Posted 8:40 a.m. Thursday, Nov. 16, 2023
The Group Insurance Board today discussed initiatives that would support program affordability for members, program innovation, and the overall sustainability of the State of Wisconsin Group Health Insurance Program. The Board also approved the release of several requests for proposal.
Following the Board’s direction, the Department of Employee Trust Funds will continue to evaluate and make recommendations in the future on changes to the structure of the local program to better control premium costs for members and employers.
ETF will also review timelines and move forward with other state and local program initiatives as prioritized by the Board, including:
- Ways to help members understand the value of the High Deductible Health Plan and increase participation.
- Cost-sharing changes to offset rising healthcare costs and simplify plan design options.
- Overcoming barriers to reduce low-value care that provides little or no benefit to members and generates unnecessary costs.
- Potential program changes to address the complex social determinants that influence health outcomes.
- Exploring the feasibility of implementation of centers of excellence in the program.
- Ways to incentivize health plans to provide care access and quality services.
Requests for Proposal
The Board approved the release of requests for proposal (RFP) for services effective January 1, 2026, including:
- One or more vendors to provide Medicare Advantage and Medicare Plus options.
- One vendor to provide administrative services for the Pharmacy Benefits Program.
- One or more vendors to provide administrative services for the Pre-Tax Savings Account Program, including the Health Savings Account, Employee Reimbursement Account, and Commuter Fringe Benefit Accounts.
All three RFPs will be released in the spring of 2024.
ETF presented results of favorable independent audits of the Uniform Dental Benefit provider and the Pharmacy Benefit Manager; highlights of recent claims expenditures and trends; and an overview of the preliminary changes for the 2025 plan year that are being explored for the Board’s approval in February.
The Board also approved the following:
- Strengthening ETF’s information security oversight of all vendors under contract with the Board by only accepting a System and Organization Controls 2 (SOC 2) report, effective December 31, 2025.
- Modifications to the standards for third-party administrators of the state Long-Term Care Insurance Program, effective January 1, 2025.
- An updated reserve fund policy that clarifies reserves are separate for the state and local programs and sets a mid-point for the target range projections of reserve balances, among other changes.
- Delegated authority to the ETF Secretary to submit the Gag Clause Prohibition Compliance Attestation, required by the Consolidated Appropriations Act of 2021 for the transparency of healthcare costs to consumers.
The Board’s next regularly scheduled meeting is February 21, 2024.