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Agenda▪ ABE Resources
▪ Changes Allowed for 2019
▪ 2019 Benefit Plan Changes
▪ State Group Health Insurance
▪ Pharmacy Benefits
▪ Supplemental Plans
▪ Individual & Family Group Life Insurance
▪ Annual Increase Option
▪ Accidental Death & Dismemberment Insurance
▪ NEW annual enrollment opportunity
▪ Other Updates
ABE Resources
Prepare
Decide
Act
October 1 – 26, 2018
ABE Resources - ALEX
• The 2019 ALEX is available to help employees make benefits decisions for 2019!
• Talk to ALEX: www.wisconsin.edu/ohrwd/benefits/alex
• The 2018 ALEX will also still be available throughout ABE.
Prepare, Decide, Act
ABE Resources
▪ ABE Website: www.wisconsin.edu/abe/
▪ ALEX: www.wisconsin.edu/ohrwd/benefits/alex
▪ ABE Portal Articles
▪ ABE Employee Presentation
▪ It’s Your Choice (IYC) Decision Guide
▪ Dental Plan Comparison
▪ Self Service (review current enrollments)
▪ ABE Brochure
▪ ABE Checklist
Prepare, Decide, Act
Benefit Plans
Prepare
Decide
Act
October 1 – 26, 2018
▪ Enroll in Health Insurance
▪ Change Health Plan Design
▪ Change Health Plan Carrier
▪ Add or Remove Uniform Dental
▪ Add or Remove Eligible Dependents
▪ Enroll in Health Opt-Out Incentive (must re-enroll each year)
▪ Cancel coverage
2019 Health Insurance - Changes Allowed
Prepare, Decide, Act
Benefit Plans – Changes AllowedBenefit Plan Open
Enrollment
Change Plans or
Coverage Levels
Add/Remove
Dependents
Cancel
Coverage
State Group Health
Insurance
Yes Plans and/or
Coverage Levels
Yes Yes
State Group Health
Opt-out Incentive
Yes - Required N/A N/A N/A
Uniform Dental Yes Coverage Levels Yes Yes
Supplemental Dental Yes Yes - Required Yes Yes
Vision Insurance Yes Coverage Levels Yes Yes
Flexible Spending
Accounts
MUST re-enroll
each year
Yes N/A Yes
Health Savings
Account
MUST re-enroll
each year
N/A N/A N/A
Individual & Family
Life Insurance
Annual Increase
OptionN/A No-Add
Yes-Remove (anytime)
Yes
(anytime)
Accidental Death &
Dismemberment
Yes (NEW) Coverage Levels N/A Yes
(anytime)
State Group Health Insurance
Health Insurance – Plan Designs
No change for 2019
Health Insurance - Terminology
Copayment:
Fixed amount you pay for a covered service, each visit, until
the annual out-of-pocket limit is met.
▪ Primary Care Physician, Chiropractic & Therapy Services: $15
▪ Specialty (ex: Podiatrist) & Urgent Care Services: $25
▪ Emergency Room (waived if admitted during visit) $75
No change for 2019
2019
Health Plan /
Access Plan*
HDHP /
Access Plan HDHP
Single Family Single Family
Deductible $250 $5001 $1,500 $3,0002
1 After an individual within a family plan meets their $250 deductible, medical
services are covered for that individual (any one individual not to exceed $250 deductible)
2 Full family deductible must be met before services are covered (this statement does not
apply to preventive services)
Health Insurance - Terminology
Deductible:
Amount you pay for covered services before the plan pays.
No change for 2019
Coinsurance: A share of the costs you pay for covered
services, calculated as a percentage.
▪ All plans require the deductible is met before coinsurance applies
▪ Coinsurance applies towards the annual out-of-pocket limit:
▪ 10% for Health Plan, HDHP and In-Network Access Plan and
Access HDHP
▪ 20% for covered durable and disposable medical equipment,
certain hearing aids and cochlear implants
▪ 30% for Out-of-Network Access Plan and Access HDHP
Health Insurance - Terminology
No change for 2019
2019
Health Plan /
Access Plan
HDHP /
Access Plan HDHP
Single Family Single Family
OOPL $1,250 $2,5001 $2,500 $5,0002
1 After an individual within a family meets the single OOPL, services covered at 100%2 The full family OOPL must be met before services are covered at 100%
Once the OOPL is met, coinsurance and copayments no longer apply.
Health Insurance - Terminology
Out-of-Pocket Limit (OOPL): Amount you pay;
inclusive of copayments, the deductible and coinsurance
No change for 2019
Deduct
ible You pay for all
medical costs until the deductible is met
Coin
sura
nce Then, you pay
coinsuranceamounts; the insurance covers the remainder of medical costs
OO
PL/M
OO
P Then, the insurance covers expenses at 100% after you meet the out-of-pocket limit or the federal maximum out-of-pocket
COPAYS do not apply toward
the deductible; however, they do
apply towards the Out-of-
Pocket Limits
Health Insurance - Terminology
Deductible, OOPL and HSA Contribution 2019 Single Family
Health Plan / Access Plan: Deductible $250 $500
Out-of-Pocket Limit $1,250 $2,500
HDHP / Access Plan HDHP: Deductible (Medical and Rx) $1,500 $3,000
Out-of-Pocket Limit (Medical and Rx) $2,500 $5,000
HSA Employer Contribution (HDHP only) $750 $1,500
Copay and Coinsurance
Preventive Services (per Affordable Care Act, 100% covered)$0 Copay and 0% Coinsurance
Primary Care Physician OfficeVisits$15 Copay and 10% Coinsurance
Specialist OfficeVisits$25 Copay and 10% Coinsurance
2019 Health Insurance – Cost Sharing
No change for 2019
State Group Health Insurance -
Changes
All 2018 health insurance plan carriers will
continue to be offered in 2019
New Health Plan Carrier: Robin with Health
Partners (Northeastern Wisconsin)
▪ Will cover the following counties: Brown, Calumet,
Florence, Green Lake, Kewaunee, Manitowoc, Marinette,
Marquette, Menominee, Oconto, Outagamie, Shawano,
Waupaca, Waushara and Winnebago
2019 Health Insurance – New Plan
2019 Health Insurance –
Name ChangesHealth Plan Name Changes
▪ WEA Trust – Northwest Chippewa Valley:
WEA Trust West – Chippewa Valley
▪ WEA Trust – Northwest Mayo Clinic Health System:
WEA Trust West – Mayo Clinic Health System
2019 Health Insurance - SMP
State Maintenance Plan (SMP):
▪ Newly available in Forest County (no longer Florence)
▪ Participants currently enrolled should contact their providers
to find out if they will be in-network in 2019.
▪ If yes, they may remain enrolled in the SMP (no action necessary)
▪ If no, they should select a new health plan during ABE
Action needed? Maybe.Employees may want to choose
a new health plan
2019 Health Insurance – Benefit Changes
• Newly Covered Services:– Telehealth
– Home sleep studies
– Initial set of hard contacts for participants with keratoconus
– Transgender services (medically necessary)
• Services No Longer Covered:– Removal of erupted teeth (will be covered by Uniform Dental)
– Removal of skin tags (unless medically necessary)
• Other Changes:– Removal of some limitations for transplants
– Annual limit for prescription foot orthotics
2019 Health Insurance - Premiums
Premium Tier
Health Plan HDHP Health Plan
Single Family Single Family
Tier 1
With Dental $88 $219 $33 $82
Without
Dental$85 $211 $30 $74
Tier 3 –(Access Plan –
In WI)
With Dental $266 $664 $211 $519
Without
Dental$263 $656 $208 $519
No change for 2019 - except crafts
workers & less than 50%
State Group Health Insurance Total Premiums: http://etf.wi.gov/members/IYC2019/et-2107prta.asp
Premium TierHealth Plan HDHP Health Plan
Single Family Single Family
Tier 2
(Access Plan –
Outside WI)
With Dental $138 $347 $83 $210
Without
Dental$135 $339 $80 $202
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2019 Health Insurance - Premiums
No change for 2019 - except crafts
workers & less than 50%
State Group Health Insurance Total Premiums: http://etf.wi.gov/members/IYC2019/et-2107prta.asp
/
2019
Premium
Tier
With Dental Without Dental
Single Family Single Family
Tier 1 $45.50 $113.50 $42.50 $105.50
Tier 2 (Access Plan –
Outside WI)
$70.50 $177.50 $67.50 $169.50
Tier 3(Access Plan –
In WI)
$134.50 $336.00 $131.50 $328.00
Graduate Assistant/Short Term Academic Staff
2019 Health Insurance - Premiums
State Group Health Insurance Total Premiums: http://etf.wi.gov/members/IYC2019/et-2107prta.asp
2019 HDHP Enrollment – Reminder
If you are enrolled in State Group Health (and covered
spouse/dependents), you must select a Primary Care
Physician (PCP) or Primary Care Clinic (PCC):
▪ Same health plan carrier in 2019:
▪ Contact your health plan carrier if you would like to
change your PCP or PCC
▪ Different health plan carrier in 2019:
▪ Contact your health plan carrier to assign a PCP or PCC
or for help designating one
2019 HDHP Enrollment – Reminder
Employees who enroll in an HDHP must provide
Coordination of Benefits (COB) information.
If you elect an HDHP and you do not provide COB information
during Annual Benefits Enrollment, you will be switched to a non-
HDHP.
Pharmacy
Benefits
Changes & Reminders
Pharmacy - ChangesLevel 3 “dispense-as-written” drugs:
Increased cost sharing for drugs that have alternatives available on the formulary list.
• 2018: 40% coinsurance up to $150 maximum• 2019: 40% coinsurance + difference between the cost of the
“dispense-as-written” brand name drug and the alternative
If unable to take an alternative medication for medical reasons, the employee’s provider may submit a Food & Drug Administration MedWatch form detailing why.
Check your prescription costs at
navitus.com
Pharmacy - ChangesLevel 3 “dispense-as-written” example:
Non-Preferred Brand Name Drug Cost: $2,000
Preferred Generic Alternative Cost: $900
Member Cost Share:
• 2018: 40% coinsurance x $2,000 brand cost = $800 (currently reduced to the $150 maximum)
• 2019: $2,000 brand cost - $900 generic cost = $1,100 differential + $150 maximum = $1,250 total cost to member
Navitus sent letters to affected employees.Check your prescription costs at
navitus.com
Pharmacy BenefitsPrescription Copays, Coinsurance and Out-of-Pocket Limits
Prescription
Drug Level
Member Costs Annual Rx OOPL –
Health Plan
Annual Rx OOPL –
HDHP
Level 1 $5 per fill $600 individual /
$1,200 family
Included in medical
OOPL
($2,500 / $5,000)
Level 2 20% ($50 max per fill) $600 individual /
$1,200 family
Level 3 40% ($150 max per fill
+ difference if
“dispense as written”)
Does not apply to Rx
OOPL. Only applies to
Federal MOOP.
Level 4
Preferred
Specialty• Filled at a
Preferred
Specialty
Pharmacy
$50 per fill$1,200 individual /
$2,400 familyCheck your prescription
costs at navitus.com
Health
Savings
Accounts
(HSA)
Changes & Reminders
Health Savings Account (HSA) - Reminders
Employment Categories
• Crafts Workers: must enroll in the HSA if electing an HDHP; will
not receive the HSA employer contribution
• Grad/Short-Term Academic Staff: not eligible for an HDHP
• University Staff-Temporary: HSA contributions are post-tax
HDHP / HSA - Eligibility
Must be eligible for BOTH the HDHP & HSA to enroll.
▪ HDHP: Must be covered by the Wisconsin Retirement System
▪ HSA: Must be enrolled in an HDHP
▪ Cannot be enrolled in Medicare or TRICARE, or another
health plan that is not considered an HDHP or be a covered
dependent under a health care FSA (such as a spouse’s)
▪ Cannot be a dependent of another person for tax purposes
Employees with J-1 visas should NOT elect the HDHP/Access
HDHP; the plans do not meet J-1 visa requirement (deductible
may not exceed $500).
HDHP / HSA - Eligibility
Participants turning age 65 in 2019 are no longer eligible for
the HDHP or HSA if they elect Social Security and/or
Medicare (or are automatically enrolled) as of the first day of
the month they turn age 65.
If it’s determined they’ve enrolled in the HDHP and HSA
during ABE; however, are not eligible, this could result in:
• HDHP enrollment changed to the Health Plan
• Premiums and claims retroactively adjusted to date of ineligibility
• Contributions to the HSA will not be allowed; if any have been
made, all contributions will need to be repaid.
HDHP / HSA – Highlights
Highlights of the HDHP/HSA that may help you determine
if this plan design is right for you and your family:
• Higher out-of-pocket costs on the front-end IF services are
incurred but much lower monthly premiums
• The HSA component allows you to begin to set aside pre-
tax monies for your out-of-pocket medical, dental and vision
expenses
• UW System will contribute up to $750 for single or $1,500
for family coverage to help you prepare for your out-of-
pocket expense (pro-rated)
• All contributions earn interest!
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Health Savings Account (HSA) - Limits
Coverage Total Contribution Limit
= (Employee + Employer)
Employee
Limit
Employer
Contribution
Single $3,500* $2,750 $750
Family $7,000* $5,500 $1,500
HSA Limits when Health Rate is Full Employer Share:
▪ If not HSA-eligible for all 12 months of the calendar year, may not be
able to contribute the full amount.
▪ Employees may make changes to their HSA contributions at any time.
*Additional $1,000 “catch-up” for employees that are or will be 55+
years of age during the plan year
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Health Savings Account (HSA) - Limits
Coverage Total Contribution Limit
= (Employee + Employer)
Employee
Limit
Employer
Contribution
Single $3,500 $3,125 $375
Family $7,000 $6,250 $750
Coverage Total Contribution Limit
= (Employee + Employer)
Employee
Limit
Employer
Contribution
Single $3,500 $3,500 $0
Family $7,000 $7,000 $0
HSA Limits for Crafts Workers:
HSA Limits when Health Rate is Less Than Half Time:
Wellness
Incentive
Reminder
Wellness Incentive
Deadline for 2018
State Group Health plan participants should complete a health
screening, health assessment and a well-being activity by October
19, 2018 in order to receive the incentive. The incentive must be
redeemed in the StayWell wellness portal by October 31, 2018.
In preparation for the 2019 program year, the StayWell portal will not be available
December 17, 2018 – 1st week of January 2019.
Health
Screening
Health
Assessment
Well-Being
Activity
2018
Incentive
No change for 2019
Health
Insurance
Opt-Out
Incentive
Reminder
Health Insurance Opt-Out Incentive
• $2,000 opt-out incentive is available through Self Service
• If elected in 2018, must re-enroll for 2019– If you do not elect the opt-out incentive or enroll in health
insurance, you will not receive the incentive nor will you have health insurance coverage in 2019.
• Incentive is taxable and paid over:– 12 pay periods = monthly paid employees
– 24 pay periods = biweekly paid employees
Dental Insurance - Uniform and
Supplemental
Uniform Dental Benefits
• Must be enrolled in State Group Health Insurance
• Administered by
• Elect health insurance with or without Uniform Dental
• If Uniform Dental is elected, dental services are:
– Not subject to the health plan deductible
– Not counted towards the health plan Out-of-Pocket Limit
• Separate ID cards provided for health and dental
• 2019 Change to Uniform Dental
– Removal of erupted teeth will be covered by Uniform Dental
(instead of by health insurance)
Supplemental Dental – Plan Options
Dental Plans No Longer Offered
▪ EPIC Benefits+
▪ Dental Wisconsin
New Dental Plans
▪ Delta Dental PPO – Select
▪ Delta Dental PPO plus Premier – Select Plus
Employees that would like supplemental dental in 2019 must
elect either the Select or Select Plus plan during ABE!
Dental Insurance – ChangesNewly Covered Services
▪ Removal of erupted teeth (Uniform Dental)
▪ Adult orthodontia (Select Plus)
Services No Longer Covered by the Supplemental Plans
▪ Preventive Services (are covered by Uniform Dental)
Other Supplemental Dental Changes
▪ No waiting periods before dental benefits take effect
▪ Employees may elect one of the supplemental plans (and
Uniform Dental if they are enrolled in SGH)
Comparison: https://www.wisconsin.edu/abe
Dental Insurance – ComparisonUniform Dental
SGH enrollees only
Supplemental
Select Plan
Supplemental
Select Plus Plan
Provider NetworkDelta Dental PPO &
Delta Dental PremierDelta Dental PPO
Delta Dental PPO &
Delta Dental Premier
Benefit Maximum $1,000 / person $1,000 / person $2,500 / person
Preventive 100% No coverage No coverage
Basic Services
100% Fillings
80% Anesthesia,
Emergency Pain Relief,
Periodontal Maintenance
No coverage (except
Anesthesia at 50%)
No coverage (except
Anesthesia at 50%)
Major Services No coverage 50% 60% or 80%
Orthodontia
(lifetime max)
50% up to $1,500
(to age 19)No coverage
50% up to $1,500
(includes adult ortho)
Comparison: https://www.wisconsin.edu/abe
Dental Insurance – NetworksPPO (Select Plan):
The PPO network delivers the deepest discounts for services.
PPO & Premier (UDB and Select Plus Plans)
The Premier network is the largest network.
Supplemental Dental – Reminders
Changes Allowed:– Enroll in Dental Insurance
– Add or remove eligible dependents
– Cancel coverage
Other Reminders:– Must remain enrolled for the entire year
– If enrolling in Uniform Dental, the coverage level
(single/family) must be the same as the coverage level for
your State Group Health enrollment
Supplemental Dental - Rates
*No change to the Uniform Dental rates for 2019.
**The Select and Select Plus plan rates decreased significantly compared to the 2018
supplemental dental plan option rates.
2019 Monthly
Premiums
Employee Employee +
Spouse
Employee+
Child(ren)
Family
Uniform Dental* $3.00 $8.00 $8.00 $8.00
Select** $8.55 $17.10 $11.54 $20.52
Select Plus** $16.19 $32.38 $29.95 $49.38
Comparison: https://www.wisconsin.edu/abe
Vision Insurance
Vision Insurance - VSP
Benefit Change:
• No charge for standard progressive lenses
• $150 retail frame allowance or $200 retail frame allowance for
featured frame brands.
Slight decrease to the vision rates for 2019.
2019
Monthly
Premiums
Employee Employee +
Spouse
Employee +
Child(ren)
Family
Vision $6.38 $12.76 $14.38 $22.98
Individual & Family Life
Insurance
Individual & Family Life Insurance
Employees covered by the Individual & Family Life
Insurance plan may increase coverage as follows:
▪ Employee: $5,000; $10,000; $15,000 or $20,000
▪ Spouse/Domestic Partner: $5,000 or $10,000
▪ Child(ren): $2,500
Maximum Coverage Levels:
▪ Employee: $300,000
▪ Spouse/Domestic Partner: $150,000
▪ Child(ren): $25,000
NOTE: Spouse/Domestic
Partner and/or Child
coverage may not exceed
employee coverage amount
Individual & Family Life Insurance
How: Complete the Annual Increase Option in Self Service
Effective Date: January 1, 2019
Paper Application: complete at any time to reduce
coverage level, remove dependents or cancel coverage. Changes
submitted throughout the calendar year are effective the first of
the month following.
Accidental Death &
Dismemberment (AD&D) Insurance
AD&D – New Enrollment Opportunity
You may also enroll in, make changes or cancel your
AD&D coverage during 2019 ABE!
How: Self Service or paper application
Effective Date:
January 1st: Self Service will automatically use a January 1st
effective date. Paper applications that specify an ABE enrollment
will be January 1st.
Earlier than January 1st: If you prefer an earlier effective date,
complete a paper application.
AD&D – New Enrollment Opportunity
Effective January 1, 2019, the plan enhancements are:
– Identity Theft Protection
– Critical Burn Benefit
– Rehabilitation Benefit
Effective January 1, 2019, the slight rate increases are:
- Single coverage: $0.08 to $1.50 per month
- Family coverage: $0.12 to $2.50 per month
Reminder: You may enroll, makes changes or cancel your
AD&D coverage at any time.
AD&D – LifeStages Identity Mgt Services*Proactive Services
When personal data is compromised, this service helps take preventive measures to
avoid identity theft (such as placing fraud alerts)
Resolution ServicesWhen personal data is compromised, this service helps recover from identity theft
with assistance to fix issues, handle notifications and provide credit/fraud monitoring
Document Replacement ServicesThis service helps to replace lost, stolen or destroyed documents and
identification as well as helps to notify government agencies as applicable
Child Identity Theft SupportThis service helps protect identities of children
*Not an all inclusive list of services
Flexible Spending Accounts
(FSA)
FSA Eligible Expenses, Dependents & Maximums
FSA Type Eligible ExpensesEligible
Dependents
Annual
Contribution
Limits*
Health Care FSA
Medical, dental,
vision &
prescription
You, your spouse,
qualified
dependent
Max: $2,650
Dependent Day Care FSA
After school care,
adult or child
daycare, preschool
You, your spouse,
qualified
dependent
Max: $5,000
dependent on tax
filing status
Limited Purpose FSA
Dental, vision &
post-deductible
expenses
You, your spouse,
qualified
dependent
Max: $2,650
*May change if IRS changes
limits significantly
FSA - Reminders
Eligibility: All benefits eligible employees except– University Staff-Temporary
– Fellows, Scholars, Graduate Intern/ Trainees, or Post-Doctoral Fellow/Trainees
Deductions (before Federal, State & FICA taxes):
– Monthly paid employees: 12 or 9 deductions per year
– Bi-Weekly paid employees: 24 deductions per year
(A and B payrolls)
Must re-enroll each year!
FSA - Reminders
Annual Carry-Over:
– Up to $500 remaining in Health Care FSA or
Limited Purpose FSA on December 31st will carry
over to the following plan year
– No carryover for Dependent Day Care FSA
Parking and/or Transit:
– Due to tax liability implications of the Tax Cuts and
Jobs Act passed by the Federal Government, the
parking and transit accounts are no longer offered
effective June 1, 2018.
Other Updates and Reminders
Uninsured employees may enroll in the Access Plan 30
days prior to retirement in order to escrow sick leave.
– Currently, retirees are then asked to drop coverage
after 30 days in conjunction with escrowing sick leave.
– Beginning in 2019, retirees may remain enrolled
until the next ABE period or when they have a
qualifying life event or may still cancel and escrow if
they wish.
Access Plan Enrollment prior to
Retirement - Change
2019 WRS Contribution RatesWRS Contribution Rates will decrease slightly for all employee
types, effective January 1, 2019.
Accumulated Sick Leave Conversion Credit Program:
Decrease from 1.20% to 1.10% January 1, 2019.
2018 2019 Change
General / Teacher / Executive
Employee Contribution 6.70% 6.55% 0.15%
Employer Contribution 6.70% 6.55% 0.15%
Total 13.40% 13.10% 0.30%
Protective
Employee Contribution 6.70% 6.55% 0.15%
Employer Contribution 10.70% 10.55% 0.15%
Total 17.40% 17.10% 0.30%
Miscellaneous
Long-Term Care (LTC): No new participants beginning January 1, 2019. Current participants may continue their LTC insurance with Mutual of Omaha (administered by HealthChoice). If participants want to make changes or cancel coverage, contact Mutual of Omaha directly.
Income Continuation Insurance (ICI):
Premiums will increase by 20% effective February 1, 2019.
Required Affordable Care Act Non-Discrimination Notice:
The UW System and the Department of Employee Trust Funds comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age disability or gender.
Next Steps: Prepare, decide and act by October
26, 2018!
Survey: Complete the survey regarding the Annual
Benefits Enrollment period. The link will be available
in your confirmation statement (after you’ve made
your elections).
Questions: Contact your human resources office.
