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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


Local Health Plan
Insurance for Employees
and Retirees
(PO6)


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 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. See important changes found as an option 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 dental (if it is offered), you do not need to do anything during open enrollment.

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 change, please see 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

Step 1 – Choose a Plan Design

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

  1. plus sign IYC Local Health Plan:
  2. Most members are enrolled in this plan. Participants 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.

     

     

  3. globe IYC Local Access Health Plan:
  4. This plan design provides freedom of choice of 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 Local Health Plan.

     

Compare medical and pharmacy benefits by plan design type.

Monthly Premium Rates:
See the full monthly premium rates for these plan designs here. You will also need to pick a health plan provider (See Step 2, below).

Made a Decision?
If you chose the IYC Local Health Plan, move on to Step 2 to select a health plan provider.

If you choose either the IYC Local Access Health Plan, you can move to Step 4. This plan is only administered through one health plan provider, WPS.

Step 2

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 there are no qualified IYC Local Health Plan providers in your county with a Tier 1 monthly premium cost, you can choose the State Maintenance Plan.

Step 3

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.

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 also found under the Make Your Choice tab may be completed, and is also available from ETF.

If you do not want to change plan design or health plan provider, or opt out of dental for 2016 (if it is offered), you do not need to do anything and your coverage will continue for the next year.

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: 9/30/2015 2:56:03 PM