How are my Health and Supplemental Insurance benefits and costs established?
For many employees, health insurance benefits are important benefits offered by the UW System. Every year, we may see changes to the health and supplemental insurance programs even if the only change is to the premium. Every fall, during the Annual Benefits Enrollment (ABE) period, there is an opportunity to enroll (or dis-enroll) in the health and/or supplemental insurance programs or make changes to coverage levels and/or change benefit plans. Below is information on the process of establishing the annual health and supplemental insurance program options and costs.
- What is the State Group Health Insurance program?
The State Group Health Insurance program is an employer-sponsored program offering group health insurance to employees of state agencies, UW System, UW Hospital and Clinics Authority and participating local government employers.
- Who administers the State Group Health Insurance Program?
The Department of Employee Trust Funds (ETF) and the Group Insurance Board (GIB) have statutory authority for program administration and oversight. All health plans follow GIB guidelines for eligibility and program requirements. The health plans all offer the same in-network benefit package called Uniform Benefits (as well as the option of electing Uniform Dental coverage for an additional cost) and annually compete in a complex process to determine the best premiums.
The UW System does not determine the plan designs, premiums, employee premium contributions or which health insurance plan carriers are offered. Changes for 2019 are expected to be finalized and approved by the GIB on August 22, 2018.
- What is the Supplemental Insurance Program?
The GIB also approves supplemental insurance plans, employee-pay-all group insurance plans that are offered via payroll deduction under the same authority as the State Group Health Insurance program. Dental and vision insurance are the two most popular supplemental insurance plans; both are offered to the same population of employees as the State Group Health Insurance program and available for employees to make changes to during ABE. The intent of the Supplemental Insurance Program is to complement the Uniform Benefits that are provided as a part of the State Group Health Insurance Program.
The UW System does not determine the plan designs, premiums, or which supplemental insurance plans are offered. Changes to the Supplemental Insurance Program for 2019 were approved by the GIB on May 16, 2018. Information on the changes will be communicated this fall prior to ABE.
- Who decides health and supplemental insurance plan premiums?
The health and supplemental insurance plans submit premium bids to the Department of Employee Trust Funds (ETF) each year for the following year. ETF reviews the bids and required claims data and takes recommendations to the Group Insurance Board (GIB). The GIB’s actuaries also review the bids, required claims data and ETF’s recommendations; then negotiations are conducted by ETF. The GIB must approve the premiums for each health and supplemental insurance plan.
For the State Group Health Insurance program, while most employees do not pay the full premium, the full premium does impact the amount of the employee premium contribution. Each year, the monthly amount that employees are required to pay for health insurance is established by the State’s Division of Personnel Management (DPM). DPM determines the employee contribution towards premium based on the provisions in Wis. Stat. § 40.05 (4) (ag) and (ah). For most employees, the monthly premium contribution may not exceed 12 percent of the average premium cost of plans offered in each premium tier.
- Who decides which health insurance plan carriers are offered?
Each health plan carrier decides if they want to participate in the State Group Health Insurance Program and determines the counties in which they will offer in-network providers. The health insurance plan carriers must meet strict contractual requirements and their participation is authorized annually by the GIB if they meet the required criteria. If a health insurance plan carrier leaves the program, its members must select a new plan during ABE.
- Who decides what benefits are covered under the State Group Health Insurance program?
The GIB generally determines the coverage offered by the health plans; however, the program must also comply with applicable state and federal laws. The GIB has a fiduciary responsibility to administer the program in accordance with state statute. The GIB decisions are based on ETF recommendations, input from the GIB actuaries and other guidance.
- Who is on the GIB and what are the responsibilities of the GIB?
The GIB is an eleven-member board that meets specified membership requirements. The GIB sets policy and oversees administration of the group health, life insurance and Income Continuation Insurance plans for state and UW employees and retirees and the group health and life insurance plans for local employers who choose to offer them. The Board may also provide other insurance plans, if employees pay the entire premium. For more information about the GIB, please click here.
Source: UW System HR