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Proposed Health Insurance Program Changes

The Department of Employee Trust Funds and the Group Insurance Board have been working with a consultant to identify ways to improve health outcomes and increase the efficient delivery of quality health care for members and their families in the state' group health insurance program. Final recommendations for program changes for 2016 will be presented to the board for approval on May 19. Meeting agenda and materials will be available online about a week prior to the meeting.

After the state legislature expanded the GIB’s authority in 2013 to provide additional oversight and strategic direction for the health insurance program, the board hired a benefits consultant to conduct research and analysis.
In a presentation to the GIB in March, the consultant offered initial observations for program changes. Here are some of the proposed changes for 2016:

  • Change office visits from coinsurance to a copay arrangement
  • Keep generic drugs affordable ($5 copay) and shift to coinsurance for brand drugs:
      • Level 2—20% copay ($50 maximum)
      • Level 3—40% copay ($150 maximum)
      • Level 4 Preferred—$50 copay
      • Level 4 Non-Preferred—40% copay ($200 maximum)
  • Introduce a deductible and increase the maximum out of pocket for Uniform Benefits
  • Increase the deductible and maximum out of pocket for the Standard Plan
  • Continue to self-insure the Standard Plan and State Maintenance Plan, as well as pharmacy and dental benefits
  • Consider switching from single and family only to a 4-tier structure
  • Increase the health savings account contribution for the high deductible health plan
  • Investigate premium-based incentives for participation in the Well Wisconsin Program
  • Establish uniform metrics to measure health plan performance

The full report is also available.

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For more information about the 2015-2017 executive budget proposals affecting the group health insurance program, see legislative update.

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