If you do not have access to employer-sponsored group health plan, you may want to buy an individual health insurance policy from a private insurer or you may be eligible for coverage under a program offered by the State of Illinois, the Comprehensive Health Insurance Plan (CHIP). However, in Illinois – as in most other states – you have limited guaranteed access to individual health insurance in the private market.

When do individual health insurers have to sell me a policy?
In Illinois, your ability to buy an individual health insurance policy from a private insurance company depends on your health status.

• In general, companies that sell individual health insurance in Illinois are free to turn you down because of your health status and other factors. When applying for an individual health insurance policy, you may be asked questions about health conditions you have now or have had in the past. Depending on your health status, insurers might refuse to sell you coverage or offer to sell you a policy that has special limitations on what it covers. If you are turned down or offered a policy with reductions or restrictions, you may be eligible for CHIP coverage.
• Under Illinois law, newborns are automatically covered under the parents’ individual health insurance policy for the first 31 days, if the policy covers dependents. The insurer may require that the parent enroll the child within the 31 days in order to continue coverage beyond the 31 days.
• If you have a dependent, disabled child, that child may remain covered under your individual health insurance policy after he or she reaches the age at which dependent coverage is usually terminated. As long as the person remains dependent because of a handicapped condition and cannot sustain employment, the individual can remain on your policy, provided that it remains in force.

What will my individual health insurance policy cover?
It depends on what you buy. Illinois does not require health insurers in the individual market to sell standardized policies. Insurers can design different policies and you will have to read and compare them carefully. However, Illinois does require all policies to cover certain benefits – for example, diabetes care and mammography screening.

What about coverage for pre-existing condition?

There are different ways that individual health insurers can exclude a pre-existing condition.

The insurer can impose an elimination rider, which is an amendment to your health insurance policy that permanently excludes coverage for a health condition, body part, or body system. Also, an insurer can impose an exclusion period for up to 24 months on any pre-existing condition.
In addition, if you make a claim during the first 2 years of coverage, your insurer can look back as far as 24 months from the time of your application to see if the condition was pre-existing. If it finds such evidence, it can refuse to pay the claim.

• Pregnancy can be considered a pre-existing condition by individual health insurers. However, genetic information, provided that it is not favorable and provided voluntarily by the individual, cannot be used as the basis of a pre-existing condition.
• Unlike group health plans, individual health insurers do not have to give you credit for prior coverage.

What can I be charged for my individual health insurance policy?
Generally, in Illinois, there are no limits on how much individual premiums can vary due to age, gender, health status, family size, and other factors.

Can my individual health insurance policy be canceled?

• Your coverage cannot be canceled because you get sick. This is called guaranteed renewability. You have this protection provided that you pay the premiums, do not defraud the company, and, in the case of managed care plans, continue to live in the plan service area. However, guaranteed renewability does not protect you from having your premiums go up at renewal, and premiums can also increase within limits as you age or your health declines.
• Some individual insurers sell temporary health insurance policies. Temporary policies are not guaranteed renewable. They will only cover you for a limited time, such as 6 months. If you want to renew coverage under a temporary policy after it expires, you will have to reapply and there is no guarantee that coverage will be reissued at all or at the same price.

Financial assistance
Help is available to certain low-income residents of Illinois who cannot afford to buy health insurance. Medicaid, the Illinois Breast and Cervical Cancer Program (IBCCP), and KidCare offer free or subsidized health insurance coverage, direct medical services or other help at little or no cost to you.

If you are interested in the following programs, you should contact a state organization directly, for no insurance agency can represent the state in this matter.

Medicaid
Medicaid is a program that provides health coverage to some low-income Illinois residents. Medicaid (also called medical assistance) covers families with children and pregnant women, medically needy individuals, the elderly, people with disabilities, and persons with breast or cervical cancer, if state and federal guidelines are met. For certain categories of people, eligibility for Medicaid is based on the amount of your household income.

Illinois Breast and Cervical Cancer Program (IBCCP)
The Illinois Breast and Cervical Cancer Program (IBCCP) provides a qualified woman with full health care benefits through Medicaid at no cost or for a nominal copayment. Women screened through this program and diagnosed with breast or cervical cancer may be eligible for free health coverage through Medicaid which extends throughout the duration of treatment. In addition, Medicaid will cover all of your medical needs including treatment for non-cancer related medical services.
In order to be eligible for screening through the IBCCP, you must live in Illinois. In addition, to qualify for mammograms you must be between the ages of 40 and 64 and to qualify for pelvic exams and pap tests you must be between 35 and 64. You may not have other health insurance and your income must be under 200% of thefederal poverty level. If you are Medicaid-eligible, you are not eligible for IBCCP.

Illinois AllKids Program
The Illinois All Kids Program is a program that provides health insurance coverage to all children under the age of 18 in Illinois. KidCare program and Medicaid are now part of All Kids. KidCare Program is a program that provides health insurance coverage to low income children and pregnant woman.