Sarah Bush Lincoln Contract Termination Update

April 11, 2018

Sarah Bush Lincoln Health Center gave notice that it will end its contract with us on June 30, 2018. This means as of July 1, 2018, Sarah Bush Lincoln will be considered out-of-network for our commercial group members.

Despite this change with Sarah Bush Lincoln, members in that area still have many options for local health care. Other in-network providers include:

  • Carle Foundation Hospital in Urbana, the only hospital in downstate Illinois on the Healthgrades list of America’s Best 50 Hospitals
  • Carle Richland Memorial Hospital in Olney
  • Crawford Memorial Hospital in Robinson
  • Decatur Memorial Hospital
  • HSHS Good Shepherd Hospital in Shelbyville
  • HSHS St. Anthony’s Memorial Hospital in Effingham
  • HSHS St. Mary’s Hospital in Decatur
  • OSF Healthcare Heart of Mary Medical Center in Urbana
  • Pana Community Hospital
  • Paris Community Hospital

We are sending letters and a flier highlighting current in-network options to affected members and employers:

We have been providing coverage in the region for more than 25 years. We remain committed to increasing choice and quality for the region, and will continue to seek solutions to ensure our members are served.

If you have any questions, contact client support.

Vasectomy Coverage on HDHP Plans and HSA Contributions

April 3, 2018

We cover contraceptives and voluntary sterilization procedures for contraceptive purposes with no copayments or deductibles for our members under fully insured policies in Illinois. This coverage is required in part by the Illinois Insurance Code, pursuant to 215 ILCS 5/356z.4 

Recently, the IRS reinforced that as defined by the federal government, male contraceptives and male sterilization are not preventive services. Therefore, plans covering these products and services without satisfying the minimum deductible for High Deductible Health Plans (HDHP) are not HDHPs that qualify an individual to deduct contributions to a Health Savings Account (HSA).

The IRS has provided transition relief for periods before 2020, which will allow individuals on a plan that would qualify as an HDHP except for its male sterilization or male contraceptives coverage to be treated as eligible for deducting contributions to an HSA.

We will work with industry partners, regulatory agencies, and the state legislature to work towards a solution for our members. We’ll continue to update you on this issue as it develops.

Direct Communication with Self-Funded Plan Participants

March 22, 2018

In addition to required communications related to claims processing, such as Explanations of Benefits, requests for additional information, and appeal determinations, from time to time, we mail or email relevant and helpful information to plan participants about topics like health and wellness, disease management, or resources and tools.

If you don’t want your self-funded plan participants to receive any of these additional, beneficial communications, please email your client consultant and let them know. We’ll be sure to exclude them from future communications.

If you have any questions, contact your client consultant.

Issue on Your Health Alliance for Employer Groups

March 21, 2018

Some of you may currently be experiencing a problem with your ability to add or waive coverage for new employees from your dashboard on Your Health Alliance for employer groups. Due to this error, these options for new employees have been moved from your dashboard to the group details page.

Our web team is working to resolve this issue by the end of the month. In the meantime, please add or waive new employees on the group details page.

If you have any questions, contact client support.

Discontinuing Rxtra in May

March 13, 2018

We will be discontinuing the Rxtra program for new and renewing large and small groups (transition, SHOP, and direct), effective May 1, 2018, and later. It will be removed from your coverage upon your group’s renewal. Please notify your employees of this change.

The program was originally meant to bring members and employer groups cost-savings. Unfortunately, it no longer meets those standards of savings.

Self-funded groups can request to continue the Rxtra program, but it will add to admin costs and higher paid claims for the group.

While we work to implement an alternative program, we would like to remind you that the member is charged the lesser of the cost of the prescription or the copay. Most Rxtra medications are on our low cost medication list, so members will likely pay less than their full copay. And given the low costs of these medications, members with coinsurance will be minimally impacted.

Members will also be able to receive 90-day fills of these prescriptions now. Under Rxtra, they were limited to 30-day fills.

We will let you know details of our new program as they become available. If you have any questions, contact client support.