Overview

The 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 offers four plan designs to select from. Pharmacy benefits are included in each plan design at no additional cost. Uniform Dental benefits may be added on for a minimal cost.

This program is administered by the Department of Employee Trust Funds (ETF).

Not sure where to start? See How To Choose Your Group Health Insurance Plan. In addition, you can 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 coverage information.

Health Plan

With the Health Plan design, you can choose from a variety of local health plan providers (insurance carriers) that offer the same Uniform Benefits package.

HDHP

The HDHP plan design provides the same Uniform Benefits package as the Health Plan design. The difference is that this plan design has a higher deductible and out-of-pocket limits but offers a lower monthly premium cost.

In exchange for the increased cost sharing, 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 enroll in 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. There are lower costs when you use in-network providers. 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 benefits package as the Access Plan design. 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.

In exchange for the increased cost sharing, 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 enroll in 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

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. Your coverage begin date depends on your employment category (as shown below) and/or selection:

  • University Staff employees may choose the effective date of coverage for health insurance to be either:
    1. As soon as possible (this will be the first of the month on or after your start date). You will pay the total premium cost for the first two months of coverage; or
    2. When the employer contributes to premiums (this will be the first of the month on or after completion of two (2) months of WRS State/UW System service). You will receive the employer contribution with the first month of coverage.
  • Faculty, Academic Staff and Limited Appointees, Student Assistants and Employees-in-Training: Coverage for health insurance will begin the first of the month on or following your date of employment or newly benefits-eligible job.

For detailed information regarding who you can cover on this plan, see the Dependent Eligibility Grid (UWS 25).

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) 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 (eBenefits), 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 and submit it to your human resources office during your enrollment period.

Some employees may not be eligible to use Self Service (eBenefits) to enroll in benefits online. If you fall into this category, submit a Health Insurance Application/Change Form 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 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.

COB information must be provided when you enroll in a health plan or as other coverage for a spouse/domestic partner is added or ended after your enrollment.

If you elect an HDHP and you do not provide the required COB information during your enrollment period, you will be defaulted to a non-HDHP.

Opt-Out Incentive

If you have other health insurance coverage that meets the Affordable Care Act’s definition of minimum essential coverage, you may be eligible to decline your State Group Health (SGH) Insurance coverage to receive an up to $2,000 Opt-Out Incentive (opt out) annually.

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 coverage in that year; or;
  • You do not receive an employer contribution towards your health insurance (Crafts workers); or;
  • You receive State Group Health Insurance under coverage of a parent, spouse or domestic partner (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 the Department of Employee Trust Funds (ETF).

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

You may be asked to certify that you have comparable health insurance coverage.

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).

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/domestic partner/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, Dental Wisconsin and EPIC Benefits+ and/or the supplemental vision plan, VSP.
  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 annual taxes.

How to Opt Out

You must complete a Health Insurance Application/Change Form (ET-2301) 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/Domestic Partner Information, if applicable), and Section 14 (to elect Opt-Out Incentive).

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

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

You must submit the Health Insurance Application/Change Form each year during the Annual Benefits Enrollment period if you want to opt out for the following plan year. This is an annual requirement.

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/domestic partner may also complete the program and earn their own reward.

Through this program, you are eligible to receive $150 for completing the Well Wisconsin program which is comprised of a health assessment and survey. 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: 4/27/2017

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.