State of Wisconsin
It's Your Choice 2016
Group Health Insurance Program
(State Employees, Retirees, Continuants and Graduate Assistants)
For Retirees without Medicare: How to Choose Your Group Health Insurance Plan
As a retiree participating in Group Health Insurance you have many options to consider whether you are a new retiree, it’s the annual It’s Your Choice open enrollment period, or you have experienced a life event that may allow for a change. However, you should also consider the following:
- Is your health plan still available next year? Sometimes health plans merge with others or change their service areas. See important changes found under the Health Options tab in the navigation bar above, and check your service area in the Health Plan Provider Map found under Health Plan Options in the navigation bar above.
- Have your premiums changed?
- Is your doctor, clinic and hospital still affiliated with your health plan?
- Have benefits changed? Changes are summarized in the important changes?
- How satisfied are participants with their health plans? Review and compare health plan report cards found under Health Plan Options in the navigation bar above.
- How do health plans compare for wellness and health management programs? See health plan features found under Health Plan Options 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. For more on these benefits, go to the Benefits tab in he navigation bar above.
Health insurance Marketplaces, also known as the Exchanges, are also available. These are separate from the group health insurance program, but may be of interest to you, especially if you are a retiree who is paying health insurance premiums through annuity deduction or directly to your health plan. For more information, visit HealthCare.gov, or call 1-800-318-2596. Also see the ACA: Marketplace Notice.
Let’s walk through some of the steps you should take to decide on a plan design and health plan.
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.
Do you have any dependents enrolled in Medicare? Click here for important information.
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.
- IYC Health Plan:
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 health plan providers 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.
- IYC HDHP:
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. You will want to review Who Is Eligible when considering this plan design.
- IYC Access Health Plan:
This plan design provides freedom of choice of doctors and hospitals across the United States. In exchange for the increased flexibility in medical providers, the monthly member premium cost is more than the IYC Health Plan and the IYC HDHP plan design options.
- IYC Access HDHP:
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. You will want to review Who Is Eligible when considering this plan design.
Compare medical and pharmacy benefits by plan design type.
Monthly Premium Rates:
You will also need to pick a health plan provider, consider the cost of each health plan provider, both with dental and without dental coverage. (See Step 2, below).
Made a Decision?
If you chose the IYC Health Plan or IYC HDHP, move on to Step 2 to select a health plan provider.
If you choose either the IYC Access Health Plan or IYC Access HDHP, you can move to Step 4. These plans are only administered through one health plan provider, WPS.
Step 2 – Choose a Geographic Coverage Area
Check out the Health Plan Coverage 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 can chose the State Maintenance Plan.
Step 3 – Choose a Health Plan Provider
Ok, 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 found under the Health Plan Options tab in the navigation bar above.
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 also found under the Make Your Choice tab may also be completed through ETF.
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 and your coverage will continue for the next year.
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.
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: 9/30/2015 9:32:20 AM