The following is information regarding recent changes to Illinois State Retiree Health Insurance. These changes only apply to those who are enrolled in Medicare. If you are affected by this change, you should be receiving a letter from CMS regarding the proposed changes to the SURS health insurance plan this week. Note: if you are covering a dependent, you must both be enrolled in Medicare for this change to affect you. If only one of you is enrolled in Medicare, then you will keep your existing coverage and May benefit choice period. Here is a summary of what we know:
Important! You must make a decision and enroll (postmarked) by December 13, 2013. There is no default choice. If you do not enroll, you will only have Medicare Parts A and B coverage which is very limited and does not include prescription drug coverage. New state coverage will start February 1st and run through December 31st of 2014. In future years, your open enrollment period for health insurance will be the same as the Medicare Fall enrollment period. You will note this has changed from May, as in past years, to fall enrollment for this year and future years. This is also the time to add or drop dependents, add, drop or change Optional life insurance coverage, and add or drop dental coverage.
Coverage Summary
Every county in the state has different choices of plan. Consult the map in the materials you receive, or follow this link and view page 8
In Champaign County, you have two choices of plans: UnitedHealthcare (UHC) PPO and Coventry Advantra HMO.
With the UHC plan, you can see any willing provider as long as the provider is in the Medicare program. You should note there is no difference for in-network and out-of-network coverage levels, as with most PPO plans. After a $100 deductible, you pay 10% of charges for services up to the $1,300 annual out-of-pocket maximum, then the plan covers 100%.
With the Coventry Advantra HMO plan, you must choose a primary care physician from within their network of providers, and use only in-network providers except for emergency care. There are copays, and the annual out-of-pocket maximum is $3000. There is a chart on page 11 of the Trail booklet comparing the costs for the two plans.
All SURS annuitants who are enrolled in Medicare Parts A&B (and SURS annuitants with Medicare enrolled dependents) will be required to enroll in a Medicare Advantage plan if they want to be covered by the SURS health insurance. These plans include prescription drug coverage (MA-PD plans; MA equals Medicare Advantage, including Part A and Part B coverage; PD equals Prescription Drug), so you do NOT have to enroll in a Medicare Part D plan.
Caution! Be careful when enrolling as you may also be receiving mailed offers from private Medigap insurance companies. These options do not qualify for State coverage. To enroll in the state plan, your forms must have the “Total Retiree Advantage Illinois” logo (Your TRAIL to Better Health). Here is the logo:
Vision, dental and life insurance benefit plans are not changing, but you must enroll in one of the State-sponsored plans to continue access to existing vision coverage. Life insurance and dental, if elected, continue automatically.
Carle Patients: It appears that if you want to stay with Carle doctors, you need to choose the UnitedHealthcare PPO.
The Coventry Advantra website will be available on November 1st. At that time, you can look there for their providers in Champaign County.
Other Notes:
For community college retirees, you are in the College Insurance Program (CIP); if your SURS is from a State University or State of Illinois Department, you are in the State Insurance Program. This is important, because prices are different for each program.
You could opt-out of state coverage and shop for an individual Medigap or Medicare Advantage coverage policy. You would lose any subsidy from SURS state coverage if you make this election. This could make sense if (1) premiums on a private policy are smaller than your 2014 2% of pension contribution (those with large pensions) or (2) you would rather pay a higher premium and continue on a Health Alliance Medicare plan.
If you are in the State Insurance program and you opt-out, you would have the option to enroll in the State-sponsored plan during the next open enrollment with coverage beginning January 2015.
If you are in the College Insurance program (CIP), opt-out provisions are different; you would want to verify them with CMS.
Complete information for: CIP – The Trail
Complete information for: State Insurance – The Trail
As always, please contact us if you have any questions or would like clarification.