The University continues to monitor the impact of the State budget impasse on employee health insurance. The University of Illinois, along with other public universities, continues to advocate strongly with the governor, legislative leaders, and rank-and-file lawmakers to resolve the budget impasse and settle this unprecedented period of uncertainty.
Eligible university employees, like the employees of other state entities, are offered health insurance coverage through the State Employees Group Insurance Program, administered by the State’s Department of Central Management Services (CMS). As the budget stalemate continues, many of you have asked questions about the impact to your health insurance.
As a covered plan participant, your medical, prescription, dental, and vision coverage has not been stopped or reduced in any way.
What is the state doing with premiums collected from my pay?
The state recently released about a month’s worth of claims payments to providers from the collected premiums. According to CMS, the state will continue to pay claims as sufficient amounts from employee premiums accumulate.
Will I be asked to pay in full and wait for reimbursement?
The majority of health providers are conducting business as usual. With most network providers affiliated with large clinics, hospitals, or organizations, there is no change in how you are charged at the time of service. Many employees have expressed concern that as the payment delay continues, providers may request full payment at the time of service. CMS and the health plan administrators are working diligently with network providers to try to avoid having clinics and hospitals charge members up front for services.
HEALTHCARE
All HMO vendors (BlueAdvantage, HMO Illinois, Health Alliance, and Coventry HMO) have agreed to continue paying claims to healthcare providers.
If you participate in the Quality Care Health Plan (Cigna), Coventry OAP, or HealthLink OAP, and you are or will be receiving care or treatment, then you may wish to call your physician’s or hospital’s billing office to confirm expectations for payment.
- In-network healthcare providers should only charge the plan’s negotiated amount. If a provider asks you to pay more than the member portion of the cost (i.e., copay or coinsurance), then you should contact your health plan who will reach out to the provider to assist you in reaching a resolution.
- Out-of-network providers may require payment up front. Additionally, out-of-network services are reimbursed at a much lower rate, which may not be economical. If you are referred to, or choose to see, an out-of-network provider, you should contact your health plan, whether the QCHP, HMO, or OAP, prior to receiving services, to ensure the services meet medical necessity criteria, to receive authorization, and to request a cost estimate. View "Out-of-Network Providers" communication for further information.
For a few independent providers (i.e., not associated with a large clinic or health organization), the state’s claim payment delay has become unsustainable. Some may no longer accept state insurance or may require payment up front. Please confirm expectations for payment in advance of your appointment. For assistance with extenuating circumstances, please first call your health plan. If your issue is not resolved, then you may want to contact CMS Member Services.
Additional information from CMS and the health plans:
- Specific questions or concerns regarding your claim payment(s) should be directed to CMS. Send an email to CMS.WebsiteBenefits@illinois.gov or call 800-442-1300, selecting 1 at the first three prompts to reach the Member Services Unit.
- In many cases, if you pay your provider up front, you will also receive interest from the state when you receive your reimbursement.
- Talk to the provider’s billing and insurance office to find out what their policy is regarding state medical claim delays. If you encounter a billing problem, call your health plan at the number listed on your ID card, who can at times intervene on your behalf.
DENTAL
If you participate in the Quality Care Dental Plan and you are or will be receiving care or treatment, you may wish to call your dental provider’s billing office to confirm expectations for payment. In-network providers should only charge the plan’s negotiated amount. For some time now, out-of-network dental providers have been asking for payment up front and requiring patients to wait for reimbursement.
- Dental Plan Member Bulletin
- For inquiries regarding the hold that has been placed on dental claims call 844-350-4432.
- General customer service questions, including claims, should continue to be directed to 800-323-1743.
Where can I find more information?
View the resources shared in our September 2015 communications.
Group Insurance Budget Impasse FAQs
CMS Notice to State Group Insurance Participants
Quality Care Health and Dental Claim Payment Delay Information
Quality Care Dental Plan Member Bulletin
As a reminder, for assistance with your personal situation, you are encouraged to first call your health plan at the number listed on your ID card. If it is not resolved, then contact CMS Member Services at CMS.WebsiteBenefits@illinois.gov or 800-442-1300, selecting 1 at the first three prompts.
We will continue to monitor the situation as the State budget impasse continues and provide more information if there are changes.
We understand the stress that the budget uncertainty is causing and, like you, hope for a resolution soon.
