State Of Wisconsin Retirement Health Insurance

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Etf Benefits Virtual Forums For Members

2022 Health Insurance & Pharmacy Webinar for State and Local Retirees
  • Scheduled throughout the open enrollment period
  • 60-minute sessions for members to ask questions about their benefits to ETF benefits staff
  • Three different session topics will be offered on a rotating basis:
  • Health insurance and pharmacy benefits for active members
  • Health insurance and pharmacy benefits for retirees
  • Dental, vision, and accident plans

Additional member education opportunities will be available during the open enrollment period. Visit the Member Education section of the ETF website to learn more.

If A Plan Is Not In The Tier 1 Does That Mean It Provides Lower Quality Health Care

State and Grad only: No. The Group Insurance Board requires that plans demonstrate high quality in order to be in the program. This is verified by our collection of data from the Consumer Assessment of Health Plans survey, the Health Plan Employer Data and Information Set and other quality measures.

What Happens If My Provider Leaves The Health Plan Mid Year

If you are enrolled in an IYC Health Plan HMO or HDHP HMO, you will need to find an in-network provider for your care. If you are in your second or third trimester of pregnancy, then you may continue to have access to your provider until the completion of postpartum care for yourself and your baby. If you are enrolled in a Preferred Provider Organization such as WEA Trust or the Access Plan and you continue to see this provider, your claims will be paid at the out-of-network benefit level.

If a provider contract terminates during the year , and you are a participant in your second or third trimester of pregnancy, the health plan is required to pay charges for covered services from these providers on a fee-for-service basis. Fee-for-service means the usual and customary charges the health plan is able to negotiate with the provider while the member is held harmless.

Health plans will individually notify members of terminating providers and will allow them an opportunity to select another provider within the health plan’s network.

Your provider leaving the plan does not give you an opportunity to change health plans midyear.

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Enroll Or Make Changes To My Health Benefits

State employees* or retirees: Use the following link to enroll, make changes to, or opt out of your health benefits.

* State employees include State of Wisconsin, Legislature and Wisconsin Court System Employees Covered by STAR Beyond Vision, Fox River Navigation System Authority, WEDC, WHEDA, WHEFA UW System and UW Hospital & Clinics.

Local employees or retirees: Turn in one of the following forms to your employer.

When And How Must I Notify My Employer And My Health Plan Of Various Changes

State Retiree Health Care Liabilities

All changes in coverage are accomplished by completing an approved electronic or paper application within 30 days after the change occurs. Employees should file an application through your benefits/payroll office to notify your health plan of changes. Retirees and continuants should file with ETF. Failure to report changes on time may result in loss of benefits or delay payment of claims. :

  • Change in health plan
  • Change in plan coverage
  • Change of address or telephone number
  • Addition/deletion of a dependent to an existing family plan

Exception: If you change your primary care physician or your primary care clinic , you may contact your health plan.

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If I Meet My Plan’s Out

Once you reach your OOPL, you no longer have to pay most copayments. You will continue to pay copayments for certain level 3 and 4 prescription drugs, and any other essential health benefit services that do not accumulate to the OOPL. If you are enrolled in the high deductible health plan , you do not have to pay for any copayments once you reach your OOPL.

There is a maximum out-of-pocket of $8,700/$17,400, which is the maximum you will pay for essential health benefits. Please see your Certificate of Coverage for information on which services apply to the OOPL and MOOP.

Local Insurance Q& a Session Reminder

ETF will host its first annual local government employer insurance question and answer session on September 24. All local employers may register to ask ETF staff any insurance benefit-related questions.

Employers must pre-register to attendthis event online via webinar. Due to the high demand, please register as soon as possible.

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Health Benefits Decision Guides Distribution

The 2022 health benefits decision guides must be distributed in a timely manner to all employees. The distribution method is determined by the employer. It is acceptable for employers to distribute health benefits decision guides using an electronic method during the COVID-19 outbreak. Employee distribution should include:

  • Employees who have indicated they do not wish to make a change during the Its Your Choice open enrollment period.
  • Remind these employees that they remain responsible for understanding the information contained in the guides and the ETF website, and that their certificate of coverage is available on the ETF website. We encourage you to point employees to the enrollment checklist on the inside cover of the Health Benefits Decision Guide for important reminders.
  • Insured employees on temporary layoff or leave of absence and those on permanent layoff paying premiums through the employer.
  • Employees who allowed health insurance coverage to lapse while on a leave of absence or a temporary layoff that encompassed the entire open enrollment period should be advised they are eligible to make a health benefits election within 30 days of returning from the leave or layoff.
  • Wisconsin Office Of The Commissioner Of Insurance Contact Information

    Wisconsin Non-Profit WEA Trust and Health Tradition Health Plan Cancels Health Coverage!

    Mailing Address:

    Information on this page has been gathered by a multitude of sources and was most recently updated in October 2022.

    Any Information on this site is not guaranteed or warranted to be correct, accurate, or up to date. StateRequirement and its members and affiliates are not responsible for any losses, monetary or otherwise. StateRequirement is not affiliated with any state, government, or licensing body. For more information, please contact your state’s authority on insurance.

    When readers purchase services discussed on our site, we often earn affiliate commissions that support our work. Learn More

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    How Are Health Premium Contributions Determined Why Was A Tiered Premium Contribution Structure Implemented

    State and Grad only: For eligible employees, the employer contribution is determined either through collective bargaining or through the applicable compensation plan.

    The three-tier health insurance program was implemented as an innovative approach that holds costs down as it creates incentives for health plans to reduce their costs to the state, and encourages employees in the state to choose the health plans that are most efficient in providing quality health care. Each health plan is rated and placed in a tier based on providing the most cost-effective, quality care . Health plans in the same tier have been determined to be within certain thresholds in their level of providing cost-effective, quality care.

    Getting Your Wisconsin Insurance License

    Your next steps will depend on whether you actually passed your exam, as well as on whether you plan to get licensed for any additional lines.

    You can attempt passing additional insurance line exams before filing your licensing application, if that is something you are actually interested in.

    After you have passed your insurance licensing exam, you will need to:

    • Complete a fingerprint and background check
    • File your licensing application
    • Wait for your application to be reviewed

    Have a look at our How to Become an Insurance Agent in Wisconsin review for more information on all the steps that you will need to take after passing your insurance exam.

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    Electronic Distribution Of The 2022 Health Benefits Decision Guides

    Employers distributing open enrollment information electronically must incorporate the following as part of their electronic distribution procedures:

    • Develop a list of all eligible employees and use that list to match against their file of employee email addresses.
    • Verify the list and then send the employee an email with the link to the guides and online information. Employers should send the email with a return receipt. This will establish a record of when the employee opened the email.
    • Due to federal regulations, employers must retain the list of employees who received an electronic copy of the IYC materials. For each employee who is sent an email message, the employer should receive a reject notice if the email address is no longer in existence.

    Note: While ETF generally recommends that you give new employees paper copies of the guides, distributing links to web versions or PDF files of the health benefits decision guides during the COVID-19 outbreak is acceptable. However, if employees who do not have access to a computer and/or employees who receive the electronic distribution but request a paper copy, must be given one.

    Make Enough Time To Study

    The State Pension Funding Gap 2016

    Not leaving enough time to prepare is one of the easiest ways to ensure that you do not pass your exam on your first attempt.

    Remember, there are zero questions on your exam that are based on common sense or critical thinking. All questions are purely factual, and so will relate to how well you understand and remember the content that you have learned.

    We recommend allocating around one to two weeks to prepare for your exam, as this should allow you to go through all of the material at least twice.

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    Employers Application Processing Instructions For Its Your Choice

    During the open enrollment period, employees should be directed to self-service enrollment options whenever possible. Employers should direct employees to the appropriate payroll center for directions on how to process any application materials.

    Employers must either provide their own electronic method of enrollment to transmit to ETF, allow their employees to enroll online or accept paper applications and enter them into myETF on behalf of the employee.

    Employers that accept a paper copy of the Group Health Insurance Application/Change form must collect the applications no later than the close of business on October 22, 2021. If an employer accepts a paper application, the employer must enter that application into the myETF Benefits system on behalf of their employee through the Online Tools link to the myETF Benefits System found on the ETF website. The application is not to be mailed or faxed to ETF for processing and keying. The deadline for employers to enter Its Your Choice applications into the myETF Benefits system is November 12, 2021.

    If the employee submits a paper application to their employer, ETF does not require that a copy of the application be submitted to ETF. Employers are not to make entries on behalf of their employee without an application as documentation of the employees request. The employer is to maintain a copy of the paper application in the employees file.

    Withdrawing/Rescinding an Its Your Choice Application

    Will An Iyc Health Plan Hmo Cover Dependent Children Who Are Living Away From Home

    Only if the IYC Health Plan HMO has providers in the community in which the child resides. Emergency or urgent care services are covered wherever they occur. However, non-emergency treatment must be received at a facility approved by the health plan. Outpatient mental health services and treatment of alcohol or drug abuse may be covered. Refer to the IYC Health Plans Certificate of Coverage online at etf.wi.gov. Contact your health plan for more information.

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    When Does The Medical Deductible Apply

    All eligible medical charges are subject to the annual deductible. There are three exceptions:

  • Office visits are subject to a per-visit copayment of $15 for primary care and therapy office visits and $25 for specialty care and urgent care visits.
  • Emergency room visits are subject to a $75 per-visit copayment.
  • Preventive services are covered at 100% per federal law.
  • These visits are not subject to the deductible, but any additional services you receive may be subject to the deductible and any applicable coinsurance.

    Virtual Open Enrollment Benefit Fair Activities

    Health Benefits in Retirement (Overview)

    ETF will host a series of online events for employers and members to provide information for the 2023 plan year. Participating vendors include health plans and supplemental vendors, such as Delta Dental, Optum, and WebMD. ETF staff will also participate. Event details and registration information will be posted to the ETF website in the near future.

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    People Are Also Reading

    In 2021, nearly 299 million Americans had health insurance, the most ever, and the number of Americans without health insurance just over 28 million in 2021 had dropped by 1.4 million people from 2019, according to the American Community Survey.

    During the pandemic, Congress has prevented states from disenrolling anyone from Medicaid, the health plan for lower-income Americans. It also increased subsidies to help pay for individual health plans bought on the Affordable Care Act markets.

    Yet the increased insurance hasnt necessarily provided sufficient financial protection and by extension, necessary medical care.

    The Affordable Care Act requires insurance plans to provide specified benefits, but it doesnt eliminate the copays and deductibles that patients must pay.

    The big but is that while its great that more people have insurance coverage, its also half the battle, said Gideon Lukens, director of research and data analysis for health policy at the left-leaning research institute, the Center on Budget and Policy Priorities. You still have to make sure people with coverage have access and dont have to sacrifice their financial security to get it.

    Health policy analysts say Congress and the states can take further steps to fatten the health insurance rolls and protect patients financial security.

    Major Retiree Health Insurance News

    Thursday brought some highly anticipated news to the 460,000 enrollees covered by the states Group Insurance Commission . After months of closed-door work to review and score the winning bids from respondents through the procurement process, the GIC unveiled the 4 Medicare and 7 non-Medicare health insurance plans to be offered starting in FY24.

    Before I outline the details of the plans selected, let me first remind you that Mass Retirees will hold a Tele-Town Hall meeting this afternoon at 1:00 PM EST. The GICs health plan announcement will be one of several important items discussed.

    We will also be joined at the start of the meeting by a special guest speaker our endorsed candidate for Lt. Governor Salem Mayor Kim Driscoll.

    To participate in todays meeting, simply accept the incoming auto-connection call at 1PM or call toll free 833-491-0336 during the time of the meeting.

    Now for the details on the big news that weve been anticipating for many months. In doing so, let me again point out that news generated by the GIC is not only important to retirees and employees covered by the state insurance plans. Policy decisions made by the GIC are closely watched by local officials, who can very quickly replicate those policies at the local level with limited input from local retirees and active employee unions.

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    Accident & Critical Illness Insurance

    Accidental injuries and critical illness happen when you least expect them. Those unexpected expenses can strain any budget. Accident insurance2 and critical illness insurance2 can help by paying cash benefits for covered injuries or illnesses.

    The Accident Pro series of products, underwritten by Golden Rule Insurance Company, combines accident insurance with critical illness, hospitalization, and accidental death and dismemberment coverage all in one. Some plans are guaranteed issue, meaning your application wont be turned down for preexisting conditions.

    Working After You Retire

    FVAW_Logo

    After retirement, there is no effect on your WRS annuity or benefits if you work for an employer not covered by the WRS.

    You may return to work with a WRS employer as a rehired annuitant*, provided certain requirements are met.

    *A rehired annuitant:

    • Is receiving a monthly WRS annuity
    • Had a valid termination and
    • Served the minimum required break in employment between retirement and returning to work and
    • Now works for an employer covered by WRS.

    If you are rehired and meet the WRS eligibility standard of two-thirds of full time, you are eligible for participation in WRS and your annuity will be suspended until you re-retire. This does not apply to employees who retired on or before July 1, 2013. For UW purposes, two-thirds of full time is calculated as follows:

    • University Staff Employees: You are expected to work one year and 1,200 hours
    • Unclassified Faculty, Academic Staff and Limited: You are expected to work one year and 880 hours

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    What Are Preventive Services

    Preventive services are routine health care that includes check-ups, patient counseling and screenings to prevent illness, disease and other health-related problems. Federal law requires that specific preventive services performed by in-network providers be offered at no cost to you. You can find a list of these preventive services here.

    How Do I Receive Health Care Benefits And Services

    You will receive identification cards from the health plan you select. If you lose these cards or need additional cards for other family members, you may request them directly from the health plan. Health plans are not required to provide you with a certificate describing your benefits. ETF provides the IYC Health Plans, Access Plan, IYC Medicare Advantage or IYC Medicare Plus Certificate of Coverage online.

    Present your identification card to the hospital or physician who is providing the service. Identification numbers are necessary for any claim to be processed or service provided.

    Most of the health plans require that non-emergency hospitalizations be prior authorized and contact be made if there is an emergency admission. Prior authorizations are required for high-tech radiology and for low back surgeries. Check with your health plan, and make sure you understand any requirements.

    For the Access Plan and State Maintenance Plan , it is recommended that you or your physician contact the health plan before you are admitted to a hospital unless it is an emergency. In an emergency, it is in your best interest to notify the health plan as soon as reasonably possible.

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