In the midst of the ongoing COVID 19 outbreak, the Illinois Department of Insurance (Department) is issuing a consumer FAQ recognizing the critical role that health insurance coverage plays in the public’s ability to access health care services.
This consumer FAQ does not apply to excepted benefit policies or short-term, limited-duration health insurance coverage.
1. Who pays for COVID 19 diagnostic testing if needed?
The federal Centers for Disease Control and Prevention (CDC) and the Illinois Department of Public Health (IDPH) are currently covering the cost of the lab test for the presence of COVID 19. Yet, hospitals might still charge their own fees for collecting the specimens, which then could be billed to the patient or to the patient’s health insurance issuer. Call your insurance provider to discuss available coverage.
2. Will I be subject to higher cost-sharing if I unintentionally receive care from out-of-network specialists in an in-network hospital?
No. The Illinois Insurance Code prohibits health insurance issuers from charging higher out-of-pocket expenses to an enrollee who sees an out-of-network provider at an in-network facility if there are no in-network providers available. However, if you willfully choose a non-network provider when an in-network provider is readily available, you might be subject to higher out-of-pocket expenses.
3. What if I have health concerns that require emergency medical services?
Insurance carriers must cover emergency services for an emergency medical condition at in-network levels regardless of which provider performs the services. Emergency services include transportation services, such as ambulance services, as well as inpatient and outpatient hospital services that are needed to evaluate or stabilize the patient. Many individuals who have contracted COVID 19 have not required emergency services. Still, exceptional circumstances may arise.
4. Should I fill or refill my current prescription drugs in anticipation of an emergency?
The CDC and American Red Cross recommend that households maintain at least a 30-day supply of any prescription drugs used by household members at all times to prepare for unexpected events. The Department has encouraged health insurance carriers to do all that they can to allow people to get more than a 30-day supply of a prescription drug at one time, subject to the limits of the prescription written by the treating healthcare provider. The Department does not recommend stockpiling prescriptions that are highly susceptible to abuse, such as opioids that may be restricted to 7-day prescriptions.
5. Can my insurance carrier cancel or refuse to renew my insurance policy if I am diagnosed with COVID 19 or a preexisting respiratory illness?
No. The Illinois Insurance Code prohibits individual or group accident and health insurance carriers from imposing any pre-existing condition exclusions, including in connection with COVID 19. Federal law and state regulations provide protections against preexisting condition exclusions in health insurance coverage, as well. However, preexisting condition consumer protections do not apply to short-term, limited-duration health insurance coverage or excepted benefit policies.
6. Where can I find more information about COVID 19?
View up to date information on how Illinois is handling COVID 19 from the
Illinois Department of Public Health
7. Is there a number to call for health insurance and HMO inquiries?
Yes. If you have questions regarding health insurance and HMO inquiries, please call the Illinois Department of Insurance at (877) 527-9431.
8. Is there a number to call for Medicare Beneficiaries and Caregiver Inquiries?
Yes. If you have questions regarding Medicare beneficiaries and caregiver inquiries, please call CMS at (800) 548-9034.
Why is this Emergency Rulemaking being introduced?
This Emergency Rulemaking (ER), which took effect on April 20, 2020, focuses on grace periods and termination of coverage, continuation coverage for employees, and measures to address the impact of a prescription drug shortage.
What does this ER do?
This ER does three things:
Does the ER apply to the group health insurance coverage that I get from my employer?
It depends on what policy you have.
For fully insured HMO policies:
If you are covered under a fully insured HMO policy from your employer, then the ER applies wherever it refers to group coverage.
For fully insured PPO policies, health policies without a preferred provider network, or voluntary health service plans:
If your employer covers you under a fully insured PPO policy, a health insurance policy without a preferred provider network, or a voluntary health service plan, then most of the ER does not apply to you. However, your insurance company will be required to cover an off-formulary drug alternative if there is a shortage of a formulary drug, and termination of your coverage based on a reduction in hours worked or lay-off will trigger the special enrollment provision.
For self-insured coverage:
If your employer has provided you self-insured coverage, then the only part of the ER that affects you is the special enrollment provision. Nothing changes for your self-insured coverage, but if you lose that coverage because your working hours were reduced or you were laid off, then any new coverage that you are eligible for that you do not purchase through the ACA Health Insurance Marketplace must allow you to have that new coverage take effect retroactively to the date after you lost your old coverage, subject to other special enrollment period requirements. Please note that, if you do backdate your new non-Marketplace coverage like this, you will be responsible to pay the premiums applicable to the period of coverage that has already passed.
How does the ER address the extension and cancellation of payment deadlines?
The ER allows an insured to request to extend payment deadlines, without interest, for health insurance coverage for at least 60 days from each original premium due date. If you have any questions about how to submit a request to delay your premium payments, contact the company that issued your policy or certificate of coverage. Please bear in mind that, for a short time after April 20, 2020, when the ER was first adopted, your issuer may still be figuring out its own process for you to submit this request.
Additionally, the ER provides that, for insureds who had already failed to make a sufficient premium payment by their policy’s due date but whose coverage had not yet terminated by April 20, 2020, issuers shall refrain from cancelling or nonrenewing their coverage for at least 60 days, which ends at June 19, 2020.
For insured individuals receiving advanced premium tax credits for Qualified Health Plans (QHPs) or stand-alone dental plans (SADP), issuers are to delay initiating the federally mandated 3-month grace period due to failure to pay premiums for 30 days from the missed payment date. A QHP or SADP is an insurance plan that is certified by the ACA Health Insurance Marketplace, provides essential health benefits, follows established limits on cost sharing, and meets other requirements under the Affordable Care Act (ACA).
For QHPs and SADPs sold through the ACA Health Insurance Marketplace, CMS has allowed the extension of payment deadlines as long as the individual is not already in a grace period and as long as the state insurance regulator grants permission.
The ER mandates issuers to extend existing deadlines by 30 days for individuals to make a binder payment for all health insurance coverage in the individual market. A binder payment is the first premium payment that you are required to make to secure new coverage.
Does this ER address issuer communication with consumers regarding grace periods?
Yes. Issuers shall communicate to insured individuals that any payment extensions and payment obligations must be paid back by the insured individual. Any unpaid payments/premiums? may be subject to billing from health care providers for unpaid claims or from the issuer for paid claims. Any communication must clearly state the issuer’s obligations during the payment extension period.
What guidance does the ER have for employers that employ 20 or more employees?
The ER requires issuers of group HMO policies to allow eligible employees to elect to continue coverage under COBRA for all employers that employ 20 or more employees as long as one person remains actively employed.
What guidance does the ER have for employers generally?
The ER requires issuers of group HMO policies to allow eligible employees to elect to continue coverage under state continuation coverage for up to 12 months for employers that employ fewer than 20 employees, as long as one person remains actively employed and enrolled in the group coverage.
How does this ER address special enrollment for health insurance coverage other than excepted benefits and short-term limited duration insurance?
The ER requires issuers of coverage not sold through the ACA Health Insurance Marketplace to waive normal special enrollment period requirements for employees who lose coverage under their employer or former employer’s group health plan to allow consumers to obtain effective coverage the day after their termination or reduction of hours.
Does this ER address possible shortages for prescription drugs?
Yes. The ER mandates issuers to provide coverage for off-formulary prescriptions at no greater cost-sharing for the insured if there is not a formulary prescription available to treat the insured. This ensures that consumers receive prescription drugs when there might be potential shortages related to the COVID-19 pandemic. This requirement applies to individual health insurance coverage and any fully insured group health insurance coverage, whether or not issued by an HMO.
Does the ER address refilling of prescription drugs?
Yes. Issuers shall allow insured individuals a one-time 90-day refill of covered maintenance medications when deemed appropriate by a prescribing physician. Issuers shall follow safety restrictions for certain types of drugs, such as opioids, benzodiazepines, and stimulants.
If I’m unable to pay my premiums for auto/homeowners, what options do I have?
You are encouraged to make every possible effort to maintain coverage by making at least the minimum payment. If that is not possible, you should contact your agent or insurance company, as many companies are extending various offers to policyholders.
If I have a claim but haven’t paid my premiums, is my loss covered?
Typically, property insurance does not have a grace period. However, the Department encourages you to contact your agent or insurance company regarding options if you are unable to pay your premium when due. Some companies are making arrangements with policyholders regarding premium payments.
If I don’t pay my premiums for a month or two, will I have to pay those back premiums?
The Department is strongly encouraging insurance companies to be as flexible as possible with consumers. Many companies have informed the Department that they are addressing consumer needs in various ways. Contact your agent or insurance company for more information.
What if my insurer notifies me that they are cancelling or non-renewing my coverage?
You are encouraged to file a consumer assistance request with the Department. The most efficient way to do that is online at: https://mc.insurance.illinois.gov/messagecenter.nsf
What is business interruption insurance?
Business interruption insurance is insurance providing lost income and extra expense coverage that businesses incur as a result of an interruption to their business operations. Business interruption insurance coverage found in most policies require that the interruption be a result of direct physical loss to the property and that the loss or damage must be a result of a covered peril. Insureds should review their policies for specific terms and conditions of their coverage.
Does my policy cover COVID-19?
Most business interruption insurance coverage contains a virus and bacteria exclusion that specifically excludes losses that result from any virus, bacterium, or other microorganism that induces or is capable of inducing physical distress, illness or diseases. Please refer to your policy for your specific coverage and consult your agent or insurer if you have questions.
I do not have any policy that says it is a business interruption policy – is it possible that I have coverage under another type of policy?
It is possible to have business interruption coverage under another type of insurance policy. For example, there may be available coverage in policies that cover perils arising out of actions by civil authorities or interruption of your supply chain. You should review your policy and see if it is a covered cause of loss or if it is excluded.
What if my business is closed due to a voluntary or mandatory government order?
Some policies may provide coverage for “civil authority”, which addresses the situation when government prohibits access to your business. If your policy requires a “covered cause of loss” to be the reason why the civil authority restricted access to your business, coverage will depend on whether the COVID-19 outbreak is deemed a covered cause of loss. Some business policies do not have this requirement. Please read your policy carefully.
If I do not have an existing business insurance policy that covers COVID-19, can I buy one?
No. You cannot purchase an insurance policy that would cover a loss that has already occurred. However, you may be able to purchase a business property policy that includes business interruption coverage for future losses. You should review the policy to determine the scope of the coverage provided and discuss any potential other stand-alone coverages that might be appropriate for future losses.
Does my business interruption insurance policy cover me if my employees stay home out of concern about COVID-19?
Business interruption insurance usually requires direct physical loss. Please refer to your policy for your specific coverage and consult your agent if you have questions.
What help is available to businesses affected by COVID-19 at the federal level?
The Small Business Administration (SBA) is offering small businesses impacted by COVID-19 up to $2 million in Economic Injury Disaster Loan Assistance (EIDL). Small businesses in Illinois are now eligible to apply for low interest U.S. Small Business Administration (SBA) Economic Injury Disaster Loans.
Under the EIDL program, the SBA makes loans available to small businesses and private non-profit organizations in designated areas of a state or territory to help alleviate economic injury caused by the COVID-19.
Small business owners can apply online, receive additional disaster assistance information and download applications . Applicants can call SBA's Customer Service Center at (800) 659-2955 or email firstname.lastname@example.org email@example.com for more information on SBA disaster assistance. For deaf or hearing-impaired individuals, call (800) 877-8339.
Completed applications should be mailed to U.S. Small Business Administration, Processing and Disbursement Center, 14925 Kingsport Road, Fort Worth, TX 76155.
What is the State of Illinois doing to further help businesses affected by COVID-19?
If you need assistance, you can access information related to ILDCEO Grants here: https://dceocovid19resources.com/pdf/DCEOCOVID-19EmergencyResourcesforBusiness.pdf
Who can help me understand my business interruption insurance?
Your insurance agent should be able to answer questions regarding coverage and exclusions found in your policy. You may also want to visit your insurance company’s website for relevant information.
If you believe that your insurance provider is not honoring your policy, you can submit a complaint on our website, and our team will review it. An online complaint can be filed here: https://mc.insurance.illinois.gov/messagecenter.nsf
Should I consult an attorney if my claim is denied?
The Illinois Department of Insurance encourages you to file a complaint with the Department if you have any concerns that that your claim was improperly denied.
Please be assured that the Illinois Department of Insurance reviews all complaints involving denied claims very closely. However, as a regulatory agency, the Department does not have the authority to determine the liability or amount of a claim.
The Department cannot provide you legal advice or represent you in any legal action. If you wish to pursue this matter, you have the right to consult legal representation or seek recovery through the court system.
If you need assistance finding an attorney to represent you, the Illinois Attorney General, Consumer Protection Division maintains a list of legal aid providers and contact to the Illinois State Bar Association on their website. http://www.illinoisattorneygeneral.gov/consumers/index.html.
NOTE:Executive Order No. 2020-29 extends the duration of temporary licenses set to expire during the Governor's Disaster Proclamation through the end of the Governor's Disaster Proclamation.
Will the Illinois Department of Insurance issue or extend temporary licenses?
Currently, the Department does issue a 90-day temporary license for applicants enrolled in a training course conducted on behalf of the appointing company.
The steps are as follows: Apply online at www.NIPR.com. A $5.00 transaction fee will be incurred by the applicant. When the appointing company pays a $50.00 fee through www.NIPR.com, the temporary license is effective once the insurance company makes the appointment.
What happens if my temporary license expires during the Disaster Proclamation?
All temporary licenses that were set to expire during the Governor's Disaster Proclamation have been extended for the duration of the Governor's Disaster Proclamation.
What if my license is up for renewal and I can’t complete my CE requirements on time?
For producers who are set to renew licenses during the Governor's Disaster Proclamation, please understand that licensing requirements are NOT suspended at this time. Resident producers can complete all CE requirements online. This includes the required 3-hour Ethics classroom course, which can now be completed by webinar or other appropriate distance learning.
When can I take my licensing exam?
Insurance exam testing will begin again on May 1, 2020, utilizing a limited seating capacity to comply with the social distancing measures in Executive Order 2020-10. For additional information, please visit www.Pearsonvue.com.
May I complete my classroom pre-licensing requirement online?
Yes, Executive Order No. 2020-29 allows the classroom portion of the pre-licensing requirement to be provided via webinar or other distance learning for the duration of the Governor's Disaster Proclamation. No exam will be required for the pre-licensing course. The provider must poll the audience to ensure the students are engaged during the presentation.
I am a Public Insurance Adjuster; may I complete my 3-hour Ethics classroom course as a webinar?
Yes. The required 3-hour Ethics classroom course may now be completed by webinar.
Executive Order No. 2020-29 suspends the classroom course requirement for the duration of the Governor's Disaster Proclamation.
I passed one portion of the exam and was scheduled to retake the failed portion. Will I have to complete both portions of the exam?
During the Governor's Disaster Proclamation, you will only need to pass the failed portion. However, if you are unable to pass the failed portion of the exam and the proclamation ends, you will be required to pass both portions.
Does my travel insurance cover risks related to COVID-19 if I get sick while travelling?
It depends. Unless a travel insurance policy contains an exception applicable to COVID-19, a policy of travel insurance that covers the risks of sickness, accident, or death incident to travel presumptively would cover such risks relating to COVID 19 if experienced while travelling. The extent of coverage for health care services, including emergency transportation within a foreign country, as well as the costs of returning to the United States for further treatment, may depend on the terms of the policy so be sure to check with your insurance carrier.
Does my travel insurance cover cancelation or interruption risks related to COVID 19?
If you purchased a Trip Cancelation or Trip Interruption policy after January 21 or 22, 2020, it is unlikely that you will be covered if your trip is canceled due a COVID 19 event—such as an coronavirus outbreak at your destination, or a quarantine that prevents you from traveling. Again, you should check with your insurance carrier for coverage and policy details.
Company Bulletin 2020-02 — Health Insurance Coverage and Travel Insurance — Insurance Coverage for Coronavirus COVID 19
Company Bulletin 2020-04 — Telehealth Services Under Executive Order 2020-09
Company Bulletin 2020-06 — Electronic Filing and Delays in Processing Under Executive Order 2020-09
Company Bulletin 2020-07 —Managed Care Applications and Renewals of Entities through SERFF
Company Bulletin 2020-08 — Use of temporary death certificates as due proof of death in policies covering preneed funeral contracts and prearrangements
Company Bulletin 2020-11 — Extending Employee Health Insurance Coverage, Grace Periods for Premiums, and Prescription Drug Coverage
State and federal laws give certain employees, spouses and dependent children the right to continue employer-based health insurance at group rates if they lose their insurance because of specific “qualifying events.” The type of policy, your employer, and qualifying event will determine who is qualified for continuing coverage and for how long.
If you lost your job-based health insurance, you may qualify for a Special Enrollment Period (SEP) through the ACA Health Insurance Marketplace.
You may also qualify for Medicaid or other health insurance programs.
Find the health insurance plan that is right for you.
Due to the COVID-19 crisis, some people no longer have health insurance coverage. Please see the information below to explore other options:
If you lost your job-based health insurance, you may qualify for a Special Enrollment Period (SEP)
ACA Marketplace, Medicaid and other health insurance programs
Health insurance contact information (websites/phone numbers)
Ombudsman Fact Sheet — provides assistance and education to Illinois consumers who do not have health insurance, are about to lose health insurance or who cannot afford to purchase health insurance
COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) is a federal law, enforced by the U.S. Department of Labor, Employee Benefits Security Administration, which provides continuation of group health coverage that otherwise might be terminated. The law contains provisions giving certain former employees, retirees, spouses and dependent children the right to temporary continuation of health coverage at group rates.
If you need further information about COBRA, HIPAA, or ERISA, visit: dol.gov/agencies/ebsa
Speak to a Live Benefits Advisor or call toll free 1-866-444-3272.
Qualifying for a Special Enrollment Period to Enroll in a Health Insurance Plan
If you recently lost your health insurance coverage through your job, you may qualify for a Special Enrollment period. Learn more.
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