HR, Payroll and Benefits News
Updated: Changes to State Group Health Insurance
June 15, 2015
The Department of Employee Trust Funds (ETF) Group Insurance Board met on May 19, 2015 and approved changes to the State Group Health insurance program. The changes affect participants’ deductibles, out-of-pocket limits, copays and drug costs.
ETF’s summary of the 2016 changes is posted here. ETF has also published a ‘Frequently Asked Questions’ (FAQ) regarding the 2016 State Group Health Changes. The FAQ is available on the Annual Benefit Enrollment period ABE website.
The 2016 State Group Health insurance changes include:
- Implementing an annual deductible of $250 for single coverage and $500 for families. Employees insured in uniform benefits plans (i.e., health maintenance organizations – HMOs) do not currently have a deductible.
- Increasing the annual out-of-pocket limit for uniform benefit plans (i.e., HMOs) from $500 to $1,000 (single coverage) and from $1,000 to $2,000 (families).
- Replacing the 10% current coinsurance patient payment for non-preventative services with a $15 copay for each primary care physician/therapy visit, and a $25 copay for each specialist visit.
- Increasing the Standard Plan annual deductible from $200 to $250 (single coverage) and from $400 to $500 (families).
- Increasing the Standard Plan annual out-of-pocket limit for single plans from $800 to $1000, and from $1,600 to $2,000 for families.
- Increasing out-of-pocket expenses for non-generic prescriptions. Instead of the current $15, $35 or $50 copays, employees will pay a percentage of the cost of the prescription, up to a specified dollar maximum ($50-$200, depending on the drug).
- Increasing the annual out-of-pocket limit for Level 1, 2 and 4 drugs. There is no out-of-pocket limit for Level 3 drugs.
- Dental coverage will no longer be included in the State Group Health insurance plan. Current dental benefits will be shifted to a stand-alone, self-insured dental plan.
- The GIB recommended that the Office of State Employee Relations (OSER) increases the state’s contribution to health savings accounts for employees who participate in a high-deductible health plan (HDHP) from $170 to $750 (single coverage) and $340 to $1,500 (families). The 2016 HDHP out-of-pocket limit has not yet been determined.
- Making advanced-care planning and/or palliative care (end-of-life care consultations) available to the seriously ill with a likely survival of less than six months.
- Adding coverage for therapies associated with habilitative care (i.e., to gain or maintain skills or functions for daily living).
All of the health plan changes will be effective on January 1, 2016.
Please note that the 2016 Annual Benefit Enrollment (ABE) period, where employees can make changes to their benefits, will take place October 5-30, 2015.
More information about plan changes for 2016, or changes you can make during ABE, will be posted to the ABE website as it becomes available. Check regularly for updates.
All changes made during the Annual Benefit Enrollment period take effect on January 1, 2016.
Source: UW System Administration
Categories: Insurance