There have been some media reports the last couple of days about the state selecting new vendors for the state retiree health insurance program. I’m working with the State Universities Annuitants Association, which represents higher education retirees.
SUAA is very concerned about the transition that is to come as the state shifts from group health insurance to the Medicare Advantage plan. Linda Brookhart, SUAA’s executive director, and I have talked with some of you about this issue already, as it will mean a monumental change in coverage for retirees who will have to decide in short order whether they want to stay on the state health care program.
Linda has put together a good rundown of what we know in the mini briefing I have included below — it’s a long document so I’d suggest focusing on the middle sections in pages 2-4. I’ve also included links to a couple of good pieces from the SJ-R and Illinois Observer on the issue.
We’ll have plenty more to say on the issue soon. But if you’re doing something with it in the meantime, let me know and I can connect you with Linda or get your more information.
October 3, 2013
The SUAA office has received many questions regarding how to comply with the letters from HMS asking for verification of dependents. The following is posted on Central Management Services (CMS) website:
NOTE: Due to the Federal government shutdown and possible subsequent delays in the government’s processing of IRS tax transcript requests, those members who need to order a federal tax return transcript should go ahead and do so. If a response is not received within two weeks, members should request an extension of the documentation deadline to HMS. Members should refer to Question 13 in the Dependent Verification Audit Frequently Asked Questions document for instructions regarding how to order the transcript and Question 10 for instructions on how to request an extension. The deadline for requesting an extension is October 25th.
Answer to Question 10 in Frequently Asked Questions on the CMS website: If you cannot meet the deadline, you may request an extension in writing through HMS prior to the deadline date. Requests for an extension should be submitted to HMS Employer Solutions by faxing 877.223.8478 or via upload at http://www.AuditOS.comor via mail at HMS Employer Solutions at PO Box 1587; Jeffersonville, IN 47131-9980
The letters now being referred to are those to the university members of SURS with dependents which were to be mailed on January 24, 2014 according to Central Management Services website. If you are a Community College member with dependents and you have not complied, please do so. Second notices have been sent out.
It has come to SUAA’s attention that most people believe the items requested for the verification of dependents is an invasion of personal privacy. There are other ways of verification. You do have the option to voice your complaints to Central Management Services:
JRTC Suite 4-500
100 W. Randolph
Chicago Il, 60601-3219
Stratton Bldg. RM 715
401 S. Spring Street
Springfield, IL 62706-4100
If for some reason you cannot access a computer or have the ability to fax, SUAA will try to assist you in any way possible. However, SUAA staff does not want to be held responsible for your personal information. All information will be shredded upon completion of the task of contacting either IRS or HMS. Let us know how we can help you as we realize there are a number of people who will have difficulty complying.
State sponsored Medicare Advantage Plan
With the onset of the State sponsored Medicare Advantage Plan coming there are, of course, many unanswered questions. This Briefing will try to address some of the information and questions that have come about within the last twenty-four hours.
These are confusing times but our readers who are 65+ and on Medicare need to understand that the changes being made do affect them except for the following three exclusions. (While the focus has been on the State Health Insurance, the College Insurance Program (CIP) and the Teacher’s Retirement Insurance Program (TRIP) will be affected also.)
· If the SURS/SERS/TRS member is on Medicare and has a dependent spouse that is younger than Medicare age then the retiree’s health insurance plan does not change until the dependent reaches Medicare age. CMS will not separate the family.
- If the SURS/SERS/TRS member is not Medicare age and has a dependent spouse who is Medicare age then the health insurance does not change for either until the SURS/SERS/TRS member reaches Medicare age. Again, CMS will not separate the family.
- If you are not age-eligible for Medicare; including those who are Medicare age ineligible due to
the inability to contribute to Medicare while working.
If you fit any of the above situations, do not read any further because the information will not apply to you.
From the CMS website –
“The Department of Central Management Services (CMS) announced today that the Medicare Advantage procurement has concluded and contracts are being awarded to the winning vendors. All members who will be offered a Medicare Advantage plan option, whether they live in Illinois or in another state, will have access to a nationwide Medicare Advantage PPO plan. Certain members residing in Illinois, depending on residential county, will also have access to a Medicare Advantage HMO plan.
Although it is the intent of CMS to award to the winning vendors, the award process includes a 7-day dispute period which will end next Wednesday, October 9th. Impacted members will be sent letters from CMS regarding the procurement and the next steps they need to take regarding their insurance coverage. More than one mailing will likely be sent as additional information is finalized and enrollment/seminar dates are scheduled.
Once all matters are finalized, the letter(s) will, at a minimum, include the following information:
- Plan design, including copayment amounts, deductibles and coinsurance percentages
- Provider networks
- Enrollment dates
- effective date of the new coverage
- monthly premiums
- Opt Out information
- Seminar dates, locations and times
Members who receive the letter and do not want to elect one of the new Medicare Advantage plan options will be instructed on how to opt out of their current health plan. Impacted members who do not elect one of the new Medicare Advantage plans offered will have their coverage terminated.
As there are certain formalities that must be followed before the procurement is finalized, limited information remains available, both in the CMS Benefits Office and with the selected vendors. We would ask that you refrain from contacting the vendors until this process is complete as their staff is not yet familiar with the plan(s) being offered. Your patience and assistance is appreciated.
Please check back to this website page often as information will be posted here once it is known.
Questions with Answers to start:
1. When will the State sponsored Medicare Advantage Plan be unveiled?
The contracts are to be signed on October 15, 2013 according to media sources.
2. What health insurance companies were awarded contracts?
United Healthcare as the Nationwide PPO
Aetna Life Insurance Company as an HMO provider for its entire service area
Humana Health Plan, Inc. as an HMO provider for its entire service area
Humana Benefit Plan of Illinois as an HMO provider for the counties of Livingston and Knox
3. Will dental and vision coverage still be available under the State sponsored Medicare Advantage
Yes. Life Insurance coverage will not change. Pharmaceutical coverage will also be included.
4. Will I be able to keep my current company such as CIGNA as my supplement?
No, the above listed companies will be the choice going forward.
5. What will be the cost of the State sponsored Medicare Advantage Plan?
University and State retirees will continue to pay the current cost of Medicare Part B and
1% of their pension until June 30 of 2014. Beginning July 1, 2014 the cost will be Medicare Part
B and 2% of their pension. CIP and TRIP has not been provided any information yet.
6. When will we be informed about CIP and TRIP insurance changes?
There is a stakeholders meeting for CIP on October 17th. Information will be available after
the meeting with Central Management Services. Likewise a meeting is planned for TRIP.
7. Will the dates for Open Enrollment change due to the new Medicare Advantage Plan?
Yes, the new dates will align with Medicare Open Enrollment. For 2013 the dates are
October 15 through December 7. With plans effective January 1, 2014.
The May Open Enrollment will no longer be available to those on Medicare.
8. If I choose to enroll in the State sponsored Medicare Plan, then I would need no other coverage?
This is correct.
9. If I stay with my current Medicare option will I lose all State coverage – vision, dental, pharmaceutical
and supplement from the State?
Yes, the State will no longer cover you with a supplement. You will need to purchase a Medicare
supplement called Medigap from the private sector insurance offerings along with vision, dental and Medicare Part D which is pharmaceutical coverage. Actually dental and vision is optional.
10. Do you know the effect of the new State sponsored Medicare Advantage Plan will have on those of
us living out-of-state if we have a traditional Medicare Plan?
The effects will be the same as those in-state. However, there will be questions that you will
need to ask your current doctors and hospitals. This will be addressed further down in this
11. I currently have traditional Medicare and the State supplement. I am not interested in joining a
Medicare Advantage Plan. Can I keep my Medicare and have a supplemental insurance?
Yes. You will need to opt out of the State sponsored Medicare Advantage Program.
You will need to purchase a Medigap plan; and, Medicare Part D which is pharmaceutical
coverage. As stated before dental and vision plans are optional. You will need to provide
proof of coverage to Central Management Services.
12. Will I need a supplemental on the State sponsored Medicare Advantage Plan since my CIGNA
coverage will be dropped?
No, the plan will be all-inclusive.
13. If I do not like my choice of traditional Medicare and Medigap Plan can I opt back into the State
supported Medicare Advantage Plan?
It is believed so, but we are checking on this as pre-existing conditions are considered for those
who are 65+ unless there is a “qualifying event” such as coverage/plan is terminated. There is
also a term called “trial right” which allows a person to try a plan for 12 months and change if
14. If I do not like my choice of the State supported Medicare Advantage Plan can I opt out ?
Yes, however we are checking on the actual ability to do this. Blue Cross Blue Shield and the
AARP United Health are two plans that do not ask questions about pre-existing health
conditions. These plans are a bit more expensive.
Check out SUAA’s Portal to shop for Medigap insurance. It will allow you to compare some of the Medigap Plans available. Don’t see one you are interested in? Make a call! No obligation.
What You Need To Know
1. Be sure to understand the coverage being provided by the State sponsored Medicare Advantage
Plan. A comparison cannot be made until the State’s Plan is made available. We will do whatever
we can to assist.
2. Be sure to ask your current health care providers if they accept Medicare Advantage Plans.
Some do not. It has been reported that some clinics in the State will not accept Medicare
Advantage as has been the case in other states.
3. Understand the difference between a PPO and an HMO; know which type of plan is best for you.
4. A nation-wide PPO does not cover you during foreign travel. However, a Plan F in Medigap does.
While there is a $250 deductable, you are covered for emergencies under Plan F. The Plan
allows you coverage until you can return home safely for further care. it does not cover non-
emergencies such as visiting a doctor for a cold remedy.
5. Know your pharmaceutical needs.
6. If purchasing a supplemental policy known as Medigap, you will also have to purchase Part D
which is pharmaceutical coverage.
7. The cost for the State sponsored Medicare Advantage Plan for university and State retirees is
the cost of Medicare Part B plus 1% of your pension; 2% beginning July 1, 2014. We are not sure
how the cost will be calculated for CIP and TRIP enrollees.
8. If you opt out of the State sponsored Medicare Advantage Plan you will no longer pay the 1%/2%.
You will pay Medicare Part B plus the cost of Medigap.
9. Open enrollment will be aligned with Medicare – for 2013 the dates are October 15 through
December 7, 2013.
10. It has been reported that those of you who are patients of Carle Clinic might find difficulty
due to the exclusion of Health Alliance. Report from Capitol Fax:
The state has selected four new contractors for state retiree health coverage, effective Jan. 1, 2014, and Health Alliance Medical Plans isn’t among them.
That will require 6,000 retirees who get their care through the Carle health system to change where they go for medical care by the end of the year, Health Alliance spokeswoman Jane Hayes said Wednesday morning. […]
None of the selected insurers has Carle in its provider networks, which is why current retirees in the state system would have to change where they go for health care, Hayes said.
We will keep you posted as new information becomes available! If one of your questions has not been provided, please email email@example.com