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INTRODUCTION
The Illinois General Assembly has created the Comprehensive Health Insurance Plan
(CHIP) to provide access to health insurance coverage for certain eligible Illinois
residents who have been denied major medical coverage because of their health by
private insurers, and to serve as an acceptable alternative mechanism for complying
with the individual portability requirements of the federal Health Insurance Portability
and Accountability Act (HIPAA). CHIP is a state program operated by a board of
directors pursuant to the Comprehensive Health Insurance Plan Act (215 ILCS 105/1 et
seq.).
CHIP provides coverage to thousands of otherwise uninsurable individuals throughout
the State of Illinois who qualify under Section 7 of the CHIP Act. This portion of the
program (Plans 2 and 3) is known as the Traditional CHIP or Section 7 pool. The
coverage provided by this pool is funded in part by the premiums paid by its
participants. The remainder of the cost of Traditional CHIP is funded by an annual
appropriation from the General Revenue Funds of the State of Illinois.
CHIP also offers a choice of four different deductible options to Illinois residents who
qualify for CHIP coverage as federally eligible individuals under Section 15 of the CHIP
Act. This portion of the program is known as the HIPAA-CHIP or Section 15 pool. Plan
5 is similar to the traditional PPO option (Plan 3), except there is no preexisting
conditions limitation and benefits for inpatient treatment of mental health are limited to
45 days per calendar year for all hospitals. The coverage provided by this pool is also
funded in part by premiums paid by its participants. The remainder of the cost of this
HIPAA-CHIP pool is funded by an assessment levied on all health insurers doing
business in Illinois.
CHIP is NOT an insurance company. It is subject to its own enabling Act, and is neither
an entitlement nor a welfare program. You must be eligible for this state program
before you can enroll. Once enrolled, you must continue to meet all of the CHIP
eligibility requirements. Failure to do so will result in your termination from the program
as of the date required by CHIP or state law.
The eligibility criteria for CHIP are different than those for private health insurance, and
the eligibility criteria for the Traditional CHIP or Section 7 pool are different than those
for the HIPAA-CHIP or Section 15 pool. There are separate eligibility and enrollment
forms for each of these CHIP pools. (Copies of each form are available on our website
or as inserts to this brochure.)
This brochure briefly describes the eligibility requirements and application
procedures for CHIP, and the various benefit plans offered by CHIP, including a
Summary of Coverage which describes the benefits, limitations, exclusions,
continuation, renewal and termination provisions. THIS BROCHURE IS NOT A
LEGAL DOCUMENT. The actual provisions of any benefit plan booklet which may
be issued to you will control. Whenever any information contained in this
brochure is in conflict with the provisions of the CHIP Act, the statutory
provisions shall control.
