Your Source for Health Reform

Topic: Dept of Insurance



The DOI is the Illinois agency charged with regulating the insurance industry’s market behavior and financial solvency. As such, it implements ACA safeguards through insurer oversight, coordinates Illinois-specific training for ACA assisters and navigators, and licenses insurance agents and brokers.


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What to Know About Provider Networks

This December 2014 fact sheet from the Illinois Department of Insurance explains how consumers can know the strength of their insurance plan’s doctor and hospital network. The fact sheet details how consumers can verify that a provider is network, what to do if a type of provider is not included in a plan, and what sufficiency standards all plans are required to follow.

Beware of Out-of-Network Benefits

This December 2014 fact sheet from the Illinois Department of Insurance describes how to read an insurance plan’s summary of benefits section for the costs of out-of-network care. The information can help consumers avoid paying unexpectedly high medical bills.

Employee Choice in Illinois

The ACA requires state exchanges of the Small Business Health Options Program to offer an employee choice model which allows an employee to select from among different plans and carriers in a plan tier determined by the employer; and it allow some other models to be offered as well. This May 2012 report by the Wakely Consulting Group for the state Department of Insurance explains in detail the considerations involved in structuring the various models. The employee choice element of Illinois’ SHOP has been delayed until 2016.

Nondiscrimination for Transgender Individuals

This July 2014 bulletin from the Illinois Department of Insurance advises private insurers that many insurance plans sold in Illinois may not discriminate against transgender people and must provide them coverage for the same medical treatment available for non-transgender policy holders. The bulletin applies only to plans required to provide essential health benefits, which excludes some large employer plans issued in the state.

DOI Gives Public Access to Insurance Filings

This August 2014 announcement by the Illinois Department of Insurance describes the new online SERFF Filing Access tool, developed under the leadership of the National Association of Insurance Commissioners, which will provide the public with direct access to insurer product filings, such as rates and forms.

DOI on Illinois’ Qualified Health Plans

This September 2013 presentation by the Illinois Department of Insurance explains and discusses the range of QHPs to be offered on the Illinois Health Insurance Marketplace beginning October 1, 2013.

Small Business Engagement in the SHOP

This study, prepared in August 2012 by the University of Illinois School of Public Health for the Illinois Department of Insurance, examined the environment for developing the state’s health insurance exchange for small business. (more…)

QHP Guidance from Illinois DOI

This guidance issued in March 2013 by the Illinois Department of Insurance gives a checklist and criteria for Qualified Health Plans to be certified on the Illinois health insurance exchange. Plans had be submitted to DOI by April 30, 2013 to be certified for open enrollment in October.

Illinois DOI Health Benefits Exchange RFP

The Request for Proposal issued in December 2010 by the state Department of Insurance for a Health Benefits Exchange. (more…)

Letter to DOI: Essential Health Benefits

A letter by several groups involved with chronic conditions sent in May 2012 to the director of the Illinois Department of Insurance, asking that the department to make information available regarding to potential benchmark plans for Illinois’ Essential Health Benefits plan. The letter lists 31 health plan benefits that are important in treating heart disease, diabetes, cancer, multiple sclerosis, and stroke.

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