WRS News Online

For State of Wisconsin Group Health Insurance Program Participants

Health Insurance Program Update

Self-insurance and/or regionalization

Over the course of two meetings (November 30, December 13), the Group Insurance Board (GIB) reviewed initial results and analysis from vendor proposals for health insurance program structural changes in 2018 that could include:

  • changing from a fully insured program to a self-insured program; and/or
  • changing to a "regionalized" structure for health plan offerings for members

The analysis included evaluation of a broad range of options/scenarios for change, projected costs and savings, provider access, and possible member disruption. In addition, discussions also covered how potential changes could affect the Wisconsin Public Employers Group Health Insurance Program (local program), the Medicare coordinated program, the currently self-insured It's Your Choice Access Plan (formerly known as the Standard Plan) and the Local Annuitant Health Program. January 2018 is the earliest any changes would take effect. Health insurance benefits and benefit plan design changes are not part of this evaluation.

At the December meeting the Board directed ETF and its consulting actuary to collect more data in order to continue deliberations. The next GIB meeting is set for February 8, 2017. Meeting materials will be posted when they become available.

Uniform Benefits changes regarding nondiscrimination on basis of gender identity

2017 Uniform Benefits coverage for procedures, services and supplies related to gender reassignment became effective January 1, in compliance with nondiscrimination requirements under the Affordable Care Act. However, the GIB held a special meeting December 30 and voted to exclude these benefits and services if all of the following were to occur:

  • A court ruling or an administrative action that enjoins, rescinds or invalidates the rules set by the federal Department of Health and Human Services (DHHS). This contingency was met when a federal judge issued a preliminary injunction on December 31, 2016.
  • Compliance with state law, Section 40.03 (6)(c);
  • Renegotiation of contracts that maintain or reduce premium costs for the state; and
  • A final opinion of the Wisconsin Department of Justice that the action taken does not constitute a breach of the Board's fiduciary duties.

The State of Wisconsin is a litigant in a federal lawsuit filed in Texas, which claims the federal DHHS rules are unlawful and an improper interpretation of federal law.

Monitor ETF's website for health insurance program news between editions of this newsletter.

To learn more about the WRS governing boards, review membership rosters, meeting schedules, agendas and past meeting minutes, visit our Governing Boards web page.

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