Department of Employee Trust Funds
Revised September 16, 2015
2016 Group Health Insurance
Changes for State Retirees
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 2106.
For Retirees Without Medicare:
- You will need to meet a medical deductible before your health plan will start paying towards certain medical expenses (except office visits).
- You will pay a copayment for office visits.
- Out-of-pocket limits are increasing.
For All State Retirees:
Prescription Drug Costs
You will pay coinsurance instead of a copayment for certain prescription drugs.
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.
If you are currently enrolled in It’s Your Choice Medicare Plus, you will be automatically enrolled in the Uniform Dental Benefits. If you do not want Uniform Dental Benefits you must file an application to opt out for 2016 during the It's Your Choice open enrollment period.
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.
Note: It’s Your Choice Medicare Plus pays only for services that Medicare covers. Medicare covers some habilitation services and is potentially adding coverage for advance care planning. Please contact WPS at 1-800-634-6448 if you have specific questions about these benefits.
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 in the following counties: Clark, Florence, Forest, Juneau, Langlade, Lincoln, Marathon, Oneida, Portage, Taylor, Vilas, Wood. Arise Health Plan will not be providing coverage in Jefferson or Marquette Counties. All Arise participants should confirm their provider network for 2016.
- Network Health is offering a new service area in the southeast part of the state, including Milwaukee, Ozaukee, Racine, Washington and Waukesha counties.
- WEA Trust will not be providing 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