HOW - State Employees
Healthcare of Wisconsin [HOW] is a statutory healthcare plan for Wisconsin state employees. HOW, a market-based alternative to the traditional insurance-based system, purchases healthcare not insurance. For taxpayers and about three hundred thousand state employees, HOW achieves the lowest costs.
HOW – Trust Fund
Instead of paying healthcare insurance companies, HOW establishes a trust fund [FUND] with the funds including the requisite initial capitalization and reserves.
The FUND covers the payments to healthcare providers for their goods and services supplied to state employees. The State of Wisconsin Investment Board manages the FUND.
HOW – What it provides?
HOW provides 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 care, pediatric care, pediatric and adult oral and vision care
HOW – What it provides?
HOW provides 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 care, pediatric care, pediatric and adult oral and vision care, medical management programs (for specific needs like obesity, back pain, and diabetes) and prescription drugs.
HOW Network
HOW creates a joint venture network [NETWORK] of healthcare providers, licensed in Wisconsin. Healthcare providers set their prices for goods and services. They set procedures for referrals, prior authorizations, patients’ appeals, payments, etc. They appoint NETWORK as their agent to negotiate a healthcare-requirements contract with Wisconsin for state employees.
HOW State Agency
HOW creates a state agency governed by a board of trustees, comprised of members from the healthcare industry and Wisconsin ex officio members. This state agency manages HOW operations, processes and pays the claims from the sale of healthcare goods and services to state employees and negotiates with NETWORK.