Health insurance laws in Illinois dictate eligibility, premiums and coverage for state residents who purchase insurance plans either individually or through their employer or union. Some of the laws favor the patient, allowing her certain rights in their health care coverage. Other laws give the insurance companies the right to exclude certain patients from coverage. The laws are subject to change under the 2010 Patient Protection and Affordable Care Act signed by President Barack Obama.
Eligibility
Under the current law as of 2010, private health insurance companies can determine their own rules for which applicants can purchase individual health policies either privately or through their employer. Insurance companies can reject applicants for any reason. Exceptions include newborns, who are guaranteed coverage under their parents' policy for the first 30 days after birth. Disabled, dependent children also are guaranteed coverage if their parents have a policy that provides for coverage of dependents.
Benefits
There is no law that requires standardized health plans in Illinois. However, insurers must cover certain medical procedures. Diabetes care and mammogram screenings are examples, as is continuous prenatal care for pregnant women. Insurers also must apply the same coverage limits and maximums to mental health conditions as they do to physical conditions.
Pre-existing Conditions
Insurers can review an applicant's medical history for the previous 24 months to uncover any pre-existing conditions that might affect the applicant's coverage. If insurers find a condition they can refuse to cover that condition for the first two years of the policy. Alternatively, if they choose, they can add the condition to the policy's "elimination rider." An elimination rider is an amendment to the insurance contract that means the insurer will never be liable for covering the condition. Pregnancy is among the pre-existing conditions that insurers will consider.
Premiums
Private health insurers in Illinois can set rates of their own choosing, with no state-imposed limits. The idea is for market competition to keep premiums down. The applicant's age, health and the type of plan he desires are factors in determining individual premium rates.
5. Renewal
When individuals seek to renew their insurance policy, the insurer has the right to raise their premiums for any reason. However, the insurer cannot cancel a policy in the event of illness at the time of renewal.
Unemployment Protection
Two federal laws--the Health Insurance Portability and Accountability Act and the Consolidated Omnibus Budget Reconciliation Act--allow individuals to retain their health insurance policy if they change jobs, lose their job or lose their coverage for other reasons (excluding fraud or nonpayment of premiums). Illinois residents have full access to coverage under these laws.
New Law
The federal insurance law that passed through Congress in March 2010 will have implications for all states, including Illinois. Most of the changes will go into effect between 2010 and 2014. The law requires all citizens to purchase insurance, either individually or through an employer, or pay a penalty. It also requires insurers to guarantee coverage and renewals regardless of pre-existing conditions. An individual's premiums would be affected only by the following factors: age, number of family members in the policy, tobacco use and location. Rates for tobacco users can exceed rates for non-tobacco users by no more than 50 percent.
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