Wis. Department of Employee Trust: GIB Approves Benefit Changes for 2025
The Board approved the following for 2025:
* Clarified contract language on the coverage of nutritional counseling for weight management regardless of bariatric surgery preparation.
* Change the lifetime limit for orthoptics (eye treatment) from two to no more than 12 sessions.
* Continue deferment of a decision to offer a new cost-saving, specialty drug manufacturer coupon program due to the pending request for proposals for a Pharmacy Benefits Program vendor.
The Board also upheld its past decision of non-coverage of weight-loss drugs due to estimated increases in program costs and lack of independent scientific studies that show an offset for drug costs with long-term medical savings. In addition, state law prevents the Board from increasing program costs without a concurrent opportunity for savings.
Segal, the Board's consulting actuary, estimated that GHIP would have a loss of
In response to interest and correspondence from members, the Board directed ETF to continue to monitor utilization, costs and effectiveness of weight-loss drugs, and to present coverage options for the Board's consideration.
Program Results
The Well Wisconsin Program, administered by WebMD, had 50,649 participants earn their
There was a 5.6% reduction in health risks for repeat 2022 and 2023 Well Wisconsin participants. For those who also participated in health coaching, there was a 7.3% reduction in health risks. The top three health risk areas are weight, exercise, and nutrition.
ETF also reported that participation in the High Deductible Health Plan increased by 9% to over 36,000 members for the 2024 plan year. The HDHP offers a lower monthly premium in return for members sharing more health care costs. The Board asked for further analysis and reporting of the HDHP product, which is currently planned for year 1 of the GHIP strategic roadmap that started in 2024.
Other Business
The Board also approved:
* The re-election of
* The open enrollment period for plan year 2025 is
* Changing the effective date of annual premium rate changes for the State Income Continuation Insurance Program to
* A new pilot program for remote patient monitoring visits and devices for managing obesity, hypertension, sleep apnea, and atrial fibrillation.
ETF provided two educational presentations on the Board's fiduciary duties and the request for proposals process for procuring services. ETF also gave an update on the
The Board's next regularly scheduled meeting is
For More Information
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Original text here: https://etf.wi.gov/news/gib-approves-benefit-changes-2025
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