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Employers

Employer Bulletin

Local WRS Employers
Vol. 22, Local N
October 28, 2005

Consider Participating 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 Group Health Insurance Program, authorized by the Group Insurance Board and administered by the Department of Employee Trust Funds (ETF), offers the following benefits:

  • competitive health insurance premium rates;
  • one-stop shopping for access to more than twenty health plan service areas statewide; and
  • a successful prescription drug program administered by the pharmacy benefits manager (PBM), that is credited with saving the state and local employers millions of dollars in prescription drug costs.

ETF announced two new programs last year as part of an ongoing effort to establish a quality, long-term partnership for purchasing health insurance for local employers:

  • A preferred provider plan (PPP) 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.

New for 2006: An integrated employer prescription drug plan for Medicare Part D eligible retirees. The Group Insurance Board has contracted with Dean Health Insurance, Inc. (DHI) to provide a fully insured benefit that provides the same level of prescription drug coverage available to active employees, while taking advantage of the new Medicare Part D benefit.

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

1) Managed Care Plans that include 15 participating health maintenance organizations (HMOs) and one participating preferred provider organization (PPO) with locations statewide. These plans provide comprehensive benefits at a lower cost than the Standard Plan in exchange for some health care provider limitations. All employees enrolled in this type of plan have the same level 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 health care at the lowest possible cost. With Uniform Benefits, employees can select a plan based on cost, quality of services, and access to specific physicians or other health care providers.

Note: The current HMO Plan has been redesignated the “Traditional HMO plan.”

2) The Standard Plan (fee-for-service indemnity) is a self-insured health plan that pools the combined claims experience of all participating local government employers. The State Maintenance Plan (SMP) is available in counties where no HMO meeting the minimum provider-availability requirements exists. Administration of these plans is changing to WPS Health Insurance (WPS) from Blue Cross & Blue Shield of Wisconsin. WPS will provide administrative services for the classic Standard Plan, Standard PPP, SMP, and their deductible options.

Note: The current “Standard Plan” has been redesignated the “Classic Standard Plan.”

Employers may select from the two following options:

  • A Standard PPP option. This option, available at a lower premium rate, allows participants to see the 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 is available for employees and annuitants, in lieu of the traditional benefit plans. This deductible option has an up-front deductible of $500 per individual / $1000 per 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. The deductible option, when chosen, applies to the HMOs, the Standard Plan, and the SMP plan option offered by the employer to all their employees and annuitants.

Options from which employers may select for plan year 2006 are listed below:

    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 in 2005).
    3. Deductible HMO Option paired with the Deductible Standard Plan (New in 2005).
    4. Deductible HMO Option paired with the Deductible Standard PPP Deductible (New in 2005).

The chart below summarizes these non-Medicare benefit options available January 1, 2006:

Uniform Benefits
Standard Plan Benefit Options
Traditional Option above, Deductible Option Below 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 maximum

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

$500/$1000 deductible
After deductible is met, Uniform Benefits apply
$500/$1000 upfront deductible 80/20 coinsurance $2000/$4000 annual out-of-pocket maximum

In-Network:
$500/$1000 deductible 80/20 coinsurance $2000/$4000 annual maximum

Out-of-Network:
$1000/$2000 deductible 70/30 coinsurance $4000/$8000 annual maximum

The 2006 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 including 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 “non-qualifying” (not underlined) have limited provider availability in the county.

Each employee has the choice of health plans offered by the employer when the employer elects to join the WPE Group Health Insurance Program. During the annual Dual-Choice enrollment period, which occurs in October, insured employees may elect, without restriction, to change to a different participating health plan within their option or to change from single to family coverage, effective the following January 1.

Joining the WPE Group Health Insurance program is as easy as filing a resolution to select the benefit option you will offer your employees and annuitants. Coverage is effective on the first day of the month following 90 days after ETF receives the resolution, unless you specify a later date. All WRS eligible employees must be offered the health insurance coverage. Eligibility includes current and future WRS retirees covered under your current group health insurance plan.

The WPE Group Health Insurance program currently has no individual underwriting and no waiting periods for pre-existing medical conditions for eligible employees and retirees covered under the employer’s group health plan prior to coverage in the WPE Group Health Insurance Program.

However, the WPE Group Health Insurance Program may require group underwriting in certain circumstances. For example, 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 the group’s risk characteristics. These large employers may also have limited effective dates.

For more information on joining the WPE Group Health Insurance Program, contact the Employer Communication Center at (608) 264-7900. 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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