WRS News Online

For State of Wisconsin Group Health Insurance Program Participants

Board Approves 2018 State Group Health Insurance

Health plans participating in the state group health insurance program will have a 0% premium increase next year, as approved by the Group Insurance Board last week. Local government employees who participate in the program will have an overall 3.3% premium increase

The It's Your Choice open enrollment period is October 2-27. This is when you can make changes for next year, including switching health plans, adding supplemental benefits, changing coverage levels or adding/deleting certain dependents, for an effective date of January 1, 2018.

The Board also approved 10 fully insured health plans, the tier structure and the coverage areas to be offered in 2018. Almost all current health care providers (i.e., doctors, specialists) will be covered. Fewer than 2% of members will need to change providers; that percentage may decrease with ongoing provider contracting.

Note: Approximately 42,000 members, including employees, retirees and their dependents, will need to choose a new plan during open enrollment, due to the following six plans leaving the program:

  • Anthem Blue Preferred Northeast
  • Arise Health Plan
  • Health Tradition Health Plan
  • Humana Eastern and Western, including Medicare Advantage
  • UnitedHealthcare of Wisconsin
  • WPS contract terminates December 31, 2017. These members will be automatically enrolled with WEA Trust if they do not select a different plan during open enrollment

2018 Health Plans 
The health plans to be offered in 2018 have consistently scored high in quality ratings, have had fewer member grievances and have lower administrative fees. These county-based plans will be Tier 1 for state members, which means they meet program requirements for cost, quality and access.

It's Your Choice Health Plan and High Deductible Health Plans:

  • Dean Health Insurance and Dean Health Insurance-Prevea360
  • Group Health Cooperative of Eau Claire
  • Group Health Cooperative of South Central Wisconsin
  • HealthPartners Health Plan
  • Medical Associates Health Plans
  • MercyCare Health Plans
  • Network Health
  • Security Health Plan – Central and Valley
  • Quartz – Community and UW Health (formerly Gundersen, Physicians Plus and Unity)
  • WEA Trust – East, Northwest Chippewa Valley and Mayo Clinic Health System

The It's Your Choice Access Plan, Access High Deductible Health Plan (HDHP), Medicare Plus, State Maintenance Plan (SMP) and SMP HDHP:

  • WEA Trust

Premium Rates for 2018
The 0% premium rate change is a result of effective contract negotiations that focused on avoiding passing on additional costs to members, and the Board's decision to draw down the state program reserve by $29 million.

The Department of Administration's Division of Personnel Management determines the state employee contribution portion of the health insurance premiums, as well as the employer contribution to the Health Savings Account. These amounts will be released in September.

While there is no increase overall for state retirees, there are fluctuations with individual health plan premiums.

Rates for participating local government employees and retirees will increase 3.3%. The Board approved the recommendation of the actuaries to not draw down the local program reserves because the balances were not enough to significantly affect the premium rates.

 Other Board Action

  • Pharmacy Benefits – The Board approved some additional pharmacy benefit changes; other changes were approved in May. These include:
    • CVS pharmacies, including Target pharmacies, will no longer be in-network
    • Certain over-the-counter medications for non-Medicare participants will no longer be covered
    • Non-Medicare participants must fill Level 4 prescriptions at mandatory specialty pharmacies – Lumicera or UW Specialty Pharmacies
    • New mail order pharmacy will be Serve You
    • New discount drug list will include drugs used for infertility, weight loss, cosmetic and lifestyle needs as prescribed
  • State and Local Group Life Insurance – premium rates and benefits will not change in 2018
  • EPIC Benefits+ and EPIC Dental Wisconsin – participants will see relatively minor changes to benefits and premium rates in 2018
  • New Vice Chair – the Board elected Stacey Rolston, Department of Administration, as the Vice Chair

For More Information
It's Your Choice open enrollment materials will be available in late September, these will include a new interactive online map, revamped Decision Guides and helpful eLearning modules.

2018 Health Plans by County - State Program
2018 Health Plans by County - Local Program
2018 Health Plans - Quality Ratings and Provider Directories
Q&A for 2018 Health Plan Changes
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