Illinois Health Insurance Plans and Pre-Existing Conditions

How does an Illinois resident with a pre-existing health condition find a quality Illinois health insurance plan? Why does it seem like it is so difficult to find a pre-existing condition Illinois health insurance plan?

Pre-existing conditions are defined as illnesses in which the person has gone to a physician, clinic, or medical facility and has received medical care in the past. Insurance companies are using these questionnaires as well as an exclusion period in order to defend themselves from people with pre-existing conditions that are seeking medical insurance.

In the state of Illinois people that are applying for an individual health insurance plan can be turned down at the insurance company’s discretion due to pre-existing conditions unless that person is eligible for an Illinois HIPAA health insurance plan.

In the state of Illinois they follow HIPAA laws very strict. The Health Insurance Portability and Accountability Act created in 1996 and effective in 1997 provides protection for people that have medical pre-existing illnesses. The law protects people by limiting their exclusion period when purchasing health insurance, lowering the chances for a member with a pre-existing condition to lose coverage, providing protections when they change jobs and guaranteeing that your health insurance policy gets renewed at the end of your coverage year.

The law however, has not eliminated the ability of individual carriers of denying health insurance to pre-existing condition people or exclude medical conditions. The only guarantee issue provisions lie in State sponsored plans and insurance company funded plans. What HIPAA does provide is for guaranteed acceptance health insurance coverage for people that meet 6 HIPAA requirements. When someone meets these 6 requirements they are considered “HIPAA eligible” and can qualify for a guaranteed issue HIPAA health insurance plan. The 6 requirements for HIPAA eligibility can often be the only avenue of health insurance coverage available to some high risk individuals with major pre-existing health conditions.

Some of the most important insurance companies in the state of Illinois handle pre-existing conditions a little bit differently, because of this it is important to do some research and actually shop around for a policy before deciding to apply. Individual plans have more exclusion that group plans and that is why they are quite a bit less expensive, because they are more restrictive.

Aetna Health Insurance who is one of the “big dogs” in the health insurance business across the United States is a primary example of exclusion period. They offer a 365 day period starting from the day of enrollment, in which a person with a pre-existing condition is not covered. It is important to note however, that if the person that has a pre-existing condition has had prior creditable coverage within 63 days immediately before the signature of the application; then the exclusion period will be waived.

Another example of this can be seen with Blue Cross and Blue Shield of Illinois, who is one of the 39 independent, community-based insurance companies that make up the national Blue Cross Blue Shield network. Since they are independent that means they might not have the same provisions as Blue Cross Blue Shield companies in other states. In Illinois, BCBS requires a member with a pre-existing condition to wait a 365 day exclusion period from the day that they sign the policy before receiving coverage for their illness.

Compared to individual coverage, group plans are a little better. They cannot turn you down due to a pre-existing condition, which makes group plans more expensive. Under HIPAA law an employer can only deny pre-existing condition coverage if the person is diagnosed, receives treatment or has care and treatment 6 months before the enrollment date. A good thing to note is that pregnancy cannot be accounted as a pre-existing condition by an employer insurer.

The total time a person can be excluded from a group health plan if they have a pre-existing condition is 12 months after enrollment (18 months if they enroll late), for this reason it is important for a person to sign up for health insurance as soon as they are offered it (if not you can be subject to 18 months instead of 12). Fortunately for some, the time can be less in case that they were covered by an insurance company for the 63 days before enrollment. Also, an insurer cannot deny coverage to a small employer (2-50) under HIPAA law.

Finding Illinois health insurance coverage when one has a pre-existing condition can be very tough. Not to mention that pre-existing conditions cover everything from cancer, HIV, Hepatitis C and even high cholesterol. It is key however, for a person that has a pre-existing condition to know all the exclusions and their rights that are provided under the HIPAA law. This is important because once you know your rights, you will be able to be more knowledgeable about the subject and avoid long exclusion periods.

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