The Group Insurance Board today approved benefit changes for the State of Wisconsin Group Health Insurance Program for the 2025 plan year.

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 $21 million in 2025 if weight-loss drugs were covered. Segal also referenced experiences of other states, such as North Carolina’s recent decision to stop coverage of weight-loss drugs due to increased program costs and no viable cost-effective alternatives. 

In response to interest and correspondence from members, the Board directed the Department of Employee Trust Funds 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 $150 incentive in 2023. This represented 33% of eligible GHIP members, including employees, retirees, and their spouses. Well Wisconsin provides tools and resources to help individuals manage their well-being, mental health, and chronic conditions as well as earn incentives. 

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 Herschel Day and Nancy Thompson as the board chair and secretary, respectively. Nathan Houdek was elected to the open vice-chair seat. 
  • The open enrollment period for plan year 2025 is September 30-October 25, 2024. 
  • Changing the effective date of annual premium rate changes for the State Income Continuation Insurance Program to April 1, beginning on April 1, 2025, and other technical updates to the state and local plan language. 
  • 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 Insurance Administration System Project, its change for go live to 2025, and related policy and program impacts. 

The Board’s next regularly scheduled meeting is May 23, 2024. 

For More Information

Group Insurance Board February 21, 2024, Meeting Agenda and Materials