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
- A deductible option for both Uniform Benefits and the Standard
Plan or Standard PPP, offering premium rates averaging 10% below
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
- 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
Effective January 1, 2005, employers may select from the two new
- 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:
- Traditional HMO
Option paired with the Classic Standard Plan (Current Option
offered to existing employers covered under WPE)
- Traditional HMO Option
paired with the Standard PPP (New option)
- Deductible HMO Option
paired with the Deductible Standard Plan (New option)
- 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:
||Standard Plan Benefit Options
||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
$1000/$2000 annual max
$2000/$4000 annual max
$500/$1000 upfront deductible
After deductible is met, Uniform Benefits
|$500/$1000 upfront deductible
$1000/$2000 annual max
$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
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 email@example.com.
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.