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:
Automatic Premium Payment Program Form
| 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 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.
Does funding limit enrollment?
Yes. Based on anticipated funding, actuaries (experts who predict how long limited funding will last) predict that the IPXP may enroll between 4,000 - 6,000 individuals. Variables that impact how many people can enroll include (1) the severity of the illnesses of those who enroll, (2) the benefit structure, and (3) the length of the coverage term.
In other words, if people who enroll have higher medical expenses than the actuaries projected, then we will be able to enroll fewer people. IPXP will be managed in a fiscally prudent manner so that every enrollee is assured coverage until January 2014.
