ALEX®, Virtual Benefits Counselor
ALEX is a new online tool that walks you through the process of picking your best benefits, and provides easy-to-understand explanations for any questions you might have along the way. Before you enroll, visit ALEX.
ALEX is not available for retirees with Medicare.
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 newly available in Forest county and no longer available in Florence.
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
Supplemental Benefits Changes
Plans No Longer Available
Coverage under these plans will end December 31, 2018.
- Anthem DentalBlue: Current participants in any of the three Anthem plans will need to choose a new Delta Dental plan to have supplemental dental coverage in 2019
- EPIC Benefits+: Current participants will need to choose a new Delta Dental plan to have supplemental dental for 2019, or Zurich for Accidental Death and Dismemberment coverage. There will be no hospital and surgical indemnity coverage option for 2019
- EPIC Dental Wisconsin: Current participants will need to choose a new Delta Dental plan to have supplemental dental for 2019
New Supplemental Dental Plans
You have 2 new options of supplemental dental to choose from:
- Delta Dental PPOSM - Select Plan
- Delta Dental PPO Plus PremierTM - Select Plus Plan
Find more information here.
Vision and Accidental Death and Dismemberment plans have some enhanced benefits for 2019 at no additional cost. Find more information here.
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.