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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)

State Maintenance Plan (SMP)

Administered by WEA Trust
1-866-485-0630
weatruststatehealthplan.com

Open Enrollment October 2 – 27, 2017

Due to significant provider network changes, if you are currently enrolled in SMP and wish to remain in it for 2018, you must file an application selecting SMP. Read below for more information on which counties SMP will be offered in.

What’s New for 2018

WEA Trust is the new administrator of SMP. If you enroll in SMP during It's Your Choice, you will receive new ID cards from WEA Trust in the mail prior to January 1, 2018.

State members: SMP will only be offered in Florence County for 2018. It will no longer be offered in Bayfield, Buffalo, Forest, Iron, Marquette, Menominee and Pepin counties.

Local members: SMP will be offered in Florence, Forest, Iron, Price (new) and Rusk counties for 2018. It will no longer be offered in Bayfield, Buffalo, Marquette, Menominee, Pepin and Vilas counties.

Benefits are changing. For a quick summary, see the Comparison of Benefit Options. Highlights are summarized below:

  • SMP will be a Preferred Provider Organization (PPO). WEA Trust will reimburse for out-of-network covered services at 50% of our maximum allowable fee, subject to a $5,000 individual, $10,000 family deductible.
  • Primary Care Physician (PCP) selection is required. You and your family members must select a PCP for your care. If you don't, WEA Trust will assign one to you, notify you in writing, and inform you how to change this PCP selection. Contact WEA Trust for more information.
  • WEA Trust's Amwell telehealth service is expanding with the addition of online therapy services. Since 2015, thousands of WEA Trust members have used Amwell for on-demand video doctor visits. Now you can also use Amwell to schedule an appointment with a highly trained therapist or psychologist. And instead of waiting weeks or months to see someone, Amwell therapists are available within a week, and sometimes even the same day. Scheduled therapy visits on Amwell are:
    • 45-minute, video-based appointments on your smartphone, tablet, or computer 0 With licensed and specially-trained therapists or psychologists
    • Available seven days a week, from 7 a.m. to 11 p.m.
    • An alternative to in-person behavioral health visits

General Information

The State Maintenance Plan, or SMP, is a health plan that offers Uniform Benefits. SMP offers in-network providers in some Michigan (for State and Local members) counties.

Provider Directory

Go to weatruststatehealthplan.com/providers to search for providers or to access a SMP directory. To request a printed directory be mailed to you, call 1-866-485-0630.

Referrals, Prior Authorizations

You must get a referral approved by WEA Trust before getting care outside the WEA Trust SMP network. Your provider must request the referral. It is ultimately the member’s responsibility to make sure the referral is submitted and approved prior to receiving services.

Prior authorization is required for certain services and procedures before you receive care. Without an approved prior authorization, WEA Trust may deny payment. A list of services requiring preauthorization can be found at https://weatrust.com/preauthorization. You will receive notification of the approval or denial for the prior authorization.

Out-of-Network Care

SMP, offered by WEA Trust, will reimburse for covered services at 50% of our maximum allowable fee, subject to a $5,000 individual, $10,000 family deductible.

Service Area

State employees and State retirees only: Florence County
Wisconsin Public Employers (WPE) employees and retirees only: Florence, Forest, Iron, Price, and Rusk Counties

Emergency and Urgent Care Outside Service Area

If you require emergency or urgent care when outside of the network, seek care at the nearest medical facility.

Contact 1-866-485-0630 or your primary care physician if assistance is needed to determine the appropriate level of care. Follow-up care must be performed by a network provider to receive network benefits.

Mental, Behavioral Health and Substance Abuse Services

No prior authorization is required for outpatient services from a network provider, except for psychiatric and neuropsychiatric testing. Prior authorization is required for in-patient and transitional care. For other services, contact 1-866-485-0630. Review the Uniform Benefits certificate for details.

24-Hour Nurseline

WEA Trust contracts with a variety of health care provider systems that offer their own nurselines. A list of those nurselines can be found at weatruststatehealthplan.com/nurseline.

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: 9/27/2017 1:06:45 PM