Department of Employee Trust Funds
Revised September 1, 2017
GIB Approves a 0% Premium Increase for Health Insurance in 2018
Health plans participating in the State of Wisconsin Group Health Insurance Program will have a 0% premium increase next year, as approved by the Group Insurance Board (Board) today. Local government employees and retirees who participate in the program will have an overall 3.3% premium increase.
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.
Approximately 42,000 members, including employees, retirees and their dependents, will need to choose a new plan during open enrollment in October, 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:
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 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
Upcoming Member Communications
In early September, ETF will post information on our website about 2018 available health plans by county, along with provider information. Members affected by the health plan changes will be able to review their options and determine which health plan(s) will cover their health care providers.
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. The open enrollment period is October 2-27.
For More Information
Group Insurance Board August 30, 2017 Meeting Agenda and Materials
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