Health Insurance for Employers

ETF does not provide quotes for employer health insurance coverage. You can calculate cost using the information below.

Employer contributions toward health insurance coverage are limited by Wisconsin Statute § 40.05(4). The most common method used to determine cost sharing is the 88% Calculation Method.  

Under the 88% Calculation Method, the employer’s share of monthly premiums will vary based on the eligible employees’ full-time equivalent (FTE): 

• 50% FTE or greater: Employer pays 50-88% of the average premium cost of qualified tier one health plans in their county for employees 
• 49% FTE or less: Employer pays 25-50% of health plan monthly premium for employees 

Premium rates are subject to change each year and are published on our website.

 The following example shows how you might calculate employer contribution for individual coverage: 

• ABC County has three qualified tier one health plans with the following individual premiums:
  • Dynamic Docs Health Care:  $1,200/month 
  • Magnificent Medical Care:   $1,000/month 
  • Punctual Provider Care:         $800/month 

• The average premium cost for the qualified tier one plans is: 
  • (Total sum of tier one plans added together) / (total number of tier one plans)
  • ($1,200 + $1,000 + $800) = $3,000 Total sum 
  • $3,000 / 3 = $1,000 average 

• Employer share range: 
  • 50-88% of $1,000 = $500-$880  

If a county does not have a qualified tier one health plan, the State Maintenance Plan (SMP)  set the 88% Calculation Method. 

Employers may join the WPE health insurance program at the beginning of each quarter:

• January 1
• April 1
• July 1
• October 1

Employers with less than 50 eligible employees should allow at least 90 days for the enrollment process.

Employers with 50 or more eligible employees should allow at least 120 days for the enrollment process.

“Health plans” refers to insurance companies that contract with networks of doctors and hospitals. Employees and annuitants may enroll in any health plan they choose and are not limited to plans in the county they are employed in.   

A new employer selects a program option or benefit design to offer its employees. The program options vary based on premiums and employee out-of-pocket costs. All program options provide access to all health plans.

Each participating employer is required to name an agent or agents to administer insurance benefits. The agent is responsible tasks such as:

• Determining coverage eligibility for each employee
• Auditing and submitting premium payments
• Collecting, auditing, and maintaining applications and maintaining payroll deductions
• Timely reporting of employee enrollments, terminations, and leave of absences
• Distributing information to employees
• Responding to inquiries from ETF

For More Information:

• Chapter 1 of the Local Employer Health Insurance Standards, Guidelines and Administration Manual (ET-1144) provides a full list of responsibilities. ETF encourages employers to review this information prior to submitting a resolution.

Employers with 50 or more eligible employees:

1. Read How to Join the Wisconsin Public Employers' Group Health Insurance Program (ET-1139).
2. Review the program options and health benefits decision guides in the above manual or on the ETF health benefits page.
3. Submit the Large Group Underwriting Checklist/Questionnaire (including payment) at the end of the ET-1139 manual at least 120 days before your desired effective date.
4. If you decide to join after receiving your group’s underwriting results, submit the following forms to ETF:
   • Resolution for Inclusion Under Wisconsin Public Employers’ Group Health Insurance Program (ET-1324)
   • Designation of Agent (ET-1313)
   • Online Access Security Agreement (ET-8928)

Employers with less than 50 eligible employees:

1. Read How to Join the Wisconsin Public Employers' Group Health Insurance Program (ET-1139).
2. Review the program options and health benefits decision guides in the above manual or on the ETF health benefits page.
3. Submit the following forms to ETF at least 90 days before your desired effective date:
   • Resolution for Inclusion Under Wisconsin Public Employers’ Group Health Insurance Program (ET-1324)
   • Designation of Agent (ET-1313)
   • Online Access Security Agreement (ET-8928)

WRS Employers:

All employees, including part-time and seasonal employees, participating in the WRS are eligible for coverage if the employer elects to participate. All employees eligible for group health insurance must be offered coverage.

Non-WRS Employers:

Currently insured employees, including part-time and seasonal employees, are eligible for group health insurance coverage if the employer elects to participate in the Wisconsin Public Employers (WPE) Group Health Insurance Program, and the employees meet certain eligibility requirements.

No. All employees eligible for group health insurance must be offered coverage.

Some employers choose to vary the employer share of contributions by employee groups. A group can be defined by:

• Start dates
• Full-time equivalency
• Coverage type (single or family)
• Collective bargaining agreements
• Geographic location
• Other breakdowns approved by ETF

Medical underwriting is a process which uses the group’s medical history to assess risk. ETF uses a third-party consultant (currently Segal Consulting) to complete underwriting. Based on their findings, an employer joining the program may have to pay a temporary surcharge. The surcharge is added to the total premium amount.

Surcharges for the 2021 Program ranged from $80-320/month for Single plans and $200-$800/month for Family plans. 

For more information, see the Underwriting Checklist/Questionnaire at the end of How to Join the Wisconsin Public Employers' Group Health Insurance Program (ET-1139).

Employers with 50 or more eligible employees must complete underwriting before submitting a resolution to join the program.

Most employers with less than 50 eligible employees do not need to go through underwriting. If an employer expects to have 50 or more eligible employees by the participation effective date, underwriting is required.

Once ETF receives all required materials, underwriting usually takes 4 to 6 weeks. Large employers with 50 or more eligible employees should submit their underwriting materials no less than 120 days before the desired effective date.

For example, if the desired effective date is January 1, then underwriting materials should be submitted by September 1.

ETF will notify you in writing once underwriting is complete.

ETF does not recommend submitting a resolution before underwriting results are received. This allows the employer to consider the impact of a surcharge (if any) on the total cost to join the program.