Have you heard about the Wisconsin Public Employers Group Health Insurance Program? This program is authorized by the Group Insurance Board and available to local employers participating in the Wisconsin Retirement System, and local government employers that do not participate in the WRS and are separate Social Security entities.

Watch a 10-minute recorded webinar about joining the WPE Group Health Insurance Program to learn more. 

The program is administered by the Department of Employee Trust Funds and offers the following benefits:

  • Competitive health insurance premium rates.
  • Four benefit designs (or program options), all with or without dental, to choose from.
  • One-stop shopping for access to many provider networks statewide.
  • A successful prescription drug benefit program administered by a pharmacy benefits manager (PBM) credited with saving state and local employers millions of dollars in prescription drug costs.
  • Support for employers, employees, and retirees with their health insurance needs.

Benefit Program Options

ETF is committed to establishing and maintaining quality, long-term partnerships with participating local government employers. As part of this mission, ETF offers four benefit designs, called program options, all with the option of with or without dental, for employers to choose from. 

For benefit details, see:

Note, employers with collective bargaining units may offer different program options to different bargaining units. Individual employees cannot choose between program options. There are separate pharmacy benefit out-of-pocket maximums that apply to all program options, except the High Deductible Health Plan (P07/P17).

The monthly premium rates, as well as a map showing plans available by county, are available on the ETF website. The map helps members to choose health plans offered where they receive health care services. They can also find links to each health plan’s covered provider directory when viewing the map within their chosen program option.

2022 Plan Year Information 

See the landing page links for each local program option that excludes dental coverage below. Note: Uniform Dental is optional and you as the employer must choose to offer it, or not, to your employees.

The program options are also outlined in chapter 201A of the Local Employer Health Insurance Standards, Guidelines and Administration Manual (ET-1144).

Participation Process

Joining the local group health insurance program consists of the following steps, depending on the size of the employer:

Large Employers, with 50 or More Employees

Large employers, with 50 or more employees, must complete the group underwriting process to learn what, if any, surcharge your group will have to pay for a limited time. The underwriting process begins 120 days prior to your effective date and takes about 30 days to complete. Groups can join the program effective January, April, July, or October 1 of any year. The surcharge will not last more than 27 months if one is applied. To begin coverage effective January 1, 2023, large employers must begin the underwriting process by August 31, 2022 and your resolution must be received by September 30, 2022.

All of your WRS-eligible employees, or WRS-eligible equivalent employees for non-WRS employers, must be offered the health insurance coverage, including part-time WRS eligible employees. Eligibility includes current and future WRS or WRS-equivalent retirees covered under your current group health insurance plan.

Underwriting determines if  a large group may join at the rates published in the annual health benefits materials, or if a large group will receive an additional per-contract, per-month surcharge, as determined by the Group Insurance Board’s consulting actuary, for no more than 27 months. The surcharge will be applied if the group’s risk is determined to be detrimental to the existing pool of covered members.

Once ETF receives the required information from the employer, the information is forwarded to the Group Insurance Board’s consulting actuary for review and surcharge determination.

ETF will provide final rates to the employer. Following underwriting and ETF notification of the final rates, the employer’s governing body must decide whether to pass a resolution for inclusion (ET-1324) to join the program. Upon filing the resolution with ETF, coverage is effective on the first day of the quarter following the 120-day process.

Small employers, with 49 or less employees

Small employers, with 49 or less employees, do not have to complete underwriting. They do need to:

  • File a resolution 60 days prior to your chosen effective date: January, April, July, or October 1. 
  • Select a program option to will offer your employees and retirees (see program options listed in this news item for details).

The employer’s governing body must pass a resolution for inclusion (ET-1324) to join the program. The employer must submit the resolution at least 60 days before the first day of the quarter they wish to have participation begin.

Premium and Employer Contribution Information

Participating employers potentially have three options available for establishing the employer contribution toward premium:

  • Three-Tiered Premium Structure
  • 88% Calculation Method
  • 105% Formula Method

For more information regarding the three options available for establishing employer contribution toward premium, please review:

A webinar is also available on calculating the employer share of the premium contribution towards the health insurance premium in the employer training section of the ETF website.

Conclusion

As a participating employer in the local group health insurance program, your employees have the option to choose any health plan offered by this program. During the annual open enrollment period lasting for four weeks in late September into October, employees and insured retirees may elect, without restriction, to change to a different participating health plan within their program option or to change from individual to family coverage, or family to individual coverage, effective the following January 1.

Contact

We’re here to help you. For more information on joining the local group health insurance program, contact the Employer Communication Center at 1-877-533-5020 or email at ETFSMBESSNewEmployer@etf.wi.gov.