Local Employer: IYC 2019 Kickoff Meeting Information

Tiering is the result of a combination of several factors that are negotiated each year, including costs, changes in rates, provider access, and risks. ETF develops the tiers in conjunction with the Group Insurance Board’s actuary, Segal Consulting (Segal). Tier 1 plans meet all the provider access requirements and have provided lower premiums that meet the Tier 1 breakpoint, which is established by the actuary and based on all the participating plans premium bids. Conversely, Tier 3 plans have the highest premiums. All premium bids are risk-adjusted, meaning that if a plan had a year of extremely high claims when compared to the other plans – this is taken into account so that the plans can be compared fairly.

The tier development process begins when participating health plans submit preliminary rate bids to Segal each summer. Preliminary rate bids are based upon the plan’s expected costs to provide services in the next year. Plans separately submit aggregate claims data which Segal uses to calculate a renewal rate for the plan. If a health plan’s preliminary premium bid is higher than Segal’s calculation, plan is told how much they need to lower their premium bid in order to be considered Tier 1. Plans have an opportunity to justify their preliminary premium bids or change their bids as part of the negotiation process. Some plans choose not to lower their bids, opting to be a Tier 2 or 3 plan for the upcoming year.

Tiers are determined on annual basis and the tiering placement of individual health plans may change from year to year.

Concerned employees should review the competing plan’s provider networks. Providers appear in multiple networks, so employees may be able to change plans and continue to see some or all their current providers. This is especially true in more rural areas where most providers accept payment from multiple health plans. All plans’ provider directories are available through the It’s Your Choice webpages, or members may contact plans directly for a copy.

It typically means their monthly premiums will increase. Tiers do not affect benefits.

The 88% and 105% tables can be found here:  2019 Wisconsin Public Employers Group Health Insurance Program

The formula calculates 88% of Tier 1 Qualified Plans' Average Premium for each county. Qualified plans meet the program’s provider access requirements.

The employer contributes an amount based typically on the 88% tables for their county. The employee pays the difference between that set contribution and the remainder (if any) for any plan. Employees may select any participating health plan.

Yes, the employer must contribute more than 50% for full-time and 25% for part-time employees. Employers can offer different contributions by class of employee (for example, police vs. administration, etc.). Generally, there should not be a class containing one individual.

No, employers are not required to notify retirees of the change. ETF is mailing a letter to retirees who cancelled their coverage within the last five years. The WRS news also includes a brief article to inform retirees.

Yes; ETF does not limit incentives offered by local employers.

Active employees cannot choose a Medicare plan for themselves and/or their spouse until they retire. If the employee or their spouse enrolls in any part of Medicare, that coverage will be the secondary payor.  Note: the only exception is for employees and their spouses who are eligible for Medicare’s End Stage Renal Disease (ESRD) program. For more information, see Frequently Asked Question #2 under Medicare Information.

Single and family premiums don’t reduce until the employee retires, enrolls in Medicare, and Medicare pays primary for their claims.

The premiums between program options are based upon actuarial factors. In the development of the factors, the actuary considers, in part, how many members meet annual deductibles and out-of-pocket limits. Also, ETF’s HDHP has a high actuarial value.  

No double coverage is allowed. A court order does not change the eligibility requirements of our program. A child can switch from one plan to another if the child moves between parents or if the custody order changes. Employees will continue to have the opportunity to decide which plan should cover the child(ren). ETF will send a letter and if the parents do not respond within 30 days, ETF will assign coverage to the parent with the earlier month/day birthdate in the calendar year. The parents will be notified of this and have a 30-day opportunity to change the coverage to the other parent’s plan. Example: Mom's birthday is April 15 and Dad's is July 20. Coverage will be assigned to Mom, since her birthday falls first in the calendar year.

Yes, based on expert guidance, ETF considers the wellness incentives as taxable and reports the names of incentive recipients and the amount of and date the incentive was issued to state and local employers on a biannual basis for processing.

ETF’s vendor for developing myETF, Vitech Systems Group, stopped providing services related to the development of the new benefits administration system. This unexpected stoppage significantly affected development of myETF and, as a result, we will not roll out the new functionality as planned on January 1, 2019. When we have additional information, we will reach out to you. Employers do not need to take any steps at this time. While this development with the vendor is disappointing, we appreciate the hard work, time and resources you and your organization have devoted to the myETF project. If you have questions, send an email to your case manager.