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 four plan designs. The plan designs generally differ in monthly premiums, cost-sharing and whether or not there is out-of-network coverage. All plan designs include pharmacy benefits (at no additional cost) and Uniform Dental benefits may be added (for a minimal cost).

Not sure where to start? Talk to ALEX or watch ETF’s “Plan Design Options eLearning” to learn more about the different plan designs. Or, click on each plan design’s web page for more information.

Eligibility

You are eligible for the State Group Health Insurance program if you are eligible for the Wisconsin Retirement System (WRS) or the Graduate Assistant benefit packages.

There are additional eligibility requirements for the HDHP and Access HDHP plan designs.

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 that you use the Health Plan Map to help you select the plan that includes the providers and hospitals in the preferred county that you would like to receive services 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 that you use the Health Plan Map to help you select a plan that includes the providers and hospitals in the preferred county that you would like to receive services in.

This plan design is paired with a Health Savings Account (HSA). UW System contributes to the HSA (if eligible) and you can, too. You must indicate how much you would like to contribute to the HSA each year with this plan design.

Not everyone is 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 you use in-network providers, which are available nationwide. In exchange for increased flexibility in medical providers, your 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) and you can, too. You must indicate how much you would like to contribute to the HSA each year with this plan design.

Not everyone is eligible to enroll in this plan design. Click on the Access HDHP plan design to learn more.

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

Enrollment

University Staff Employees

You have two opportunities to enroll yourself and eligible family members in the State Group Health Insurance program:

1. Within 30 days from your date of employment or your newly benefits-eligible job

    You may choose your coverage effective date:

  • As soon as possible (the first of the month on or after your start date). No employer contribution for the first two months of coverage; you 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). You 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 your premium (if you do 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

You have 30 days from your date of employment or your newly benefits-eligible job to enroll yourself and eligible family members in the State Group Health Insurance program.

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

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

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

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

Important Enrollment Information

If you are a University Staff employee and you are enrolling in State Group Health Insurance using Self Service, your coverage will begin when the employer contributes to the premium. If you wish for coverage to begin as soon as possible, you will have to complete a Health Insurance Application/Change Form pdf and submit it to your human resources office during your enrollment period.

Some employees may not be eligible to use Self Service to enroll in benefits online. If you fall into this category, submit a Health Insurance Application/Change Form pdf to your human resources office during your enrollment period.

If you are enrolling in either the HDHP or Access HDHP plan design, you will also have to enroll in the Health Savings Account (HSA) which requires a paper enrollment form. 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 you are covered under your 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 you elect an HDHP and do not provide the required COB information during your enrollment period, you will be defaulted to a non-HDHP.

Health Insurance Opt-Out Incentive

If you have other health insurance coverage that meets the Affordable Care Act’s definition of minimum essential coverage, or you do not want health insurance coverage through the State Group Health Insurance program, you may be eligible to receive a stipend of up to $2,000 (Opt-Out Incentive) by opting out of State Group Health Insurance.

You are not eligible for the Opt-Out Incentive if:

  • You are not a Wisconsin Retirement System participant (i.e., you are an employee covered under the Graduate/Short-Term Academic Staff benefits package); or
  • You were eligible for a State contribution (as a Wisconsin Retirement System participant) to health insurance in 2015 and elected not to receive State Group Health Insurance in that year; or
  • You do not receive an employer contribution towards your health insurance (Crafts workers); or
  • You receive State Group Health Insurance through a parent or spouse (including the Grad benefit program at the UW System or UW Hospital and Clinics). Employees of the UW System, UW Hospital and Clinic and state agencies all participate in the State Group Health Insurance program through ETF.

Health insurance coverage through a parent or spouse who is employed by a local government entity does not disqualify you for the Health Insurance Opt-Out Incentive.

The $2,000 Opt-Out Incentive is prorated and, if elected, is paid for months that you are eligible for the employer contribution towards a health insurance premium. You will receive an equal portion of the payment in each payroll period (for employees paid on a biweekly basis, payment will be distributed through 24 payrolls a year).

The Health Opt-Out Incentive does not carry over from year to year. It must be re-elected each year during Annual Benefits Enrollment.

Important Considerations

  1. Impact on Sick Leave Credits. Unused sick leave can provide a valuable benefit. When you retire, or if you should die while an employee, unused sick leave is converted into credits to pay for health insurance for you or your surviving spouse/dependents but only if you are covered under the health insurance program. If you choose to opt out, your unused sick leave credits have no value until/unless you re-enroll in the health insurance program in the future.
  2. Re-enrolling in health insurance. You may re-enroll during the year if you have a qualifying life event (such as marriage, birth of a child, loss of other coverage). The $2,000 Opt-Out Incentive will be prorated by payroll period and you will lose any portion that is payable after you have re-enrolled.
  3. Enrollment in Other Benefit Plans. If you opt out of health insurance, you will not be eligible for Uniform Dental benefits as that is available only through the health insurance. However, during the Annual Benefits Enrollment (ABE) period you may still be able to elect the supplemental dental plans and/or the vision plan.
  4. The $2,000 Opt-Out Incentive is taxable.
  5. Affordable Care Act (ACA). The ACA requires most Americans to have health insurance or pay a penalty. If you opt out of this health insurance program and do not have other coverage, you may be subject to a fine when you file your taxes.

How to Opt Out

You must complete a Health Insurance Application/Change Form pdf and submit it to your human resources office within 30 days of your date of employment or your newly benefits-eligible job. When completing the application, you must fill out Section 1 (Applicant Information), Section 2 (Spouse Information, if applicable), and Section 14 (to elect Opt-Out Incentive).

If you are using Self Service to make your other elections or changes during your initial 30-day enrollment period, you must still complete a paper application for the opt out incentive.

If you are unsure whether you are eligible to waive health insurance and receive the $2,000 Opt-Out Incentive, please contact your human resources office for assistance.

You must re-enroll in the Health Opt-Out Incentive each year during the Annual Benefits Enrollment period if you want to opt out for the following plan year. This is an annual requirement. Health Opt-Out elections do not carry over from year to year.

Well Wisconsin

Well Wisconsin is a program designed to make you more aware of your current and future health risks, and save you money in the process. This program is administered by StayWell.

Active employees and retirees enrolled in the State Group Health Insurance program are eligible to participate in the Well Wisconsin program. An enrolled spouse may also complete the program to earn their own incentive.

Through this program, you are eligible to receive $150 for completing the Well Wisconsin program which is comprised of a health screening, health assessment and one of StayWell’s Well-Being activities. This financial incentive is taxable.

For more information, see https://wellwisconsin.staywell.com/

EEOC Notice: Wellness

Premiums

For State Group Health Insurance premiums, see the Premiums page.

Forms & Resources

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


last updated: 12/06/2018

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