Implementation of the 2010 Patient Protection and Affordable Care Act is affecting state regulations as the laws come into compliance with new federal requirements. This is especially true of the manner in which pre-existing condition exclusions are handled. Since 2010, children cannot be excluded from health care coverage based on a pre-existing condition and they may remain on their parents’ health policies up to age 26 even if they are not in school or if they have married. The same protection against pre-existing condition exclusions will be extended to adults in 2014.
Immediately in the wake of the passage of the Affordable Care Act states were charged with creating high-risk insurance pools to remain in place until January 1, 2014 at which time health insurance exchanges are to become operational.
General Insurance Regulations
Health insurance requirements in Illinois are based on health status, but non-discrimination laws prevent premium increases for health conditions in group plans. Currently state law also stipulates that if a condition has never been diagnosed or treated before the policy is issued, it cannot be considered pre-existing. If exclusion periods are applied, they cannot last more than 12 months. Policies cannot be cancelled as long as the premiums have been paid.
In Illinois, all children under 1 year of age are eligible for health insurance. Regulations also allow early retirees who are at least 55 to recoup up to 65% of their health insurance costs through the Federal Pension Benefits Guarantee Corporation. Although standardized health plans are not mandated in the state, insurers are required to provide diabetes care and mammograms. There are no limits on premium levels.
Health Insurance Exchanges
Illinois has declared its intent to establish the Illinois Health Benefits Exchange, but the process was stalled at the end of the 2011 legislative session. Debate continued over the form of the exchange, which continues into 2012.
Pre-Existing Condition Insurance
The state’s Pre-Existing Condition Insurance Plan program is administered by the Illinois Departments of Insurance and Public Health and includes coverage for primary and specialty care, hospitalization, and prescription drugs. Premiums range from $76 to $693 for non-smokers, with deductibles of $500 to $5000. Out-of-pocket limits fall between $2,850 and $5000. (All levels are age and option dependent.)
Medicaid
All eligibility for Medicaid and CHIP-funded Medicaid Expansions are determined based on a percentage of the Federal Poverty Level. In Illinois, children under age 5 qualify at 133% FLP with infants under 1year are eligible for CHIP at 200%. Children 6-19 are eligible for Medicaid at 100% and CHIP at 133%.
Pregnant women qualify for Medicaid at 20%, parents at 400%, and non-elderly disabled Social Security recipients at 100%.
Medicare
More than 1,769,000 state residents are enrolled in Medicare with 1,780,700 accessing Medicare prescription drug coverage.