Today, the Group Insurance Board is establishing premium rates for the 2026 planning year. They’ve also approved qualifications for the health planning service area alongside other benefits for the Wisconsin Health Insurance Program (GHIP).
“The initial bids for the 2026 Health Plan indicated a 13.4% increase in premiums, which could potentially have been brought down to 5.4% with effective negotiations,” mentioned Lennie Walk, who directs Strategic Health Policy at the Employee Trust Fund (ETF).
Segal, serving as an actuary for the ETF and the board, offered various pricing options, which included fees aimed at stabilizing reserves for GHIP.
Details regarding actual monthly premium costs for 2026, as well as other benefits information, will be shared before the annual open enrollment period, which runs from October 6-31, 2025.
2026 Employee Fees
The state program is seeing an average non-Medicare premium increase of 8%. The administration and HR departments will determine premium contributions for state employees and those to employers’ health savings accounts.
In local programs, the average non-Medicare premium increase stands at 11.5%, with employers setting the premium contributions for local employees.
These overall costs encompass medical, pharmacy, dental, along with stabilization and management expenses.
2026 Retirement Fees
The listed fees for retirees do not include stabilization charges.
For retirees who qualify for Medicare, the fee for Medicare Advantage’s medical-only plan is increasing by $35.30 per member. Furthermore, the fees for Medicare and medical exclusive plans will rise by $45.02 for the state program and $47.83 for local programs.
Pharmacy costs for retirees will increase by $13.22 for the state program and $31.10 for local programs.
If retirees opt for uniform dentistry, those fees will see increases of $1.40 per individual and $2.90 for family members.
Plan Your Service Area Qualifications for 2026
All health plans achieved Tier 1 status for the state program. The State Maintenance Plan (SMP) will be available only in Florence counties for the state program and in 48 out of 72 counties for the local program.
Health plans undergo evaluations and are classified into tiers 1-3 based on provider access and the operational ability to serve members in each county. For counties without a Tier 1 health plan, SMPs will be offered as Tier 1 plans alongside various eligible plans.
Other Businesses
The board has approved several items:
- A three-year contract with Metropolitan Life Insurance Company for Supplemental Eye Insurance Coverage starting January 1, 2026
- A three-year contract with Securian Financial for Group Accident Insurance coverage, effective January 1, 2026
- A 10% premium reduction in state income continuity insurance (ICI) plans, with continued premium vacations for local ICI plans in 2026
- An actuarial evaluation of state and local ICI plans as of December 31, 2024
- An updated policy for managing preparations for the Wisconsin Public Employer Group Life Insurance Program
The ETF has provided updates for multi-year programs to implement the Insurance Scheme (IAS), which is set to launch with the University of Wisconsin this summer and will extend to all other employers in 2026.
The Board’s next meeting is scheduled for August 13th, 2025.
