Health Alliance blames enrollment criteria for denied retiree plans

Oct 4, 2013

A Health Alliance spokeswoman says criteria regarding enrollment numbers kept the insurance carrier from offering Medicare Advantage plans to retirees. The Urbana-based insurer learned this week that it was excluded for retiree plans starting in January, while the state directed those 15,000 people to four other carriers. Spokeswoman Jane Hayes says Health Alliance was required to have one or more employers who have a minimum of 1,000 participants enrolled in Medicare Advantage. She says it’s hard to find an employer with that many retirees in any benefit plan, noting more employers are dropping health care coverage for retirees:

 “State Farm and Caterpillar put their retirees into a benefit exchange, so they can choose a number of Medicare Advantage plans, but their employers don’t choose for them.  So it’s sort of an endorsement. State Farm and Caterpillar endorse Health Alliance as a Medicare Advantage offering for their employees, but they don’t pay for it."

 Hayes says because the Health Alliance bid was rejected based on the enrollment requirement, its pricing was never reviewed. 

She says the company has submitted a Freedom of Information Act request to see the winning bids for Medicare Advantage plans from Aetna Life, Humana Health, Humana Benefit, and United Healthcare, to see if the options are in the best interest of the state and its retirees. Hayes says Health Alliance will also seek an extension of the time it has to dispute the state’s decision. She says it’s hearing from a lot of retirees who are upset over the prospect of changing providers.