Idaho state government health insurance to be managed by new insurer for the first time since 2004

BOISE (Idaho Capital Sun) — Idaho’s state government employee health insurance — covering more than 25,000 employees and over 35,000 of their family members — is set to be managed by Regence BlueShield of Idaho this summer, as Idaho change’s insurers for the first time in nearly two decades.

The contract for Regence BlueShield, signed Jan. 4, sets the Lewiston-based insurer to take over Idaho state health insurance policies in July. 

But a final decision on the contract is still pending until a lawsuit is resolved that seeks to uncover how outside analysts compared costs between insurers that wanted the contract. Blue Cross of Idaho, the insurer that held the contract since 2004, sued the state over those and other records concealed.

Idaho’s health insurance plan covers nearly 62,000 people, Idaho Department of Administration spokesperson Kim Rau said. Another 632 retired employees and 138 retiree family members are also covered, she said. In 2022, Idaho allowed teachers to access the Idaho state employee insurance plans.

Regence previously held the Idaho state employee health insurance contract for several years before Blue Cross, according to records provided by the Idaho Department of Administration, dating back to the late 1970s. 

Regence, a nonprofit mutual health insurer, serves more than 396,000 Idahoans, according to contract bid documents. 

A Regence spokesperson said the company is working toward a “smooth transition” to overseeing the contract after the state’s “rigorous and disciplined solicitation process.”

“We’re honored by the state’s decision to award the contract to administer the state employee health plan to Regence BlueShield of Idaho, following a rigorous and disciplined solicitation process,” spokesperson Lou Ripel told the Idaho Capital Sun in a statement. 

A Blue Cross spokesperson called for more transparency around the process.

“The state purchasing process must be transparent,” Blue Cross spokesperson Mike Reynoldson told the Sun in a statement. “This decision will impact the health care of over sixty-thousand state workers, educators and their families. The people of Idaho have the right to understand how this multi-billion dollar state contract was awarded, including what caused the cost of each bidder to change by hundreds-of-millions of dollars between July and November.”

Idaho officials said in court filings the July data was too flawed to use.

Are you an Idaho state employee or family member? Here’s how your health insurance is changing.

Regence will offer three health insurance plan tiers: Preferred Provider Organization (PPO), traditional and high-deductible. Regence, under the contract, “must ensure that its network covers nearly every available practitioner and facility in the state of Idaho.” The insurer must also “continue to maximize its provider network in Idaho,” according to the contract.

Regence must also help patients switch over, the contract says:

• Regence “shall provide transition of care services” for 90 days. Those services would be provided when someone covered “needs to continue receiving treatment from an out-of-pocket provider who was treating the insured as an in-network provider with the previous carrier.” Regence could bill those services, during the change, at its highest allowable in-network rate for such services. People insured could see “uncovered costs.”
• Regence must identify and contact people covered who have pre-authorizations during the switch if their pre-authorizations need renewed.

 

• Regence should help members transition prescription pre-authorizations. The contract offers two options, at the state’s choice: Continue covering medications under pre-authorizations for six months to 12 months, or waive requirements for pre-authorizations, possibly for three to six months.

 

Regence must also, according to the contract, provide an optional mail-in pharmacy “and steer (covered employees and their families) toward mail-in by designing out-of-pocket cost shares to incentivize mail as the primary order and refill mechanism.”

Regence, a nonprofit mutual health insurer, serves more than 396,000 Idahoans, according to contract bid documents. 

Printed insurance ID cards must be mailed to people insured on or around the second week of June, the contract says. Employee communication timelines are still being finalized, Rau told the Sun on Friday.

Rau said more information on the contract change will be available to employees before this spring’s open enrollment, which is a time period when people can enroll in new insurance policies or change their coverage, without a significant life change. Open enrollment is April 22 to May 10, Rau said.

“Teams across the company are working to ensure a smooth transition and onboarding for all state employees and their dependents by this summer,” Regence spokesperson Riepl told the Sun. “We remain on track to provide all those covered by the state plan unsurpassed access to high-quality care and exceptional customer service beginning July 1, 2024, and continuing for many years thereafter.”

On the same day as the contract was signed, Idaho Department of Administration Director Steve Bailey told finalist companies vying for the contract in a letter that he’d issue a final decision after an expected decision from a judge overseeing a public records lawsuit. 

While a judge ordered the agency to release additional information it concealed in that lawsuit earlier this month, her decision is on hold. Bailey plans to make a decision on the contract award, also contested by Blue Cross, once that case is resolved, Rau said Friday.