Illinois Comprehensive Health Insurance Plan–CHIP

CHIP is a state program that is established and maintained by the State of Illinois to provide health insurance coverage for residents of Illinois who, due to the existence or history of a medical condition, are unable to acquire coverage through private insurance, an HMO or an employer sponsored group health plan.

CHIP is not an insurance company. It is neither an entitlement nor a welfare program. There are restrictive requirements and significant cost-sharing obligations.

Who Is Eligible For CHIP coverage?

Illinois residents can generally qualify for CHIP if they meet one of the following criteria:

  1. If they have applied for individual health insurance and have been rejected because of a preexisting condition;
  2. If they have a policy that is substantially similar to CHIP which costs them more than they would pay for CHIP coverage; or
  3. If they have one of 31 presumptive conditions, i.e., conditions presumed to result in automatic rejection by an insurance company;
  4. Since July 1, 1997, federally eligible individuals are also eligible for CHIP coverage under Section 15 of the CHIP Act. Federally eligible individuals (generally those who have been insured previously without a gap in insurance) have no waiting list for CHIP coverage.

(Traditional CHIP (Section 7) has been capped at approximately 6,000 participants due to fiscal constraints. Applications are still accepted and waitlisted. Federal CHIP (Section 15) is open to all eligible individuals with no waitlist.)

What Are The Various Coverage Plans Offered under CHIP?

Three plans are available to eligible persons under CHIP. Each benefit plan offers deductible options of $500, $1,000, $1,500, and $2,500. A six-month pre-existing condition limitation applies to Plans 2 and 3 but not to Plan 5.

CHIP Plan 2 is for persons who are eligible for Medicare and have primary coverage under both Medicare Parts A and B due to disability or end-stage renal disease.

CHIP Plan 3 is Preferred Provider Organization (Hospital PPO) plan available to persons who qualify for traditional CHIP under Section 7 and who are not eligible for Medicare.

CHIP Plan 5 is a PPO plan for federally eligible individuals who qualify for HIPAA-CHIP under Section 15.

What Are The Monthly Premiums?

Premiums charged by CHIP are currently set at 135 percent of the average rates charged individuals for comparable major medical coverage by five or more of the largest insurance companies in the individual health insurance market in Illinois.

Premiums paid by persons insured by CHIP averaged approximately $5,130 per year in 2002. The lifetime maximum for benefits is $1,000,000 per individual. Premiums will vary by gender, age, geographic area, deductible amount, and type of plan.

How To Apply

Call ICHIP at 866-851-2751 for information and applications.

Link to: www.chip.state.il.us/ for information and applications.

Call the Uninsured Ombudsperson Program: 877-527-9431 for questions related to securing private health insurance.