New Eligibility for Retirees
You can re-enroll in health insurance through ETF if you meet these 3 requirements:
- You are a WRS member who retired from a local employer
- You were covered by the Group Health Insurance Program on your retirement date
- Your former employer still participates in the Group Health Insurance Program
Previously, if you canceled your coverage, you could never re-enroll in the program.
Health Plan Changes
There are 2 new health plans. Robin with HealthPartners and Medicare Advantage. Robin with HealthPartners has coverage in northeast Wisconsin.
The State Maintenance Plan's (SMP) coverage area has changed. SMP is no longer available in Iron and Price counties. SMP will be newly available in Buffalo, Marinette, Pepin, Pierce, Polk, Shawano, St. Croix, Waupaca, Waushara, and Wood counties.
Medical Benefit Changes
- Telehealth: Telehealth services will be covered 100% for non-High Deductible Health Plan (HDHP) options. HDHP participants pay the full cost until their deductible is met.
- Gender Identity Services: The exclusion related to benefits or services based on gender identity is removed for 2019.
- Home Sleep Studies: Coverage for medically necessary sleep studies at home.
- Contact Lenses for Keratoconus Treatment: Coverage for one set of medically necessary hard contact lenses if being treated for keratoconus. Consider supplemental vision coverage for additional sets.
- Tooth Extractions: Coverage for extraction (removal) of erupted teeth (above the gumline) will be covered by the Uniform Dental Benefit instead of the medical benefit.
- Transplants: Transplant coverage language has been simplified to defer to clinical teams to make decisions on appropriateness.
- Skin Tags: Skin tag removal is excluded.
- Prescription Foot Orthotics: Coverage for only one orthotic per foot, per year.
Pharmacy Benefit Changes
This change does not apply to retirees with Medicare.
Some doctors write prescriptions as "DAW-1," or "dispense as written." This means the pharmacist will fill the brand name drug as written and will not substitute an available generic equivalent.
Starting in 2019, you will pay more for "DAW-1" brand name level 3 drugs unless you cannot take the generic equivalent due to a medical need. If you have a medical need, your doctor must submit a one-time FDA MedWatch form to Navitus for the prescription. Have your doctor contact Navitus for the form.