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Employers

Employer Bulletin

Local Health Employers
Vol. 21, Local K
October 8, 2004

Employer Bulletin Reviews 2005 Health Insurance Premium Rates Provided To Local Governments; New Options Available in the Wisconsin Public Employers Group Health Insurance Program

2005 Health Insurance Premium Rates

The 2005 monthly premium rates for local government employers enrolled in the Wisconsin Public Employers (WPE) Group Health Insurance Program, including rates for new options announced below, and a map showing plans available by county are included in this bulletin. Plans underlined on the map are “qualified” and defined as meeting minimum requirements for the number of primary providers, a hospital (if one exists in the county), pharmacy, chiropractor, and dentist (if applicable) physically located in specific counties. Plans on the map that are not underlined—”non-qualified”—have limited provider availability in the county. Each employee has a choice of the plans offered. During the annual Dual-Choice enrollment period, insured employees may elect without restriction to change to a different participating plan, either “qualified” or “non-qualified,” or to change from single to family coverage, effective the following January 1.

ETF Announces New Options within the WPE Group Health Insurance Program

Local Government employers participating in the Wisconsin Public Employers (WPE) Group Health Insurance Program available through the Department of Employee Trust Funds (ETF) are invited to consider electing the following new health program options available for plan year 2005:

  • A preferred provider plan (PPP) administered by Blue Cross Blue Shield of Wisconsin as an option to the classic fee-for-service Standard Plan.
  • A deductible option for both Uniform Benefits and the Standard Plan, offering premium rates that average 10% below traditional rates.
  • A combination of the PPP and deductible Uniform Benefit option.

This bulletin is intended to provide some basic information and direct you to more detailed information on selecting the new options.

The WPE Group Health Insurance Program currently offers two types of plans:

  • Health Maintenance Organization (HMO) Plans that include 15 participating health organizations with locations statewide. HMOs provide comprehensive benefits at a lower cost than the Standard Plan in exchange for some health care provider limitations. All employees enrolled in HMOs have the same levels of coverage, called Uniform Benefits, with the exception of dental coverage, which may be offered at the discretion of the health plan. Uniform Benefits are designed to ease employee plan selection and assist ETF’s efforts to negotiate quality care at the lowest possible cost. With Uniform Benefits, employees can select an HMO based on cost, quality of services, and access to specific physicians or other health care providers. (Note: The current HMO Plan has been re-designated as the “Traditional HMO.”)
  • Standard Plan (fee-for-service indemnity) is a self-insured health plan that pools the combined claims experience of all participating local governments. (Note: The current “Standard Plan” has been re-designated as the “Classic Standard Plan.”) The State Maintenance Plan (SMP) is available in counties where no HMO exists with the minimum provider availability requirements.

Local government employers now have three new health insurance program options available in 2005. These options include a combination of higher deductibles and/or a PPP option for the fee-for-service standard plan, allowing employers additional flexibility in offering less costly health insurance plans.

Effective January 1, 2005, you can offer new options, instead of the current benefit option you participate in:

  • Standard PPP - The Standard PPP option, available at a lower premium rate, allows participants to see any provider of their choice, but with differences in reimbursement depending on whether participants go to an in-network or an out-of-network provider. Blue Cross Blue Shield of Wisconsin provides administrative services for the classic Standard Plan, Standard PPP, and SMP.
  • A deductible option for your employees and annuitants, in lieu of the “traditional HMO” benefit plan. The deductible option has an up-front deductible of $500 individual / $1000 family per calendar year on all plans for medical services. (Note: The deductible does not apply to pharmacy benefits.) Once the deductible has been met, the traditional benefits are administered as described for each plan.

Listed below are the options available to employers for plan year 2005.

  1. Traditional HMO Option paired with the Classic Standard Plan (Current benefit option you are covered under)
  2. Traditional HMO Option paired with the Standard PPP (New option)
  3. Deductible HMO Option paired with the Deductible Standard Plan (New option)
  4. Deductible HMO Option paired with the Deductible Standard PPP (New option)

The chart below summarizes these non-Medicare benefit options available January 1, 2005:

Uniform Benefits Standard Plan Benefit Options
Traditional Option Classic Standard OR Standard PPP
Traditional Uniform Benefits

$250/$500 major medical deductible

80/20 major medical coinsurance

$1250/$2500 annual out-of-pocket maximum

In-Network:
$250/$500 deductible
90/10 coinsurance
$1000/$2000 annual max

Out-of-Network:
$500/$1000 deductible
70/30 coinsurance
$2000/$4000 annual max

$500/$1000 upfront deductible

After deductible is met, Uniform Benefits apply.

$500/$1000 upfront deductible

In-Network:
$500/$1000 deductible
90/10 coinsurance
$1000/$2000 annual max

Out-of-Network:
$1000/$2000 deductiable
70/30 coinsurance
$2000/$4000 annual max

What Must I Do Now?

  • If you wish to remain in the current benefit plan (Traditional HMO Option paired with the Classic Standard Plan), do nothing.
  • If you wish to offer the new deductible option paired with either the Deductible Standard Plan or the Deductible Standard PPP or the traditional HMO Option paired with the Standard PPP to employees and annuitants, you must file a new resolution (attached to this bulletin) to select your new choice. Coverage is effective on the first day of the month following 90 days after ETF receives the resolution. Should you wish to offer one of the new options during Plan Year 2005, the resolution must be received by ETF by March 1, 2005. Resolutions received between March 1 and October 1, 2005, will have an effective date of January 1, 2006. For changes in plan year 2006, resolutions must be filed by October 1, 2005.

For more information on these new options from the WPE Group Health Insurance Program, contact Rick Parpart, ETF, Division of Trust Finance & Employer Services, P.O. Box 7931, Madison, WI 53707-7931. Call (608) 267-2198, FAX (608) 266-5801, or e-mail rick.parpart@etf.state.wi.us. Information about the WPE Group Health Insurance Program and other benefit programs is also available on our Internet site at etf.wi.gov.

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