Posted 5:50 a.m. Friday, May 20, 2022

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The Group Insurance Board has approved several health and pharmacy benefit changes for plan year 2023. The changes were recommended by the Department of Employee Trust Funds, based on feedback from members, health plans, and other stakeholders.

Summary of Benefit Changes

  • Implementing a clear bagging program through the University of Wisconsin Specialty Pharmacy for members receiving care within the UW System.
    • Clear bagging means that a health system’s own specialty pharmacy is responsible for delivering medication to the site of administration to a patient.
  • Allowing health plans to waive prior authorization for remote patient monitoring when appropriate.
  • Established specific coverage criteria for the pulmonary rehabilitation therapy benefit.
  • Allowing separate behavioral therapy sessions with a patient’s immediate family as part of a mental health and substance use disorder treatment plan. Separate family-only sessions are currently excluded.

Pre-Tax Savings Account Changes

  • Minimum Election and Carryover Amounts: Effective January 1, 2023, members who enroll in a flexible spending or commuter benefit account will be required to have a minimum annual election amount of $50. There must also be at least $50 in these accounts at the end of the year for funds to be carried over to the next plan year.
  • Flexible Spending Account Cancellation Rule: Effective January 1, 2023, cancellations of FSA enrollments will be effective on the last day of the month in which a participating member cancels their coverage or terminates their employment.

Optum, the pre-tax savings account administrator, will provide additional details to affected members.

Other Board Action

The Board also approved:

  • The approval of a 20% premium decrease for the state income continuation insurance program and an extension of the local ICI premium holiday for 2023.
  • The selection of DeltaVision, offered by Delta Dental of Wisconsin in partnership with EyeMed Vision Care, as the supplemental vision vendor through December 2025.
  • The selection of HealthChoice (broker) and Mutual of Omaha (insurer) as the long-term care insurance vendor through December 2024.
  • The selection of Securian Financial as the accident plan vendor through December 2025.
  • A contract extension for Optum through December 2025.
  • Various minor language changes to ensure administrative compliance with the federal No Surprises Act.

The Board agreed to meet in June for further discussion on possible coverage for weight loss drugs.

The Board’s next regularly scheduled quarterly meeting is set for August 17, 2022.

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