Illinois Standard Health Applications
On January 5, 2010, Governor Quinn signed into law the "Illinois Insurance Fairness Act" [Public Act 96-857] which, in part, provided for the creation of standardized health insurance applications to allow individuals and small businesses in Illinois to more easily shop for health insurance and compare competing plans.
Beginning January 1, 2011, instead of filling out separate applications for each insurer, individuals and small business employees will only need to complete one “standard” application, which may then be submitted to every health insurer offering coverage in Illinois. Insurers may require applicants to complete a separate “administrative section” to obtain information the company needs in order to process the application (e.g., payment information or specific coverage selections).
Applications are available in PDF format below. You may download and fill out the application electronically, or print out and complete the application by hand. All insurers offering individual or small employer coverage in Illinois are required to accept these applications both electronically and in paper form. You should contact each insurer for more information about how to submit a completed standard application.
- Illinois Standard Health Application for Individual & Family Health Insurance Coverage
- Additional Pages
If additional space is needed for the following sections, please download and complete the following document(s), sign and date all additional pages, and attach them to your application.
- Additional Pages
- Illinois Standard Health Employee Application for Small Employers
- Additional Pages
If additional space is needed for the following section, please download and complete the following document, sign and date all additional pages, and attach them to your application.
- Additional Pages
For More Information
Call our Office of Consumer Health toll-free at (877) 527-9431 or visit us on our website at http://insurance.illinois.gov