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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2016 State of Wisconsin Group Health Insurance Program
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Wisconsin Department Of Employee Trust Funds

It's Your Choice 2016


State of Wisconsin
Group Health Insurance Program
(State Employees, Retirees, Continuants and Graduate Assistants)

How to Choose Your Group Health Insurance Plan

There are various times throughout your employment when you might consider enrolling in or making changes to your health benefits. This may be when you are a new employee, annually during the It’s Your Choice open enrollment period, or when you experience a life event that may allow for a change. Consider the following:

  • Is your health plan still available next year? Sometimes health plans merge with others or change their service areas. These changes are listed in important changes found as an option in the navigation bar above.
  • Have your premiums changed?
  • Is your doctor, clinic, hospital still affiliated with your health plan?
  • Have benefits changed? Changes are summarized in important changes.
  • How satisfied are participants with their health plans? Review and compare the health plan report cards found under the Health Plan Options tab in the navigation bar above.
  • How do health plans compare for wellness and health management programs? See health plan features found under the Health Plan Options tab in the navigation bar above.

If you are happy with your current plan and do not want to opt out of dental, you do not need to do anything during open enrollment unless you want to enroll in an optional plan, a flexible spending account or parking/transit benefits. For more on these benefits, go to the Benefits tab in the navigation bar above.

Let’s walk through some of the steps you should when deciding on a plan design and a health plan for 2016.

Note: If you have experienced a life event, please visit the Life Change Event Guide, found under the Helpful Info tab in the navigation bar above, to see what your options are.

Step 1

Step 1 – Choose a Plan Design

First, decide which plan design you would like. The following is a summary of the four primary health insurance plan designs of the State Group Health Insurance Program. For more plan design information, choose the Health Plan Options tab in the navigation bar above.

  1. plus sign IYC Health Plan:
  2. Approximately 98% of state members are enrolled in this plan. You can choose from a variety of health plan providers that offer the same uniform benefits package.

    Note: While these plans all offer the same uniform benefits package, this does not mean that they will treat all illnesses or injuries in an identical manner. Treatment will vary depending on patient needs, the physicians’ preferred practices, and the health plan provider's managed care policies and procedures.

  3. piggy IYC HDHP:
  4. This plan offers the same uniform benefits package and the same choice of health plan providers as the IYC Health Plan. The difference is that this design has a higher deductible and out-of-pocket limits, and lower monthly premium costs. In exchange for the increased cost sharing, monthly premium costs are less than the IYC Health Plan. This design is also paired with a Health Savings Account (HSA). An HSA is a savings account that you own, it allows you to save money tax-free for eligible medical expenses. Your employer may also make a contribution to your HSA, if you are eligible. You will want to review who is eligible when considering this plan design.

  5. globe IYC Access Health Plan:
  6. This plan design provides freedom of choice for doctors and hospitals across the country. In exchange for the increased flexibility in medical providers, the monthly member premium cost is more than the IYC Health Plan and IYC HDHP.

  7. briefcase IYC Access HDHP:
  8. This plan design provides freedom of choice for doctors and hospitals across the country, along with a higher deductible and out-of-pocket limits. In exchange for the increased cost sharing, monthly premium costs are less than the IYC Access Health Plan. This design is also paired with a Health Savings Account (HSA). An HSA is a savings account that you own, it allows you to save money tax-free for eligible medical expenses. Your employer may also make a contribution to your HSA, if you are eligible. You will want to review who is eligible when considering this plan design.

Find a comparison of medical and pharmacy benefits by plan design type, as well as monthly premium rates online.

Choosing a geographic coverage area (see Step 2) will help you in choosing a health plan provider.

Made a Decision?
Note: The IYC Access Plan and IYC Access HDHP are administered only by WPS. If you chose either of these plan designs, you may go directly to Step 4 to enroll.

If you have chosen the IYC Health Plan or the IYC HDHP, continue to Step 2 to select a health plan provider.

Step 2

Step 2 – Choose a Geographic Coverage Area

Check out the Health Plan Provider Map found under the Health Plan Options tab in the navigation bar above. The map shows you which health plan providers are available in your area. You do not have to choose a health plan provider in your county, but keep in mind how far you are willing to travel for services.

The map also shows whether the available health plan providers are considered “qualified.” A qualified health plan provider meets certain medical provider access requirements.

In the event that there are no qualified IYC Health Plan providers in your county with a Tier 1 monthly premium cost, you may want to choose the State Maintenance Plan

Step 3

Step 3 – Choose a Health Plan Provider

Now you know what health plan providers you have to choose from. Next, you will want to check out the specific health plan features and plan descriptions (found under the Health Plan Options tab in the navigation bar above) to learn about their quality ratings and medical provider networks (including specialists and hospitals), as well as other features, which may include:

  • referral and prior authorization requirements,
  • whether they require you to select a primary care provider (PCP) and other administrative requirements, and
  • whether they offer a member web portal, a 24-hour nurse line, and wellness and health management programs.

You will also want to consider the cost of choosing each health plan provider. Note the monthly premium cost for single or family coverage. You will find these total rates both with dental and without dental coverage under the Health Plan Options tab in the navigation bar above. You can also find employee monthly premium contribution amounts here.

Step 4

Step 4 – Enroll or Make a Change

Now that you have chosen a plan design and health plan provider, you will need to either enroll or make a change to your current enrollment. Make changes or enroll online using myETF Benefits found under the Make Your Choice tab in the navigation bar above. A paper application may also be found here and completed through your benefits office (if you are an active employee) or ETF (if you are a COBRA continuant).

If you do not want to change plan design or health plan provider, or opt out of dental for 2016, you do not need to do anything, unless you want to enroll in an optional plan, a flexible spending account, or parking/transit benefits. Your current health insurance coverage will continue for the next year.

UW System and UW Hospital and Clinics employees: Do not use the myETF Benefits system to enroll in or make changes to coverage. UW System employees should go to www.wisconsin.edu/ohrwd/benefits and contact your UW institution human resources department for enrollment instructions. UW Hospital and Clinics employees must complete a paper application and submit it to your human resources/benefits office.

Step 5

Step 5 – Stay Up To Date

Sign up for It's Your Choice e-alerts on health and wellness benefits, and related topics of interest.

Disclaimer:
Every effort has been made to ensure that this information is accurate, but may be subject to change. Please note revision dates located at the bottom of each page. In the event of conflicting information, federal law, state statute, state health contracts and/or policies and provisions established by the State of Wisconsin Group Insurance Board shall be followed.

This page was last modified on: 9/28/2015 4:31:03 PM