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Bariatric surgery

Terrie Senty, who developed diabetes and heart disease in recent years, said in 2016 the state wouldn't have to pay for the cost of those conditions if it covered weight-loss surgery for all state workers years ago, when Senty looked into getting the procedure. This week, the state approved the coverage.

Wisconsin will cover weight-loss surgery for state employees who qualify, joining most states in providing such coverage, the board overseeing state worker health benefits decided this week.

Coverage for bariatric surgery and other weight loss services for state workers and dependents who have a body mass index of 35 or greater will begin next year, after the Group Insurance Board approved the benefit Wednesday.

Health plans can authorize coverage for bariatric surgery and other services for people with lower BMIs if it meets the plans’ medical policy and is medically necessary, the insurance board said.

The benefit changes were recommended by the state Department of Employee Trust Funds, based on feedback from participants, constituent groups and health plans, according to an ETF statement. The insurance board also reviewed new reports from ETF for monitoring program outcomes and health plan performance.

ETF administers health benefits for about 250,000 state and local government workers and their family members, many of whom live in Dane County.

Also starting next year, coverage will be expanded for members with congenital defects and vaccines will be covered at in-network retail pharmacies. Periodontal maintenance will be available through dental coverage.

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Coverage of gastric bypasses and other bariatric surgery is expected to cost $1 million to $3 million a year in claims, but the costs are expected to be recovered in about 30 months. The coverage shouldn’t increase premiums, ETF said.

“I think this will be a huge opportunity for many state employees to improve their health,” said Dr. Luke Funk, a bariatric surgeon at UW Health who had urged the state to offer the coverage.

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