Illinois Health Care Insurance Polcies and Pre-Existing Conditions
How does an Illinois resident with a preexisting medical condition find a quality Illinois medical insurance plan? Why does it seem like it’s so difficult to find a preexisting condition Illinois medical insurance plan?
Preexisting medical 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 corporations are using these questionnaires as well as an exclusion period in order to defend themselves from individuals with preexisting medical conditions that are seeking medical insurance.
In the state of Illinois individuals that are signing up for an individual medical insurance plan can be turned down at the insurance company’s discretion due to preexisting medical conditions unless that person is eligible for an Illinois HIPAA medical insurance plan.
In the state of Illinois they follow HIPAA laws very strict. The Health Care Insurance Portability and Accountability Act created in 1996 and effective in 1997 provides protection for individuals that have medical pre-existing illnesses. The law protects individuals by limiting their exclusion period when getting medical insurance, lowering the chances for a member with a preexisting condition to lose coverage, providing protections when they change jobs and guaranteeing that your medical insurance policy gets renewed at the end of your coverage year.
The law however, has not eliminated the ability of individual carriers of denying medical insurance to preexisting condition individuals 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 medical insurance coverage for individuals that meet 6 HIPAA requirements. When someone meets these 6 requirements they are considered “HIPAA eligible” and can qualify for a guaranteed issue HIPAA medical insurance plan. The 6 requirements for HIPAA eligibility can often be the only avenue of medical insurance coverage available to some high risk individuals with major preexisting medical conditions.
Some of the most important insurance carriers in the state of Illinois handle preexisting medical conditions a little bit differently, because of this it’s 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 Care Insurance who is one of the “big dogs” in the medical insurance companyacross 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 preexisting condition isn’t covered. It’s important to note however, that if the person that has a preexisting condition has had prior creditable coverage within 63 days immediately before the signature of the enrollment form; then the exclusion period will be waived.
Another example of this can be seen with BC/BS of Illinois, who is one of the 39 independent, community-based insurance carriers that make up the national BC/BS network. Since they are independent that means they may not have the same provisions as BC/BS corporations in other states. In Illinois, BCBS requires a member with a preexisting 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 can’t turn you down due to a pre-existing condition, which makes group plans more expensive. Under HIPAA law an employer can only deny preexisting condition coverage if the person is diagnosed, receives treatment or has care and treatment 6 months before the enrollment date. A high quality thing to note is that pregnancy can’t be accounted as a preexisting condition by an employer insurer.
The total time a person can be excluded from a group medical plan if they have a preexisting condition is 12 months after enrollment (18 months if they enroll late), for this reason it’s important for a person to sign up for medical insurance as soon as they are offered it (if not you can be subject to 18 months instead of 12). Thankfully 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 can’t deny coverage to a small employer (2-50) under HIPAA law.
Locating Illinois medical insurance coverage when one has a preexisting condition can be very tough. Not to mention that preexisting medical conditions cover everything from cancer, HIV, Hepatitis C and even high cholesterol. It’s key however, for a person that has a preexisting condition to know all the exclusions and their rights that are provided under the HIPAA law. That’s important because once you know your rights, you will be able to be more knowledgeable about the subject and avoid long exclusion periods.
You’ll only find good medical insurance that covers preexisting medical conditions if you shop around. Do not forget that not all insurance carriers have the same approval criteria so it’s important to shop around and speak with a licensed Illinois medical insurance agent if you’ve preexisting medical conditions and need assistance finding medical insurance coverage. Be sure and do your research to learn more about Illinois HIPAA medical insurance and about medical insurance for pre-existing conditions.
