Private coverage of abortion care in IL

As of June 2019, the Illinois Reproductive Health Act requires most private health insurance plans to cover abortion as they do other pregnancy related care no matter what the reason is for the abortion.

How do I know if my insurance plan covers abortion care? 

If your insurance plan is an Illinois-based plan and is NOT self-insured/self-funded, or a “qualified” plan, then your insurance is required to cover abortion care. 

How do I know if my plan is issued in Illinois or is a self-insured or self-funded plan? 

You should contact your employer or health insurance company directly to find out if your plan is issued in Illinois or is a self-insured, self-funded plan, or qualified health plan.

What if I am still denied even if my plan is issued in Illinois and is not a self-insured plan? 

There may be other reasons why your claim was denied. One of the most common reasons is that you have not met your deductible for out of pocket costs yet. 

Follow-up with your insurance to confirm why you were denied. Document your phone calls by noting the name of the person you speak to, the date of the call and a brief summary of the conversation including why you were denied.

What do I do if I’m denied?   

If you are wrongly denied, you can file an appeal with your insurance company. In the appeal, include your name, policy information, and the details about when and why you were denied coverage. You may also chose to file a complaint with the Department of Insurance. See below for a draft complaint letter that you may use to for your appeal or DOI complaint.  You can file both simultaneously. 

You can file your Consumer Health Care Complaint Form here: https://insurance.illinois.gov/Complaints/UnderstandComplaintProcess.html

Before filing a complaint, confirm that:

• Your plan is an Illinois based plan 

• Your plan is NOT a self- insured, self-funded, or qualified plan 

• Confirm you are denied because your plan does not cover abortion care