State Agencies and Local Health Employers
Vol. 20, No. 11
August 8, 2003
Health Insurance Dual-Choice Information
October 6-24, 2003 is the Dual Choice Enrollment period for coverage
effective January 1, 2004. Dual-Choice provides an opportunity for
insured subscribers (active employees, annuitants, and former employees
who have continued their coverage) to change health insurance plans
and/or change from single to family coverage without a waiting period
for pre-existing conditions.
The 2004 It's Your Choice booklets will be supplied
to all state agencies prior to October 7 for distribution to employees.
In November, you will receive an Employer Bulletin containing
additional instructions for Dual-Choice reporting. The Department
of Employee Trust Funds (DETF) will distribute monthly reporting
forms for 2004 during the second week of November 2003.
Pharmacy Benefits Manager (PBM)
The Group Insurance Board met on July 9, 2003 to approve selection
of a contractor to administer a prescription drug program for the
State of Wisconsin Group Health Insurance Program. The Pharmacy
Benefit Manager (PBM) selected was Navitus Health Solutions. Navitus
is a Wisconsin-based consortium of health care organizations including
Dean Health System, SSM Health Care, Inc., Touchpoint Health Plan,
ThedaCare, and Bellin Health. The switch to Navitus as the PBM for
the health insurance program will be effective January 1, 2004.
As part of the new prescription drug program under Navitus, a three-level
co-pay structure for pharmacy benefits will be implemented in 2004.
The three-level co-pay structure is as follows:
Level 1* Copayment for Formulary Prescription Drugs: $5
Level 2** Copayment for Formulary Prescription Drugs: $15
Level 3 Copayment for Non-Formulary Prescription Drugs: $35
*Level 1 consists of most generic and certain low cost brand name
**Level 2 consists of preferred brand name and certain higher cost
A formulary is a list of prescription drugs that are determined
to be medically and cost effective. It is established by a committee
of physicians and pharmacists .
The annual Out-of-Pocket Maximum will be $300 per participant or
$600 per family (applies to Level 1 and Level 2 Prescription Drugs/Insulin).
Level 3 co-payments do not apply to the out of pocket maximum.
Navitus is expecting to implement a Web site with formulary
and pharmacy listings by the Dual Choice enrollment period
(October 6 – 24, 2003). Please check DETF's Internet
site at etf.wi.gov for new information on the PBM or any
other health insurance changes. Click on the "2004 Health Insurance
Program Changes" button for the latest updates. The next issue
of It's Your Benefit, set for publication in mid-September,
will highlight the PBM changes as well as any issues related to
the upcoming Dual Choice enrollment period. DETF will provide additional
information about reporting requirements in future Employer Bulletins.
Employers should work with DETF to resolve PBM eligibility issues.
Other Uniform Benefits Plan Changes:
The GIB also approved changes to the Uniform Benefits to be effective
January 1, 2004. The most substantive change is that non-surgical
removal of third molars, when performed by an oral surgeon, is now
included as a covered benefit.
Overview of the 3-Tier Health Insurance Program
Consistent with the state budget and subject to collective bargaining
agreements, the state employee health insurance monthly premium
contribution will be determined by a 3-tier formula. The 3-tier
premium approach will not affect participating local government
employer contributions at this time.
Each plan will be analyzed by DETF to evaluate its cost of providing
benefits under the state employee health insurance program. The
most efficient plans will be placed in Tier 1, the moderately efficient
plans in Tier 2, and the least efficient plans in Tier 3.
The amount that employees will be required to contribute to their
health insurance premiums will depend on the tier level of the health
plan they choose. The Tier 1 plans will be available to employees
for the lowest cost. Plans in higher tiers will be more expensive
to employees. This approach creates incentives for health plans
to improve the efficiency with which they provide services. Placement
in a more favorable tier will help the plans attract and retain
members, while reducing their charges to the state.
For additional information please visit DETF's Internet site.
The Department of Employment Relations also has an overview of the
three-tier health model on its site at http://der.state.wi.us.
Contact Joan Steele at DETF with PBM or 3-Tier Health Insurance
Program questions. You may reach Joan by phone at (608) 266-6465,
or by e-mail at email@example.com.
Dual Choice Kickoff Meeting
The annual Dual-Choice Kick-off meeting is set for Wednesday, October
1, 2003 from 9:00 A.M. to 11:30 A.M. at the Mendota Mental
Health Institute Conference Center, 301 Troy Drive, Madison, Wisconsin.
Directions and a map to the Kickoff were provided in Employer
Bulletin Vol. 20, No. 7 dated May 23, 2003. A copy of this
bulletin is available on DET's Internet site at http://etf.wi.gov.
This meeting provides an opportunity for employers to receive information
from health plan representatives and from DETF employees about health
plan changes taking effect January 1, 2004. Please call the Employer
Communication Center at (608) 264-7900 with questions.
A list of Health Plan Contacts (ET-1728) will be available at the
Dual-Choice kickoff meeting.
Registration is required for the Dual-Choice Kickoff meeting, as
DETF anticipates a large number of attendees due to the program
changes noted above. Please fill out the
registration form attached to this bulletin
and return it to Wendy Pink by fax at (608) 266-5801, or by mail
Department of Employee Trust Funds
Attn: Wendy Pink
P.O. Box 7931
Madison, WI 53707-7931