Individual & Family Q&A

Yes, a number of our individual plans are designed to be compatible with HSAs.

If you choose an HSA-eligible plan design, you have the freedom to select where you would like to set up your financial HSA account. We do not contract with or recommend any HSA custodian. Contact a trusted bank or financial institution for more information about setting up an HSA.

As you become eligible for Medicare, you may continue your individual plan coverage. Please note when individual plan members become eligible for Medicare, we become a secondary payer to Medicare.

To be complete, you must send us:

• Fully completed application form.
• Check for your first month's premium or complete the Authorization for Automatic Transfer of Funds page within the application form.

We offer the following premium payment methods:

• Automated cash handling (ACH) – ACH is our automated bank withdrawal program. With ACH, the exact premium amount is automatically withdrawn from your bank account monthly.
• Direct billing – If you choose direct billing, we will bill you monthly. You may prepay your monthly premium up to 12 months in advance.

Note: Premium checks must be from a personal checking account. We will accept business account checks under these following guidelines:

• Subscriber is self-employed.
• The business is not paying for more than two employees.
• The billing address remains the subscriber's address.

Many factors determine your premium, such as:

• Tobacco/non-tobacco use
• Selection of deductible, coinsurance and benefit options
• The age of you and your spouse (if applicable) on the policy effective date
• Coverage option, for example: single, applicant/spouse, applicant and child(ren) or full family
• Location of residence

You must first pay up to the amount of your deductible before we will make payments toward services. After the deductible is met, we will pay a percentage of the coinsurance until you have met the dollar amount listed in the annual out-of-pocket limit.

For health savings account plans, if you have family coverage, the family deductible must be satisfied before we will pay for covered services.

If you need emergency care, you should call 911 or proceed immediately to the nearest medical facility. Emergency care is covered anywhere in the world. If you are out of our service area and must use a non-plan provider, call the Customer Care Center as soon as reasonably possible.

If you need urgent care and are within our service area, you must use a plan physician, clinic or urgent care facility.

If you are outside our service area and cannot safely return to receive care from a plan provider, go to the nearest appropriate medical facility and notify the Customer Care Center as soon as possible. Follow-up care must be received from a plan provider.

A qualified dependent may be the subscriber's:

• Legally married spouse 
• Partner in a Civil Union; 
• Married or unmarried biological child, stepchild, child of a partner in a Civil Union, adopted child, foster child, legal ward and any child placed for adoption (by court order, a licensed county agency, an Illinois child welfare agency, or a child welfare agency licensed by another State) through the end of the month in which the child turns 26 years of age. All placements and adoptions must follow Illinois placement and adoptions laws. Contact our Customer Care Center if you have any questions; 
• Biological child, stepchild, child of a partner in a Civil Union, foster child, or adopted child who was called to active duty prior to reaching the age of 27 and is a full-time student. The child has up to 12 months after completing active duty to apply for full-time student status at an institution of higher education. If the child has been called to active duty more than once in four years since the first call to active duty, eligibility will be determined based on the child’s age at the time of the first call to active duty; 
• Dependent's biological child until the Subscriber’s dependent reaches the age of 18.