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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)

What is changing in 2016

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Whether you are satisfied with your current health plan, looking to make changes to your current coverage or are a new employee, you should know what is changing for 2016. Read this section and see if there are changes that affect you. At minimum you should confirm your current health plan service area and provider network is available for 2016.

FOR RETIREES WITHOUT MEDICARE

Medical Costs

Check out the complete Comparison of Medical Benefits Chart.

FOR ALL STATE RETIREES

Prescription Drug Costs

You will pay coinsurance instead of a copayment for certain prescription drugs. See the Pharmacy Comparison of Benefits table with Medicare or without Medicare for more information.

Dental

The Uniform Dental Benefit will be offered by Delta Dental instead of through health plans. You will automatically be enrolled in your current health plan with Uniform Dental Benefits unless you file an application to opt out.

If you are enrolled in It’s Your Choice Medicare Plus, you will have Uniform Dental Benefits available to you beginning in 2016. If you do not want Uniform Dental Benefits beginning on January 1, you must file an application to opt out durring open enrollment.

Medical Benefits

Habilitation services are now covered. These services help you learn or improve skills and functioning for daily living.

Advance care planning and/or a palliative care consultation should be offered to participants facing a serious illness and survival of less than 12 months so they are fully informed of care options. Advance care planning is a new covered benefit for any participant who is diagnosed with a terminal illness.

Note: It’s Your Choice Medicare Plus pays only for services that Medicare covers. Medicare covers some habilitation services and is potentially adding coverage for advance care planning. Please contact WPS at 1-800-634-6448 if you have specific questions about these benefits.

Plan Design Names Changing

The health plan design names are changing.

  • It’s Your Choice Health Plan (IYC Health Plan) was formerly Coinsurance Uniform Benefits
  • It’s Your Choice High Deductible Health Plan (IYC HDHP) was formerly High Deductible Health Plan (HDHP)
  • It’s Your Choice Access Health Plan (IYC Access Health Plan) was formerly Standard Plan
  • It’s Your Choice Access High Deductible Health Plan (IYC Access HDHP) was formerly HDHP Standard Plan
  • It’s Your Choice Health Plan Medicare (IYC Medicare) was formerly Uniform Benefits Medicare Prime
  • It’s Your Choice Medicare Advantage (IYC Medicare Advantage) was formerly Medicare Advantage
  • It’s Your Choice Medicare Plus (IYC Medicare Plus) was formerly Medicare Plus

Health Plan Changes to Note

  • Arise Health Plan is now offering a combined service area and a new Aspirus service area. All Arise participants should confirm their provider network for 2016.
  • Network Health Plan is offering a new service area in the southeast part of the state.
  • WEA Trust will not provide coverage in the following service areas/counties:
    • East: Florence, Fond du Lac, Forest, Jefferson, Kenosha, Langlade, Lincoln, Marinette, Oneida, Price, Racine, Taylor, Vilas
    • Northwest Chippewa Valley: Burnett, Sawyer, Trempealeau
    • Northwest Mayo Clinic Health System: Buffalo

See a detailed list of health plans available by county, and confirm your health plan's service area.

Other Changes

Coverage end date in case of death: In the event you should pass away, your coverage will cease at the end of the month of your death and continuation for your surviving dependents will begin the first of the month following. Previously, the effective date was dependent on whether premiums had been deducted.

Move to a new county: If you move to a new county you can now switch to any health plan. Previously, you were limited to the health plans offered in the new county.

Dependents only covered once: Dependents can only be covered once within the program (including state or local). If determined that a dependent is double-covered, the members will have 30 days to determine who will cover the dependent and then one must file an application dropping the coverage. Previously, there was no double-coverage restriction.

Participation of Adult Children in Well Wisconsin: Effective January 1, 2016, adult children will no longer be eligible for the Well Wisconsin Incentive program. The incentive will continue to be available for active employees and retirees participating in the State of Wisconsin Group Health Insurance Program and their enrolled spouse/domestic partner. This is the result of the Equal Employment Opportunity Commission’s (EEOC) recent ruling on the applicability of Genetic Information Nondiscrimination Act (GINA) to employee wellness programs and the proposed rule amending GINA to allow spouse participation.

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: 1/25/2016 10:44:23 AM