Secure Financial Solutions

Why should I have health insurance in Illinois?

Health care costs have risen much faster than the rate of inflation over the past decade and it seems there is no end in sight. If you do not have health insurance in Illinois, just one visit to a hospital can bring financial ruin to you and your family.

While health insurance costs are also rising, it is important that you have at least some coverage that is affordable so that if a major illness or injury happens, you won't be headed to bankruptcy court!

There are many types of health insurance policies available from different insurers. We are committed to finding the best health insurance policy for you and your family that offers the most coverage for the dollar.

What is the best type of Illinois health insurance to have?

The best health insurance policy to have is the one that you won't be broke by having poor coverage and won't make you poor by paying the premiums every month!

What are the different types of health insurance in Illinois?

The most common type of health insurance is a major medical plan. This type of policy normally covers hospitalization, medications, and often covers routine doctor visits.

The manner in which your benefits are provided are different with each plan as follows:

PPO (Preferred Provider Organization) A group of hospitals and doctors contracted with a network to provide medical services at a negotiated rate. You are generally allowed to go to any hospital or doctor within the network and receive the PPO discounted rate for care.
If you decide to use services outside the network, your out of pocket costs can be much higher due to increased deductibles and co-pays. Most major medical plans in this area are PPO plans.

HMO (Health Maintenance Organization) These are network type of plans similar to PPO's, but the networks are more limited in size and location. You must choose a PCP (primary care physician) from the network who is responsible to manage all of your health care services.

If you need treatment from someone other than your PCP, you are generally required to get a referral for other health care services. HMO coverage is usually the most comprehensive in regards to out of pocket expenses of all plans that use a network, but coverage outside the network can be expensive or non-existent! Premiums can be higher than PPO plans because of extra services covered.

Indemnity plans This type of plan offers the most choices because you are allowed to go to almost any doctor or hospital. You are not required to use network services, such as in PPO's and HMO's. The downside to these plans is that routine doctor visits and preventative care are not usually covered. The premiums, deductibles and co-pays are generally higher on these plans.


Are there any other types of Illinois health plans besides major medical plans?

There are other options available that can provide limited insurance coverage. They are generally used as a supplement to coverage you already have. Some policies cover only hospitalization (in or out patient, depending on the policy) for a certain number of days or only certain surgical expenses.

Hospital indemnity policies would pay you a certain amount each day you were hospitalized. They do not pay for any other expenses. Cancer and other specific illness policies will cover diagnosis and treatment of a certain disease. Some policies cover only medical expenses as the result of an accident.

What is the difference between "Group" and "Individual" Illinois health insurance?

Group health insurance plans are offered by the employer and are available to most full time workers at that particular business.

Individual plans are purchased by persons who may want or need an alternative to what is offered at work, and want to control the benefits and cost for their personal and family needs.

Individual and group health insurance - Advantages and Disadvantages

INDIVIDUAL ILLINOIS HEALTH INSURANCE:

Advantages:- You get to choose the health insurance company and type of policy that suits your needs! The policy options are decided by you instead of your employer, and you don't pay for additional benefits that may not be necessary for your situation.

Your coverage is "portable", so even if you are no longer working for that particular employer, you can keep your health insurance coverage in force!

The premiums are based on your health history (also, your spouse and family if coverage is purchased for them), so you are not paying extra premiums based on the age and health of persons in an employer group. Premiums can sometimes be less than group health insurance for this reason.

Disadvantages:- With individual health insurance, you are responsible for the entire premium. There is no subsidy from your employer. Pre-existing health conditions are generally subject to a 12 month waiting period.

If you have major health issues, premiums may be charged at a higher rate than normal, certain illnesses may be not be covered for a certain or indefinite period of time (known as a waiver), or you may be declined coverage under an individual health insurance plan.

(If you cannot obtain coverage, however, because of health issues, you may be eligible for a state funded health insurance plan, such as ICHIP www.chip.state.il.us )

ILLINOIS GROUP HEALTH INSURANCE:

Advantages:- Your employer pays for a portion or sometimes (very rarely!) the entire health insurance premium. Some employers even pay for your spouse, partner, and dependents.

For persons with major health issues, a group health insurance plan may be their only option for affordable coverage, because they are not eligible for individual health insurance.

Disadvantages:- Many self-employed people cannot qualify for group health insurance if they do not have a spouse that has group coverage where they work.

Even if your spouse or partner has coverage, many group health plans do not pay for any portion of the health insurance premiums for spouses, partners or dependents.

With the cost of group health insurance plans increasing dramatically (especially in the last few years!), many companies have passed more of the cost onto their workers or even dropped health insurance coverage altogether! Remember, the employer can change coverage and benefits at any time.

What are other options if I lose my job and need Illinois health insurance?

COBRA Continuation Coverage

If you purchase insurance coverage through your employer and your employer has 20 or more employees, you are entitled to continuation coverage by the federal Consolidated Omnibus Budget Reconciliation Act (COBRA). Your state may require continuation coverage to be offered by smaller employers - typically those with less than 20 employees.

Under COBRA, if you leave your current job you have the option to continue your health care coverage for up to 18 months. You are required to pay the full premium yourself, even if your employer paid part of your premium while you were employed, and the employer may charge an additional, limited administrative fee.

To be eligible for COBRA coverage you must meet the following requirements:

You must have had 18 months of continuous creditable coverage; with at least the last day having been under a group health policy (coverage is considered continuous if it is not interrupted by a break of 63 or more consecutive days).

You must not be eligible for Medicare, Medicaid or a group health policy or have other major medical health insurance.

You must apply for health insurance for which you are deemed an eligible individual within 63 days of losing your prior coverage.

For more information on COBRA, please go to the federal Department of Labor Employee Benefits Security Administration website at: www.dol.gov/ebsa

Important tips when buying health insurance in Illinois!

1. Make certain you purchase real insurance, NOT a discount plan!

You may see advertising that offers health discounts for a low monthly fee. These plans are NOT health insurance and are sold to unsuspecting persons who do not realize what they have bought until they find out they have no real coverage. Avoid at all costs!

2. Avoid most limited benefit plans.

These plans are usually sold by an agent that only represents one specific company as a cheap alternative to major medical plans. Beware, in most cases you can be exposed to significantly large out pocket expenses. (sometimes in the hundreds of thousands of dollars!), because the benefits are limited to a certain amount for specific illnesses or calendar year.

3. Watch for "association plans".

They are sold to persons on the basis that you are part of a "group" that can negotiate lower premiums. Their so called group of "self-employed" is little more than a way for a poorly rated company to sell insurance.

Some association plans are set up this way to avoid insurance regulation in your state.

These plans are NOT group insurance and do not have the same rights and protections of group policies, such as premium rates and mandated coverage for specific conditions.

Some of these plans are limited benefit plans sold by unscrupulous agents with little knowledge and are represented as major medical plans. Get information on the specific health insurance plan and not just the association.

4. Remember the warning signs of fraud:

Agents who use high pressure or will not let you compare plans from other companies.

Agents who tell you this is a "special offer" or "discount rate" unless you sign up today.

When you see the words "health plan "without the word "insurance" anywhere in the literature.

Agents who tell you that the plan is guaranteed issue to everyone regardless of health. This usually means the plan has very limited benefits.

If you feel that you need to file a complaint against the insurance company or agent, please go to www.idfpr.com/DOI/Main/consumer.asp for more information.

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