Personal Care/Christie Clinic Clients Take Note: Special Enrollment Begins This Week

A new Special Enrollment Period (SEP) began on Monday for those who receive their health insurance coverage through the state. Special Enrollment offers an opportunity to review your insurance carrier options and make a change if you wish. This may be particularly helpful now to Personal Care enrollees with Christie Clinic physicians.  Below are Central Management Services answers to some of the questions you may have:

Q. What changes can I make during the SEP?

A. You can only change health carriers during this SEP. No other changes will be permitted.
Q. I want to change carriers. Is there a form that I need to fill out?

A. Forms for individuals enrolled in the State, College or Local

Government plans can be found on the Benefits website (www.benefitchoice.il.gov). Individuals enrolled in the Teachers’ plan should have received a form directly from TRS.

Q. How do I know if my doctor is enrolled in one of the plans?

A. Information regarding each of the plan administrators coverage area and networks are available on their websites. You can also contact the plan administrator with specific questions.

Q. I am enrolled in PersonalCare and my primary doctor is at Christie Clinic. If I don’t change health insurance and they end their contract, what options do I have to choose a new health insurance plan?

A. Outside of the SEP or the annual Benefit Choice period, members may only change health insurance plans if they experience a Qualifying Change in Status (QCIS). For a contract issue, such as the one currently occurring between PersonalCare and Christie Clinic, the only issue that will result in a QCIS is the loss of a primary care physician (PCP). Only individuals enrolled in Persona1Care HMO are assigned a PCP so, only these members would be eligible to make a change. If you are enrolled in PersonalCare HMO and your PCP leaves the network, you may:

• Choose another PCP within that plan;
• Change managed care plans; or
• Enroll in the Quality Care Health Plan.