WRS News Online

Health Insurance Update

For State of Wisconsin Group Health Insurance Program Participants

In February the Group Insurance Board approved moving to a self-insured/regionalized program structure for the group health insurance program, starting in 2018. The decision to change from the current fully-insured program structure capped off an intense year of discussion, review, and analysis of options and bids from third party administrators competing to provide administrative services for the program on behalf of our approximately 250,000 participants.

At the time WRS News Online was published, contract negotiations were underway with the third party administrators whose winning bids were selected at that February meeting. Wisconsin regions and participating health plans under the proposed plan to regionalize the structure of the health insurance program are shown in the accompanying map.

Ninety-eight percent of the current health care providers will be available under the new model, including those of Group Health Cooperative of South Central Wisconsin. GHC providers have contracted with Quartz to offer services starting in 2018. ETF estimates the vendors' broad networks will provide access to more Wisconsin providers than under the current program, and that participants will be able to choose from two to three vendors in each region. ETF will provide online tools to easily find covered health care providers. Watch for information in early summer.

Note: The 2017-2019 executive state budget anticipates the GIB will transition to a self-insured health model (See Legislative Update). The contracts with the third party administrators must be sent to the Joint Committee on Finance for review, as required by 2015 Act 119. The JCF has the authority to reject the contract(s).

The Board's February decision, combined with wellness and improved data analytics efforts already underway, center on improving health outcomes and quality of care, maintaining current benefit levels, ensuring quality provider access, and containing program costs.

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