Health Plans

New Health Plan

No Action Required: Aspirus Health Plan is newly available for the 2022 plan year

Service Area Change

Action Required for Quartz Community Members: Quartz Community is now Quartz Central and Quartz West. Members currently enrolled in Quartz Community should select a new health plan. If you don’t select a new health plan, you will be enrolled in a renamed Quartz offering based on the location of your current primary care provider/clinic. 

State Maintenance Plan

Changes can happen each year. Use the health plan search on our website to find health plans and covered providers where you receive care. 

  • The State Maintenance Plan (SMP) will no longer be available in the following counties: Buffalo, Crawford, Jackson, La Crosse, Monroe, Pepin, and Trempealeau.
  • SMP will be newly offered in the following counties: Forest and Wood.
  • SMP will continue to be offered in the following counties: Florence, Pierce, Polk, Rusk, and St. Croix.

Silver Sneakers Availability (Retirees Only)

WEA Trust, with the IYC Medicare Plus plan design, will continue to offer the Silver Sneakers gym membership for 2022.

UnitedHealthcare, with the IYC Medicare Advantage plan design, will transition to Renew Active effective January 1, 2022. Contact UnitedHealthcare with questions.

Benefit Changes

Medical Benefit Changes

Coverage added for medically necessary orthognathic surgeries (i.e., corrective jaw surgeries).

  • The medical maximum out-of-pocket limit has been updated to follow the annual federal maximum updated values.
  • All medical benefits will be applied to the maximum out-of-pocket limit.
  • The timeframe requirement for extractions/dental repairs due to accidents has been removed.
  • Telemedicine coverage has been updated. See etf.wi.gov/telemedicine for more details.

Pharmacy Benefit Changes

For Non-Medicare Members:

  • Continuous Glucose Monitors are now covered on the pharmacy benefit. Coverage is now available under both the medical and pharmacy benefit.
  • Level 4 pharmacy benefit out-of-pocket limit has been removed.

Dental Benefit Changes

Coverage added for composite resin fillings for back teeth to the Uniform Dental benefit. White composite resin fillings will be covered for both front and back teeth in 2022.

Accident Plan

Beginning January 1, 2022, cash payment amounts for most claims will increase.

Outpatient rehabilitation therapy will be newly covered in 2022.

Wellness

Vendor Name Change

WebMD has acquired StayWell and is now the Well Wisconsin program vendor.

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