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.
DETAILS:
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.
For up-to-date
information, employees can visit https://www.illinois.gov/cms/Employees/benefits/StateEmployee/Pages/QCHPQCDPClaimPaymentDelay.aspx
EMPLOYEES CAN check the status of their Delta Dental
claims at http://deltadentalil.com/ 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 http://soi.deltadentalil.com/SOIUpdate201609.pdf .
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 CMS.WebsiteBenefits@illinois.gov
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: www.hr.uillinois.edu/benefits/state_healthcare_update.
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 CMS.WebsiteBenefits@illinois.gov.
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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