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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

man thinking

Health Plan Changes

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.

Health Plans No Longer Available

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.

Health Plan Name Changes (No Action Required)

  • 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.

Medicare Advantage

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.

IYC Access Plan / Access High Deductible Health Plan (HDHP) Medicare Plus

State Maintenance Plan (SMP) / SMP HDHP

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 will automatically be transitioned to WEA Trust if another plan is not selected during IYC open enrollment.

IYC Access Plan In-Network Cost-Sharing Changes

All prices are listed as individual / family. See benefit comparison 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

IYC Access Plan Overview of Benefit Changes

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

SMP County Changes

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 live in Florence County will be limited to SMP providers in and near Florence County.

SMP now offers some out-of-network benefits.

Medical Benefits

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.

No Domestic Partner Coverage
Due to a state budget proposal, it’s likely that domestic partners will not be covered in 2018. Stay connected with ETF to learn the latest on this legislation.

Pharmacy Benefits

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.  

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.

Supplemental Benefits

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 Benefits+ & 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

Wellness

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: 2018 participation will also determine your eligibility for a 2019 premium reduction. The 2019 premium reduction will increase if both you and your eligible spouse participate in the 2018 Well Wisconsin Program. Watch for more information from StayWell in 2018.

 

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: 9/8/2017 11:16:57 AM