State of Wisconsin
It's Your Choice 2016
Group Health Insurance Program
(State Employees, Retirees, Continuants and Graduate Assistants)
For Retirees with 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, you have experienced a life event that may allow for a change, or it's the annual It's Your Choice open enrollment period. 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 the Health Plan Options tab 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 the Uniform Dental Benefit, you do not need to do anything 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 who are not enrolled in Medicare? Click here for important information
Medicare Step 1 – Choose a Plan Design that works with your Medicare coverage
First, decide which plan design you would like by reading the summaries below and by going to the plan design options page found under the Health Plan Options tab in the navigation bar above. It is important to remember that if you are retired and are eligible to participate in Medicare that you must do the following:
- Enroll in Medicare Parts A and B. You will automatically be enrolled in the Medicare Part D program that is part of the State Group Health Insurance Program.
- Notify ETF. It is important that you contact us immediately or your Medicare coordinated coverage may be delayed.
- Understand that Medicare will be the primary payer of your covered medical services and prescription drugs.
The following is a summary of the three primary health insurance plan designs of the State Group Health Insurance Program. These plan designs all work a little differently and are coordinated with Medicare.
- IYC Health Plan - Medicare:
The majority of state retirees are enrolled in this plan. You can choose from a variety of health plan providers that offer the same uniform benefits package.
If you were enrolled in the IYC Health Plan plan prior to enrolling in Medicare Parts A and B, you will automatically be moved into this plan design.
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’s managed care policies and procedures.
- IYC Medicare Advantage:
This plan is only offered by Humana and allows members to use any health care provider in the United States that accepts payments from Humana; however, you will have greater out-of-pocket expenses when you use out-of-network providers. The in-network benefit of the IYC Health Plan - Medicare Advantage is modeled to replicate the IYC Health Plan benefit package.
- IYC Medicare Plus:
This plan is administered by WPS and permits you and your eligible dependents to receive care from any qualified health care provider anywhere in the world for treatment covered by the plan. You may be responsible for filing claims and for finding the providers who can best meet your needs.
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 - Medicare option, move to Step 2 to select a health plan provider.
If you chose IYC Medicare Advantage or IYC Medicare Plus, move to Step 4, below.
Medicare 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 plan 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.
Medicare 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.
Medicare 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. A paper application 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 11:39:19 AM