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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2018 State of Wisconsin Group Health Insurance Program
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2018 It's Your Choice - State of Wisconsin Group Health Insurance for Employees and Retirees

Wisconsin Department Of Employee Trust FundsIt's Your Choice 2018


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

Meet Alex!

ALEX is an interactive benefits counselor that educates you on the benefits you are eligible for and makes a personalized recommendation based on your needs. To get started, select the version of ALEX that best suits you:

(NOTE: Chrome or Firefox are the preferred internet browsers for ALEX.
And remember, you are not enrolling with ALEX but learning about your options!
)

Benefits of ALEX

The benefits of using ALEX include:

  • ALEX speaks in plain English, making it easy to understand!
  • ALEX gets to know you and your needs through a series of questions, so he can be as helpful as possible!
  • ALEX will only show you the plans you’re eligible for, providing a customized experience
  • It feels like you’re having a real conversation with a benefits expert
  • ALEX can be accessed anytime, anywhere and on any device, as long as you have internet connection!
  • It’s totally anonymous!

Frequently Asked Questions

General

It depends. How many questions do you have? ALEX is tailored to your needs and interests. It may only take a few minutes or you can spend more time and get more detailed information. Remember, you do not need to complete your ALEX conversation in one sitting. If you provide ALEX with an email address, he will save your answers for your next visit.

The information that you enter into ALEX is completely confidential and is not shared in any way. The only information collected is the number of employees in each Employment Category who visit ALEX and any feedback entered about your experience but we do not track who entered the comments.

Jellyvision, the creator of ALEX, is working on making the tool as accessible as possible to users. ALEX provides audio captioning and keyboard only navigation, as well as other enhancements. You can find details here. While meeting all Web Content Accessibility Guidelines (WCAG) 2.0 Level AA may not be possible due to ALEX’s dynamic and interactive nature, Jellyvision is currently working to achieve maximum accessibility.

If you need help accessing ALEX, you may feel most comfortable working with a trusted friend or family member. You can also ask for help from your employer benefits specialist, or ETF, if you are a retiree.

Okay, ALEX isn’t for everyone. You can have a conversation without sound by clicking the Closed Caption (cc) button at the top right side of the ALEX screen. You can also review benefits information through the It's Your Choice section of the website.

It is important to understand what these terms mean so that you can fully understand your potential out-of-pocket costs. ALEX does include explanations of the common insurance terms as it explains how the plan designs work. Click here for a Glossary of Health Coverage and Medical Terms, provided by the U.S. Department of Labor.

Health Plans

ALEX includes a link to provider information on the comparison of health plan designs and when a health plan design is recommended, but you don’t need to go back through the ALEX presentation to get that information.

For more information about the major health system providers for each health plan and links to the health plan’s provider directory, click here. When you click on a county on the map, the available health plans and their five major health system provider groups will be shown (click on the Find Providers icon for their full provider directory). By clicking on a health plan name, you will be directed to a page that includes a link to the health plan’s provider directory and plan contact information if you want to confirm whether a particular provider is in the plan’s provider network.

ALEX is designed to help you understand your choices based primarily on your estimated out-of-pocket costs. Because all of the health plans have the same out-of-pocket costs, such as deductible, copays and coinsurance, there is no financial advantage to you of choosing one health plan over another. The exception is the Access Plan that has the same in-network coverage but has a higher premium because it offers nationwide and out-of-network coverage.

Once you have decided what plan design you prefer (HDHP or non-HDHP), you can select the health plan that best meets your needs based on its providers, convenience and other considerations that may be important to you.

HDHPs are right for some, and not for others. Before enrolling for an HDHP, be sure you understand that you are financially responsible for all non-preventive medical expenses you incur, including prescriptions, until you reach the annual deductible. A deductible is the amount of money you have to pay for medical costs before your health insurance starts picking up a greater portion of the tab. So, for instance, if you’re in an HDHP with a $3,000 deductible, you’ll have to cover $3,000 in medical costs out of your own pocket before your insurance starts to pay benefits.

In addition, if you enroll in an HDHP, you are required to enroll in a Health Savings Account (HSA). An HSA is an individually-owned, tax-advantaged savings account that you may use to pay for medical, dental, prescription and vision expenses for you, your spouse and qualifying dependents.

In order to enroll in an HDHP and an HSA, you must be eligible for both plans.

View our Plan Design Options eLearning to help determine if an HDHP is right for you.

The HDHPs and Health Plans both have deductibles before benefits are payable. The difference is the amount of that deductible and what it applies to. Both plan designs will cover an annual preventive exam at no cost to you (there may be expenses from the exam, however, that do not qualify as preventive).

If you have family coverage with an HDHP:

  • You will pay for all non-preventive medical services until you meet your annual $3,000 family deductible ($1,500 if you have single coverage). This includes visits to medical providers, including chiropractor, physical therapy, etc., tests, procedures and facility charges. Benefits are payable once the deductible is met.
  • Prescription drugs are subject to the deductible.

If you have family coverage with a Health Plan:

  • You will pay for all non-preventive medical services until you meet your annual $500 family deductible ($250 if you have single coverage). If an individual within a family plan meets the annual individual $250 deductible, the Uniform Benefits will take effect for that individual.
  • This includes tests, procedures and facility charges Benefits are payable once the deductible is met.
  • Visits to medical providers, including chiropractor, physical therapy, etc., are subject to the office visit copay only even if the deductible has not been met.
  • Prescription drugs are not subject to the deductible.

The intent of offering ALEX is to provide you with tools and resources to help you make the best benefits choices for you and your family. Because of the lower monthly employee premium contribution and the employer's contribution to an eligible employee’s Health Savings Account (HSA), it is not unusual for the HDHP to have lower estimated out-of-pocket costs than the Health Plans and be recommended by ALEX.

But an HDHP is not for everyone! See the "Is a High Deductible Health Plan (HDHP) Right for Me?" question for more information and resources.

These are all examples of office visits that are subject to the primary care copayment. When ALEX asks you to estimate the number of primary care visits for the year, you can include your expected visits to these types of providers

The Access Plans are more costly because they are the only plans to offer a national provider network and also provides coverage if you use non-network providers. These are the plans that people tend to select when they want to have access out-of-network providers like Mayo Clinic, John Hopkins, or other specialty providers. It is also the plans that retirees who live outside of Wisconsin may select. These two groups tend to have higher than average claims costs, which has directly led to higher premium costs. There is also little ability for the health plan to negotiate for reduced pricing when non-network providers are used.

The Access Plans are not usually considered unless one of the situations described above apply or if there are dependents who reside or attend school outside of the Health Plans’ service areas and their expected medical costs exceed the additional premium costs for the Access Plans.

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: 9/17/2018 12:35:11 PM