Chip
Illinois Comprehensive Health Insurance Plan, the state-run program for eligible Illinois residents with high health risks (called a state health benefits risk pool). CHIP provides health insurance for those who are HIPAA eligible, and to others with serious health conditions who have been denied individual health insurance by a private health insurance company or would have to personally pay premiums in excess of the applicable CHIP rate.
COBRA
Stands for the Consolidated Omnibus Budget Reconciliation Act, a federal law in effect since 1986. COBRA permits you and your dependents to continue in your employer’s group health plan after your job ends. If your employer has 20 or more employees, you may be eligible for COBRA continuation coverage when you retire, quit, are fired, or work reduced hours. Continuation coverage also extends to surviving, divorced or separated spouses; dependent children; and children who lose their dependent status under their parent’s plan rules. You may choose to continue in the group health plan for a limited time and pay the full premium (including the share your employer used to pay on your behalf). COBRA continuation coverage generally lasts 18 months, or 36 months for dependents in certain circumstances.
Coinsurance
The amount as a percentage of a covered expense that you pay after your deductible is met.
Continuous Coverage
Under federal rules, health insurance coverage that is not interrupted by a break of 63 or more days in a row. Employer waiting periods and HMO affiliation periods do not count as gaps in health insurance coverage for the purpose of determining if coverage is continuous. Federal rules apply to you if you are joining a self-insured group health plan.
Copay
The specified dollar amount that you pay to a provider for certain covered services.
Creditable Coverage
Health insurance coverage under any of the following: a group health plan; individual health insurance; Medicare; Medicaid; CHAMPUS (health coverage for military personnel, retirees, and dependents); Federal Employees Health Benefits Program (FEHBP); Indian Health Service; Peace Corps; Public Health Plan (any plan established or maintained by a State, the U.S. government, a foreign country); State Children’s Health Insurance Program; or a state health insurance high risk pool.
Deductible
The amount of expense that you must pay before insurance company benefits are provided.
Guaranteed Issue
A requirement that health plans must permit you to enroll regardless of your health status, age, gender, or other factors that might predict your use of health services. All small group health plans sold to small employers in Illinois are guaranteed issue. Plans that are guaranteed issue can turn you away for other reasons.
HIPAA Eligible
Status you attain once you have had 18 months of continuous creditable health coverage. To be HIPAA eligible, you also must have used up any COBRA or state continuation coverage; you must not be eligible for Medicare or Medicaid; you must not have other health insurance; and you must apply for individual health insurance within 63 days of losing your prior creditable coverage. When you are buying individual health insurance, HIPAA eligibility gives you greater protections than you would otherwise have in Illinois and in other states.
Inpatient
Means that you are confined as a registered bed patient in a health care facility.
Network Provider
A hospital, health care facility, physician,or health service provider who has a written agreement with the insurance company to provide services to all covered persons.
Pre-existing Condition (Group Health Plans)
Any condition (either physical or mental) for which a diagnosis, care, or treatment was recommended or received within the 6-month period immediately preceding enrollment in a health plan. Pregnancy cannot be counted as a pre-existing condition, as long as your group health plan offers maternity benefits. Genetic information about your likelihood of developing a disease or condition, without a diagnosis of that disease or condition, cannot be considered a pre-existing condition. Newborns, newly adopted children, and children placed for adoption covered within 30 days cannot be subject to pre-existing condition exclusions.
Pre-existing Condition (Individual Health Policies)
Any condition for which a diagnosis, care or treatment was recommended or received within the 2 year prior to coverage. In addition, if you make a claim during the first 2 years of coverage, your plan can look back 12 months, from the date of your application, for any symptoms or signs that would have prompted a prudent person to seek medical care, or advice. If it finds such evidence, it can apply a 2 year pre-existing exclusion period for that condition.
Pre-existing Condition Exclusion Period
The time during which a health plan will not pay for covered care relating to a pre-existing condition. |
