A Periodic Publication of Wisconsin's Association of Career Employees
By Sally Drew, President
Major changes in Administration of Group Health Insurance being investigated by ETF and GIB
The Wisconsin Department of Employee Trust Funds (ETF) and Group Insurance Board GIB) are issuing a set of Requests for Proposals (RFPs) that could make major changes in the way that group health insurance for state employees and retirees are administered and provided.
Administrative Services for the State of Wisconsin Health Benefit Program (ETG0003)
The purpose of this Request for Proposal (RFP) is to provide interested and qualified health benefits plan administrative vendors with information to prepare and submit competitive proposals to provide third party administrative services for the State of Wisconsin Group Health Insurance Program (GHIP) and the Wisconsin Public Employer (WPE) program for local government employees, managed by ETF. The RFP incorporates specifications related to recommendations made by Segal Consulting in November 2015.
The objective of this RFP is to acquire health benefits administrators that will be strategic partners in providing services that will accommodate the current uniform benefit plan design and enhancing the value of the plan through the following changes:
Proposals are being requested for the following:
- Transition to a self-insured health benefit program;
- Regional, statewide, and nationwide networks;
- Consistent administration of health benefits;
- Value based plan design; and,
- Data sharing and strategic coordination with other contractors and/or third party administrators, such as the Department’s data warehouse, Pharmacy Benefit Manager (PBM), Board’s consulting actuary (Segal Consulting), and wellness and disease management contractor.
According to the RFP, it is undetermined whether the contract(s) awarded as a result of this RFP will include the requirement to provide services to Medicare annuitants. The Board may choose to carve out coverage for this population.
- Statewide/Nationwide, Self-Funded
- Multiple Regional, Self-Funded
Evaluation and processes
Proposals that pass the preliminary evaluation may be reviewed by an evaluation committee and scored against predetermined criteria. The committee may review written proposals, references, additional clarifications, oral presentations, site visits and other information to score proposals. The method to score the section dealing with cost, data, utilization and network submission will be performed by the Board’s consulting actuary (Segal Consulting).
The contract term for providing administrative services for group health coverage will commence on the contract start date and shall extend through December 31, 2022. The Board retains the option, by mutual agreement of the Board and the successful proposer, to renew the contract for two (2) additional two (2) year periods extending the contract through December 31, 2026, subject to the satisfactory negotiation of terms, including pricing.
The GIB is scheduled to review RFP responses at their November, 2016 meeting. It is likely that a portion of this meeting will be closed. Following GIB consideration and recommendation, ETF is required to send its proposed budget for Group Health Insurance to the Joint Finance Committee.
The ACE Board intends to consider and report on issues and problems at each Board meeting.
ACE plans to develop a program to be held at Capitol Lakes in early September to talk further about group health insurance issues. ACE plans to work with several groups on this program, including Protect our Wisconsin Retirement System (POWRS), and the Wisconsin Coalition for Retirement Services some of whose members have also expressed interest in the group health insurance changes.
There will be additional information on this process on the new ACE website.
Wellness and Disease Management (ETG0005)
An RFP was issued April 25 and responses reviewed on July 12 to select a vendor to provide Wellness and Disease Management. The contract start date is proposed to be August 15, 2016. A letter of intent to award the contract was sent to the StayWell Company, LLC