Illinois may be one of the first states to start providing health insurance in a new high-risk pool funded under national health overhaul, but enrollment will be limited, eligibility requirements tight and coverage may not begin until late summer.
Illinois Department of Insurance Director Michael McRaith said the state will manage the program carefully to make sure there’s enough money to keep everyone who enrolls covered until Jan. 1, 2014, when the new health law will prohibit insurers from denying coverage to people with pre-existing conditions.
Illinois expects to receive nearly $200 million from the federal government to start covering people with medical problems who’ve been uninsured for at least six months. The state estimates that 4,000 to 6,000 people will be covered in the new program. Many more are expected to apply for coverage.
“It’s important to temper the expectations,” McRaith said. “This is a transitional program with a finite set of dollars for the state of Illinois … As a result we anticipate more applicants than the funds will allow us to enroll.”
No one can apply yet.
Before the program can start, federal health officials must approve the state’s plan. Then Illinois will seek bids from third-party contractors to manage the medical plan and pharmacy benefits program.
“We’re hoping to begin enrollment in the later days of summer,” McRaith said.
The state’s submission to the U.S. Department of Health and Human Services gives clues to what the program will look like.
It will be called the Temporary High Risk Pool, separate from but similar to the state’s existing high-risk pool, called the Illinois Comprehensive Health Insurance Plan, ICHIP.
Applicants for the new pool would have to have one of 31 listed medical conditions, which include leukemia, Parkinson’s disease, AIDS, juvenile diabetes and chemical dependency.
People who’ve been rejected for health coverage for “unlisted” reasons may qualify, McRaith said, but he cautions that eligibility is likely to be tight because of limited federal funding.
Only legal residents would be eligible and enrollees would have to show a birth certificate, green card or other proof they are in the United States legally.
Under the federal law, they must have been uninsured for six months.
McRaith said applicants must answer in writing whether they have ever had health insurance and, if so, when it ended. If it ended within the preceding 12 months, applicants will be asked to document when coverage ended.
Trained staff will review applications and check to see if applicants can get coverage instead through an employer, Medicaid or Medicare, McRaith said.
Illinois is proposing a plan with a $2,000 annual deductible and 80 percent-20 percent coinsurance.
Enrollees would have one plan option, a preferred provider plan. If an enrollee used a doctor outside the network, he or she would have to pay 20 percent higher coinsurance.
It’s still unclear how much premiums will be. But the federal law requires that the new, temporary pools charge no more than standard rates. Illinois will have a consulting actuary calculate a standard rate by averaging the premium rates charged for similar plans by the largest insurers offering coverage in Illinois.
It will cost about $2.8 million a year to administer the program, depending on how many people are enrolled.
“Given the limited funding for the federally funded pool, the objective and plan is to minimize administrative expenses and to maximize enrollment,” McRaith said.
Illinois proposal: http://www.insurance.illinois.gov/hiric/resources/HHS(underscore)Sol icitationRsp.pdf
Topics Illinois
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