HOW - State Employees
Wisconsin provides its employees with benefits including healthcare insurance. Healthcare of Wisconsin [HOW] is a new law and a better way to provide state employees with healthcare because it 1) deals directly healthcare providers and 2) eliminates insurance companies and pharmacy benefit managers. HOW is neither a governmental single payer “Medicare for All” plan nor a self-insurance plan. Wisconsin would not assume the tasks customarily assigned to a healthcare insurance company.
State employees keep the healthcare providers they love and lose the insurance companies they don't.
HOW – It Works!
With one exception, HOW uses current state agencies and policies to provide healthcare to state employees. The one exception is the statutory creation of a joint venture network (JV), comprised of healthcare providers licensed in Wisconsin. These healthcare providers manage themselves. They set their prices for goods and services. They set procedures for payments, referrals, prior authorizations, patients’ appeals, services utilization, etc. They would appoint the JV as their agent to negotiate with the state of Wisconsin a single healthcare requirements contract for state employees.
HOW - Healthcare Benefits
This single requirements contract between the JV and the state of Wisconsin provides Affordable-Care-Act-mandated healthcare for hospitalizations, medical coverage, ambulatory patient, urgency, emergency, pregnancy, maternity, newborn care, mental health, substance abuse disorder, rehabilitative and habilitative care and devices, laboratory, preventative and wellness, pediatric care, pediatric and adult oral and vision care, medical management programs and prescription drugs. HOW achieves the lowest costs for taxpayers saving taxpayers millions of dollars.
HOW – Trust Fund
Instead of paying premiums to insurance companies, the state of Wisconsin pays its premiums into a trust fund [FUND] together with the requisite initial capitalization and reserves. State employees pay their premium portions into the FUND, which pays the healthcare providers for their goods and services. The State of Wisconsin Investment Board manages the FUND.
HOW - State Agencies
The JV processes their members claims to present to the State of Wisconsin. Current state agencies and existing policies manage HOW operations including negotiation with the JV on behalf of state employees. These agencies pay the claims from the sale of healthcare goods and services to state employees to the JV. HOW ha
HOW - State Agencies
The JV processes their members claims to present to the State of Wisconsin. Current state agencies and existing policies manage HOW operations including negotiation with the JV on behalf of state employees. These agencies pay the claims from the sale of healthcare goods and services to state employees to the JV. HOW has its minimal costs too, including additional personnel to Wisconsin agencies.