DOI Pat Quinn Governor Andrew Boron, Director

Illinois Pre-Existing Condition Insurance Plan (IPXP)

Illinois' Federally-Funded Temporary High Risk Pool

With the passage of the Patient Protection and Affordable Care Act ("national health reform" or "the Affordable Care Act") on March 23, 2010, Illinois families and employers can anticipate a health insurance marketplace that will provide more meaningful benefits, be more accountable to consumers, and be more transparent. Most health insurance reforms are scheduled to be implemented and effective by January 1, 2014.

The establishment of a federally-funded temporary high risk pool is among the components of the Affordable Care Act that were implemented early on. By design, the federally-funded high risk pool provides transitional coverage to 2014 for the currently uninsured with preexisting conditions.  Of course, effective January 1, 2014, the Affordable Care Act prohibits health insurers from basing coverage or pricing decisions on health status. We know that day will not arrive soon enough for many families and employers, especially in Illinois which does not require that health insurer rate increases be actuarially justified.

Frequently Asked Questions

What is the Illinois Pre-Existing Condition Insurance Plan?

In Illinois, the federally-funded temporary high risk pool is known as the Illinois Pre-Existing Condition Insurance Plan (IPXP). The IPXP is a transitional insurance program for uninsured Illinois residents. The IPXP is not a public aid or entitlement program. Enrollees will be required to pay a premium and out-of-pocket costs.

When can I enroll in the IPXP?

Enrollment commences weekly after IPXP:

  1. receives a completed application and required documentation,
  2. confirms applicant eligibility, and
  3. receives premium payment.

Who is eligible to enroll in the IPXP?

The Affordable Care Act established eligibility criteria for federally-funded high risk pools like the IPXP. To enroll, a person must:

  1. Be a U.S. citizen, national, or legal resident;
  2. Be uninsured for 6 months; and
  3. Have a preexisting condition.

The Affordable Care Act specifies that enrollment in an existing high risk pool, like ICHIP, constitutes insurance.

How is the IPXP being funded?

The federal health reform law, known as the "Patient Protection and Affordable Care Act" (the "Affordable Care Act"), appropriates $5 billion to all the states to fund temporary high risk pools in every state. The $5 billion is allotted to the states on a population-based formula. Illinois' share will be an estimated $196 million.

In addition to the federal funds, the IPXP will be funded by premiums paid by enrollees.

Claims and administrative expenses will be forwarded to and paid by the federal government, not the State.

What is the IPXP benefit design (deductibles, out-of-pocket costs, etc.)?

The IPXP covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available, even if it’s to treat a pre-existing condition.

Effective January 1, 2012, there are four deductible options to choose from:

  High Option Standard Option Extended Option Low Option
Deductible $5,000 $2,000 $1,000 $500
Premium Refer to the monthly premium table and instructions Refer to the monthly premium table and instructions Refer to the monthly premium table and instructions Refer to the monthly premium table and instructions
Cost Sharing (Co-insurance) 100/0 80/20 80/20 80/20
Out-of-Pocket Limits:
Medical (including the deductible		 $5,000 $4,350 $3,350 $2,850
Pharmacy included in medical $1,600 $1,600 $1,600
Maximum Out-of-Pocket $5,000 $5,950 $4,950 $4,450
Out-of-Network Additional limits apply for out-of-network service Additional limits apply for out-of-network service Additional limits apply for out-of-network service Additional limits apply for out-of-network service

How can I enroll in IPXP?

You can fill out and submit an IPXP enrollment application online, or print out a PDF version of the application and mail, fax, or deliver it to:

Health Alliance Medical Plans
Attn: Illinois Pre-Existing Condition Insurance Plan
301 S. Vine St.
Urbana, IL 61801

You can also contact the IPXP using the following phone numbers:

Phone: (877) 210-9167
Fax: (217) 337-3425
TTY: (800) 526-0844 (Illinois Relay) or 711 (TTY/TTD)

What if I have another question?

If your question involves the IPXP, you can see our list of Frequently Asked Questions, call the IPXP's toll free number at (877) 210-9167, or email your question directly to IPXPInquiry@healthalliance.org.

If you are a current ICHIP enrollee or your question involves ICHIP, please call ICHIP toll-free at (866) 851-2751 or visit the ICHIP website at www.chip.state.il.us.

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