Today, the Group Insurance Committee approved the public offering period for the 2027 plan year, scheduled from October 5 to 30, 2026. They also discussed proposed design changes and cost-sharing adjustment options, but opted to postpone their decisions for a later meeting.
The Board also decided to hold off on a decision about the Access Guidance Services (AGS) program until they receive more information on potential cost reductions from the Group Health Insurance Program (GHIP). This AGS program allows non-Medicare members who purchase expensive medications to use manufacturer co-pay coupons to reduce their cost-sharing and co-pay limits.
To address the pending items, the board instructed the Employee Trust Fund Office to arrange a special board meeting within the next two weeks.
Changes regarding the health plan’s management agreement and benefits covered by both the health and pharmacy programs have been approved.
Highlights of changes for 2027
- Coverage for compression garments used to treat lymphedema is being expanded to align with the policy of the Centers for Medicare and Medicaid Services.
- The maximum additional visit limits for physical therapy, speech therapy, and occupational therapy will be adjusted to create a single combined limit for all treatment areas.
- There’s also an expansion in health benefits related to degenerative eye disease, sleep apnea, and other chronic conditions.
The ETF shared updates on the anti-obesity medicine (AOM) market, which included information on usage, health outcomes, and emerging cost trends. The Board also contemplated the possibility of introducing another formulary tier for AOMs that would involve rebates and higher out-of-pocket costs for members.
No decisions were made regarding the addition of AOM at this meeting.
Wellness Program
The Board commenced discussions about the purpose and future of the Well Wisconsin program.
In the next steps, the ETF will assess the role of incentives and review best practices and trends in wellness programs in both the public and private sectors.
Other Business
The Board also approved:
- Annual officer elections, including Chair Herschel Day, Vice Chair Nathan Hordek, and Secretary Nancy Thompson.
- Changes aimed at standardizing coverage language and clarifying expectations for health plans to appoint a primary care provider or clinic.
- Non-substantive updates to governance policies and procedures.
In addition to the special meeting scheduled in March, the board anticipates setting the 2027 rate during its regular meeting on May 21, 2026.
