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FAQ

Frequently Asked Questions

Group Insurance Board

The information provided below is current as of May 9, 2017. For the most up-to-date information on the State of Wisconsin Group Health Insurance Program and the Wisconsin Public Employers Group Health Insurance Program, visit the It’s Your Choice section on our website or follow ETF on Twitter. You may also subscribe to It’s Your Choice e-alerts about health benefits and related health and wellness topics.

General Information | Benefits and Services | Regionalization
Self-Insurance | Vendor Contracts

GENERAL INFORMATION

Why did the Group Insurance Board (Board) make changes to the health program?
The Board made the decision to change from the current fully-insured program structure after a year of review, analysis and consideration of different options to achieve the following goals:

  • Quality care
  • Maintain benefit levels
  • Ensure provider access
  • Contain program costs
Analysis from the Board’s consulting actuary, Segal, shows that 98% of all current providers will be available in the new structure. The changes are estimated to save taxpayers $60 million over the 2017-2019 biennium. Similar savings is anticipated future years.

BENEFITS AND SERVICES

Are my medical benefits changing?
The Board will finalize 2018 benefits it’s May board meeting, but has indicated that they would like to minimize benefit changes for next year.

The benefits covered by the statewide It’s Your Choice Access Plan will mirror Uniform Benefits starting January 1, 2018. The differences are outlined in the table, below:

Benefit

IYC Access Health Plan

Uniform Benefits

Bariatric Surgery

Covered

Excluded

Adult hearing aids and adult cochlear implants

Excluded

Covered

Transplants

Covers bone marrow, musculoskeletal, corneal, and kidney

Covers bone marrow, musculoskeletal, corneal, kidney, parathyroid, heart, liver, kidney with pancreas, heart with lung, and lung

Oral Surgery

Covers 23 procedures

Covers 11 procedures

In/Out-of-Network

In- and Out-of-Network coverage available

In-Network coverage only

Are my dental benefits changing?
No.

Which health plans will be offered for 2018?

Self Insurance Map

Region North East South West
Statewide Vendor Anthem Anthem Anthem Anthem

Regional Vendor(s)

Security

Anthem
Network

Dean
Quartz

HealthPartners

Why did the Board choose these health plan vendors?
The board chose vendors that scored well in the areas of quality measures, strong health management programs and cost effectiveness.

What will I need to do if my health plan will not be available in 2018?
You will need to choose a different plan during the It’s Your Choice open enrollment period this fall. ETF will provide information in plenty of time for you to make a decision about which plan to choose for 2018.

How will I know which plans cover my primary care doctor and the rest of my health care team?
ETF will provide information in plenty of time for you to make a decision about which plan to choose for 2018. Educational eLearning modules will be provided throughout the year to guide you through this transition process. While it might seem as though these are big changes, you will not see a difference in how your healthcare is delivered. The biggest change for you may just be the insurance card in your wallet.

What will my premium contribution be in 2018?
Premium contribution amounts will provided during the It’s Your Choice open enrollment period this fall.

REGIONALIZATION

What is regionalization, and why did the Board decide to regionalize the program?
The Board approved dividing the state into four regions, with one statewide health plan and additional health plans offering coverage in each region. This change was recommended by the Board’s actuary, Segal. For more information, read the discussion that starts here in the Segal report.

The Board wanted to increase access to providers in all parts of the state, streamline program administration, simplify program information for participants, and control costs. Only the health plans offering the highest-quality providers at the best value will participate in a region. Many of the health plans' provider networks overlap. This means that many members can continue to see the providers (physicians, hospitals, clinics) they see today, even if they have to choose a different health plan.

How will regionalization affect my choice of doctors?
98% of current providers will be available under the new program structure. During the It’s Your Choice open enrollment period, use the provider directories for the health plans in your region to determine which health plan offers your current providers.

When will I see provider directories from the health plans?
Provider directories will be available during the It’s Your Choice open enrollment period this fall.

Is it possible that my current doctor won’t be offered by any health plan?
Yes, but it is unlikely. 98% of current providers will be available under the new program structure. During the It’s Your Choice open enrollment period, use the provider directories for the health plans in your region to determine which health plan offers your current providers.

I live outside of Wisconsin and am enrolled in the IYC Access Plan (formerly Standard). How does this change affect me?
You will still have access to providers statewide and nationwide, but your in-network benefits will now be the same as participants in the Uniform Benefit programs. More information regarding out-of-network benefits will be available prior to the It’s Your Choice open enrollment period this fall.

Anthem will replace WPS as the administrator of this plan option.

SELF-INSURANCE

What does changing the group health insurance program from fully-insured to self-insured mean?
This means that instead of paying health plans a monthly premium for coverage, the State will pay medical claims directly through third-party administrators.  The State of Wisconsin already administers three self-insured benefit programs: pharmacy, uniform dental and the state-wide It’s Your Choice Access Health Plan.

Here is a 5-minute video explaining self-insurance.

Will I have to pay more for health insurance?
Self-insurance only relates to how claims are paid. Here is a 5-minute video explaining self-insurance.

VENDOR CONTRACTS

The 2017-2019 executive state budget anticipates the GIB will transition to a self-insured health model. On May 8, 2017, the Board and the state Division of Personnel Management submitted signed contracts with vendors for self-insuring the group health insurance program to the Joint Committee on Finance, as required by law. The JCF has the authority to reject these contract(s).

Is the Joint Committee on Finance (JCF) required to make a decision to approve or reject the contracts within 21 days?
No. The JCF need only notify the Group Insurance Board (Board) that it has scheduled a meeting or a hearing for further review within the 21 days. Both the Board and ETF have stressed how important it is to have a timely decision.

Could the JCF approve some contracts and reject others?
Yes. For example, in its joint letter to JCF, the Board and the state Division of Personnel Management asked for special consideration regarding the statewide/nationwide contract with Anthem Blue Cross Blue Shield. Anthem is the vendor selected to replace WPS as the administrator of the It’s Your Choice Access Health Plan (formerly the Standard Plan), which is already self-insured. The current contract with WPS expires December 31, 2017.

What if the JCF rejects all of the contracts?
The Group Insurance Board (Board) will meet to determine next steps. Watch the ETF website for the Board meeting schedule, agendas and materials. For timely updates, sign up for ETF E-mail Updates and follow ETF on Twitter.

If the JCF approves the contracts, when will the contracts take effect?
The contracts could be executed as soon as early June to allow time for transition planning and implementation. For group health insurance participants, the changes will not take effect until January 1, 2018 – the start of the new plan year.

Could the Board still decide to regionalize the program even if the JCF rejects the self-insured contracts?
Yes. If the JCF rejects the self-insured contracts, the Board could still decide to move forward with a regional program structure.

 

Where can I find more Information?
For the most up-to-date information on the State of Wisconsin Group Health Insurance Program and the Wisconsin Public Employers Group Health Insurance Program, visit the It’s Your Choice section on our website or follow ETF on Twitter. You may also subscribe to It’s Your Choice e-alerts about health benefits and related health and wellness topics.

For more detail see the following documents:
Group Insurance Board Motion to Approve New Program Structure (Februrary 8, 2017)

E-Learning: Self-Insurance in 5 Minutes

Executive Summary – Results and Analysis (December 13, 2016)

December 13, 2016 GIB Meeting Agenda and Materials

GIB Selects Data Warehousing Vendor, Deliberates Program Changes (November 30, 2016)

GIB Reviews Vendor Proposal Requirements for Self-Insurance (May 18, 2016)

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