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Illinois Continuation Coverage Law

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With the high costs of medical care, maintaining health coverage is very important to most individuals and families. Illinois law does not require employers to provide health benefits for their employees or their families. However, if you are covered by an employer's health benefits, loss of coverage can be devastating.

State and federal laws give certain employees, spouses and dependent children the right to continue employer-sponsored health benefits at group rates if they lose their benefits because of specific "qualifying events." The type of qualifying event determines who is qualified for continued coverage and for how long.

This fact sheet provides specific information on the Illinois Continuation Law and compares its basic provisions to three other continuation laws: the Illinois Spousal Continuation Law, the Illinois Dependent Child Continuation Law and the federal continuation requirements under COBRA (the Consolidated Omnibus Budget Reconciliation Act). The chart at the bottom of this fact sheet provides a comparison of the laws pertaining to continuation of health benefits.

Under all four laws:

  • The employer or plan administrator must notify you of your right to continue your health benefits when certain qualifying events have occurred. If both the state and federal laws apply to your situation, the employer or plan administrator must offer you both options. You must choose one or the other option.

    NOTE: In some cases, the spouse, former spouse, dependent child or guardian must notify the employer and/or insurer that a qualifying event has occurred, such as divorce from or death of the covered employee or attainment of the limiting age by the dependent child. If you don't give proper notification, your continuation rights may be lost.

  • Once you are offered continuation, you must elect to continue coverage within a certain time period, called the election period. If you don't tell the employer you want to continue coverage before the election period expires, you may lose your right to continue coverage. If you have the option of either the state or federal continuations, once you make your choice, you can't change your decision if the election period has expired.
  • Coverage will continue for the maximum amount of time required by law. However, coverage may end earlier in some cases, such as when the beneficiary becomes eligible for Medicare, or if the employer no longer offers any group health insurance benefits for employees.
  • You must pay the entire premium for the coverage, including the part you used to pay as well as the part the employer paid before the qualifying event. In addition, you may also be required to pay an administrative fee under certain circumstances for COBRA and Spousal Continuation.

    Your group insurance certificate, evidence of coverage or benefit plan summary booklet explains your options and responsibilities in detail. You should read the information now. Don't wait until you need your continuation rights.

What Is The Illinois Continuation Law?

The Illinois Continuation Law protects individuals who lose their group health insurance coverage with an employer group of any size due to termination of employment or reduction in hours.

Which Employers Must Offer Continuation Coverage Under The Illinois Law?

  • Employers offering fully insured group and accident health plans, regardless of the group's size;
  • Employers offering fully insured HMO coverage, regardless of the group's size.

The Illinois law does not apply to:

  • Self-insured employers;
  • Self-insured health and welfare benefit plans, such as union plans;
  • Insurance policies or trusts written in other states.

Note: For HMOs, the law does apply to contracts written outside of Illinois if the HMO member is a resident of Illinois and the HMO has established a provider network in Illinois. To determine if your HMO coverage provides Illinois continuation, contact the HMO or check your certificate of coverage.

Who Is Eligible For Continuation Coverage Under The Illinois Law?

Continuation of coverage must be offered to you and your eligible dependents who were continuously covered under group coverage for three months prior to termination of employment.

Illinois continuation does not apply if:

  • You were terminated for committing a work-related felony and have admitted to or been convicted of such felony;
  • You were terminated for a work-related theft for which your employer was in no way responsible and you have admitted to or been convicted of such theft;
  • You are covered by Medicare;
  • You are covered by any other insured or self-insured plan of group hospital, surgical or medical coverage.

What Are The Notification Deadlines?

Your employer must notify you in writing of your right to Illinois continuation coverage upon termination of your employment.

You must request such continuation in writing within the ten-day period following the later of: 1) the date of employment termination; or 2) the date you are given written notice of your right to continuation.

IN NO EVENT, may you elect Illinois continuation more than 60 days after the date of employment termination.

How Much Will Illinois Continuation Coverage Cost?

The premium for Illinois continuation coverage for you, your spouse and dependent children may not exceed that of the group rate. You are responsible for paying the entire premium for the coverage, including the portion which was formerly paid by your employer.

What Benefits Are Available With Illinois Continuation Coverage?

Benefits for hospital, surgical or major medical are the same as they were under your previous group coverage. However, dental, vision care, prescription drug benefits, disability income, specified disease benefits and supplementary benefits are not required and may no longer be available under the continuation coverage.

How Long Does Illinois Continuation Coverage Last?

Continuation coverage must be provided for nine months after the date your insurance stops because your employment is terminated or your hours are reduced.

Continuation coverage may terminate earlier than nine months if:

  • You become eligible for Medicare;
  • You are covered by any other insured or self-insured group medical, hospital or surgical plan;
  • You fail to make timely premium payments for coverage;
  • Your employer's group policy is terminated in its entirety and not replaced with another group policy.

What Happens When My Illinois Continuation Ends?

You or your dependents may convert coverage to an individual policy at any time during the continuation period or at the end of the period, except when the continuing person becomes eligible for Medicare.

You may also want to shop around for an individual policy on your own. You may be able to find better coverage at a more affordable rate. An insurance broker in your area can assist you in applying for individual coverage.

If you or your dependents have a medical condition that precludes the purchase of individual coverage, the HIPAA CHIP plan offered by the Illinois Comprehensive Health Insurance Plan may be an option when the continuation policy expires. This plan provides coverage for individuals with an uninsurable health condition, without preexisting condition exclusions or limitations, if there has not been a break in coverage of more than 90 days. We encourage you to apply for the HIPAA CHIP plan at least two months prior to your Illinois continuation coverage expiration in order to allow ample time for the application to be processed. For an application and information, you should contact the Illinois Comprehensive Health Insurance Plan (ICHIP) at (866) 851-2751 or at http://www.chip.state.il.us/chip.htm.

NOTE: If you have a medical condition that renders you uninsurable and you elect a conversion policy rather than HIPAA CHIP, you will lose your rights to elect HIPAA CHIP. If you elect the conversion policy and then decide, for whatever reason, to drop it, you will not be eligible for the HIPAA CHIP plan. You will have to apply for coverage with the regular CHIP plan, which sometimes has a waiting list and does not pay for preexisting conditions for the first six months of coverage.

  

 

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