25-02-2025
Health Alliance discontinuing plans at year's end; Medicare Advantage to continue
CENTRAL ILLINOIS (WCIA) — Carle Health has announced that its healthcare plans through Health Alliance will cease business at the end of this year.
Health Alliance is the largest health insurer in Central and Southern Illinois, with more than 240,000 members. But on Jan. 1, 2026, all of their plans will be discontinued except for Medicare Advantage.
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'As a leader in healthcare, Carle Health has an obligation to set the standard for excellence,' officials said in a press release. 'We continually evaluate and expand on successful components of our organization while addressing areas that may fall short. Every action and strategy we pursue is rooted in our mission to be a trusted partner in healthcare decisions, ensuring we effectively utilize our resources to best serve our patients, families and communities.'
According to a release sent out by Carle Health, the health insurance industry has changed dramatically in the last several years, particularly for provider-owned insurers. This has led to health plans struggling to achieve 'operational and financial efficiency,' according to the release from Carle Health.
Medical inflation, rising prescription drug costs, increased utilization of health care services, and higher volumes of chronic medical conditions have led to 'considerable financial strain.'
'Carle Health has had to make decisions that enable us to better focus on our core services, built around the health and wellbeing of patients,' James C. Leonard, MD, Carle Health President and Chief Executive Officer said. 'We recognize that in today's health insurance environment, our health plans no longer successfully compete and Carle Health must effectively utilize our resources to meet the changing needs of customers.'
Officials clarified that throughout the remainder of 2025, health plans will maintain operations necessary to support claims processing and meeting ongoing business needs, regulatory mandates and contractual obligations.
Carle Health also said that the organization has begun to communicate with employees, customers and impacted partners about the changes. Now, they're working to make sure all 'regulatory requirements are met' and make adjustments to continue to serve its members through the end of the calendar year.
'We are so grateful for the commitment of all the health plan employees who will continue to serve customers as we navigate this transition. They have consistently brought innovative solutions, unique programming and unmatched customer service to improve the health outcomes of those we serve for decades, and that impact is felt by members across the country,' Sinead Madigan, Health Alliance President said.
Carle Health also said that membership information will still be available through the Hally/MyChart member platform beyond the end of the year.
Effective immediately, Health Alliance will address all group proposals, renewals and existing groups in the following fasion:
Coverage will continue for all existing insured Large Group, Small Group, Self-funded, Balance or Medicare Supplement (group or individual) customers that have already renewed in 2025.
Renewals will continue to be provided throughout 2025 for Large and Small Group customers who have yet to renew, but coverage will end on Dec. 31, regardless of renewal date or any other date listed on contracts or prior communication.
All existing Self-Funded and Balance groups will end without the opportunity for renewal the day prior to their scheduled 2025 renewal date or Dec. 31.
All outstanding Self-Funded and Balance renewal proposals for effective dates on or after April 1 will be withdrawn with no offer for renewal.
Health Alliance will continue to produce Small Group insured proposals for effective dates through and including Dec. 1. Coverage for these proposals will end Dec. 31.
If requested, Health Alliance will continue to produce Large Group insured proposals for effective dates through and including July 1. Coverage for all such proposals will end Dec. 31. Coverage for all other Large Group and Small Group insured proposals will end Dec. 31, regardless of what date is indicated in the proposal.
No Large Group insured proposals will be offered beyond July 1, and no Small Group insured proposals will be offered beyond Dec. 1.
'Health Alliance and FirstCarolinaCare will continue to provide a high level of service to existing customers through the end of the year,' officials said. 'This includes processing of claims, as well as renewing fully insured plans to support employers and individuals seeking to obtain new or maintain current health plan products.'
The Health Alliance President shared a statement on the plans to discontinue their 'all lines of business.'
We are so grateful for the commitment of all the health plan employees who will continue to serve customers as we navigate this transition. They have consistently brought innovative solutions, unique programming and unmatched customer service to improve the health outcomes of those we serve for decades, and that impact is felt by members across the country.
Sinead Madigan, Health Alliance President
Health Alliance members are advised to contact their client consultant if they have any questions. Carle Health also said that membership information will still be available through the Hally/MyChart member platform beyond the end of the year.
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