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Individuals

An individual health insurance policy is your own personal policy that is not tied to an employers group plan.  Premiums are based on your age, zip code, and smoker status. As of 1/01/2014, the Affordable Care Act (ACA) law prohibits insurance companies from discriminating against individuals with preexisting conditions and coverage will be guaranteed. Once you are approved, the insurance company cannot cancel your coverage for excessive claims.

There are 10 essential benefits that all individual health insurance plans will have.

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These benefits are defined by the ACA and are included in all plans by default. Another new limitation added by the ACA is that you can only sign up for coverage during the open enrollment period. This period will run from November 15th, 2014 to Febuary 15th, 2015. You can only sign up for insurance outside of the open enrollment period only if you qualify for a special enrollment.

Some of the reasons for Special Enrollment include:

  • Loss of minimum essential coverage, such as the loss of a job or through a divorce.
  • Change in family size due to factors such as marriage, birth, adoption, divorce, or death.
  • Change to citizenship or immigration status.
  • Release from incarceration.
  • Current plan substantially violated a material provision of its contract.
  • Newly eligible or ineligible for premium tax credits or cost-sharing assistance.
  • Newly pregnant or disabled (may result in eligibility for Medicaid and loss of premium tax credit
  • eligibility).
  • Permanent move to a new ZIP code and have access to new health plans.
  • Member of an American Indian tribe (American Indians can enroll in a plan or change plans one time each month).
  • Demonstrated other extenuating circumstances that qualify for special enrollment.

Deciding between an employer’s plan or going with an individual health insurance plan?

Lately, many employers have been paying less and less for the employees coverage on a group plan, or cancelling group coverage all together.  If your employer is generous enough to pay more than 50% of the premium for employee coverage, staying on your group coverage will probably be the logical choice.  Also, please keep in mind that most group plan contributions made by the employee are done on a pre-tax basis and individual insurance uses post tax. However, you still should compare your employee contribution under a group plan to the other non-group/personal options available.  Rates under a group health plan can often be more expensive than those offered for individual health insurance.   You should also consider buying your own personal policy if you are self-employed, unemployed, a student, or if you are a non-smoker.  Individual health insurance plans can be written on anyone age 19 through age 64.

An example of things to think about when looking for individual health insurance.

Blue Cross & Blue Shield of Illinois offers a unique range of health insurance plans that are now available to individual adults and families.  Each plan is backed by the financial strength and stability of Blue Cross and Blue Shield of Illinois.  Regardless of the plan you select, you will benefit from the experience, expertise and stability of the leading health insurer in Illinois. In the current market Blue Cross is being very aggressive and their price is always the lowest when comparing plans from other companies such as Humana or United Health Care.

Blue Cross Blue Shield of Illinois offers both Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) programs for their personal individual/family policies.  There are two different PPO hospital and doctor lists, many deductibles with varying out of pocket costs, and HSA plans.

Below is an informational piece from Humana explaining the main differences between HMO and PPO plans.

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