State Group Health Insurance
Plan Overview
Description: The plan provides comprehensive medical and prescription coverage. Other benefits such as dental coverage vary among plans. You can choose between a Health Maintenance Organization (HMO) and the Standard Plan (a Preferred Provider Plan). HMO plans provide coverage for an annual eye exam. The prescription drug benefit is administered by Navitus.
Premiums
Health Insurance Monthly Premiums by Employee CategoryLearn More
- It's Your Choice: 2013 Decision Guide | Corrections/Updates
- It's Your Choice: 2013 Reference Guide | Corrections/Updates
- State Group Health Insurance - ETF Overview
- State Group Health Insurance - ETF Resources
- Coverage End Dates for Dependents
- Dental Benefits Offered by HMO Plans
Pharmacy Benefits Manager
Navitus Health SolutionsHealth Plans Contact Information and Directories
Administered by
WI Department of Employee Trust Funds (ETF)
Send questions to: benefits@ohr.wisc.edu
Health Plans
2013 Comparison between Uniform Benefits (HMOs) and the Standard Plan: 2013
Eligible employees may enroll in any of the health plans state-wide:
List of Health Plans
There are four Health Maintenance Organizations (HMOs) available in Dane County, WI where the main UW-Madison campus is located:
- Dean Health Plan
Website | Overview | Providers | 2013 Map- Local Phone: (608) 828-1301
- Toll-free: (800) 279-1301
- Group Health Cooperative of South Central Wisconsin (GHC-SCW)
Website | Overview | Providers | 2013 Map- Local Phone: (608) 828-4853
- Toll-free: (800) 605-4327
- Physicians Plus
Website | Overview | Providers | 2013 Map- Local Phone: (608) 282-8900
- Toll-free: (800) 545-5015
- Unity Health Insurance - UW Health
Website | Overview | Providers | 2013 Map- Toll-free: (800) 362-3310
The Standard Preferred Provider Plan (PPP) is also available in Dane County, WI and features a state-wide and national network of providers.
- Standard Preferred Provider Plan (PPP) — WPS Health Insurance
Website | Overview | WPS Statewide/National Network | Providers | 2013 Map- Toll-free: (800) 634-6448
If you live in another Wisconsin County, you can use the Health Plan by County tool to locate Health Plans available in your county:
2013 Health Plan by County
Navitus Health Solutions Pharmacy Benefits Manager
All participants in the State Group Health Insurance Program receive their pharmacy benefits through Navitus regardless of the health plan they have chosen. This allows Employee Trust Funds (ETF) to administer pharmacy benefits uniformly for all participants. Navitus, the third party administrator of the prescription drug program, is primarily responsible for processing and paying prescription drug claims. In addition, they develop and maintain the formulary, contract with pharmacies, and negotiate discounts and rebates with drug manufacturers.
After you receive your Navitus ID Cards, visit the Navitus web site to create an online member account. Member pharmacy benefit information, including detailed and updated formulary information, is available via secure online access at: http://members.navitus.com/. You can also call Navitus Customer Care toll free at 1-866-333-2757 with questions about the formulary.
Brochure
Navitus Member Booklet - State of Wisconsin ETF
2013 Out-of-Pocket Limits
HMO Plan Subscribers: $410 per individual and $820 per family.
PPP (Standard Plan) Subscribers: $1,000 per individual and $2,000 per family.
The four-level formulary requires co-payments of $5 (Level 1), $15 (Level 2) $35 (Level 3), and $50 (Level 4). Copayments for non-formulary drugs (all Level 3 and some Level 4 drugs) are not applied against the prescription drug or specialty medication out-of-pocket limit.
2012 Out-of-Pocket Maximums
HMO Plan Subscribers: $410 per individual and $820 per family.
PPP (Standard Plan) Subscribers: $1,000 per individual and $2,000 per family.
The three-level formulary requires co-payments of $5 (Level 1), $15 (Level 2) and $35 (Level 3). Level 3 co-payments are not applied against the out-of-pocket maximum.
2013 Navitus Information
It's Your Choice: 2013 Decision Guide extract, Navitus, p. 74-752012 Navitus Information
It's Your Choice: 2012 Decision Guide extract, Navitus, p. 82-83Navitus Frequently Asked Questions
Navitus FAQ - State of Wisconsin Group Health Insurance ProgramNavitus Formulary for the State of Wisconsin
- 2013 State of Wisconsin Quick Formulary (01/01/2013)
- 2013 State of Wisconsin Complete Formulary (01/01/2013)
- 2012 State of Wisconsin Quick Formulary (01/01/2012)
- 2012 State of Wisconsin Complete Formulary (01/01/2012)
Navitus Mail Order Service
Navitus Specialty Pharmacy Program
Navitus Specialty Pharmacy ProgramPlease call Customer Care at 877-651-4943 or visit www.diplomatpharmacy.com if you would like to know more about SpecialtyRx.
Navitus Health Solutions Contact Information
Navitus Customer Care (866) 333-2757 toll-free
Navitus Health Solutions - Contact Us
Publications
There are two It's Your Choice guides. The Decision Guide contains information about your health plan options. The Reference Guide contains important state and federal notifications, frequently asked questions, and the Certificate of Coverage.
It's Your Choice: 2013 Decision Guide
2013 Decision Guide Extracts
- Important Changes for 2013, p. 2-6
- Frequently Asked Questions, p. 7-15
- Introduction to Health Plan Options, p. 18-19
- Health Plan Map and Premium Rates, p. 20-25
- Comparison of Benefit Options, p. 27-31
- Health Plan Features — At A Glance, p. 32-36
- Health Plans, p. 37-64
- Health Plan Quality Information, p. 65-73
- Navitus: Pharmacy Benefits Manager, p. 74-75
- Glossary, p. 94-100
- Health Plan Contact Information, inside back cover
It's Your Choice: 2013 Reference Guide
2013 Reference Guide Extracts
- State and Federal Notifications, p. 3-13
- Patient Rights and Responsibilities, p. 14-16
- Frequently Asked Questions, p. 17-61
- Uniform Benefits (Certificate of Coverage), p. 62-119
Standard Plan
Forms
Note: Use Adobe Reader to open and complete PDF forms.
MAC Users: Do not use "Preview", a PDF reader.
Application | Submit to your Payroll & Benefits Office.
- Health Insurance Application/Change Form, ET-2301
- Add a Domestic Partner (same or opposite sex) and his/her Eligible Dependent
- Tax Considerations: Imputed Income and Health Insurance Benefits
Affidavit for Non-citizen Insurance | Submit to your Payroll & Benefits Office
Affidavit for Insurance Purposes, UWS 93
Complete this form if you are unable to provide a Social Security Number for a non-citizen spouse or non-citizen eligible dependent. Submit the Affidavit with your application.