What To Do if Your Health Insurance Plan is Terminated

In an effort to help the public better manage their health insurance needs, the Illinois Department of Insurance (DOI) is informing consumers of the process by which insurance companies terminate a health insurance plan in Illinois and the steps to take in the event a consumer’s health insurance plan is terminated.

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.

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.