Employer FLASH: OSF Tiered Plan Termination – Groups with Tiered Plans

Health Alliance^™ has been notified that OSF HealthCare providers and facilities will no longer be part of the Health Alliance and Simplete POS tiered plans’ network. This means OSF HealthCare will soon be out of network for your plan. This change is effective January 1, 2024.

OSF HealthCare remains a full participant in Health Alliance non-tiered products, which cover the vast majority of Health Alliance Employer, Individual and Medicare members.

Health Systems like OSF HealthCare contract with insurance companies like Health Alliance to be part of their provider networks. These contracts periodically come up for review. In most cases, an agreement can be made where the health system continues to be part of the network. Tiered network plans give members flexibility when it comes to their out-of-pocket costs. When members choose a Tier 1 provider their out-of-pocket costs are the lowest, and with a Tier 2 provider they pay a little more. In order to offer reduced cost-sharing for Tier 1 and Tier 2, providers that choose to be part of a tiered network plan must agree to certain contract terms that allow us to offer a competitively priced plan. We engaged in open conversations with OSF HealthCare and actively worked to reach contract terms that were reasonable for both sides. Unfortunately, we were not able to come to an agreement with OSF HealthCare on the tiered network product. As previously noted, OSF HealthCare remains in-network for all other products.

Please ensure that your eligible employees are aware of the change effective January 1, 2024. For the balance of the 2023 calendar year, OSF HealthCare will continue to participate as a Tier 2 provider in Health Alliance and Simplete POS tiered networks. We’re notifying all members, regardless of whether they’ve seen an OSF HealthCare provider. This is to ensure they’re aware of the change in the network. It’s important that employees choose providers that are in-network and establish a relationship with that provider to avoid a disruption in their healthcare services. We’re available to help our members find in-network options and create a plan to transition any care plans to in-network providers. Some members being treated for certain conditions may be covered by “continuity of care.” This means they may still be able to continue care at OSF HealthCare providers and facilities at the in-network benefit level for a period of time, even after OSF HealthCare is no longer part of the network. For a general description of our tiered networks, please refer to the tables below.

Our 3-tier plans are available in these counties, DeWitt and Tazewell. The plans are also available in Knox County for Large Groups. This chart only lists hospitals and some of the more well-known clinics, not the entire list of providers available in each tier. For a full list of providers in each tier, visit HealthAlliance.org/Find-Care.

*OSF HealthCare is part of the network for most product lines, although effective 1/1/2024 they will no longer participate in the 3-tier network. If an employee uses an OSF HealthCare provider or facility on or after 1/1/2024, it will be covered at the out-of-network level.

You can search the full list of Simplete network providers by visiting MeetSimplete.com.

*Also includes some exclusive providers from other health systems.
**Some exceptions and exclusions may apply to specific providers.