Carle

Carle Foundation Hospital

URBANA — Now that Carle Health and Aetna have reached a tentative deal, worries may end for thousands of state retirees fearful they would lose access to their Carle doctors.

On the same day that two East Central Illinois state legislators filed bills in an effort to bring retirees some choice in their 2023 health insurance, Carle and Aetna announced Monday that they’d reached a tentative agreement on a contract that will make Carle an in-network provider for the new state-sponsored Aetna Medicare Advantage PPO.

Finalization of the contract will give Medicare-eligible state retirees in Champaign-Urbana, Danville, Hoopeston, Mattoon-Charleston and surrounding communities access to Carle hospitals and providers, according to Carle and Aetna.

Rick Frommeyer, senior vice president of Aetna Group Retiree Solutions, said the “tentative” agreement means both sides have agreed on the financial terms “and it’s just putting the overall business terms together and getting the contract signed.”

He said he doesn’t anticipate any obstacles to finalizing a contract.

Frommeyer said Aetna is excited about the opportunities for state retiree members to be able to see their Carle providers.

“And we’re excited about the opportunity for them to also get to experience Aetna and the collaborative relationship that we’re going to have with Carle and the ability for them to be able to experience what countless retirees in other states across the country are,” he said.

Dennis Hesch, Carle executive vice president and chief financial/strategy officer, said Carle is also excited to be able to work with state retirees — and happy to have reached that point on the day before open enrollment was set to start today.

“We never lost sight of our patients,” he said. “Negotiations have many moving parts that, in the end, all need to balance, but we were determined to keep trying until we reached a contract that is good for our patients, our hospitals and provider offices, and for the state and Aetna.”

The Aetna Medicare Advantage PPO is the only insurance option the state is offering its Medicare-eligible retirees — which has worried those in this part of Illinois because Carle and Aetna didn’t have a contract allowing members of that plan to see Carle providers.

Frommeyer said that while Aetna and Carle will have a contract making Carle an in-network provider, the Aetna plan will also still have an extended service waiver for members, allowing them coverage when they travel outside the area at providers that accept Medicare.

A bill filed earlier Monday by State Rep. Mike Marron, R-Fithian, called on the Illinois Department of Central Management Services to make at least two health insurance choices available for state retirees with a goal of getting the measure passed in the fall veto session before open enrollment ends Nov. 30.

A separate bill also filed Monday by state Sen. Chapin Rose, R-Mahomet, was intended to let retirees choose alternate health insurance plans by requiring the state to reimburse them the same amount their state-sponsored plan premium would cost them.

Rose later said it was “great news” that Aetna and Carle had a tentative deal.

“But this whole mess should have never happened in the first place,” Rose said. “The incompetence of the (J.B.) Pritzker administration knows no bounds.

“Myself and Representative Marron will continue to push for our retirees to have a choice in their insurance provider so that this never happens again under any governor’s administration. Enabling people to choose their own doctor is the fair and right thing to do.”

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