Today, the Group Insurance Board approved benefit changes for plan year 2026. In addition, the Board decided to not adjust cost-sharing for any of the Group Health Insurance Program plan designs offered.
While rate negotiations with health plans are in process, the Department of Employee Trust Funds (ETF) expects premiums will need to be increased to offset rising insurance costs and a stabilization charge added for the reserve fund.
Rates for 2026 will be set by the Board in May. Information about rates and other changes will be shared with members during open enrollment.
Highlights of Changes for 2026
- Shift the diabetes pilot program for non-High Deductible Health Plan members to a standard benefit.
- Cover continuous glucose monitors solely under the pharmacy benefit.
- Expand eligible conditions for medically necessary biofeedback treatment.
- Update a qualifying life event to allow members to change plans when enrolling in Medicare and change coverage and health plans after the death of a spouse or dependent.
- Allow Medicare Advantage members to earn the Well Wisconsin incentive.
After deliberation on program cost pressures, the impact of possible federal changes and other considerations, the Board opted to not include coverage of weight-loss drugs for 2026 and directed ETF to re-evaluate coverage in the future.
Other Business
The Board also approved:
- October 6-31, 2025, as the open enrollment period for plan year 2026.
- The extension of the contract with the third-party administrator of the Income Continuation Insurance Program, effective January 1, 2027.
- Changes to program agreements with health plans, including penalties for customer service performance standards based on a health plan’s membership size; change will be implemented in 2025.
The Board’s next meeting is May 21, 2025.