Observations and comments about state government by State Representative Robert W. Pritchard.
The State’s new Health Insurance contract took another detour last week thus adding to the confusion, frustration and justifiable concern of state employees and retirees. Enrollment in one of the plan options must still be made by the close of business on Friday June 17.
Last Friday a circuit judge in Sangamon County issued a temporary restraining order against Governor Pat Quinn’s administration – ordering it to stop implementation of the Open Access Plan (OAP) contracts while the court litigates the underlying claims made by Health Alliance and Humana. The Governor has indicated that he intends to appeal the decision of the circuit court.
In response to Friday’s ruling, the Commission on Government Forecasting and Accountability (COGFA) voted on June 14 to give the Governor the authority to enter into 90 day emergency group health insurance contracts with the current providers of insurance. The Quinn administration believes they could have the contracts finalized as soon as today or Thursday.
As information becomes available, it will be emailed to plan members and posted on the Illinois Department of Central Management Services (CMS) website: (www.benefitschoice.il.gov). Look for the plan based on your employment (such as State Employee Insurance and Benefit Programs, Teachers’ Retirement Insurance Program, etc.).
As contracts are finalized, the CMS website will be able to provide the most up-to-date information available. I ask that you please share this email and information with other state employees, teachers and retirees that you may know.
Again let me say that the confusion about the new insurance plan has resulted from the Governor’s decision to change providers, the appeals made by the insurance companies who lost the contract, and the failure of the new providers to have a state-wide network of doctors and hospitals that are preferred by employees and retirees. I have been involved in legislative efforts to overturn, delay and modify the Governor’s actions. The resulting confusion and concern among employees and retirees was unnecessary.
While not all of the information regarding the 90-day plan extension has been finalized, I want to pass along the following questions and answers (Q & A) from CMS that were published today in the State Journal-Register newspaper in Springfield.
Questions and answers
Q: How soon will there be more managed-care options available to members of the state of Illinois group health insurance plan?
A: Emergency 90-day contracts could be finalized as soon as today or Thursday, in which case information will be emailed to plan members and posted on the Web site of the Illinois Department of Central Management Services (www.benefitschoice.il.gov).
Q: If a member is already covered by Health Alliance, HealthLink OAP or Humana HMO and hasn’t made a decision on a health-care plan for fiscal 2012, and the state is able to offer 90-day contracts with those three plans, does the member have to notify the state to continue coverage?
A: No. But if the member is now covered by one of those plans, already has chosen another plan for fiscal 2012 and wants to switch back to the original plan, the member must file paperwork making his or her choice known. To guarantee the selection, the member’s paperwork must be received by the state by 5 p.m. Friday. It’s still possible the state will be able to change selections based on paperwork submitted a few days after Friday, but it’s not guaranteed.
Q: What if 90-day contracts can’t be worked out with Health Alliance or HealthLink or Humana or Personal Care before Friday?
A: If people currently covered by those plans fail to make a selection by the end of business Friday, and there are no new short-term contracts with those vendors, people will be enrolled, by default, in CIGNA’s Quality Care plan – at least for the time being. State officials stress, however, that there will be another enrollment period sometime this fall, so people will have another chance to make changes.
Q: If a member has signed up for the HealthLink OAP for fiscal 2012 to receive Tier 1 benefits, and both HealthLink and Health Alliance are included in the 90-day contracts, does the member need to switch to Health Alliance to ensure access to Springfield Clinic doctors?
A: It’s possible that your doctor will participate in both Health Alliance and in the Tier 1 benefit of HealthLink’s OAP, so members of both Health Alliance and HealthLink could have HMO-type coverage for care. More details are expected in the next few days.
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