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Health insurance choices

State employees and their families will be choosing their health insurance plans for 2015 this month.

With Meriter-UnityPoint Health and UW Health recently reaching a détente, a big question during this fall’s open enrollment season for health insurance is whether people who dropped Physicians Plus in recent years will return.

Physicians Plus, Meriter-UnityPoint Health’s health insurance company, lost tens of thousands of members after it started requiring special approval two years ago for patients to get certain services at UW Health. Unity Health Plans, UW Health’s health insurance company, gained tens of thousands of members.

Now, with a four-year contract announced in July between Physicians Plus and UW Health, which had been feuding for several years, Physicians Plus has stopped requiring special approval and is playing up its full access to UW Health.

“We’ve added all of UW Health to give you more choices,” a recent Physicians Plus ad reads.

“Current Physicians Plus clients are very happy about this ... (and) other employers will look at them again,” said Brad Niebuhr, a senior account executive with the Madison office of M3 Insurance, a brokerage firm.

Sign-up for health insurance for next year runs from Monday to Oct. 31 for about 209,000 state workers, retirees and their family members, including about 86,000 in Dane County.

Many other employers in and around Dane County, where Physicians Plus, Unity, Dean Health Plan and Group Health Cooperative of South Central Wisconsin compete to cover most residents, have open enrollment periods this month through December.

Madison-based WEA Trust and Monona-based WPS Health Insurance insure many people statewide but cover relatively few in Dane County.

Nationally, about 55 percent of companies — 94 percent of those with 100 or more workers — offer health insurance, according to a Kaiser Family Foundation Survey in September.

Some employers say they aren’t offering health coverage because it is now available through the Affordable Care Act’s government-run exchanges, or marketplace. Enrollment for that coverage, provided through a variety of private insurance plans, runs Nov. 15 to Feb. 15 at healthcare.gov.

Few Madison-area companies have given up employer coverage, and many have started offering several options with a range of deductibles, co-payments and premiums, Niebuhr said. Such “private exchanges,” where workers shop online among plans offered by their employer, are expected to become more common in coming years, he said.

The average premium for family coverage through employers this year is $16,834, with workers paying $4,823, the Kaiser survey found. For worker-only coverage, the average premium is $6,025, with workers paying $1,081.

About 17 percent of insured workers nationwide are in high-deductible plans with health savings accounts, which are offered by 27 percent of employers that provide health insurance, the Kaiser survey found.

In Wisconsin, the state Department of Employee Trust Funds is requiring health insurers to offer high-deductible plans for the first time next year, with deductibles of $1,500 for single coverage and $3,000 for a family plan. Monthly premiums are $32 for single coverage and $81 for family coverage for high-deductible plans, compared with $92 and $230, respectively, for regular plans.

Among state workers, retirees and family members in Dane County, Unity has about 43,000 members, Dean has 38,000, Group Health has 15,000 and Physicians Plus has 12,000.

The health plans are stressing different aspects of their brands as they vie to attract state workers and others.

Physicians Plus is emphasizing the return of UW Health to its network.

The company, which had more than 113,000 members overall four years ago, is down to 61,000. Most of the decline came after the company proposed restrictions on UW Health services in 2011 and then implemented the program, known as “care navigation,” in 2012, effective at the beginning of 2013.

Physicians Plus lost $30.3 million in 2012 and $16.5 million last year before joining the rest of Meriter Health Services in becoming part of Iowa-based UnityPoint Health this year.

The new contract with UW Health “has more reasonable rates between both organizations,” so care navigation is no longer needed, a Meriter memo said.

Physicians Plus spokesman Scott Shoemaker said the restored tie to UW Health has generated interest. “The network expansion has generated enthusiasm amongst both current and prospective customers,” he said.

Unity, which has about 152,000 members, up from 95,000 four years ago, continues to emphasize its even closer connection to UW Health.

“Choose Unity and get guaranteed access to all of the physicians, clinics and hospitals of UW Health,” a Unity ad reads.

Unity spokeswoman Jennifer Dinehart said that because Unity is owned by UW Health, “there never has been a question about accessing UW Health providers with no referral requirements.”

Group Health’s ads stress its placement in the National Committee for Quality Assurance’s annual rankings of health plans, which are based on consumer satisfaction and measures of prevention and treatment.

Group Health ranked 14th among 507 plans ranked this year, the highest of any plan in Wisconsin. Unity was 38th, Physicians Plus 57th and Dean 71st.

Group Health has about 76,000 members, compared to 73,000 at the end of last year.

Dean has about 268,000 members, up from 257,000 at the end of last year. Dean merged last year with SSM Health Care, which owns St. Mary’s Hospital in Madison.

“We are stressing being an integrated healthcare system with clinics working with the hospital working with the health plan,” Dean spokeswoman Mary Carr Lee said.

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David Wahlberg is the health and medicine reporter for the Wisconsin State Journal.