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Continuation of Illinois Health Insurance-Dependent Children
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.
Medequote understands that, and that is why we are the Illinois health insurance experts for individual, family, and the self employed. We service that segment of the community and do it well. We offer short term plans from Assurant, World, Celtic, and UniCare that can be used for Cobra replacement.
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 Dependent Child Continuation Law and compares its basic provisions to three other continuation laws: the Illinois Spousal Continuation Law, the Illinois 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.
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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.
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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.
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You must pay the entire premium for the coverage, including the part the employee 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.
The 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 Dependent Child Continuation Law?
The Illinois Dependent Child Continuation Law, effective July 1, 2004, protects dependent children who lose their group health insurance coverage with an employer group of any size due to:
- Attainment of the limiting age under the policy; or
- The death of the insured parent (and coverage is not available under the Spousal Continuation Law.)
Which Employers Must Offer Continuation Coverage Under The Illinois Dependent Child Continuation 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 applies 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 Dependent Child Continuation Law?
Continuation of coverage must be offered to eligible dependents covered under group coverage on the day before the qualifying event.
Illinois dependent child continuation does not apply if:
- The child is covered by any other insured or self-insured plan of group hospital, surgical or medical coverage.
- The child is eligible for coverage under the Illinois Spousal Continuation Law.
What Are The Notification Deadlines?
The dependent child or responsible adult acting on behalf of the dependent child must notify the employer or the insurer in writing of the qualifying event within 30 days of the event.
How Much Will Illinois Dependent Child Continuation Coverage Cost?
The premium for Illinois dependent child continuation coverage shall be the sum of the amount that would be charged to an employee (if the dependent child were an employee) plus any contributions the employer would have made on behalf of the employee.
What Benefits Are Available With Illinois Dependent Child Continuation Coverage?
Benefits for hospital, surgical or major medical are the same as they were under the previous group coverage.
How Long Does Illinois Dependent Child Continuation Coverage Last?
Continuation coverage must be provided for a maximum of two years after the date the insurance stops because of attainment of the limiting age or death of insured parent.
Continuation coverage may terminate earlier than two years:
- If premiums are not made in a timely manner;
- When coverage would terminate under the terms of the policy if the dependent child was still an eligible dependent of the employee, such as when the employee terminates employment with the employer;
- When the dependent child becomes an insured employee under any other group health plan.
What Happens When Illinois Dependent Child Continuation Ends?
The dependent child may convert coverage to an individual policy at any time during the continuation period or at the end of the period.
The dependent child may also want to shop around for an individual policy on his own. Better coverage may be available at a more affordable rate. An insurance broker in the area can assist.
If the dependent child has 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 that the dependent child apply for the HIPAA CHIP plan at least two months prior to the expiration of the Illinois dependent child continuation coverage in order to allow ample time for the application to be processed. For an application and information, please contact the Illinois Comprehensive Health Insurance Plan (ICHIP) at (866) 851-2751 or at http://www.chip.state.il.us.
NOTE: Dependent children with medical conditions that render them uninsurable, who elect a conversion policy rather than HIPAA CHIP, will lose the right to elect HIPAA CHIP. In other words, if a conversion policy is elected and then dropped for whatever reason, the child will not be eligible for the HIPAA CHIP plan. Coverage with the regular CHIP plan would still be an option, but the plan may have a waiting list and does not pay for preexisting conditions for the first six months of coverage.
Give is a call at 800-391-7469 if we can be of any help.
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