Overview

UW System offers comprehensive medical and prescription drug coverage to eligible employees and their family members through the State Group Health Insurance program. The State Group Health Insurance program is administered by the Department of Employee Trust Funds (ETF) and offers different plan designs. The plan designs differ in monthly premiums, cost-sharing and whether or not there is out-of-network coverage. All plan designs include pharmacy benefits.

Not sure where to start? Talk to ALEX, watch ETF’s “Plan Design Options eLearning” or click on each plan design in the menu to the left for more information.

Eligibility

Employees are eligible for the State Group Health Insurance program if they are eligible for the Wisconsin Retirement System (WRS) or the Graduate Assistant/Short-Term Benefit Packages.

Dependents: The State Group Health Insurance program allows an employee’s eligible dependents to be covered by one group health insurance program only. This means that if an employee works for UW System and the employee’s spouse works for a state or local employer that also offers the State Group Health Insurance program (state program) or the Wisconsin Public Employers (WPE) Group Health Insurance program (local program) and the employee’s spouse enrolls in coverage through their employer, their dependents may only be covered under one plan, the employee’s plan OR the spouse’s plan.

Plan Designs

Click on each plan design below (or on the left-hand menu) for additional information.

Health Plan

The Health Plan design has a lower deductible and lower out-of-pocket limits, but a higher monthly premium. This plan design only covers out-of-network benefits for emergency and urgent care services. For this reason, it is important to use the Health Plan Map to help select the plan that includes the providers and hospitals in the preferred county that services will be received in.

HDHP

The HDHP plan design has a higher deductible and higher out-of-pocket limits but the lowest monthly premium. This plan design only covers out-of-network benefits for emergency and urgent care services. For this reason, it is important to use the Health Plan Map to help select a plan that includes the providers and hospitals in the preferred county that services will be received in.

This plan design is paired with a Health Savings Account (HSA). UW System contributes to the HSA (if eligible). Employees must indicate how much they would like to contribute to the HSA each year with this plan design.

All employees are not eligible to enroll in this plan design. Click on the HDHP plan design to learn more.

Access Plan

The Access Plan design provides freedom of choice for doctors or hospitals across the country (nationwide coverage). There are lower costs when in-network providers are used. In exchange for increased flexibility in medical providers, the monthly premium cost is more than for the Health Plan and HDHP plan designs.

Access HDHP

The Access HDHP plan design provides the same freedom of choice for doctors or hospitals across the country (nationwide coverage). The difference is that this plan design has a higher deductible and out-of-pocket limits but offers a lower monthly premium cost than the Access plan design.

This plan design is paired with a Health Savings Account (HSA). The UW System contributes to the HSA (if eligible). Employees must indicate how much they would like to contribute to the HSA each year with this plan design.

All employees are not eligible to enroll in this plan design. Click on the Access HDHP plan design to learn more.

To compare the plan designs, see the Comparison of Medical Benefits Chart.

Enrollment

University Staff Employees

Employees have two opportunities to enroll in the State Group Health Insurance program:

1. Within 30 days from date of employment or the date of obtaining benefits-eligible job

    Employees may choose their coverage effective date:

  • As soon as possible (the first of the month on or after start date). No employer contribution for the first two months of coverage; employees will pay the total premium cost for the first two months of coverage; or
  • When the employer contributes to premiums (the first of the month on or following the completion of two (2) months of state WRS service). Employee will receive the employer contribution with the first month of coverage after completion of two months of state WRS service.

2. Enroll prior to becoming eligible for the employer contribution towards the premium (if employee does not already have two months of state WRS service).

    Coverage is effective on the first day of the month on or following the completion of two months of state WRS service   (when you become eligible for the employer contribution).

Faculty, Academic Staff and Limited Appointees, Student Assistants and Employees-in-Training

Employees have 30 days from the date of employment or the date of obtaining a benefits-eligible job to enroll in the State Group Health Insurance program.

Coverage is effective on the first day of the month on or following date of employment or date of of obtaining a benefits-eligible job.

For information regarding who can be covered, see the Dependent Eligibility Chart (UWS 25) pdf .

Note: If a dependent is being covered who does not have a Social Security Number because he or she is not a United States citizen, employees must submit an Affidavit for Insurance Purposes Form (UWS 93) pdf at the time of enrollment to indicate that they family member does not have a Social Security Number.

If the employee does not enroll in the State Group Health Insurance program during their initial 30-day enrollment period, they may enroll during the Annual Benefits Enrollment (ABE) period or if they have a qualifying life event. See Life Events for more information.

Important Enrollment Information

University Staff employees enrolling in State Group Health Insurance using Self Service – Coverage will begin when the employer contributes to the premium. For coverage to begin as soon as possible, employees will need to complete a Health Insurance Application/Change Form pdf and submit it to the human resources office during their enrollment period.

Some employees may not be eligible to use Self Service to enroll in benefits online. If an employee falls into this category, they should complete a Health Insurance Application/Change Form pdf and submit it to the human resources office during their enrollment period.

If enrolling in either the HDHP or Access HDHP plan design, employees will be required to enroll in the Health Savings Account (HSA). Complete the HSA Enrollment Form pdf and submit it to your human resources office during your enrollment period.

Coordination of Benefits Information Required

Employees who enroll in State Group Health Insurance must provide Coordination of Benefits (COB) information in Self Service. Follow the instructions in Self Service to provide this information. (See How To Enroll for more information on Self Service.)

For the question “Other Health Insurance”- If employees are covered under their spouse or parent’s insurance, answer “Yes” to this question and provide the insurance policy information, which can be found on your insurance card. If you are NOT covered under your spouse or parent’s insurance, or you do not have other health insurance coverage, please answer “No” to this question.

If an employees elects an HDHP and does not provide the required COB information during their enrollment period, they will be defaulted to a non-HDHP.

Opt-Out Incentive

The Opt-Out Incentive information has moved. In the left hand menu, go to Health Insurance then Opt-Out Incentive to access this information.

Well Wisconsin

The Well Wisconsin information has moved. In the left hand menu, click Wellness Resources then Well Wisconsin Program.

Premiums

For State Group Health Insurance premiums, click here.

Forms & Resources

For all State Group Health Insurance forms and resources, click here.


last updated: 03/20/2019

Every effort has been made to ensure this information is current and correct. Information on this page does not guarantee enrollment, benefits and/or the ability to make changes to your benefits.