It's Your Choice 2016
Local High Deductible Health Plan
Insurance for Employees
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 you have experienced 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, and check your service area.
- 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.
- How do health plans compare for wellness and health management programs? See Health Plan Features.
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, please go to the Life Change Event Guide to see what your options are.
Do you have any dependents enrolled in Medicare? Click here for important information.
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.
- IYC Local HDHP:
You may choose from a variety of health plan providers that offer the same uniform benefits package.
- IYC Local Access HDHP:
This plan design provides freedom of choice for doctors and hospitals across the United States, along with a higher deductible and out-of-pocket limits.
Compare medical and pharmacy benefits by plan design type.
Monthly Premium Rates:
See the 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 IYC Local HDHP, move on to Step 2 to select a health plan provider.
If you chose IYC Local Access HDHP, you can move to Step 4. This plan is only administered through one health plan provider, WPS.
Step 2 – Choose a Geographic Coverage Area
Check out the Health Plan Coverage Map. 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 HDHP providers in your county with a Tier 1 monthly premium cost, you can choose the State Maintenance Plan.
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 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 – 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. A paper application may also 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 – Stay Up To Date
Sign up for It's Your Choice e-alerts on health and wellness benefits, and related topics of interest.
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: 9/25/2015 4:34:16 PM