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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)

Important Changes for 2018

 

Woman thinking

There are several changes to the available health plans for 2018. Use the interactive map to find health plans and covered providers where you live or receive care.

Not seeing your health plan?

Change can happen each year. Some plans are no longer available, some have merged or changed their name. See Available Health Plans for more information.

If you are currently enrolled in any of the following health plans, you will need to choose a new plan for 2018:

  • Anthem Blue Preferred Northeast
  • Arise Health Plan
  • Health Tradition Health Plan
  • Humana Eastern and Western, including Medicare Advantage
  • UnitedHealthcare of Wisconsin
  • WPS – Contract ends December 31, 2017. If you are enrolled in a WPS plan, you will be auto-enrolled with the new administrator, WEA Trust, if you do not choose a new plan during open enrollment.
  • Unity Health Insurance – Community now Quartz – Community
  • Unity Health Insurance – UW Health now Quartz – UW Health
  • Health Plan Mergers (No Action Required) Gundersen Health Plan now part of Quartz - Community
  • Physicians Plus now part of Quartz – UW Health or Quartz – Community, depending on primary care provider’s location
  • Network Health – Northeast and Network Health - Southeast now combined as Network Health Plan

NOTE: If you take no action during open enrollment, you’ll be enrolled in the renamed or merged plan listed above.

The Medicare Advantage Program administered by Humana will not be available in 2018. If you are currently enrolled in Medicare Advantage, you must choose a new plan during open enrollment. Medicare Plus is another plan option with nationwide provider access. See details here.

Someone on my health plan is in the middle of medical treatment and we have to change health plans. What do I need to do?

WEA Trust will be the new administrator of these plan designs. Here is a summary of in-network benefit changes. See detailed plan design comparisons and benefit comparisons If you are a current participant, you will also receive information in the mail from your health plan. Participants of these plans, except SMP and SMP HDHP, will automatically be transitioned to WEA Trust if another plan is not selected during IYC open enrollment.

All prices are listed as individual / family. See Breakdown of Your Costs by Plan Design for more information.

 

 

Access Health Plan Access HDHP
2017 2018 2017 2018
Combined Medical & Prescription Deductible Not applicable $1,700 / $3,400 $1,500 / $3,000
Prescription Out-of-Pocket Limit $1,000 / $2,000 $600 / $1,200 Not applicable Not applicable
Combined Medical & Prescription Out-of-Pocket-limit (OOPL) Not applicable $3,500 / $6500 $2,500 / $5,000
Durable Medical Equipment 10% coinsurance up to OOPL 20% coinsurance up to OOPL 10% coinsurance up to OOPL 20% coinsurance up to OOPL

Now Covered

  • Vision exams
  • Transplants: heart, liver, kidney with pancreas, heart with lung, and lung
  • Adult hearing aids and cochlear implants
  • Smoking cessation

No Longer Covered

  • Surgical treatment of morbid obesity
  • Certain oral surgery procedures
  • Genetic testing or counseling unless medically necessary to diagnose or treat an existing illness.
  • Clinical trials unless mandated by law.

Change

  • Cardiac rehabilitation services and Durable Medical Equipment (DME) must be pre-approved by your health plan. Full benefit information can be found in our IYC Access Plan Certificate of Coverage.

Now administered by WEA Trust, will be only be available in Florence County and will have a new provider network. Click here for details. Participants who choose SMP will be limited to providers in and near Florence County.

SMP is no longer available in Bayfield, Buffalo, Forest, Iron, Marquette, Menominee or Pepin counties. There will not be Minnesota providers offered in 2018. All SMP participants, even if you wish to stay in SMP, must select a health plan during open enrollment or you will not have coverage in 2018.

SMP now offers some out-of-network benefits; see plan details here.

Domestic partners will not be covered in 2018. Affected members will receive information about COBRA continuation from their employer or ETF, depending on whether they are an employee, a retiree or a continuant.

Domestic partners and their dependents coverage will automatically end after December 31, 2017.

Primary Care Provider Required

All participants are required to select a primary care provider. If you don’t have one, contact your health plan for help. Your health plan may assign you a primary care provider. You can change your assigned provider by contacting your health plan.

Certain Pharmacies No Longer In-Network
CVS (including Target pharmacies) and certain other out-of-state pharmacies are no longer in-network. Find in-network pharmacies at Navitus.com.  This change does not affect members enrolled in the Navitus MedicareRx Medicare Part D prescription drug plan. Navitus MedicareRx members see website for details.

Certain Over the Counter Medications No Longer Covered
This includes medications such as steroid nasal sprays like Fluticasone, known as Flonase®, and medication to treat heartburn such as Omeprazole, known as Prilosec. If you have a prescription for these medications, you can use your Health Care Flexible Spending account to pay for them with your TASC Card or to be reimbursed.

Does this affect me?
Navitus will send you information in the mail If you take prescribed medications impacted by these changes.

MedicareRx Members
This change does not affect members enrolled in the Navitus MedicareRx Medicare Part D prescription drug plan.

New Mandatory Specialty Pharmacies (Level 4 Prescriptions)
Level 4 prescription drugs can be filled at Lumicera or the UW Specialty Pharmacy. Diplomat will no longer be the preferred specialty pharmacy. This change does not affect members enrolled in the Navitus MedicareRx Medicare Part D prescription drug plan. Navitus MedicareRx members see website for details.

New Mail Order Pharmacy
Serve You is replacing WellDyneRx as the mail order pharmacy. Current participants will receive detailed information in the mail from Navitus. Call Navitus at 1-866-333-2757 with questions.

Medication Therapy Management Available
You can learn how to manage your medications through a free Medication Therapy Management Program. Navitus will contact you if you are eligible.

New Discounted Drug List
Though these drugs are not covered by your pharmacy benefit, you’ll receive a discount on them if you have a prescription. The discount drug list will include drugs used for infertility, weight loss, cosmetic and other lifestyle needs as prescribed by your doctor.

New Navitus Public Website
Navitus has developed a new public website for participants of the State/WPE Group Health Insurance Program that does not require you to log in. This site provides information about your 2018 plan options, such as benefits, formularies, a pharmacy locator and prior authorization requirements.

NOTE: If you are already enrolled in the State/WPE Group Health Insurance Program this public site does not provide 2017 benefit information or allow you to access your personal prescription history. We encourage you to log on to the NaviGate for Members portal for more detailed pharmacy benefit information.

VSP (Vision Insurance)

  2017 2018
Contact lens and frame allowances $130 $150
UV Lens Protection Coating 20-25% off Full Coverage
Contact lens exam copay $60 $40
Primary EyeCare Supplemental Coverage Not available $20 copay for:
  • Treatment for eye pain or infection
  • Testing for sudden vision changes
  • Cataract monitoring exams
  • Retinal screenings

 

Epic Dental Wisconsin

Changes for Existing Participants only

  2017 2018
Annual Benefit Maximum $1,000 $1,250
Waiting period for basic and major restorative coverage 3 months None

 

Additional changes for current employees & retirees enrolling for the first time

  2017 2018
Waiting period for basic & major restorative coverage 3 months None
Waiting period on orthodontic coverage 12 months 24 months
Annual Benefit Maximum
Year 1
Year 2
Year 3+
$1,000
$600
$800
$1,250

Well Wisconsin Program
The $150 Well Wisconsin incentive will continue to be available to you and your enrolled spouse. To earn the $150, you will need to complete the current incentive requirements, plus a third step of an easy health engagement activity through StayWell.

State and UW Employees: ETF previously communicated plans to move the program incentive from a gift card to a premium reduction in 2019 for active state employees. However, this transition will not occur for 2019. Participation in 2018 will not affect premium rates in 2019. All participants will continue to receive the $150 gift card upon completion of the program steps.

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: 12/14/2017 2:02:37 PM
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