Health Alliance Medical Plans' top executive expects glitches and confusion as Illinois' health marketplace opens for business Tuesday but says the company has taken steps to handle a glut of incoming calls.
Editor's note: Jeff Ingrum, president and CEO at the Urbana-based Health Alliance Medical Plans, will be a guest on "Penny for Your Thoughts" at 10 a.m. Tuesday on WDWS AM-1400. He will be talking about the start of the state's health insurance marketplace under the federal Affordable Care Act.
URBANA — Health Alliance Medical Plans' top executive expects glitches and confusion as Illinois' health marketplace opens for business Tuesday but says the company has taken steps to handle a glut of incoming calls.
Health Alliance has added more than a half-dozen extra customer service representatives who have been trained to handle inquiries for the state marketplace and has a Bloomington call center available to handle some routine calls that aren't related to marketplace insurance plans, to prevent its phone lines from becoming overloaded, according to the company's CEO Jeff Ingrum.
Nobody could predict how many people would try to sign up for insurance coverage and tax subsidies through the marketplace — which has been named Get Covered Illinois — on its first day, Ingrum said. But Health Alliance expects to get the calls from people hitting snags, especially those in communities where it is the major insurer.
"Because of the fact that things aren't going to be working smoothly, they will turn to their insurance company," he said.
Urbana-based Health Alliance is one of eight insurers that will be offering health plans in the Illinois marketplace, one of the state exchanges set up to sell health coverage under the Affordable Care Act. Illinois's marketplace is one of the exchanges that will be operating as a state-federal partnership.
Ingrum said Health Alliance's contracts were signed a couple of weeks ago, approving final details and rates for the nine individual plans and 13 small group plans the company is offering in 97 counties through the Illinois marketplace.
Details of those plans have been closely guarded until the marketplace opens online. Health Alliance didn't disclose details of its own plans and couldn't learn what its competitors are offering until they became public Tuesday, he said.
For the first year of enrollment, the state projects about 300,000 Illinois residents will enroll in health coverage through the marketplace, with Ingrum looking for 6,000 to 10,000 of those new enrollees to sign up for Health Alliance, he said.
The company expects to pick up less business in the small-group market the first year, because of a delay in part of the Affordable Care Act intended to provide health coverage for small businesses and their employees. For the first year, employers will be limited to offering a single health plan choice, rather than multiple plans.
"We're being very cautious," Ingrum said about projections. "Obviously there are a lot of unknowns about how this will work."
Another unknown: How young adults who are currently uninsured will respond to the requirement under the Affordable Care Act that nearly everyone have health insurance next year or pay a penalty. Ingrum looks at potential premium costs even for those at the lowest income entering the marketplace versus the penalty for the first year, and projects accordingly.
"I think there is significant likelihood that a lot of the younger population will take the penalty," he predicted.
The process for Health Alliance leading up to the opening of Illinois' marketplace has been frustrating, Ingrum said.
Many of the final rules and regulations have come late in the process — among them such technical details as how insurers will get paid for tax credits and cost-sharing for people being covered under marketplace plans, he said.
Changes in rules have forced the company to make technology changes, and an interface to enter new Health Alliance members directly from the marketplace to Health Alliance won't be working at first. The company will have to manually enter new members for about a month, Ingrum said.
Many people who are already covered by insurance, for example, through group employer plans, won't have to do anything as the marketplace opens today. But they won't be unaffected.
Jane Hayes, senior vice president of corporate communications, said some fees and requirements related to the federal law apply to health plans both on and off the marketplace, and they're going to be affecting costs for all insured customers.
Among those requirements: The age rating band has been compressed, meaning the difference between what insurers can charge seniors versus younger people has narrowed from five times higher for seniors to three times higher. And the 10 essential health benefits that must be included in all marketplace plans must also be included in all health plans, Hayes said.
"And that all contributes to prices of plans, and are being added, so we expect the cost of the same health plans will be different today versus tomorrow," she said.
Otherwise, Hayes said, the company might not end up being able to meet another Affordable Care Act requirement to spend at least 80 percent of every premium dollar on health care. Currently, Health Alliance exceeds that requirement by spending 92 percent of its large-group premium income and 87 percent of its individual-plan premium income on health care, she and Ingrum said.