Health Alliance: Enrollment Criteria Prompted Being Dropped


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 said Health Alliance was required to have one or more employers who have a minimum of 1,000 participants enrolled in Medicare Advantage. 

She said it is 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,"  Hayes said. "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. "

"With all the all the 16 years of experience in Medicare Advantage, and all the experience and high-quality ratings that we have, the high satisfaction that we have," she added. "We really felt like Health Alliance was a good offering for these retirees."

Hayes explained that Health Alliance also had to have a public-sector employer with at least 500 participants. She said because the Health Alliance bid was rejected based on the enrollment requirement, its pricing was never reviewed.

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 added that Health Alliance will also seek an extension of the time it has to dispute the state’s decision. She said it is hearing from a lot of retirees who are 'distraught' and 'upset' over the prospect of changing their provider.

Story source: WILL