What Are the Limits on My Protections?

 As important as they are, the federal and state health insurance reforms are limited.  Therefore, you also should understand how the laws do not protect you.

  • If you change jobs, you usually cannot take your old health benefits with you. Except when you exercise your federal COBRA or state continuation rights, you are not entitled to take your actual group health plan with you when you leave a job. 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.
  • If you work for certain non-federal public employers in Illinois, not all of the group health plan protections may apply to you.
  • 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.

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