September 20, 2019 IRTA
Retired Teachers 2020 TRAIL Information
TRS has just posted on their website information about the upcoming 2020 TRAIL Information, including workshops.
The Open Enrollment Period is October 15 to November 15. You cannot make any change to your health insurance plan BEFORE October 15.
TRAIL is a Medicare Advantage health plan for retired teachers who qualify or did qualify for Medicare before September 30, 2019.
You can get links to the following information in the IRTA's member's-only section of the website:
- 2020 TRIP TRAIL Mailer
- 2020 TRIP TRAIL Decision Guide
- 2020 TRIP TRAIL FAQs
- 2020 TRIP Plan Administrators
- 2020 TRAIL Plan Map
- 2020 TRAIL Seminar Schedule
If you have any questions beyond what is posted on the website, please contact My Benefits Marketplace – mybenefits.Illinois.gov or 844-251-1777
July 10, 2019
ELIGIBLE RETIREES & SURVIVORS HAVE FALL OPEN ENROLLMENT PERIOD FOR TRAIL If you are eligible for the Total Retiree Advantage Illinois (TRAIL) open enrollment this fall, you will receive information in the coming months from the Illinois Department of Central Management Services Bureau of Benefits.
The Teachers’ Retirement Insurance Program (TRIP) offers annuitants and survivors a healthcare program called TRAIL. This program provides eligible members and their covered dependents comprehensive medical and prescription drug coverage through Medicare Advantage plans (commonly referred to as “MAPD” plans).
To be eligible for coverage under a TRAIL MAPD plan, you and your eligible dependents must live in the United States or in one of the U.S. territories and be enrolled in Medicare Parts A and B due to age or disability with an effective date before Sept. 30, 2019.
The 2020 plan year begins Jan. 1 and is effective through Dec. 31, 2020.
If you are currently enrolled in one of the TRAIL Medicare Advantage plans, your enrollment will continue. You do not need to do anything during the fall open enrollment period unless you want to make a change. If you want to make a change to your current Medicare Advantage health plan or dependent coverage, please follow the directions provided in your fall open enrollment notification.
July 22, 2018
On August 21, 2018 Governor Rauner signed into law SB3046 (Public Act 100-1017). SB3046 was an initiative of IRTA's. The bill provides that on and after the effective date of this amendatory Act, eligible TRS benefit recipients and TRS dependent beneficiaries may elect to participate in TRIP (this includes participants in TRAIL) if they previously opted out of the program. The bill provides that the election must be made during the benefit recipient's annual open enrollment period, subject to specified conditions.SB3046 becomes effective immediately.
Senator Manar and Representative Gordan-Booth were the main sponsors of this legislation. In addition there were several other representatives and senators that co- sponsored the legislation.
July 16, 2018
ELIGIBLE RETIREES & SURVIVORS HAVE FALL OPEN ENROLLMENT PERIOD FOR TRAIL If you are eligible for the Total Retiree Advantage Illinois (TRAIL) open enrollment this fall, you will receive information from the Illinois Department of Central Management Services.
The Teachers’ Retirement Insurance Program (TRIP) offers annuitants and survivors the TRAIL healthcare program. This program provides eligible members and their covered dependents comprehensive medical and prescription drug coverage through Medicare Advantage plans (commonly referred to as “MAPD” plans).
To be eligible for coverage under a TRAIL plan, you and your eligible dependents must live in the United States or the U.S. territories and be enrolled in Medicare Parts A and B due to age or disability with an effective date on or before Sept. 30, 2018.
The plan year begins Jan. 1 and is effective through Dec. 31, 2019.
If you are currently enrolled in one of the TRAIL Medicare Advantage plans, your enrollment will continue – you do not need to do anything unless you want to make a change. If you want to make a change to your current Medicare Advantage health plan or dependent coverage, please follow the directions provided with your fall information.
TRIP participants not enrolled in a TRAIL plan had their open enrollment period in May 2018.
October 26, 2017 from IRTA
The State of Illinois offers members of the Teachers' Retirement Insurance Program (TRIP) a healthcare program called Total Retiree Advantage Illinois (TRAIL). This program provides eligible members and their covered dependents comprehensive medical and prescription drug coverage through Medicare Advantage Prescription Drug plans (commonly referred to as "MAPD" plans.
The TRAIL MAPD Open Enrollment period began October 16 and runs through November 16, 2017. Online or phone enrollment can only be processed during that time period. The effective date of the new plan will be January 1, 2018. If you are currently enrolled in TRAIL MAPD, and wish to keep your coverage as is, you do not need to do anything. However, if you wish to make any changes to your current TRAIL MAPD coverage, contact MyBenefits (toll-free) 844-251-1777 or MyBenefits.illinois.gov.
· If you receive any solicitations via mail or email concerning Medicare without the TRAIL logos (as seen above) on it please disregard it unless you are considering leaving the Teachers' Retirement Insurance Program (TRIP). Please remember once you leave TRIP/TRAIL you cannot reenroll.
May 25, 2017
SB 42 Passes Senate; Reinstates Appropriation Retiree Healthcare
(May 24, 2017 - SPRINGFIELD, ILL) - Members of the Illinois Retired Teachers Association (IRTA) are praising lawmakers for not passing another unconstitutional measure aimed at diminishing benefits for retired teachers. The Illinois Senate voted Tuesday on a bill that provides contributing funding for the Teachers Retirement Insurance Program (T.R.I.P.).
“It is unimaginable to think what retired teachers and families would endure if the continuing appropriation was eviscerated,” IRTA President Dave Davison said. “We continue to sound the alarm that it would be catastrophic to retired educators.”
Senate Bill 42, sponsored by Senator Andy Manar, was amended and passed on Tuesday to reinstate the continuing appropriation for T.R.I.P. in state statute. The bill when originally proposed last week, did not include the provision to sustain the T.R.I.P. continuing appropriation.
“IRTA members and their families spoke loudly and firmly that promised healthcare benefits cannot be diminished,” Mary Shaw, IRTA Governmental Affairs Director said. “Thousands of our members contacted their senators when this bill was originally proposed, and today we know that legislators heard the message.”
The IRTA has been advised by Tabet DiVito & Rothstein LLC that, “Retired Illinois educators’ health insurance benefits are protected by the Pension Protection Clause for the reasons set forth in Kanerva v. Weems.”
“The IRTA believes that not funding T.R.I.P. is not only unfair it is unconstitutional,” IRTA Executive Director Jim Bachman said. “The IRTA will protect and defend the benefits promised to retired educators. “
In 2015, the IRTA successfully defended an unconstitutional assault on pension benefits that were put in place by then Governor Quinn when he signed Senate Bill 1 into law.
On May 8, 2015, the Illinois Supreme Court unanimously struck down the state's 2013 pension reform law, Senate Bill 1, upholding a lower court ruling that it violated the state constitution under the pension protection clause.
The bill now go to the House of Representatives for consideration.
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The Illinois Retired Teachers Association is a not-for-profit, non-partisan organization of retired educators. The Association serves the needs and interests of its members through advocacy, education, cooperation and socialization in a flexible organizational structure.
IRTA | Springfield, Ill. | 217-523-8488| www.irtaonline.org
May 17, 2017
Teacher Retirement Insurance Program Update
The current TRIP benefit choice period is May 1-31, 2017. On July 1, 2017, the Teacher Retirement Insurance Program – TCHP will move to Aetna as the plan administrator. The Quality Care Plan administered by CIGNA will be replaced with the Aetna PPO plan.
Also, Coventry HMO and Coventry OAP is now Aetna HMO and Aetna OAP. If you were enrolled in either of the Coventry plans, you will now be automatically enrolled in the Aetna plan unless you choose to make a change.
These changes only affect TRIP participants that are not in the Medicare Advantage Plans.
Here are some facts and tips to help as you move to AETNA:
You don’t need to do anything. If you are currently enrolled in CIGNA and wish to stay in the TCHP, you and your covered family members will be automatically moved to the Aetna PPO plan as of July 1, 2017.
You’ll have access to Aetna’s national health care network. This means when you need care, you’ll have access to more than 664,330 primary care doctors and specialists and more than 5,667 hospitals nationwide. It is your responsibility to check if your providers are in the network by visiting www.aetnastateofillinois.com.
For more information, go to MyBenefits.illinois.gov or if you have questions regarding sign-up, contact the My Benefits Marketplace Service Center at 1-844- 251-1777.
May 8, 2017 IRTA
Dear IRTA TRIP Participants,
The current TRIP benefit choice period is May 1-31, 2017. On July 1, 2017, the Teacher Retirement Insurance Program - TCHP will move to Aetna as the plan administrator. The Quality Care Plan administered by CIGNA will be replaced with the Aetna PPO plan.
Also, Coventry HMO and Coventry OAP is now Aetna HMO and Aetna OAP. If you were enrolled in either of the Coventry plans, you will now be automatically enrolled in the Aetna plan unless you choose to make a change.
These changes only affect TRIP participants that are not in the Medicare Advantage Plans.
Here are some facts and tips to help as you move to AETNA:
You don't need to do anything. If you are currently enrolled in CIGNA and wish to stay in the TCHP, you and your covered family members will be automatically moved to the Aetna PPO plan as of July 1, 2017.
You'll have access to Aetna's national health care network. This means when you need care, you'll have access to more than 664,330 primary care doctors and specialists and more than 5,667 hospitals nationwide. It is your responsibility to check if your providers are in the network by visiting www.aetnastateofillinois.com.
For more information, go to MyBenefits.illinois.gov or if you have questions regarding sign-up, contact the My Benefits Marketplace Service Center at 1-844-251-1777.
Sincerely,
IRTA
ILLINOIS RETIRED TEACHERS ASSOCIATION
828 S. Second Street, 4th Floor
Springfield, IL 62704
1.800.728.4782
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April 13, 2017 from Ed Wollet, IRTA Legislative Chairman
A couple of questions arose from the original email that may be of common interest...
Is it true that any increase in the premium can be no greater than
5% in a year?
Yes. Current statute limits annual premium increases to 5% for TRIP participants. The state currently pays about $111M for their share of TRIP. This is funded through a continuing resolution because there is no state budget. Insurance premium costs to the state rose by about 8% last year. That means the state has to cover more of the premium cost. There is talk around the capitol to increase the 5% participant cap to have participants absorb more (or all) of the insurance premium increases. Currently, no senate or house bills have been introduced to increase the cap.
Does the Governor’s recommendation include defunding of both standard TRIP and Trail or just standard TRIP?
Yes. The budget line item that is zeroed out is found on page 101 of the governor's latest budget proposal. If adopted by the General Assembly there would be no funding for either standard TRIP (non-Medicare eligible) and TRAIL (Medicare eligible). The link to the proposed state budget is FY2018OperatingBudgetBook.pdf Near the top of page 101 is "Teachers' Retirement System". Under that title is "Retiree Healthcare Contributions" and "General Funds". The governor's proposed state appropriation for FY2018 is on the far right hand side and shows zero appropriated for TRS retiree health insurance.
June 10, 2016
Some of you have had a questions regarding United Health Care leaving Illinois. Please see answer below from Rich Frankenfeld at TRS.
While it is true that United Healthcare recently announced that it is getting out of the ACA (Obamacare) business in Illinois in 2017, it has nothing to do with United HealthCare's participation in the state-sponsored health care programs for retired state employees and retired teachers.
The state is required to rebid the contracts for health care providers frequently and is currently in the process of doing so. Central Management Services (CMS) is currently in discussions with the teacher employee groups (IEA, IFT, IRTA, School Administrators, etc.) which is the first step in the process.
However, the Open Enrollment Period for Medicare Advantage plans for retired teachers/state employees is next fall -- mid-October to mid-November. Participants will be notified by early September of any changes in benefits and premiums. Then, participants will have the opportunity to remain with their current carrier or to switch to another carrier.
March 3, 2016 Retired teachers lobby against insurance cuts
By Drew Zimmerman
State Capitol Bureau
Posted Mar. 2, 2016 at 6:50 PM
Updated Mar 2, 2016 at 7:30 PM
Retired downstate educators spoke out Wednesday against health insurance cuts in Gov. Bruce Rauner’s proposed 2017 budget that they say would deny them promised benefits.
“Teachers are being made scapegoats for budget problems created by decades of politicians, both Democrats and Republicans, who weren’t fully funding the teacher pension fund and benefit funds,” said Dave Davison, Illinois Retired Teachers Association president.
Rauner’s proposed budget would eliminate state contributions to the group health insurance plan of the Teachers’ Retirement System. IRTA estimates this would increase health-care costs for members of the Teachers Retirement Insurance Program by double, at minimum.
“Retired educators do pay premiums, anywhere between $42 and $793 for their coverage, so they are participating,” said James Bachman, IRTA spokesman. “Part of TRIP is also that school districts and active teachers pay in.”
The state’s portion of TRIP funding is about 24 percent of the approximately $451 million program. The appropriations bill signed by Rauner last year to fund primary and secondary education included TRIP coverage, Bachman said.
While cutting the TRIP funding this go-round, Rauner’s proposed budget for the fiscal year that begins July 1 would fully fund the state’s "foundation level" education formula for students, something that hasn’t been done in seven years.
“In conjunction with this record funding (for schools), the budget also recommends limiting the state subsidy to health-care plans that cover people that were never employed by the state,” said Rauner spokeswoman Catherine Kelly. “This will allow us to allocate more resources to students in the classroom.”
Retired teacher Patsy Sherrard of Normal, one of the visitors lobbying at the Capitol Wednesday, said Rauner's action is disrespectful to all retirees.
“My concern today is that the governor is attempting to alter that agreement and take away the guarantees that were made when I started my career as a teacher,” Sherrard said. “Retirees didn’t cause the budget crisis, and we should not be expected to rescue the state from the current budget mess.”
Bachman said the governor’s action to cut insurance for retired teachers conflicts with his contention that K-12 education is the most important state expense.
“I think it’s the total opposite,” Bachman said. “I truly believe if you’re in total support of education, you’re not only going to support the educators that are out there today, but the educators that were out there in the past and the benefits they were promised.”
Davison said the state must find a revenue stream to adequately fund benefits.
“They should not default on their promises made to teachers,” he said. “Promises to teachers must be kept.”
Ed Wollet
March 3, 2016
Retired Teachers Stand Against
Proposed Insurance Cuts
IRTA calls for member support and solidarity to fight the potential theft of benefits!
Only 36,000 of 106,000+ TRS annuitants are members of IRTA. Encourage a fellow teacher to join IRTA Today!
SPRINGFIELD, ILL- Members of the Illinois Retired Teachers Association (IRTA), a statewide association of retired educators, their families and supporters, held a news conference Wednesday at the Illinois Capitol about the need to protect and defend the benefits promised to retired teachers.
"We are sounding the alarm in regard to the proposed budget by the governor that would be catastrophic to retired educators," Dave Davison said, a former high school math teacher, administrator and coach and current president of the Illinois Retired Teachers Association. "It is unimaginable to think what retired teachers and families would endure if the governor's proposed cuts to the Teachers Retirement Insurance Program, commonly referred to as "TRIP" is allowed to pass."
In Governor Rauner's proposed budget, the contributions paid by the state to the group health insurance plan provided to TRS annuitants, survivors and retired employees has been zeroed out. IRTA estimates that at a minimum, healthcare costs for TRIP members would double.
"Teachers again are being used as the scapegoats for budget problems created by decades of politicians who did not fully fund teacher pension and benefit funds," Davison added. "The proposals being floated are immoral. These are the people who taught your parents, you and now your children."
Retired teacher Patsy Sherrard from Normal, Ill. taught business education in Marseilles and Gridley before retiring in 1993. She said she never received a large salary, but the trade-off was the promise that she would receive pension benefits that would not be diminished and part of that was a state subsidized health insurance plan when she retired. That promise gave her the sense of security, which made her small salary manageable during her years teaching.
"My concern today is that the Governor is attempting to alter that agreement and take away the guarantees that were made when I started my career as a teacher," Sherrard said. "This action is disrespectful to all retired teachers. Retirees didn't cause the budget crisis and we should not be expected to rescue the state from the current budget mess. This legislature must find real solutions to the budget situation rather than taking away our benefits."
Pensions, and the health insurance that all retired teachers pay premiums for, are crucial for us to be able to live. Sherrard said she is the embodiment of why these promised benefits cannot be stolen away. "I supplement my pension, with a small social security check, which most teachers do not receive, and a part-time job so I can afford a modest lifestyle," Sherrard said. "I am struggling. I am 76 years old with serious health issues. I have Breast Cancer and Non-Hodgkin's Lymphoma. Although presently in remission, the threat of cancer's return is always lurking. This is why my health insurance, and its affordability, is a constant concern to me. I cannot afford, on my income, to double or triple the cost I pay every month in premiums."
"Retired teachers in Illinois are being treated like criminals; the state is treating us like we didn't pay into our pensions, that we are somehow stealing money from the state. We deserve better. I urge the Governor and legislators to find other viable options to solve the state's budget crisis," Sherrard concluded.
"It will take the combined support of all Illinois retired teachers to combat another threat," IRTA Executive Director Jim Bachman said.
In 2015, the IRTA successfully defended an unconstitutional assault on pension benefits that were put in place by then Governor Quinn when he signed Senate Bill 1 into law.
On May 8, 2015, the Illinois Supreme Court unanimously struck down the state's 2013 pension reform law, Senate Bill 1, upholding a lower court ruling that it violated the state constitution under the pension protection clause.
"The answer the State should be looking for is to find a revenue stream to adequately fund the pension systems and not defaulting on a promise to teachers," IRTA Government Affairs Director Mary Shaw said.
"Raiding future health benefits is theft, and it must be called out as such," Bachman said. "The state will be stealing from teachers if these ideas come to fruition."
IRTA encourages all members to make sure they are current with their membership status to receive all the latest news and information about this and future threats. Join or renew your IRTA membership today by CLICKING HERE. IRTA members are asked to forward this message to any retired teacher, spouse or any other teacher supporter who is not yet a member of IRTA.
"It will take the combined support of all Illinois retired teachers to combat this new and urgent threat," Bachman concluded.
The Illinois Retired Teachers Association represents 36,000 retired teachers and their families. IRTA is the sole watchdog for retired teachers in the Illinois legislature. Its goal is to maintain and improve benefits for annuitants of the Teachers' Retirement System (TRS); promote education and the professional, social and economic status of all members; and work in cooperation with other organizations to obtain these goals. For more information, to JOIN or RENEW NOW as a member or associate, visit IRTA's website at http://www.irtaonline.org.
November 2, 2015
2016 MEDICARE PART B PREMIUM INCREASES RESULTING FROM THE HOLD HARMLESS PROVISION
On Thursday October 29, 2015, the U.S. House and Senate passed the “Bi-Partisan Budget Act of 2015,” a two-year budget deal that will, when signed into law by President Obama, will only increase premiums to Medicare Part B by 15%. This means that someone currently paying $104.90 will see an increase to $120.70 a month in 2016 instead of $159.30.
According to the 2015 Medicare Trustees Report, about 30 percent of Medicare Part B beneficiaries would have shouldered the full cost of the 2016 premium increase of 52 percent.
This increase would have affected state retirees excluded from Social Security coverage. Without the effect of the hold harmless provision, Medicare Part B premiums would have increase from $104.90 per month to $159.30 per month because there was no cost-of-living adjustment (COLA) to Social Security benefits.
Although this is still an increase, this can be considered a good compromise, instead of increasing premiums by 52%, they will still be increased but at a much smaller, more manageable, 15% rate.
September 17, 2015
Claims for Medicare Advantage members undisturbed by state budget impasse
Click here: http://www.sj-r.com/article/20150916/NEWS/150919584/1994/NEWS
May 1, 2015
The Benefit Choice Period for those annuitants who participate in the non-Medicare Advantage program has begun.
• Not for Medicare Advantage members – fall enrollment
• May 1 through June 1, 2015 is the Benefit Choice Enrollment Period
• If no change – DO NOTHING
• Will be effective July 1, 2015
• Flyers were sent April 24
• More information on CMS Web site – May 1
• CMS Web Site -- http://www.illinois.gov/cms/Employees/benefits/Teachers/Pages/default.aspx
Rich Frankenfeld
TRS Director of Outreach
2815 W. Washington St.
PO Box 19253
Springfield, IL 62794-9253
March 4, 2015
Subject: United Health Care Prescription Drug Summary
Please be aware after further discussions with CMS United Health may not be able to change the misleading wording on the 'Prescription Drug Summaries" due to requirements of the Federal Government regarding Medicare Advantage Programs. Please be aware the State of Illinois negotiated caps for your copayments for both Stage 3 and Stage 4 for the State of Illinois programs. The caps negotiated may not be able to be shown on these summary reports but in fact and practice are as follows:
When you are in Stage 3 which is between $2,960 and $4,700 drug costs you do not pay as per the normal Federal Medicare program. In the normal Federal Medicare program this period is called the "Donut Hole" and you would pay 50% to 45% of the actual drug cost Your State negotiated copayment is the same as the initial amount for a copayment without increase. You face no increases during Stage 3.
If you reach Stage 4 generic drugs have a copayment of $2.65, name brand drugs a copayment of $6.60, or 5% whichever is greater. If 5% is greater your payment is not unlimited as in the normal Federal Medicare program. The 5% is capped at no more than $60.
Please help get this information out. We hope CMS is able to utilize whatever communication methods available to pass this information along to all enrolled members.
Thank you for sharing this information with others who are enrolled in one of the State's Medicare Advantage programs.
Dave Marshall
Director - Illinois Association of Retired Regional Superintendents of Schools
March 1, 2015
Just a heads up. My wife received a Monthly Prescription Drug Summary that contained some incorrect information. It showed coverage that included the donut hole or Stage #3 on the form letter where it indicates you would have to pay 45% of the cost of any drug from out of pocket costs between $2,960 up to $4,700.
This is incorrect we do not have the donut hole requirement like that on private Medicare Advantage Programs. Our coverage is like it was explained when we signed up. I have attached an explanation of the coverage we have.
If you receive such a notice it is incorrect. I have contacted United Health and the representative was going to bring this to the attention of her supervisors. Hopefully this will be correct so it does not cause confusion to our members.
Dave Marshall
October 10, 2014 Medicare Advantage "Trail" Program
Click here: http://www2.illinois.gov/cms/Employees/benefits/trail/Pages/default.aspx
September 20, 2014 Seminar Medicare Advantage Program
Rockford, October 14
Giovanni's 610 N. Bell School Road Rockford, IL 9:30 a.m. - 11:30 a.m.
September 19, 2014 Subject: Medicare Advantage Program
Since the Open Enrollment for the 2015 Medicare Advantage program (TRAIL) is October 15 through November 15 , I have been getting many questions about the 2015 program – who is eligible, when will I get my packet, what options do I have, etc.
CMS has told us that during the first full week in October (hopefully October 6), CMS will be posting information on their web site about the 2015 Medicare Advantage Program.
In addition, CMS will be holding informational seminars in October explaining the 2015 Medicare Advantage program. Attached is a listing of these seminars.
Remember, check out the CMS web site after October 6 -- http://www2.illinois.gov/cms/Employees/benefits/trail/Pages/default.aspx
Rich Frankenfeld
TRS Director of Outreach
2815 W. Washington St.
PO Box 19253
Springfield, IL 62794-9253
217-753-0973
September 12, 2014 Medicare Advantage Programs
If you and all the dependents you have covered on your TRIP or State Employee Health Insurance program are covered by Medicare Parts A and B on or prior to September 30, 2014 you will be asked to select one of the State sponsored Medicare Advantage programs for you health insurance. The enrollment period is October 15 to November 15 for coverage to begin on January 1, 2015. You should receive information from CMS so watch your mailbox. If you do not select one of these State plans you will loose your State Health Insurance. Please be aware you will receive many mailing from health insurance companies regarding Medicare plans. The only plans approved by the State of Illinois will carry the "Trail Retiree Advantage Illinois" logo. If you enroll in a plan not sponsored by the State of Illinois you also loose your State Health Insurance. Watch for material from CMS. It will be your official information and forms. The State Medicare Advantage Programs this year are:
United Health Care PPO
Coventry Advantra HMO
Health Alliance MAPD HMO
Humana HMO
Not all plans are available in all Counties. Your information from CMS will indicate which plans are available for your County. The information will also include details about the different plans.
Please feel free to share this alert with others.
Dave Marshall
June 12, 2014 IRTA
The Department of Central Management Services has amended its contract with United Healthcare to change the co-pay of the prescription drug plan when you reach the catastrophic level. This change will only affect a small group of people that are enrolled in the United Healthcare Medicare Advantage Plan. If you reach the catastrophic stage (out-of-pocket costs total $4,550 or more) your co-pay will now not exceed $50. The chart below is provided by the CMS. This amendment is retroactive to the beginning of the plan year; United Healthcare in the upcoming months will be contacting the individuals affected prior to this change to determine reimbursement. To find out more information concerning your Medicare Advantage Prescription Drug Coverage go to the IRTA website, www.irtaonline.org
STAGE 4Catastrophic Coverage Stage - You enter this stage when your true out-of-pocket coststotal $4,550. You stay in this stage until the end of the plan year.
In this stage you no longer pay the plan's standard copayment; instead, how much you pay depends on which State-sponsored MA-PD plan you have enrolled in. The table below provides the benefit offered by each MA-PD plan in 2014 and by a standard Part D plan. The benefit for a standard Part D plan has been established by the federal government for 2014. Coventry MA-PD HMOHumana MA-PD HMO PlanUnitedHealthcare MA-PD PPO PlanStandard Part D PlanYou pay:Generic: $2.55 copayment per 30-day supply
Nongeneric: $6.35 copayment per 30-day supplyGeneric: Greater of 5% of the retail cost or $2.55 copayment, not to exceed amounts below:
Nongeneric: Greater of 5% of the retail cost or $6.35 copayment, not to exceed amounts below:
1-30 day supply: $40
31-60 day supply: $80
61-90 day supply: $120
(90-day supply: $80 if purchased through Mail Order)Generic (up to 90-day supply): Greater of 5% of the retail cost or $2.55 copayment, not to exceed $50
Nongeneric (up to 90-day supply): Greater of 5% of the retail cost or $6.35 copayment, not to exceed $50Generic (up to 90-day supply): Greater of 5% of the retail cost or $2.55 copayment
Nongeneric (up to 90-day supply): Greater of 5% of the retail cost or $6.35 copayment
May 23, 2014 Committee approves proposal to expand retiree insurance options
Click here: http://www.sj-r.com/article/20140521/NEWS/140529838
Not a done deal, but something to watch.
May 15, 2014 United Health Advantage Plan
I just returned from a meeting in Rock Island where a representatives of United Health and CMS presented. The good news is it appears that United Health and CMS has reached an agreement regarding the "catastrophic coverage" for prescriptions. You reach the catastrophic level once the total amount paid by you and the company for the year for prescriptions reaches $4,550. Most will not reach this level. If you do, once you get there the original agreement said you pay $2.55 copay for generics, $6.55 for other prescriptions or 5% of the cost of the drug whichever is greater. The 5% was the issue for very expensive medications. It appears that will be changed so the 5% is capped at $50 maximum copay for any drugs regardless of the price. It also appears that this will be retroactive to Feb. 1, 2014. This is outstanding news for those impacted by this. If you had a drug that costs $10,000 per month you would have paid 5% or $500 per month. With this change that will become only $50 per month. If you already paid the higher rates it appears you will receive a rebate sometime.
Dave Marshall
May 5, 2014 IRTA
Please see the following explanation from United Health Care and the State of Illinois Department of Central Management Services regarding the cost of prescriptions once a member enters the "coverage gap" and "catastrophic" coverage.
When a member enters the prescription Medicare Part D 'coverage gap' (the amount between $2,850 and $4,550) the amounts that the member pays for their prescriptions is still the copayment amount; however, the amount the member pays (i.e., the copayment) is added to any manufacturer's discount given to the plan for brand name drugs the member filled. The manufacturer's discount is usually 50% of the drug's retail value and is given to the plan (UHC/OptumRX) for the cost of the drug. It is this discount that is also added to the member's copayment that can throw them over the $4,550 amount into the 'catastrophic' coverage. Once in the catastrophic level, the member will usually end up paying 5% of the cost of the drug. All of these costs are indicated on the Explanation of Benefits (EOB) from UHC. The member will get two separate EOBs, one for medical services and one for prescriptions. The member will only receive an EOB if they had medical or prescription expenses during the month. The prescription EOB will list the name of the drug, the date it was filled, the pharmacy that filled the prescription, the tier the drug is in, what the plan paid for the drug, what the member paid for the drug (copayment) and 'other' payments, which are the manufacturer's discounts. Please see the following example:
Humera (brand name drug was discounted 50%; total cost of the drug is not on the EOB, but in this case was $5,130.36)
Plan Paid - $2,735.09
Member Paid - $50.00 (copayment)
Discount - $2,345.27
The Department of Central Management Services continues to work with United Health Care (UHC) to negotiate a fair alternative. IRTA will continue to keep our members updated on any future changes.
May 1, 2014
The annual Benefits Choice Period for the Teachers Retirement Insurance Program (TRIP) will be May 1 through June 2, 2014. Detailed TRIP information booklets have been mailed by the Department of Central Management Services. You should be receiving the materials shortly.
The Benefits Choice Period is the time that TRIP participants may change health insurance carriers or add a dependent to their insurance coverage, provided that the dependent has not been enrolled in TRIP previously.
Here are your options during the Benefits Choice Period:
- If you are satisfied with your current TRIP health insurance, you don’t have to do anything.
- If you would like to change your insurance, please complete the Benefits Choice form from this link: http://trs.illinois.gov/members/forms/TRIP.pdf
- If you would like to add an eligible dependent, please call TRS for a TRIP enrollment form at (800) 877-7896. DO NOT use the Benefits Choice form to add a dependent.
If you turn 65 during 2014 BEFORE September 30, 2014 and become eligible for Medicare A & B coverage, you will have two enrollment periods this year because your circumstances are different. You will still make any changes you want in your current TRIP coverage during the May 1 – June 2 Benefits Choice Period. You will retain this coverage through Dec. 31, 2014. Later this fall, you will receive information about selecting a Medicare Advantage Prescription Drug (MA-PD) insurance plan. For continued health insurance coverage, you will be required to select a Medicare Advantage plan. Your Medicare Advantage coverage will take effect on Jan. 1, 2015. After that, your annual Benefits Choice Period will occur in the fall of each year.
TRIP Members who become eligible for Medicare A & B AFTER September 30, 2014, will remain on a TRIP Medicare supplement plan through calendar year 2015 and will select a Medicare Advantage Plan in October of 2015 for coverage beginning Jan. 1, 2016.
Members who are turning 65 and are NOT eligible for Medicare A & B must provide proof of ineligibility from Medicare. These members may enroll TRIP coverage for “over 65 without Medicare.” They are not eligible to enroll in a MA-PD plan.
Member Services Division
Teachers' Retirement System of the State of Illinois
April 30 Health Care Choices
If you and all your dependents will be starting Medicare this year and you will need to start the Medicare Advantage programs in January, the open enrollment period for your current health insurance is this spring for health insurance coverage to start July 1. Please be aware
You can continue your current program until the end of the calendar year or you can also switch to another plan this spring if you wish. That plan will be in force until the end of the year.
This fall you can choose one of the Medicare Advantage programs available to those retirees who are eligible for Medicare – Coventry HMO, Humana HMO or United Healthcare PPO. At that time, you cannot keep Health Alliance or any other choice you made in the spring.
Let me know if you have any further questions.
Rich Frankenfeld
TRS Director of Outreach
2815 W. Washington St.
PO Box 19253
Springfield, IL 62794-9253
217-753-0973
February 22, 2014This is the latest information concerning our lawsuit related to our pension benefits being reduced which was shared with the Legislative Committee of IRTA on Thursday (Feb 20th) of this week by our part time lobbyist, Andrew Bodewes and IRTA Executive Director, Jim Bachman.
The re-enrollment into TRIP (something we cannot presently do) is the legislation contained in HB4272. State employees and I think University Professors can re-enroll but we cannot. We think we should be able to as well and support legislation that would cause that to happen.
Dave Davison
Legislative Update: Andrew Bodewes and Jim Bachman told that the focus of the legislative program at this time is on pursuing health care issues. TRIP does not allow re-enrollment into the program once a retiree opts out. Elaine Nekritz is the lead sponsor of House Bill 4272 which we support.
February 12, 2014
This email concerns only those TRIP members on the Illinois Medicare Advantage Plan (TRAIL-TRIP).
This email contains information about using OptumRx vs Walgreens for four 90 day prescription drugs and compares the prices for these medications using each pharmacy. NOTE: This is only an example. The copays you experience will be different depending on your prescriptions.
Drug OptumRx Walgreens
1 $15.20 $ 18.19
2 87.34 111.89
3 100.00 100.00
4 36.03 25.00
Total $258.57 $277.16
There is some savings with certain drugs by using OptumRx mail service (~$80/year). With the Illinois Medicare Advantage Plan, you do not have to get your drugs from a single source so there would be a little savings by splitting the prescriptions between OptumRx (1, 2, 3) and Walgreens (4).
Ed Wollet
February 8, 2014
After several phone calls with Leslie Ingram Booth of CMS , I was informed that the only way to get a 90 day benefit for a 60 day cost was from Optim RX, the mail order pharmacy that deals with UHC. Walgreens, CVS, etc. will not provide the service. In fact, my local Walgreens pharmacy knew nothing of the matter. My wife and I have enrolled with Optum. She got her first delivery today, and I'm supposed to get my first delivery in a few days. from Joe Purpura
February 7, 2014
Hello Everyone...
I spoke to the Comptroller's office today about the delay in receiving the February pension statement. They told me that there was a problem with the sorting equipment and it will be coming out soon.
Also, some contacts concerning those on the new state of Illinois Medicare Advantage Plan (TRAIL). If you or a dependent have not received your insurance card and Silver Sneakers program card, please contact UHC at 888-867-5548 . A temporary insurance card can be printed from the internet.
Ed Wollet
January 8, 2013 SCAM ALERT
A member was contacted by a person representing himself as a United Health Care representative. He phished for personal information about the upcoming change to her mother's insurance change. Neither CMS nor UHC had any knowledge of anyone calling for information.
If you are contacted by someone who appears to be trying to get personal information, I would suggest you do not answer these questions until you have verified with UHC that the information is actually missing. The contact number for United Healthcare is 888-223-1092.
December 3, 2013 IRTA
Dependent Eligibility Verification Audit
Important Update For Retirees on the Teachers Retirement Insurance Program: The Department of Central Management Services has extended the deadline for submitting documentation for the State of Illinois Retiree group to January 31, 2014 to allow members adequate time to obtain needed documentation from the IRS.
November 26, 2013
TRS has already received nearly 10,000 Medicare Advantage forms. In addition to the regular work week, some TRS staff spent last Saturday processing these forms.
TRS will send these members a receipt by either email (if you had an email address with us prior to the date you submitted your form) or by first class US mail.
If you don’t receive this confirmation with 10 days of when you submitted your form, please feel free to call TRS.
If you wait until December to submit your form, you are welcome to send your form by certified mail so that you will receive a conformation that we have your form.
Rich Frankenfeld
Director of Outreach
November 25, 2013
IRTA Executive Director Jim Bachman spoke to the North Lake Shore Retired Teachers in Des Plaines this afternoon. Pensions and healthcare were addressed. Bachman reiterated the recommendation of IRTA that retirees remain with one of the State of Illinois plans (United Healthcare or Humana) at least through 2014. He addressed the anxiety that the State of Illinois United Healthcare Advantage plan would not offer the same services as Medicare or that the plan would deny claims that Medicare would approve – Bachman strongly rejected both premises .
Bachman also stressed that unlike all other Advantage Plans which have negotiated reduced fees with providers, the State of IL plan pays doctors and institutions the same exact amount as Medicare . He also explained that providers need to understand how the State of IL plans work; thus, retirees are urged to contact United Healthcare (UHC) and ask that they contact their doctor or hospital to provide them with plan information: 888-223-1092 (Group #12809).
November 21, 2013
FYI -- A few members, who believe they qualify for the new Medicare Advantage plans, have personally told me that they had not received the Medicare Advantage Enrollment kit from CMS. If they don’t receive it by next Monday, November 25, please call TRS 800-877-7896 and request a form.
While they may also print one from the CMS web site, we ask that they wait a few days to see if the official one arrives. The official one has a bar code which would make it easier for processing.
http://www2.illinois.gov/cms/Employees/benefits/trail/trip/Documents/TRIP_Form.pdf
Also, any member who believes they are qualified for the new Medicare Advantage program and has not previously enrolled in TRIP can contact our office and ask that an Enrollment Form and materials be sent.
If members need help completing the Enrollment form, please watch our enrollment video, posted on the TRS home page at trs.illinois.gov.
Rich Frankenfeld
TRS Director of Outreach
2815 W. Washington St.
PO Box 19253
Springfield, IL 62794-9253
217-753-0973
November 20, 2013
If you are interested to be sure your dependent verification information was received and correct you can go to:
https://auditos.com/
You can also try to call 877-658-0596
I never did get through to the phone number, but got immediate answer on the web address. It will tell you your status. You need your reference number found on your HMS information.
Rolland "Dave" Marshall
November 18, 2013 You should know from Bob Lyons
I went to the post office Saturday to mail TRS my selection for health care insurance and, as has been reported elsewhere, the envelope required a 66 cent stamp. TRS suggests that the need for a registered letter is only if you are mailing your selection in the very last days. If you have an email address on your selection form, TRS will email you that they have received your selection. Those without email will receive a reply by mail. Returning the form you received with its barcode is helpfully to TRS. And it was a decision by CMS not to supply an envelope.
**Editor's note: I still plan on sending my health care insurance selection via registered letter.
While you should not make your decision until you have all the information you need, TRS obviously hopes that you will not wait until the last days to make your selection.
The state of Illinois’ decision to get out of the health care insurance business for retired state employees, retired university and community college workers, and retired teachers had nothing to do with the Affordable Care Act, but everything to do with saving money. The ability of the private for-profit companies to offer such low price insurance to us is because they are receiving a monthly payment from the Federal government for each of us that enrolls in their plan. United Health Care would likely make a profit on me, as long as I am healthy, if I paid them nothing every month. My wife is retired and receives an IMRF pension and has a Medicare Advantage plan from UHC with zero premiums. The total out of pockets costs are higher and some service like the “silver sneakers” require a small monthly charge, but UHC will make most of the money from the Medicare payment from Social Security and the funds directly from the Federal Government.
For those who are concerned about the insurance companies drastically raising their fees next year, that has not been were their profits have been gained, but as recent news stories have shown, the Federal government hopes to reduce their costs for Medicare going forward. These companies make their profits not only from the amount they collect from the government but also from what they can keep of those funds. We should all understand that the insurance companies are in business to make money. For example: “UnitedHealth Group Incorporated is a diversified managed health care company headquartered in Minnetonka,Minnesota, U.S. It is No. 17 on Fortune magazines top 500 companies in the United States.” They are doing well.
November 17, 2013
If you have not been able to attend one of the seminars or would like to review again. It is now on the CMS webpage for you to watch at: http://www2.illinois.gov/cms/Employees/benefits/trail/Pages/TRAILSeminar.aspx
November 11, 2013
The enrollment forms were mailed on Thursday. Retirees in the Teachers’ Program should begin receiving the TRAIL Enrollment Kits today. The forms will also be available online Tuesday morning. The form can be printed, filled out, and sent to the Teachers’ Retirement System.
http://www2.illinois.gov/cms/Employees/benefits/trail/Pages/default.aspx
November 5, 2913 TRIP meeting and TRS
You are invited to attend a Town Hall meeting with Teachers' Retirement System Executive Director Dick Ingram on Tuesday, Nov. 12 in Rockford. Director Ingram’s Town Hall presentation will be about issues facing TRS and its members. This presentation will include a very general overview of the state's new Medicare Advantage program for Medicare participants in TRIP. More specific information about Medicare Advantage is available from the Illinois Department of Central Management Services: http://www2.illinois.gov/cms/Employees/benefits/Teachers/Pages/TRIPMedicareAdvantage.aspx
November 12 – Rockford
Jefferson High School Auditorium
4145 Samuelson Road
7:00 – 8:30 PM
We hope to see you next Tuesday!
Member Services Division
Teachers' Retirement System of the State of Illinois
October 31, 2013 IRTA
The Illinois Department of Central Management Services has posted dedicated phone numbers for the Medicare Advantage Plan Administrators. If you have questions about any of the plans being offered, please contact the appropriate carrier below.
Plan Component
Administrator's Name
Customer Service Phone Numbers
UnitedHealthcare Group Medicare Advantage PPO
UnitedHealthcare
(888) 223-1092
Coventry Advantra HMO
Coventry Advantra
(855) 223-4807
Humana Medicare
Employer HMO
The Humana Benefit Plan HMO and
the Humana Health Plan HMO
Humana
(800) 951-0125
October 30, 2013 IRTA
The Department of Central Management Services has developed a new website for individuals that are required to enroll in a Medicare Advantage Plan. The website address is:http://www2.illinois.gov/cms/Employees/benefits/trail/Pages/default.aspx. All of the plan details are outlined at this website along with the seminar schedule. This information will also be mailed to you prior to the enrollment period which begins November 12th.
Members of TRIP must be enrolled in Medicare Parts A and B in order to be eligible for the Total Retiree Advantage Illinois (TRAIL) Program. In addition, any covered dependent must also be enrolled in Medicare Parts A and B in order to be eligible for TRAIL coverage. If any member of the household is not enrolled in Medicare Parts A and B, no one in the household will be eligible for TRAIL Medicare Advantage plans. Members and dependents of non-Medicare households must seek benefits under the non-Medicare programs offered by the State during the May Benefit Choice period, which are described on the Benefits website at www.benefitschoice.il.gov.
October 28, 2013
The Medicare Advantage plan administrators phone numbers are available. The Retiree Medicare Advantage Seminar Schedule will be posted as soon as it is finalized. Initial letters have been mailed to all impacted members. NOTE: All impacted members should receive their Medicare Enrollment Packet the week of November 11th. 10/28/13
October 26, 2013 Don't make hasty insurance decisions
Click here: http://www.sj-r.com/breaking/x450313318/State-to-retirees-Don-t-make-hasty-insurance-decisions
October 26, 2013 Medicare Advantage Plans
• Medicare enrollees have traditionally received Medicare coverage through a fee-for-service system under which the federal government paid for Medicare covered expenses. Individuals could also buy supplemental coverage for gaps in the Medicare program. For state retirees, this supplemental coverage was provided by the State Employees Group Health Insurance Plan (and TRIP and CIP for applicable retirees).
•
Under the AFSCME contract, retirees will now transition to a managed care product, Medicare Advantage, under which the federal government and the state will pay premiums to a third party managed care organization through which all care will be coordinated. The new Medicare Advantage plans will go into effect February 1, 2014.
•
Medicare Advantage plans provide medical and prescription drug coverage. They are Medicare-approved plans that include Medicare Part A (hospital insurance), Part B (medical insurance) and Part D (prescription drug) coverage under one plan with one card.
Plan choices
• All eligible members can choose coverage under the nationwide MA-PD PPO plan administered by United Healthcare (UHC).
• Illinois residents may also be eligible to enroll in a MA-PD HMO plan offered by Aetna (Aetna is offering the Coventry Advantra HMO, which is administered by Coventry of Illinois) and/or Humana.
• The United PPO plan will be available to retirees in all 102 counties in Illinois. Availability of the HMO plans varies from county to county. There is no HMO option available in 48 counties. (see the attached map for the providers’ coverage areas.)
About the United PPO Plan
• The passive PPO plan, offered by United Healthcare (UHC), does not have restrictions of in- and out-of-network coverage. Members can see any willing provider as long as the provider is in the Medicare program - the provider does not have to be in the UHC network.
•
When a member goes out-of-network for care, the PPO plan pays providers the same amount as Medicare would have paid, and members pay the same out of pocket percentage as if they had stayed in the network.
About the HMO Plans
• Members who enroll in one of these plans, either Coventry Advantra or Humana, must choose a primary care physician from the HMO’s network of providers. The physician you select will coordinate your care and refer you to specialists when needed.
•
Out-of-network care is covered only in cases of emergency
Enrollment
• Eligible retirees will receive an enrollment kit containing an Open Enrollment Form before the start of the Open Enrollment Period on November 12th. The Open Enrollment Period will be November 12 through December 13, 2013 .
•
CMS stresses that retirees must complete the Open Enrollment Form and return it to their retirement system postmarked by December 13, 2013, to have State-sponsored medical, prescription drug, vision and dental coverage after January 31, 2014.
•
The Open Enrollment Period will now be held in the fall of each year. For 2014, the plan year will begin February 1 and end December 31, 2014. Retirees will remain enrolled in their current State healthcare plans through January 31, 2014. The new Medicare Advantage coverage retirees select will start February 1, 2014.
•
There is no “rolling” enrollment. Retirees who become Medicare-eligible after this fall’s open enrollment period is closed will remain in their current plan until the next open enrollment period next fall.
• Medicare-eligible retirees who miss the December 13, 2013, enrollment deadline will see medical, prescription drug, vision and dental coverage for themselves and their dependents end January 31, 2014.
• *It is very important that members of TRIP and CIP are aware that if they miss this deadline and “opt out”, they will not be allowed back into the state system at a future date.
• Other retirees’ next opportunity to enroll in one of the State sponsored Medicare Advantage plans will be in the fall of 2014 for coverage effective January 1, 2015.
• “Split-household” exception: Medicare-eligible retirees with a dependent on their insurance who is not yet Medicare eligible (such as a younger spouse) will remain in their current insurance plan until their dependent is also Medicare-eligible.
Rate Schedule effective February 1, 2014
• Coventry Advanta HMO: Member $35.36 Dependent $106.08
• Humana HMO: Member $55.34 Dependent $166.02
• United Healthcare PPO: Member $47.56 Dependent $142.67
More Details are Coming
• Meetings about retirees’ new coverage options will be held throughout Illinois this fall. A schedule of meeting locations, dates and times, as well as the dedicated phone numbers for each of the plans, will be mailed in the State’s open enrollment kit, as well as posted on the Benefits website at www.benefitschoice.il.gov .
• Representative Brady has scheduled two meeting times at the ISU Alumni Center for November 26 at 9:30am and 1:30pm
• All materials provided by the State will have the new State of Illinois retiree Medicare Advantage logo and program name, “Total Retiree Advantage Illinois – Your Trail to Better Health,” on them.
October 24, 2013 Insurance map for employees with Medicare/Medicare Advantage
Click here: http://www2.illinois.gov/cms/Employees/benefits/StateEmployee/Documents/Medicare_Advantage_Map.pdf
October 22, 2013 IRTA
CMS
I L L I N O I S Pat Quinn, Governor
DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
Simone McNeil, Acting Director
Open Enrollment Period: November 12 - December 13, 2013
2014 Coverage Period: February 1 - December 31, 2014
Important Retiree Healthcare Benefit Information
October 21, 2013
Dear TRIP Retiree, Survivor or Dependent:
We are pleased to announce important changes to your retiree healthcare benefits. Effective February 1,
2014, the State will offer new, comprehensive and valuable Medicare Advantage plans that will provide medical and
prescription drug coverage for eligible retirees and their eligible dependents. These plans, commonly known as “MAPD”
plans are Medicare-approved plans that include Medicare Part A (hospital insurance), Part B (medical insurance)
and Part D (prescription drug) coverage. The advantage of having coverage under these plans is that you will have
all the medical and prescription drug coverage you need in one plan, with one ID card. Whichever plan you choose,
your plan administrator will be there to help you if you have any claim-related issues with doctors, hospitals,
pharmacies or other providers.
You will receive an enrollment kit containing an Open Enrollment Form before the start of the Open Enrollment
Period on November 12th. The Open Enrollment Period will be November 12 through December 13, 2013. You
must complete the Open Enrollment Form and return it to the Teachers’ Retirement System (TRS)
postmarked by December 13, 2013, to have State-sponsored medical and prescription drug coverage after
January 31, 2014.
Your healthcare plan choices: All eligible members can choose coverage under the nationwide MD-PD PPO plan,
administered by UnitedHealthcare (UHC). As an alternative to the UHC PPO plan, if you are an Illinois resident, you
may be eligible to enroll in a MD-PD HMO plan offered by Aetna (Aetna is offering the Coventry Advantra HMO,
which is administered by Coventry of Illinois) and/or Humana (HMO plans vary by Illinois county of residence).
These companies are three of the largest and most well-respected providers of these kinds of plans in the country
and were selected through a State-run procurement process that took into account plan quality, access to
doctors/hospitals and pharmacies, member services and cost.
About the MA-PD Preferred Provider Organization (PPO) Plan
The passive PPO plan, offered by UnitedHealthcare (UHC), does not have restrictions of in- and out-of-network
coverage. Members can see any willing provider as long as the provider is in the Medicare program - the provider
does not have to be in the UHC network. When a member goes out-of-network for care, the PPO plan pays
providers just as much as Medicare would have paid, and members pay the same out of pocket percentage as if they
had stayed in the network.
About the MA-PD Health Maintenance Organization (HMO) Plans
Members who enroll in one of these plans, either Coventry Advantra or Humana, must choose a primary care
physician from the HMO’s network of providers. The physician you select will coordinate your care and refer you to
specialists when needed. Out-of-network care is covered only in cases of emergency
The “Plan Year” is Changing
Your Open Enrollment Period will now be held in the fall of each year instead of during the month of May, as in the past.
For 2014, the plan year will begin February 1 and end December 31, 2014. You will remain enrolled in your current
State healthcare plans through January 31, 2014. The new MA-PD coverage you choose will start February 1,
2014.
Rate Schedule effective February 1, 2014
TRIP Medicare Advantage Plan Monthly Rates
Coventry Advantra HMO-member rate-$35.36 Dependent Rate-$106.08
Humana-member rate-$55.34 dependent rate-$166.02
UnitedHealthcare PPO- member rate-$47.56 dependent rate-$142.67
Failure to Enroll
If you miss the December 13, 2013, enrollment deadline, medical and prescription drug coverage for you and your
enrolled dependents will end January 31, 2014, and you will not be allowed to re-enroll in the Teachers’
Retirement Insurance Program (TRIP) at any time in the future.
More Details are Coming
Meetings about your new coverage options will be held throughout Illinois this fall. A schedule of meeting locations,
dates and times, as well as the dedicated phone numbers for each of the plans, will be mailed in the State’s open
enrollment kit, as well as posted on the Benefits website at www.benefitschoice.il.gov. This kit will be sent prior to
the beginning of the Open Enrollment Period. The MA-PD health plans (i.e., UnitedHealthcare, Coventry Advantra
and/or Humana) will also be sending you plan information. All materials provided by the State and by the plan
administrators will be posted on the Benefits website.
As an added benefit to members, the MA-PD plans offer a variety of wellness/clinical programs, such as the Silver
Sneakers® fitness program. Although the programs vary by health plan vendor, some examples include wellness
programs, disease management programs, case management programs, discount programs, medication therapy
management and meal programs.
Watch your mailbox in the coming weeks for more information about the Open Enrollment Period and the valuable
and comprehensive MA-PD plans available to you. Please pay careful attention to information packets that have
the new State of Illinois retiree Medicare Advantage logo and program name, “Total Retiree Advantage
Illinois – Your Trail to Better Health,” on them. These information packets will have information about the
plans available to you through your State of Illinois insurance.
Sincerely,
CMS Group Insurance Division
October 18, 2013 IRTA
I have just returned from a "train the trainer" seminar hosted by the Department of Central Management Services concerning the State Medicare Advantage plan. In addition to myself two other employees in the office attended the seminar.
Currently, CMS is waiting for approval of the letter which will be sent to all qualifying participants. To receive the letter members must meet BOTH of the following criteria:
- The member must be enrolled in Medicare Parts A and B, AND
- If the member has dependents on his/her coverage, ALL of the covered dependents must also be enrolled in both Medicare Part A and B.
CMS is expecting final approval of the letter today therefore the letter should be mailed by the beginning of next week. The letter will be delivered in a CMS envelope. The letter should be printed on yellow paper. Included in the letter will be general information about the plans, enrollment period dates, and premium rates.
You should receive a postcard shortly after the initial letter reminding you of the enrollment dates. A third mailing will be sent to you including an enrollment kit, a map of coverage area, dates and locations of seminars. You will also receive informational kits from the vendors.
October 17, 2013 IRTA
The Department of Central Management Services announced yesterday that the enrollment period for the Medicare Advantage plans has been set for November 12 through December 13, 2013. This change extends the previously announced enrollment period by one week. The effective date of the new plan will be February 1, 2014.
The IRTA continues to monitor the healthcare information that is being provided by the Department. We will send you any additional information as soon as we receive it.
If you are not a Medicare primary TRIP participant this plan does not affect you.
October 13, 2013 Hearing to be held on state retiree health insurance changes
With complaints continuing to come into lawmakers’ offices about changes planned to state retiree health insurance, a legislative panel has scheduled a hearing on the issue during the upcoming veto session.
The Commission on Government Forecasting and Accountability will hold a hearing Oct. 23 at the Statehouse to get updated information about the state’s plan to switch Medicare-eligible retirees to a Medicare Advantage plan.
It will replace the program familiar to retirees in which they are covered by the federal Medicare program and have Medicare supplement coverage provided by the same health insurance available to active employees.
“I hope we have some retiree groups who are allowed to testify and maybe ask the department (of Central Management Services) some questions,” said Rep. Raymond Poe, R-Springfield, a COGFA member. “There’s two things going on — verification of spouses and dependents and Medicare Advantage. I hope we can help people understand a lot more where they are going.”
“At this point, there is a lot of concern and thus a lot of distrust,” said Sen. Mike Frerichs, D-Champaign, a co-chair of COGFA. “A lot of it is not understanding how this will work. A lot of my constituents feel they have not been properly educated about these changes.”
“There’s some concerns with retirees that they don’t’ understand why they need to be foisted off of the Medicare option and into the Medicare Advantage plan,” said Rep. Jil Tracy, R-Quincy, COGFA’s other co-chair. “They have a great concern it’s not going to be equal to the care they are getting now.”
Must be ‘comparable’
During contract talks with the American Federation of State, County and Municipal Employees the two sides agreed to a series of measures to help control health insurance costs. One of those was to put Medicare-eligible employees into a Medicare Advantage plan. The plan is basically federal Medicare coverage provided by private health insurance. The companies receive financial assistance from Washington for providing the coverage.
State officials have said they believe the state can save $100 million with the change.
The AFSCME contract stipulated that the new health insurance coverage had to be “comparable” to what retirees were receiving in the past. However, the union doesn’t know yet if the Medicare Advantage plans recently selected by the state will meet that definition.
“AFSCME is closely analyzing the information made public this week to ensure that access and benefits are comparable to those currently offered, as our contract requires,” the union’s spokesman, Anders Lindall, said. “Since that information was only made public Wednesday, our analysis is still in the early stages.”
Tracy said she’s heard from people all over the state concerned that the new insurance plan will be more costly or more restrictive. She’s also heard from retirees who live out of state who are afraid their options for medical care will be more limited than they are now.
There will be four plans offered to retirees: Aetna Life Insurance Medicare Advantage HMO; Human Health Plan Medicare Advantage HMO; Humana Benefit Plan, available only in Livingston and Knox counties; and UnitedHealthcare nationwide Medicare Advantage PPO.
Retirees will have to make their selections between Nov. 12 and Dec. 6. The plans go into effect Feb. 1, according to the CMS website. That is a month later than originally planned.
CMS did not respond to questions about the change.
No Health Alliance
Health Alliance, a major provider of health coverage to state employees now, was not one of the companies selected to provide a Medicare Advantage plan.
Health Alliance Medical Plans decided not to appeal the contract denial within the state’s administrative channels, and the Urbana-based insurer isn’t planning to sue the state over the decision, according to Health Alliance senior vice president Jane Hayes.
The company’s bid was rejected based on a technicality, she said. The state, in its request for proposals, required that successful bidders already have at least five years of experience administering Medicare Advantage plans for one or more employers with at least 1,000 participants. The bidder also was required to have at least one year of experience running Medicare Advantage plans for a governmental employer with at least 500 participants.
Even though the company didn’t meet all of these requirements, the state could have waived them and still granted Health Alliance a contract in light of other comparable experience, Hayes said.
Health Alliance has more than five years of experience managing Medicare Advantage plans, including such plans for public-sector employers, the company’s bid says.
Those public-sector employers include the city of Springfield, Champaign County government and Illinois College in Jacksonville. The combined number of people covered across all of its Medicare Advantage plans totaled more than 15,000, the company’s bid says, though Health Alliance’s clients don’t include entities that meet the state’s size requirements.
Hayes said she is aware that the Illinois General Assembly’s Commission on Government Forecasting and Accountability is planning a meeting later this month to discuss the state’s decision on Medicare Advantage contracts.
“We’d like to see it reversed,” she said. “We don’t know if it will be.”
Big Brother?
While questions about the Medicare Advantage plans will be part of the hearing, Poe also wants to delve into the state’s efforts to verify dependent coverage claimed by retirees.
“We’re getting a lot of calls, especially on verification,” Poe said. “I think (retirees) are reading a lot into it that Big Brother is wanting a lot more information than they’re entitled to. Why do they want to see your checking account, why do they want to see if your house is paid for, why do they want to know if you have mortgages? The people calling us feel they are prying a little further than they should.”
State officials are trying to determine if spouses and other dependents claimed by retirees on their health insurance are, in fact, entitled to coverage. The state hired a company to conduct the verifications. To prove that a spouse is a spouse, for example, a person must provide the front page of their 2012 federal tax return transcript and another document issued within the last 60 days from a bank, mortgage or credit card statement listing both names.
AFSCME said its retirees chapter is also fielding a number of calls from former state and university workers about the verification process.
“Given that there was no advance notice of this new procedure, and that the information requested is of a sensitive nature, it’s understandable that retirees are worried,” Lindall said.
AFSCME successfully lobbied CMS to extend the deadline to provide the verification information until Dec. 6.
Poe said the insurance issue is a hot one in his district as retirees come up to him with questions about what is going on.
“We’re not having town hall meetings, but everywhere I go to eat or do something, I think we’re having them because people are concerned,” Poe said.
October 12, 2013 IRTA
Medicare Advantage Information
The Department of Central Management Services (CMS) has awarded contracts to the winning vendors of the following Medicare Advantage plan options for members of the State Employees Group Insurance Program, Teachers’ Retirement Insurance Program (TRIP) and the College Insurance Program (CIP):
- Aetna Life Insurance Company - a Medicare Advantage HMO Plan;
- Humana Health plan - a Medicare Advantage HMO Plan;
- Humana Benefit Plan - a Medicare Advantage HMO Plan for the counties of Livingston and Knox; and
- United Healthcare - a nationwide Medicare Advantage PPO
- The member must be enrolled in Medicare Parts A and B, AND
- If the member has dependents on his/her coverage, ALL of the covered dependents must also be enrolled in both Medicare Part A and B.
- If the member has a dependent on his/her coverage who is not enrolled in Medicare Parts A and B, the member will not be included in the group of members set to be offered a Medicare Advantage plan. The member and dependents will all remain in the current health plan.
- If the member RESIDES outside of the United States, the member will not be included in the group set to be offered a Medicare Advantage plan. The member will remain in the current health plan.
- The cut-off age for the enrollment period this fall is set for members turning the age of 65 on or before September 30, 2013. Members who will be 65 on October 1, 2013, or after will be included in the group set to be offered a Medicare Advantage plan during the fall of 2014. These members will remain in their current health plan until January 2015.
IMPORTANT: The federal Medicare enrollment period begins October 15th and concludes December 7th, 2013. That means non-State sponsored Medicare Advantage and Medicare Supplement plans are also sending information to our members during the same enrollment period that the State will be sending its Medicare Advantage plan information. In order for members to avoid mistakenly electing a non-State plan during this enrollment period and inadvertently losing their State of Illinois insurance coverage, members should only review information packets that have the State of Illinois retiree Medicare Advantage logo. Although the logo is not yet ready for the initial letter, it will be included on all future communications pieces both from the Department and from the selected vendors. In addition to these communications, the Department is developing a separate website for retirees which will be dedicated just to you.
Over the next two weeks the Central Management Services’ Bureau of Benefits staff will be:
- Working with the new health plan vendors to develop communication pieces for its members;
- Developing a Frequently Asked Questions (FAQ) document to answer questions (the FAQ will be posted on the website once it is ready);
- Developing a new State of Illinois Medicare Advantage website for eligible members;
- Developing toll-free phone numbers for the new Medicare Advantage vendor Customer Service units (the new phone numbers will be posted on the website once they are ready);
- Training internal staff who take calls from members, as well as retirement system staff, to be able to answer questions regarding the new Medicare Advantage plans;
- Training the new vendors’ Medicare Advantage Customer Service staff so that they will be able to respond to questions specific to the State of Illinois plans being offered; and
- Developing a schedule of state-wide presentations for all members interested in finding out more about the State-sponsored Medicare Advantage plans being offered. The schedule will be posted on the retiree benefits website and included in the enrollment packet that will be mailed to each member. Most presentations will be scheduled to take place during the month of November. Online website presentations are also being developed for members who may not be able to physically attend a meeting.
How much will the new Medicare Advantage Plan cost?
State retirees will continue to pay the 1% of their annuity for the Medicare Advantage coverage. The dependent rate for state retirees will not change. Retired teachers and community college employees will be provided new Medicare Advantage rates as soon as they are finalized and approved. The rates will be posted on the retiree benefits website and provided in the State of Illinois enrollment kit.
What happens to a member’s other State-offered plan benefits, like dental, vision and life insurance? Will a member still have them when changing to a Medicare Advantage plan?
Yes, members will continue to have the same dental, vision, and life plan benefits from the same plan administrators that they are currently enrolled.
Will a member be able to make changes to his/her coverage during the annual Benefit Choice Period held in May each year?
No. Retirees who become part of the State-sponsored Medicare Advantage group of members have a new annual enrollment period in the fall of each year to coincide with the federal Medicare calendar plan year. Although the effective date of coverage this year will be February 1st, future plan years will have an effective date of January 1st for any plan changes. Any plan changes that were allowed during the Benefit Choice Period held in May will now be allowed during the fall enrollment period instead.
Do the State-sponsored Medicare Advantage plans include prescription coverage?
Yes, all of the Medicare Advantage plans being offered have prescription drug coverage included with no gap (i.e., donut hole).
Are there any special programs being offered through these Medicare Advantage plans?
Yes, each Medicare Advantage plan offers a variety of wellness/clinical programs, such as the Silver Sneakers® fitness program. Although the programs vary by health plan vendor, some examples include various wellness programs, disease management programs, case management programs, discount programs, medication therapy management and meal programs.
How will a member know which State-sponsored Medicare Advantage plans will be offered in his/her Illinois county?
Once finalized, a map of the plans offered in each of the Illinois counties will be posted to the retiree benefits website and will be included in the State of Illinois enrollment kit.
What if I don’t make a change or send in an enrollment form?
Members who do not send a completed enrollment form to their retirement system by the due date of December 6th, will not be enrolled in one of the State-sponsored Medicare Advantage plans, nor will they remain in their current health plan. These members will have original Medicare coverage only. If the member is a state retiree, they may enroll in a State-sponsored Medicare Advantage plan during a future fall enrollment period and would have coverage effective the following January. Members who are retired teachers and community college employees who do not complete and return the enrollment form will not be allowed to re-enroll in the TRIP or CIP plan at any time in the future.
When will members be given the plan design details for each of the State-sponsored Medicare Advantage plans being offered?
The plan design documents are being finalized for each type of plan and should be ready to post in the next few days. Once the documents are approved, they will be posted to this website. A map of the plans available in your county will also be posted.
Members are encouraged to check the Central Management Services website periodically for further information below.
Click here: http://www2.illinois.gov/cms/Employees/benefits/Teachers/Pages/default.aspx
October 11, 2013
On October 10, 2013 the TRIP Advisory Committee met to discuss several issues related to the health insurance plan. A timeline was communicated by the Department of Central Management Services for the notices to be sent to TRIP participants concerning the Medicare Advantage plan. A detailed letter outlining the different plans will be sent to TRIP participants that qualify the week of October 14, 2013. Within the body of the letter a timeline will be outlined so that participants will know when the enrollment period will begin and end. At this time we do not know if the letter will include premiums but it was suggested to CMS that they hold off sending the letter until they could include the premium amounts.
I will continue to keep you informed as we work through the health insurance changes.
Sincerely,
James Bachman
Executive Director
Illinois Retired Teachers Association
October 10, 2013
Regarding the new Medicare Advantage Plans that will be provided by the state (Central Management Services, i.e. “CMS”) for retired teachers:
There is some new useful information here, but not a whole lot. Certainly no specific information for retired teachers on premiums, benefits or health care providers ( doctors, hospitals, etc). When you read the statement, you will see it is just not available yet. It is still being developed.
We do now know who the vendors are. We just don’t know what the premiums or benefits are for the plans they are setting up for CMS’s Medicare Advantage Plans. We also don’t know what doctors and hospitals are included in the networks for the HMO Plans. We don’t know who the preferred doctors or preferred hospitals are in the PPO Plan offered by United Healthcare.
Actually, there is a lot we still don’t know. Hopefully, the information will be available soon.
I am confident; IRTA will get the information to you as soon as it is available. We cannot speculate. We don’t want to provide misinformation. There is confusion enough already. We do not want to contribute to more confusion.
Dave Davison
October 7, 2013 IRTA
From CMS:
Due to the issues surrounding the Federal Government shutdown, the due date for documents under the dependent audit that is impacting members of TRIP has been extended to December 6, 2013.
Members do not need to request an extension. It will occur automatically
October 4, 2013 Dependent eligibility verification audit
Just in case you missed it – CMS has added this information on their web page in response to questions regarding the impact of the federal government’s shutdown on gathering information for the Dependency Audit.
NOTE: Due to the Federal government shutdown and possible subsequent delays in the government’s processing of IRS tax transcript requests, those members who need to order a federal tax return transcript should go ahead and do so. If a response is not received within two weeks, members should request an extension of the documentation deadline to HMS. Members should refer to Question 13 in the Dependent Verification Audit Frequently Asked Questions document for instructions regarding how to order the transcript and Question 10 for instructions on how to request an extension. The deadline for requesting an extension is October 25th.
To read the entire Dependent Eligibility Verification information, check the CMS web page --
http://www2.illinois.gov/cms/Employees/benefits/Teachers/Pages/DEPENDENTELIGIBILITYVERIFICATIONAUDIT.aspx
October 2, 2013 IRTA
The Department of Central Management Services (CMS) announced today that the Medicare Advantage procurement has concluded and contracts are being awarded to the winning vendors. All members who will be offered a Medicare Advantage plan option, whether they live in Illinois or in another state, will have access to a nationwide Medicare Advantage PPO plan. Certain members residing in Illinois, depending on residential county, will also have access to a Medicare Advantage HMO plan. It is the Department’s intent to award the following contracts –
- Aetna Life Insurance Company - a Medicare Advantage HMO Plan;
- Humana Health plan - a Medicare Advantage HMO Plan;
- Humana Benefit Plan - a Medicare Advantage HMO Plan for the counties of Livingston and Knox; and
- United Healthcare - a nationwide Medicare Advantage PPO
Once all matters are finalized, the letter(s) will, at a minimum, include the following information:
- Plan design, including copayment amounts, deductibles and coinsurance percentages
- Provider networks
- Enrollment dates
- Effective date of the new coverage
- Monthly premiums
- Opt out information
- Seminar dates, locations and times
As there are certain formalities that must be followed before the procurement is finalized, limited information remains available, both in the CMS Benefits Office and with the selected vendors. CMS is asking that you refrain from contacting the vendors until this process is complete as their staff is not yet familiar with the plan(s) being offered. Your patience and assistance is appreciated.
Please check back to the CMS website often as information will be posted there once it is known.
http://www2.illinois.gov/cms/Employees/benefits/Teachers/Pages/default.aspx
October 2, 2013 United Health Care snags 3.6 billion Illinois health care contract
Click here: http://www.illinoisobserver.net/2013/10/01/extra-unitedhealthcare-snags-3-6-billion-illinois-health-care-contract/
From Central Management Services (CMS) web site:
DEPENDENT ELIGIBILITY VERIFICATION AUDIT
To ensure that only eligible dependents are covered under the Teachers’ Retirement Insurance Program (TRIP), the Illinois Department of Central Management Services has retained the services of HMS Employer Solutions (HMS), an independent firm, to conduct a Dependent Eligibility Verification Audit.
By law, the State's plans, including TRIP, can only cover eligible members and dependents. While most dependents are eligible, some dependents in the plan may no longer meet the eligibility guidelines.
HMS is mailing a letter to each TRIP member who has a dependent enrolled. The letter will detail the steps and documentation required to keep your dependents covered. The signed letter and all required documentation must be submitted directly to HMS by the due date indicated on the letter.
In an effort to assist in the audit process, a Frequently Asked Questions document will be included in the mailing. HMS has developed a secure website at www.AuditOS.com which is available to all members who are included in this audit. By registering on this website, you will find more details regarding this audit as well as assistance in locating and submitting your documentation.
When you receive any correspondence from HMS Employer Solutions, please read it carefully as there are specific due dates when certain information needs to be submitted. Failure to follow the instructions could result in loss of coverage for your dependents.
Rich Frankenfeld
TRS Director of Outreach
2815 W. Washington St.
PO Box 19253
Springfield, IL 62794-9253
217-753-0973
October 1, 2013 IRTA
The State of Illinois Department of Central Management Services is giving notice of its award of contacts subsequent to the solicitation for offers in response to the Medicare Advantage Plans.
The following contracts will be awarded: 1) Aetna Life Insurance Company will receive a contract to provide a Medicare Advantage Plan-HMO for its entire service area; 2) Humana Health plan will receive a contact to provide a Medicare Advantage Plan-HMO for its entire service area; 3) Humana Benefit Plan will receive a contract to provide a Medicare Advantage Plan-HMO for the Counties of Livingston and Knox; and 4) United Healthcare will receive a contract to provide a Medicare Advantage-PPO.
More details will follow in the coming days.
September 29, 2013 Questions on state retiree insurance unanswered as deadline nears
Click here: http://www.sj-r.com/top-stories/x452544223/Questions-on-state-retiree-insurance-unanswered-as-deadline-nears
September 26, 2013 IRTA
The Department of Central Management Services is sending a verification letter to TRIP participants to ensure that only eligible dependents are covered under TRIP.
By law, the State plans, can only cover members and eligible dependents.
As a participant in TRIP, you must provide all required documentation for each enrolled dependent no later than October 25, 2013.
If you do not have enrolled dependents in TRIP you will not receive this letter.
September 19, 2013 Medicare Gap vs. Medicare Advantage Plans
Click here: http://www.medicarerights.org/fliers/Medigaps/Medigaps-vs.-Medicare-Advantage.pdf?nrd=1
September 17, 2013
Jim Bachman, Executive Director of IRTA discussed the current health insurance issues. IRTA is in current negotiation to secure a supplemental plan for IRTA member retirees. It would require the purchase of a prescription plan. This would be apart from TRIP.
Information about this plan will come through voter voice or robo phone calls.
September 11, 2013
Teachers’ Retirement Insurance
Program (TRIP) in the News
Medicare Advantage Plans
This document is intended to help answer questions with regard to the recent news that the State of Illinois plans to implement a Medicare Advantage Plan for Medicare-eligible TRIP participants.
What is Medicare Advantage?
Simply put, it is the incorporation of Medicare into the retired state employees' and retired teachers’ health insurance plans. The state becomes the sole administrator of what were previously two health insurance providers (Medicare and TRIP).
The state will be implementing a Medicare Advantage Plan for Medicare-eligible State Employees’ Retirement System (SERS) and State Universities Retirement System (SURS) participants pursuant to the recently settled AFSCME state employment contract. Since the state also administers TRIP, along with the health insurance benefits of SERS and SURS retirees, it believes that by shifting to this type of plan for all retirees that it can provide the same level of health care services while reducing costs through:
Economies of scale
Improving the quality of health care provided
More proactive health care delivery
It is important to know that the AFSCME contract requires that the Medicare Advantage plans offered to retirees must be comparable in access, benefits and plan design to the health care coverage that the state’s Medicare-eligible retirees had prior to the transition to Medicare Advantage.
Medicare Advantage plans are becoming more widely utilized as they steadily improve consumer services. Nearly one-third of all Medicare beneficiaries have chosen to participate in Medicare Advantage plans. Several states are now utilizing Medicare Advantage plans to provide health care benefits to public sector retirees.
What does this mean for you?
The Medicare Advantage plan will take the place of BOTH your Medicare and your TRIP supplemental health insurance. The Medicare Advantage plan will cover Medical Parts A (Hospital Insurance), B (Medical Insurance) and D (Prescription Drugs).
Medicare Advantage plans cover all emergency and urgent care claims. Hospice care is the only coverage that will continue to be provided to retirees under “original Medicare.”
Retirees age 65 or older who are not eligible for Medicare will not be eligible to participate in a Medicare Advantage plan, but will be eligible for coverage in TRIP.
When will I know more details about the state’s Medicare Advantage plan?
The Illinois Department of Central Management Services (CMS) has issued a Request for Proposal (RFP) to solicit bids from health insurance firms that offer Medicare Advantage plans. More details should be forthcoming by October.
Although the State of Illinois is known to delay medical payments to medical providers, retirees will not be forced to pay up front the full cost for health care under Medicare Advantage.
Will there be an option to have a supplemental “Medigap” plan rather than participate in Medicare Advantage?
The RFP that was issued by CMS allows insurers to submit bids to cover both Medicare Advantage and Medicare Supplement Plans (“Medigap”). It is uncertain as to whether the Medigap plans will be able to fit within the state’s cost parameters and be offered.
If a Medigap plan is offered, members are encouraged to weigh the coverage and cost options of that plan versus the coverage and costs of the Medicare Advantage plan.
What should I expect on Jan. 1, 2014?
Prior to Jan. 1, depending on the outcome of the RFP bidding process, retirees should have the opportunity to choose between a Medicare Advantage plan comparable either to the Teachers’ Choice Health Plan (PPO) or the Managed Care Plan (HMO/OAP).
If Medigap plans are also offered, retirees will be able to choose a Medigap plan as an alternative to Medicare Advantage.
September 7, 2013
Retired teachers once again are concerned over actions by the State. This time it is over a recent announcement about health insurance. I want to share my perspectives to prevent conjecture.
It is important to note that IRTA, IFT, IEA, and the other members on that TRIP advisory committee are endeavoring to cooperate on providing news to members. As a matter of fact, the initial email to members of IRTA and IEA are the same because they agreed that would be helpful.
Because the TRIP advisory committee had not met in years, I was fed up and wrote two registered letters this summer to both the Governor and CMS Director decrying the communication problems that not holding meetings created and urging the State to see that the meetings resumed quarterly. That prodding seems to have worked. But we will see over time.
It is very important for retirees to understand that the committee is ADVISORY. Many falsely believe that TRS or the advocacy groups control the insurance provisions.
IRTA has been monitoring the “below the radar” law enacted this year that called for the state to seek bids on a Medicare Advantage program. A Medicare Advantage program combines Medicare with a supplemental insurance policy. The initial view was that this new law would be aimed at state employees as a pilot program, not those retirees in TRIP. But that has changed. The State simply wants to save money.
From the perspective of legislative leaders, this new direction does not make sense from a strategic point of view. Previously they wanted us to trade our COLA for access to health insurance. Now the state is going in a different direction???
At the recent TRIP committee meeting when the new Medicare Advantage plan was mentioned by CMS, there were no significant details. CMS will release those later, even though they must know some parameters because of the bid solicitation. But given the changes this year in co-pay and deductibles ( such as with Cigna) that confused retirees and prompted many calls to CMS, it is not surprising that CMS wants to have their act together.
Those who attended the TRIP advisory committee have learned that around October 1, CMS will announce a new Illinois Medicare Advantage Plan. CMS plans to hold informational meetings around the state then. From mid-October through the end of November, Medicare Primary participants in TRIP and other state insurance programs would have to decide whether to go it alone in getting supplementary insurance or to sign up with the new state plan. I agree with those who believe that the decision period for the new Illinois Medicare Advantage should be longer. Even if CMS holds meetings around the state after October 1, insurance can be confusing and changes can frighten retirees. I am sure all the affected groups would ask for more time. But it appears the state wants the sign up completed by November 30th in order to have all of December to roll out the new insurance on Jan. 1, 2014.
It appears that only those who are now Medicare Primary will have to choose. They would not be eligible for the current TRIP policy. It appears that the non-Medicare primary group (those not eligible for Medicare and those under 65) will not be affected yet by the new program.
IRTA has been proactive in planning for this. This summer your executive board met with insurance consultants to review our options. One of those options is researching alternative insurance plans for our members. We are looking at type F supplemental insurance which provides the widest coverage while avoiding co-pays. We are also looking at GROUP policies because they can shield participants from age-related cost increases and also looking at drug supplemental policies.
My advice is to avoid panicky decisions. Wait to see what news surfaces around October 1. Then watch for IRTA bulletins and meetings. It is not prudent to jump right now into a new health insurance program without knowing the facts.
Retirees can take some comfort in knowing that their organizations are monitoring and sharing what little information they have with their members. But they cannot share information they do not yet have, and it is not smart to share or ask for conjecture.
Tell any non-member friends that their best action right now is to join the state IRTA so they are ready to receive information and take advantage of any possible IRTA group plan.
I hope this information will help you answer questions and concerns from retired teachers. Thank you for your steady leadership.
I am Gary Elmen, President of IRTA
September 6, 2013
Representatives from IEA, IFT and I had a conference call yesterday with Janice Bonneville from CMS to follow up on our August 21st TRIP meeting. There is no additional information on the Medicare Advantage Plan at this time. The seminars will not be scheduled until they have executed the contract. CMS is still planning to execute the contract on October 1st. I am currently working on alternatives plans with outside providers. We will continue to meet with CMS to provide you and the membership with the latest news.
August 30, 2013 From Gary Elmen, IRTA President
It is important to note that IRTA, IFT, IEA, and the other members on that TRIP advisory committee are endeavoring to cooperate. As a matter of fact, the initial email to members of IRTA and IEA are the same because they agreed that would be helpful.
Because that TRIP advisory committee had not met in years, I was fed up and wrote two registered letters this summer to both the Governor and CMS Director decrying the communication problems that has created and urging them to see that the meetings resumed quarterly. That prodding seems to have worked. We will see over time.
Aside from Cinda's defense of the We Are One coalition backing of the bill to trade off pension rights for some vague unenforceable health insurance promise (which IRTA publicly opposed and is willing to fight in court), her outline of the statute creating the TRIP advisory committee was helpful in showing that it is indeed advisory.
This is very important for retirees to understand. Many falsely believe that TRS or the advocacy groups control the insurance provisions.
IRTA has been monitoring the "below the radar" law enacted this year that called for the state to seek bids on a Medicare Advantage program. The initial view was that this would be aimed at state employees as a pilot program, not those retirees in TRIP. But that has changed.
This new direction does not make sense from a strategic point of view from the legislative leaders' perspective. Previously they wanted us to trade our COLA for access to health insurance. Now a different direction???
At the recent TRIP committee meeting when the new Medicare Advantage plan was mentioned, there were no significant details. CMS will release those later, even though they must know some parameters because of the bid solicitation. But given the changes this year in copays/deductibles (e.g. Cigna) that confused retirees and prompted many calls to CMS, it is not surprising that CMS wants to have their act together.
Yes, I agree that the decision period for the new Illinois Medicare Advantage should be longer. Even if CMS holds meetings around the state after October 1, insurance can be confusing and changes can frighten retirees. I am sure all the affected groups would push for more time.
On top of this all is the Federal Affordable Care Act. Every couple weeks we hear of changes in the timelines and guidelines. Shifting sand! It remains to be seen how that will affect us all.
But retirees can take some comfort in knowing that their organizations are monitoring and sharing what little information they have with their members. But they cannot share information they do not yet have, and it is not smart to share conjecture.
Best wishes.
Gary Elmen
President, IRTA
August 23, 2013 From our Area Rep. David Davison
The following information provided by IRTA was sent to IRTA members who are registered for Voter Voice yesterday. (Thursday, August 22) I have been telling people to be on the lookout for something of the nature that is described in the information provided in the statement. It is happening.
The Teachers Retirement Insurance Program Committee met yesterday, August 22. Items that were discussed included program funding and plan design. In addition, the Department of Central Management Services announced that TRIP Medicare primary retirees would be required to enroll in a State-sponsored Medicare Advantage Plan.
The State of Illinois requested bids for a State-sponsored Medicare plan on June 21, 2013. It is the goal of the State of Illinois, Department of Central Management Services (DCMS) to have a contract in place by October 1, 2013, which will allow an enrollment period to make elections which will be effective January 1, 2014. One or more of the following options will be available choices for coverage for anyone who has Medicare as their primary coverage:
- Medicare Advantage Plan
- HMO
- Nationwide PPO
More information will be posted to this website as it becomes available. Please check back often.
Note: At this time, members who have one or more dependents on their coverage who do not have Medicare as their primary coverage will not be required to change to one of the new Medicare plan options.
The committee will be meeting again in October. We will continue to keep you updated on the Medicare Advantage plan.
Sincerely,
James Bachman
Executive Director
Illinois Retired Teachers Association
jbachman@irtaonline.org
1-800-728-4782
powered by voterVOICE
I checked the CMS website just now. Presently, there is no additional information on that website other than what Jim Bachman has provided below. I did not find anything about the Medicare Advantage Program on the TRS website other than a link to the CMS website.
I have a 92 year old mother-in-law who will be impacted by this, that does not have a clue that it is coming. She does not use a computer. It will be up to my wife and I to help her understand how this Medicare Advantage Plan will impact her and to decide what is best for her to do relative to supplemental health insurance. All of us probably have family or friends in the same boat as my wife’s mother. Please keep that in mind and help those people know what is happening.
I would just add that IRTA understands how important health insurance is to its members and will make every effort to keep members informed about this new Medicare Advantage Plan being implemented by the Illinois Department of Central Management Services. (CMS)----as the information becomes available. Maybe I should not say anything in addition to what Jim has said above, but I’m gonna. Consider the source.
The following relates to the many calls our IRTA Central Office is receiving.
· This new Medicare Advantage Plan will impact TRS annuitants and their spouses whose primary health insurance is provided by Medicare and who use TRIP as their supplemental health insurance plan. (TRIP stands for Teachers Retirement Insurance Plan)
· It appears that if you are a TRS annuitant who is Medicare Primary that uses TRIP as your supplemental insurance and your spouse is not Medicare Primary, you will have to participate in the Medicare Advantage Program or buy your supplemental health insurance on the open market. Your spouse will be able to continue with his/her present supplemental insurance plan.
· The insurance companies providing the HMO(s) and the PPO(s) that are described above as part of the Medicare Advantage Plan have not been identified by CMS at the present time.
· CMS has not provided information about the benefits nor premiums associated with Medicare Advantage Plan.
· TRIP will still be available for Non Medicare eligible TRS members and their spouses.
· The Medicare Advantage Plans will not keep TRS annuitants and their spouses from keeping or buying a Medicare Supplemental Health Insurance Plan on the open market from an insurance broker not affiliated with TRIP or the Medicare Advantage Plan.
· Obviously, it is too early to tell which doctors and hospitals will participate in the Medicare Advantage Plan.
· It is dangerous to say anything is definite as long as CMS is still developing the “rules and regs” of the program. People that have dealt with state agencies know the rules and regs can and often do change right up to implementation.
Really, I guess the only thing we know for sure is that the Medicare Advantage Plan will be implemented starting January 1, 2014, and TRS annuitants are impacted by it. Hopefully, more information will follow soon. Maybe not until the end of September though. Look for November to be the month we have to make decisions and October to be the month they provide detailed information.
Since I am a Medicare Primary type guy and my wife is also, we are going to be looking into what is available from a broker on the open market before November. It appears my wife and I are not going to be using TRIP starting January 1, 2014. (Not that far away.) We have been with TRIP a long time.
Hopefully, IRTA will be able to provide information about supplemental health insurance for Medicare Primary annuitants before November also. That way, we should have time to compare what is available through the Medicare Advantage Plan with what is available from an independent broker in time to give it some serious thought.
August 22, 2013 IRTA
The Teachers Retirement Insurance Program Committee met yesterday, August 22. Items that were discussed included program funding and plan design. In addition, the Department of Central Management Services announced that TRIP Medicare primary retirees would be required to enroll in a State-sponsored Medicare Advantage Plan.
The State of Illinois requested bids for a State-sponsored Medicare plan on June 21, 2013. It is the goal of the State of Illinois, Department of Central Management Services (DCMS) to have a contract in place by October 1, 2013, which will allow an enrollment period to make elections which will be effective January 1, 2014. One or more of the following options will be available choices for coverage for anyone who has Medicare as their primary coverage:
- Medicare Advantage Plan
- HMO
- Nationwide PPO
More information will be posted to this website as it becomes available. Please check back often.
Note: At this time, members who have one or more dependents on their coverage who do not have Medicare as their primary coverage will not be required to change to one of the new Medicare plan options.
The committee will be meeting again in October. We will continue to keep you updated on the Medicare Advantage plan.
Sincerely,
James Bachman
Executive Director
Illinois Retired Teachers Association
jbachman@irtaonline.org
1-800-728-4782
August 20, 2013
The IRTA has posted the following on their website.
CMS Mailing to Medicare Participants
The State of Illinois Central Management Services recently sent a mailing to 9,700 Medicare participants asking for a copy of the front of their Medicare card. IRTA has contacted CMS and verified that this is a legitimate request. CMS is currently conducting a membership cleanup of their records.
A copy of the front of the Medicare card is needed so CMS will have your Medicare id#. CMS would like to stress that if you received the request, to please send a copy of the Medicare card to the CMS address provided so their records can be updated.
July 22, 2013 New TRIP Information from Ed Wollet
In a conference call this week I spoke to Chris Owsley (CMS management) and Sinead Madigan (Health Alliance legislative director).
Below is a summary of that conversation for those retirees who have Medicare primary and a TRIP HMO or TRIP OAP. Just a reminder that HMO's would include programs such as Health Alliance (HA), BC/BS, and HMO Illinois. OAP's include programs such as Health Link and Coventry.
Initial problems came to light when advice from Central Management System representatives (CMS) did not match with advice from customer service representatives a Health Alliance. Specifically, were issues about co-payments and coordination of benefits with Medicare.
The latest understandings I have following the conference with Chris and Sinead are:
1. HMO/OAPs will recognize any doctor for payment regardless whether the doctor is in network or out of network because Medicare has no such in network requirement.
2. Any applicable deductible is due only on the residual amount not paid by Medicare. So, Medicare will pay first, the deductible will be applied to the remaining amount, and HMO/OAPs will pay the balance.
3. There is a health insurance "bank" that each individual accumulates during the benefit year. When credits (the difference between the Medicare payment and HMO/OAP payment) are accumulated they will be used to pay the individual's co-payments. The bank is not cumulative and begins anew each year. The bank is for the individual participant's use and is not "pooled" for all participants to use. Any amount in the bank at the end of the benefit year is returned to health insurance provider. I am still unclear as to the calculations used to determine the amount in the bank, how the individual can determine how much is in the bank, and how this money is used to determine future premiums.
4. The premium for either an HMO or OAP is the same. Only TCHP participants pay a higher premium.
From this phone conversation, it appears that there have been no changes to the Medicare primary/TRIP secondary benefits for this year. The original misinformation being disseminated by HA will be corrected (Sinead Madigan). I appreciate the work that Leslie Ankrom-Booth (CMS Medicare coordination specialist) put in to help me understand this issue and to push it up the line.
One final note...when I asked if this could have been avoided by having a TRIP board meeting, I was told by Chris Owsley that calling that meeting was for someone higher up. The next level up is the director of CMS. I know that our IRTA president, Gary Elmen, has pushed for such a meeting.
July 10, 2013
Your question: I believe I have it that TCHP participants will see an increase in premiums and will have a 60/40 major medical split.
Even though non-Medicare members previously incurred the 60/40 split applied to out-of-network services, Medicare members could go to any Medicare provider and have their benefits paid at the in-network (80/20) benefit level. Effective July 1st, Medicare members will need to ensure their provider is in the Cigna network to have their benefits paid at 80%. If they use an out-of-network provider, yes you are correct, the amount that Cigna will pay after Medicare pays their portion of the claim will be 60%.
Your question: Those currently using TRIP as a supplement to Medicare will see a premium increase and will have to make co-payments for office visits and hospitalizations where in the past all expenses above and beyond the Medicare payment were picked up by the supplement.
Yes, there was a premium increase for all TRIP members ($4.97 for TCHP Medicare members/per month); however, if I am understanding your question correctly, no for the copayment question. Medicare members will still not be charged the copayment each time they are hospitalized or go to the ER. Those 'additional deductibles' will not be applied to Medicare members.
July 3, 2013
Just a reminder – All health insurance premiums, whether for TRIP or the State plan, are paid in arrears.
Therefore, the first time the new premiums for FY 2014 will be deducted from one’s pension check will be with the August 1 pension check.
You can find the new premiums for TRIP on the CMS web site --
http://www2.illinois.gov/cms/Employees/benefits/Teachers/Pages/FY2014TRIPRates.aspx
The new premiums for the State health insurance plan can also be found on the CMS web site –
http://www2.illinois.gov/cms/Employees/benefits/StateEmployee/Documents/Retiree_Premiums.pdf
Rich Frankenfeld
TRS Director of Outreach
By DOUG FINKE (doug.finke@sj-r.com)
The State Journal-Register
Posted Nov 19, 2012 @ 10:30 PM
Last update Nov 19, 2012 @ 10:37 PM
The state has awarded contracts to Health Alliance HMO and Coventry Health Care HMO to provide health-care coverage to state employees, retirees and their dependents.
The new contracts have an initial term of 3 1/2 years, but the state has the option of an additional five, one-year renewals. The new contracts are set to begin Jan. 1.
Awarding the contracts essentially resolves a controversy that erupted in 2011 when the state rebid health insurance contracts and did not select Health Alliance or Humana, two longtime providers of state health insurance to thousands of employees and retirees.
Instead, the state awarded HMO contracts to Blue Cross and Blue Shield, even though the company didn’t contract with health-care providers in some downstate counties. The Department of Healthcare and Family Services said the switch would save the state $1 billion over 10 years.
The change sparked a legislative and legal battle over the state’s decision. The state eventually agreed to rebid the contracts.
“It resolves the issue of the rebidding of the group insurance contracts for state employees and retirees,” said DHFS spokesman Mike Claffey. “We’re happy to move forward.”
Blue Cross and Blue Shield will continue to provide HMO coverage for people in the Chicago area.
Claffey did not provide costs for the new contracts, but said the state no longer expects to save the $1 billion over 10 years that it previously expected.
Health Alliance HMO covers 43,141 members and 43,504 dependents, DHFS said. Coventry HMO (formerly Personal Care) covers 5,408 members and 4,608 dependents.
“We are pleased to continue our longstanding relationship with the state of Illinois and our service to more than 94,000 members who live in our service areas,” Health Alliance CEO Jeff Ingrum said in a statement. “We applaud the state for taking steps to ensure that members can continue important relationships with their healthcare providers.”
The state had issued temporary contracts extending Health Alliance and Coventry coverage while the new bids were being taken. Consequently, there is no need for a special enrollment period for members.
However, about 8,000 people covered by Health Alliance Illinois will need to select new insurance coverage. The plan covered people in several western and far southern counties.
Health Alliance Illinois also had a temporary contract, but that is ending with the new HMO contracts being awarded. Health Alliance Illinois was a self-insured plan and did not meet the bid criteria for a fully-insured plan, Claffey said.
“They were not allowed to bid because they are not a fully insured plan,” Claffey said.
People enrolled in that plan will be given a chance to change carriers. Claffey said letters will be sent to them advising them of the changes and how to select a new carrier.
Doug Finke can be reached at 788-1527.A reminder from CMS –
Medicare-eligible individuals enrolled in the Teachers' Retirement Insurance Program (TRIP) have prescription drug coverage that is on average as good as, or better than, the standard Medicare prescription drug coverage (Medicare Part D) and should not enroll in a Medicare Part D plan during this Medicare Part D open enrollment season , unless you qualify for low-income/extra-help assistance.
Rich Frankenfeld
TRS Director of Outreach
Latest Trip Information
TRS has just been advised by CMS that the 90-day emergency contracts with Health Alliance HMO, Health Alliance Illinois and Coventry HMO have been extended until the managed care procurement process is completed, not to exceed June 30, 2013.
Rich Frankenfeld
August 30. 3012
This just in from CMS – Looks like another extension is in the works. We’ll keep you updated.
A request has been made to extend the current contracts with Health Alliance HMO, Health Alliance Illinois and Coventry HMO for a minimum of 94 days (through the end of the calendar year). In order to extend, a hearing must be held before the CPO (Chief Procurement Officer). This hearing, set for September 5, 2012, is not a legislative hearing but more of a procedural matter.
If you receive calls regarding the extension, please advise members that CMS has requested to extend the contracts and is working through the process. CMS will update members through the ‘Latest News’ section of the CMS Benefits Website as soon as a decision on the extension is made.
Rich Frankenfeld
FY2013 TRIP Benefit Choice Booklet
FY2013 Summary of Changes
TRIP BENEFIT CHOICE PERIOD FY2013
The Benefit Choice Period will be May 1 through June 15, 2012, for all Teachers’ Retirement Insurance Program (TRIP) benefit recipients. The FY2013 Benefit Choice Options booklet contains the latest information regarding the Benefit Choice Period options, as well as other benefit information. Elections will be effective July 1, 2012.
During the annual Benefit Choice Period, benefit recipients are allowed to make changes to their group insurance coverage, such as add a dependent or change their health plan. Benefit recipients should make all Benefit Choice changes on the Benefit Choice form available on the TRS website or by calling TRS at (800) 877-7896. Only members wishing to make a change to their coverage should complete the form. The Benefit Choice form must be submitted to TRS by June 15, 2012.
May 23, 2012
IRTA
In an effort to ensure that health carriers are in place for the start of the next fiscal year (July 1, 2012), a decision has been made to enter into emergency contracts with Health Alliance HMO, Health Alliance Illinois and Coventry Health Care HMO. These contracts will be for 90 days with an option to extend for an additional period as needed. Members may view the Illinois county map which lists health plans by county to determine which health plans are available in their area. The following list includes all of the health plans that will be available for FY2013:
- Teachers' Choice Health Plan (administered by Cigna) (D3)
- BlueAdvantage HMO (CI)
- Coventry HMO (AS)
- Coventry OAP (CH)
- Health Alliance HMO (AH)
- Health Alliance Illinois (BS)
- HealthLink OAP (CF)
- HMO Illinois (BY)
The plans in bold are available in Winnebago County.
Members will receive a letter indicating listing the available health plans and the deadline by which they must submit a Benefit Choice Form if they wish to make a change. Forms must be submitted to TRS by June 15, 2012.
May 9, 2012
The following information has been posted to the Latest News section of the CMS Benefits website (http://www.benefitschoice.il.gov ).
Four of the managed care plans that will be in place for FY2013 are known and may be elected during the Benefit Choice Period if desired. Please note, however, that these are not necessarily all of the managed care plans that will be available in the upcoming plan year.
Once all of the health plan contracts have been decided for the upcoming plan year, the Benefit Choice Options booklet and the Benefit website will be updated with those options.
At this time the following health plans available for the FY2013 and will be available in the same counties as they are in the current plan year:
· Quality Care Health Plan (administered by Cigna) (D3)
· BlueAdvantage HMO (CI)
· HMO Illinois (BY)
· Coventry OAP (CH)
· HealthLink OAP (CF)
To be clear, the list of health plans above are those that are known to be available for the FY2013 plan year and is not necessarily an all inclusive list of the plans that will be available.
Once all of the health plans contracts are in place for FY2013, the Benefit Choice Options booklet and the Benefits website will be updated with that information.
Additionally, all members will be mailed a letter telling them their health plan options and the end date by which a Benefit Choice Election form must be submitted for those members electing to change their health plan election. Members will be given sufficient time to make their health plan decision and election.
Rich Frankenfeld
TRS Director of Outreach
2815 W. Washington St.
May 1, 2012
CMS has just updated their web site with the most recent TRIP information (see below).
Here is what we know so far:
· Health carriers options have not been finalized.
· No end date for the Benefit Choice Period has been set since carrier options are still unknown.
· However, TRIP premium rates have been set. See the Benefit Choice Booklet link below (page 4 ).
As soon as information is received, it will be posted here. Members may also check the CMS web site for updates – click on the website below.
http://www2.illinois.gov/cms/Employees/benefits/Insurance/Pages/TeachersRetirementInsurance.aspx
http://www2.illinois.gov/cms/Employees/benefits/Insurance/Pages/TeachersRetirementInsurance.aspx
TRIP Benefit Choice Period FY2013
The Benefit Choice Period will begin May 1, 2012, for all benefit recipients. Even though the Benefit Choice Period will begin May 1st, an end date has not been set since the health carrier options for plan year 2013 have not yet been finalized. Once the health carrier contracts are finalized, the Benefit Choice Period end date will be announced. Benefit recipients will be given sufficient time to make an informed decision regarding their health plan election.
During the annual Benefit Choice Period, benefit recipients are allowed to make changes to their group insurance coverage, such as add dependent coverage. This year, members should delay making health plan changes until the health carrier contracts have been finalized. Once the Benefit Choice Period end date has been announced, the Benefit Choice form will need to be submitted to TRS by the announced due date. Any elected changes in coverage will be effective July 1, 2012.
During the annual Benefit Choice Period, Benefit Recipients may:
· Change health plans. Members should delay making health plan changes until the health carrier contracts have been finalized.
· Add dependent coverage if never previously enrolled.
The FY2013 Benefit Choice Options Booklet and a summary of the FY2013 benefit changes are available by clicking on the links below:
· FY2013 TRIP Benefit Choice Booklet [PDF, 3.6 MB]
· FY2013 Summary of Changes [PDF, 114KB]
All Benefit Choice changes should be made on the Benefit Choice Form available through the Teachers' Retirement System (TRS) website ( trs.illinois.gov ). Benefit recipients should not complete a form if no changes are being made. If you are enrolling yourself or an eligible dependent for the first time during the Benefit Choice Period, please contact TRS at (800) 877-7896 for a TRIP enrollment application. All forms must be submitted to TRS for processing.
