Risk Pool Information

Posted by Lloyd on June 11, 2012
Health

The General Assembly of the State of Illinois created the Illinois Comprehensive Health Insurance Plan (ICHIP) to provide access to health insurance coverage to all residents of Illinois who are denied adequate health insurance, because of their health, by any insurer.
For the traditional risk pool for state eligible persons (Section 7), the State of Illinois funds any deficit incurred under plans 1-3 by an appropriation made by the General Assembly. As such, Illinois was the first state to directly pay the costs of the pool without assessing health insurers doing business in that state.

The state originally placed a cap of 4,000 on the number of participants who were allowed to be enrolled in the traditional risk pool at any time. This cap has been raised four times to 5,250, and as a result no waiting list currently exists. Since its inception in May 1989, more than 14,000 participants have been covered by this state-funded plan.

Effective July 1, 1997, ICHIP also began serving as an acceptable alternative mechanism for providing portable and accessible individual health insurance coverage for federally eligible individuals who qualify for coverage under plans 4 or 5 in accordance with a new Section 15 of the CHIP Act. Any deficits incurred or expected to be incurred under plans 4 and 5 for these federally eligible individuals are funded by assessment of all health insurers doing business in Illinois pursuant to Public Act 90-30. Since July 1, 1997, more than 1,200 eligible individuals have been covered by these industry-funded plans.

Blue Cross and Blue Shield of Illinois serves as the Illinois plan administrator.

Requirements
For the traditional risk pool (plans 1-3) the participant must:

be a citizen or permanent resident alien
be a resident of the state for at least 180 days
have received a rejection or refusal to issue the insurance for health reasons by one insurer
have received a refusal to issue the insurance except at a rate exceeding the plan rate.

Coverage is also available to those with medical proof from their doctors of having any of the conditions from a list promulgated by the board.

For the HIPAA (Federally Eligible Individuals) Pool (Plans 4-5) the participant must:

be a U.S. citizen or permanent resident alien and be a resident of the state;
have at least 18 months of prior qualified credible coverage;
have had his or her most recent prior credible coverage under group health insurance coverage offered by a health insurance issuer, a group health plan, a governmental plan, or a church plan;
not have had a break of more than 62 days between periods of prior credible coverage.

Not be eligible for coverage under a group health plan, part A or part B or Medicare, or medical assistance, and not have any other health insurance coverage;

Not have had his or her most recent coverage terminated due to nonpayment of premium or fraud;
Have elected and exhausted COBRA or other continuation coverage, if offered;
Have completed, signed and submitted s Section 15 Eligibility and Enrollment Form that is received by the CHIP Board Office no later than 63 days after the date his or her last group insurance ended

There is no waiting period for pre-existing conditions for federally eligible individuals who qualify and enroll in plans 4 or 5.

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