calculators
forms and publications
news
about etf
frequently asked questions
contact etf
site map
video library
related links
home
top of page
home
members retirees employers governing boards careers at etf
 
Employers

Employer Bulletin

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 drugs

**Level 2 consists of preferred brand name and certain higher cost generic drugs

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 joan.steele@etf.state.wi.us.

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 at:

Department of Employee Trust Funds
Attn: Wendy Pink
P.O. Box 7931
Madison, WI 53707-7931

 

supporting excellence in Wisconsin public service