State Marketplace Profiles: Illinois
Updated as of October 15, 2013
Establishing the Marketplace
While Governor Pat Quinn (D) had considered establishing a state-based marketplace via executive order, he began moving in the direction of a state-federal partnership marketplace in July 2012.1,2 While the state has established a Partnership Marketplace, the administration still intends to transition to a fully State-based Marketplace in 2015 and will continue with the necessary planning. Illinois will be performing both plan management and consumer assistance functions in the Partnership Marketplace. The Illinois Marketplace has been branded Get Covered Illinois.
In 2011, the Governor signed SB 1555 into law declaring the state’s intent to establish the Illinois Health Benefits Exchange and created the Health Benefits Exchange Legislative Study Committee.3 Legislation establishing a state-based health insurance exchange remains pending (HB 3227).4
Contracting with Plans: In December 2011, Illinois hired a subcontractor to propose a process for qualified health plan (QHP) certification, recertification, and decertification.5 The Department of Insurance also solicited input from carriers on the implementation of QHP standards. In March 2013, the Department of Insurance released guidelines for QHPs that included application guidelines and checklists.6 The guidelines specified that QHPs must offer silver and gold level plans, as well as a child-only plan. Issuers may offer multiple QHPs within metal tiers, but they must offer meaningful differences in plan designs. The bulletin also included requirements related to benefit standards, network adequacy, quality reporting, and rating standards (QHPs will be allowed to adjust their rates based on age (3:1), tobacco use (1.5:1), and 13 geographic rating areas). QHPs will be certified for one year.
On May 1, 2013, Governor Quinn announced the Department of Illinois received applications from six health insurance carriers seeking to provide 165 Qualified Health Plans through the Marketplace.7 Rates were announced in September 2013 and were lower than the Department of Health and Human Services had predicted.8
Dental and Vision Benefits: Stand-alone Dental Plans are offered through the Marketplace and are Qualified Health Plans.9 Dental benefits are also included in some comprehensive health insurance plans through the marketplace.10
Risk Adjustment, Reinsurance, and Risk Corridors (RRR): The Department of Insurance hired subcontractors in December 2011 to evaluate options for the state’s RRR programs. The final report will provide the state with a comprehensive work plan for the implementation of risk adjustment mechanisms. Based on preliminary results, the state has decided to defer to the federal risk adjustment program for 2014 (also a necessity for state-federal partnership exchanges); however the state is evaluating its capacity to run reinsurance at the state level in 2014.11
Consumer Assistance and Outreach: As a Partnership Marketplace, Illinois is prohibited from funding a Navigator program, but is required to establish an In-person Assister program. In May 2013, the state released the Request for Applications (RFA) for the In-person Counselor (IPC) program. On July 17, 2013, the state awarded grants totaling $27 million to 44 community organizations to serve as IPCs to conduct outreach and education, and facilitate enrollment in QHPs through the Marketplace and in Medicaid.12 IPCs must complete a training program designed to prepare them to educate consumers about the ACA and their health care options and pass a certification exam.
The IPC program will operate alongside a federally-funded Navigator program. On August 15, 2013, the Centers for Medicare and Medicaid Services selected 11 navigator organizations in Illinois to receive $3.1 million. The Navigators will perform any of the same roles as the IPCs. Also in August 2013, Governor Quinn signed a bill specifying certification requirements for Navigators.13 These federally-funded Navigators must be certified before performing any of their duties. In addition, they are prohibited from providing advice on which plans individuals should sign up for and must refer consumers who had previously worked with a producer back to that producer unless the producer is not authorized to sell QHPs in the Marketplace or the consumers choose not to receive assistance from the producer. Insurance Brokers are authorized to sell individual insurance plans within the Marketplace, but must be registered with CMS.14
On September 25, 2013, Illinois Health Insurance Marketplace announced “Get Covered Illinois” as the official brand name.15 The brand and logo are part of a larger statewide advertising campaign by Downtown Partners, Chicago that will gradually build through the fall and winter of 2013. Both the website and the official call center, Get Covered Illinois Help Desk, launched on October 1, 2013. The Marketplace includes plans from eight major insurance companies and at least 75 plans are offered in each county.16
Small Business Health Options Program (SHOP) Exchange: In December 2011, the state hired subcontractors to assist with SHOP-specific functions and anticipates deliverables including possible SHOP models and a work plan for the development of a SHOP Marketplace. The state also conducted a survey with potential users of the SHOP Marketplace to identify market conditions and services and features important to potential users.17 Currently, the SHOP Marketplace is facilitated by the federal government through HealthCare.gov. For plan year 2014, employers will select one health insurance plan for their employees. In subsequent years, employees will have more plan choice and employers will be able to select a fixed contribution amount and tier of coverage from which an employee can choose any plan.18
Coordination with Medicaid: Governor Quinn approved SB 26 in July 2013 to expand Medicaid to all adults with incomes below 138% of the federal poverty level (FPL).19 Individuals will answer several questions on the Get Covered Illinois website, and will either be directed to the Marketplace or to ABE, the state’s smart online application system where consumers can apply for Medicaid, nutrition, and income assistance.20
Essential Health Benefits (EHB): The Affordable Care Act (ACA) requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Marketplace, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. The Illinois Health Care Reform Implementation Council accepted public comments and recommended the BlueCross BlueShield of Illinois BlueAdvantage small group plan supplemented by the federal BlueVision package and the AllKids dental package as the benchmark package.21
In September 2010, the Illinois Department of Insurance received a federal Marketplace Planning grant of $1 million. The Department has also received three federal Level One Establishment grants-one for $5.1 million awarded in August 2011, a second for $32.8 million in May 2012, and a third for $115.8 million in February 2013.22 The grants are used to conduct research on risk adjustment, reinsurance, the navigator program, the certification of QHPs, and the SHOP Marketplace as well as to build the Governor’s health reform website.23 The state will use the majority of the funds to support the design, building, establishment, and maintenance of the IT systems required for the Marketplace. Funds will also be used to set up a design management team, continue the development of a consumer assistance portal, and continue the development of a Navigator education and training program.
On February 13, 2013, Illinois received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a Partnership Marketplace.24 The state has pursued both plan management and consumer assistance functions. Enrollment in the Marketplace began on October 1, 2013.
Illinois is also continuing its planning efforts to transition to a fully State-based Marketplace in 2015. In January 2013, the Health Care Reform Implementation Council released a survey, available to the public through the Illinois health care reform website, to seek stakeholder input on the functions of a State-based Marketplace.25
Johnson, Carla. “Ill. Governor mulls executive order on exchange.” May 14, 2012. Associated Press.
Olsen, Dean. “State to work with feds on health insurance exchange.” July 18, 2012. The State Journal-Register.
Senate Bill 1555. Introduced February 9, 2011.
HB 3227, Re-referred to Rules Committee in August 2013.
Level 1 Stage 2 Project Narrative. Demonstration of Past Progress in Exchange Planning Core Areas.
Illinois Department of Insurance. Bulletin #2013-06. March 29, 2013.
Illinois Government News Network. Governor Quinn Announced 165 Qualified Health Care Plans Apply to Provide Coverage for Illinois’ Uninsured. May 1, 2013.
Illinois Government News Network. Governor Quinn Announces Health Plan Rates are 25 Percent Below HHS Estimates. September 24, 2013.
Illinois Department of Insurance. Company Bulletin 2013-08. May 31, 2013.
Get Covered Illinois. Dental Coverage.
Performance Progress report Illinois Level 1 Exchange Establishment Grant. 6/30/12.
Office of the Governor Pat Quinn. July 17, 2013. Governor Quinn Announces 44 Community Organizations to Drive Affordable Care Act Outreach and Enrollment.
Illinois General Assembly. Public Act 98-0524. August 23, 2013.
Illinois Government, Health Care Reform. Question Area: Navigators, Agents, Brokers and IPCs.
Illinois Government News Network. September 25, 2013.
Illinois Department of Insurance. Illinois Qualified Health Plans Summary of Filed Plans as of September 25, 2013.
Performance Progress report Illinois Level 1 Exchange Establishment Grant. 6/30/12.
Illinois Health Insurance Marketplace. Small Businesses and the Affordable Care Act.
Illinois Department of Human Services. July 23, 2013.
Illinois Department of Human Services. October 1, 2013. Statewide options now available through Illinois’ Office Health Marketplace created by the Affordable Care Act.
Illinois Health Care Reform Implementation Council. September 28, 2012, EHB Workgroup.
CMS. Illinois Affordable Insurance Exchange Grants Awards List.
Letter from Secretary Sebelius to Governor Quinn. February 13, 2013.
also of interest
- Children’s Coverage: What Matters Most to Parents Results from Focus Groups in 6 Cities
- Strategies in 4 Safety-Net Hospitals to Adapt to the ACA
- How Will the Uninsured in Illinois Fare Under the Affordable Care Act?
- Fast Track to Coverage: Facilitating Enrollment of Eligible People into the Medicaid Expansion