State Group Health
Important Changes for 2014
Resources
You should review the following documents for detailed health plan and coverage information.
Health plans may expand or reduce their network annually and access to providers can change. Be sure to verify that your current providers will still be available to you in 2014. See the Health Plan Contact Information webpage for the phone number and website of your health plan.
Benefit Changes for 2014
- Uniform Dental Benefits: All health plans, except the Standard Plan and SMP, will offer the same level of dental benefits in 2014. Previously health plans were able to offer different levels of dental coverage. You should review your new coverage levels under Uniform Dental benefits (see Uniform Dental tab) to ensure it fits your needs.
- All health plans will offer a $150 incentive for the completion of a Health Risk Assessment (HRA) and a biometric screening. Prior to 2014, the incentives offered differed by health plan. Your adult dependents are also eligible for the $150 incentive. Contact your health plan or visit wellwisconsin.wi.gov for more information on wellness benefits.
| Health Plan | What’s New in 2014? | Action Needed During ABE |
|---|---|---|
| Anthem Blue Northwest | Plan will no longer be available | If currently enrolled in this plan, you MUST select a new plan during ABE as your health plan for 2014. If you fail to elect a new plan, you will be moved to the Standard Plan, which is the most expensive plan offered. |
| Dean Prevea 360 | New plan | May enroll for plan in Brown, Kewaunee, Manitowoc, Marinette, Oconto, Outagamie, Sheboygan and Menominee Counties |
| UnitedHealthCare – Northeast and United HealthCare – Southeast |
Merging into one plan | If currently enrolled in either plan and you want to keep UnitedHealth Care for 2014, you do not need to do anything. |
| WEA Trust PPO – Northwest | Offering two distinct provider networks – the Chippewa Valley or the Mayo Health System | Current and new members must select one of the provider networks during the ABE period. If a network is not selected, the member’s previous medical services will determine their network for 2014 (all family members will be placed in the same network). The employee may change networks once per calendar year. |
| WEA Trust PPO – South Central |
New plan | May enroll for plan in Dane County |
Uniform Dental Benefits
To ensure that all members receive the same level of dental coverage through their health insurance, health plans (except the Standard Plan and SMP) will offer the same dental coverage in 2014. This is called Uniform Dental Benefits. Your health plan still decides if you need to see certain dentists (in-network) to have benefits paid. See the Uniform Dental Benefits Certificate of Coverage for details about what dental services will be covered in 2014 and to determine if there are any changes in your dental coverage for 2014.
The Uniform Dental Benefit is included in your health insurance coverage at no additional cost to you. It is intended to provide coverage for diagnostic, preventive and restorative services (such as fillings). It does not include coverage for major dental services, such as crowns, root canals or implants.
For more information on Uniform Dental Benefits, see Frequently Asked Questions 2 through 7 beginning on Page 9 of the It's Your Choice 2014 Decision Guide.
If you are enrolled in EPIC Benefits+ or Dental Wisconsin, or are considering enrolling in EPIC Benefits+ for 2014, see a Dental Comparison Chart to learn how Uniform Dental Benefits may affect your other dental plans.
| Key Plan Provisions | ||
|---|---|---|
| In-Network Provider | Designated Out-of-Network Provider* |
|
| Deductible | $0 | $0 |
| Annual Benefit Maximum (per person) |
$1,000 | $1,000 |
| Diagnostic/Preventive (E.g. Routine evaluations, x-rays, flouride treatment) |
100% | 75% |
| Restorative (E.g. Fillings) |
100% | 50% |
| Periodontal (Maintenance Only) |
80% | 50% |
| Adjunctive Services (E.g. Local Anesthesia) |
80% | 50% |
| Orthodontia (Children Only) |
50% | 50% |
| Ortho Lifetime Maximum | $1,500 | $1,500 |
* A health plan may designate and authorize out-of-network providers so that at least one dentist is available in each county or major city, if applicable.
NOTE: Coverage provided by Uniform Dental Benefits is a decrease in coverage for the following health plans: Gundersen Lutheran, Health Tradition, Humana and WEA Trust plans.
