Enrollee Protection

Enrollee Protection

The Illinois Health Maintenance Organization Guaranty Association is a non-profit organization that provides limited protection to HMO enrollees who reside in Illinois when an HMO licensed in Illinois becomes insolvent. That protection extends to enrollees’ beneficiaries, payees and assignees in certain circumstances.

The protection provided by the Association is based on Illinois law and on the contractual obligations of the insolvent HMO to its enrollees at the time of the insolvency.  The aggregate statutory liability of the Association cannot exceed $500,000 with respect to any one individual.

The Board assesses Member HMOs for the funds necessary to carry out the powers and duties of the Association.

HMOs and agents are prohibited by state law from using the existence of the Association to solicit enrollees in health care plans.

If you are not an Illinois resident:  Nonresident enrollees of an Illinois HMO may be protected by this Association if:  (1) they reside in states which have associations similar to this Association; (2) they are not eligible for coverage by such associations; (3) the insolvent HMO never held a license or certificate of authority in such states; and, (4) the insolvent HMO was domiciled in Illinois.

The Association is not a licensed HMO and does not sell health care plans.  If you are an enrollee of an HMO and need coverage information for your existing HMO, please contact your HMO or the Illinois Department of Insurance at 1-217-782-4515.

For more information about the Association please review the Frequently Asked Questions (FAQs) section of this website.