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News

Department of Employee Trust Funds
Revised June 9, 2015

GIB Approves Health Insurance Benefit Changes for 2016

The Group Insurance Board (GIB) has approved benefit changes and increased member cost sharing for the state’s group health insurance program in 2016. The changes will provide a projected cost savings of $85 million over the next two years, which meets requirements proposed in the 2015-2017 State Budget.

Benefit Changes at a Glance:

Coinsurance Uniform Benefits Plan (approximately 98% of ETF members are enrolled in this plan)

 

Single

Family

Benefit Year

2015

2016

2015

2016

Deductible

$0

$250

$0

$500

Out-of-Pocket Limit

$500

$1,000

$1,000

$2,000


Benefit Year

2015

2016

Primary Care Physician Office Visit*

10% coinsurance

$15 copay

Specialist Office Visits**

10% coinsurance

$25 copay

*The primary care copay will also apply to visits for chiropractic and therapy services.
**The specialty copay will also apply to urgent care visits.

Notes:

  • There is no copay or deductible for routine preventive health services.
  • The state employee percentage share of premium contributions are currently 88% employer paid and 12% employee paid. Premium contributions for state employees are set by OSER in late August.
  • These medical benefit changes do not apply to annuitants who are eligible for and enrolled in Medicare Parts A, B and D.

Standard Plan

 

Single

Family

Benefit Year

2015

2016

2015

2016

Deductible (Preferred Provider)

$200

$250

$400

$500

Out-of-Pocket Limit

$800

$1,000

$1,600

$2,000

Note: This does not apply to annuitants who are eligible for and enrolled in Medicare Parts A, B and D.

High Deductible Health Plan and Health Savings Account (HSA)

 

Single

Family

Benefit Year

2015

2016

2015

2016

HSA Employer Contribution*

$170

$750

$340

$1,500

*The HSA employer contribution amounts listed are supported by the GIB, but the Office of State Employment Relations (OSER) makes the final determination on HSA contributions.

Note: The annual deductibles ($1,500 Single / $3,000 Family) and out-of-pocket maximums ($2,500 Single / $5,000 Family) remain the same for 2016.

Pharmacy Benefits

Benefit Year 2015 2016

Member Costs

Generic – Level 1

$5

$5

Brand – Level 2

$15

20% ($50 maximum)

Brand – Level 3

$351

40% ($150 maximum)1

Brand – Level 4

  • Preferred Pharmacy
  • Non-preferred Pharmacy

 

$152
$50

 

$502
40% ($200 maximum)

Member Out-of-Pocket Limits (OOPL)

Levels 1 & 2

$410 Single / $820 Family

$600 Single / $1,200 Family

Level 4

$1,000 Single / $2,000 Family

$1,200 Single / $2,400 Family

1 Level 3 copays do not apply toward OOPL.
2 Reduced copay applies when Preferred Specialty Medications are obtained from a Preferred Specialty Pharmacy.

Note: This also applies to annuitants who are eligible for and enrolled in Medicare Parts A, B and D.

The GIB also approved:

  • Adding coverage for advanced care planning and/or a palliative care consultation to ensure that members facing serious illness and survival of less than 6 months are informed of care options and are able to make treatment decisions based on their individual values and goals of care; and habilitative services that help members keep, learn, or improve skills and functioning for daily living.
  • Shifting current dental benefits to a stand-alone, self-insured dental plan. Delta Dental of Wisconsin has been selected as the plan administrator, pending contract negotiations.

The 2015-2017 State Budget, currently under development by the legislature, contains a provision offering a $2,000 opt-out incentive for state employees who choose not to enroll in the group health insurance program. The biennial state budget process has not been completed. Therefore, this provision is neither final nor approved.

Premium rates for state and local employees and retirees will be set after health plan contract negotiations are completed this summer by ETF. Then, rates for 2016 are approved by the GIB and announced in August.

You will have the opportunity to learn more about plan benefits for 2016 and make choices during the It’s Your Choice open enrollment period, October 5-30, 2015.

Additional ETF resources:
Frequently Asked Questions about changes

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