have a break in coverage of 63 days or more, you may have to satisfy a new pre-existing condition exclusion period when you join a new group health plan.
• Even if your coverage is continuous, there may be a pre-existing condition exclusion period for some benefits if you join a group health plan that covers benefits your old plan did not. For example, say you move from a group plan that does not cover prescription drugs to one that does. You may have to wait up to one year before your new health plan will pay for drugs prescribed to treat a pre-existing condition.
• In Illinois, your access to individual health insurance may depend on your health status. Private insurers are not prohibited from turning you down, charging more or limiting coverage because of pre-existing conditions. If you are HIPAA eligible, the Illinois Comprehensive Health Insurance Plan (CHIP) is your only guaranteed access to individual health insurance coverage, though you may be able to buy individual health insurance from private insurance companies.
• In most cases the law does not limit what you can be charged for individual health insurance. You can be charged substantially higher premiums because of your health status, age, gender, and other characteristics.
• If you enroll in the Illinois Comprehensive Health Insurance Plan and are not HIPAA eligible, you will face a pre-existing condition exclusion period.
• If you move away from Illinois, you may not be able to buy individual health insurance in another state unless you are HIPAA eligible.
• If you are a small employer, you might be charged more for health insurance if someone in your group is sick. While there are limits on what you can be charged based on health status, premiums can be significantly higher if someone in your group has a serious health condition. Also, the insurance carrier can turn you down if your small business does not meet the participation or contribution requirements.

Please remember that the above information cannot substitute any legal, accounting or other professional advice.