Illinois has a high-risk pool program, called Illinois Comprehensive Health Insurance Plan (CHIP) that offers insurance for people with health conditions who are unable to buy private health insurance coverage and for people who are HIPAA eligible. CHIP is also considered a qualified health plan for individuals eligible for the health coverage tax credit (HCTC). (see Financial Assistance)

When can I get a policy from CHIP?

· If you are HIPAA eligible, you can buy health insurance from CHIP. This coverage is called HIPAA-CHIP.

· If you are eligible for the Health Coverage Tax Credit (HCTC), you can buy insurance from CHIP. This is called TAA/PBGC CHIP.

· If you are not HIPAA eligible, you can buy coverage from CHIP if you are a resident of Illinois for at least 6 months and can demonstrate proof of eligibility. This is called Traditional CHIP. There are several different ways to show eligibility:

o You have been turned down for substantially similar individual health insurance coverage by at least one insurance company because of a pre-existing health condition;

o You have a substantially similar individual health insurance policy that is more expensive than the rate you would pay for CHIP coverage;

o You have one of 31 medical conditions, such as AIDS, Cystic Fibrosis or Parkinson’s disease, for which CHIP provides automatic eligibility.

You only need to show that you are eligible in one of these ways in order to apply for a CHIP policy.

· CHIP limits the number of people who can enroll in Traditional CHIP. This limit is based on the availability of state finances used to subsidize this state program. If the limit has been reached when you apply, you may not be able to enroll at that time but your name will be placed on a waiting list. In addition, as enrollment opportunities become available, applicants will be contacted in the order in which their names appear on the waiting list. The enrollment limit does not apply to HIPAA-CHIP or TAA/PBGC CHIP. If you are HIPAA eligible or HCTC eligible, you can always enroll in CHIP.

As of July 1, 2009, enrollment into Traditional CHIP has been closed. A waiting list is kept for applicants who wish to be considered at a later date.

· CHIP does offer optional family coverage. However, each member of your family who wants to enroll in CHIP will have to qualify on his or her own.

What does a CHIP policy cover?

· CHIP offers coverage through a Preferred Provider Organization (PPO) plan. The PPO has a network of doctors and hospitals in your area. Coverage includes hospital and physician care, diagnostic tests and x-rays, prescription drugs and other services.

· Both those eligible for HIPPA-CHIP and Traditional-CHIP receive basically the same benefit options. However, HIPAA-CHIP participants are not subject to a pre-existing condition limitation.

· CHIP offers you the choice of eight plans, each with a different deductible. The annual deductible options are $500, $1,000, $1,500, $2,500 and $5,000, and qualified Health Savings Account deductible health plans with $1,200, $2,000 and $5,200 deductible options. In addition, you will be responsible for a coinsurance charge each time you receive care.

Once you have met your deductible, you will be charged 20% coinsurance for care from a PPO provider and 40% coinsurance for care from a non-PPO provider. After you pay a maximum amount for covered services (also called out-of-pocket limit) CHIP will pay 100% of the cost of your covered care.

CHIP’s out-of pocket limit is different depending on if the care you receive is in-network or out-of-network. For in-network care, the limit is $1,500 above your deductible. The limit is $4,500 above your deductible for out-of-network care.

· CHIP does not provide routine maternity benefits. However, at the time of enrollment or marriage, participants may purchase a maternity indemnity rider in $500 increments that will cover limited maternity benefits. The maximum number of increments available is based on your geographical area, but in no case can you buy more than 8 increments.

No maternity benefits are available for the three Health Savings Account qualified health plans and a maternity rider is not available for purchase.

· CHIP also offers a separate benefit plan policy for those eligible persons who are enrolled in both Parts A and B of Medicare due to disability or end-stage renal disease. This plan is secondary to Medicare and the benefits provided by CHIP are reduced by any amounts that are payable under Medicare Parts A and B.

As of July 1, 2009, enrollment into Medicare CHIP has been closed. A waiting list is kept for applicants who wish to be considered at a later date.

What about coverage for a pre-existing condition?

· If you are HIPAA eligible or eligible for the Health Coverage Tax Credit (HCTC), you will not have a pre-existing condition exclusion when you enroll in CHIP. Elimination riders are not permitted on CHIP plans.

· If you are not HIPAA eligible, you will have a 6-month pre-existing condition exclusion period when you first enroll in CHIP. When you enroll, CHIP will look back 6 months to see if you had a condition for which you actually received medical advice, diagnosis, care or treatment.

CHIP will not credit your prior coverage against this pre-existing exclusion period.

· Pregnancy is not considered a pre-existing condition, but CHIP does not provide any routine maternity benefits. However, an optional, limited, maternity rider is available at the time you initially enroll in CHIP or in the case that you are a participant, within 60 days of marriage (see above).

What can I be charged for a CHIP policy?

· Premiums will vary based on the plan you choose. In addition, CHIP charges enrollees different rates based on their age, gender and geographical area.

For example, as of June 2009, the monthly premium for a 24-year-old single man living in Chicago with Traditional CHIP coverage ranges from $247 to $360, depending on the deductible he chooses. By contrast, the monthly premium for a 64-year-old single man living in Chicago with Traditional CHIP coverage ranges from $1,041 to $1,466.

· Premiums are slightly lower for HIPAA-CHIP participants versus those eligible for Traditional CHIP and TAA/PBGC CHIP.

· CHIP premium rate tables are usually updated twice per year on February 1 and August 1 and are subject to changes without notice.

For further information about CHIP rates, visit the CHIP website at http://www.chip.state.il.us or call (800) 962-8384.

How long does CHIP coverage last?

· CHIP policies are renewable as long as you pay your premiums, continue to reside in Illinois, and meet other eligibility requirements.