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Selecting A Health Plan

1. Can family members covered under one policy choose different health plans?

*No, for all state and grad employees, and any retirees and continuants who have single or family coverage where either all individuals have Medicare or none do.

*Yes, for retirees and eligible continuants who have family coverage where at least one individual has Medicare and at least one does not. This is called a Medicare Some contract. See Medicare Advantage FAQs Question: Can I or my Medicare enrolled dependent choose to be insured by IYC Medicare Advantage or Medicare Plus, and the non-Medicare individual choose a non-Medicare IYC Health Plan under my family coverage?

2. Can I elect a family plan for medical and an individual plan under the Uniform Dental Benefit?

No. Uniform Dental coverage mirrors your health insurance coverage. For example: If you elect family health insurance coverage with dental, you will be enrolled in family Uniform Dental coverage.

3. Can I receive medical care outside of my health plan network?

This can be a concern for members who travel and those with covered dependents living elsewhere, such as a college student living away from home. Consider the following when selecting a health plan:

If you are covered through an It's Your Choice (IYC) Health Plan HMO, you are required to obtain allowable care only from providers in the IYC Health Plan HMO's network. IYC Health Plan HMOs will cover emergency care outside of their service areas, but you must get any follow-up care from providers in the IYC Health Plan HMO's network. Do not expect to join an IYC Health Plan HMO and get a referral to a non-HMO physician. An IYC Health Plan HMO generally refers outside its network only if it is unable to provide needed care within the HMO.

If you are covered through a Preferred Provider Organization (PPO) such as the Access Plan, you have the flexibility to seek care outside a particular service area. However, out-of-network care is subject to higher deductible and coinsurance amounts.

Retirees only: If you or your dependents are covered through IYC Medicare Advantage or Medicare Plus, you have the freedom of choosing to see any provider who accepts Medicare. IYC Medicare Advantage offers coverage for participants with Medicare Parts A and B, with both in- and out-of-network benefits. For more information see www.medicare.gov/your-medicare-costs/part-a-costs/assignment/costs-and-assignment.html. 

4. How can I get a list of the physicians participating in each plan?

Contact the plan directly or follow the instructions found on the 2024: Health Plan Search page by clicking on the health plan name. The Department of Employee Trust Funds (ETF) and your benefits/payroll/personnel office do not have this information.

5. What steps should I follow to enroll in the health insurance program?

  • Determine which plans have providers in your area.
  • Contact the health plans directly for information regarding available physicians, medical facilities, and services. You must contact Delta Dental directly for information regarding the Uniform Dental Benefit and available dental providers.
  • Review the health plan rates, report card information, and the 2024: Health Plan Search page.
  • To enroll, see the Enroll or Make Changes page. You can also request a paper application from your payroll or benefits office. If you are an active employee, you can file the application with your employer. If you are a retiree, you will file your Health Insurance Application/Change for Retirees & COBRA Continuants (ET-2331) with ETF. Note: if you select family coverage, you must enroll all eligible dependents. 

6. Someone on my health plan is in the middle of medical treatment and we have to change health plans. What do I need to do?

If you or someone in your family is in the middle of medical treatment or has complex healthcare needs when you need to change health plans, you should keep a few things in mind when you make your health plan choice.

First, check the provider directories of the health plans you are considering, and try to find one with your doctor in network.

Next, contact the plan you have selected and ask what their process is for transitioning your care. They may ask you to submit a form or to speak with someone in their care management team.

If your new health insurance does not work with your doctor, but you are getting treatment for a serious condition, call your new health insurance company to let them know about your treatment. Depending on what illness or condition you are receiving treatment for your new health insurance company may be able to work with your current doctor while you finish treatment. Be sure to tell your current doctor that you have new health insurance.

New Employee Enrollment

7. When does my coverage go into effect as a new employee?

State and Grad only: If eligible, you may enroll for individual or family coverage in any of the available health plans, provided you file an electronic or paper health application with your benefits/payroll office within the required enrollment period stated below:

  1. Within 30 days of your date of hire or first eligible appointment. Coverage will be effective on the first of the month on or following your hire date or on the date you are eligible for an employer contribution, whichever you choose. Check with your payroll or benefits office to find out when your employer contribution begins. If you choose to start your coverage before you receive employer contributions, you will pay the full premium until your employer’s contribution begins.
  2. You may also enroll during the annual open enrollment period for coverage to be effective January 1 of the following year.
  3. Grad only: If this is not your first eligible appointment, you may still be eligible for the initial 30-day enrollment period if you had a 30-day employment break between appointments.

There are no interim effective dates except as required by law. If you do not submit a completed application within 30 days of your date of hire your coverage cannot be effective before the month you become eligible for the employer contribution toward health insurance premiums. However, you may enroll for individual coverage within 30 days of your date of hire and change to family coverage if your electronic or paper application is received prior to the date the employer contributions begin.

If you cancel your policy prior to the date that the state contribution starts, you may reenroll in health insurance with the new coverage becoming effective on the first day of the month state contribution begins.

You cannot assume that the month when your first payroll deduction occurs is the month when your coverage begins. For further information on deductions and coverage effective dates contact your benefits/payroll/personnel office.

State only: Important information for limited-term employees (LTE) and employees not eligible for full-time contributions:

  • For LTEs who are enrolling for coverage, employer contribution would become available upon completion of six months under the Wisconsin Retirement System (WRS).
  • The initial enrollment opportunity for most employees begins with their participation under the WRS. However, if you are in a WRS-covered LTE position or an employee who is eligible but appointed to work less than 1,040 hours per year, you have another enrollment period if:
  1. There has been a 30-day termination of employment break; or
  2. Your hours of employment increase due to a change in your appointment, and you qualify for a higher share of employer contribution toward health insurance premiums; or
  3. You are appointed to a permanent position, and you now qualify for the full share of employer contribution.

If you apply for coverage within 30 days after one of these events, coverage will be effective on the first of the month following your new hire date, or the date you are eligible for the increase in employer contribution. Retroactive effective dates are not allowed. This does not provide an opportunity to change from individual to family coverage.

Other Enrollment Opportunities

8. Are there other enrollment opportunities available to me after my initial one expires?

You may be able to get health insurance coverage if you are otherwise eligible under specific circumstances as described below:

  • If you are an active employee, and you and/or your dependent(s) are not insured under the State of Wisconsin Group Health Insurance Program because of being insured under a group health insurance plan elsewhere, you may take advantage of a special 30-day enrollment period to become insured in the State of Wisconsin Group Health Insurance Program as described below. These also apply to retirees, if your annuity began (or you received a lump-sum retirement benefit) within 30 days after your employment termination date and you have escrowed your sick leave account:
    • Your eligibility for that other coverage is lost involuntarily, or the employer's premium contribution for the other plan ends, or
    • You and/or your dependents lose medical coverage:
      • Under medical assistance (Medicaid); or
      • Upon return from active military service with the armed forces. Employees must return to employment within 180 days of release from active duty. You are entitled to enroll regardless of the coverage in effect. Coverage is effective on the date of your re-employment; or
      • As a citizen of a country with national healthcare coverage comparable to the Access Plan.

The enrollment period begins on the date the other group health insurance coverage terminates because of loss of eligibility (for example, termination of employment, divorce, expiration of COBRA, etc., but not voluntary cancellation of coverage or the loss of COBRA due to nonpayment of premiums) or the employer's premium contribution ends.

  • If you are currently enrolled in the State of Wisconsin Group Health Insurance Program with individual coverage because your dependents are insured under a group health insurance plan elsewhere, and eligibility for that coverage is lost or the employer's premium contribution for the other plan ends, you may take advantage of a special 30-day enrollment period to change from individual to family coverage. You must enroll all eligible dependents with the exception of adult child dependents (19 and older) who have other group health insurance coverage. 
  • If you are currently enrolled in the State of Wisconsin Group Health Insurance Program with family coverage, you may request to provide coverage for your eligible adult child (19 or older) who is not currently insured during the annual open enrollment period. Coverage for your child will be effective the following January 1. For more information, see the Dependent Information FAQs.
  • State and Grad only: If you are not insured under the State of Wisconsin Group Health Insurance Program and have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may enroll if coverage is elected within 30 days of marriage or 60 days of the other events. Coverage is effective on the date of marriage, birth, adoption, or placement for adoption.
  • State and Grad only: If you and/or your dependents lose medical coverage under the Children's Health Insurance Program (CHIP) or become eligible to participate in a premium assistance program, you will have an opportunity to enroll in the State of Wisconsin Group Health Insurance Program without waiting periods for preexisting conditions. You can do this by filing an application either electronically or via paper within 60 days of the loss of eligibility or the date you become eligible for premium assistance and by providing evidence satisfactory to ETF.
  • Grad only: If you were eligible for graduate assistant benefits but elected not to enroll in this program upon initial eligibility, you will have a second enrollment opportunity if you later become eligible for a WRS-eligible position even if there is no break in service of 30 days or more.
  • State and Grad only: If you do not enroll during a designated enrollment period you may enroll for health insurance coverage, if you are otherwise eligible, during the annual open enrollment period.
  • Retirees only: Certain former state employees who receive a retirement annuity (or have received a lump-sum retirement benefit) within 30 days of termination of employment who would like to enroll or reenroll in the State of Wisconsin Group Health Insurance Program in most cases will have to do this during the annual open enrollment period in the fall for January 1, coverage. For more information, see Questions below: Can I enroll in health insurance coverage during open enrollment since my coverage lapsed after retirement? and Can I delay or initiate use of sick leave credits after I retire?
  • Prospective Retirees only: If you are an employee who is not enrolled under the State of Wisconsin Group Health Insurance Program as you near retirement and you wish to enroll in order to escrow or use your sick leave credits to pay for premiums in retirement:
    • You must enroll in the Access Plan effective the first of the month prior to retirement. You must have 30 days of employee coverage prior to retirement. You may enroll for individual coverage though you later intend to initiate the use of sick leave credits and enroll with family coverage. However, if you die while your sick leave credits are escrowed, your dependents will not be able to reenroll if they were never previously covered under your contract, and those credits will be forfeited.
    • You may submit an escrow application and if your coverage is found to be comparable (by ETF), you can cancel your Access Plan coverage once you retire. If your other coverage is not comparable, then you can choose to stay on the Access Plan until the next open enrollment period. During open enrollment, you will be able to change health plans.
  • Former employees (with 20 years of creditable WRS service who terminated employment prior to becoming eligible for an immediate annuity): You may enroll or reenroll in the state group health insurance program within 30 days after the date ETF receives your application for your annuity, regardless of whether or not you had insurance at the time of termination. If you have preserved sick leave credits, you may enroll or reenroll and initiate the use of these credits to pay for your coverage even if you have not yet begun your annuity.

Open Enrollment

The annual open enrollment period is the opportunity for eligible employees, currently insured retirees, and currently insured continuants and retirees to select or change to one of the many health plans offered by the State of Wisconsin Group Health Insurance Program.

The following list contains some of the most commonly asked questions about the enrollment period. You can also find information about key terms in the Glossary of Health Coverage and Medical Terms. Additional medical definitions are found in the online Certificates of Coverage.

9. What is an open enrollment period?

The open enrollment period is an opportunity to change health plans, change from family to individual coverage, enroll if you had previously deferred coverage, cancel your coverage, or cancel the coverage for your adult dependent child (19 or older). It is offered only to employees, retirees, COBRA/continuants, and surviving spouses and dependents who are eligible under the State of Wisconsin Group Health Insurance Program. Changes made become effective January 1 of the following year

10. May I change from individual to family coverage during the open enrollment period?

Yes, coverage will be effective January 1 of the following year for all eligible dependents.

Making Changes During It's Your Choice Open Enrollment

11. How do I change health plans during open enrollment?

If you decide to change to a different health plan, employees are encouraged to make changes online using your employer's electronic enrollment system or you may submit a paper application using the following instructions:

Active employees may get an application online or receive paper applications from your benefits/payroll office to complete and return to that office.

Retirees and Continuants only: may get an application online, or contact ETF for a copy and submit it to ETF.

Applications received after the deadline will not be accepted.

Note: If you plan to stay with your current health plan for next year and you are not changing your coverage, you do not need to take any action. However, members in the High Deductible Health Plan (HDHP) must reenroll in their Health Savings Account (HSA) annually.

12. What is the effective date of changes made during the open enrollment period?

Coverage changes are effective January 1 of the following year.

13. What if I change my mind about the health plan I selected during the open enrollment period?

You may submit or make changes anytime during the open enrollment period either online or by filling out a paper application. If you change your mind after that time you may withdraw your application (and keep your current coverage) by following these instructions before December 31:

  • Active employees should inform their benefits/payroll office in writing; or
  • Retirees and Continuants should notify ETF in writing.

Other rules apply when canceling coverage. For more information, see the Cancellation or Termination of Health Coverage FAQs.

14. Which other changes can be made during the open enrollment period if my health insurance premiums are taken pre-tax?

During the annual open enrollment period you can add or drop coverage for yourself and/or your adult dependent children (19 or older) or do a spouse to spouse transfer of your health insurance coverage.

Retiree Enrollment

Important Note: If you are eligible or will become eligible for Medicare, you will also want to refer to the Medicare Information FAQs.

15. What happens to my health insurance when I become a retiree?

When you retire your health insurance plan will automatically continue if your retirement annuity from the Wisconsin Retirement System begins within 30 days after your employment termination date. If you terminate employment after 20 years of creditable service but are not eligible for an immediate annuity, your completed Group Health Insurance Application/Change for Retirees & COBRA Continuants (ET-2331) form with a Group Health Insurance Program Continuation Application (ET-2155) form must be received by ETF within 90 days of your termination of employment to continue coverage. You may switch coverage to any other available health plan during the open enrollment period.

16. Can I enroll in health insurance coverage during open enrollment since my coverage lapsed after retirement?

An enrollment opportunity is available to:

  • Former state employees who have 20 years of WRS-creditable service and took or are eligible for an immediate annuity. You may reenroll even if the annuity you are eligible for is deferred.
  • Former state employees with 20 years of WRS-creditable service who are not eligible for an immediate annuity.
  • Retired state employees with less than 20 years of WRS-creditable service who:
    • were insured immediately prior to termination of employment, and
    • are receiving a WRS retirement annuity or received a lump-sum WRS retirement benefit that began within 30 days of termination of employment.
  • Surviving dependents of an eligible state retiree if they were insured at the time of the retiree’s death.

This opportunity is not available to:

  • Members receiving a duty disability benefit as it is not considered a WRS disability annuity under law.
  • Survivors or dependents who were not insured at the time of the state retiree’s death

To enroll or reenroll you must submit a Group Health Insurance Application/Change for Retirees (ET-2331)  to ETF during the annual open enrollment period.

You would not be eligible to use any sick leave credits to pay premiums if you enroll under this provision. There are separate enrollment opportunities for members who have escrowed their sick leave (See Other Enrollment Opportunities above or contact ETF for details.)

17. Can I delay or initiate use of sick leave credits after I retire?

Yes. For Wisconsin Retirement System retirees, 40.65 disability or long-term disability insurance recipients, or their surviving insured dependents, if you are eligible to use your sick leave credits, you may elect to delay use (escrow) or initiate use of sick leave credits annually.

In order to escrow, you must certify that you have health coverage comparable to the State of Wisconsin's Access Plan. If you are insured by a local government employer who offers coverage under the Wisconsin Public Employers Group Health Insurance Program, administered by ETF, that coverage is comparable to State coverage. You may escrow only once during a calendar year, and your credits will be in escrow the first of the month following receipt of the Sick Leave Escrow Application (ET-4305).

You may later initiate use of your sick leave credits at two different times. In order to do this, you must certify that you have been continuously covered under health insurance coverage comparable to the State of Wisconsin's Access Plan. This may be done during the open enrollment period for coverage effective January 1 of the following year, or the first of any month in the following year. In addition, you may reenroll and initiate use of sick leave credits if you lose eligibility for your comparable coverage (not voluntary cancellation) or the contribution for it (if it is an employer sponsored health plan). You may do this by filing an application within 30 days of the loss (See the Sick Leave Conversion Credit Program (ET-4132) brochure for more information or contact ETF.)

If you escrow with individual coverage, you may reenroll and initiate use of sick leave credits with family coverage. However, if you die while your sick leave credits are escrowed, your dependents will not be able to reenroll if they have never been covered under your contract previously, and those credits will be forfeited.

State only: If you are an employee who deferred coverage and who wants to preserve your sick leave credits for later use, you may enroll for coverage in the Access Plan 30 days prior to retirement.