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
- 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
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
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
- 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
Note: The deductible does not apply to pharmacy
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
- 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 in
- Deductible HMO Option paired with the Deductible Standard
Plan (New in 2005).
- 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:
Standard Plan Benefit
|Traditional Option above, Deductible Option
||Classic Standard OR
|Traditional Uniform Benefits
||$250/$500 major medical deductible
80/20 major medical coinsurance $1250/$2500 annual out-of-pocket
$250/$500 deductible 90/10 coinsurance $1000/$2000 annual
$500/$1000 deductible 70/30 coinsurance
$2000/$4000 annual maximum
After deductible is met, Uniform Benefits apply
|$500/$1000 upfront deductible 80/20 coinsurance
$2000/$4000 annual out-of-pocket maximum
$500/$1000 deductible 80/20 coinsurance $2000/$4000 annual
$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
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
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.