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Employers

Employer Bulletin

Local Health Employers
Vol. 22, Local J
August 16, 2005

Consider WPE Group Health Insurance Program Options for 2006

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 from the following health program options available for plan year 2006:

  • A Standard Plan that is a preferred provider plan (PPP) administered by Wisconsin Physician Service (WPS) Health Insurance, as an option to the classic fee-for-service Standard Plan.
  • A deductible option for both Uniform Benefits and the Standard Plan or the Standard PPP, offering premium rates that average 10% below traditional rates.

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

You may elect to participate in one of the following options, effective January 1, 2006, instead of the current benefit option in which you currently participate:

  • 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.
  • A deductible option for your employees and annuitants, in lieu of the “traditional HMO” benefit plan and the Classic Standard Plan.
  1. The Deductible Uniform Benefit option: This option has an up-front deductible of $500 individual / $1000 family per calendar year 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.

    AND

  2. The Deductible Standard Plan: This program continues to offer participants the choice to see any provider with up-front deductible and coinsurance amounts on all medical services. (The Classic Standard Plan has deductible and coinsurance amounts on major medical services only.)

    OR

  3. The Deductible Standard PPP: This PPP program operates as the Standard PPP, but has a larger deductible to allow greater premium savings.

Listed below are the options available to employers for plan year 2006.

  1. Traditional HMO Option paired with the Classic Standard Plan
  2. Traditional HMO Option paired with the Standard PPP
  3. Deductible HMO Option paired with the Deductible Standard Plan
  4. Deductible HMO Option paired with the Deductible Standard PPP

What Must I Do Now?

  • If you wish to remain in your current benefit plan, do nothing.
  • If you wish to offer a different benefit plan to employees and annuitants, you must file a new resolution (attached to this bulletin) to select your new choice. The resolution must be received by ETF by October 1, 2005, for coverage effective January 1, 2006.

For more information on the WPE Group Health Insurance Program options, contact ETF’s Employer Communication Center at (608) 264-7900. Information regarding the WPE Group Health Insurance Program and other benefit programs is also available on our Internet site at http://etf.wi.gov.

This chart summarizes these non-Medicare benefit options available January 1, 2006.

supporting excellence in Wisconsin public service