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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)


2015 Health Plan Report Card

Grievance Rating

The 2014 grievance ratings for each health plan appears below.

The health plan’s grievance process is the first step in resolving member complaints.  The most frequent types of grievances filed by ETF members in 2014 were related to:

  • Coverage denials based on medical necessity
  • Non-covered services
  • Plan service and administration

Lower rates may be more desirable when selecting a health plan.  So lower grievance rates have higher star ratings.  Higher grievance rates have less stars.

Grievance Rating

Health Plan Star Rating
Anthem Blue (all plans)1 11
Arise Health Plan (all plans)2 22
Dean Health Insurance (all plans)3 44
Group Health Cooperative of Eau Claire 55
GHC of South Central Wisconsin 44
Gundersen Health Plan 33
Health Tradition Health Plan 33
HealthPartners Health Plan 22
Humana (all plans)4 11
Medical Associates Health Plans 55
MercyCare Health Plans 33
Network Health5 33
Physicians Plus  33
Security Health Plan 33
UnitedHealthcare of Wisconsin 22
Unity (all plans)6 33
WEA Trust (all plans)7 44
WPS (all plans)8 22

TABLE KEY

Sort columns by clicking on the header.

5

Highest rating

4

 

3

 

2

 

1

lowest rating

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

Quality resource linksOther Quality Resource links for ratings.

List of MeasuresHealth Plan Features and links to plan description pages.

notes:

1.2016 ETF participating Anthem plans include Northeast and Southeast
2.2016 ETF participating Arise plans include Arise Health Plan and Arise Health Plan - Aspirus Arise
3.2016 ETF participating Dean plans include Dean Health Insurance and Dean Prevea360
4.2016 ETF participating Humana plans include Eastern and Western
5.2016 ETF participating Network Health plans include Northeast and Southeast.
6.2016 ETF participating Unity plans include Unity-Community and Unity-UW Health
7.2016 ETF participating WEA Trust plans include East, South Central, Northwest Chippewa Valley and Northwest Mayo Clinic Health System
8 ETF participating WPS plans include the IYC Access Plan, SMP and IYC Medicare Plus.

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 12:06:09 PM