On July 1, 2013, operation of the Illinois Pre-Existing Condition Insurance Plan (IPXP) is transitioning to the federally run Pre-Existing Condition Insurance Plan (PCIP). Members should watch for a letter from the federal government that includes the PCIP Enrollment Form (shown below). PCIP coverage runs through December 2013.
IPXP/PCIP Information and Resources:
- PCIP Enrollment Transition FAQ
- PCIP Transition of Care
- PCIP Prosthetic Preauthorization Form
- PCIP Spinal Surgery Preauthorization Form
- PCIP Durable Medical Equipment Preauthorization Form
- PCIP Benefits Summary
- IPXP (State of Illinois) Notification Letter
- PCIP Enrollment Form
- Enrollment Suspension FAQ
- Answers to frequently asked questions about IPXP enrollment suspension.
- Benefit Plan Highlights
- Information about what IPXP covers.
- Find A HealthLink Network Provider
- For residents of Alexander, Bond, Calhoun, Clinton, Cook, DuPage, Hardin, Jersey, Kane, Kendall, Lake, Madison, Massac, McHenry, Monroe, Pope, Pulaski, St. Clair and Will counties.
- Find A Health Alliance Network Provider
- For those who do not reside in the HealthLink counties above.
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- Contact Us
Some of the coverage highlights of IPXP include:
- Preexisting conditions are covered.
- Choice of four calendar year deductibles: $500, $1,000, $2,000 or $5,000.
- PPO coverage.
- Prescription drugs covered without a deductible (except for the $5,000 deductible plan) with an out-of-pocket maximum of $1,600 per calendar year. Services other than prescription drugs subject to calendar year deductible.
- Coinsurance for all services is 20% with the $500, $1,000 and $2,000 deductible plan (for non-preferred PPO providers coinsurance is 40%). With the $5,000 deductible plan, there’s no coinsurance after the deductible is met (for non-preferred PPO providers coinsurance is 20%).
- Calendar year out-of-pocket limits: Out-of-pocket expenses are limited each calendar year for major medical expenses.
|For the $500 deductible plan: $2,850.|
|For the $1,000 deductible plan: $3,350.|
|For the $2,000 deductible plan: $4,350.|
|For the $5,000 deductible plan: $5,000.|
|For the $500 deductible plan: $5,000.|
|For the $1,000 deductible plan: $5,500.|
|For the $2,000 deductible plan: $6,500.|
|For the $5,000 deductible plan: $7,150.|