December 9, 2016

Unstable Situation Concerning Health Insurance

By Susan S. Stevens

IT TAKES a long, long time for many health insurance claims to be paid. And no end is in sight.

THE STATE of Illinois is more than a year and a half behind in paying some of bills. Once in a while, there’s a breakthrough on insurance payments. But many doctors, dentists, and other health care providers are still waiting. And some of those providers want State employees to pay up-front, then collect from the State when they can. Not only current employees, but also retirees, face these problems. The State deficit is the chief reason, complicated by the lack of a State budget and a labor contract impasse.

THE ILLINOIS comptroller’s office on Nov. 23 had a $10.7 billion backlog of unpaid bills and was five months behind in paying vouchers for such things as health care, comptroller’s spokesman Rich Carter said. As of Nov. 22, the State needed $140 billion to pay all of its bills and pension obligations, the Illinois Policy Institute said.

CENTRAL MANAGEMENT Services reported Nov. 11 that the State had been releasing funds collected from employee premiums to pay claims submitted during part but not all of last year.

Quality Care Health Plan (administered by Cigna)
Claims processed through May 8, 2015, have been released to QCHP-contracted providers (as of Dec. 2, 2016).
Claims processed through Feb. 20, 2015, have been released to non-QCHP-contracted providers (as of Dec. 2, 2016).

HealthLink OAP
Claims processed through June 22, 2015, have been released.

Coventry OAP
Claims processed through July 22, 2015, have been released.

Quality Care Dental Plan (administered by Delta Dental of Illinois)
Claims processed through Oct. 31, 2015, have been released to PPO-contracted providers. Claims processed through Sept. 19, 2015, have been released to Premier-contracted providers. Claims processed through April 4, 2015, have been released to mon-network providers.

EMPLOYEES CAN check the status of their Delta Dental claims at to see if they are among the claims being scheduled for payment. For inquiries regarding the hold/delay on dental claims, call (844) 350-4432. General dental plan customer service questions should be directed to 1 (800) 323-1743. See the notice to dentists at .

IF YOU are experiencing extenuating circumstances due to a health insurance payment delay issues, first contact your health insurance plan for assistance. If not resolved, or if you are denied services, contact CMS at or 1 (800) 442-1300, selecting 1 at the first three prompts.

OTHER RESOURCES? KATIE ROSS, senior director of the U of I Human Resources Administration, points out a University website, which contains some news articles with the most recent information:

THE MYBENEFITS Marketplace website, which went live Sept. 30, may also help. MyBenefits Marketplace is the State’s new online system to provide self-service tools to assist employees with health, dental, and life insurance, and flexible spending account (MCAP/DCAP) plans. Employees can access this system through NESSIE or UI New Hire. Employees will use this system to enroll in or make changes to their state insurance benefits as a new hire, when experiencing a qualifying change in status (i.e., add/drop a dependent and other changes), or during the State’s annual Benefit Choice period.

SPECIFIC QUESTIONS or concerns regarding a claim payment? Contact the CMS Benefits Group Insurance at

U of I officials and the University Office of Government Relations staff met with several legislators and senior officials in the governor’s office repeatedly this autumn. “Their meetings kept our employees’ access to healthcare at the forefront and encouraged the recent agreement for dental claim payments,” Ross said. “They have worked tirelessly to advocate on behalf of faculty and staff on these important healthcare issues, and will continue to do so.”

“THERE HAVE been some good developments, not great, but something,” Ross said.

A NEW complication arose Nov. 15, when the Illinois Labor Relations Board declared an impasse between Governor Bruce Rauner’s administration and the American Federation of State, County and Municipal Employees Council 31, the State’s largest employees’ union, on a new worker contract. With an impasse declared, the governor may unilaterally make decisions on healthcare coverage, and for health insurance, U of I employees’ health insurance is covered by the AFSCME contract. University employees do not have the option of going outside the State system to obtain health insurance, unless they provide proof of other non-state coverage.

“WE INTEND to appeal that ruling to the courts,” AFSCME spokesman Anders Lindall said. The labor board and union urged Rauner to resume contract talks, and the union said it does not want to strike. The State council of AFSCME on Nov. 30 filed suit to stop Governor Rauner from imposing contract terms because he has declared negotiations deadlocked.

LACK OF a State budget continues to be a huge problem. Rauner and Democrats who control the General Assembly have restarted budget negotiations, but the election campaigns thwarted compromise. There is no sign the uncertainty will end any time soon.

RAUNER DEMANDS that lawmakers approve parts of his economic “Turnaround Agenda” before he agrees to a broader budget plan. Democrats say Rauner should bypass his proposed agenda for the time being so an agreement can be reached on a spending plan.

U of I President Timothy Killeen recently sent employees an email, saying: “Although the labor board ruling may be a noteworthy step in the process, it is impossible to predict with any certainty the end result and impact on University employee healthcare costs during this lengthy ongoing litigation and negotiation process.”

“IN THE meantime, U of I System leaders continue to voice concerns to state leaders, including advocating on behalf of faculty and staff about the State’s claim payment delay,” Killeen said. “Our efforts have helped spur some progress on dental claims, and we continue to vigorously oppose the State’s suggestion that it may collect premiums retroactively. These advocacy efforts will continue. I hope you will join our advocacy efforts, and I will continue to update you as the process unfolds.”

ROSS SAID, “Based on the public statements from both the State and AFSCME, we might expect to see some additional plan choices and potentially some level of cost increase to employees. However, actual changes are still unknown at this time, and are subject to the ongoing negotiations and any further ILRB proceedings.”

THERE HAS been speculation – acknowledged as a special notice in the 2017 Benefits Choice flyer –  that the State, if it raises employees’ contributions for healthcare coverage, may backdate that increase and demand premiums retroactively. The University has asked the State to begin charging new premiums only after employees have been given another opportunity to fully consider all plan options and any associated new costs.

AFSCME HAS not had a contract for its 40,000 members since July 2015. The union says employees covered by the top insurance plan would have to pay 100 percent more in health care in the first year of the contract, followed by up to ten percent increases per year. There are also no pay increases over the four-year term of the contract. Lindall called that a “pay cut,” which he said would amount to $10,000 lost over four years for the average employee and perhaps more for those with family coverage.  AFSCME has pushed for no increases in healthcare premiums for the first year followed by a 5% premium increase per year for the out-years of the contract.

THE STATE maintains that the 2012-1015 AFSCME contract, in aggregate, qualifies as a platinum healthcare plan.  But Lindall says that the vast majority of State employees are not opting to use the top coverage. Going forward, members may need to opt for cheaper plans to hold premiums in check and accept higher copays, Lindall indicated.

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