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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)

High Deductible Health Plan

An It’s Your Choice (IYC) High Deductible Health Plan (HDHP) is a health plan offering that combines a Health Savings Account (HSA) with the uniform benefits offered by the State of Wisconsin Group Health Insurance program. An HDHP paired with an HSA gives you greater flexibility and discretion over how you use your health care dollars.

HDHPs have higher annual deductibles and out-of-pocket maximum limits than other traditional health plan offerings. With an HDHP, the annual deductible must be met before plan benefits are paid for services other than in-network preventive care services (as mandated by federal law), which are covered 100%.

There are two different IYC HDHP plan options available to you:

  • IYC High Deductible Health Plan
  • IYC Access High Deductible Health Plan

If you enroll in an IYC HDHP, you must enroll in the state-offered HSA program. For more information about the HSA, please visit the HSA page.

Red Piggy Bank iconThe It’s Your Choice High Deductible Health Plan (IYC HDHP) provides the same uniform benefits package and health plan providers as the It’s Your Choice Health Plan. The difference is that this plan option 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 pairs with a Health Savings Account (HSA).If you decide to enroll in the HDHP, you must open and contribute to the HSA. Many members contribute the money they save on their health insurance premiums to their HSA. If you are eligible, your employer may contribute up to $750 individual/$1,500 family.

For benefit information, see the Breakdown of Your Costs by Plan Design. 

IYC HDHP Annual Medical Deductible

Coverage Level

2018 Deductible Amount

2017 Deductible Amount

Individual Plan

$1,500

$1,500

Family Plan

$3,000

$3,000

For benefit information, see the Breakdown of Your Costs by Plan Design. 

 

Green Piggy Bank IconIt’s Your Choice Access High Deductible (IYC HDHP) provides freedom of choice for 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 pairs with a Health Savings Account (HSA). If you decide to enroll in the HDHP, you must open and contribute to the HSA. Many members contribute the money they save on their health insurance premiums to their HSA. If you are eligible, your employer may contribute up to $750 individual/$1,500 family.

For benefit information, see the Breakdown of Your Costs by Plan Design. 

IYC Access HDHP Annual Medical Deductible


Coverage Level

2018 Deductible   In-Network

2018 Deductible
Out-of-Network

2017 Deductible  In-Network

2017 Deductible Out-of-Network

Individual Plan

$1,700

$2,000

$1,700

$2,000

Family Plan

$3,400

$4,000

$3,400

$2,000

For benefit information, see the Breakdown of Your Costs by Plan Design. 

Eligible Employees

  • State employees, except those who are eligible for the graduate assistant/short term academic staff benefits package and are not in the Wisconsin Retirement System, are eligible to participate in the HDHP and HSA.
  • Limited Term Employees (LTEs) who are eligible for the State of Wisconsin Group Health Insurance Program.
  • Retirees1 younger than age 65.

Coverage Requirements and Considerations

  • You must be covered by an It’s Your Choice (IYC) High Deductible Health Plan (HDHP) and enrolled in a Health Savings Account (HSA).
  • You cannot have any other health coverage that pays for out-of-pocket health care expenses before you meet your plan deductible (including Medicare).
  • You must notify your human resources/benefits office of any other health coverage when enrolling in, and at any point while enrolled in, the HDHP and HSA.
  • In addition:
    • You cannot be enrolled in Medicare Part A or Part B.
    • You cannot be covered by TRICARE, or have accessed your Veterans Administration (VA) benefits in the past 90 days (to contribute to an HSA).
    • You cannot be claimed as a dependent on another person’s tax return (unless it’s your spouse).
    • You (and your spouse) cannot have a Health Care FSA in the same year.

1 Retirees enrolled in IYC HDHP/HSA benefit option must keep HSA open and active, and pay $3.00 monthly service fee.

High deductible health plans (HDHP) usually have lower monthly premiums than plans with lower deductibles. By using the untaxed funds in your health savings account (HSA) to pay for expenses before you reach your deductible, you reduce your overall health care costs.

Expense Types
There are three types of expenses associated with an HDHP:

  • Deductible – You pay all costs until you reach your deductible.
    • You can pay for services with your HSA or other funds.
    • Your preventive care is covered 100% when you use an in-network doctor (as required by federal law). 
    • Deductible includes prescription drugs and applies to the Out-of-Pocket Limit (OOPL).
    • If you are enrolled in a family plan, the entire family deductible must be met before coverage begins.
  • Coinsurance - You and your plan share the cost of services.
    • Once the deductible is met, your plan will pay a percentage of costs and you will pay the remaining percentage (percentage varies by plan).
    • You can pay your coinsurance share using your HSA or other funds.
  • Out-of-Pocket Limit – The most you’ll have to pay during the plan year.
    • When your deductible and co-insurance payments reach this limit, you are done paying for the year.
    • The plan will pay 100% of expenses for the rest of the year.
    • This limit protects you in the event of a major medical event.

Pharmacy Benefits
The plan will not pay for medical or prescription costs until the annual deductible is met, except:

Payment for Services
When you have a health event, present your insurance card to your doctor. Your doctor will send a claim to your health plan to provide discount information. You will receive a statement for payment.

To pay for eligible medical expenses:

  • You can use your TASC Card or pay out of pocket.
  • If you choose to pay out of pocket, you can either choose to reimburse yourself or keep the funds in your HSA to grow your savings.

Be sure to keep all receipts and pertinent documentation to prove your HSA was used for eligible medical expenses. For more information about eligible medical expenses, see the HSA Eligible Medical Expenses flyer.

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: 10/5/2017 4:36:58 PM