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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2019 Local Health Plan Insurance Program
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2019 It's Your Choice - Local Health Plan Insurance for Employees and Retirees
Wisconsin Department Of Employee Trust Funds It's Your Choice 2019


Local Health Plan
Insurance for Employees
and Retirees
(PO6, PO16)


State Maintenance Plan (SMP)

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

Open Enrollment October 1 – 26, 2018

If you are currently enrolled in SMP and do not wish to change plans during open enrollment, you will remain enrolled. Note however, the service area has changed.

What’s New for 2019

State members: SMP will only be offered in Forest County for 2019. It will no longer be offered in Florence County.

Local members: SMP will be offered in Buffalo, Florence, Forest, Marinette, Pepin, Pierce, Polk, Rusk, Shawano, St. Croix, Waupaca, Waushara and Wood counties. It will no longer be offered in Iron and Price counties.

WEA Trust is offering some innovative new programs for SMP members starting in 2019.

  • Low back pain program: If you are among the 80% of people who will experience low back pain at some point in your life, our program powered by Kiio™ could help you. The program uses a mobile app to guide you through exercise routines personalized for your specific pain. More information at WEAtrust.com/LowBackPain
  • Innovative diabetes program: WEA Trust members with Type 1 or Type 2 diabetes will have access to our Livongo for Diabetes™ program. Livongo combines innovative technology and trained staff to help you
    better manage your disease. This cutting-edge program includes: A smart touchscreen glucose meter with real time feedback, unlimited test strips mailed directly to your home, and 24/7 support from a Certified Diabetes Educator. More information at WEAtrust.com/Livongo

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: Forest County
Wisconsin Public Employers (WPE) employees and retirees only: Buffalo, Florence, Forest, Marinette, Pepin, Pierce, Polk, Rusk, Shawano, St. Croix, Waupaca, Waushara and Wood 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: 9/7/2018 10:59:51 AM