Conflicting advice about how to handle state insurance changes
URBANA — Enroll now. No, wait. Enroll now.
State employees and retirees continue to get conflicting messages about whether they should enroll in new health plans or wait to see if something changes, but University of Illinois employees who have to make an insurance change are being strongly advised against waiting until the June 17 deadline.
The latest advice to delay enrollment until close to the deadline came from the American Federation of State, County and Municipal Employees Council 31, which has filed a grievance about the state's insurance selections.
But everyone trying to enroll at once could overload the system and leave some people unable to enroll in a managed-care plan at all.
Those state members who don't enroll by the deadline will be default-enrolled in the state's Quality Care insurance plan, according to the Illinois Department of Healthcare and Family Services.
"I know a lot of people out there are telling you to wait and wait and wait," said Jennifer Steiling, a UI benefits officer, meeting with a large group of employees at the Beckman Institute on Thursday.
The meeting was one of seven information sessions on the new insurance choices for UI employees being held in Springfield and Urbana.
Of major importance for state members is how much it's going to cost them to access their medical providers under the new self-funded Open Access Plans being administered by HealthLink and PersonalCare.
That's been confusing, because these plans consist of three tiers, and out-of-pocket costs for members are linked to what tier in which their doctors and hospitals participate.
Open Access Plans are described as managed-care plans that offer members choice, with some level of coverage on all three tiers, and the most generous coverage on tier 1.
In Champaign County, the PersonalCare OPA includes Provena Covenant Medical Center, Christie Clinic and Carle Foundation Hospital on its tier one, and Carle doctors on its tier two, Steiling said.
The HealthLink OPA also has Covenant and Christie on its tier one, but both Carle doctors and Carle hospital are on tier two of that plan, she said.
But still ... confusion continues.
"Even Carle hospital had their information wrong on the system," Steiling said. "It's just a confusing time right now."
In an email to The News-Gazette on Thursday, Carle said it has existing contracts that cover all Carle services, including all Carle physicians and Carle Foundation Hospital services, with HealthLink and PersonalCare for the state's Open Access Plans, and with CIGNA for the state's Quality Care Health Plan, and expects to be in tier 2 of both open access plans come July 1.
But it's possible the health plans could place Carle providers and services in a different tier, Carle spokesman Sean Williams said.
"Carle patients are encouraged to choose either PersonalCare OAP or HealthLink OAP to maintain their relationship with Carle providers. It is important that state members contact their group insurance representatives or the Illinois Department of Central Management Services for any coverage details. And members are encouraged to contact the governor and their local legislators if they are dissatisfied with the decision to eliminate Health Alliance as a state benefit offering," he said.
More confusion: UI employee Katrina Little said she came to the meeting trying to sort through all the different information. For example, she said, she was told just that day that Christie Clinic primary-care doctors will be on tier one, but a Christie orthopedic surgeon would be on tier two.
Christie Clinic spokeswoman Karen Blatzer said later that all Christie doctors will be on tier one of both open access plans.
Marsha Dunlap, a Beckman Institute employee, said she has to switch from the Health Alliance HMO, and this change was thrown at her and others all at once. Now she wants to find out what it's going to cost her to keep the same doctor.
"Basically, my main concern is bottom line," she said.
Nils Oberg, a programmer in civil & environmental engineering, said he and his family are also insured by Health Alliance and are Carle patients.
"It's really unclear what my options are," he said before the meeting began.
The Illinois Department of Healthcare and Family Services will offer a second enrollment in the fall, allowing some limited switches in health plans to accommodate members who have to choose open access plans now while so many provider/health plan contracts are in the works. One major change was just announced Thursday when Springfield Clinic announced it will offer the HealthLink Open Access tier one for state employees.
Meanwhile, UI employees and others affected by the state insurance changes are being urged to study all the health plan details carefully.
"People are so confused right now, they are asking us what plan to choose," Steiling said.
MoreIt would have been nice if CMS or HFS informed ALL state employees in the area of these benefit fairs, rather than, apparently, just U of I employees. After all, HFS Director Hamos has said that HFS and CMS are committed to clearing up the misinformation that has been put out by other entities.
The fix is in.
SERS told me on Tuesday that a letter with forms is being sent to state retirees. CMS is supposed to inform current state employees also. SURS has been most helpful to the university retirees. This has been in the works for some time now; but they are just now getting the information out with a two week deadline. AFSCME is wanting more time for employees, and retirees to get the information needed in making the decision. Pity the poor person who is on vacation now. When they get back, they will be surprised with Quality Care.
Quality Care is the most expensive option available in the C-U area. While the majority of state employees in the area work for the U. of I., there are hundreds who work for DHS, HFS, Child Support, DCFS, IDOT, IDES, etc., who should have been given timely notification of related seminars or meetings. Hopefully AFSCME has legal standing to request and receive an injunction. The Governor's office almost certainly, albeit difficult to prove legally, influenced the changes and HFS Director Julie Hamos as a political appointee is supporting Gov. Quinn. Money buys influence, especially in IL. Follow the money.
Talk about confusing. I discovered that some of my doctors were not listed in PersonalCare at all, although Carle lists PersonalCare as one of the choices that will allow employees to keep their doctors. After calls to Carle and PersonalCare customer service, it appears as if PersonalCare has not updated their site, but they will cover all Carle doctors as if July 1. (Of course, there is a nice phone disclaimer that the information provided does not prove coverage, so if the representative I talked to is wrong I have no recourse). So one point is taken care of, now I can move on to the hospital coverage and the deductibles. The deductibles are the reason the Governor's office lies every time it claims state employees won't pay more under its plan. Unless and until Carle moves into a tier 1 position, the deductibles mean employees will pay hundreds of dollars they did not pay under Health Alliance. These are big changes, and July 17 is not long enough to decide.
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