WRS News Online

Health Insurance Program Changes for 2016

Family camping photoThe Group Insurance Board approved medical, pharmacy, and dental benefit changes to the state and local group health insurance programs for 2016. All changes apply to all participating state and local employees, retirees, and continuants.

In general, the 2016 program changes center on increased cost sharing for members in the forms of:

  • Added deductibles
  • New office visit copayments
  • Increased out-of-pocket limits
  • Coinsurance for certain prescription drugs

Here are 10 things to know for 2016:

  1. The It’s Your Choice open enrollment period for all participants is October 5-30, 2015. This is your annual opportunity to change from one health plan to another, switch from single to family coverage, or add/delete certain dependents. Changes become effective January 1, 2016.
  2. Our usual It’s Your Choice materials will be replaced with an expanded collection of specially-designed web pages and 12-to-16-page printed guides. We’ll have separate guides for active state employees, state retirees and continuants, and local government employees, retirees and continuants. On our website you’ll be able to:
    • Follow step-by-step guidelines to choose a health plan
    • Use an interactive map to find plans in your county
    • Get answers to frequently asked questions
    • Check detailed plan quality ratings
    • Review all covered benefits and services
    • Learn about options to supplement coverage
  3. The Uniform Dental Benefit will be available through Delta Dental and will no longer be offered through your health plan. You must have coverage under the group health insurance program in order to elect dental coverage. Delta Dental’s provider network directory will be available for review prior to open enrollment.
    • State employees: You will be automatically enrolled in the Uniform Dental Benefit for 2016. If you do not want this coverage, you must opt out of it during the It’s Your Choice open enrollment period.
    • Local government employees: Your employer will choose whether to offer the Uniform Dental Benefit and provide details to all employees.
    Note: Supplemental dental insurance (e.g., EPIC Benefits+, EPIC Dental Wisconsin) will remain separate optional plan offerings.
  4. Most members will now pay a medical deductible of $250 for individual or $500 for family coverage.
  5. Most members will pay office visit copayments of $15 for primary care and therapy office visits and $25 for specialty care and urgent care visits. The office visit copayments will not be subject to the deductible but will count toward meeting the out-of-pocket limit. In addition, the existing 10% coinsurance will still apply to additional services at the office visit. Note: There is no copayment or deductible for routine preventive health services, as mandated by the Affordable Care Act.
  6. Out-of-pocket limits will increase for medical and prescription drugs.
  7. There will be coinsurance for certain prescription drugs.
  8. State employees can receive a $2,000 payment to opt out of the group health insurance program. State employees not eligible for this incentive include those who (a) chose not to be covered in calendar year 2015; and (b) an employee whose spouse or domestic partner is also a state employee and is covered by the group health insurance program.
  9. We are renaming some familiar terms to simplify the complex and sometimes confusing world of health benefits communications. See the tables below:

State Employees, Retirees and Continuants

Current Name

New Name in 2016

Coinsurance Uniform Benefits (a.k.a., the HMO plans)

It’s Your Choice Health Plan

High Deductible Health Plan

It’s Your Choice High Deductible Health Plan

Standard Plan

It’s Your Choice Access Health Plan  

HDHP Standard Plan

It’s Your Choice Access High Deductible Health Plan


Local Employees, Retirees and Continuants

Program Option #

Current Name

New Name in 2016

PO2

Traditional HMO – Standard PPO

It’s Your Choice Local Traditional – w/ Dental Option

PO4

Deductible HMO – Standard PPO

It’s Your Choice Local Deductible – w/ Dental Option

PO6

Coinsurance HMO – Standard PPO

It’s Your Choice Local Health Plan – w/ Dental Option

PO7

High Deductible Health Plan HMO – Standard PPO

It’s Your Choice Local High Deductible Health Plan – w/ Dental Option

  1. Answers to frequently asked questions can be found here.