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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)


What is changing in 2016

Woman thinking

Whether you are satisfied with your current health plan or are looking to make changes to your current coverage, 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 WITH MEDICARE

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.

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 former 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 Medicare health plan design names are changing.

  • 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.

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: 9/28/2015 12:44:56 PM