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 When an insurance company chooses to stop providing a particular
type of coverage, the company must go through two important
processes:
1) Notify the Illinois Department of Insurance of the company’s
decision. - The company’s notice must contain: a specific
description of the type of coverage affected; the total number of
covered lives affected; a draft of the letter that will be sent to
the plan sponsors and participants, beneficiaries or covered
individuals; time frames for the actions being taken; and any
options the plan sponsors, participants, beneficiaries or covered
individuals may have available to them under 215 ILCS 97/50.
2) Notify the plan sponsor, participants, beneficiaries and
covered individuals. 90 days prior to the renewal date. - The
notice of discontinuance of coverage must be sent to: the individual
insured for individual plans; and the plan sponsor, participant and
beneficiaries for group plans. The health insurance company must
offer the insured all of its other available products. (See 50 IL
Admin. Code 2025.60 for more specific information)
Under the federal requirements for Affordable Care Act Marketplace
plans, the insurance company must “crosswalk” (move) the insured to
the company’s insurance plan that is closest to the plan being
terminated. However, the insured is not required to join the
proposed “crosswalk” plan – the insured can select any Marketplace
plan.
When an insurance company follows the processes above, the
Department allows the termination, files the information on the
System for Electronic Rate and Form Filing (SERFF) and keeps a
spreadsheet with the information for reference. The ability to make
these types of changes is allowed both at the State and Federal
level. For information regarding access to SERFF, visit
http://insurance.illinois.gov/newsrls
/2014/08/DOIannouncesSERFFaccess.pdf
What Should I Do If My Health Insurance Plan Is Terminated?
If you have received notice that your Marketplace insurance plan is
being terminated, you have several choices:
1. You may choose to move to the plan the insurance company notified
you would best resemble your current plan;
2. You may choose to shop for other plans within the same insurance
company;
3. You may choose to shop on the Marketplace for other insurance
company plans in your area;
4. You may choose to shop off the Marketplace (please note
off-marketplace plans do not offer Federal income related subsidies)
If you are not sure, and would like additional assistance, you
may choose to:
1. Request in person assistance through the Get Covered Illinois
Consumer Assistance program.
2. Contact an independent insurance agent or broker to see what is
available outside the Marketplace.
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Questions to Ask
When reviewing your options, it is of major importance to understand whether
your current plan is a network plan where provider choice is limited to those in
a particular network, and whether you want to continue with a network plan. It
is IMPORTANT to understand that insurance companies may have multiple provider
networks. As you compare plans, make sure you view the network which goes with
the particular plan you are considering. Doctors, hospitals and other providers
may be in one of the company’s provider networks, but not in others.
As you look at each company’s provider networks with this information in mind,
you will notice the differences in the number of primary care physicians and
specialists that are available to you and the geographic locations of those
providers. Larger networks offer you more provider choices, but may have higher
insurance premiums. Even if you are currently healthy, it is important to pay
attention to the specialists available in the networks you consider in case you
need specialized care in the future.
Obtaining 2016 Health Insurance Marketplace Plan Information
The Department is awaiting final approval from the federal government regarding
the health insurance plans that will be available in 2016. Approval is expected
the week of October 19th. The Open Enrollment period is November 1, 2015,
through January 31, 2016.
Marketplace insurance plan information is available on the internet at
https://getcovered .illinois.gov/en
and
https://www.healthcare. gov/choose-a-plan/comparing-plans/. You can
also call the Get Covered Illinois team at 1-866-311-1119. Telephone assistance
is available Monday through Saturday 8:00 a.m. – 8:00 p.m.
More Information
The Department’s mission is to protect consumers by providing assistance and
information, by efficiently regulating the insurance industry’s market behavior
and financial solvency, and by fostering a competitive insurance marketplace.
The Illinois Department of Insurance assists consumers with all insurance
complaints, including health, auto, life, and homeowner. Consumers in need of
information or assistance should visit the Department’s web site at
insurance.illinois.gov or call our toll-free hotline at (877) 527-9431.
[Alissandra Calderon, Illinois
Department of Insurance.] |
