POLICY

  1. Families whose children are enrolled under private insurance plans are required to use their benefits to assist in meeting the costs of covered Early Intervention (EI) services and Assistive Technology devices unless a pre-billing waiver or insurance exemption has been approved prior to services being rendered. Insurance waivers and exemptions cannot be backdated and only cover dates of service after the approval date.
    1. The CFC will forward insurance documentation in the form of the insurance card, the Insurance Affidavit, Assignment and Release form and the CFC Fax Cover Sheet for Insurance Requests to the EI Central Billing Office (CBO) for a limited benefit verification in order to help the CFC determine the appropriate service provider based on insurance company restrictions and requirements. The family and the service provider in cooperation with the insurance company will determine insurance benefits for service provision purposes. NOTE: Information obtained by the CBO is limited and should not be used by providers in place of verifying benefits for their own billing and service provision purposes.
  2. All EI service providers are required to bill private insurance prior to billing the CBO unless a pre-billing waiver or insurance exemption has been approved. The only exceptions are: Developmental Therapists, Interpreters, Deaf Mentors, and Physicians providing only medical diagnostics, Transportation providers and Parent Liaisons.
  3. Families may request exemption from private insurance use for one or more services if such use would put the family at material risk of losing their coverage as specified on the Insurance Exemption Request form. Submit a request for exemption if the following criteria apply.
    1. The individual insurance plan/policy covering the child was purchased individually and the child is not eligible for group medical insurance.
    2. The child's private insurance plan/policy has a lifetime cap (annual cap does not apply) for one or more types of early intervention services, which could be exhausted during the IFSP period based on the estimated cost of the EI services.
  4. Service Coordinators are required to enter public and/or private insurance information in Cornerstone on the PA35 screen. The CBO is responsible for entering the insurance detail into the CBO system. Information entered into the CBO system is sent back to each CFC through the Cornerstone "begin of day" process.
  5. Families, including families with private insurance who may be eligible for All Kids or Division of Specialized Care for Children (DSCC) services as indicated by the Screening Device For Determining Family Fees and Eligibility for All Kids and DSCC (Screening Device), are required to apply for benefits through All Kids or accept referral to DSCC in order to initiate and remain eligible for EI services, except for those services that are available at no cost to the family. NOTE: The All Kids program encompasses a population that extends beyond the scope of the annual gross income identified on the Screening Device For Determining Family Fees and Eligibility for All Kids and DSCC. Families whose income exceeds the annual gross income identified on the Screening Device may be eligible for All Kids Level 2 and above. Families who do not have insurance are strongly encouraged to complete the All Kids Application. However, for this population only, failure to complete the application does not prevent those families from receiving all EI services that a child might be determined eligible to receive. Families who have All Kids Level 2 and above may be assessed a family fee.
  6. As payer of last resort, all other resources must be maximized to cover the costs of EI services prior to utilizing state and federal resources for EI services. If a family refuses to utilize other available resources to cover the cost of services, including noncompliance with EI system requirements such as enrollment with All Kids, etc., the family (with or without private insurance) will only be able to receive EI services that are available at no cost to the family. See note above concerning the All Kids Level 2 and above.

PROCEDURES

the list styles have changed due to the original list not being available in this format

  1. Determining Other Eligibility

    During Intake and prior to each annual IFSP, complete the Screening Device For Determining Family Fees and Eligibility for All Kids and DSCC to determine potential eligibility for All Kids and/or DSCC services. (See INTAKE for procedure). If indicated, complete and submit an All Kids application and/or make a referral to DSCC. As part of the referral to DSCC and with proper authorization (documented with the Consent for Release of Information form), send a copy of the completed Screening Device For Determining Family Fees and Eligibility for All Kids and DSCC and the following Cornerstone screens/reports to the DSCC local office: Participant Enrollment Information, Assessment History, and Insurance. File the completed Screening Device and Consent form in the child's CFC permanent record. NOTE: Refer to Chapter 18 of the Cornerstone Reference Manual for information concerning the Cornerstone screens/reports.

Documenting Insurance Coverage

  1. Complete the following steps to document insurance coverage.
    1. Assist the family in completion of the Insurance Affidavit, Assignment and Release form.
    2. If the child has private health insurance ONLY, obtain a copy of the current insurance card for the hardcopy record and enter "BILL INSURANCE FIRST" on the Cornerstone PA35 screen.
    3. If the child has public health insurance (All Kids) ONLY, input the child's All KidsRecipient Identification Number (RIN) into Cornerstone and enter "NO PRIVATE INSURANCE" on the PA35 screen.
    4. If the child has both public and private health insurance enter "BILL INSURANCE FIRST" on the PA35 screen and also input the child's All Kids Recipient Identification Number (RIN) into Cornerstone.
    5. If the child does not have public and/or private health insurance enter "NO PRIVATE INSURANCE" on the PA35 screen.
    6. If the child's insurance is provided through the Illinois Comprehensive Health Insurance Program (CHIP), enter "BILL INSURANCE FIRST" on the PA35 screen.
      1. A family enrolled in the CHIP program automatically qualifies for an insurance exemption. However, the Service Coordinator must still submit insurance documentation in the form of the insurance card, the Insurance Affidavit, Assignment and Release and the CFC Fax Cover Sheet for Insurance Requests to the EI Central Billing Office (CBO) for verification. NOTE: Refer to 3.0 and 4.0 for procedures to submit insurance documentation.
      2. Upon receipt of verification that the family is enrolled in the CHIP program, the Processor will issue a pre-approved Insurance Exemption Request form and a completed CBO Insurance Benefit Verification form and forward them to the CFC.
    7. If a child's insurance is provided through the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) or the Medical Program of the Veterans Administration (CHAMPVA), enter "BILL INSURANCE FIRST" on the PA35 screen.
      1. CHAMPUS and CHAMPVA are administered by TRICARE. TRICARE requires an "Authorization to Disclose Information" form to be submitted and processed by TRICARE before information can be released to the CBO to complete the insurance benefit verification process. Complete the form and submit it to the child's insurance company prior to submitting the CBO Insurance Benefit Verification form to the CBO. The authorization line on the TRICARE form must always state "All Representatives of the Early Intervention Program".
      2. For these plans the Service Coordinator must also submit a Social Security number to the CBO.

Forwarding Insurance Documentation

  1. The CFC will obtain the following information from the family and forward via fax to their assigned Insurance Claims Processor at the CBO:
    1. A copy of the front and back of the child/family's insurance card; and
    2. A completed Insurance Affidavit, Assignment and Release; and
    3. A completed CFC Fax Cover Sheet for Insurance Requests; and
    4. If there has been a change in insurance and the CFC is updating insurance information, a completed Change of Insurance Notification form; or
    5. If the Family has chosen to complete the Insurance Exemption Request prior to the initial IFSP, also submit a copy of that form. NOTE: It is important to complete the Insurance Exemption Request form as early in the intake process as possible in order to prevent delays in the ability to generate authorizations and begin direct service provision. See Intake section for information on completing this form prior to the initial IFSP. 

CBO Benefit Verification

  1. Upon receipt of the required insurance information from the CFC, CBO staff will contact the insurance company for basic benefit verification to assist the CFC in making referrals to providers in accordance with insurance requirements.
    1. The CBO Insurance Claims Processor will contact the insurance company for basic benefit verification for PT, OT and ST service only, unless otherwise specified on the CFC Fax Cover Sheet for Insurance Requests.
    2. If the insurance plan does not limit provider choice, the Processor will forward a completed CBO Insurance Benefit Verification form to the CFC within five (5) business days. NOTE: Data received after noon, will be counted as received the following business day.
    3. If the insurance plan does limit provider choice, the Processor will compare a list of insurance mandated providers with enrolled EI providers and will forward the resulting list and a completed CBO Insurance Benefit Verification form to the CFC. The list will include providers whose addresses fall within 50 miles of the family's address.
    4. The Insurance Benefit Verification form issued by the CBO is not to replace the more detailed insurance benefit verification that must be completed by providers. It is the responsibility of the provider to verify benefits with the insurance company. If a provider fails to verify benefits, they may not be paid if discrepancies occur.
    5. If an Insurance Exemption Request or Pre-Billing Insurance Waiver Request form has not previously been submitted, upon receipt of the CBO Insurance Benefit Verification form from the CBO the Service Coordinator will review the form closely to determine whether a pre-billing waiver or exemption might apply.

Determining the Need for a Pre-billing Waiver

  1. During the Benefit Verification process if the Processor determines that the plan limits provider choice, the CBO will forward a list of EI enrolled insurance mandated providers whose addresses fall within 50 miles of the family's address to the CFC. Upon review of the list of insurance mandated providers the CFC may determine that a pre-billing waiver should be requested based upon any of the following circumstances.
    1. An insurance mandated provider is not available to receive the referral and begin services immediately (within 15 business days). This reason should also be used if the insurance mandated provider is unable to perform the services as written in the IFSP. Required documentation includes:
      1. The insurance company website listing of insurance required providers; or
      2. Notes from CFC staff conversations with the insurance company including the name of the contacted representative, date of contact, and phone number or email address; and
      3. Date services could begin by the insurance mandated provider
    2. When services are to be rendered in a center or office location and the family would have to travel more than an additional 15 miles or an additional 30 minutes to the insurance provider as compared to travel to a different enrolled provider (APPLICABLE FOR CENTER BASED SERVICES ONLY). Required documentation includes:
    3. Name, address and contact information of the EI enrolled and credentialed provider to whom the waiver is applicable; and
    4. Description of the family's primary mode of transportation; and
    5. The address that the family would be traveling from.
  2. The Service Coordinator must complete the following steps to submit a request for a Pre-Billing Waiver:
    1. Determine which type of waiver applies.
    2. Complete all information on the Pre-Billing Insurance Waiver Request form including:
      1. Child's full name;
      2. Child's date of birth;
      3. Child's EI number;
      4. Current IFSP begin date (Waivers can only be requested within the current IFSP period);
      5. Current IFSP end date;
      6. Pre-billing waiver request type;
      7. Provider's name (if identified), discipline and tax ID number;
      8. Parent or guardian's signature, address and date signed; and
      9. CFC Manager and Service Coordinator signature and date signed.
    3. Forward the form to the CBO along with all required documentation. Note: If any item on the form is missing or incomplete, the Pre-Billing Waiver request cannot be processed.
      1. The CBO will provide determination of the Pre-Billing Waiver request to the CFC within 10 business days of receipt of the request.
      2. Attach all documentation to the original waiver and maintain in the child's CFC permanent record.
    4. Eligibility for a Pre-Billing Insurance Waiver must be redetermined and re-issued at the time of the annual IFSP Meeting or earlier if the family reports a change to one or more of the situation's specified in the "Documenting Insurance Coverage Procedure" of this section. NOTE: It is not necessary to reissue a Pre-Billing Insurance Waiver to cover the time period created by extending an IFSP end date. Notify the CBO of the extension by emailing the information to your assigned Insurance Claims Processor or by faxing it to the Processor at: 877/895-8197.
  3. During the Benefit Verification process the Processor may determine that the plan limits provider choice and in limited situations, a pre-approved, pre-billing waiver may be automatically generated to allow authorizations for direct service provision to be made to any available enrolled EI provider. The Processor will issue a pre-approved Pre-Billing Waiver Request form for PT, OT and ST services only, unless another service was otherwise specified on the CFC Fax Cover Sheet for Insurance Requests. The situations in which a pre-approved, pre-billing waiver may be generated include the following.
    1. There are no insurance mandated providers that are also credentialed/enrolled as providers in the EI Services System.
      1. If none of the insurance mandated providers are enrolled EI providers, the Processor will issue an approved Pre-Billing Waiver Request form and a completed CBO Insurance Benefit Verification form and forward them to the CFC.
      2. If waivers are required for services other than those previously specified on the CFC Fax Cover Sheet for Insurance Requests, the CFC will send a new Fax Cover Sheet that identifies the specific service(s) and a Pre- Billing Waiver Request form to the CBO. Such requests will be completed and returned to the CFC within five (5) working days.
    2. The required Primary Care Physician (PCP) referral is unobtainable.
      1. If it is determined that a PCP referral is required in order for the insurance company to approve benefits, the CBO Insurance Claims Processor will contact the PCP to determine the PCP's referral requirements and procedures.
      2. If the PCP will not refer to an enrolled EI provider, the Processor will issue a pre-approved Pre-Billing Waiver Request form and a completed CBO Insurance Benefit Verification form and forward them to the CFC. NOTE: A physician's prescription must still be obtained prior to direct service provision, routed to the appropriate service provider and a copy maintained in the CFC permanent record for services that will be provided by Audiologists, Speech Language Pathologists, Occupational Therapists, and Physical Therapists:

Determining the Need for an Insurance Exemption

  1. If the family qualifies for Insurance Use Exemption, provide them with a copy of the Insurance Exemption Request form and explain the three types of exemptions that may be requested which include the following.
    1. Private Purchase/Non-Group Plan - the plan was purchased privately and is not part of a group plan. Required documentation to CBO includes:
      1. Current written documentation from the insurance company that demonstrates that the plan was purchased privately and is not part of a group plan; and
      2. If a CBO Insurance Benefit Verification form was previously completed by the CBO, also submit a copy of that form.
    2. Lifetime Cap on some or all IFSP services - there is a lifetime cap (annual cap does not apply) for the insurance plan or for a specific service that could be endangered by billing the insurance for EI services. Required documentation to CBO includes:
      1. Written documentation from the insurance company that states the amount of the cap; or
      2. Written documentation from the insurance company that shows the remaining amount of the cap that has not been expended if that figure is to be used in considering the validity of the request; and
      3. Copies of the Cornerstone direct service authorizations.
    3. Illinois Comprehensive Health Insurance Program - A family enrolled in the Illinois Comprehensive Health Insurance Program (ICHIP) automatically qualifies for an insurance exemption. Required documentation to CBO includes:
      1. A copy of the ICHIP insurance card.
  2. Complete all information on the Insurance Exemption Request Form including the following:
    1. Child's full name;
    2. Child's date of birth;
    3. Child's EI number;
    4. Current IFSP begin date if established (Exemptions can only be requested for the IFSP period during which they are requested);
    5. Current IFSP end date if established;
    6. Specify the type of exemption requested;
    7. Services for which the exemption is requested (for lifetime cap requests only);
    8. Parent or guardian's signature, address and date; and
    9. CFC Manager and Service Coordinator signature and date.

NOTE: It is important to complete the Insurance Exemption Request form as early in the intake process as possible in order to prevent delays in the ability to generate authorizations and begin direct service provision. If this form is submitted during the intake process it will be prior to the IFSP Meeting. Therefore, there will not yet be an established IFSP begin and end date.

  1. Based upon the type of exemption requested, forward all required documentation and the completed Insurance Exemption Request form to the CBO. Note: If any item on the form is missing or incomplete, the form will be returned to the sender for completion.
    1. The CBO will provide determination of the Exemption request within 10 business days of receipt of the request.
    2. Forward a copy of the approved/denied Insurance Exemption Request form to all applicable providers.
    3. Eligibility for Insurance Exemption must be re-determined and re-issued at the time of the annual IFSP meeting or earlier if the family reports a change to one or more of the situations specified in the Documenting Insurance Coverage Procedure of this section. NOTE: It is not necessary to reissue an Insurance Exemption Request to cover the time period created by extending an IFSP end date. Notify the CBO of the extension by emailing your assigned Insurance Claims Processor or by faxing the information to your assigned processor at: 877/895-8197.

  2. Types of Plans and Provider Restrictions

    1. No provider restrictions apply in the following situation.
    2. The insurance company does not limit which providers the family may choose for direct service provision. Under this situation the CFC may refer the child to any EI enrolled provider that a family may choose for direct service provision.
    3. Upon making the referral the CFC must explain to the provider that the initial benefit verification indicated that the plan does not limit which providers may be chosen to provide direct services. However, it is still the responsibility of the provider to verify with the insurance company that the services they will be providing, as outlined by the IFSP, are consistent with the provisions of the plan and to determine if any special considerations must be made prior to beginning services.
  3. Provider restrictions do apply in the following situations.
    1. The insurance company requires providers to enroll in order to receive payment from the insurance company directly. If the provider does not enroll, payments are rendered directly to the insurance policy holder.
      1. The insurance company has indicated that providers must become an enrolled provider before payment can be made directly to the provider.
      2. Providers may be able to provide services for such insurance companies, however payment and Explanation Of Benefits (EOBs) will be sent directly to the insurance policy holder (family). The provider would then be responsible for working with the family in order to obtain the insurance payment and copies of the EOBs.
      3. In this situation it is critical for the provider to obtain copies of the EOBs in case the provider is required to seek additional payment from the CBO, as DHS policy requires that such claims be accompanied by an insurance company's EOBs.
  4. The insurance company will only cover the costs of services rendered by providers that are enrolled in their network.
  5. Flexibility in Provider Restrictions - In these situations, the provider could be paid for services if certain conditions are met. If those conditions are not met, services are only reimbursed if rendered by a preferred provider and the denial from the insurance company typically will not allow the provider to be paid by the CBO.
    1. Out of Network Benefits Available
      1. The insurance company has an enhanced reimbursement rate for providers that are enrolled in their preferred or closed networks but offer a lower rate of reimbursement to providers that are out of network
      2. CFCs may refer the child to an out of network Early Intervention credentialed provider
    2. Primary Care Physician (PCP) Referral Required
      1. The insurance company will provide payment to non-enrolled or preferred providers as long as the child's PCP has referred the child to the provider prior to beginning services.
      2. The family should assist the provider in obtaining the PCP referral if necessary.
      3. If a PCP's referral is required for the family to see providers other than those mandated by the insurance company, but one is unable to be obtained, the family will be required to utilize the insurance mandated provider unless a Pre-Billing Waiver Request is applicable and approved prior to service provision.
  6. Preferred Providers Only (PPO)
    1. The insurance company has indicated that providers must apply and become a preferred provider or claims will be denied.
    2. The CFC is only allowed to make direct service referrals to providers included in the insurance company's network. If none of the insurance company mandated providers are able to see the child for one of the Pre-Billing Waiver reasons, the CFC should request a Pre-Billing waiver from the CBO (process outlined above) in order to make a referral to a non-insurance required EI credentialed provider
    3. If a waiver is requested, the CFC will not make a referral for direct service provision until the approval/denial for insurance waiver has been received from the CBO.

Determining the Provider

  1. Based upon the type of insurance, insurance restrictions, waivers or exemptions, assist the family to choose a provider by giving the family a list of enrolled EI providers in the geographic area. Determination of benefits AND OUT OF NETWORK PAYMENT STATUS is established in cooperation between the family, insurance company, and the provider.
    1. IF THE INSURANCE COMPANY will not approve payment to an out-of-network provider, the family will be required to accept services from an in-network provider in accordance with all applicable EI rules and statutes.
  2. Print and attach the following information to the full IFSP and distribute the information to the IFSP team members and the family:
    1. Front and back of family's insurance card, if applicable;
    2. Insurance Affidavit, Assignment, and Release form;
    3. Insurance Exemption Request form, if applicable; and
    4. Pre-Billing Waiver Request form, if applicable.
  3. Tell families that they must inform their Service Coordinator immediately if the child's All Kids or private insurance coverage changes. Failure to inform the Service Coordinator of the change may result in the provider's inability to receive payment from the insurance company and/or the CBO.

Updating Insurance Information

  1. When a family's insurance coverage changes or insurance coverage is obtained for the first time on an active child who is already receiving EI services, the provider is given 45 days from the date that the CBO receives a copy of the insurance card or the information identified in Procedure 20.0 below in order to determine what, if any, provider restrictions and/or pre-authorization requirements the new insurance carrier has on their plan. The provider may bill the CBO for dates of service that fall within that 45 day time frame. Under these circumstances it is the responsibility of the Service Coordinator to assist the family by immediately beginning the steps to complete the change of insurance and the CBO insurance benefit verification process.
    1. When the CFC receives notification from the family or a service provider that insurance coverage has changed, the CFC must immediately begin the steps to complete the change of insurance process by completing the following steps:
      1. Document insurance coverage in Cornerstone (see Documenting Insurance Coverage Procedure);
      2. Forward the new insurance information to CBO, including a completed Change of Insurance Notification form (see Forwarding Insurance Information Procedure);
      3. Begin the CBO insurance benefit verification process (see CBO Benefit Verification Procedure); and
      4. If the CFC has determined the need for a Pre-Billing Waiver, submit a Pre-Billing Waiver Request form (see Determining the Need for a Pre- Billing Waiver Procedure). The 45-day period will begin on the date that the CBO receives a copy of the new insurance card and the forms identified above.
    2. During this 45-day period, all providers should bill the CBO for services. No insurance company EOB will be required during this period unless all conditions and requirements of the new insurance plan have been identified and met by the provider or until the expiration of the 45-day period. NOTE: At the end of the 45-day period providers will no longer receive payment from the CBO.
    3. During their monthly contact with the family the Service Coordinator should always check to determine if the family's insurance status or any other pertinent family information has changed. If any pertinent information has changed, the Service Coordinator should immediately takes the steps required to update the child's information with the CBO or in the Cornerstone system
  2. If the new insurance card is not yet available, the CFC must complete and forward the following information to the CBO. A new Insurance Affidavit, Assignment and Release form, the CFC Fax Cover Sheet for Insurance Requests and the following information related to the new insurance company on the Change of Insurance Notification form:
    1. Name of the new insurance company;
    2. Policy number;
    3. Phone number for the new insurance company;
    4. Policy holder's name;
    5. Policy holder's date of birth;
    6. Child's name;
    7. Child's date of birth; or
    8. Written information from the insurance company that contains the information found in a) through g) above.
  3. Upon verification of a change in insurance coverage from private insurance to public insurance (i.e., All Kids):
    1. Change the PA35 screen in Cornerstone to "NO PRIVATE INSURANCE".
    2. Complete an F2-SHARE function in Cornerstone to bring any existing All Kids information into the child's electronic EI record.
    3. If existing All Kids information is available, check to make sure the information is accurate.
    4. If no existing All Kids information is available, enter the child's public insurance information into Cornerstone.
    5. Follow Cornerstone procedures to discontinue existing provider authorizations and generate new provider authorizations to reflect the change in insurance status and immediately fax the new authorizations to providers.
  4. Upon verification of a change in insurance coverage from private or public insurance to no insurance:
    1. Notify the CFC Insurance Claims Processor by sending the Processor an email stating that there has been a change in insurance coverage to "No Insurance".
    2. The Processor will respond via email within five (5) business days and will provide the CFC with conformation and/or information concerning the status of the insurance policy.
    3. Based upon the information received from the Processor, change the PA35 screen in Cornerstone to NO PRIVATE INSURANCE, if necessary.
    4. Follow Cornerstone procedures to discontinue existing provider authorizations and generate new provider authorizations to reflect the change in insurance status and immediately fax the new authorizations to providers.
  5. Upon verification of a change in insurance coverage from public insurance to private insurance:
    1. Notify the CFC Insurance Claims Processor by forwarding the new insurance information to CBO, including a completed Change of Insurance Notification form (see Forwarding Insurance Information Procedure).
    2. Begin the CBO insurance benefit verification process (see CBO Benefit Verification Procedure).
    3. If the CFC has determined the need for a Pre-Billing Waiver, submit a Pre-Billing Insurance Waiver Request form (see Determining the Need for a Pre-Billing Waiver Procedure).
    4. Based upon the information received from the Processor, change the PA35 screen in Cornerstone to "BILL INSURANCE FIRST".
    5. Follow Cornerstone procedures to discontinue existing provider authorizations and generate new provider authorizations to reflect the change in insurance status and immediately fax the new authorizations to providers.

PROVIDER RESPONSIBILITIES

  • 23.0 The EI provider must verify that IFSP services are a covered benefit under the insurance plan. There may be multiple plans. For example, vision or speech related services may be covered in a separate policy.
  • 23.0 The provider should always check with the family when providing direct services to determine if the family's insurance status has changed. If the provider learns that the insurance has changed, the provider should inform the CFC immediately so that the CFC can begin the change of insurance process.

DEFINITIONS

Enrolled Provider
A provider that is credentialed and enrolled in the EI Services System to provide direct service to children.

Approved Provider
A provider that is authorized to provide services and bill an insurance company as part of their network of providers.

Private Plans

  • Health Maintenance Organization - HMO
    An HMO relies heavily on their network of providers and will typically require documentation and a standardized process to cover providers outside the network.
  • Preferred Provider Organization - PPO
    PPO contracts with a network of preferred providers but will reimburse at a lower rate for out-ofnetwork providers.
  • Point-of-Service - POS
    A POS plan combines an HMO and PPO. A provider may subscribe to one or both plans. Because of the PPO component, out-of-network providers may be used. When requesting a list of network providers make certain both HMO and PPO providers are being included.
  • Private Insurance - Group (may also be HMO, PPO or POS)
    Group insurance is usually offered through an employer. The employer may purchase a policy from an insurance company or may administer its own (self-insured) plan. Group health insurance may also be offered through other organizations or special-interest groups. Coverage varies with each plan.
  • Private Insurance - Individual (may also be HMO, PPO or POS)
    Health insurance is purchased out-of-pocket directly from an insurance company to cover one of more members of a family. Coverage varies widely with each plan. This type of plan is eligible for an Insurance Exemption.

Government - Sponsored Health Plans

  • Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) and
    Civilian Health and Medical Program of the Veterans Administration (CHAMPVA)
    These are federal programs to cover health expenses of the dependents of military personnel and veterans. They are secondary to commercial health plans. Military medical-care providers are to be used if available. Prior authorization may be required for use of civilian providers. Administered by TRICARE.
  • Illinois Comprehensive Health Insurance Plan - ICHIP
    CHIP is a state-subsidized program for Illinois residents who cannot otherwise purchase major medical insurance due to a pre-existing condition or disability. It is administered by Blue Cross/Blue Shield of Illinois

Public - Sponsored Health Plans

All Kids
All Kids is a comprehensive health insurance program that is available to uninsured children in the State of Illinois. It is administered by the Illinois Department of Healthcare and Family Services and includes the following:

Medicaid/All Kids Assist
Medicaid is a federally assisted program to help with medical expenses of eligible low-income families. It is administrated through the Illinois Department of Healthcare and Family Services.

All Kids Share, Premium or Rebate
Children whose families are not eligible for Medicaid (All Kids Assist) due to income may be eligible for these low-income programs.

  1. All Kids Share and Premium require a co-pay for services.
  2. All Kids Premium also requires payment of a premium.
  3. All Kids Rebate reimburses the policyholder for the cost of other health insurance.