WHEN DO INDIVIDUAL HEALTH INSURERS HAVE TO SELL ME A policy? 

In Illinois, your ability to buy an individual health insurance policy from a private insurance company depends on your health status. 

• In general, companies that sell individual health insurance in Illinois are free to turn you down because of your health status and other factors. When applying for an individual health insurance policy, you may be asked questions about health conditions you have now or have had in the past. Depending on your health status, insurers might refuse to sell you coverage or offer to sell you a policy that has special limitations on what it covers. If you are turned down or offered a policy with reductions or restrictions, you may be eligible for CHIP coverage (see page 14).
• Under Illinois law, newborns are automatically covered under the parents’ individual health insurance policy for the first 31 days, if the policy covers dependents. The insurer may require that the parent enroll the child within the 31 days in order to continue coverage beyond the 31 days.
• If you have a dependent, disabled child, that child may remain covered under your individual health insurance policy after he or she reaches the age at which dependent coverage is usually terminated. As long as the person remains dependent because of a handicapped condition and cannot sustain employment, the individual can remain on your policy, provided that it remains in force.

WHAT WILL MY INDIVIDUAL HEALTH insurance policy COVER?

• It depends on what you buy. Illinois does not require health insurers in the individual market to sell standardized policies. Insurers can design different policies and you will have to read and compare them carefully. However, Illinois does require all policies to cover certain benefits - for example, diabetes care and mammography screening. Check with the Illinois Department of Insurance for more information about mandated benefits.

WHAT ABOUT COVERAGE FOR MY PRE-EXISTING CONDITION?

• There are different ways that individual health insurers can exclude a pre-existing condition.

The insurer can impose an elimination rider, which is an amendment to your health insurance policy that permanently excludes coverage for a health condition, body part, or body system. Also, an insurer can impose an exclusion period for up to 24 months on any pre-existing condition.

In addition, if you make a claim during the first 2 years of coverage, your insurer can look back as far as 24 months from the time of your application to see if the condition was pre-existing.  If it finds such evidence, it can refuse to pay the claim. 

• Pregnancy can be considered a pre-existing condition by individual health insurers. However, genetic information, provided that it is not favorable and provided voluntarily by the individual, cannot be used as the basis of a pre-existing condition.
• Unlike group health plans, individual health insurers do not have to give you credit for prior coverage.

WHAT CAN I BE CHARGED FOR My INDIVIDUAL HEALTH Insurance Policy?

• Generally, in Illinois, there are no limits on how much individual premiums can vary due to age, gender, health status, family size, and other factors.

CAN MY INDIVIDUAL HEALTH INSURANCE POLICY BE CANCELED?

• Your coverage cannot be canceled because you get sick. This is called guaranteed renewability. You have this protection provided that you pay the premiums, do not defraud the company, and, in the case of managed care plans, continue to live in the plan service area. However, guaranteed renewability does not protect you from having your premiums go up at renewal, and premiums can also increase within limits as you age or your health declines.
• Some individual insurers sell temporary health insurance policies. Temporary policies are not guaranteed renewable. They will only cover you for a limited time, such as 6 months. If you want to renew coverage under a temporary policy after it expires, you will have to reapply and there is no guarantee that coverage will be re-issued at all or at the same price.