Key Takeaways
- Illinois group health insurance is regulated under both state and federal law (ERISA, ACA)
- COBRA continuation coverage applies to employers with 20 or more employees
- Illinois mini-COBRA applies to employers with fewer than 20 employees
- Small group defined as 2-50 employees in Illinois
- Mental health parity requirements apply to group health plans
Illinois Group Health Insurance
Illinois group health insurance is heavily regulated at both state and federal levels to protect employees and their dependents.
Regulatory Framework
| Regulation | Applies To |
|---|---|
| ERISA | Most private employer plans |
| ACA | All health plans |
| Illinois Insurance Code | Insured group plans |
| Illinois HMO Act | HMO group plans |
Group Size Definitions
Illinois uses federal group size definitions:
| Market Segment | Employee Count |
|---|---|
| Small Group | 2-50 full-time equivalent |
| Large Group | 51 or more full-time equivalent |
Small Group Requirements
Illinois small group health insurance must provide:
- Guaranteed issue (cannot deny coverage)
- Community rating (no health-based rates)
- Essential health benefits
- Mental health parity
- No pre-existing condition exclusions
COBRA Continuation Coverage
The federal COBRA law requires continuation coverage:
COBRA Basics
| Aspect | Requirement |
|---|---|
| Applies To | Employers with 20+ employees |
| Duration | 18-36 months depending on event |
| Premium | Up to 102% of group rate |
| Coverage | Same as active employees |
Qualifying Events
| Event | Duration |
|---|---|
| Employment termination | 18 months |
| Reduced hours | 18 months |
| Divorce/legal separation | 36 months |
| Death of employee | 36 months |
| Medicare entitlement | 36 months |
| Dependent child aging out | 36 months |
Exam Tip: COBRA applies to employers with 20 or more employees. For smaller employers, look to Illinois mini-COBRA.
Illinois Mini-COBRA
For employers with fewer than 20 employees, Illinois provides mini-COBRA continuation:
Mini-COBRA Coverage
| Aspect | Illinois Requirement |
|---|---|
| Applies To | Employers with 2-19 employees |
| Duration | Up to 12 months |
| Premium | Up to 102% of group rate |
| Coverage | Same benefits as active employees |
When Mini-COBRA Applies
- Employee loses coverage due to termination or reduced hours
- Dependent loses coverage due to death, divorce, or age-out
- Employee becomes Medicare-eligible
Mental Health Parity
Illinois requires mental health parity in group health plans:
Parity Requirements
| Aspect | Must Be Equal |
|---|---|
| Copays | Same as medical/surgical |
| Deductibles | Same as medical/surgical |
| Annual Limits | Same as medical/surgical |
| Lifetime Limits | Same as medical/surgical |
| Treatment Limits | Same as medical/surgical |
Covered Conditions
Illinois mental health parity applies to:
- All mental health conditions
- Substance use disorders
- Autism spectrum disorders
- Behavioral health conditions
HIPAA Portability
Group health plans must comply with HIPAA portability:
Key HIPAA Provisions
- Cannot deny enrollment based on health status
- Must provide certificate of creditable coverage
- Limits pre-existing condition exclusions
- Protects against discrimination
What is the minimum employer size for federal COBRA to apply?
How long is Illinois mini-COBRA continuation coverage?
What does mental health parity require in Illinois group health plans?
What is the definition of a small group in Illinois?