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 2017 State of Wisconsin Group Health Insurance Program
members retirees employers governing boards careers at etf
skip to end of menu
2017 It's Your Choice - State of Wisconsin Group Health Insurance for Employees and Retirees

Wisconsin Department Of Employee Trust FundsIt's Your Choice 2017


State of Wisconsin
Group Health Insurance Program
(State Employees, Retirees, Continuants and Graduate Assistants)

How to Choose Your Group Health Insurance Plan

There are various times throughout your employment when you might consider enrolling in or making changes to your health benefits. This may be when you are a new employee, annually during the 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. Review important changes.
  • Have your premiums changed?
  • Is your doctor, clinic, hospital still affiliated with your health plan?
  • Have benefits changed? Changes are summarized in important changes.
  • How satisfied are participants with their health plans? Review and compare the health plan report cards.
  • How do health plans compare for wellness and health management programs? Check out health plan features.
If you are happy with your current plan and do not want to opt out of medical coverage or decline Uniform Dental Benefits coverage, you do not need to do anything during open enrollment unless you want to enroll in Options to Supplement Your Coverage, or take advantage of Pre-Tax Savings, such as health care and dependent care flexible spending accounts or parking/transit benefits.
Remember, annual elections are required to participate in flexible spending accounts, and parking and transit benefits.

Let’s walk through some of the steps you should when deciding on a plan design and a health plan for 2017.

Note: If you have experienced a life event, such as a change in marital status or move to a new county, you should review the Life Changes and Coverage Changes chart to see what your options are and how long you have to enroll for coverage or make a change.

For additional information, see the It's Your Choice FAQs.

Step 1

Step 1 – Choose a Plan Design

First, decide which plan design you would like. The following is a summary of the four primary health insurance plan designs of the State Group Health Insurance Program. For more plan design information, choose the Compare Plans tab in the navigation bar above.

  1. plus sign IYC Health Plan:
  2. Most state members are enrolled in this plan. This plan allows you to choose from a variety of health plan providers that offer the same uniform benefits package.

    Note: While these plans 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. piggy IYC HDHP:
  4. This plan provides the same uniform benefits package and health plan providers as the IYC Health Plan. The difference is that this plan has a higher deductible and out-of-pocket limits. In exchange for the increased cost sharing, this plan offers a lower monthly premium cost and is paired with a required Health Savings Account (HSA), which is an account you own and allows you to save money tax-free for eligible medical expenses. If you decide to enroll in the HDHP, you must open and contribute to the HSA. If you are eligible, your employer may contribute up to $750 individual/$1,500 family. You will want to review who is eligible when considering this plan design.

  5. globe IYC Access Health Plan:
  6. This plan provides freedom of choice of doctors and hospitals across the country. In exchange for the increased flexibility in medical providers, the monthly premium is higher than the IYC Health Plan and IYC HDHP.

  7. green piggy IYC Access HDHP:
  8. This plan provides freedom of choice of doctors and hospitals across the country, along with a higher deductible and out-of-pocket limits. In exchange for the increased cost sharing, this plan offers a lower monthly premium cost and is paired with a required Health Savings Account (HSA), which is an account you own and allows you to save money tax-free for eligible medical expenses. If you decide to enroll in the HDHP, you must open and contribute to the HSA. If you are eligible, your employer may contribute up to $750 individual/$1,500 family. You will want to review who is eligible when considering this plan design.

Find a comparison of medical and pharmacy benefits by plan design type, as well as monthly premium rates online.

Choosing a geographic coverage area (see Step 2) will help you in choosing a health plan provider.

Made a Decision?
Note: The IYC Access Plan and IYC Access HDHP are administered only by WPS. If you chose either of these plan designs, you may go directly to Step 4 to enroll.

If you have chosen the IYC Health Plan or the IYC HDHP, continue to Step 2 to select a health plan provider.

Step 2

Step 2 – Choose a Geographic Coverage Area

Check out the Health Plan Provider Map. This interactive 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 (has the minimum allowable number of clinics, hospitals and providers available in that county). Some health plans may be listed, but have limited availability.

In the event that there are no qualified IYC Health Plan providers in your county with a Tier 1 monthly premium cost, you may want to choose the State Maintenance Plan

Step 3

Step 3 – Choose a Health Plan Provider

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. You will find these total rates both with dental and without dental coverage under the Rates tab in the navigation bar above. You can also find employee monthly premium contribution amounts here.

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. The process to enroll or make changes may differ between employers; go to the Enrollment tab in the navigation bar above for specific instructions. A paper application may be completed and submitted to your benefits office (if you are an active employee) or ETF (if you are a COBRA continuant).

If you do not want to change plan design or health plan provider, or opt out of medical coverage or waive dental coverage, you do not need to do anything, unless you want to enroll in Options to Supplement Your Coverage, or take advantage of Pre-Tax Savings, such as health care and dependent care flexible spending accounts, or parking and transit benefits. Remember, annual elections are required to participate in flexible spending accounts and parking/transit benefits. If you don't do anything, and your health plan and provider is still available in your county, your current health insurance coverage will continue 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: 10/3/2016 1:40:53 PM