On February 8, 2016, the Group Insurance Board (GIB) approved a motion to move to a self-insurance funding model for the State Group Health Insurance program effective January, 2018. In addition, a move to a regional service model was approved.
According to the GIB, the move to self-insurance seeks to maintain benefits, contain costs and improve quality of the State Group Health Insurance program. The proposed change requires approval by the state legislature. This approval has not yet occurred.
What is a Self-Insurance Funding Model?
Self-insurance is a way to finance employer health insurance programs. Currently in 2017, the state pays health insurance companies a fixed amount for employee health insurance coverage, and the health insurance companies pay all medical claims. In the proposed model, the state pays medical claims directly to providers through third-party administrators.
What is a Regional Service Model?
The GIB approved dividing the state into four regions, with one statewide health plan and additional health plans offering coverage in each region. The GIB expects that regionalization will streamline program administration, control costs and simplify program information for participants.
To view a map of the proposed regions and which health plans will be offered in each region for 2018, visit the Department of Employee Trust Funds (EFT) Frequently Asked Questions about the proposed health insurance program changes.
How Will These Changes Affect an Employees’ Choice of Doctors?
The proposed change to a self-insurance funding model with a regional service model is not expected to impact employee provider choices (physicians, hospitals, clinics) as 98% of current providers will be available under the new program structure.
It is expected that many of the health plans' provider networks will overlap. This means that many members can continue to see the providers they see today, even if they have to choose a different health plan.
Will Employees Pay More for Health Insurance in 2018 in a Self-insured Model?
The employee costs for premiums are unknown at this time. Premiums will be available in the fall, and all employees will have time to review premiums, plan offerings and make any changes to their current coverage during the Annual Benefits Enrollment period.
As more details about the proposed self-insurance program become available, updates will be provided. In the meantime, employees may find the following resources informative:
Source: UW Service Center