Illinois Covered Plan Details

Governor Rod R. Blagojevich announced "Illinois Covered," his historic and comprehensive plan to give every Illinoisan access to affordable and quality health coverage.

Plan Components Being Implemented:

• Expanding Existing Programs
• Illinois Covered Assist
• Illinois Covered Rebate

Plan Components Still Being Pursued:

• Illinois Covered Choice
• Expanding Dependent Coverage
• Roadmap to Health
• Insurance Reforms
• Employer Assessment
• Illinois Covered Trust Fund

Plan Components Being Implemented:

Expanding Existing Programs: FamilyCare, HBWD, All Kids Bridge, Illinois Breast and Cervical Cancer Program:

	To provide access to affordable, comprehensive coverage for more Illinoisans, the FamilyCare program - now serving families up to 185% FPL - will be expanded to include families up to 400% FPL.
	The Health Benefits for Workers with Disabilities program, which allows disabled Illinoisans to go back to work without losing their health benefits, will be expanded from 200% to 350% FPL.
	Expansion Of Coverage For Young Illinoisans: Coverage for sick or injured kids 19-21 who are too old for All Kids The Governor has directed the Director of the Department of Insurance, who is the Chairman of the Board of Directors for the Comprehensive Health Insurance Program (CHIP), to develop a bridge for children with pre-existing conditions who become too old for All Kids and have no access to insurance. These young adults, who suffer from cancer, diabetes, and other pre-existing conditions, will be able to continue coverage until the age of 21 at the same cost they paid for All Kids.
	Breast And Cervical Cancer Screening And Treatment: Screening and treatment for all uninsured Illinoisans On October 1, the Illinois Breast and Cervical Cancer Program expanded to provide free mammograms, breast exams, pelvic exams and Pap tests for all uninsured women in Illinois. If diagnosed with breast or cervical cancer upon screening, program participants will have access to coverage for treatment. The program previously served only low- income women. Find out more at cancerscreening.illinois.gov

Illinois Covered Assist:

Access to care for low-income, uninsured adults

• A new State program focused on primary care and disease management for those who are very low-income—under 100% of the federal poverty level (FPL) (currently a single person who makes less than $10,210 annually, or a couple making less than $13,690 annually)—and who do not have health insurance or access to current Medicaid programs.
  
  
• Assist will provide access to a medical home through a community health center, a prescription drug benefit, and reimburse hospitals for non-elective in-patient services for Assist beneficiaries.

Illinois Covered Rebate:

Helping working families pay their health insurance premiums

• Middle class families and individuals with employer-provided insurance outside the Choice program will be eligible for help paying their health insurance premiums – 20% of their premium (up to $1,000 per year).

• Illinoisans who choose Illinois Covered Choice (through an employer or on their own) will be eligible for Covered Rebate if their income is below 300% FPL. 

Plan Components Still Being Pursued:

While Governor Blagojevich is using his executive authority to expand healthcare to over 500,000 more Illinoisans, more work needs to be done. Governor Blagojevich will continue to push to provide access to affordable, quality healthcare for ALL Illinoisans.

Illinois Covered Choice:

Guaranteed, affordable private insurance plans for small businesses and individuals

• Small businesses and individuals will be able to buy into guaranteed, affordable private plans regardless of health status or income level.
  
  
• The State will provide reinsurance for this private insurance policy, which will thereby make Choice premiums more affordable and stable.

  Employers with up to 25 employees can buy the Illinois Covered Choice group policy if they contribute toward the premium. Their employees with incomes below 300% FPL ($60,000 for a family of four) will be eligible for premium assistance through Illinois Covered Rebate, making Choice even more affordable.

  Individuals can purchase Illinois Covered Choice at affordable rates. Individuals with incomes below 300% FPL will be eligible for premium assistance through Illinois Covered Rebate. 

Expanding Dependent Coverage:

For all health insurance policies that include an offer of dependent coverage, insurers must now offer parents the opportunity to extend coverage of their own policy to their dependent children through the age of 29.

Roadmap to Health:

The State will work with consumers and Illinois healthcare providers to improve the overall healthcare system. A statewide consensus plan will be developed for promoting wellness and managing chronic conditions. The State will build upon recent efforts to improve patient safety, promote electronic medical records, improve access to information on quality of care and reduce administrative costs. The entire statewide healthcare economy will benefit from these improvements. Since 70% of overall healthcare costs are for chronic diseases, this component is essential for bringing down overall healthcare costs for businesses and consumers alike.

Insurance Reforms:

• Healthcare Transparency and Consumer Protection. Insurance companies will now be required to provide more detailed information to the State in order to make them more accountable to consumers. Insurance companies also will be prohibited from raising premiums on individuals just because they get sick. 
  
  
• The Office Of Patient Protection. To aid consumers overwhelmed by the challenges of health insurance – from interpreting a policy to fighting a claim denial – the Division Of Insurance will consolidate several regulatory functions into the consumer-friendly Office Of Patient Protection.
  
  
• Group Plan Non-Discrimination. To require fairness in group health insurance policies, employers will now be required to pay the same or higher percentage of premium to workers of all income levels.
  
  
• Improved Health Insurance Applications. Insurers may deny health insurance claims based on the purported inadequacy of information contained in the insured’s application. With the new application form law, insurers must ask questions that elicit meaningful and detailed responses.
  
  
• Right to Independent, External Review Of Denied Claim. In Illinois, only HMO members are entitled by law to an external review of a denied claim by independent medical professionals. With SB5, policyholders of all health insurers will have the right to an independent external review upon denial of a claim.
  

Employer Assessment:

The Illinois Covered program is funded through a 3% payroll assessment only on employers with 10 or more employees that are not already spending at least 4% of payroll on health care for their employees. The assessment is calculated based on full-time equivalent employees, and excludes employees who have insurance through a spouse or dependent. If an employer has part-time employees, the employer will add up all the hours worked by employees and divide by 1,500 to get the full-time equivalent.

Illinois Covered Trust Fund:

Funds from the Employer Assessment will be deposited into the Illinois Covered Trust Fund. These funds will be the sole source of funding for the Illinois Covered programs which cannot, by law, exceed the value of the Trust Fund. A Trust Fund Accountability Panel will have oversight over the Fund.