Department of Employee Trust Funds
Revised September 16, 2015
2016 Group Health Insurance
Changes for State Active Employees
All health plan service area changes will be detailed in the It’s Your Choice web materials during open enrollment. Please verify your health plan service area and provider network is available for 2016.
The Uniform Dental Benefit will be offered by Delta Dental instead of through health plans. You will automatically be enrolled in your current health plan with Uniform Dental Benefits if you do not make any changes for 2016. If you do not want the Uniform Dental Benefit, you must opt out during open enrollment, October 5-30, 2015.
Medical & Prescription Drug Costs
- You will need to meet a medical deductible before your health plan will start paying towards certain medical expenses (except for office visits).
- You will pay a copayment for office visits.
- You will pay coinsurance instead of a copayment for certain prescription drugs.
- Out-of-pocket limits are increasing.
Habilitation services are now covered. These services help you learn or improve skills and functioning for daily living.
Advance care planning and/or a palliative care consultation should be offered to participants facing a serious illness and survival of less than 12 months so they are fully informed of care options. Advance care planning is a new covered benefit for any participant who is diagnosed with a terminal illness.
Increased HSA Employer Contribution
For 2016, employers will increase their health savings account contribution to $750 per individual/$1,500 per family for those enrolled in the high deductible health plans.
Group Health Insurance Opt-Out Option
You may be eligible to receive $2,000 from your employer if you opt out of state group health insurance coverage. Contact your employer to see if you are eligible for this option.
Significant Health Plan Changes to Note:
This provides a summary of key changes only. Complete information about 2016 changes will be detailed in the It’s Your Choice web materials during open enrollment.
- Arise Health Plan is now offering a combined service area and a new Aspirus service area. All Arise participants should confirm their provider network for 2016.
- Network Health Plan is offering a new service area in the southeast part of the state.
- WEA Trust will not provide coverage in the following service areas/counties:
- East: Florence, Fond du Lac, Forest, Jefferson, Kenosha, Langlade, Lincoln, Marinette, Oneida, Price, Racine, Taylor, Vilas
- Northwest Chippewa Valley: Burnett, Sawyer, Trempealeau
- Northwest Mayo Clinic Health System: Buffalo