CHICAGO – State employees, retirees and dependents would be able to keep their current managed-care plans -- including Health Alliance and Humana – beyond July 1 under short-term contracts state officials will try to negotiate.

CHICAGO – State employees, retirees and dependents would be able to keep their current managed-care plans -- including Health Alliance and Humana – beyond July 1 under short-term contracts state officials will try to negotiate.


The General Assembly's Commission on Government Forecasting and Accountability on Tuesday gave state officials authority to work out 90-day contracts with HealthLink and Personal Care for “open-access” plans. Officials from the Illinois Department of Healthcare and Family Services said they will try to work out similar short-term contracts with Health Alliance and Humana, the losing bidders in the state's recent health-care contract awards.


State employees “should feel relieved that there will be no break in their health-care coverage as of July 1,” Julie Hamos, HFS director, said after COGFA met in downtown Chicago. “In most cases, they can stay with the plan they have enjoyed.”


The 434,000 people insured by the state saw their options for health plans dwindle to three after a ruling Friday by Sangamon County Associate Judge Brian Otwell.


Of the three, CIGNA's Quality Care plan has significantly higher premiums and out-of-pocket costs than the OAP and HMO plans. The other two, Blue Cross’ Blue Advantage and HMO Illinois, are available only in 38 counties.


 


New options possible today


Quality Care and the Blue Cross HMOs weren't affected by COGFA's vote Tuesday, but it appears that additional options could be offered to state employees as soon as today.


The short-term contracts might have to be extended beyond September if the lawsuits by Health Alliance and Humana remain unresolved. COGFA approval could be needed for future extensions, Hamos said.


Janice Bonneville, deputy director for benefits at the Illinois Department of Central Management Services., said CMS will post updates on the Web and notify members when the 90-day contracts are finalized.


The state’s open-enrollment period for health coverage ends Friday.


If short-term contracts are reached, Bonneville said people already enrolled in Health Alliance HMO, Humana HMO and the HealthLink open-access plan for the current fiscal year will automatically continue in those plans unless they already have filed paperwork to join different plans.


People who already have made choices for fiscal 2012, but want to change based on the new options will have until 5 p.m. Friday to submit paperwork, Bonneville said.


People who miss the deadline shouldn't necessarily give up, she said, because CMS will continue to process changes for a few days after Friday.


Second benefit period


Those who miss the deadline Friday, however, won't be guaranteed a change, she said. She added that the state will offer a second benefit-selection period sometime this fall.


“The staff isn’t going to throw anything away on Monday that they didn’t receive on Friday. They’re still going to take those forms, but I can’t have a member tell me on the 2nd of July, ‘I meant to send this in.’ There has to be a cutoff date, and that date continues to be the 17th.”


Hamos said lawyers from Attorney General Lisa Madigan’s office will ask Otwell to quickly lift his Friday order now that COGFA has given approval for the emergency contracts. Otwell ruled that the state couldn’t proceed with new self-insured OAP open-access plans because COGFA had prohibited future self-insured plans in a vote May 25.


Otwell’s order Friday granted temporary relief to Health Alliance and Humana, but he is expected to issue permanent orders in coming months on COGFA’s authority and on claims by the companies that the managed-care contracts should be rebid.


COGFA co-chairman Jeff Schoenberg, D-Evanston, said the emergency contracts will create higher-than-normal costs for the state. Republican COGFA members said that’s not necessarily the case.


Dean Olsen can be reached at (217) 788-1543.


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 from Springfield Clinic doctors, 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 Springfield Clinic 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 from Springfield Clinic doctors. More details are expected in the next few days.