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News

Department of Employee Trust Funds
Revised February 10, 2017

Board Opts for Self-Insured/Regional Program Structure

The Group Insurance Board (Board) today approved a new self-insured/regional program structure for the State of Wisconsin Group Health Insurance Program and the Wisconsin Public Employers (WPE) Group Health Insurance Program, starting in 2018.

The Board made the decision to change from the current fully-insured program structure after a year of review, analysis and consideration of different options to achieve the following goals:

  • Quality care
  • Maintain benefit levels
  • Ensure provider access
  • Contain program costs

Analysis from the Board’s consulting actuary, Segal, shows that 98% of all current providers will be available in the new structure. The changes are estimated to save taxpayers $60 million over the 2017-2019 biennium. Similar savings are anticipated in future years.

 “The Board’s decision to change from a fully-insured to a self-insured program structure, combined with wellness and data collection initiatives already underway, centers on improving health outcomes for participants and quality of care,” said Lisa Ellinger, Director of ETF’s Office of Strategic Health Policy.

ETF already administers three self-insured benefit programs: pharmacy, uniform dental and the statewide It’s Your Choice Access Health Plan.

The Board will issue Intent to Award Letters to six vendors, for three-year contracts. Compcare Health Services Insurance Corporation (Anthem Blue Cross Blue Shield) will administer statewide/nationwide services in partnership with five regional vendors. The vendors for regional services are:

  • Anthem Blue Cross Blue Shield
  • Dean Health Plan, Inc.
  • HealthPartners Administrators, Inc.
  • Network Health Administrative Services, LLC
  • Security Administrative Services, LLC
  • SPWI TPA, Inc. (Quartz*)

* Quartz is affiliated with Unity Health Insurance and Gundersen Health Plan.

The following map shows the regions and selected vendors for each:

Self Insurance MAp

Region North East South West
Statewide Vendor Anthem Anthem Anthem Anthem

Regional Vendor(s)

Security

Anthem
Network

Dean
Quartz

HealthPartners

The new contracts to self-insure through third party administrators must be sent to the Joint Committee on Finance (JCF) for review, as required by 2015 Act 119. The JCF has the authority to either reject the contract(s) or take no action; the latter would allow the process to continue.

Participant Impact
Program participants can anticipate the following enhancements:

  • Improved quality and value – Health plans will be contractually held to performance standards that ensure high quality and strong medical management programs.
  • Improved provider access – The broad networks of the statewide vendors will provide access to more Wisconsin providers than under the current program. Participants will have two to three health plan vendors to choose from in each region.
  • Improved customer service – New performance standards will ensure consistent customer experiences.

Preliminary Timeline and Next Steps

Action

Estimated Timing

Board issues Intent to Award Letters to vendors

February 2017

ETF enters contract negotiations with vendors

February – March 2017

Board submits letter to JCF for 21-day passive review of contracts with vendors

April 2017

JCF decision

May 2017

Board signs contracts with vendors

May 2017

Board meeting: Board finalizes benefits and It’s Your Choice open enrollment dates for 2018

May 24, 2017

Board meeting

August 2017

It’s Your Choice open enrollment for 2018 benefit year

October – November 2017

Other Board Action Items
The Board also approved the following changes for 2018:

  • Medicare Plans – The Board instructed ETF to negotiate the following contracts for 2018:
    • It’s Your Choice Medicare Plus to be administered by Anthem
    • It’s Your Choice Medicare Advantage to be administered by Humana
    • It’s Your Choice Health Plan Medicare to be administered by the regional vendors

  • It’s Your Choice Access Health Plan (formerly the Standard Plan) – Benefits will be aligned with Uniform Benefits and administered by Anthem
  • Local Annuitant Health Program (LAHP) – The LAHP will be consolidated into the WPE Program
  • Income Continuation Insurance Program – Board approved ETF proposal for redesign
  • Income Continuation Insurance and Long-Term Disability Insurance Programs – Board approved extension for administrative services contract with Aetna Life Insurance Company and transfer oversight from the Group Insurance Board to the ETF Board

For More Information

Group Insurance Board Letter (Self-Insurance) to Joint Committee on Finance (Februrary 9, 2017)

Group Insurance Board Motion to Approve New Program Structure (Februrary 8, 2017)

Frequently Asked Questions: Group Insurance Board Action and Initiatives

E-Learning: Self-Insurance in 5 Minutes

Executive Summary – Results and Analysis (December 13, 2016)

December 13, 2016 GIB Meeting Agenda and Materials

GIB Selects Data Warehousing Vendor, Deliberates Program Changes (November 30, 2016)

GIB Reviews Vendor Proposal Requirements for Self-Insurance (May 18, 2016)

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