It's Your Choice 2017
Local Health Plan
Insurance for Employees
For Retirees with 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, you have experienced a life event that may allow for a change, or it's the annual It's Your Choice open enrollment period. 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 in the Health Plan Provider Map.
- Have your premiums changed?
- Is your doctor, clinic and 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 health plan report cards.
- How do health plans compare for wellness and health management programs? Review and compare health plan features.
If you are happy with your current plan, and do not want to decline Uniform Dental Benefit coverage (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, such as a change in marital status or you moved to a new county, you should review the Changes and Coverage Changes chart to see what your options are and how long you have to submit an application to enroll or make a change.
Do you have any dependents who are not enrolled in Medicare? Click here for important information.
For additional information, see the It's Your Choice FAQs.
Medicare Step 1 – Choose a Plan Design that works with your Medicare coverage
First, you will want to decide which plan design you would like by reading the summaries below and by reviewing Plan Designs for Medicare. It is important to remember that if you are retired and are eligible to participate in Medicare that you must do the following:
- Enroll in Medicare Parts A and B. You will automatically be enrolled in the Medicare Part D program that is part of the Wisconsin Public Employers (WPE) Group Health Insurance Program.
- Notify ETF. It is important that you contact us immediately or your Medicare coordinated coverage may be delayed.
- Understand that Medicare will be the primary payer of your covered medical services and prescription drugs.
The following is a summary of the three primary health insurance plan designs of the Wisconsin Public Employers (WPE) Group Health Insurance Program. These plan designs all work a little differently and are coordinated with Medicare.
- IYC Health Plan - Medicare:
The majority of local retirees are enrolled in this plan. IYC Medicare is coordinated with all of your health plan coverage options. You will remain covered by the plan you select after you are enrolled in Medicare Parts A and B.
- If you were enrolled in the IYC Local Health Plan plan prior to enrolling in Medicare Parts A and B, you will automatically be moved into this plan design.
- 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’s managed care policies and procedures.
- IYC Medicare Advantage:
This plan is only offered by Humana and allows members to use any health care provider in the United States that accepts Medicare. Benefits are the same in- and out-of-network. If you decide to seek care from an out-of-network provider, your share of the costs may be slightly higher for medical equipment and supplies. The in-network benefit of the IYC Medicare Advantage is modeled to replicate the IYC Local Health Plan benefit package.
- IYC Medicare Plus:
This plan is a fee-for-service Medicare supplement plan administered by WPS. This plan is available to eligible retirees enrolled in Medicare Parts A and B and generally only pays Medicare deductibles and coinsurance. It's Your Choice Medicare Plus permits you and your eligible dependents to receive care from any qualified health care provider nationwide, or during worldwide travel, for treatment covered by the plan.
Compare medical and pharmacy benefits by plan design type.
Monthly Premium Rates:
See the monthly premium rates for these plan designs here. For the IYC Health Plan - Medicare option, you will also need to pick a health plan provider (See Step 2, below).
Made a Decision?
If you chose the IYC Health Plan - Medicare option, move on to Step 2 to select a health plan provider.
If you chose IYC Medicare Advantage or IYC Medicare Plus, move to Step 4, below.
Medicare Step 2 – Choose a Geographic Coverage Area
Check out the Health Plan Coverage Map. This interactive map shows you which health plan providers are available in your area. You do not have to choose a plan 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.
Medicare 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.
Medicare 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, or a paper application may be completed and submitted to ETF.
If you do not want to change plan design or health plan provider, or decline dental coverage
for 2017, 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: 11/1/2016 2:08:21 PM