Your browser does not support JavaScript!
calculators
Member Education
forms and publications
news
about etf
frequently asked questions
contact etf
site map
related links
home
top of page
Wisconsin Department of Employee Trust Funds header image It's Your Choice 2016 State of Wisconsin Group Health Insurance Program
members retirees employers governing boards careers at etf
Wisconsin Department Of Employee Trust Funds It's Your Choice 2016


Local Traditional Plan
Insurance for Employees
and Retirees
(PO2)


What is changing in 2016

Man thinking

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 EMPLOYEES AND RETIREES

Prescription Drug Costs

You will pay coinsurance instead of a copayment for certain prescription drugs. Out-of-pocket limits for certain proscription drugs are increasing. See the Pharmacy Comparison of Benefits table for more information.

Dental

(IF YOUR EMPLOYER OFFERS THE UNIFORM DENTAL BENEFIT)

The Uniform Dental Benefit will be offered by Delta Dental instead of through health plans. If your employer offers the Uniform Dental Benefit you will automatically be enrolled in dental coverage regardless of what health plan you are enrolled in for 2016 (including It’s Your Choice Medicare Plus). You may opt out by filing an application/change form.

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 Local Traditional Health Plan (IYC Local Traditional) was formerly Traditional Uniform Benefits
  • It’s Your Choice Local Access Health Plan (IYC Local Access Health Plan) was formerly 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

New effective date for new hires: Coverage will now be effective on the first of the month on or following your hire date, or on the date that you are eligible for an employer contribution. Previously, the effective date was the first of the month following your employer’s receipt of your completed application.

New effective date for employees eligible for an increase in employer contribution: Coverage will now be effective on the first of the month following the date in which you become eligible for an increase in employer contribution. Previously, the effective date was the first of the month following your employer’s receipt of your completed application.

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.

Removal of six month waiting period for life insurance and income continuation insurance (ICI):  There will no longer be a six month waiting period for ICI and life insurance to become effective. This is effective January 1, 2016 for all employees with a hire date of July 1, 2015 or after.

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