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Employers

Employer Bulletin

Local WRS Employers
Vol. 21, Local L
October 8, 2004

New Options Available in the Wisconsin Public Employers Group Health Insurance Program

Now is the time for employers participating in the Wisconsin Retirement System (WRS) to consider joining the Wisconsin Public Employers (WPE) Group Health Insurance Program. The WPE insurance program, administered by the Department of Employee Trust Funds (ETF), is the program of choice for more than 300 municipalities that rely on it for competitive health insurance premium rates and one stop shopping for access to more than twenty plan service areas statewide. The program also incorporates the successful new prescription drug program administered by the pharmacy benefits manager (PBM), Navitus Health Solutions, credited with saving the state millions of dollars in prescription drug costs.

In our ongoing effort to provide a quality, long-term partnership for purchasing health insurance to local employers, ETF announces two new programs:

  • 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 or Standard PPP, offering premium rates averaging 10% below traditional rates.

This Bulletin is intended to provide some basic information as well as direct you to more detailed information.

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.

Effective January 1, 2005, employers may select from the two new programs:

  • 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 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 from which employers may select for plan year 2005:

  1. Traditional HMO Option paired with the Classic Standard Plan (Current Option offered to existing employers covered under WPE)
  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 Deductible (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 deductible
70/30 coinsurance
$2000/$4000 annual max

The 2005 monthly premium rates and a map showing plans available by county are included in this bulletin. Plans underlined on the map are “qualified” which is 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 his or her choice of the health plans that are offered when the employer elects to join the WPE Group Health Insurance Program and selects one of the options noted above. During the annual dual-choice enrollment period, normally offered in October, insured employees may elect, without restriction, to change to a different participating health plan or to change from single to family coverage, effective the following January 1.

To join the WPE Health Insurance Program, you must file a resolution selecting the benefit option you will offer your employees and annuitants. Coverage is effective on the first day of the month following 90 days after the Department receives the resolution, unless you specify a later month. All employees eligible for WRS must be offered coverage. Eligibility includes current and future WRS retirees covered under your current group health insurance plan.

The WPE health program currently has no individual underwriting and no waiting periods for pre-existing medical conditions for eligible employees and retirees who were covered under the employer’s group health plan prior to coverage in the WPE Health Insurance Program. However, effective January 1, 2005, the program will require group underwriting in certain circumstances. Employers with 100 or more eligible employees are underwritten to determine whether the group should be assessed a variable, per contract per month surcharge for a specified period of time based on their risk characteristics. These large employers may also have limited effective dates.

Groups with average risk characteristics receive no surcharge. Groups with higher than average risk characteristics are assessed a surcharge tied to that risk for the first 12 months. For the second 12 month period (months 13 through 24) in the program, the surcharge is reduced by half and is eliminated after the 24th month of continuous participation.

For more information on joining the WPE Group Health Insurance Program, contact Rick Parpart, ETF, Division of Trust Finance and 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 regarding the WPE Group Health Insurance program, as well as other ETF administered benefit programs, is also available on our Internet site at http://etf.wi.gov.

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