Harvard Pilgrim & Fallon Dropped; Tufts Now Medicare Only
JANUARY 19, 2018: Thursday, the state’s Group Insurance Commission (GIC) shocked enrollees by voting to drop Harvard Pilgrim Healthcare and Fallon as providers. The move also relegates Tufts to a Medicare Supplement and Medicare Advantage plans only. All changes take effect on July 1, 2018 with the start of the new fiscal year.
Harvard Pilgrim & Fallon Dropped; Tufts Now Medicare Only
JANUARY 19, 2018: Thursday, the state’s Group Insurance Commission (GIC) shocked enrollees by voting to drop Harvard Pilgrim Healthcare and Fallon as providers. The move also relegates Tufts to a Medicare Supplement and Medicare Advantage plans only. All changes take effect on July 1, 2018 with the start of the new fiscal year.
“This news hit like a bombshell at Thursday morning’s Commission meeting. There had been some anticipation of perhaps one or two plans being dropped, but no one expected that three of the largest and most popular health insurance plans would be dropped all at once,” said Association Legislative Director Shawn Duhamel, who was present at the meeting along with senior officials from many public employee unions. “There is not only great concern on the impact this has on our collective members, but also in the manner in which the GIC conducts its business.
“GIC Commissioners did not receive word of the proposed changes until late on Wednesday, leaving little time for deliberation or debate. Changes of this magnitude, regardless of the merits, must be openly discussed and proper time allowed for input from those impacted.”
After lengthy debate over procedural matters, including a proposal by union officials to delay the vote by two weeks – to allow for public input during the GIC’s public hearing process now underway, the question was called, resulting in an 8-5 vote in favor of the changes.
Those impacted by these changes are encouraged to attend any of the 8 GIC Public Hearings scheduled between Monday, January 22nd and Monday January 29th. Click here for more information on the complete Public Hearing schedule.
Over 100,000 Subscribers Impacted
Currently, Tufts is the GIC’s largest non-Medicare plan covering roughly 40,000 active employees and non-Medicare Retirees. Harvard Pilgrim and Fallon carry some 31,000 and 8,000 non-Medicare subscribers respectively. Including the loss of Harvard and Fallon’s Medicare plans, more than 100,000 GIC subscribers are directly impacted by the changes.
The GIC has selected three insurance carriers to provide non-Medicare coverage and two carriers for Medicare. Each impacted subscriber will now be forced to select a new health insurance plan during the GIC’s open enrollment period, which begins April 3, 2018.
When pressed by retiree and union representatives on what, if any, negative impact might be felt in terms of quality of benefits and universal access, GIC officials claimed that very few negative impacts were likely to be felt. They claim that consideration has be given to ensure that proper coverage exists across the Commonwealth in all geographic areas.
“The devil is absolutely in the details when it comes to health insurance,” says Association Insurance Coordinator Cheryl Stillman, herself a veteran of the GIC staff. “Anyone being displaced by these changes must pay close attention to whether or not their doctors and hospital are part of the new plan they select. The vast majority of Massachusetts providers are part of all GIC insurance plans, but coverage is not 100% universal. We cannot take anything for granted here!”
Medicare enrolled retirees can rest easy that the popular Optional Medicare Extension (OME) Plan, run by UniCare, has been renewed for at least three years (with two one year extensions possible). UniCare will also remain a non-Medicare provider for both retirees and active employees.
As the GIC’s largest current provider, Unicare insures some 45,000 non-Medicare retirees and active employees, along with more than 70,000 Medicare enrollees. UniCare is also the plan of choice for retirees living the majority of the year outside of Massachusetts.
In addition to UniCare, the GIC has also contracted with Health New England and Neighborhood Health Plan as non-Medicare insurance plan options. Medicare enrollees would have the option to choose between Tufts and UniCare’s plans.
Mass Retirees and leaders from nearly every public employee union, as well as the Massachusetts AFL-CIO, continue to work together to pass legislation that would change the make-up of the 17-Member GIC to provide for a more open and balanced Commission. Other legislative efforts are also underway to mitigate out-of-pocket costs and prevent municipalities from further increasing insurance premium contribution rates on retirees.